22 June 2015.
|
21
|
EMQ. COC: starting and missed pills.
|
|
22
|
Role-play. Communication skills: X-linked recessive
inheritance. You have been asked to go over the key aspects of recessive
inheritance with a new FY1.
|
|
23
|
EMQ. Headache
|
|
24
|
SBA. MBRRACE. Structure of Reports
|
21. EMQ. COC: starting and missed pills.
Added
to remind you that basic contraception is on the list
Lead-in.
The following scenarios relate to the combined oral
contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at
all.
Abbreviations.
UPSI: unprotected
sexual intercourse.
Option list.
A.
pill that is ≥ 12
hours late.
B.
pill that is > 12
hours late.
C.
pill that is ≥ 24
hours late.
D.
pill that is > 24
hours late.
E.
two missed pills at
any time in a single cycle.
F.
the first pill taken
in one’s first love affair, now recalled with fond nostalgia for its
effectiveness in preventing pregnancy, the Prince having been truly a loathsome
toad.
G.
no additional
contraception required.
H.
additional contraception
required for 7 days.
I.
emergency contraception
should be considered.
J.
emergency
contraception should be recommended.
K.
take the missed pill
immediately, but not if it means 2 pills in one day; no additional
contraception needed; pill-free interval as normal.
L.
take the missed pill
immediately, even if it means 2 pills in one day; no additional contraception
needed; pill-free interval as normal.
M. take the missed pill immediately, even if it means 2 pills
in one day; additional contraception for 7 days; pill-free interval as usual.
N.
take one of the missed
pills immediately, discard the other missed pills, use extra contraception for
7 days and discuss emergency contraception with your doctor.
O.
take the missed pills
immediately, use extra contraception for 7 days and discuss emergency
contraception with your doctor.
P.
continuous combined
preparation.
Q.
bi-phasic preparation.
R.
quadriphasic
preparation.
S.
cannot be answered
from the data given.
T.
none of the above.
Scenario 1.
What is the definition of a
missed pill?
Scenario 2.
What is the definition of two
missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice
should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What
advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation.
The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a
21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a
21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the
first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the
second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack.
What advice should be given?
Scenario 11
What kind of preparation is
Qlaira?
22. Roleplay.
You
are the SpR on call for the delivery unit. It is a quiet day with no-one in
labour. The last patient to deliver was a woman who had been screened for an
X-linked recessive disorder (XLRD). The baby had been found to be a carrier,
like her.
The
consultant thinks it would be a good idea for you to discuss the key points of
XLRD with the new FY1.
What
label might be best for most appropriate educational technique for this
situation?
Option list.
1.
brainstorming.
2.
brainwashing
3.
cream cake circle.
4.
Delphi technique.
5.
doughnut round.
6.
1 minute preceptor method.
7.
teaching peers / junior colleagues
8.
schema activation.
9.
schema refinement.
10.
small group discussion.
11.
snowballing.
12.
snowboarding.
23. 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.
|
1.
|
abdominal migraine
|
|
2.
|
analgesia overuse headache
aka medication overuse headache
|
|
3.
|
bacterial meningitis
|
|
4.
|
benign intracranial
hypertension
|
|
5.
|
BP check
|
|
6.
|
cerebral venous sinus
thrombosis
|
|
7.
|
chest X-ray
|
|
8.
|
cluster headache
|
|
9.
|
severe PET / impending
eclampsia
|
|
10.
|
malaria
|
|
11.
|
meningococcal meningitis
|
|
12.
|
methyldopa
|
|
13.
|
methysergide
|
|
14.
|
migraine
|
|
15.
|
MRI brain scan
|
|
16.
|
nifedipine
|
|
17.
|
nitrofurantoin
|
|
18.
|
pancreatitis
|
|
19.
|
sinusitis
|
|
20.
|
subdural haematoma
|
|
21.
|
subarachnoid haemorrhage
|
|
22.
|
tension headache
|
|
23.
|
ultrasound scan of the
abdomen
|
|
24.
|
|
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?
24. MBRRACE. Structure
of Reports.
These questions relate to the MBRRACE Reports
and their structure.
Abbreviations.
MBRRACE: MBRRACE-UK:
Mothers and Babies:
Reducing Risk through Audits and Confidential Enquiries in the UK.
MBRRACE 09-12: Saving Lives, Improving Mothers’ Care Lessons
learned to inform future maternity care from the UK and Ireland Confidential
Enquiries into Maternal Deaths and Morbidity 2009-012. Published
December 2014.
Question 1.
Lead-in
How often
will MBRRACE produce Reports?
Option List
|
A.
|
Every
year
|
|
B.
|
Every two years
|
|
C.
|
Every three years
|
|
D.
|
Every five years
|
|
E.
|
Whenever it has sufficient data, but not at more than
5-year intervals.
|
Question 2.
Lead-in
How does
MBRRACE categorise the contents of its Reports?
Option List
|
A.
|
Epidemiological
data
|
|
B.
|
Incidence data
|
|
C.
|
Analysed data
|
|
D.
|
Epidemiological data + analysed data
|
|
E.
|
Incidence data + analysed data
|
|
F.
|
None of the above
|
Question 3.
Lead-in
How often
will basic data on maternal deaths be published by MBRRACE?
Option List
|
A.
|
twice
each year
|
|
B.
|
once each year
|
|
C.
|
once every two years
|
|
D.
|
once every three years
|
|
E.
|
once every five years
|
Question 4.
Lead-in
How often
will MBRRACE publish analysis of data by specific topics?
Option List
|
A.
|
twice
each year
|
|
B.
|
once each year
|
|
C.
|
once every two years
|
|
D.
|
once every three years
|
|
E.
|
once every five years
|
Question 5.
Lead-in
How often
will a detailed analysis be published about an important, individual topic such
as sepsis?
Option List
|
A.
|
every
year
|
|
B.
|
every two years
|
|
C.
|
every three years
|
|
D.
|
every four years
|
|
E.
|
every five years
|
Question 6.
Lead-in
What years
were covered in the basic data included in the 2014 Report?
Option List
|
A.
|
2008-10
|
|
B.
|
2009-11
|
|
C.
|
2009-12
|
|
D.
|
2010-12
|
|
E.
|
none of the above
|
Question 7.
Lead-in
Which of
the following topics did not have in-depth analysis in the 2014 Report?
Option List
|
A.
|
amniocentesis
|
|
B.
|
amniotic
fluid embolism
|
|
C.
|
anaesthesia
|
|
D.
|
connective tissue disorders
|
|
E.
|
endocrine disorders
|
Question 8.
Lead-in
What years
will be covered in the basic data included in the 2015 Report?
Option List
|
A.
|
2011-13
|
|
B.
|
2012-14
|
|
C.
|
2013-14
|
|
D.
|
2013-15
|
|
E.
|
2013-16
|
Question 9.
Lead-in
Which of
the following topics will not have in-depth analysis in the 2015 Report?
Option List
|
A.
|
coincidental
deaths
|
|
B.
|
malignancy
|
|
C.
|
placenta
accreta, increta and percreta
|
|
D.
|
psychiatric disease
|
|
E.
|
thrombosis and VTE
|
Question 10.
Lead-in
What years
will be covered in the basic data included in the 2016 Report?
Option List
|
A.
|
2011-13
|
|
B.
|
2012-14
|
|
C.
|
2013-14
|
|
D.
|
2013-15
|
|
E.
|
2013-16
|
Question 11.
Lead-in
Which of
the following topics will not have in-depth analysis in the 2016 Report?
Option List
|
A.
|
cardiac
disease
|
|
B.
|
diabetes
|
|
C.
|
early pregnancy deaths
|
|
D.
|
eclampsia
|
|
E.
|
pre-eclampsia
|
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