7th. January 2016.
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36
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SBA. Classification of urgency of
Caesarean section
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37
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EMQ. Hepatitis B
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38
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EMQ. Education
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39
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EMQ. Maternal mortality definitions
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40
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Communication skills
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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
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3
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4
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5
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6
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7
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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
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a colour scale in the form of a spectrum
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“red
flag” numbering system
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a
table of the 10 most common reasons for high urgency classification
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a
table of the 10 most common reasons for low urgency classification
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the
web address of an app that automatically decides the urgency classification
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Question 4.
Lead-in
What does GP11 say is the purpose of the additional aid?
Option List
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it allows automatic, uniform classification
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it
highlights the degree of urgency to encourage efficient action by staff
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it
assists staff in learning the correct classifications
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it
encourages reflective learning
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it
reinforces the concept of ‘continuum
of urgency’
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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
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the grade of the senior anaesthetist
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the
grade of the senior obstetrician
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the
time from the delivery decision being taken until the theatre staff and
anaesthetist have been fully informed
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the
time from the delivery decision being taken until the consent form is
completed
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the
time for the woman to reach the operating theatre
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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
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research shows that DDI ≤ 30 minutes is associated with best fetal
outcomes
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research
shows that DDI ≤ 30 minutes is associated with best maternal outcomes
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research
shows that DDI ≤ 30 minutes is associated with best educational and neuro-developmental
outcomes at age 7 years
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it
is an accepted audit tool that tests the efficiency of the delivery team
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the
NHSLA’s CNST requires that ≥ 90% of category 1 C sections have a DDI ≤ 30
minutes
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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.
- brainstorming.
- brainwashing
- cream cake circle.
- Delphi technique.
- demonstration & practice
using clinical model.
- doughnut round.
- interactive lecture with
EMQs.
- lecture.
- 1 minute preceptor method.
- teaching peers / junior
colleagues
- schema activation.
- schema refinement.
- small group discussion.
- snowballing.
- snowboarding.
- true
- 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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