|
36
|
Role-play. Shoulder dystocia
|
|
37
|
Role-play. Hydatidiform
mole
|
|
38
|
Viva. Air
travel in pregnancy
|
|
39
|
EMQ. Headache
|
|
40
|
EMQ.
Education
|
36. Role-play. Shoulder dystocia.
Candidate’s instructions.
You are the on-call SpR for the labour ward. It is an
unusually quiet afternoon, with only one patient in labour and she is a healthy
para 1 with a previous normal delivery.
There is a new FY1 in the department. She was on call
yesterday when there was a difficult delivery due to shoulder dystocia. The
baby needed to be resuscitated and the mother sustained a 4th.
degree tear. The FY1 felt completely useless and would like an introduction to
shoulder dystocia so that she can be of some practical use the next time she is
involved with a case.
The examiner will not react,
respond to questions or offer advice.
37. Roleplay. Hydatidiform mole.
Candidate’s instructions.
You are the SpR in the gynae clinic. The consultant has said
that it will be a good experience for you to see the next patient. She was
recently an inpatient for evacuation of retained products after an apparent
miscarriage at 8 weeks. The histology report showed a complete mole. The GP was
asked to see her. An appointment was sent to her to attend today.
Your task is to take a history and explain the
implications of the diagnosis.
38. Viva. Air travel in pregnancy.
Air Travel and Pregnancy.
Candidate’s instructions.
This is a viva station about air travel & pregnancy.
The examiner will ask you 15 questions.
When you have finished a question, you will not be
allowed to return to it as later questions may indicate the answer. If you
return, no marks will be awarded, even for correct answers.
39. EMQ. Headache.
Lead-in.
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.
40.
EMQ. Education.
Education.
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.
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