41
|
Viva. Prepare
obstetric history tutorial
|
42
|
Role-play. Emergency
contraception
|
43
|
Viva. Emergency
contraception
|
44
|
EMQ. Abortion
Act
|
45
|
EMQ. Parvovirus
|
41.
Structured conversation. Prepare obstetric history tutorial.
Candidate’s
instructions.
You
are to conduct a tutorial with hospital’s junior obstetricians and midwives
about how to take an obstetric history. Consider the headlines you would put in
a model for taking and presenting an obstetric history and how you would
conduct the tutorial.
Then
you will have a ‘structured conversation’ with the examiner, who will ask 4
questions.
1. What are your headlines for taking a
history?
2. What clinical situations do you envisage
covering?
3. What teaching methods would you consider
for use in the tutorial.
4. Which methods would be most suitable and
why.
42.
Role-play. Emergency contraception.
Candidate’s
instructions.
You
are the SpR on call for gynaecology and have been asked to see Jennifer Jones
who has attended the A&E department requesting EC.
43. Structured
conversation. Emergency contraception.
Candidate’s
instructions.
The
examiner will ask 17 questions. When you have answered a question and moved on you
will not be allowed to return to an earlier question and no marks will be given
if you do, so you will just be wasting time.
44. EMQ.
Abortion Act.
Abortion
Act & TOP.
Scenario
1
Lead
in.
How
many abortions were performed on residents of E&W aged 15-44 in 2016?
Option
list
A
|
about 50,000
|
B
|
about 100,000
|
C
|
about 150,000
|
D
|
about 200,000
|
E
|
about 250,000
|
F
|
> 250,000
|
Scenario
2
Lead
in.
What
was the approximate rate of abortion in E&W residents in 2016?
Option
list
A
|
1 per 1,000 resident women aged 15-44
|
B
|
10 per 1,000 resident women aged 15-44
|
C
|
15 per 1,000 resident women aged 15-44
|
D
|
20 per 1,000 resident women aged 15-44
|
E
|
50 per 1,000 resident women aged 15-44
|
F
|
100 per 1,000 resident women aged 15-44
|
Scenario
3
Lead
in.
The
rate of abortion has declined by >20% in residents of E&W in the past
ten years.
Pick
the answer from the option list that best matches the above statement.
Option
list
A
|
False
|
B
|
Haven’t a clue
|
C
|
Maybe
|
D
|
No data exist
|
E
|
True
|
Scenario
4
Lead
in.
What proportion
of TOPs were performed at gestations <10 weeks in E&W in 2016?
Option
list
A
|
50%
|
B
|
60%
|
C
|
70%
|
D
|
80%
|
E
|
90%
|
Scenario
5
Lead
in.
There
has been a significant improvement in the proportion of TOPs performed early in
the past decade.
Option
list
A
|
False
|
B
|
Haven’t a clue
|
C
|
Maybe
|
D
|
No data exist
|
E
|
True
|
Scenario
6
Lead
in.
What
% of abortions were performed after 24 weeks?
Option
list
A
|
< 1%
|
B
|
1 - 3%
|
C
|
4 – 6%
|
D
|
7 – 9%
|
E
|
≥ 10%
|
Scenario
7
Lead
in.
What
proportion of TOPs were performed using medical, not surgical techniques?
Option
list
A
|
20%
|
B
|
30%
|
C
|
40%
|
D
|
50%
|
E
|
60%
|
F
|
70%
|
G
|
80%
|
Scenario
8
Lead
in.
Which
age had the highest rate of TOP?
Option
list
A
|
18
|
B
|
19
|
C
|
20
|
D
|
21
|
E
|
22
|
F
|
23
|
G
|
24
|
H
|
25
|
Scenario
9
Lead
in.
What
happened to the rate of TOP in 2016 for girls <18 years compared with 2013?
Option
list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario
10
Lead in.
What
happened to the rate of TOP in 2015 for girls <16 years compared with 2006?
Option
list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario
11
Lead
in.
What
happened to the rate of TOP in 2016 for girls <16 years compared with 2015?
Option
list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario
12
Lead
in
Approximately
what proportion of women having TOP in 2016 had previously had one or more
TOPs?
Option
list
A
|
1%
|
B
|
5%
|
C
|
10%
|
D
|
20%
|
E
|
30%
|
F
|
40%
|
G
|
50%
|
Scenario
13
Lead
in
What
age group of women 1n 2016 were most likely to have had previous TOP?
Option
list
Age
|
|
A
|
< 18
|
B
|
18-19
|
C
|
20-24
|
D
|
25-29
|
E
|
30-34
|
F
|
≥ 35
|
Scenario
14
Lead
in
There
were 185,824 TOPs in 2015. How many deaths occurred?
Option
list
A
|
0 - 9
|
B
|
10 – 19
|
C
|
20 – 39
|
D
|
40 - 59
|
E
|
≥ 60
|
Scenario
15
Lead
in
There
were 185,824 TOPs in 2015. What was the rate of significant complications?
Option
list
A
|
<1%
|
B
|
1%
|
C
|
3%
|
D
|
5%
|
E
|
10%
|
Scenario
16
Lead
in
The
RCOG recommends that women having TOP should have chlamydia screening. What
proportion of women had this done in 2016?
Option
list
A
|
<10%
|
B
|
10- 24%
|
C
|
25- 49%
|
D
|
50- 79%
|
E
|
80- 89%
|
F
|
≥ 90%
|
Scenario
17
Lead
in.
The
Abortion Act gives a number of legal grounds for TOP. Which of the following is
listed as “1 (1) a”?
Option
list
1
|
that the pregnancy has not exceeded its 24th. week
and that the continuance of the pregnancy would involve risk, greater than if
the pregnancy were terminated, of injury to the physical or mental health of
the pregnant woman or any existing children of her family
|
2
|
the pregnancy has not exceeded its 24th. week and
that the continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of any
existing children of the family of the pregnant woman
|
3
|
the continuance of the pregnancy would involve risk to the life
of the pregnant woman greater than if the pregnancy were terminated
|
4
|
the termination is necessary to prevent grave permanent injury
to the physical or mental health of the pregnant woman
|
5
|
there is a substantial risk that if the child were born it would
suffer from such physical or mental abnormalities as to be seriously
handicapped
|
Scenario
18
Lead
in.
The
Abortion Act gives a number of legal grounds for TOP. Which of the following is
listed as “1 (1) b”?
Option
list
1
|
that the pregnancy has not exceeded its 24th. week and that the
continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of the
pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk to the life
of the pregnant woman greater than if the pregnancy were terminated
|
3
|
the termination is necessary to prevent grave permanent injury
to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were born it would
suffer from such physical or mental abnormalities as to be seriously
handicapped
|
5
|
none of the above
|
Scenario
19
Lead
in.
The
Abortion Act gives a number of legal grounds for TOP. Which of the following is
listed as “1 (1) c.
Option
list
1
|
that the pregnancy has not exceeded its 24th. week and that the
continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of the
pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk to the life
of the pregnant woman greater than if the pregnancy were terminated
|
3
|
the termination is necessary to prevent grave permanent injury
to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were born it would
suffer from such physical or mental abnormalities as to be seriously
handicapped
|
5
|
none of the above
|
Scenario
20
Lead
in.
The
Abortion Act gives a number of legal grounds for TOP. Which of the following is
listed as “1 (1) d”?
Option
list
1
|
that the pregnancy has not exceeded its 24th. week and that the
continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of the
pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk to the life
of the pregnant woman greater than if the pregnancy were terminated
|
3
|
the termination is necessary to prevent grave permanent injury
to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were born it would
suffer from such physical or mental abnormalities as to be seriously
handicapped
|
5
|
none of the above
|
Scenario
21
Lead
in.
The
Abortion Act gives a number of legal grounds for TOP. Which of the following is
listed as “1 (1) e”?
Option
list
1
|
the pregnancy has not exceeded its 24th. week and
that the continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of the
pregnant woman
|
2
|
the pregnancy has not exceeded its 24th. week and
that the continuance of the pregnancy would involve risk, greater than if the
pregnancy were terminated, of injury to the physical or mental health of any
existing children of the family of the pregnant woman
|
3
|
the continuance of the pregnancy would involve risk to the life
of the pregnant woman greater than if the pregnancy were terminated
|
4
|
the termination is necessary to prevent grave permanent injury
to the physical or mental health of the pregnant woman
|
5
|
there is a substantial risk that if the child were born it would
suffer from such physical or mental abnormalities as to be seriously
handicapped
|
6
|
none of the above
|
Scenario
22
Lead
in.
With
regard to the wording of the Abortion Act and grounds “F” and “G”. Which of the
following statements are true?
1
|
“F” & “G” are grounds for TOP in an emergency with only one
doctor needing to sign the legal form necessary for the TOP to take place
|
2
|
“F” & “G” are grounds
for TOP after 24 weeks.
|
3
|
“F” relates to TOP to save the woman’s life
|
4
|
“F” relates to TOP to prevent grave permanent injury her physical
or mental health
|
5
|
“F” & “G” do not exist.
|
Option
list
A
|
1 + 3
|
B
|
1 + 4
|
C
|
2 + 3
|
D
|
2 + 4
|
E
|
5
|
Scenario
23
Lead
in
In
relation to terms such as “substantial risk”, “grave permanent injury” and
“seriously handicapped”, which of the following is true?
Option
list
A
|
The terms were defined by a Parliamentary sub-committee,
examples were given and are included in Appendix 2 (b) to the Act.
|
B
|
The terms were defined by a Parliamentary sub-committee,
examples were given and are included in Appendix 2 (c) to the Act.
|
C
|
The terms were defined by the General Medical Council, examples
were given and the information can be downloaded from the GMC website.
|
D
|
The terms were defined by the RCOG, examples were given and the
information can be downloaded from the RCOG website.
|
E
|
The terms have not been defined.
|
Scenario
24
Lead
in
Which
of the following statement is true about the most common grounds for TOP?
Option
list
1
|
TOP is most commonly done on ground A from Certificate A.
|
2
|
TOP is most commonly done on ground B from Certificate A.
|
3
|
TOP is most commonly done on ground C from Certificate A.
|
4
|
TOP is most commonly done on ground D from Certificate A.
|
5
|
TOP is most commonly done on ground E from Certificate A.
|
6
|
TOP is most commonly done on ground F from Certificate A.
|
7
|
TOP is most commonly done on ground G from Certificate A.
|
8
|
TOP is most commonly done on ground H from Certificate A.
|
Scenario
25
Lead
in
Which
of the following statements is true in relation to the upper gestational limit
for TOP to be legal in the UK.
1
|
Termination of pregnancy is legal to 24 weeks
|
2
|
Termination of pregnancy is legal after 24 weeks if the mother
is at serious risk of death or grave, permanent injury or there is a major
risk of the fetus having a serious anomaly.
|
3
|
Termination of pregnancy is legal after 24 weeks if the mother’s
life is at serious risk or there is a major risk of the fetus having a
serious anomaly, but only if approved by the Department of Health’s “Late
Termination of Pregnancy Assessment Panel”.
|
4
|
Termination of pregnancy is illegal after 24 weeks, but is still
done if the mother’s life is at serious risk or there is a major risk of the
fetus having a serious anomaly and there is a long-standing agreement that
the police and legal authorities will “turn a blind eye”.
|
Option
list
A
|
1 + 2
|
B
|
1 + 3
|
C
|
1 + 4
|
D
|
2 + 4
|
E
|
5
|
Scenario
26
Lead
in
Which
of the following statement are true in relation to TOP after 24 weeks?
Statements
1
|
TOP is illegal after 24 weeks
|
2
|
The mother must agree to feticide pre-TOP
|
3
|
Feticide must be offered
|
4
|
There must be very serious grounds for the TOP
|
5
|
Gender-selection TOP is unacceptable
|
Option
list
A
|
1
|
B
|
1 + 2
|
C
|
2 + 3 + 5
|
D
|
3 + 4
|
E
|
3 + 4 + 5
|
Scenario
27
Lead
in
TOPs done under ground E are those done at any gestation because
of fetal abnormality. The anomalies are coded using ICD10. The HSA4
notification form relating to each TOP should have details of the ICD10 code
for the fetal anomaly.
Which of the following statements is the most accurate in relation
to the percentage of HSA4 forms that contain the required information?
A
|
0- 24%
|
B
|
25- 49%
|
C
|
50- 59%
|
D
|
60- 69%
|
E
|
≥ 70%
|
Scenario
28
Lead
in
TOPs done under ground E are those done at any gestation because
of fetal abnormality. Which, if any, of the following statements are true of
TOPs under ground E in 2015?
A
|
the average of the woman was 34, compared to 21 for
the average for all grounds
|
B
|
congenital malformations were the grounds in >
80% of cases
|
C
|
Down’s syndrome was the most common reason for
ground E TOP
|
D
|
fetal cardiac anomalies were the most common reason
for ground E TOP
|
E
|
fetal nervous system anomalies were the most common
reason for ground E TOP
|
Scenario
29
Lead
in
Which
form relates to certifying that a woman requesting a TOP can have it done
legally?
Option
list
A
|
HSA1
|
B
|
HSA2
|
C
|
HSA3
|
D
|
HSA4
|
E
|
HSA5
|
Scenario
30
Lead
in
Which
form must the practitioner performing the TOP complete to notify the Department
of Health that a TOP has been done?
Option
list
A
|
HSA1
|
B
|
HSA2
|
C
|
HSA3
|
D
|
HSA4
|
E
|
HSA5
|
Scenario
31
Lead
in
A
doctor signing the form giving the grounds for a TOP must have seen the woman.
Option
list
A
|
True
|
B
|
False
|
C
|
Sometimes
|
D
|
Don’t know & don’t care
|
Scenario
32
Lead
in
A
doctor performing a TOP must be one of the doctors who signed the initial form
giving the grounds for the TOP.
Option
list
A
|
True
|
B
|
False
|
C
|
Sometimes
|
D
|
Don’t know & don’t care
|
Scenario
33
Lead
in
What
is the time scale for the return of the form notifying that a TOP has taken
place?
Option
list
A
|
3 working days
|
B
|
5 working days
|
C
|
1 week
|
D
|
2 weeks
|
E
|
1 month
|
Scenario
34
Lead
in.
A woman seeks 1st. trimester TOP on social grounds
which she declines to discuss in detail.
Which of the following statements apply?
Option
List
A
|
TOP can be done under clause A of Certificate A
|
B
|
TOP can be done under clause B of Certificate A
|
C
|
TOP can be done under clause C of Certificate A
|
D
|
TOP can be done under clause D of Certificate A
|
E
|
TOP can be done under clause E of Certificate A
|
F
|
TOP can be done under clause F of Certificate A
|
G
|
TOP can be done under clause G of Certificate A
|
F
|
there is no clause authorising TOP on social grounds
|
Scenario
35
A woman seeks 1st. trimester TOP. She has pulmonary hypertension
and has been advised of the risks of pregnancy by her cardiologist.
Which of the following statements apply?
Use
the Option list for Question 34.
Scenario
36
A woman books at 26 weeks. She has an unplanned pregnancy. She has
pulmonary hypertension and has been advised of the risks of pregnancy by her
cardiologist.
Which of the following statements apply?
Use
the Option list for Question 34.
45. Parvovirus.
Lead-in.
The
following scenarios relate to parvovirus infection
Abbreviations.
PvB19: parvovirus B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option
list.
There is none: make up your own answers!
Scenario
1.
What type of virus is parvovirus?
Scenario
2.
Is
the title B19 something to do with the American B19 bomber, its potentially
devastating bomb load and the comparably devastating consequences of the
parvovirus on human erythroid cell precursors?
Scenario
3.
PVB19
in the UK occurs in mini-epidemics at 3 - 4 year intervals, usually during the
summer months.
Scenario
4.
Which animal acts as the main reservoir for infection?
Scenario
5.
What
percentage of UK adults are immune to parvovirus infection?
Scenario
6.
What names are given to acute infection in the human?
Scenario
7.
What
is the incubation period for parvovirus infection?
Scenario
8
What
is the duration of infectivity for parvovirus infection?
Scenario
9.
What
are the usual symptoms of parvovirus infection in the adult?
Scenario
10.
What
is the incidence of parvovirus infection in pregnancy?
Scenario
11.
How
is recent infection diagnosed?
Scenario
12.
How
long does PvIgM persist and why is this important?
Scenario
13.
What
is the rate of vertical transmission of parvovirus infection?
Scenario
14.
Are
women with parvovirus infection who are asymptomatic less likely to pass the
virus to their fetuses?
Scenario
15.
To
what degree is parvovirus infection teratogenic?
Scenario
16.
What
proportion of pregnancies infected with parvovirus are lost?
Scenario
17.
What
is the timescale for the onset of hydrops?
Scenario
18.
Laboratories
are advised to retain bloods obtained at booking for at least 2 years for
possible future reference. True or false?
Scenario
19.
What
ultrasound features would trigger consideration of cordocentesis?
Scenario
20.
Must
suspected parvovirus infection be notified to the authorities? Yes or No.
Scenario
21.
Possible parvovirus infection does not need to be investigated
after 20 week’s gestation. True or
false?
Scenario
22
If serum is sent to the laboratory from a woman with a rash in
pregnancy for screening for rubella, the laboratory should automatically test
for parvovirus infection too. True or
false?
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