Website.
25 February 2016.
72
|
SBA. Appendicitis in pregnancy
|
73
|
EMQ. Caesarean section and NICE’s CG132
|
74
|
SBA. Prophylactic antibiotics &
Caesarean section
|
75
|
EMQ. Puerperal psychosis and mental
health
|
76
|
EMQ. Group B streptococcus & neonate
|
77
|
EMQ. Gestational trophoblastic disease
|
72. SBA. SBA.
Appendicitis in pregnancy
Abbreviations.
AIP
|
Appendicitis
in pregnancy
|
CRP
|
C
reactive protein
|
CT
|
computed
tomography, also known as computerised tomography
|
RLQP
|
right
lower quadrant pain
|
RUQP
|
right upper
quadrant pain
|
Question 1.
Lead-in
What is
the approximate incidence of appendicitis in pregnancy?
Option List
A.
|
1 in 500
|
B.
|
1 in 1,000
|
C.
|
1 in 2,000
|
D.
|
1 in 5,000
|
E.
|
1 in 10,000
|
Question 2.
Lead-in
When is appendicitis
in pregnancy most common?
Option List
A.
|
first
trimester
|
B.
|
second trimester
|
C.
|
trimester
|
D.
|
1st. and 2nd. stages of labour
|
E.
|
in the hours after the 3rd. stage of labour
|
F.
|
during the puerperium
|
Question 3.
Lead-in
What
eponymous title is given to the surface marker for the appendix?
Option List
A.
|
McBarney’s
point
|
B.
|
MacBurney’s point
|
C.
|
McBurney’s point
|
D.
|
MacBorney’s point
|
E.
|
McBorney’s point
|
Question 4.
Lead-in
Where is
the point referred to in the above question?
Option List
A.
|
1/3 of
the way along the line joining the anterior superior iliac spine and umbilicus
|
B.
|
1/2 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
C.
|
2/3 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
D.
|
1/3 of the way along the line joining the left and
right anterior superior iliac spines
|
E.
|
1/2 of the way along the line joining the left and
right anterior superior iliac spines
|
Question 5.
Lead-in
Which, if
any, of the following statements are true about the person after whom the point
in the above questions is named?
Statements
A.
|
he spent
2 years as a postgraduate working in Berlin, London, Paris and Vienna
|
B.
|
he was
Professor of surgery at the Roosevelt hospital, New York from 1889 to 1894
|
C.
|
he presented his classical paper on appendicitis to the
NY Surgical Society in 1889
|
D.
|
he was a transvestite
|
E.
|
he died of a heart attack while on a hunting trip
|
Question 6.
Lead-in.
Pick the
best option from the list below in relation to right lower quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RLQP is
as common in the pregnant as in the non-pregnant
|
C
|
RLQP is
less common in the pregnant
|
D
|
RLQP is more common in the pregnant
|
E
|
RLQP is rare in pregnancy
|
Question 7.
Lead-in.
Pick the
best option from the list below in relation to right upper quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RUQP is
½ as common in the pregnant as in the non-pregnant
|
C
|
RUQP is
as common in the pregnant as in the non-pregnant
|
D
|
RUQP is
twice as common in the pregnant as in the non-pregnant
|
E
|
RUQP is
four times as common in the pregnant as in the non-pregnant
|
Question 8.
Lead-in.
Pick the
best option from the list below in relation to nausea in AIP in the pregnant
and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
nausea
is as common in the pregnant as in the non-pregnant
|
C
|
nausea
is less common in the pregnant
|
D
|
nausea is more common in the pregnant
|
E
|
nausea is rare in pregnancy
|
Question 9.
Lead-in.
Which
condition did CMACE say should be excluded in women presenting acutely with
gastrointestinal symptoms?
Option List
A
|
aortic dissection
|
B
|
appendicitis
|
C
|
Caesarean
section scar pregnancy
|
D
|
ectopic pregnancy
|
E
|
pancreatitis
|
F
|
ovarian torsion
|
Question 10.
Lead-in.
Pick the
best option from the list below in relation to abdominal guarding in AIP in the
pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
abdominal
guarding is as common in the pregnant as in the non-pregnant
|
C
|
abdominal
guarding is less common in the pregnant
|
D
|
abdominal
guarding is more common in the pregnant
|
E
|
abdominal
guarding is rare in pregnancy
|
Question 11.
Lead-in.
Pick the
best option from the list below in relation to rebound tenderness in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
rebound tenderness is as common in the pregnant as in
the non-pregnant
|
C
|
rebound tenderness is less common in the pregnant
|
D
|
rebound tenderness is more common in the pregnant
|
E
|
rebound tenderness is rare in pregnancy
|
Question 12.
Lead-in.
Pick the
best option from the list below in relation to fever in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
fever is
as common in the pregnant as in the non-pregnant
|
C
|
fever is
less common in the pregnant
|
D
|
fever
is more common in the pregnant
|
E
|
fever
is rare in pregnancy
|
Question 13.
Lead-in
How useful
is the finding of leucocytosis in making the diagnosis of AIP?
Option List
A.
|
sine qua
non
|
B.
|
very useful
|
C.
|
not very useful
|
D.
|
I don’t know
|
Question 14.
How useful
is the finding of a raised CRP level the diagnosis of AIP?
Option List
A.
|
sine qua
non
|
B.
|
very useful
|
C.
|
not very useful
|
D.
|
I don’t know
|
Question 15.
Lead-in
What are
the ultrasound features of appendicitis?
Option List
A
|
appendix
with diameter > 0.6 mm.
|
B
|
appendix with diameter > 1 cm.
|
C
|
blind-ending tubular structure
|
D
|
non-compressible
tubular structure
|
E
|
none of the above
|
Question 16.
Lead-in
What
figures do W&M give for sensitivity & specificity for US diagnosis of
appendicitis?
Option List
Sensitivity
|
Specificity
|
|
A
|
≥65%
|
≥80%
|
B
|
≥75%
|
≥85%
|
C
|
≥86%
|
≥97%
|
D
|
≥91%
|
≥98%
|
E
|
≥95%
|
≥95%
|
Question 17.
Lead-in
Which, if
any, of the following statements are true about CT scanning for the diagnosis
of AIP?
Option List
A
|
CT
scanning has sensitivity > 85% and specificity >95%
|
B
|
CT scanning exposes mother and fetus to radiation doses
of little concern
|
C
|
CT scanning has replaced ultrasound scanning for AIP
|
D
|
CT scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
CT scanning is of proven value and most useful after inconclusive ultrasound scanning
|
Question 18.
Lead-in
Which, if
any, of the following statements are true about MRI scanning for the diagnosis
of AIP?
Option List
A
|
MRI
scanning has sensitivity > 90% and specificity >97%
|
B
|
MRI scanning exposes mother and fetus to radiation
doses of little concern
|
C
|
MRI scanning has replaced ultrasound scanning for AIP
|
D
|
MRI scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
MRI scanning is of proven value and most useful after inconclusive ultrasound scanning
|
Question 19
Lead-in
Which, if
any, of the following statements are true about the complications of AIP?
Option List
A
|
fetal
loss rate in uncomplicated AIP is about 1.5%
|
B
|
fetal loss rate in AIP complicated by peritonitis is
about 6%
|
C
|
fetal
loss rate in AIP complicated by perforation of the appendix is up to 36%
|
D
|
pre-term delivery rates increase in AIP complicated by
perforation of the appendix
|
E
|
a low level of suspicion should apply to the diagnosis
of AIP in relation to surgical intervention
|
Question 20
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparotomy
should be done through a grid-iron incision with the mid-point the surface
marker for the appendix in the right iliac fossa
|
B
|
laparotomy should be done through a right paramedian
incision starting at the level of the umbilicus
|
C
|
about
35% of laparotomies show no evidence of appendicitis
|
D
|
the appendix should be removed even if it looks normal
|
E
|
antibiotic therapy is an alternative to surgery in
early cases of AIP
|
Question 21
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparotomy
should be done through a grid-iron incision with the mid-point the surface
marker for the appendix in the right iliac fossa
|
B
|
laparotomy should be done through a right paramedian
incision starting at the level of the umbilicus
|
C
|
about
35% of laparotomies show no evidence of appendicitis
|
D
|
the appendix should be removed even if it looks normal
|
E
|
antibiotic therapy is an alternative to surgery in
early cases of acute AIP
|
Question 22
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparoscopic
appendicectomy is an acceptable alternative to laparotomy, but only in the 1st.
trimester
|
B
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, but only in the 1st. & 2nd.
trimesters
|
C
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, at all gestations
|
D
|
there is evidence that laparoscopic appendicectomy is
associated with doubling of the rate of fetal loss
|
73 SBA. Caesarean section and NICE’s CG132
Lead-in.
The following scenarios relate to Caesarean section.
Abbreviations.
cART: combination
anti-retroviral treatment.
CDUS: colour Doppler
ultrasound scan.
HAART: highly active
anti-retroviral therapy.
HCV: hepatitis C virus.
HSV: herpes simplex
virus.
MOD: mode of delivery.
MPA: morbid placental
adherence.
MRI: magnetic resonance
imaging.
MTCT: mother-to-child transmission.
NVD: normal vaginal
delivery.
pCs planned Caesarean
section.
pvd planned vaginal
delivery.
PVL: plasma viral load.
SROM: spontaneous rupture of
membranes.
VBAC: vaginal birth after
Caesarean section.
Option list.
There is none, to make you think!
Scenarios.
1)
MPA is suspected on a routine 20 week scan
in a woman who has had two LSCSs. What advice should she be given in relation
to the value of colour Doppler US and MRI?
2)
What advice is
given about women who are infected with hepatitis B?
a a woman is
known to have HIV. When should a decision be taken about MOD?
b. at what
gestation should pCs be done as part of management of HIV in pregnancy?
c. at what
gestation should pCs be done in the woman with HIV, if the grounds are
obstetric or the woman’s wish, but not part of the management of HIV?
d. what advice
about MOD should be given to a woman with PVL <50 HIV RNA copies/mL at 36
weeks?
e. what advice
about MOD should be given to a woman with PVL of 200 HIV RNA copies/mL at 36
weeks?
f. what advice about
MOD should be given to a woman with PVL of 300 HIV RNA copies/mL at 36 weeks?
g. what advice
about MOD should be given to a woman with PVL of 400 HIV RNA copies/mL at 36
weeks?
h. what advice
about MOD should be given to a woman with PVL of 600 HIV RNA copies/mL at 36
weeks?
i. a woman with
HIV has been advised that normal delivery is recommended. What additional
interventions should be offered when she goes into labour?
k. what is an
elite controller?
1
|
member of the staff of Black
Rod in the House of Lords
|
2
|
crowd marshal at the Members’
Pavilion at Lord’s Cricket Ground.
|
3
|
Gentleman Usher at Buckingham
Palace party
|
4
|
one of the anti-retroviral
drugs that are essential components of HAART.
|
5
|
individual who is infected
with HIV but maintains low viral and healthy CD4 counts long-term with ART.
|
6
|
individual who is infected
with HIV but maintains low viral and healthy CD4 counts long-term without
ART.
|
l. a woman is
taking zidovudine monotherapy. Her PVL is <50 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
m. a woman is
taking zidovudine monotherapy. Her PVL is 200 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
n. a woman is
taking zidovudine monotherapy. Her PVL is 500 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
o. a woman is an
elite controller. What advice will you give re MOD?
3)
What advice is
given about women who are infected with hepatitis C
4)
What advice is
given about women who are infected with HIV?
5)
What advice is given about women who are
infected with HIV + hepatitis B?
6)
What advice is
given about women who are infected with HIV + hepatitis C
7)
A woman with HIV
takes HAART and has a PVL < 50 copies per ml. She wishes Caesarean section
for non-obstetric reasons. She has been counselled and Caesarean section has
been agreed. At what gestation should it be done?
8)
What advice should
be given to the woman with HSV infection in pregnancy?
9)
What is the risk
of MTCT after primary HSV infection in the 3rd. trimester?
10)
A woman presents
with genital herpes at 36 weeks’ gestation in her first pregnancy. As far as
she is aware, this is her first episode of HSV infection. What is the chance
that it is a recurrent infection?
11)
A woman presents
with genital herpes at 36 weeks’ gestation in her third pregnancy. As far as
she is aware, this is her first episode of HSV infection. What is the chance
that it is a recurrent infection?
12)
A woman presents with genital herpes at 36
weeks’ gestation in her first pregnancy. As far as she is aware, this is her
first episode of HSV infection. What test should be done to clarify whether it
is a 1ry. or recurrent infection?
13)
A woman presents with genital herpes at 36
weeks’ gestation in her first pregnancy. As far as she is aware, this is her first
episode of HSV infection. Swabs are taken from the skin lesions and blood is
taken for HSV type-specific antibodies. She goes into labour at 38 weeks before
the results of the HSV type specific antibody tests are available. What advice
should be given re mode of delivery?
14)
A woman presents
with genital herpes at 36 weeks’ gestation in her first pregnancy. As far as
she is aware, this is her first episode of HSV infection. Swabs are taken from
the skin lesions and blood is taken for HSV type-specific antibodies and
confirm 1ry. infection. She goes into labour with intact membranes at
38 weeks and declines Cs. What action should be taken with regard to anti-viral
treatment?
15)
A woman presents
in labour at 38 week’s gestation, 2 weeks after a 1ry. infection
with genital HSV. She declines Caesarean section, but opts for antiviral
treatment for her and the baby. Which drug should be considered and in what
doses?
16)
A woman presents
in labour at 38 week’s gestation, 2 weeks after a 1ry. infection
with genital HSV. She had SROM 6 hours before.
17)
A woman presents
in early labour at 38 weeks’ gestation. She has a history or recurrent genital
HSV. She has a typical herpetic blister on the vulva. What risk of neonatal
infection will you quote in the discussion?
18)
A woman presents
in labour at term with lesions and a history that are typical of 1ry.
genital HSV infection. Which invasive procedures, if any, should be avoided?
19)
A woman with a
history of recurrent genital herpes presents in labour at 40 weeks with a
typical vulval herpetic blister. Which invasive procedure, if any, should be avoided?
20)
A baby is born by
Caesarean section after maternal 1ry. genital herpes one month
before. Which, if any, of the following are appropriate?
Option
list.
A. liaise with the neonatal unit
B. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
C. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
D. lumbar puncture for evidence of HSV
E. parents to be educated re good hand hygiene
F. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
G. strict infection control procedures should be put in place
for both mother and baby.
H. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
I.
parents advised to
seek medical help if they have concerns, in particular, skin, eye or mucous
membrane lesions, lethargy, irritability or poor feeding
21)
A baby is born
normally after maternal 1ry. genital herpes one month before. The
mother had declined C section and intends to breast feed. Which, if any, of the
following are appropriate? Option list.
J.
liaise with the
neonatal unit
K. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
L. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
M. lumbar puncture for evidence of HSV
N. parents to be educated re good hand hygiene
O. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
P. strict infection control procedures should be put in place
for both mother and baby.
Q. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
R. parents advised to seek medical help if they have concerns,
in particular, skin, eye or mucous membrane lesions, lethargy, irritability or
poor feeding,
S. involvement of child protection service.
22)
A baby is born by
Caesarean section after maternal 1ry. genital herpes one month
before. Which, if any, of the following are appropriate?
Option
list.
T. liaise with the neonatal unit
U. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
V. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
W. lumbar puncture for evidence of HSV
X. parents to be educated re good hand hygiene
Y. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
Z. strict infection control procedures should be put in place
for both mother and baby.
AA. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
BB. parents advised to seek medical help if they have concerns,
in particular, skin, eye or mucous membrane lesions, lethargy, irritability or
poor feeding
23)
What proportion of
neonatal HSV infection is thought to be due to infection after birth?
24)
What steps should
be taken to reduce the risk of neonatal HSV infection?
25)
A primigravida attends
for booking. She requests Caesarean section. There are no clinical grounds. Outline your management.
26)
A woman with BMI
> 50 should be offered Caesarean section. True/ False.
27)
When should
prophylactic antibiotics in relation to the timing of the operation?
28)
A woman has had
her 3rd. Caesarean section. She wants to know the advice you would
give re the risks of subsequent vaginal delivery.
29) What are the key aspects of induction of general
anaesthesia for unplanned Cs?
30) What should be done about thromboprophylaxis for women
having Cs?
31) Which abdominal incision is
recommended for Cs?
A
|
William
Fletcher Shaw
|
B
|
Victor
Bonney
|
C
|
Ignaz
Semmelweis
|
D
|
Joel-Cohen
|
E
|
Pfannenstiel
|
32) Separate scalpels should be used
for the skin and subsequent incisions to reduce infection. True/False.
33) If the lower segment is
well-formed, blunt dissection should be used to extend the initial uterine
incision. True / False.
34) What is the risk of fetal
laceration?
A
|
0.1%
|
B
|
0.5%
|
C
|
1%
|
D
|
2%
|
E
|
5%
|
35) Routine use of forceps to deliver
the head is acceptable practice. True / False.
36) I.v. syntometrine is the
recommended oxytocic. True / False.
37) Which of the following statements
reflects the advice in CG132 about delivery of the placenta.
A
|
Crede’s
manoeuvre is the recommended routine method for DOP
|
B
|
Leopold’s manoeuvre is the recommended routine method
for DOP
|
C
|
Steptoe’s
manoeuvre is the recommended routine method for DOP
|
D
|
CCT
is the recommended routine method for DOP
|
E
|
MROP
manoeuvre is the recommended routine method for DOP
|
38) Co-amoxiclav is on the list of
recommended antibiotics in CG132 for routine prophylaxis at Cs. True / False.
39) Repair of the uterus is best done
with the uterus exteriorised. True / False.
40) CG132 advises that single or
double-layer closure of the lower segment are equivalent and closure is a
matter of choice for the surgeon. True / False.
41) CG132 advises closure of both
visceral and parietal peritoneum. True / False.
42) Mass closure with a
non-absorbable suture should be used for closure of mid-line incisions. True /
False.
43) What is the suggested threshold
for closure of the subcutaneous fat?
Subcutaneous
fat thickness
|
|
A
|
1
cm.
|
B
|
2
cm.
|
C
|
3
cm.
|
D
|
4
cm.
|
E
|
≥ 5
cm.
|
44) Liberal use of subcutaneous
drains is encouraged to reduce wound infection rates. True / False.
45) When choosing an antibiotic for
prophylactic use at Cs, what infections should particularly be considered?
46) Staff should be silent
immediately before and after the birth of the baby as hearing the mother’s
voice as the first ex-utero experience encourages bonding. True / False.
74 SBA. Prophylactic antibiotics &
Caesarean section
For each scenario, pick the best answer from the option
list.
Scenario 1.
What % of women will have infection after C. section?
Option list.
A
|
<5 %
|
B
|
5 – 9.9%
|
C
|
10 – 19.9%%
|
D
|
> 20%
|
Scenario 2.
Which, if any, of the following statements are correct
about who should be offered prophylactic
antibiotics for Cs?
Option list.
A
|
all women
|
B
|
women with known predisposition to infection – e.g.
diabetes
|
C
|
women with ruptured membranes for > 24 hours
|
D
|
women who are carriers of Gp B streptococcus
|
E
|
women who
|
Scenario 3.
When should prophylactic antibiotics be administered?
Option list.
A
|
administer 6 hours before skin incision
|
B
|
administer 12 hours before skin incision
|
C
|
administer with skin incision
|
D
|
administer after cord clamping
|
E
|
none of the above
|
Scenario 4.
Which antibiotic should be used?
Option list.
A
|
amoxicillin + metronidazole i.m.
|
B
|
antibiotic effective against local organisms most
likely to cause wound infection
|
C
|
antibiotic effective against endometritis, UTI &
wound infection
|
D
|
antibiotic effective against Gp. B streptococcus.
|
E
|
none of the above
|
Scenario 5.
Which antibiotic does NICE say should not be used and why?
Option list.
A
|
amoxicillin
|
B
|
co-amoxiclav
|
C
|
flucloxacillin
|
D
|
rifampicin
|
E
|
streptomycin
|
75 SBA. Puerperal psychosis and mental health
Puerperal mental illness.
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.
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?
76 EMQ. Group B streptococcus
Lead-in.
The following scenarios relate to Group B Streptococcal
disease.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
EOGBS: early-onset GBS disease.
GBS: Group B streptococcus.
IAP: intrapartum antibiotic
prophylaxis.
Option list.
1. Streptococcus agaractiae
2. Streptococcus intergalacticae
3. Streptococcus agalactiae
4. Streptococcus ubernastiae
5. Lancelot
6. Lanceforth
7. Lanceford
8. Landscape
9. 0.01%
10. 0.02%
11. 0.023%
12. 0.025%
13. 0.05%
14. 0.1%
15. 0.5%
16. 0.53%
17. 0.54%
18. 0.6%
19. 0.63%
20. 0.75%
21. 0.9%
22. 1%
23. 2%
24. 2.3%
25. 2.4%
26. 2.5%
27. 5%
28. 10%
29. 15%
30. 20%
31. 25%
32. 26.3%
33. 21%
34. 30%
35. 35%
36. 1
37. 2
38. 3
39. 5
40. 6
41. 9
42. 10
43. True
44. False
45. you are driving me mad with all these percentages
Scenario 1.
What is the scientific name for
GBS?
Scenario 2.
Which animal is the main
reservoir of GBS in relation to neonatal GBS?
Scenario 2.
What system is used for
grouping streptococci?
Scenario 3.
Where does GBS disease feature
in the list of serious early-onset neonatal infection?
Scenario 4.
What is the upper limit in days
for time of onset in the definition of “early-onset” disease?
Scenario 5.
GBS is a gram-negative,
capsulated organism.
Scenario 6.
What is the incidence of EOGBS
in the UK in the babies of women who have not been screened for GBS or had IAP?
Scenario 7
What is the incidence of EOGBS
in the babies of American women who have had antenatal GBS screening and IAP if
screen +ve?
Scenario 8
What is the mortality rate of
EOGBS in the UK?
77 SBA. Gestational
Trophoblastic Disease (GTD)
Lead-in.
The following scenarios relate to GTD. For each, select
the number that best fits the scenario. Pick one option from the option list.
Each option can be used once, more than once or not at all.
Option list.
A.
|
100%.
|
B.
|
20%.
|
C.
|
15%.
|
D.
|
10%.
|
E.
|
5%.
|
F.
|
2.5%.
|
G.
|
1.5%.
|
H.
|
0.5%.
|
I.
|
1 in 35.
|
J.
|
1 in 55.
|
K.
|
1 in 65.
|
L.
|
1 in 700.
|
M.
|
1 in 1,000.
|
N.
|
Ö64.
|
O.
|
pr2.
|
P.
|
increased.
|
Q.
|
reduced.
|
R.
|
increased by a factor of 2.
|
S.
|
increased by a factor of 5.
|
T.
|
increased by a factor of 10.
|
U.
|
increased by a factor of 20.
|
V.
|
increased by a factor of 30.
|
W.
|
increased by a factor of > 100.
|
X.
|
hydatidiform mole, both partial and complete.
|
Y.
|
hydatidiform mole, both partial and complete and
placental site tumour.
|
Z.
|
partial mole, complete mole, invasive and metastatic
mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid
trophoblastic tumour.
|
AA.
|
choriocarcinoma invasive and metastatic mole and
epithelioid trophoblastic tumour.
|
BB.
|
true
|
CC.
|
false
|
DD.
|
None of the above.
|
Abbreviations.
GTD: gestational
trophoblastic disease
GTN: gestational
trophoblastic neoplasia.
PSTT: placental site
trophoblastic tumour
Scenario 1.
What is the incidence of GTD in
the UK?
Scenario 2
What is the difference between GTD and GTN?
Scenario 3
A woman had a complete mole in her first pregnancy. She
is pregnant for the second time. What is the risk that it is another molar
pregnancy?
Scenario 4.
A woman has had two molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 5
A woman has had three molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 6
Cystic placental spaces in the placenta and a ratio of
transverse to anterioposterior
measurements of the gestation sac < 1.5 are strongly
suggestive of a partial mole. True /
False
Scenario 7.
What is the risk of persistent GTD after a complete mole?
Scenario 8.
What is the risk
of requiring chemotherapy after a complete mole?
Scenario 9.
What is the risk of persistent
GTD after a partial mole?
Scenario 10
What is the risk of requiring
chemotherapy after a partial mole?
Scenario 11
What is the risk of requiring
chemotherapy with hCG level > 20,000 i.u. one month after evacuation?
Scenario 12
What is the overall risk of
requiring chemotherapy after molar pregnancy in the UK?
Scenario 13
What is the risk of requiring
chemotherapy in the USA compared with the UK?
Scenario 14
What is the risk of molar
pregnancy at age 15 compared to age 30?
Scenario 15
What is the risk of molar
pregnancy at age 45 compared to age 30?
