|
20 |
Role-play. Teach FY1 about complaint
procedures |
|
21 |
Role-play. Anencephaly |
|
22 |
Roleplay. PMB |
|
23 |
EMQ. Family Origin Questionnaire |
|
24 |
EMQ. Tranexamic acid |
20. Role-play. Teach FY1 about complaint
procedures
Candidate’s instructions.
You are a 5th. year SpR. It is a quiet day on
the labour ward. The consultant on duty happens to be responsible for risk
management and has asked you to teach a new O&G trainee about complaints.
21. Role-play. Anencephaly
Candidate’s instructions.
You are an SpR5 and running the ante-natal clinic – your
consultant has been called to help a consultant colleague with an emergency on
the labour unit and is not available for advice.
You are about to see Jean Hathersage. She is 25 years old
and had a 10-week scan last week that showed anencephaly. She stated that she
did not want TOP. She was counselled, given information leaflets and asked to
return to the antenatal clinical today for further discussion.
Your task is to conduct that discussion.
22. Roleplay. PMB
Candidate's Instructions.
You are a 5th. year SpR. You are about to see
Jane Tarzan.
The GP letter reads as
follows.
Tree-top House,
High Street,
Biblioville.
BV996OO.
Re: Jean Tarzan, DOB 17 August 1940,
16 High Rise Flats,
Biblioville.
Dear Doctor,
Mrs Tarzan reports some bleeding down below. She has got
up quite a head of steam about it, but she is a rather excitable type with a
strange husband who seems to spend most of his time communing with animals in
the local woods. Please advise.
John Lacklustre.
23. EMQ. Family Origin Questionnaire
Lead-in.
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. |
24. EMQ. Tranexamic acid
This
topic featured in the exam in 2019 and 2021, probably prompted by WHOT.
Abbreviations.
APA: anti-platelet
agent.
DOAC: direct
oral anticoagulant.
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 |
Scenario 10.
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 |
