|
15 |
Role-play. Complaint. Mis-filed combined
Ds test report. |
|
16 |
EMQ. Family Origin Questionnaire |
|
17 |
EMQ. Cystic fibrosis |
|
18 |
EMQ. Tranexamic acid |
15. Role-play.
Mis-filed Ds test report.
Candidate's Instructions.
You are the SpR in the ante-natal clinic. The consultant
has been called to the labour ward to help with a case of placenta accreta and
you have been put in charge of the clinic.
Mrs Jones had a “combined test” at 11 weeks which gave a
risk of Down’s syndrome of 1: 40. The report was filed in the notes in error by
a clerk without being shown to any of the medical or midwifery staff.
She attended today for the routine 20-week scan. The ultrasonographer
found the report in the notes, realised that no action had been taken, informed
the patient and made arrangements for her to see you urgently.
16. EMQ.
Family Origin Questionnaire.
Tarek informs me that there was an EMQ on this in the Part 2. It
could easily be included in a Part 3 station. It will be familiar to those
who work in the UK, but maybe not in detail as it is probably usually completed
by midwives. It won’t be known to those who have not worked in the
UK. You can download it from UKGOV website. It is only two
pages and very easy to understand if you spend ten minutes or so scrutinising
it. Do it – questions will then be easy!
Abbreviations.
αTM: α-thalassaemia major, aka αo
thalassaemia and HbBarts hydrops fetalis syndrome.
βTM: β-thalassaemia major, aka βo thalassaemia.
CE: capillary
electrophoresis
FBC: full blood count.
FOQ: UK Government’s Family Origin Questionnaire.
Hb: haemoglobin.
HbBH: HbBarts hydrops fetalis syndrome.
HPLC: high-performance liquid
chromatography.
MCH: mean cell Hb.
NHSSTS: NHS screening for Sickle Cell and
Thalassaemia in pregnancy.
NHSSTH: NHS Sickle Cell and Thalassaemia
Programme’s: Antenatal_Laboratory_Handbook.
NHSSCTPIF: NHS Antenatal screening for Sickle Cell and
Thalassaemia Patient
information.
NHS321: NHS update
SCD: sickle cell disease.
SCT: sickle cell trait.
SCTP: NHS’s
list of prevalence of SCD and thalassaemia by NHS Trust.
UKTS: UK Thalassaemia Society.
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 |
|
B |
to
identify those who are not entitled to free NHS care |
|
C |
to monitor
the degree to which different ethnic groups use the NHS |
|
D |
to screen for sickle
cell disease |
|
E |
to screen
for α-thalassaemia |
|
F |
none of
the above. |
Question 2.
What is a low-risk area?
Option list. An area in which the prevalence
of booking bloods +ve for sickle cell or thalassaemia is less than:
|
A |
1% |
|
B |
2% |
|
C |
5% |
|
D |
7.5% |
|
E |
10% |
Question 3.
What is a high-risk area?
Option list. There is none.
Question 4.
What screening is offered in low-risk
areas?
Option list.
|
A |
none |
|
B |
FOQ |
|
C |
maternal testing |
|
D |
maternal + paternal testing |
|
E |
none of the above |
Question 5.
What screening is offered in high-risk
areas?
Option list.
|
A |
none |
|
B |
FOQ |
|
C |
maternal testing |
|
D |
maternal + paternal testing |
|
E |
none of the above |
Question 6.
What are listed by the NHS as ‘essential elements’
of the FOQ?
Option list. There is none to challenge your
brain. But you should be able to work out what they are if you go back to
basics.
Question 7.
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.
|
A |
the
pregnant woman |
|
B |
the
woman’s partner/husband |
|
C |
the
biological father of the pregnancy |
|
D |
the
postman in case he delivered more than the mail |
|
E |
the queen |
|
F |
the woman’s
mother |
|
G |
the
woman’s father |
|
H |
the
woman’s siblings |
|
I |
none of
the above |
Question 8.
Which generations should be included?
Option list.
|
A |
the current
generation |
|
B |
the
current generation + the previous generation |
|
C |
the
current generation + 2 previous generations |
|
D |
the
current generation + 3 previous generations |
|
E |
the
current generation + as many previous generations as possible |
|
F |
none of
the above |
Question 9.
Who should complete the FOQ? This
is an EMQ with only one correct answer.
Option list.
|
A |
the woman |
|
B |
the
woman’s husband / partner |
|
C |
the
biological father of the pregnancy |
|
D |
the
midwife |
|
E |
the
obstetrician |
|
F |
an interpreter
if the woman & partner are not fluent in English |
|
G |
none of
the above |
Question 10.
What other responsibilities does the
person completing the FOQ have? There is no option list so as not to
make it too easy.
Question 11.
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 |
|
B |
those that
suggest a possible ↑ risk of neonatal jaundice |
|
C |
those
that suggest a possible ↑ risk of HepB |
|
D |
those that
suggest a possible ↑ risk of SCD. SCT or
thalassaemia |
|
E |
those
showing areas with a ↑ risk of having SCD. SCT or
thalassaemia |
|
F |
none of
the above |
Question 12.
What is the significance of the red
‘hash’ mark # that appears alongside some of
the boxes? There is only one correct answer.
Option list.
|
A |
the box
that must be completed |
|
B |
just
decoration to make the form more pleasing to the eye |
|
C |
denotes area
with ↑ risk of bilharzia |
|
D |
denotes area
with ↑ risk of falciparum malaria |
|
E |
denotes area
with ↑ risk of α-thalassaemia |
|
F |
denotes area
with ↑ risk of β-thalassaemia |
|
G |
none of
the above |
Question 13.
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 |
|
D |
the woman
should be screened using Hb and red cell indices |
|
E |
the woman
should be screened using electrophoresis |
|
F |
none of
the above |
Question 14.
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 |
|
D |
the woman
should be screened using Hb and red cell indices |
|
E |
the woman
should be screened using electrophoresis |
|
F |
none of the
above |
Question 15.
A woman books at 10 weeks gestation in
a low-risk area. She does not wish to complete the FOQ. Which, if any, of the
following are recommended.
Option list.
|
A |
accept her wishes if you feel
she is fully informed |
|
B |
give her a good slapping for
being stupid |
|
C |
offer blood tests to screen for
sickle and haemoglobinopathy |
|
D |
refer her to a psychiatrist |
|
E |
tell her to have a serious
think about the potential benefits |
|
F |
none of the above. |
17. EMQ.
Cystic fibrosis.
For
each scenario choose the option that gives the best answer.
And, to make you behave in a
model fashion, there is no option list, so you have to decide the correct
answer.
Scenario 1.
A woman is 8
weeks pregnant and known to be a carrier of cystic fibrosis. Her husband is
Caucasian.
What is the risk
of the child having cystic fibrosis?
Scenario 2.
A healthy woman
attends for pre-pregnancy counselling. Her brother has cystic fibrosis. Her
husband is Caucasian. He has been screened for cystic fibrosis. The test was
negative.
What is the risk
of them having a child with cystic fibrosis?
Scenario 3.
A healthy woman
is a carrier of cystic fibrosis. She attends for pre-pregnancy counselling. Her
husband has cystic fibrosis. What is the risk of them having a child with CF?
Scenario 4.
A
healthy woman attends for pre-pregnancy counselling. Her sister has had a child
with cystic fibrosis. What is her risk of being a carrier?
Scenario 5.
A woman attends
for pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk
that she is a carrier?
Scenario 6 .
A woman attends
for pre-pregnancy counselling. Her mother has cystic fibrosis. The partner’s
risk of being a carrier is 1 in X. What is the risk that she will have a child
with CF?
Scenario 7.
A healthy
Caucasian woman is 10 weeks pregnant. Her husband is a carrier of cystic
fibrosis.
Which test would
you arrange?
Scenario 8.
A woman attends
for pre-pregnancy counselling. She has read about diagnosing CF using cffDNA
from maternal blood. Is it possible to test for CF in this way?
Scenario 9.
A woman and her
husband are carriers of cystic fibrosis. What is the risk of an affected child?
Scenario 10.
A woman and her
husband are carriers of cystic fibrosis.
What can they do
to reduce the risk of having an affected child?
Scenario 11.
A woman and her
husband are carriers of cystic fibrosis. Can CVS exclude an affected pregnancy?
Scenario 12.
A woman with
cystic fibrosis is planning pregnancy. Her husband is a carrier of cystic fibrosis. What is the risk
of having an affected child?
Scenario 13.
A woman with
cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She
has been advised not to breastfeed because her breast milk will be
protein-deficient due to malabsorption.
Is this advice correct?
Scenario 14.
A woman with
cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has
been advised not to breastfeed because her breast milk will contain abnormally
low levels of sodium.
Is this advice
correct?
TOG
CPD. 2009. 11. 1. These are open access so are produced here.
Cystic fibrosis and pregnancy
Regarding cystic fibrosis,
1. here are approximately 8000 people living with
this disease in the UK. True / False
2. the main cause of death is liver disease. True / False
Women with cystic fibrosis
3. have an approximately 50% reduced
fertility. True / False
4. have a life expectancy of approximately 50
years. True / False
With regard to pregnancy in women with cystic fibrosis,
5. their babies usually have an appropriate
birthweight for their gestational age. True / False
6. approximately 70% of babies are born
prematurely. True / False
7. the risk of developing gestational diabetes
is higher than in the general population. True / False
8. the risk of miscarriage is higher than in
the general population. True / False
9. the risk of congenital malformations is
similar to that in women who are carriers. True / False
Women with cystic fibrosis who become pregnant,
10. have a shortened life expectancy compared with
women who do not. True / False
If a woman with cystic fibrosis becomes pregnant, the risk
of the baby being born with cystic fibrosis
11. is 50% if the father carries one of the
common gene mutations for cystic fibrosis. True / False
12. is < 1 in 250 if the father does not carry
any of the common CF mutations. True / False
During pregnancy, a woman with cystic fibrosis
13. should be cared for by a multidisciplinary
team, including a physician and an obstetrician with a special interest in CF
in pregnancy. True / False
14. should have a GTT if she did not have CF-related
diabetes prior to pregnancy. True / False
In pregnant women with cystic fibrosis,
15. the instrumental delivery rate is
approximately 40%. True / False
16. the use of epidural analgesia during delivery
is contraindicated. True / False
17. the risk of poor pregnancy outcome increases
if the FEV1 is < 70%. True / False
Post- delivery in women with cystic fibrosis
18. breastfeeding is contraindicated because of
the high sodium content of breast milk. True / False
Which of the following statements about cystic fibrosis are correct?
19. Menarche in girls with CF occurs at the same
time as in unaffected girls. True / False
20. Fertility in women with CF is affected to the
same extent as it is in men with CF. True / False
18. EMQ.
Tranexamic acid.
This
topic featured in the exam in 2019. probably prompted by WHOT. Could also be
part of a viva station.
Abbreviations.
APA: anti-platelet
agent.
DOAC: direct
oral anticoagulants.
EBL: estimated
blood loss.
NOAC: novel
oral anticoagulant.
PPH: postpartum
haemorrhage.
TA: tranexamic
acid.
2oxc: 2-oxoclopiodogrel.
WHOT: WHO’s
“Updated
WHO Recommendation on TA for the Treatment of PPH”. 2017.
Scenario 1.
Which, if any, of the following
describe the main mode of action of tranexamic acid? This is not a true EMQ as there
may be more than one correct answer.
Option list.
|
A |
inhibition of conversion of plasminogen to plasmin |
|
B |
inhibition of fibrinolysis |
|
C |
inhibition of factor Xa |
|
D |
inhibition of heparin activity |
|
E |
inhibition of plasmin activity |
|
F |
promotion of conversion of fibrinogen to fibrin |
|
G |
promotion of conversion of prothrombin to thrombin |
|
H |
promotion of platelet activation |
|
I |
promotion of platelet production |
Scenario 2.
Which, if any, of the following
statements are true?
Option list.
|
A |
GOH say that TA should be considered when an apixaban
antagonist is required |
|
B |
GOH say that TA should be considered when a clopidogrel
antagonist is required |
|
C |
GOH say that TA should be considered when a factor Xa agonist
is required |
|
D |
GOH say that TA should be considered when a factor Xa
antagonist is required |
|
E |
GOH say that TA should be considered when a heparin antagonist is required |
|
F |
GOH say that TA should be considered when Protein C is
deficient |
|
G |
GOH say that TA should be considered when Protein S is
deficient |
|
H |
none of the above |
Scenario 3.
Which, if any, of the following
statements are true in relation to TA? This is not a true EMQ as there may be
more than one correct answer.
Option list.
|
A |
TA is teratogenic in rats and should be avoided in the
first trimester |
|
B |
TA has not been shown to be teratogenic and is safe to
use in pregnancy |
|
C |
TA is excreted is contraindicated in breastfeeding as
the levels equate to maternal levels |
|
D |
TA levels in breast milk are one hundredth of maternal
levels |
|
E |
none of the above. |
Scenario 4.
Which, if any, of the following
statements are listed by eMC as contraindications?
Option list.
|
A |
asthma |
|
B |
barbiturate use |
|
C |
consumption coagulopathy |
|
D |
convulsions |
|
E |
severe renal impairment |
Scenario 5.
Which, if any, of the following
is included in the definition of PPH in WHOT?
Option list.
|
A |
EBL ≥ 500 mL after vaginal birth or
C section |
|
B |
EBL ≥ 1,00 mL after vaginal birth
or C section |
|
C |
EBL ≥ 500 mL after vaginal birth or
≥ 1,00 mL C section |
|
D |
EBL ≥ 1,000 mL after vaginal birth
or ≥ 500 mL C section |
|
E |
none of the above |
Scenario 6.
What other category of patient
is included in the WHOT definition of PPP?
Option list. There is none, to make you think.
Scenario 7.
Which of the following are
included in the WHOT recommendations?
Option list.
|
A |
TA to be given to all women with a history of PPH |
|
B |
TA to be given to all women in established labour |
|
C |
TA to be given to all having C section |
|
D |
TA to be given to all women having episiotomy |
|
E |
TA to be given to all women having instrumental delivery |
|
F |
none of the above |
Scenario 8.
Which, if any, of the following
are included in WHOT?
Option list.
|
A |
TA should be given within 3 hours of the birth |
|
B |
TA should be given within 6 hours of the birth |
|
C |
TA should be given IV as a bolus of 10g |
|
D |
TA should be given IV at a dose of 1g in 10mL over 5
minutes |
|
E |
TA should be given IV at a dose of 1g in 10mL over 10
minutes |
|
F |
TA should be given IV at a dose of 5g in 20mL over 5
minutes |
|
G |
TA should be given IV at a dose of 5g in 20mL over 10
minutes |
Scenario 9.
Which, if any, of the following
statements is included WHOT?
Option list.
|
A |
the benefit from TA declines by about 10% for every 5 minutes
of delay in starting Rx |
|
B |
the benefit from TA declines by about 10% for every 10 minutes
of delay in starting Rx |
|
C |
the benefit from TA declines by about 10% for every 15 minutes
of delay in starting Rx |
|
D |
the benefit from TA declines by about 10% for every 20 minutes
of delay in starting Rx |
|
E |
the benefit from TA declines by about 10% for every 25 minutes
of delay in starting Rx |
|
F |
the benefit from TA declines by about 10% for every 30 minutes
of delay in starting Rx |
|
G |
none of the above |
Which, if any, of the following statements are included in WHOT?
Option list.
|
A |
TA is
relatively cheap |
|
B |
TA has a shelf
life of 5 years |
|
C |
TA can be
stored safely at room temperature |
|
D |
TA is widely
available in most countries |
|
E |
none of the
above. |
Scenario 11.
Which, if any, of the following
statements are true of the differences between the updated version of WHOT in
2017 and the 2012 version?
Option list.
|
A |
TA to be used from the start of treatment of PPH |
|
B |
TA to be used only for cases with suspected or proven
genital tract trauma |
|
C |
TA to be used as early as possible |
|
D |
TA not to be used > 5 hours after the birth |
|
E |
clearer instructions were given about the rate of
administration |
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