50
|
Role-play. Stillbirth. Six week follow-up
|
51
|
Viva. Perinatal mortality
|
52
|
EMQ. Puerperal
mental health.
|
53
|
Role-play. Fragile X syndrome
|
50. Stillbirth.
Candidate’s
instructions.
This is a roleplay station.
Mrs. Brown has come for
follow-up 6/52 after delivery of a stillborn baby.
Reduced fetal movements had
been noted at 38 weeks.
She was admitted and FDIU was
confirmed.
The scan also showed IUGR.
She opted for induction of
labour.
Prostin was used and she had a
normal delivery 12 hours later.
Effective analgesia was
provided by epidural anaesthesia.
There were no complications.
Full investigation, including
PM, was normal apart from the birthweight, which was < 5th.
centile. Your task is to explain the results and advise about the next
pregnancy.
51. Perinatal
mortality.
Candidate’s instructions.
This is a viva station about
perinatal mortality.
The examiner will ask you X
questions.
As you move from one question
to the next, you are not allowed to go back to previous questions and will get
no marks if you do.
52. Puerperal mental
health.
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 recent MMRs 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.
Scenario 17
You are the on-call SpR for
obstetrics. A woman has just had a normal delivery of a 30 week baby that
requires resuscitation. The mother says that the baby must be left alone and
not resuscitated. The paediatric SpR and midwives are uncertain about what to
do. What action will you take?
Scenario 18
You are the on-call SpR for
obstetrics. The midwife on the postnatal ward phones for advice. A primigravida
who delivered yesterday has stated that the baby is not hers and is refusing to
care for it. What action will you take?
Scenario 19
You are the on-call Consultant
in O&G. The community midwife has phoned for advice. She was asked to visit
a primiparous woman who had a normal delivery seven days before. The husband
reports that she has struck him several times. The woman tells her that voices
have informed her that this man is not her husband and that she should drive
him away in case he rapes her. What action will you take?
Scenario 20
You are the on-call Consultant
in O&G. The community midwife has phoned. She has just been phoned by a
woman who had a Caesarean section for breech presentation four weeks ago. She
has been told by God that breech babies are the spawn of the Devil and she is
going to the local multi-storey car park to jump off with the baby so that the
baby cannot grow up and harm people and so that she cannot have more Devil
babies. What action will you advise?
53. Fragile X
syndrome
Candidate's
Instructions.
You are about to see Mary
White who has been booked in with her first pregnancy by the midwife in the
antenatal clinic. The midwife has asked you to see her as Mary has told her
that there is a family history of Fragile X syndrome.
Your task is to discuss
Fragile X syndrome and the implications for Mary.
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