Thursday 21 June 2018

Tutorial 21st. June 2018




34
EMQ. Zika infection in pregnancy
35
EMQ. Mental Capacity Act
36
EMQ. Confidentiality & consent
37
EMQ. Headache
38
EMQ. Education

34.   EMQ. Zika virus & pregnancy.
Abbreviations.
CZVS:          Congenital Zika Virus Syndrome.
FMS:           fetal medicine specialist.
HC               head circumference.
PCR:            polymerase chain reaction.
RTPCR:       Reverse transcription polymerase chain reaction
Question 1.              
What kind of virus is Zika?
A
DNA
B
DNA + RNA during intermediate stage
C
RNA
D
RNA + DNA during intermediate stage
Question 2.              
To which family of viruses does the Zika virus belong?
A
adenoviruses
B
flaviviruses
C
herpesviruses
D
orthomyxoviruses
E
parvoviruses
F
picornaviruses
G
retroviruses
H
togaviruses
Question 3.              
What other human infections are caused by  viruses from this family? This is not a proper EMQ: there may be more than one correct answer.
A
bubonic plague
B
chikungunya
C
chicken pox
D
common cold
E
dengue fever
F
hepatitis C
G
Japanese encephalitis
H
malaria
I
San Francisco encephalitis
J
St. Louis encephalitis
K
West Nile virus
L
Yellow fever
Question 4.              
When was the first reported identification of Zika virus infection in an animal and what was the animal?
A
1922 in a hippopotamus
B
1928 is a giraffe
C
1935 in a macaque monkey
D
1947 in a Rhesus negative monkey
E
1950 in a chimpanzee
H
none of the above.
Question 5.              
Why is the virus called “Zika”?
A
it was first described as “zoonosis affecting Intestines, Kidneys and Adrenals”
B
the animal from which it was first isolated was the Zika monkey
C
the animal from which it was first isolated was a monkey from the Zika area of Zambia
D
the animal from which it was first isolated was a monkey from the Zika forest in Uganda
E
it was first identified in the Zika laboratory of the CDC
F
it was first identified by Dr Emily Zika, Professor of Virology, Pretoria, South Africa
G
Zika is the Zulu word for ‘small head’ and the association was 1st. noted in a Zulu baby
Question 6.              
What is the main reservoir of the Zika virus?
A
anteaters
B
horses
C
humans
D
marmosets
E
monkeys
F
parrots
G
rats
Question 7.              
How is the Zika virus transmitted? This is not a true EMQ as there may be > 1 correct answer.
A
Aedes aegypti mosquitos
B
Aedes albopictus: Asian tiger mosquito
C
Anopheles gambiae mosquitos
D
Culex pipiens  mosquitos
E
fleas
F
ticks
G
worms
H
none of the above.
Question 8.              
At what time of day is transmission of infection most likely?
A
afternoon
B
evening
C
morning
D
night
E
mid-morning and mid-afternoon to dusk
F
two hours after sunrise
G
two hours before sunset
H
two hours after sunset
I
two hours after sunrise and two hours before sunset
J
none of the above
Question 9.              
Where do  aegypti mosquitoes breed?
Which, if any of the following
A
in large stretches of water with reed beds
B
in water near human habitation
C
in water remote from human habitation
D
in water in human habitations
E
in water with volume > 5 litres
F
in water with volume > 50 litres
G
in water with volume > 500 litres
H
none of the above.
Question 10.          
When did the current interest in the Zika virus and pregnancy begin and why?
A
Brazil reported an in microcephaly with a possible link to maternal Zika infection in 2014
B
Brazil reported an ↑ in microcephaly with a possible link to maternal Zika infection in 2015
C
Brazil reported an ↑ in microcephaly with a possible link to maternal Zika infection in 2016
D
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2014
E
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2015
F
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2016
H
none of the above
Question 11.          
How did the WHO categorise the problem and when?
A
Public Health Emergency of International Concern 2015
B
Public Health Emergency of International Concern 2016
C
Public Health Emergency of International Concern 2017
D
Public Health Emergency of International Concern 2018
E
none of the above
Question 12.          
Is Zika virus infection a notifiable condition in the UK?
A
No
B
Yes, but only if people have returned from an area with a high prevalence of Zika
C
Yes, but only if the woman and her partner have returned from an area with high prevalence of Zika
D
Yes, but only if fetal damage has occurred.
E
none of the above
Question 13.          
How is the risk of getting a Zika virus infection from travelling to a particular country categorised? Which, if any, of the following feature?
A
frightful
B
high
C
low
D
moderate
E
scary
F
none of the above
Question 14.          
How long does it take for symptoms of Zika infection to develop?
A
1 – 5 days
B
1 – 7 days
C
2 – 5 days
D
2 – 7 days
E
2 – 10 days
F
3 – 7 days
G
3 – 12 days
H
5 – 10 days
Question 15.          
How long do symptoms of Zika infection last?
A
1 – 5 days
B
1 – 7 days
C
2 – 5 days
D
2 – 7 days
E
2 – 10 days
F
3 – 7 days
G
3 – 12 days
H
5 – 10 days
Question 16.          
What are the most common symptoms of Zika infection? There is no option list – write what you think.
Question 17.          
Is Zika infection more severe in pregnancy?
A
No
B
Yes
Question 18.          
What abnormalities have been associated with Congenital Zika Virus Syndrome? There is no option list, just write as many as you can think of.
Question 19.          
Is gestation related to the risk of vertical transmission of the Zika virus? Which, if any, of the following statements are true?
A
evidence is unclear
B
evidence suggests it probably is
C
evidence suggests it probably is not
D
no
E
yes
Question 20.          
What is the risk of adverse fetal outcomes for women proven to have had Zika virus infection?
A
~   5%
B
~ 10%
C
~ 15%
D
~ 20%
E
~ 25%
F
~30%
G
> 30%
H
none of the above
Question 21.          
What advice should be given to a pregnant woman planning to travel to an area with high risk of transmission of Zika infection?
A
consider postponing travel until after the pregnancy
B
don’t go to the area
C
get vaccinated
D
stay indoors from dawn to dusk
E
take chloroquine as prophylaxis
F
take chloroquine + proguanil as prophylaxis
G
take proguanil as prophylaxis
Question 22.          
What advice should be given to a pregnant woman planning to travel to an area with moderate risk of transmission of Zika infection?
A
consider postponing travel until after the pregnancy
B
don’t go to the area
C
get vaccinated
D
stay indoors from dawn to dusk
E
take chloroquine as prophylaxis
F
take chloroquine + proguanil as prophylaxis
G
take proguanil as prophylaxis
Question 23.          
What advice should be given to a woman who decides to travel to an area of high or moderate risk?
There is no option list: jot down everything you think would be relevant.
Question 24.          
A woman returns to the UK from a high-risk Zika area? She develops symptoms suggestive of Zika infection 4 weeks later. What testing should be offered?
A
abdominal ultrasound
B
amniocentesis
C
MR scan
D
no test indicated
E
TVS
F
Zika IgA 
G
Zika IgG 
H
Zika IgG + IgM
I
Zika IgA + IgG + IgM 
J
Zika PCR
Question 25.          
A woman who wishes to be pregnant has returned to the UK from an area of high-risk for Zika infection. Her partner had remained in the UK? What advice should she be given?
A
use barrier contraception for 8 weeks
B
use effective contraception for 8 weeks
C
use barrier contraception + effective contraception for 8 weeks
D
use barrier contraception for 12 weeks
E
use effective contraception for 12 weeks
F
use barrier contraception + effective contraception for 12 weeks
Question 26.          
A man travels to an area with high-risk of Zika infection? On his return to the UK his wife is keen to start a pregnancy. What advice should be given?
A
use barrier contraception for 8 weeks
B
use effective contraception for 8 weeks
C
use effective contraception + barrier contraception for 8 weeks
D
use barrier contraception for 12 weeks
E
use effective contraception for 12 weeks
F
use effective contraception + barrier contraception for 12 weeks
G
use barrier contraception for 6 months
H
use effective contraception for 6 months
I
use effective contraception + barrier contraception for 6 months
J
none of the above.
Question 27.          
A man travels to an area with high-risk of Zika infection for two weeks? During his stay he has symptoms suggestive of Zika infection. His wife is pregnant. What testing should be offered on his return?
A
discuss with local infection specialist
B
discuss with RIPL
C
no test indicated
D
Zika IgG 
E
Zika IgG + IgM
F
Zika IgA + IgG + IgM 
G
Zika PCR
H
none of the above
Question 28.          
A woman is shown to have had a Zika infection? How useful is amniocentesis for assessing the risk to the fetus and determining if an infected fetus in affected?
A
PCR on amniocentesis is the gold standard for diagnosing fetal infection
B
PCR on amniocentesis is of unknown value for diagnosing fetal infection
C
PCR on amniocentesis is of little value for diagnosing fetal infection
D
PCR on amniocentesis is the gold standard for determining the risk of an infected fetus being affected
E
PCR on amniocentesis is of unknown value for determining the risk of an infected fetus being affected
F
PCR on amniocentesis is of little value for diagnosing fetal infection
Question 29.          
What advice and treatment should be offered to the non-pregnant individual with symptoms of Zika infection? This is not a true EMQ as more than one option could be true.
A
adequate fluids
B
acyclovir from GP
C
bed rest for 48 hours
D
emergency contraception
E
get advice from A&E centre
F
offer TOP
G
paracetamol if needed for pain
H

Question 30.          
A pregnant woman returns from a high-risk Zika area and develops symptoms suggestive of infection? She develops a high fever and is admitted to hospital. What particular things should be done?
A
anticoagulant prophylaxis
B
paracetamol + tepid sponging
C
exclude  chikungunya
D
exclude dengue
E
exclude malaria
F
exclude UTI
G
exclude Zika
H
exclude other causes of pyrexial illness
I
offer TOP
J
none of the above
Question 31.          
A woman with possible Zika exposure has a –ve test for virus antibodies 4 weeks after the last possible exposure. Is this sufficiently long to reassure her that she has not been infected?
A
no
B
yes
C
we don’t know
Question 32.          
A pregnant woman has visited a country with high-risk for Zika exposure but been asymptomatic during her stay and for two weeks on her return? What testing should be offered?
A
baseline ultrasound + repeat at 18-20 weeks
B
baseline ultrasound  + repeat at 28-30 weeks
C
baseline ultrasound + repeat at 18-20 weeks + consider repeat at 28-30 weeks
D
amniocentesis
E
MR scan
F
no test indicated
G
Zika IgG 
H
Zika IgG + IgM
I
Zika IgA + IgG + IgM 
J
Zika PCR
Question 33.          
A pregnant woman with possible Zika exposure has an ultrasound scan showing the fetal BPD to be > 2 SDs below the mean for that gestation. What should be done?
A
discuss amniocentesis to confirm fetal infection
B
discuss with the local virologist
C
offer TOP
D
refer to a fetal medicine specialist
E
screen the mother for recent Zika infection
F
none of the above
Question 34.          
A pregnant woman with possible Zika exposure has an ultrasound scan showing significant brain abnormality. What further testing should be discussed?
A
amniocentesis + PCR
B
amniocentesis + RT-PCR
C
MR scan
D
Zika IgG 
E
Zika IgG + IgM
F
Zika IgA + IgG + IgM
G
none of the above

35.   EMQ. Mental Capacity Act 2005.
Abbreviations.
CAD:     Court-appointed Deputy.
COP:     Court of Protection.
FGR:      fetal growth restriction.
LPA:      Lasting Power of Attorney.
PoA:      Power of Attorney.
Option list.
A.        Yes
B.         No
C.         True
D.        False
E.         Does not exist
F.         The husband
G.        A parent
H.        The child
I.           the General Practitioner
J.          the Consultant
K.         the Registrar
L.          The Consultant treating the patient
M.      A Consultant not involved in treating the patient
N.        The Medical Director
O.        A person with Powers of Attorney
P.         The sheriff or sheriff’s deputy
Q.        Balance of probabilities
R.         Beyond reasonable doubt
S.         None of the above.
Scenario 1.
A person with LPA is normally not a family member.
Scenario 2.
A Sheriff’s Deputy is normally not a family member.
Scenario 3.
A person with PoA can consent to treatment for the patient who lacks capacity.
Scenario 4.
A Court-appointed Deputy can consent to treatment for the patient who lacks capacity, but must go back to the Court of Protection if further consent is required for additional treatment.
Scenario 5.
A person with PoA can authorise withdrawal of all care except basic care in cases of individuals with persistent vegetative states.
Scenario 6.
An advance decision can authorise withdrawal of all but basic care in cases of persistent vegetative states.
Scenario 7
A person with PoA cannot overrule an advance direction about withdrawal or withholding of life-sustaining care.
Scenario 8
A woman is seen in the antenatal clinic at 39 weeks’ gestation. Her blood pressure is 180/110 and she has +++ of proteinuria on dipstick testing. She has mild epigastric pain. A scan shows evidence of FGR with the baby on the 2nd. centile. Doppler studies of the umbilical artery are abnormal and a non-stress CTG shows loss of variability and variable decelerations. She is advised that she appears to have severe pre-eclampsia and is at risk of eclampsia and of intracranial haemorrhage. She is told of the associated risk of mortality and morbidity. She is also advised that the baby is showing evidence of severe FGR and has abnormal Doppler studies and CTG which could lead to death or hypoxic damage. She declines admission or treatment. She says she trusts in God and wishes to leave her fate and that of her baby in His hands. She is seen by a psychiatrist who assesses her as competent under the MCA and with no evidence of mental disorder. The obstetrician wants to apply to the COP for an order for compulsory treatment. Can he do this?
Scenario 9
A woman is admitted at 36 weeks’ gestation with evidence of placental abruption. She is semi-comatose and shocked. There is active bleeding and the cervical os is closed. Fetal heart activity is present but with bradycardia and decelerations. The consultant decides that Caesarean section is the best option to save her live and that of the baby. When reading the notes, the registrar comes across an advance notice drawn up by the woman and her solicitor. It states that she does not wish Caesarean section, regardless of the risk to her and the baby. The consultant tells the registrar that they can ignore it now that she is no longer competent and get on with the Caesarean section for which she will be thankful afterwards. The registrar says that the advance notice is binding. Who is correct?
Scenario 10
An 8 year old girl is admitted with abdominal pain. Appendicitis is diagnosed with peritonitis and surgery is advised. The parents decline treatment on religious grounds. Can the consultant in charge overrule the parents and give consent?

36.   EMQ. Confidentiality & consent.
Option list.
This EMQ has no option list. This is to make you decide your answers.
Scenario 1.
A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed. Her mother attends clinic 1 hour after the child has left. She demands full information about her daughter. The consultant has delegated you to deal with her. Which option best fits the action you will take?
Scenario 2.
A 17-year-old A-level student attends the gynaecology clinic requesting TOP. She is accompanied by her 30-year-old mathematics teacher, who is her lover and wishes to give consent. Which option best fits the action you will take?
Scenario 3.
A 12-year-old girl attends the gynaecology clinic with her mother seeking contraceptive advice. She has an 18-year-old boyfriend whom the parents like and she wishes to start having sex. Which option best fits the action you will take?
Scenario 4.
A 15-year-old girl who is Fraser competent is referred to the gynaecology clinic with a complaint of vaginal discharge. She reveals that she has been having consensual sexual intercourse for six months with her 18-year-old boyfriend. She asks for advice about suitable contraception as she is happy in the relationship and wants to continue to have sex. Which option best fits the action you will take?
Scenario 5.
You are the new oncology consultant and have just operated on the wife of a local General Practitioner for suspected ovarian cancer. The diagnosis is confirmed and you proceed with appropriate surgery. On completion of the operation you go to the surgeon’s room for a coffee. The senior consultant anaesthetist who was not involved in theatre but is the Medical Director and tells you he is a close friend of the woman, asks what the diagnosis and prognosis are. Which option best fits the action you will take?
Scenario 6.
You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. She has given a history of 2 terminations but no other pregnancies. She is Rhesus negative, but has Rhesus antibodies. Which option best fits the action you will take?
Scenario 7
You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. Her serology tests have proved +ve for syphilis. You have spoken to the consultant bacteriologist who says that they have run confirmatory tests and they are +ve too. He is sure the woman has active syphilis. Which option best fits the action(s) you will take?
Scenario 8
A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed despite your best efforts to persuade her. Who will give consent for the procedure?
Scenario 9
An immature 15-year-old girl attends the gynaecology clinic requesting TOP. She is accompanied by her 25-year-old sister who is a lawyer with whom she has been staying since she knew she was pregnant. She does not want her parents to be informed. The girl is assessed as not Fraser competent. The sister says that she is happy to act in loco parentis and to give consent. Which option best fits the action(s) you will take?
Scenario 10
A 25-year-old woman with Down’s syndrome attends the clinic accompanied by her mother. She has menorrhagia and copes badly with the hygiene aspects. The menorrhagia is bad enough for her now to be on treatment for iron-deficiency anaemia. She has tried all the standard medical methods. To complicate the problem, she has become close friends with a young man she has met at College, to which she travels independently each weekday. Her mother fears that she may already be involved in sexual activity and cannot get an accurate answer from her about it. The mother is keen for her to have hysterectomy to deal with both problems. If you agree that the surgery is appropriate, who can give consent?
Scenario 11
A 25-year-old woman with Down’s syndrome is admitted from College after collapsing. The clinical features are of ectopic pregnancy and she states that she has UPSI with her boyfriend of six months. She has tachycardia and hypotension and it is felt that she should have urgent surgery. You reckon that she is not competent to consent for surgery. Who can give consent?
Scenario 12
A 25-year-old woman with Down’s syndrome is admitted from College after collapsing. The clinical features are of ectopic pregnancy and she states that she has UPSI with her boyfriend of six months. She has tachycardia and hypotension and it is felt that she should have urgent surgery. You reckon that she is not competent to consent for surgery. What limits are there on the surgery?
Scenario 13.
You are the SpR on call and are asked to see a 10-year-old child in the A&E department. She has been brought because of vaginal bleeding. She is accompanied by her parents who give a story of her injuring herself falling of her bike. Examination shows vaginal bleeding and you think the hymen looks torn. You suspect sexual abuse and don’t believe the parents’ story. When this is discussed with the parents they say it is impossible and that they do not want involvement of police or social workers. What action will you take?
Scenario 14.
You are the SpR in theatre with your consultant. Mrs Mary White, age 45, has been listed for abdominal hysterectomy and bilateral salpingo-oophorectomy – she has a long history of menorrhagia that has not responded to conservative measures. Her mother had ovarian cancer diagnosed at 55 and died from the disease 3 years later. A 10 cm., solid tumour of the left ovary is found on opening the abdomen. Which of the following options is the correct course of action?
A
close the abdomen, see her to explain the findings and book a follow-up appointment in the gynaecological clinic to discuss further management
B
close the abdomen, arrange to see her to explain the findings and refer to the gynaecological oncologist to discuss further management
C
continue with the operation, but don’t remove the left ovary
D
continue with the operation, removing the uterus and both ovaries and tubes
E
continue with the operation, removing the uterus and both ovaries and tubes and obtaining peritoneal washings
F
ask the gynaecological oncologist to attend to perform definitive surgery on the basis that the cyst is likely to be malignant
G
phone the legal department for advice
H
phone the Court of Protection for advice
Scenario 15.
You are an SpR in theatre with your consultant.
Mrs Mary White, age 45, has been listed for abdominal hysterectomy and bilateral salpingo-oophorectomy – she has a long history of menorrhagia that has not responded to conservative measures. Her mother had ovarian cancer diagnosed at 55 and died from the disease 3 years later.
You perform examination under anaesthesia prior to the abdomen being opened. You find a 10 cm., mass to the left of the uterus. It feels solid. There is no evidence of ascites or other pathology.
 Which of the following options is the correct course of action?
A
Cancel the operation and arrange review in the gynaecology department in 6 weeks
B
Cancel the operation and arrange review by the oncology team
C
Cancel the operation and arrange an urgent scan
D
Continue with the planned procedure
E
Ask the gynaecological oncologist to attend theatre to examine the patient and advise
F
Perform laparoscopy to identify the nature of the mass
G
Phone the legal department

37.   EMQ. Headache.
Option list.
1.       abdominal migraine
2.       analgesia overuse  aka medication overuse
3.       bacterial meningitis
4.       benign intracranial hypertension
5.       BP check
6.       cerebral venous sinus thrombosis
7.       chest X-ray
8.       cluster
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
23.   ultrasound scan of the abdomen
Scenario 1.
A 40-year-old para 3 is admitted at 38 weeks by ambulance with severe  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 s. They are worse on exercise, even mild exercise such as walking up stairs. She experiences photophobia with the s. Which is the most likely diagnosis?
Scenario 3.
A woman returns from a sub-Saharan area of Africa. She develops severe , fever and rigors. What diagnosis should particularly be in the minds of the attending doctors?
Scenario 4.
A woman at 37 weeks has s. They particularly occur at night without obvious triggers. They occur every few days.
Scenario 5.
A primigravida has had s 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 s at 36 weeks. The history reveals that the s 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: methyldopa, methysergide, nifedipine or nitrofurantoin?
Scenario 7
A woman is booked for Caesarean section and wishes regional anaesthesia. She had severe  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?
Scenario 8
A 25-year-old primigravida complains of s which started two weeks before when she attends for her 20 week scan. There is no significant history of previous . 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  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 , 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 , 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  in pregnancy? These are not on the option list – you need to dig them out of your head.

38.   EMQ. Education.
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.





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