Website
28
|
EMQ. Galactosaemia.
|
29
|
Role-play. Woman attends for pre-pregnancy
counselling as she plans her 1st. pregnancy. Her sister recently had a baby
with Down’s syndrome.
|
30
|
EMQ. Education.
|
31
|
EMQ. Headache.
|
28. EMQ. Galactosaemia.
Abbreviations.
GA: galactose
GAA: galactosaemia
Scenario 1.
What is galactosemia? There is
no option list.
Scenario 2.
What is the mode of inheritance?
There is no option list.
Scenario 3.
Which of the following is the
most common cause of galactosemia in Caucasians?
Option list.
A
|
mutation of the GALE gene
|
B
|
mutation of the GALF gene
|
C
|
mutation of the GALK gene
|
D
|
mutation of the GALk1 gene
|
E
|
mutation of the GALT gene
|
Scenario 4.
What is the mutation which
causes Classical Galactosaemia?
Option list.
A
|
Q188L
|
B
|
Q188M
|
C
|
Q188R
|
D
|
R188L
|
E
|
R188M
|
F
|
R188R
|
G
|
None of the above
|
Scenario 5.
What is the Duarte mutation?
There is no option list.
Scenario 6.
What are the main sources of
galactose? There is no option list.
Scenario 7.
What is the approximate prevalence
of galactosemia? There is no option list.
Scenario 8.
Which of the following groups
has the highest prevalence of galactosaemia?
Option list.
A
|
Armenians
|
B
|
Ashkenazi Jews
|
C
|
French absinthe drinkers
|
D
|
Irish campers
|
E
|
Irish travellers
|
F
|
Masai
|
G
|
Scottish campers
|
H
|
None of the above
|
Scenario 9.
Which is the most common mutation
in the group with the highest incidence of galactosemia? There is no option
list.
Scenario 10.
Which, if any, of the following
are linked to untreated GAA in the newborn?
Option list.
A
|
risk of coagulation problems
|
B
|
risk of congenital hypothyroidism
|
C
|
risk of diabetes
|
D
|
risk of diarrhoea
|
E
|
risk of failure to thrive
|
F
|
risk of liver failure
|
G
|
risk of renal failure
|
H
|
risk of staphylococcal infection
|
Scenario 11.
What are the main problems
associated with non-treatment of galactosaemia in adults? There is no option
list.
Scenario 12.
Which, if any, of the following
statements are true in relation to the effects of a galactose-reduced diet
(GRD) on long-term complications (LTCs)?
Option list.
A
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth
|
B
|
a GRD has a major protective effect on LTCs, but only
if started within 12 weeks of birth
|
C
|
a GRD has a major protective effect on LTCs, but only
if followed meticulously
|
D
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth and continued for life
|
E
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth and continued for life
|
F
|
none of the above
|
Scenario 13.
Is screening for galactosaemia
included in the UK neonatal screening programme? If not, why not?
29. Role-play. Woman attends for
pre-pregnancy counselling as she plans her 1st. pregnancy.
Her sister recently had a baby
with Down’s syndrome.
Candidate’s instructions.
You are the SpR in the gynaecology clinic. You have been asked to see
Jenny Williams, who has come for pre-pregnancy counselling.
Letter from the General Practitioner.
5 High Street,
Deersworthy,
Kent.
DO9 1JY.
Re Mrs. J. Williams,
Manor Place,
Deersworthy.
Dear Dr.,
Please see this woman who is planning pregnancy. I understand that her
sister has had a baby with Down’s syndrome.
Regards, Dr. Jolly.
30. 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.
31. EMQ. Headache.
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 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 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 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 Caesarean 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.
Questions from TOG article by
Revell & Moorish. 2014. This is open access.
Headaches in pregnancy
Red flag features for headaches include:
1. headache that changes with posture True / False
2. associated vomiting True / False
3. occipital location True / False
4. associated visual disturbance. True / False
Migraine is classically,
5. bilateral. True / False
6. pulsating. True / False
7. aggravated by physical exercise. True / False
With regard to migraine headaches in pregnancy,
8. there is an increase in the frequency of
attacks without aura. True / False
9. women who suffer from this have not been
shown to have an increase in the risk of pre-eclampsia. True / False
10. the 5HT1-receptor sumatriptan has been shown
to be teratogenic. True
/ False
11. women presenting with an aura for the first
time are not at an increased risk of intracranial disease. True / False Posterior
reversible encephalopathy syndrome,
12. is associated with an impairment of the
autoregulatory mechanism which maintains constant cerebral blood flow where
there are blood pressure fluctuations. True / False
13. when it is associated with pre-eclampsia,
management should follow the pathway for managing severe pre-eclampsia. True / False
With regard to cerebral venous thrombosis,
14. the incidence in western countries in
pregnancy ranges from 1 in 2500 deliveries to 1 in 10 000 deliveries. True / False
15. the greatest risk in pregnancy is mainly in
the last four weeks. True / False
16. the most common site is the sagittal sinus. True / False
17. a plain computed tomography is a highly sensitive
investigation. True /
False
18. T2-weighted magnetic resonance imaging has
been shown to have limited value in diagnosis. True / False
19. the outcome is better when it is associated
with pregnancy and the puerperium compared to that occurring outside pregnancy.
True / False
20. when it occurs in pregnancy, it is a
contraindication for future pregnancies. True / False
No comments:
Post a Comment