Monday, 4 May 2015

Tutorial 4th. May 2015

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Role-play. Stillbirth. Six week follow-up
Viva. Perinatal mortality
EMQ. Puerperal mental health.
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.
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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