Contact us.
|
31
|
EMQ.
Germ cell and sex cord tumours
|
|
32
|
EMQ.
Gestational Trophoblastic Disease (GTD)
|
|
33
|
EMQ.
Haemophilia
|
|
34
|
EMQ.
Headache
|
|
35
|
EMQ.
Obstetric cholestasis 1
|
|
36
|
EMQ.
Obstetric cholestasis 2
|
|
37
|
EMQ.
PPH
|
|
38
|
EMQ.
Puerperal mental illness
|
|
39
|
EMQ.
Risk management 1
|
|
37
|
EMQ.
Vulval conditions
|
|
79
|
A woman
attends the A&E Department complaining that she has been raped. The
A&E consultant says he has no experience in dealing with this problem and
asks you to take care of the woman.
1.
Discuss the risk management issues relating to such a case for the average
DGH. 4 marks
2.
Justify your immediate management. 10
marks
3.
Outline the subsequent management. 6
marks
|
|
80
|
With
regard to Gestational Trophoblastic Neoplasia.
Outline the factors influencing
prognosis.
|
|
81
|
A
73-year-old woman is referred with vault prolapse 5 years after hysterectomy.
1.
Discuss the steps that can be taken during and after hysterectomy to reduce
the risk of vault prolapse. 4
marks
2.
Justify the history you will obtain.
4 marks
3.
Evaluate the management options. 12 marks
|
|
82
|
A
nulliparous woman notices reduced fetal movements at 37 weeks and phones the
delivery unit for advice.
1.
Outline the immediate management. 14
marks
2.
Justify the subsequent management.
6 marks.
|
|
83
|
Home
birth.
A
woman books at 10 weeks’ gestation and states that she is keen to have a home
birth.
1.
What are the key legal issues in relation to home birth? 2
marks
2.
Justify the history you will take. 4
marks
3.
Critically evaluate the advice you will give re the risks & benefits of
home birth. 6 marks
4.
Justify your management plan. 8 marks
|
|
84
|
A
primigravid woman attends the antenatal booking clinic at 5 weeks’ gestation.
She smells strongly of alcohol. She admits to consuming at least ½ bottle of
vodka each day.
1.
Critically evaluate the public health advice available in the UK about
alcohol and pregnancy.
4 marks.
2.
Critically evaluate screening for alcohol abuse in pregnancy. 4
marks.
3.
Critically evaluate the risks to the fetus and child of the mother who abuses
alcohol in pregnancy. 6
marks.
4.
Justify the management you would arrange for this patient. 6
marks.
|
|
85
|
Read
the RCOG’s document on the maternity dashboard http://www.rcog.org.uk/womens-health/clinical-guidance/maternity-dashboard-clinical-performance-and-governance-score-card. I
doubt it will come as an essay but it could be in the MCQs and EMQs.
|
Germ cell and sex cord tumours and
substances secreted.
Lead-in.
The
following scenarios relate to the substances that ovarian cell tumours usually
secrete.
For
each, select the most appropriate substance from the option list.
Each
option can be used once, more than once or not at all.
Option List.
A.
None.
B.
a-fetoprotein.
C.
a-fetoprotein
+ hCG.
D.
a1-antitrypsin
E.
Androgen.
F.
Ascites.
G. Walthard
H.
Ca125
I.
hCG.
J.
β-hCG
K.
Follicle stimulating hormone.
L.
Luteinising hormone.
M. Oestrogen.
N. Prolactin.
O. Thyroxine
sufficient to produce hyperthyroidism.
P.
Pleuritic fluid.
Q. None of
the above.
Scenario 1.
Mature cystic teratoma.
Scenario 2.
Granulosa cell tumour.
Scenario 3.
Sertoli-Leydig tumours.
Scenario 4 .
Brenner tumour.
Scenario 5.
Struma ovarii.
Scenario 6.
Embryonal carcinoma.
Scenario 7.
Polyembryoma.
Scenario 8.
Endodermal sinus tumour (Yolk sac tumour).
Scenario 9.
Dysgerminoma.
Scenario 10.
Primary ovarian choriocarcinomas.
Gestational Trophoblastic
Disease (GTD)
Lead-in.
The
following scenarios relate to gestational trophoblastic disease.
For
each, select the number that best fits the scenario.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Scenario 1.
What is the incidence of GTD in the UK pregnant population?
Scenario 2.
A
woman had a complete mole in her first pregnancy. She is pregnant for the
second time. What is the risk that it is another molar pregnancy?
Scenario
3.
A
woman has had two molar pregnancies. What is the risk of molar pregnancy if she
becomes pregnant again?
Scenario 4.
What
is the risk of persistent GTD after a complete mole?
Scenario 5.
What is the risk of requiring chemotherapy
after a complete mole?
Scenario 6.
What is the risk of persistent GTD after a partial mole?
Scenario 7
What is the risk of requiring chemotherapy after a partial mole?
Scenario 8
What is the risk of requiring chemotherapy with hCG level >
20,000 i.u. one month after evacuation?
Scenario 9
What is the overall risk of requiring chemotherapy after molar
pregnancy in the UK?
Scenario 9
What is the risk of requiring chemotherapy in the USA compared
with the UK?
Scenario 10
What is the risk of molar pregnancy at age 15 compared to age 30?
Scenario 11
What is the risk of molar pregnancy at age 45 compared to age 30?
Option list.
|
|
100%
|
|
|
20%
|
|
|
<
20%
|
|
|
15%
|
|
|
<15%
|
|
|
<
10%
|
|
|
10%
|
|
|
5%
|
|
|
2.5%
|
|
|
1.5%
|
|
|
0.5%
|
|
|
1
in 35
|
|
|
1
in 55
|
|
|
1
in 65
|
|
|
1
in 700
|
|
|
1
in 1,000
|
|
|
Ö64
|
|
|
pr2
|
|
|
increased
|
|
|
reduced
|
|
|
increased
by a factor of 2
|
|
|
increased
by a factor of 5
|
|
|
increased
by a factor of 10
|
|
|
increased
by a factor of 20
|
|
|
increased
by a factor of 30
|
|
|
increased
by a factor of > 100
|
Haemophilia.
Lead-in.
The
following scenarios relate to haemophilia A, factor VIII deficiency (HA).
For
each, select the most appropriate answer from the option list.
Each
option can be used once, more than once or not at all.
Scenario 1.
A woman attends for pre-pregnancy counselling. Her brother has
haemophilia A. What is her risk of being a carrier?
Scenario 2 .
A woman attends for pre-pregnancy counselling. Her father has
haemophilia A. What is her risk of being a carrier?
Scenario 3.
If she is tested and found to be a carrier, what tests will you
arrange for her partner?
Scenario 4.
If she is a carrier, what is the risk to her male offspring?
Scenario 5.
If she is a carrier, what is the risk to her female offspring?
Scenario 6.
If she is a carrier and her
partner has haemophilia A, what are the risks to their female offspring?
Scenario 7.
If she is a carrier and her partner has haemophilia A, what are
the risks to their male offspring?
Headache in pregnancy.
Lead-in.
The following scenarios relate to headache
in pregnancy.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Option list.
- abdominal migraine
- analgesia overuse headache aka
medication overuse headache
- bacterial meningitis
- benign intracranial hypertension
- BP check
- cerebral venous sinus thrombosis
- chest X-ray
- cluster headache
- severe PET / impending eclampsia
- malaria
- meningococcal meningitis
- methyldopa
- methysergide
- migraine
- MRI brain scan
- nifedipine
- nitrofurantoin
- pancreatitis
- sinusitis
- subdural haematoma
- subarachnoid haemorrhage
- tension headache
- ultrasound scan of the abdomen
Scenario 1.
A 40-year-old para 3 is admitted at 38 weeks by ambulance with
severe headache of sudden onset. She describes it as “the worst I’ve ever had”.
Which diagnosis needs to be excluded urgently?
Scenario 2.
A 32-year-old para 1 has recently experienced headaches. They are
worse on exercise, even mild exercise such as walking up stairs. She
experiences photophobia with the headaches. Which is the most likely diagnosis?
Scenario 3.
A woman returns from a sub-Saharan area of Africa. She develops
severe headache, fever and rigors. What diagnosis should particularly be in the
minds of the attending doctors?
Scenario 4.
A
woman at 37 weeks has developed headaches. They particularly occur at night
without obvious triggers. They occur every few days and she then has
Scenario 5.
A
primigravida has had headaches on a regular basis for many years. They occur
most days, are bilateral and are worse when she is stressed. What is the most
likely diagnosis?
Scenario 6.
A woman complains of recent headaches at 36 weeks. The history
reveals that the headaches started soon after she began treatment with a drug
prescribed by her GP. Which is the most likely of the following drugs to be the
culprit: 7. methyldopa, methysergide,
nifedipine and Nitrofurantoin?
Scenario 7
A woman is booked for Caesarean section and wishes regional
anaesthesia. She had severe headache due to dural tap after a previous Caesarean
section. She wants to take all possible steps to reduce the risk of having this
again. Which of epidural and spinal
anaesthesia has the lower risk of causing dural tap headache?
Scenario 8
A 25-year-old primigravida complains of headaches which started
two weeks before when she attends for her 20 week scan. There is no significant
history of previous headache. The pain occurs behind her right eye and she
describes it as severe and “stabbing” in nature. The pain is so severe that she
cannot sit still and has to walk about. She has noticed that her right eye
becomes reddened and “watery” during the attack and her nose is “runny”. The
attacks have no obvious trigger and mostly occur a few hours after she has gone
to sleep. The usually last about 20 minutes. She has no other symptoms. She
smokes 20 cigarettes a day but does not take any other drugs, legal or
otherwise. What is the most likely diagnosis?
Scenario 9
A woman has a 5-year history of unilateral, throbbing headache
often preceded by nausea, visual disturbances, photophobia and sensitivity to
loud noise. What is the most likely diagnosis?
Scenario 10
A
primigravida is admitted at 38 weeks complaining of headache, abdominal pain
and a sensation of flashing lights. What would be the appropriate initial
investigation?
Scenario 11
A
woman with BMI of 35 attends for her combined Downs syndrome screening test.
She complains of pain behind her eyes. The pain is worst last thing at night
before she goes to sleep or if she has to get up in the night. She has noticed she
has noticed horizontal diplopia on several
occasions. She has no other symptoms. Examination shows papilloedema.
Scenario 12
A
grande-multip of 40 years experienced sudden-onset, severe headache, vomited
several times and then collapsed, all within the space of 30 minutes. She is
admitted urgently in a semi-comatose state. Examination shows neck-stiffness
and left hemi-paresis.
Scenario 13.
What did the MMR include as “red flags” for headache in pregnancy?
Obstetric cholestasis. (OC).
Definition & Diagnosis.
Lead-in.
The
following scenarios relate to the definition and diagnosis.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
gamma
GT: gamma-glutamyl transferase
GTG: RCOG’s Green-top Guideline No. 43. April
2011.
OC: obstetric cholestasis.
Suggested reading.
The GTG is “must read”. It
is also dealt with in MCQ paper 1, question 41. I don’t think you need to read
anything more.
Option list.
A.
true
B.
false
C.
don’t be daft
D.
pruritus of pregnancy with no other explanation
which is associated with abnormal LFTs, raised bile acids and pale stools, all
of which resolve postnatally
E.
pruritus of pregnancy with no other explanation
which is associated with abnormal LFTs, ± raised bile acids and pale stools,
all of which resolve postnatally
F.
pruritus of pregnancy with no other explanation
which is associated with abnormal LFTs, ± raised bile acids, all of which
resolve postnatally
G.
pruritus of pregnancy with no other explanation which is
associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile
acids and pale stools, all of which resolve postnatally
H.
pruritus of pregnancy with no other explanation
which is associated with abnormal LFTs (using pregnancy-specific ranges), ±
raised bile acids, all of which resolve postnatally
I.
levels do not usually rise in pregnancy
J.
mostly originates in the placenta
K.
levels vary with the time of day
L.
no information in the GTG
M.
none of the above
Scenario 1.
The
international definition of OC was agreed at a conference in Tokyo in 1985.
Scenario 2.
What
is the GTG’s definition of OC?
Scenario 3.
What
is the incidence of pruritus in pregnancy?
Scenario 4.
Hepatitis B and C, but not hepatitis A, may cause pruritus and
abnormal LFTs in pregnancy.
Scenario 5.
Infection with the Ebstein Barr virus may cause pruritus and
abnormal LFTs in pregnancy.
Scenario 6.
The cytomegalovirus may cause pruritus and abnormal LFTs in
pregnancy.
Scenario 7.
The herpes zoster virus may cause pruritus and abnormal LFTs in
pregnancy.
Scenario 8.
Chronic active hepatitis and secondary biliary cirrhosis are
included in the GTG’s list of conditions to be considered in the differential
diagnosis.
Scenario 9.
Bilirubin levels are normally elevated in the early stages of OC
and remain elevated until the condition resolves after delivery.
Scenario 10.
Liver
function tests become abnormal as soon as the pruritus is noted.
Scenario 11.
Levels
of bile acids commonly rise significantly after meals making fasting levels
mandatory for diagnosis.
Scenario 12.
The
upper limit of normal for transaminases, gamma GT and bile acids is about 20%
lower in pregnancy.
Scenario 13.
Once a diagnosis of OC has been made, tests of liver function should
not be repeated until the puerperium
Scenario 14.
LFTs should be checked weekly until they have returned to normal
after delivery of the baby in a case of OC.
Scenario 15.
Once a diagnosis of OC has been made, the activated partial
thromboplastin time (APTT) should be measured and a full coagulation screen
done if it is prolonged.
Scenario 16.
Delivery at 37 weeks should be recommended because of the risk of
FDIU in the later weeks of pregnancy.
Scenario 17.
What additional pre-labour monitoring of fetal welfare is
advisable in the third trimester?
Scenario 18.
Prophylactic steroids should be offered at 28 weeks because of the
risk of spontaneous premature labour.
Obstetric cholestasis. (OC).
Prevalence.
Lead-in.
The
following scenarios relate to the prevalence of OC.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
GTG: RCOG’s Green-top Guideline No. 43. April
2011.
OC: obstetric cholestasis.
Option list.
A.
0.1%
B.
0.5%
C.
0.7%
D.
1 – 1.2%
E.
1.2% to 1.5%
F.
1.5 – 2%
G. 2.4%
H.
3 – 3.5%
I.
5%
J.
7%
K.
15%
L.
white
M. brown
N. blue-green
O. red-brown, striped
P.
no information in the GTG
Q. none of the above
Scenario 1.
What is the overall prevalence in the UK population?
Scenario 2.
What is the overall prevalence in the Indian and Pakistani Asian
populations?
Scenario 3.
What is the overall prevalence in Scandinavia?
Scenario 4.
What
is the overall prevalence in Chile?
Scenario 5.
What
is the overall prevalence in Araucanian Indians?
Scenario 6.
What is the overall prevalence in Eskimos?
Scenario 7.
What
is the incidence of pruritus in pregnancy?
Scenario 8.
What colour of eggs do Araucanian chickens lay?
Postpartum haemorrhage.
Lead-in.
The
following scenarios relate to post-partum haemorrhage.
For
each, select the appropriate answer.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
APH: antepartum haemorrhage.
GTG: Green-top Guideline No 52. “Prevention and
Management of PPH.”
i.m. intramuscularly.
PPH: postpartum haemorrhage.
s.c. subcutaneously.
Scenario 1.
A 34 year-old, para 4 delivers the first twin and bleeds loses 250
ml. of fresh blood. A further 300 ml. is lost after the delivery of the second
baby. What is the classification of the bleeding?
Scenario 2.
A
25 year-old nulliparous woman delivers a stillborn
baby at 22 weeks. 1,000 ml. of fresh bleeding occurs in the next 2 hours. What
is the classification of the bleeding?
Scenario 3.
A
45 year-old primigravid woman is readmitted at 10
weeks post-delivery as she has bled continuously for 3 weeks. What is the
classification of the bleeding?
Scenario 4.
A
34 year-old woman passes placental tissue and 500 ml.
of fresh blood 14 weeks after delivery of her second child. What is the
classification of the bleeding?
Scenario 5.
Which
drug is recommended by the GTG for routine use in the active management of the
3rd. stage?
Scenario 6.
By
what amount does active management using syntometrine reduce the risk of 1ry. PPH?
Scenario 7.
What
is the definition of primary PPH?
Scenario 8.
What
is the definition of secondary PPH?
Option list.
Bleeding
from the birth canal ≥ 500 ml.
Bleeding
from the birth canal ≥ 500 ml. up to 24 hours after delivery of the placenta.
Bleeding
from the birth canal ≥ 500 ml. from 24 hours after delivery of the placenta
until 6 weeks later.
Bleeding
from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the placenta
until 6 weeks later.
Bleeding
from the birth canal ≥ 500 ml. from 24 hours after delivery of the baby until 12
weeks later.
Bleeding
from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the baby until
12 weeks later.
Abnormal
bleeding from the birth canal from 24 hours after delivery of the baby until 12
weeks later.
APH.
1ry.
PPH.
Major
primary PPH.
2ry.
PPH.
Syntocinon
5 i.u. i.m.
Syntometrine
5 mg. i.m.
Misoprostol
10 mg. orally.
Gemeprost
40 mg. rectally.
Vasopressin
5 i.u. s.c.
20%
40%
60%
80%
None
of the above.
Puerperal mental illness.
Lead-in.
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.
Risk Management /
Disciplinary procedures.
Lead-in.
The
following scenarios relate to risk management / disciplinary procedures.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
DOH: Department of Health.
Option list.
A.
allow the practice to continue
B.
stop the practice until a full investigation has
been done
C.
stop the practice permanently
D.
arrange an investigation by a senior consultant
from another hospital
E.
decide the practice does not involve added risk
F.
declare the risk to be acceptable
G.
cancel admissions for surgery
H.
arrange adverse incident analysis
I.
arrange audit
J.
arrange research
K.
arrange a formal warning for the doctor
L.
arrange retirement for the doctor
M.
arrange dismissal for the doctor
N.
consult the on-call consultant
O.
consult the Clinical Director
P.
consult the Educational Supervisor / College
Tutor
Q.
consult the Medical Director
R.
consult the Chief Executive
S.
consult the Postgraduate Dean.
T.
consult the hospital’s lawyer
U.
write to Her Majesty at Buckingham Palace
V.
consult your Medical Defence Body
W.
consult the British Medical Association
X.
consult the RCOG
Y.
report the matter to the GMC
Z.
allow return to work
AA.
allow return to work, but offer support
BB.
arrange a “return to work” package specific to
the doctor
CC.
none of the above
Scenario 1
You are the Clinical Director. 1 62-year-old Consultant colleague
has been off work for 8 weeks with a broken arm sustained in a skiing accident.
He sends you a certificate from his specialist to say that he is now fit to
return to work. He indicates that he wishes to return to work immediately. What
action will you take?
Scenario 2
You are the Clinical Director. 1 62-year-old Consultant colleague
has been off work for 8 weeks with a severe bereavement reaction to the suicide
of a family member. He sends you a certificate from his GP to say that he is
now fit to return to work. He indicates that he wishes to return to work
immediately. What action will you take?
Scenario 3
You are the Clinical Director. 1 62-year-old Consultant colleague
has been off work for 6 months after having a coronary thrombosis. He sends you
a certificate from his specialist to say that he is now fit to return to work.
He indicates that he wishes to return to work immediately. What action will you
take?
Scenario 4
You are the Clinical Director. A 62-year-old Consultant has
returned to work after four months’ sick leave after a coronary thrombosis. He
has three cases on his first operating list and all have complications reported
by the Sister on the gynaecology ward. What action will you take?
Scenario 5.
A Consultant has been in her first consultant post for two months.
Three of the four patients on a single operating list develop post-operative
wound infections. What action will you take?
Scenario 6.
You have recently been appointed Clinical Director. A consultant has
been in post for ten years and prefers to operate with the same nurse
assistant. No complications have been reported. What action will you take?
Scenario 7.
You are the Clinical Director. A consultant has an operating
list in a peripheral unit 20 miles from the main hospital. There is no
resident doctor with post-operative care being provided by nurses. The cases
dealt with on the list traditionally were minor, day-cases. You have been told that the consultant, who
was appointed 6 months ago, has recently been doing hysterectomies and prolapse
repairs to get the waiting list down. What action will you take?
Scenario 8.
You are the Clinical Director. The blood bank informs you that
there is a problem with supplies and fully cross-matched blood cannot be
guaranteed for tomorrow’s arranged surgical cases.
What action will you take?
Scenario 9.
You are the on-call SpR. It is 8 pm. The blood bank informs you
that there is a problem with supplies and fully cross-matched blood cannot be
guaranteed for tomorrow’s arranged surgical cases.
What action will you take?
Scenario 10.
An SpR is half an hour late for starting his duties on three
occasions in one week. His consultant wishes to have this dealt with as a
disciplinary matter to “nip it in the bud” and teach him a lesson. He reports
it to you, the Clinical Director asking you to discipline the doctor. What
action will you take?
Scenario 11
An SpR gets into an argument with the senior midwife on the labour
ward and in the heat of the moment slaps her across the face. You are the
Clinical Director and the matter is reported to you next day.
Scenario 12
Your consultant is the Clinical Director and a nasty man. You
apply 6 months in advance for study leave for the week before the written part
of the Part Ii MRCOG exam. He tells you that he plans to go on holiday at that
time and you are not going to get any leave. In addition, he tells you that if
you complain about this he will give you a terrible reference and tell all his
consultant friends that you are a waste of space in order to ruin your career.
What action can you take?
Scenario 13
A SpR fails an OSATS, but falsifies his records to indicate that
it has been completed satisfactorily. You are the Educational Advisor and this
is brought to your attention. What action will you take ?>
Scenario 14
A SpR2 uploaded reflective practice putting him in a good light
after a case which had been handled sub-optimally by him.
Scenario 15
You
are a FY2 and assist the senior consultant at a
hysterectomy. The operation goes well initially, but then there is a lot of
bleeding and a ureter is cut. The consultant urologist attends and repairs the
ureter. The woman bleeds vaginally that evening and is taken back to theatre by
another consultant and ends up in the ICU. You became convinced during the
operation that you could smell alcohol on the consultant gynaecologist’s
breath. What are your responsibilities?
Scenario 16
When
do you need to inform the Consultant on-call?
Scenario 17
When
do you need to inform the Clinical Director?
Scenario 18
When
do you need to inform the Medical Director?
Scenario 19
When
do you need to inform the GMC?
Scenario 20
What
are the roles of the BMA and MDU?
Scenario 21
What
are the differences between verbal and written warnings?
Vulval conditions.
Lead-in.
The following
scenarios relate to vulval conditions.
Choose the
most likely vulval condition from the option list.
Each option
can be used once, more than once or not at all.
Scenario 1.
A
22 year-old woman attends the colposcopy clinic after 2 smears showing minor
atypia. The cervical appearances are of aceto-white with punctation.
Scenario 2.
A
60-year old woman has an erythematous rash of the vulva extending to the inner
thighs. A similar rash is noted under the breasts. She is not known to have
diabetes.
Scenario 3.
A
woman attends the gynaecology clinic with a vulval rash. It has a “lacy”
appearance.
Scenario 4.
A
35-year old woman attends is noted to have a vulval fistula. She has a history
of episodic diarrhoea.
Scenario 5.
A
25-year old woman attends the gynaecology clinic with a history of intense
vulval itching and soreness. The appearances are of diffuse erythema with
excoriation. Diabetes, candidiasis and other local infections have been
eliminated by the GP.
Scenario 6.
A
35-year old woman attends the gynaecology clinic with vulvitis. She also has a
scalp rash. Clinical examination shows scaly, pink patches with signs of
excoriation. Skin samples grow Malassezia
ovalis.
Scenario 7.
A
40-year old woman has evidence of chronic vulval ulceration. She has recently
been seen by a dermatologist for mouth ulceration and has been started on
thalidomide.
Scenario 8.
An
African woman of 35 years attends the gynaecology clinic. She has a ten-year
history of chronic vulval ulceration. Examination shows multiple, tender vulval
and pubic subcutaneous nodules, some of which have ulcerated.
Scenario 9.
A
Caucasian woman of 29 years attends the gynaecology clinic with a chronic
vulval rash. Examination shows erythematous areas with clearly defined margins
and white scaly patches.
Scenario 10.
A
30-year old woman attends the gynaecology clinic with vulval itching.
Examination shows erythema of the labia minora and perineum. Full-thickness
biopsy shows abnormal cell maturation throughout the epithelium with increased
mitotic activity.
Option list.
A.
|
Acne.
|
B.
|
Behçet’s
syndrome.
|
C.
|
Candidiasis.
|
D.
|
CIN
3
|
E.
|
CIN1
|
F.
|
Crohn’s
disease.
|
G.
|
Dermatitis.
|
H.
|
Eczema.
|
I.
|
Genital
warts.
|
J.
|
Hidradenitis
suppurativa.
|
K.
|
Leprosy.
|
L.
|
Lichen
planus
|
M.
|
Lichen
sclerosis
|
N.
|
Lymphogranuloma
venereum
|
O.
|
Normal
skin.
|
P.
|
Psoriasis.
|
Q.
|
Seborrhoeic
dermatitis.
|
R.
|
Type
1 diabetes mellitus
|
S.
|
Type
2 diabetes mellitus
|
T.
|
Ulcerative
colitis.
|
U.
|
VIN
III.
|
