Monday, 22 October 2018

Tutorial 22 October 2018



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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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