23rd. November
2017.
7
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EMQ. Antenatal steroids.
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8
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EMQ. Maternal Mortality definitions
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9
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EMQ. Coroner 1-3
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10
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EMQ. Antepartum haemorrhage
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11
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EMQ. Cystic fibrosis.
|
7. EMQ. Antenatal steroids.
Lead-in.
The following scenarios relate to antenatal steroid use
and the neonate.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ANS: antenatal steroids.
FGR: fetal growth restriction.
GTG: Green-Top Guideline No 7 from the RCOG. “Antenatal
Corticosteroids to Reduce Neonatal Morbidity and Mortality.”
RDS: respiratory distress syndrome. In ancient
times known as “hyaline membrane disease”. Now better known as “surfactant-deficient
lung disease of the new-born”.
Option list.
There is no option list.
I want you to come up with your
answers.
Scenario 1.
What are the benefits to the
neonate of appropriate administration of antenatal steroids?
Scenario 2.
At what gestations should
antenatal steroids be offered to women with singleton pregnancies who are at
risk of premature labour?
Scenario 3.
At what gestations should
antenatal steroids be offered to women with multiple pregnancies who are at
risk of premature labour?
Scenario 4.
What advice is contained in the
GTG in relation to very early gestations, threatened premature labour and the
use of antenatal steroids.
Scenario 5.
What advice is contained in the GTG in relation to
antenatal steroids and Caesarean section?
Scenario 6.
What advice is given in the GTG
about ANS in relation to the fetus with FGR at risk of premature delivery?
Scenario 7
What advice is given in the GTG
in relation to ANS for women with IDDM?
Scenario 8
What advice is in the GTG in
relation to adverse effects of ANS on the fetus?
Scenario 9
What advice is in the GTG in
relation to short-term maternal adverse effects?
Scenario 10
What contraindications to ANS are cited in the GTG?
Scenario 11
What is the recommended drug regime for ANS
administration?
Scenario 12.
What
is the time-scale for maximum effect of ANS in reducing RDS?
Scenario 13.
When
should repeat courses of ANS be given?
Scenario 14.
When may
antenatal steroids be beneficial to the fetus apart from accelerating lung
maturation?
8. EMQ. Maternal Mortality definitions
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.
Option list.
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”?
Scenario 19.
A pregnant woman is walking on
the beach at 10 weeks when she is struck by lightning and dies. What kind of
death is this?
Scenario 20.
A woman is sitting on the beach
breastfeeding her 2-month old baby when she is struck by lightning and dies.
What kind of death is this.
9. EMQ. Coroner 1-3
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
The Coroner. Question 1.
Option list.
A.
an independent
judicial officer
B.
a barrister acting for
the Local Police Authority
C.
the regional
representative of the Home Office
D.
the regional
representative of the Queen.
E.
an employee of the
High Court.
F.
the Local Authority
G.
the Local Police
Authority
H.
the Home Office
I.
the High Court
J.
the Queen
Scenario 1.
What is the best description of
the status of the Coroner?
Scenario 2.
Who appoints the Coroner?
Scenario 3.
Who pays for the Coroner and
the coronial service?
The Coroner. Question 2.
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
must have had
experience as a detective in the police force with rank of Inspector or above
B.
must be a barrister,
lawyer or doctor with at least 5 years’ experience
C.
must be a legally qualified
individual with at least 5 years’ experience
D.
must be a trained
bereavement counsellor
E.
must be able to play
the bagpipes
F.
Monday - Friday; 09.00 - 17.00 hours, including bank
holidays
G.
Monday - Friday; 09.00
- 17.00 hours, excluding bank holidays
H.
All the time
I.
to arrest people
suspected of unlawful killing
J.
to manage traffic in
the vicinity of the Coroner’s court
K.
to make enquiries on
behalf of the Coroner
L.
to make enquiries on
behalf of the Coroner and provide administrative support
M. to play bagpipes at coronial funerals
Scenario 1.
What qualifications must the
Coroner have?
Scenario 2.
What are the hours of
availability of the Coroner?
Scenario 3.
What is the role of the
Coroner’s Officers?
The Coroner. Question 3.
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
the death must be
reported to the Coroner
B.
the death does not
need to be reported to the Coroner
C.
the Coroner must order
the return of the body for an inquest
D.
the Coroner must order
a post-mortem examination
E.
the Coroner must hold
an inquest
F.
the Coroner should
arrange for the death to be investigated by the Home Office
G.
the death must be reported
to the authorities of the country in which it took place in order that a
certificate of death can be issued
H.
a certificate of live
birth
I.
a certificate of
stillbirth
J.
a certificate of
miscarriage
K.
yes
L.
no
M. none of the above
Scenario 1.
A resident of Manchester dies suddenly while visiting the
town of his birth in Scotland. His family decides that he will be buried there.
His body is held at the premises of a local funeral director. What actions
should be taken with regard to the Manchester coroner?
Scenario 2.
A resident of London dies suddenly while visiting
Manchester, where he was born. His family decides that he will be buried in
Manchester. His body is held at the premises of a Manchester funeral director.
What actions should be taken with regard to the Manchester coroner?
Scenario 3.
A resident of Manchester dies
on holiday in his native Greece. The family decide that he will be buried in
Greece. What steps must be taken to obtain a valid death certificate?
Scenario 4.
A man of 65 dies of terminal
lung cancer. The GP visited daily until going on holiday three weeks before the
death. He has now returned and says that he will sign a death certificate, but
needs to visit the funeral director to see the body first. Will this be a valid death certificate?
Scenario 5.
A man of 65 dies of terminal
lung cancer. The GP, who visited daily up to the day of his death and attended
to confirm the death, is on holiday. He says that he will sign a death
certificate and put it in the post, so that it will arrive in the morning. Will
this be a valid death certificate?
Scenario 6.
A man of 65 dies of terminal
lung cancer. The GP, who visited daily up to the day before his death, has been
on holiday since. However, he says that he will sign a death certificate and
put it in the post, so that it will arrive in the morning. Will this be a valid
death certificate?
Scenario 7.
A 65-year-old man dies suddenly
12 hours after admission to the local coronary care unit with chest pain,
despite the apparently satisfactory insertion of a coronary artery stent after
a diagnosis of coronary artery thrombosis. What action should be taken with
regard to the Coroner?
Scenario 8.
A 16-year-old girl is admitted
at 36 weeks’ gestation in her first
pregnancy with placental abruption. She is given the best possible care but
develops DIC and hypovolaemic shock and dies after 48 hours. What action should
be taken with regard to the coroner?
Scenario 9.
A 28-year-old woman is admitted
with placental abruption at 36 weeks. She has bruising on the abdominal wall
and the admitting midwife suspects that she has been the victim of domestic
violence, though the woman denies it. Despite best possible care she dies as a
consequence of bleeding. What action should be taken with regard to the
coroner?
Scenario 10.
A 30-year-old woman delivers
normally at home attended by her husband, but has a PPH. The husband practises
herbal medicine. He applies various potions but her condition deteriorates. She
is admitted to hospital by emergency ambulance some hours later in a shocked
condition. She is given the best possible care and is admitted to the ICU. She
dies 7 days later of multi-organ failure and ARDS attributed to hypovolaemic
shock. What action should be taken with regard to the coroner?
Scenario 11.
A woman is admitted at 23 weeks
in premature labour. There is evidence of fetal heart activity throughout the
labour, with the last record being 5 minutes before the baby delivers. The baby
shows no evidence of life at birth. The mother requests a death certificate so
that she can register the birth and arrange a funeral. What form of certificate
should be issued?
Scenario 12.
A woman is admitted at 26
weeks’ gestation in premature labour. The presentation is footling breech. At 8
cm. cervical dilatation the trunk is delivered and the cord prolapses. There is
good evidence of fetal life with fetal movements and pulsation of the cord. The
head is trapped and it takes 5 minutes to deliver it. The baby is pulseless,
apnoeic and without visible movement at birth. Intubation and CPR are carried
out for 20 minutes when the baby is declared dead. What action should be taken
with regard to the coroner?
Scenario 13.
A 65-year-old man dies 2 hours
after admission to hospital with an apparent stroke. The coroner requests
access to the notes. What access should be provided?
Option list.
A
|
provide access to the records by
the Coroner in person
|
B
|
provide unrestricted access to
the medical records by the coroner’s officers
|
C
|
provide a copy of the hospital
records to the coroner or her officers
|
D
|
provide a medical report, but no
access to the medical records
|
E
|
provide a copy of the letter to
the GP about the recent admission
|
F
|
none of the above
|
10. EMQ. Antepartum haemorrhage
Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the baby
B.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the placenta.
C.
genital tract bleeding ≥ 500 ml. from 24 weeks,
or earlier if the baby is live-born, until the delivery of the baby.
D.
1
E.
2
F.
3
G.
4
H.
5
I.
6
J.
7
K.
8
L.
9
M. 10
N.
15
O.
20
P.
30
Q.
50
R.
100
S.
500
T.
1,000
U.
true
V.
false
W. none
of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml.
for minor APH
Scenario 3.
What is the upper limit in ml.
of major haemorrhage
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor
for placental abruption.
Scenario 7
List 10 risk factors for
placental abruption.
Scenario 8
List 6 risk factors for
placenta previa.
Scenario 9
In what % of pregnancies does
APH occur?
Scenario 10
With regards to steps that can be taken to reduce the
incidence of APH, what things would you include in a viva in the OSCE?
11. EMQ. Cystic fibrosis.
This question is about cystic fibrosis. And, to make you behave in a
model fashion, there is no option list, so you have to decide the correct
answer.
Question 1.
A woman is 8 weeks
pregnant and known to be a carrier of cystic fibrosis.
Her husband is
Caucasian.
What is the risk of
the child having cystic fibrosis?
Question 2.
A healthy woman
attends for pre-pregnancy counselling.
Her brother has
cystic fibrosis. Her husband is Caucasian.
He has been
screened for cystic fibrosis. The test was negative.
What is the
approximate risk of them having a child with cystic fibrosis?
Question 3.
A healthy woman is
a known carrier of cystic fibrosis.
She attends for
pre-pregnancy counselling. Her husband has cystic fibrosis.
What is the risk of
them having a child with CF?
Question 4.
A
healthy woman attends for pre-pregnancy counselling. Her sister has had a child
with cystic fibrosis.
What is
her risk of being a carrier?
Question 5.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk
that she is a carrier?
Question 6.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
The partner’s risk
of being a carrier is 1 in X.
What is the risk
that she will have a child with CF?
Question 7.
A healthy Caucasian
woman is 10 weeks pregnant.
Her husband is a
known carrier of cystic fibrosis.
Which test would
you arrange?
Question 8.
A woman attends for
pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from
maternal blood. Is it possible to test for CF in this way?
Question 9.
A woman and her
husband are known carriers of cystic fibrosis.
What is the risk of
them having an affected child?
Question 10.
A woman and her
husband are known carriers of cystic fibrosis.
What can they do to
reduce the risk of having an affected child?
Question 11.
A woman and her
husband are known carriers of cystic fibrosis.
Can CVS exclude an
affected pregnancy?
Question 12.
A woman with cystic
fibrosis is planning pregnancy. Her husband is a carrier of cystic fibrosis.
What is the risk of having an affected child?
Question 13.
A woman with cystic
fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been
advised not to breastfeed because her breast milk will be protein-deficient due
to malabsorption.
Is this advice
correct?
Question 14.
A woman with cystic
fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been
advised not to breastfeed because her breast milk will contain abnormally low
levels of sodium.
Is this advice
correct?
