Thursday, 7 January 2016

Tutorial 7th. January 2016


7th. January 2016.

36
SBA. Classification of urgency of Caesarean section
37
EMQ. Hepatitis B
38
EMQ. Education
39
EMQ. Maternal mortality definitions
40
Communication skills

36.   Classification of urgency of Caesarean section
Abbreviations.
CNST:      Clinical Negligence Scheme for Trusts
DDI:         decision-to-delivery interval
GP11.      RCOG’s Good Practice 11. 2010. Classification of urgency of Caesarean section – a continuum of risk.
Lucas.   “Urgency of caesarean section: a new classification.”  J R Soc Med. 2000 Jul;93(7):346-50.
MDT:       multi-disciplinary team
NHSLA:    NHS Litigation Authority.

Question 1.
Lead-in
How many categories are included in the classification of urgency in GP11?
Option List
  1.  
3
  1.  
4
  1.  
5
  1.  
6
  1.  
7
Question 2.
Lead-in
What are the definitions used for the categories?
There is no option list! Just write your answers.
Question 3.
Lead-in
What additional aid is included in GP11 in relation to the classification of urgency?
Option List
  1.  
a colour scale in the form of a spectrum
  1.  
“red flag” numbering system
  1.  
a table of the 10 most common reasons for high urgency classification
  1.  
a table of the 10 most common reasons for low urgency classification
  1.  
the web address of an app that automatically decides the urgency classification
Question 4.
Lead-in
What does GP11 say is the purpose of the additional aid?
Option List

  1.  
it allows automatic, uniform classification
  1.  
it highlights the degree of urgency to encourage efficient action by staff
  1.  
it assists staff in learning the correct classifications
  1.  
it encourages reflective learning
  1.  
it reinforces the concept of ‘continuum  of urgency’
Question 5.
Lead-in
GP11 says: “Good communication is central to timely delivery of the fetus, while avoiding unnecessary risk to the mother”.
What does it say is a critical indicator of the DDI?
Option List
  1.  
the grade of the senior anaesthetist
  1.  
the grade of the senior obstetrician
  1.  
the time from the delivery decision being taken until the theatre staff and anaesthetist have been fully informed
  1.  
the time from the delivery decision being taken until the consent form is completed
  1.  
the time for the woman to reach the operating theatre
Question 6.
Lead-in
GP11 devotes a section to communication. It makes 5 points. How many can you conjure up (useful for an OSCE station)?
Question 7.
Lead-in
GP11 gives a target DDI for C section for “fetal compromise” of 30 minutes. What it the rationale for this?
Option List
  1.  
research shows that DDI ≤ 30 minutes is associated with best fetal outcomes
  1.  
research shows that DDI ≤ 30 minutes is associated with best maternal outcomes
  1.  
research shows that DDI ≤ 30 minutes is associated with best educational and neuro-developmental outcomes at age 7 years
  1.  
it is an accepted audit tool that tests the efficiency of the delivery team
  1.  
the NHSLA’s CNST requires that ≥ 90% of category 1 C sections have a DDI ≤ 30 minutes
Question 8.
Lead-in
GP11 had a concluding section entitled “Recommendations”, of which there were three. What were they?
Question 9.
Lead-in
Give two examples of clinical cases for each of the categories of risk.

37.         Hepatitis B and pregnancy.
Lead-in.
Each of the following scenarios relates to hepatitis B and pregnancy.
Instructions.
For each scenario, select the most appropriate option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
HBcAg:      hepatitis B core antigen
HBeAg:      hepatitis B e antigen           
HBsAg:      hepatitis B surface antigen
HBcAb:      antibody to hepatitis B core antigen
HBeAb:     antibody to hepatitis B e antigen
HBsAb:      antibody to hepatitis B surface antigen
HBIG:         hepatitis B immunoglobulin
HBV:          hepatitis B virus
Option list.
A.      acyclovir
B.      divorce
C.      HBcAg +ve
D.     HBeAg +ve
E.      HbsAg +ve
F.       HBsAg +ve; HBsAb –ve; HBcAb -ve
G.     HBsAg +ve; HBsAb –ve on two tests six months apart
H.     HBsAG –ve; HBsAb -ve on two tests six months apart
I.        HBsAg –ve; HBsAb +ve; HBcAb –ve
J.        HBsAg –ve; HBsAb +ve; HBcAb +ve
K.      HBsAg –ve; HBsAb +ve
L.       HBsAg +ve; HBcAg +ve
M.   HBV vaccine.
N.     HBIG
O.     HBV vaccine + HBIG
P.      immune as a result of infection
Q.     immune as a result of vaccination
R.      not immune
S.       chronic carrier of HBV infection
T.      10%
U.     30%
V.      50%
W.   60%
X.      70 - 90%
Y.      soap and boiling water
Z.       10% dilution of bleach in water
AA. 10% dilution of formaldehyde in alcohol
BB.  ultraviolet irradiation
CC.  yes
DD.no
EE.  none of the above

Scenario 1.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she has an acute infection?
Scenario 2.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of natural infection?
Scenario 3.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?
Scenario 4.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 6 months ago. What results on routine blood testing would indicate that she is a chronic carrier of HBV infection?
Scenario 5.
Testing shows that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb. What does this mean in relation to his HBV status?
Scenario 6.
Testing shows that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.
What does this mean in relation to his HBV status?
Scenario 7
A primigravid woman at 8 weeks gestation is found to be non-immune to the HBV. She has recently married and her husband is a chronic carrier. What should be done to protect her from infection?
Scenario 8
A woman is a known carrier of Hepatitis B. What is the risk of vertical transmission in the first trimester?
Scenario 9
A woman is a known carrier of Hepatitis B. What is the risk of the neonate who has been infected by vertical transmission in the third trimester becoming a carrier without treatment?
Scenario 10
How effective is hepatitis B prophylaxis in preventing chronic carrier status developing in a neonate infected as a result of vertical transmission?
Scenario 11
Can a woman who is a chronic HBV carrier breastfeed safely?
Scenario 12.
Hepatitis B infection is the most dangerous of the viral hepatitis infections in pregnancy.
Scenario 13.
A pregnant woman who is not immune to HBV has a partner who is a chronic carrier. Can HBV vaccine be administered safely in pregnancy?
Scenario 14.
A pregnant woman who is not immune has a partner with acute hepatitis due to HBV. He cuts his hand and bleeds onto the kitchen table. How should she clean the surface to ensure that she gets rid of the virus?
Scenario 15.
Is it true that the presence of HBeAg in maternal blood is a particular risk factor for vertical transmission? Not really a scenario, but never mind!

38. Education.
Lead-in.
The following scenarios relate to medical education
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
EMQ:    extended, matching question.
PBL:       problem-based learning.
Option list.
  1. brainstorming.
  2. brainwashing
  3. cream cake circle.
  4. Delphi technique.
  5. demonstration & practice using clinical model.
  6. doughnut round.
  7. interactive lecture with EMQs.
  8. lecture.
  9. 1 minute preceptor method.
  10. teaching peers / junior colleagues
  11. schema activation.
  12. schema refinement.
  13. small group discussion.
  14. snowballing.
  15. snowboarding.
  16. true
  17. false
Scenario 1.
A woman is admitted with an eclamptic seizure. The acute episode is dealt with and she is put on an appropriate protocol. You wish to use the case to outline key aspects of PET and eclampsia to the two medical students who are on the labour ward with you. Which would be the most appropriate approach?
Scenario 2.
You have been asked to provide a summary of the key aspects of the recent Maternal Mortality Meeting to the annual GP refresher course. There are likely to be 100 attendees. Which would be the most appropriate approach?
Scenario 3.
You have been asked to teach a new trainee the use of the ventouse. Which would be the most appropriate approach?
Scenario 4.
You have been asked to teach a group of medical students about PPH. To your surprise you find that they have good basic knowledge. Which technique will you apply to get the most from the teaching session?
Scenario 5.
Your consultant has asked you to get the unit’s medical students to prepare some questions about breech delivery which they can ask of their peers when they next meet. Which technique will you use?
Scenario 6.
You have been asked to discuss 2ry. amenorrhoea with your unit’s medical students. You are uncertain about the amount of basic physiology and endocrinology they remember from basic science teaching. Which technique will you use?
Scenario 7
The RCOG has asked you to chair a Green-top Guideline development committee. You find that there is very little by way of research evidence to help with the process. The College has assembled a team of consultants with expertise and interest in the subject. Which technique would be best to reach consensus on the various elements of the GTG?
Scenario 8
Which of the listed teaching techniques is least likely to lead to deep learning?
Scenario 9
An interactive lecture with EMQs is the best method of teaching. True or false.
Scenario 10
Only 20% of what is taught in a lecture is retained. True or false.
Scenario 11.
The main role of the teacher is information provision. True or false.
Scenario 12.
The main role of the teacher is to be a role model.  True or false.

39. Maternal Mortality.
Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each scenario.
Each option can be used once, more than once or not at all.
Option List.
A.   Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.
B.    Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.
C.    Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.
D.   Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.
E.    A pregnancy going to 24 weeks or beyond.
F.    A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.
G.   Maternal deaths per 100,000 maternities.
H.   Maternal deaths per 100,000 live births.
I.      Direct + indirect deaths per 100,000 maternities.
J.     Direct + indirect deaths per 100,000 live births.
K.    Direct death.
L.     Indirect death.
M. Early death.
N.   Late death.
O.   Extra-late death.
P.    Fortuitous death.
Q.   Coincidental death.
R.    Accidental death.
S.    Maternal murder.
T.    Not a maternal death.
U.   Yes
V.   No.
W. I have no idea.
X.    None of the above.
Abbreviations.
MMR:      Maternal Mortality Rate.
MMRat:  Maternal Mortality Ratio.
SUDEP:    Sudden Unexplained Death in Epilepsy.           
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational trophoblastic disease, develops choriocarcinomas and dies from it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?
Scenario 7
A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality Ratio?
Scenario 12
A woman is diagnosed with breast cancer. She has missed a period and a pregnancy test is +ve. She decides to continue with the pregnancy. The breast cancer does not respond to treatment and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the subject of domestic violence is killed at 12 weeks’ gestation by her partner. What kind of death is it?
Scenario 14
A woman is struck by lightning as she runs across a road. As a result she falls under the wheels of a large lorry which runs over abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?
Scenario 15
A woman is abducted by Martians who are keen to study human pregnancy. She dies as a result of the treatment she receives. As this death could only have occurred because she was pregnant, is it a direct death?
Scenario 16
Could a maternal death from malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from malignancy be classified as “Coincidental”?
.            


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