Tutorial 3rd. February 2022

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14	Role-play. Menorrhagia. Difficult patient
15	Role-play. Teach an FY1 the basics of audit
16	EMQ. Cystic fibrosis
17	MCQ. Folic acid fortification of flour

 

14.         Role-play. Menorrhagia. Difficult patient.

Candidate’s instructions.

You are an ST5 and are in the gynaecology clinic. A patient has been aggressive towards the reception and nursing staff, insisting that she must see the consultant, not a junior doctor. She shouted at both the receptionist and the nurses, saying: ‘I want to see the organ grinder, not the bloody monkey’.

The consultant says that she has no intention of seeing her and that you need to learn to deal with difficult patients. The GP referral letter has gone missing. Your task is to deal with the patient.

 

15.         Role-play. Teach an FY1 the basics of audit.

Candidate’s instructions.

You are the SpR on call for the labour ward. It is a quiet afternoon. All the patients are healthy and in normal labour. Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination. A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it. Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.

 

16.         EMQ. Cystic fibrosis.

There is no option list to make you behave in a model fashion - you have to decide the correct answer.

Scenario 1. A woman is 8 weeks pregnant and a carrier of CF. Her husband is Caucasian. What is the risk of the child having CF?

Scenario 2. A healthy woman attends for pre-pregnancy counselling. Her brother has CF. Her husband is Caucasian and has a negative CF screen. What is the risk of them having a child with CF?

Scenario 3. A healthy woman is a carrier of CF. She attends for pre-pregnancy counselling. Her husband has CF. 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 CF. What is her risk of being a carrier?

Scenario 5. A woman attends for pre-pregnancy counselling. Her mother has CF.

What is the risk that she is a carrier?

Scenario 6 . A woman attends for pre-pregnancy counselling. Her mother has CF.

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 CF. 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 CF. What is the risk of an affected child?

Scenario 10. A woman and her husband are carriers of CF. What can they do to reduce the risk of having an affected child?

Scenario 11. A woman and her husband are carriers of CF. Can CVS exclude an affected pregnancy?

Scenario 12. A woman has CF, her husband is a carrier. What is their risk of an affected child?

Scenario 13. A woman with CF delivers a 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 CF delivers a 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

 

17.         MCQ. Fortification of flour with folic acid.

MCQ Paper 7. Question 23. Folic acid & pregnancy.

a.  the dosage for routine prophylaxis of neural tube defect is 0.4 mg. daily.

b.  the dosage for prophylaxis for patients with spina bifida or who have had a pregnancy affected by neural tube defect is 5mg. daily.

c.   folic acid reduces the risk of neural tube defect by about 70%.

d.  folic acid and anti-epilepsy drugs may interact adversely.

e.  folic acid reduces the risk of placental abruption.

f.   folic acid can provoke sub-acute combined degeneration of the cord.

g.  fortification of flour with folic acid was introduced in the USA in 1998.

h.  fortification of flour with folic acid in the USA has been linked to a 50% reduction in the incidence of neural tube defects. The overall figure is reckoned to be ~ 20%, but some areas have reported figures as high as 50%

i.   fortification of flour with folic acid was introduced in the UK in 2005.