Tutorial 7th. March 2022

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7 March 2022.

7	Role-play. Explain Down syndrome screening to FY1.
8	Role-play. Non-viable early pregnancy
9	Viva. Cochrane
10	EMQ. Cystic fibrosis

 

7.     Role-play. Explain Down syndrome screening to FY1

Candidate’s instructions.

You are the registrar running the labour ward. Things are quiet. A new FY1 sat with a midwife yesterday while she booked a patient in the antenatal clinic. Screening for Down’s syndrome was discussed and the FY1 realised they did not know much about the subject. The consultant has asked you to give them a tutorial on the subject.

8.     Role-play. Non-viable early pregnancy

Candidate’s instructions.

You are the SpR in the ante-natal clinic. The consultant who was in clinic has been asked to assist her consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary. 

One of the midwives asks you to see Jane Brown, who has just had a scan in the early pregnancy unit.  She is primigravid and the gestation is 8 weeks. She has had some bleeding.   

An ultrasound scan = IUP.  CRL = 12 mm.  No fetal heart activity.  No adnexal masses.

9.     Viva. Cochrane

Candidate’s instructions.

This is a viva about the Cochrane Collaboration.

The examiner will ask 10 questions and give one instruction.

The information below will be referred to.

10.   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. Cystic fibrosis and pregnancy

These are open access so are produced here.

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