Monday, 7 October 2013

Tutorial 7th. October 2013

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We had an EMQ to add some facts to the puerperal psychiatric disease station we discussed last time. I hope to add some clinical stations and will re-circulate this question when I have done so.
Then a roleplay about PMS.
And a viva about diathermy.


The following scenarios relate to puerperal mental illness.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
If I had put all the answers into the option list it would have been enormous. So there are quite a few where you need to decide what your answer would be. Opting for “none of the above” is not exercising your brain – make sure you come up with an answer.

Option list.
a.         arrange admission to hospital under Section 5 of the Mental Health Act
b.        send a referral letter to the perinatal psychiatrist requesting an urgent appointment.
c.         send an e-mail to the perinatal psychiatrist requesting an urgent appointment.
d.        phone the community psychiatric team.
e.        phone the on-call psychiatrist.
f.          arrange to see the patient in the next ante-natal clinic.
g.         arrange to see the patient urgently.
h.        send a referral letter to the social services department.
i.           phone the fire brigade.
j.          phone the police.
k.         there is no such thing.
l.           4 weeks
m.      6 weeks
n.        12 weeks
o.        26 weeks
p.        1 year
q.        <1%
r.          1-5%
s.         5-10%
t.          10-20%
u.        25%
v.         50%
w.       60%
x.         70%
y.         80%
z.         True
aa.     False
bb.    none of the above.

Scenario 1
What is the internationally agreed classification for postpartum psychiatric disease?
Scenario 2
What time limits does DSM-IV use for postpartum psychiatric disorders?
Scenario 3
What time limits does ICD-10 use pro postpartum psychiatric disorders?
Scenario 4
What clinical classification would you use in a viva or SAQ?
Scenario 5
What is the incidence of suicide in relation to pregnancy and the puerperium?
Scenario 6
What are the main conditions associated with suicide in pregnancy and the postnatal period?
Scenario 7
Most suicides occur in single women of low social class who have poor education. True / False
Scenario 8
The preferred method of suicide reported in the MMR was drug overdose.  True / False.
Scenario 9
When are women with Social Services involvement particularly at risk of suicide.
Scenario 10
Which women have the highest risk for puerperal psychosis and what is the risk?
Scenario 11.
What is the risk of puerperal psychosis for a primigravida with BPD?
Scenario 12
What is the risk of PP in a woman with no history of psychiatric illness but who has a FH of PP?
Scenario 13
Should screening include the identification of women with no history of psychiatric illness but who has a FH of PP?
Scenario 14
What do the Confidential Enquiries into Maternal Deaths say about the use of the term “postnatal depression”?
Scenario 15
Women with schizophrenia have a ≥ 25% risk of puerperal recurrence. True / False
Scenario 16
If lithium therapy for BPD is stopped in pregnancy, there is an increased risk of severe puerperal illness. True / False. 


Candidate's Instructions.
This is a roleplay station.
Your task is to take a history and advise about initial investigations and management.

GP Letter.
The Medical Centre,
Haversham Way,
XS89 9JH.

Re Jenny Smith,
55 Town Street,

Dear Doctor,
Please see this woman who complains of pre-menstrual syndrome. I don’t really believe in this condition so have not attempted to treat it.
Dr. N. O. G. Ood.


Suggested structure of a MRCOG viva.
1.    What is diathermy?
2.    What kind of current is used?
3.    Why use high frequency current?
4.    What types of current are used? I'll need to re-word this, but I meant the answer to deal with the types of effects you are trying to produce and the relevant types of current.
5.    How is diathermy applied?
6.    Risks of diathermy.

7.    Discuss direct coupling and its implications

8.    Discuss capacitive coupling and its implications.

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