13 Role-play. Developmental dysplasia of the
hip. 14 Structured conversation. Labour ward
scenario 1. 15 Structured discussion. Breastfeeding. 16 SBA. Pertussis
You are the SpR in the antenatal
clinic. Jenny Brown has been booked in her second pregnancy by the midwife. She
has some questions about congenital dislocation of the hip, which affected her
first child, now 6 years old. The midwife who did the booking does not feel
able to provide adequate answers and has asked you to see the patient.
14. Structured
conversation. Labour ward scenario 1.
Candidate’s instructions.
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 used
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. Cx. 6 cms. |
|
2 |
Mrs AH |
Primigravida at T. In labour. Cx. 5 cms. |
|
3 |
Mrs. BH |
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3. |
|
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. |
|
5 |
Mrs KW |
Para 1. In labour. Cx. 5 cm. Ceph at spines. |
|
6 |
Mrs KT |
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear
liquor. |
|
7 |
Mrs TB |
Para 1. T+4. Clinically big baby. Cx fully dilated for 1
hour. Early decelerations. |
|
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. |
|
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
|
1 |
Mrs JB |
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding. |
|
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.
15. Pertussis.
Question 1.
Why is
pertussis of current concern in obstetrics?
Option List
|
A |
Research
has linked pertussis in the 1st. trimester with an ↑ risk of
congenital heart disease |
|
B |
A mini-epidemic since 2011 has
caused ↑ deaths of mothers & of babies < 3 months |
|
C |
A mini-epidemic since 2011 has
caused ↑ deaths of babies < 3 months |
|
D |
The infecting organism has become
increasingly drug-resistant |
|
E |
The infecting organism has become
increasingly virulent |
Question 2.
Which
organism causes whooping cough?
Option List
|
A |
Bordella pertussis |
|
B |
Bacteroides
pertussis |
|
C |
Rotavirus
whoopoe |
|
D |
Respiratory syncytiovirus
pertussis |
|
E |
None of the
above |
Question 3.
Which, if
any, of the following statements is true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space, there are more than 5 options and there may be more
than one correct answer.
Option List
|
A |
the organism is aerobic |
|
B |
the organism is anaerobic |
|
C |
the organism is capsulated |
|
D |
the organism is flagellate |
|
E |
the
organism is an obligate intra-cellular parasite |
|
F |
the organism is a Gram -ve
diplococcus |
|
G |
the organism is a Gram +ve
diplococcus |
|
H |
the organism requires special
transport media |
|
I |
no one is going to ask me any of
this stuff |
Which of the following statements is true?
Option List
|
A |
Pertussis is no longer a
significant threat to infants |
|
B |
Pertussis remains a significant threat to infants |
|
C |
The risk of death from pertussis is eliminated by timely
antibiotic therapy |
|
D |
the risk of death from pertussis is eliminated by timely
antiviral therapy |
|
E |
None of the above |
Question 5.
Which of the
following statements is true?
Option List
|
A |
Pertussis is not a notifiable disease |
|
B |
Pertussis is a
notifiable disease |
|
C |
Pertussis is
not a notifiable disease, but cases should be reported to the local bacteriologist |
|
D |
Pertussis is
not a notifiable disease, but cases should be subject to audit |
Question 6.
What is the
main mode of spread of the organism that causes pertussis?
Option List
|
A |
contact
with contaminated surfaces |
|
B |
contaminated food |
|
C |
contaminated water |
|
D |
respiratory droplets |
|
E |
none of the above |
Question 7.
What is the
main reservoir of the organism that causes pertussis?
Option List
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of the above |
Question 8.
What is the epidemiology
of pertussis?
Option List
|
A |
the condition is endemic |
|
B |
the condition
is endemic with mini-epidemics every 3-5 years |
|
C |
the condition
is endemic with mini-epidemics most years in the winter months |
|
D |
the condition
is epidemic, with outbreaks at roughly three-year intervals |
|
E |
the condition
is epidemic, with outbreaks at unpredictable intervals |
Question 9.
What is the
incubation period for pertussis?
Option List
|
A |
3-6 days |
|
B |
7-10 days |
|
C |
11-14
days |
|
D |
15-18
days |
|
E |
none
of the above. |
Question 10.
What is the
duration of infectivity of someone with pertussis?
Option List
|
A |
2
days from exposure → 5 days after onset of paroxysms of coughing |
|
B |
3
days from exposure → 10 days after onset of paroxysms of coughing |
|
C |
4
days from exposure → 14 days after onset of paroxysms of coughing |
|
D |
6
days from exposure → 21 days after onset of paroxysms of coughing |
|
E |
none
of the above |
Question 11.
What % of
non-immune, close contacts of pertussis will develop the disease?
Option List
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
What
practical issues are current for obstetrician in relation to pertussis?
Option List
|
A |
The DOH advises that all pregnant women be immunised to
↓maternal death rates. |
|
B |
The DOH advises
that all pregnant women be immunised to ↓ deaths in babies < 3 months. |
|
C |
The DOH advises
that all babies be immunised at birth. |
|
D |
The DOH advised
that “Boostrix- IPV” should
replace “Repevax” from July 2014. |
|
E |
The DOH advises
that immunisation of pregnant women be continued until 2019 |
Question 13.
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routing child immunisation was
introduced?
Option List
|
A |
the
number was 10,000 |
|
B |
the
number was 5,000 |
|
C |
the
number was 4,000 |
|
D |
the
number was 3,500 |
|
E |
the
number was <1,000 |
Question 14.
Which, if
any, of the following statements are true in relation to pertussis vaccine.
Option List
|
A |
“Boostrix- IPV” is a vaccine for pertussis
only |
|
B |
“Repevax”
is a vaccine for pertussis only |
|
C |
“Boostrix- IPV” & “Repevax” are live, attenuated vaccines |
|
D |
“Boostrix- IPV” & “Repevax” act against diphtheria, tetanus and
polio as well as pertussis |
|
E |
“Boostrix- IPV” & “Repevax” are acellular |
Question 15.
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
Option List
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the above |
Question 16.
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 17.
A woman has proven pertussis in early pregnancy. Should she still be
offered vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 18.
A pregnant woman misses out on vaccination as part of the TIPP. Should
vaccination still be offered in the puerperium?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
16. Structured
conversation. Breastfeeding.
Candidate’s instructions.
The
examiner will ask 7 questions about breasfeeding.
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