Thursday, 11 October 2018

Tutorial 11th. October 2018

Urogynae tutorial. Fiona Reid.
EMQ. Headache
EMQ. Education

The slides for the uro-gynae tutorial are on Dropbox in the ‘materials for the tutorials’ folder.

35. Tutorial. Uro-gynae.
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

36. EMQ. Headache.
The following scenarios relate to headache in pregnancy. Pick one option from the option list. Each option can be used once, more than once or not at all.
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 headache 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 headaches. They are worse on exercise, even mild exercise such as walking up stairs. She experiences photophobia with the headaches. Which is the most likely diagnosis?
Scenario 3.
A woman returns from a sub-Saharan area of Africa. She develops severe headache, fever and rigors. What diagnosis should particularly be in the minds of the attending doctors?
Scenario 4.
A woman at 37 weeks has headaches. They particularly occur at night without obvious triggers. They occur every few days.
Scenario 5.
A primigravida has had headaches 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 headaches at 36 weeks. The history reveals that they 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 headache due to dural tap after a previous C section. She wants to take all possible steps to reduce the risk of having this again. Which of epidural / spinal anaesthesia has the lower risk of causing dural tap?
Scenario 8
A 25-year-old primigravida attends for her 20-week scan and complains of headache which started two weeks before. There is no significant history. 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 headache 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 headache, 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 headache, 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 headache in pregnancy? These are not on the option list – you need to dig them out of your head.

37. 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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