1st. August July
2022.
|
37 |
Role-play. VBAC. |
|
38 |
EMQ. APH. |
|
39 |
EMQ. Cervical cancer staging. |
|
40 |
EMQ. Montgomery & consent. |
37. Role-play.
VBAC.
You are a 5th.
year SpR in the antenatal clinic. The midwives have asked you to see Maria
Shufflebottom who has recently moved to the area. She is 36 weeks advanced in
her second pregnancy. Her first baby was delivered by elective Caesarean
section for breech presentation.
The midwives
report that the history and findings are normal apart from the Cs.
38. APH.
Abbreviations.
ART: assisted reproduction technology
FGR: fetal growth restriction
GTG: Green-top
guideline no 63
PET: pre-eclampsia
Option list.
A.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the baby
B.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the placenta.
C.
genital tract bleeding ≥ 500 ml. from 24 weeks
or earlier if the baby is live-born until the delivery of the baby.
D. 1
E.
2
F.
3
G. 4
H. 5
I.
6
J.
7
K.
8
L.
9
M. 10
N. 15
O. 20
P.
30
Q. 50
R.
100
S.
500
T.
1,000
U. true
V.
false
W. none
of the above
Scenario 1. What
is the definition of APH?
Scenario 2. What is
the upper limit in ml. for minor APH
Scenario 3. What is
the upper limit in ml. of major haemorrhage
Scenario 4. What is the % risk of recurrence
after 1 abruption?
Scenario 5. What is the % risk of recurrence
after 2 abruptions?
Scenario 6. What is
the major risk factor for placental abruption.
Scenario 7. List 10
risk factors for placental abruption.
Scenario 8. List 6
risk factors for placenta previa.
Scenario 9. In what
% of pregnancies does APH occur?
Scenario 10. With regards to steps that can be
taken to reduce the incidence of APH, what things would you include in a viva
in the OSCE?
39. Cervical cancer staging.
Option list.
|
A |
Micro-invasive cervical cancer. |
|
B |
Stage IA1 |
|
C |
Stage IA2 |
|
D |
Stage IA3 |
|
E |
Stage IB1 |
|
F |
Stage IB2 |
|
G |
Stage IB3 |
|
H |
Stage IIA |
|
I |
Stage IIB |
|
J |
Stage IIC |
|
K |
Stage IIIa |
|
L |
Stage IIIB |
|
M |
Stage IIIC |
|
N |
Stage IVA |
|
O |
Stage IVB |
|
P |
Stage IVC |
|
Q |
Stage VA |
|
R |
Stage VB |
|
S |
Stage VC |
|
T |
None of the above. |
Scenario 1.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 2 mm and 6 mm in width. The resection margins are tumour-free. There
is no evidence of spread outside the uterus. She is nulliparous and wishes to
retain her fertility.
Scenario 2.
A woman of 25 has a cone biopsy. The histology report
shows squamous cell carcinoma penetrating to a depth of 4 mm and 6 mm in width.
The resection margins are tumour-free. There is no evidence of spread outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 3.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 5 mm and 6 mm in width. The resection margins are not tumour-free.
There is no evidence of spread outside the uterus. She is nulliparous and
wishes to retain her fertility.
Scenario 4.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 3 cm in width. The resection margins are tumour-free. There
is no evidence of extension outside the cervix. She is nulliparous and wishes
to retain her fertility.
Scenario 5.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 5 cm in width. The resection margins are tumour-free. She is
nulliparous and wishes to retain her fertility.
Scenario 6.
A woman of 38 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 4 mm and 6mm in width. The resection margins are tumour-free. An MR
scan shows involvement of the lymphatic nodes in the left of the pelvis.
Scenario 7.
A woman of 45 has carcinoma of
the cervix. It extends into the parametrium, but not to the pelvic sidewall. It
involves the upper 1/3 of the vagina. There is MRI evidence of para-aortic node
involvement.
Scenario 8.
A woman of 55 has carcinoma of
the cervix. It extends to the pelvic sidewall. It involves the upper 1/3 of the
vagina. She has a secondary on the end of her nose.
Scenario 9.
A woman of 55 has carcinoma of
the cervix. It involves the bladder mucosa.
Scenario 10.
A woman of 35 has a proven
cancer of the cervix with extension into the right parametrium, but not to the
pelvic sidewall. Left hydroureter and left non-functioning kidney are noted on
IVP and there is no other explanation for the findings. Cystoscopy shows
bullous oedema of the bladder mucosa.
Scenario 11.
A woman of 25 has a cone
biopsy. It shows malignant melanoma. The lesion, which was not visible to the
naked eye, invades to a depth of 3 mm and is 5 mm in width. The margins of the
biopsy are clear. There is evidence of lymphatic vessel involvement. There is
no evidence of spread outside the uterus.
40. Montgomery & consent.
Abbreviations.
BMA: British
Medical Association.
GMC: General
Medical Council.
Question 1.
Which, if any, of the following statements is most accurate?
Lead-in
|
A |
The
Montgomery ruling largely replaces the Bolam ruling |
|
B |
The Montgomery ruling largely replaces the Chester
ruling |
|
C |
The Montgomery ruling largely replaces the Sidaway
ruling |
|
D |
The Montgomery ruling is being contested in the
European Court by the GMC as it infringes the rights of doctors |
|
E |
The Montgomery ruling is being contested in the
European Court by the BMA as it infringes the rights of doctors |
Question
2.
Which, if any, of the following statements are true?
Lead-in
|
A |
the
level of risk, however small, must be disclosed if a patient requests it |
|
B |
the level of risk of damage from a procedure need not
be disclosed if < 1% |
|
C |
the level of risk of damage from a procedure need not
be disclosed if < 10% |
|
D |
a material risk is one that would be reflected in
damages > £100,000 if negligence were proved in court |
|
E |
a material risk is one that would be reflected in
damages > £1,000,000 if negligence were proved in court |
|
F |
a material risk is one that involves anatomical damage,
not emotional or psychological |
|
G |
a material risk is one that a reasonable person in the
patient’s situation would be likely to regards as significant |
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