Website
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67 |
Role-play. Farmer’s wife at booking. |
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68 |
Structured discussion. Enhanced
recovery. |
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69 |
Structured discussion. Labour ward
prioritisation. |
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70 |
EMQ. Family origin questionnaire |
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71 |
SBA. Kisspeptin. |
Candidate’s instructions.
You are an SpR5 and are
running the antenatal clinic – your consultant is absent due to illness. You
are about to see Mary Hapsburg. She has been booked by an experienced midwife
who has done the relevant investigations and given all the routine booking
advice about healthy life-style, Down’s syndrome screening, etc. All that is
left is the advice about farming which she was not comfortable about advising
on – she has asked you to see Mary to do this.
The GP letter reads:
“Please see Mary Hapsburg who is 28 years old. This is her first pregnancy and
the gestation will be 10 weeks, calculated from her LMP, by the time of the
appointment. She is healthy and rubella-immune. She and her husband are farmers
and she wishes to know the implications
for her and her pregnancy. I don’t know much about this and leave it to you to
provide expert advice”.
Your
task is to take a history and advise her in relation to pregnancy and farming.
Candidate's instructions.
69. Structured discussion. Labour ward prioritisation.
You are the registrar on
duty and responsible for the labour and gynae wards. You have just had the
handover. Your task is to discuss the overall management of the wards with the
examiner, to prioritise the patients and decide the allocation of staff to care
for them.
This station was written
for the first tutorial I ran for the OSCE exam when it was introduced more than
20 years ago. There are a number of phrases and concepts that reveal this
distant origin, but I have retained them for nostalgic reasons. I ran the
tutorial on a Sunday afternoon when I was on-call and using what was happening
on the labour and gynae wards that day.
Labour Ward.
Sunday 13.00 hours.
|
1 |
Mrs JH |
Primigravida. T+8.
In labour. 6 cms. |
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2 |
Mrs AH |
Primigravida at T. In
labour. 5 cms. |
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3 |
Mrs. BH |
Para 2. 30 days post
delivery. 2ry. PPH > 1,000 ml. Hb. 9.3. |
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4 |
Mrs SB |
Primigravida. 32/52
gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding.
Nephrostomy tube in situ - not draining since this morning. Low placenta on
20 week scan. |
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5 |
Mrs KW |
Para 1. In labour. Cx.
5 cm. Ceph at spines. |
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6 |
Mrs KT |
Para 0+1. 38
weeks. SROM. Ceph 2 cm. above spines. Clear liquor. |
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7 |
Mrs TB |
Para 1. T+4.
Clinically big baby. Cx fully dilated for 1 hour. Early decelerations. |
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8 |
Mrs RJ |
Primigravida. Epidural.
RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position.
Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours. |
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9 |
Mrs KC |
Transfer from ICU. 13
days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and
fever. Infected endometriotic cyst removed. IV antibiotics changed to oral. |
Gynaecology
ward.
8 major post-operative
cases who have been seen on the morning ward round and are stable. The husband
of a patient who had Wertheim
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1 |
Mrs JB |
10 week incomplete
miscarriage. Hb. 10.8. Moderate fresh bleeding. |
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2 |
Ms AS |
19 years old.
Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular
5 cm. ovarian cyst. |
Medical staff:
Consultant at home.
Registrar - you.
Senior House Officer with
12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist
on call at home.
Midwifery
staff:
Senior Sister. Trained to take theatre cases. Able to site
IV infusions and suture episiotomies and tears.
3 staff midwives. 1
trained to take theatre cases. Two able to site IV infusions.
1 Community midwife
looking after Mrs. KW.
2 Pupil Midwives.
70. EMQ. Family origin questionnaire.
Question 1.
What is the
main purpose of the Family Origin Questionnaire? This is an EMQ with only one
correct answer.
Option
list.
|
A |
to identify illegal immigrants |
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B |
to identify those who are not entitled to free NHS care |
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C |
to monitor the degree to which different ethnic groups use the NHS |
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D |
to screen for sickle cell disease |
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E |
to screen for α-thalassaemia |
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F |
none of the above. |
Question 2.
Whose ancestry is asked
about in the FOQ? This is not a true EMQ as there may be more than one correct
answer.
Option
list.
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A |
the pregnant woman |
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B |
the woman’s partner/husband |
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C |
the biological father of the pregnancy |
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D |
the postman in case he delivered more than the mail |
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E |
the queen |
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F |
the woman’s mother |
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G |
the woman’s father |
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H |
the woman’s siblings |
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I |
none of the above |
Question 3.
Which generations should be included? This is an EMQ with only one correct
answer.
Option
list.
|
A |
the current generation |
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B |
the current generation + the previous generation |
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C |
the current generation + 2 previous generations |
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D |
the current generation + 3 previous generations |
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E |
the current generation + as many previous generations as possible |
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F |
none of the above |
Question 4.
Who should complete the FOQ? This is an EMQ with only one correct answer.
Option
list.
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A |
the woman |
|
B |
the woman’s husband / partner |
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C |
the biological father of the pregnancy |
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D |
the midwife |
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E |
the obstetrician |
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F |
an interpreter if the woman & partner are not fluent in English |
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G |
none of the above |
Question 5.
What other responsibilities does the person completing the FOQ have?
There is no option list so as not to make it too easy.
Question 6.
Which tick boxes are highlighted in yellow on the FAQ. This is an EMQ
with one correct answer.
Option
list.
|
A |
those that must be completed |
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B |
those that suggest a possible ↑ risk of
neonatal jaundice |
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C |
those that suggest a possible ↑ risk of HepB |
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D |
those that suggest a possible ↑ risk of SCD.
SCT or thalassaemia |
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E |
those showing areas with a ↑ risk of
having SCD. SCT or thalassaemia |
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F |
none of the above |
Question 7.
What is the significance of the red ‘hash’ mark # that appears alongside some of the
boxes. There is only one correct answer.
Option
list.
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A |
the box that must be completed |
|
B |
just decoration to make the form more pleasing to the eye |
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C |
denotes area with ↑ risk of
bilharzia |
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D |
denotes area with ↑ risk of
falciparum malaria |
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E |
denotes area with ↑ risk of α-thalassaemia |
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F |
denotes area with ↑ risk of β-thalassaemia |
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G |
none of the above |
Question 8.
A woman books at 10 weeks in her 1st. pregnancy. Her husband
in Turkish and healthy. What screening for sickle cell and thalassaemia should
be offered?
Option
list.
|
A |
screening depends on whether the area is high or low risk |
|
B |
screening depends on whether the FOQ shows high or low risk |
|
C |
the husband should first be screened |
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D |
the woman should be screened using Hb and red cell indices |
|
E |
the woman should be screened using electrophoresis |
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F |
none of the above |
Question 9.
A woman books at 10 weeks in her 1st. pregnancy. Her husband
is English and healthy. What screening for sickle cell and thalassaemia should
be offered?
Option
list.
|
A |
screening depends on whether the area is high or low risk |
|
B |
screening depends on whether the FOQ shows high or low risk |
|
C |
the husband should first be screened |
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D |
the woman should be screened using Hb and red cell indices |
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E |
the woman should be screened using electrophoresis |
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F |
none of the above |
71. SBA. Kisspeptin.
Lead in.
Pick the best answer from
the list below about kisspeptin.
Option list.
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A |
is a pheromone released
by the salivary glands during passionate embraces |
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B |
is a digestive enzyme
released by the salivary glands during passionate embraces |
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C |
is a digestive enzyme
found in human carnivores but not vegetarians |
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D |
is thought necessary for
trophoblastic invasion and low levels have been linked to miscarriage,
recurrent miscarriage and ↑ risk of PET |
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E |
is named after “Kiss me
quick” chocolate |
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F |
does not exist and this
question is a very poor joke by someone who should know better |
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