|
41 |
Structured conversation. |
|
42 |
EMQ. The MAGPIE trial
|
|
43 |
EMQ. Tranexamic acid |
|
44 |
EMQ. G6PDD & G6PD |
|
45 |
EMQ. Risk management |
41. Structured
conversation. Topic to be announced.
42. EMQ.
The MAGPIE trial.
Question 1.
Which, if any, of the following is
true of the Magpie trial?
Option list.
|
A |
it
compared MgSO4 with placebo in the management of eclampsia /
severe PET |
|
B |
it
compared MgSO4 with lytic cocktail in the management of eclampsia
/ severe PET |
|
C |
it
compared MgSO4 with phenytoin in the management of eclampsia /
severe PET |
|
D |
it
compared MgSO4 with alcohol in the management of threatened
premature labour |
|
E |
it
compared MgSO4 with atosiban in the management of threatened
premature labour |
|
F |
it
compared MgSO4 with ritodrine in the management of threatened
premature labour |
|
G |
it
compared MgSO4 with dexamethasone in the prevention of cerebral
palsy due to extreme prematurity |
|
H |
it
compared MgSO4 with placebo in the prevention of cerebral palsy
due to extreme prematurity |
|
I |
none of
the above |
Question
2. Which
if any of the following are true of the Magpie trial?
Option
list.
|
A |
it involved ~ 1,000 women |
|
B |
it involved ~ 10,000 women |
|
C |
it involved ~ 20,000 women |
|
C |
it involved > 20,000 women |
|
D |
it involved ~ 30 hospitals |
|
E |
it involved ~ 50 hospitals |
|
F |
it involved ~ 80 hospitals |
|
G |
it involved > 150 hospitals |
|
H |
it involved 5 countries |
|
I |
it involved 10 countries |
|
J |
it involved 20 countries |
|
K |
it involved 30 countries |
|
L |
it involved 50 countries |
|
M |
it involved >50 countries |
Question
3. Which
if any of the following are true?
Option
list.
|
A |
almost 50% of the women were in Africa |
|
B |
almost 50% of the women were in America |
|
C |
almost 50% of the women were in Asia |
|
D |
almost 50% of the women were in Australia / New Zealand |
|
E |
almost 50% of the women were in Europe |
Question
4. Which,
if any, of the following is true of the Magpie trial?
Option
list.
|
A |
cerebral palsy rates at 2 years were ↓ by the use of MgSO4
in babies born < 34 weeks |
|
B |
cerebral palsy rates at 2 years were unchanged by the use of MgSO4 in babies
born < 34 week |
|
C |
eclampsia rates were reduced by about half by the use of MgSO4
|
|
D |
eclampsia rates were reduced by about half by the use of MgSO4
but only in underdeveloped countries |
|
E |
maternal mortality was significantly ↓ by the use of MgSO4 |
|
F |
maternal mortality was significantly ↓ by the use of MgSO4,
but only in underdeveloped countries |
|
G |
premature delivery was significantly ↓ by the use of MgSO4 |
|
H |
perinatal mortality from prematurity was significantly ↓ by the
use of MgSO4 |
43. EMQ.
Tranexamic acid.
This
topic featured in the exam in 2019 and 2021, probably prompted by WHOT.
Abbreviations.
EBL: estimated
blood loss.
PPH: postpartum
haemorrhage.
TA: tranexamic
acid.
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?
|
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 |
Scenario 12.
Which, if any, of
the following statements are true of GTG52?
Option list.
|
A |
it is being updated |
|
B |
it advises use of TA for all cases of PPH with no
contraindications |
|
C |
it advises prophylactic use of TA for women at ↑ risk of bleeding prior to C
section |
|
D |
in its present form it puts obstetricians at risk of
being found negligent |
|
E |
none of the above. |
44. EMQ.
G6PDD & G6PD.
Glucose-6-phosphate dehydrogenase deficiency.
Abbreviations.
G6PD: glucose-6-phosphatase
deficiency
G6PDD: glucose-6-phosphate
dehydrogenase deficiency
Scenario 1.
What is G6PDD?
There is no option list.
Scenario 2.
What categories
are applied to G6PDD by the WHO? There is no option list.
Scenario 3.
What other names
are commonly used for G6PDD? There is no option list.
Scenario 4.
Which, if any, of
the following statements are true in relation to G6PDD?
Option list.
|
A |
it is the most common enzyme defect in humans |
|
B |
it is the most common RBC enzyme defect in humans |
|
C |
it is the most common cause of neonatal jaundice |
|
D |
it is the most common cause of sickling crises |
|
E |
is a glycogen storage disorder |
|
F |
most of those with G6PDD have chronic anaemia |
Scenario 5.
Approximately how
many people are affected by G6PDD worldwide?
Option list.
|
A |
1,000 million |
|
B |
800 million |
|
C |
600 million |
|
D |
400 million |
|
E |
100 million |
|
F |
50 million |
|
G |
20 million |
|
H |
10 million |
|
I |
none of the above |
Scenario 6.
Which population
has the highest prevalence of G6PDD?
Option list.
|
A |
American Amish |
|
B |
Asians |
|
C |
Ashkenazi Jews |
|
D |
Eskimos |
|
E |
Irish Travellers |
|
F |
Kurdistan Jews |
|
G |
Sub-Saharan Africans |
|
H |
Turks |
|
I |
Uzbekistan albinos |
|
J |
None of the above |
Scenario
7.
Which, if any, of
the following is the mode of inheritance of G6PDD?
Option list.
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Scenario
8.
Approximately how
many mutations of the G6PDD gene have been identified?
Scenario
9.
Which, if any, of
the following is the mode of inheritance of G6PD?
Option list.
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Scenario 10.
Which foodstuff
can trigger haemolysis in G6PDD and gives us one of the alternative
names for the condition? What
is the common name for the foodstuff? Which pest particularly attacks it? There
is no option list.
Scenario 11.
Which, if any, of
the following drugs may cause haemolysis in those with G6PDD?
Option list.
|
A |
aspirin |
|
B |
diphenhydramine |
|
C |
nalidixic acid |
|
D |
nitrofurantoin |
|
E |
paracetamol |
|
F |
phenytoin |
|
G |
sulphamethoxazole |
|
H |
trimethoprim |
45. EMQ.
Risk management.
Lead-in.
The
following scenarios relate to risk management / disciplinary procedures.
Abbreviations.
BMA: British
Medical Association
DOH: Department of Health.
Option
list.
A.
allow the practice to continue
B.
stop the practice until a full
investigation has been done
C.
stop the practice permanently
D.
arrange an investigation by a
senior consultant from another hospital
E.
decide the practice does not
involve added risk
F.
declare the risk to be acceptable
G.
cancel admissions for surgery
H.
arrange adverse incident analysis
I.
arrange audit
J.
arrange research
K.
arrange a formal warning for the
doctor
L.
arrange retirement for the doctor
M.
arrange dismissal for the doctor
N.
consult the on-call consultant
O.
consult the Clinical Director
P.
consult the Educational Supervisor
/ College Tutor
Q.
consult the Medical Director
R.
consult the Chief Executive
S.
consult the Postgraduate Dean.
T.
consult the hospital’s lawyer
U.
write to Her Majesty at Buckingham
Palace
V.
consult your Medical Defence Body
W.
consult the British Medical
Association
X.
consult the RCOG
Y.
report the matter to the GMC
Z.
allow return to work
AA.
allow return to work, but offer
support
BB.
arrange a “return to work” package
specific to the doctor
CC.
none of the above
Scenario
1. You are the Clinical Director. A 62-year-old
Consultant colleague has been off work for 8 weeks with a broken arm sustained
in a skiing accident. He sends you a certificate from his specialist to say
that he is now fit to return to work. He indicates that he wishes to return to
work immediately. What action will you take?
Scenario
2. You are the Clinical Director. A 62-year-old
Consultant colleague has been off work for 8 weeks with a severe bereavement
reaction to the suicide of a family member. He sends you a certificate from his
GP to say that he is now fit to return to work. He indicates that he wishes to
return to work immediately. What action will you take?
Scenario
3. You are the Clinical Director. A 62-year-old Consultant
colleague has been off work for 6 months after having a coronary thrombosis. He
sends you a certificate from his specialist to say that he is now fit to return
to work. He indicates that he wishes to return to work immediately. What action
will you take?
Scenario
4. You are the Clinical Director. A 62-year-old
Consultant has returned to work after four months’ sick leave after a coronary
thrombosis. He has three cases on his first operating list and all have complications
reported by the Sister on the gynaecology ward. What action will you take?
Scenario
5. A Consultant has been in her first consultant post for
two months. Three of the four patients on a single operating list develop post-operative
wound infections. What action will you take?
Scenario
6. You have recently been appointed Clinical Director. A consultant
has been in post for ten years and prefers to operate with the same nurse
assistant. No complications have been reported. What action will you take?
Scenario
7. You are the Clinical Director. A
consultant has an operating list in a peripheral unit 20 miles from the main
hospital. There is no resident doctor with post-operative care being provided
by nurses. The cases dealt with on the list traditionally were minor and
day-cases. You have been told that the
consultant, who was appointed 6 months ago, has recently been doing
hysterectomies and prolapse repairs to get the waiting list down. What action will you take?
Scenario
8. You are the Clinical Director. The blood bank informs
you that there is a problem with supplies and fully cross-matched blood cannot
be guaranteed for tomorrow’s arranged surgical cases. What action will you
take?
Scenario
9. You are the on-call SpR. It is 8 pm. The blood bank informs
you that there is a problem with supplies and fully cross-matched blood cannot
be guaranteed for tomorrow’s arranged surgical cases. What action will you
take?
Scenario
10. A SpR is half an hour late for starting his duties on
three occasions in one week. His consultant wishes to have this dealt with as a
disciplinary matter to “nip it in the bud” and teach him a lesson. He reports
it to you, the Clinical Director, asking you to discipline the doctor. What
action will you take?
Scenario
11, A SpR gets into an argument with the senior midwife on
the labour ward and in the heat of the moment slaps her across the face. You
are the Clinical Director and the matter is reported to you next day.
Scenario
12, Your consultant is the Clinical Director and a nasty
man. You apply 6 months in advance for study leave for the week before the
written part of the Part Ii MRCOG exam. He tells you that he plans to go on
holiday at that time and you are not going to get any leave. In addition, he
tells you that if you complain about this he will give you a terrible reference
and tell all his consultant friends that you are a waste of space in order to
ruin your career. What action can you take?
Scenario
13, A SpR fails an OSATS, but falsifies his records to
indicate that it has been completed satisfactorily. You are the Educational
Advisor and this is brought to your attention. What action will you take?
Scenario
14. You are the Clinical Director. A SpR2 uploaded
reflective practice putting himself in a good light after a case which had been
handled sub-optimally by him. What action will you take?
Scenario
15. You are an
FY2 and assist the senior consultant at a hysterectomy. The operation goes
well initially, but then there is a lot of bleeding and a ureter is cut. The
consultant urologist attends and repairs the ureter. The woman bleeds vaginally
that evening and is taken back to theatre by another consultant and ends up in
the ICU. You became convinced during the operation that you could smell alcohol
on the consultant gynaecologist’s breath. What are your responsibilities?
Scenario
16. When do you need to inform the Consultant on-call?
Scenario
17. When do you need to inform the Clinical Director?
Scenario
18. When do you need to inform the Medical Director?
Scenario
19. When do you need to inform the GMC?
Scenario
20. What are the roles of the BMA and MDU?
Scenario
21. What are the differences between verbal and written warnings?
Scenario
22. A
SpR1 has been asked to carry out an audit and 50 sets of case-notes are to be
used.
He is
given 49 sets of notes and a day in which to go through them and extract the
necessary data.
This
he does in the hospital. The final set of notes cannot be found initially, but
are found two weeks later. The doctor is given the notes on a Friday afternoon
as he is leaving for home. He decides to take the notes home to extract the
data. On the way home he stops at his favourite supermarket.
When
he emerges, his car has been stolen with the notes inside. He reports the theft
to the police.
He
informs you, the Clinical Director, on the Monday when he returns to work. What
action will you take?
Scenario
23. You are the SpR for the delivery unit. During a quiet moment you
head for the staff room adjacent to the operating theatre for a coffee. As you
pass the anaesthetic room you hear loud snoring. You look in and find the
on-call anaesthetic registrar unconscious on his back on the floor with an
anaesthetic mask by his face attached to a cylinder of nitrous oxide. What
action will you take?
Option
list.
|
A |
call for help |
|
B |
go back to the labour ward and pretend that nothing has happened |
|
C |
go back to the labour ward and inform the senior midwife |
|
D |
phone the GMC |
|
E |
phone the on-call consultant anaesthetist |
|
F |
phone the on-call consultant obstetrician |
|
G |
phone the police |
|
H |
put the anaesthetist in the recovery position and remove the
mask |
|
I |
none of the above |
Scenario
24. This is a follow-on from the
previous station.
What
action will you take next?
Scenario
25. You are the Clinical Director. It is the morning after the events
in scenarios 22 and 23.
The on-call consultant obstetrician comes to see you and reports
what has happened.
What action will you take?
Option
list.
|
A |
discuss the case with the Chief Executive |
|
B |
discuss the case with the Medical Defence Union |
|
C |
discuss the case with the BMA |
|
D |
discuss the case with the Medical Director |
|
E |
discuss the case with the most senior person in the personnel
department |
|
F |
discuss the case with the Postgraduate Dean |
|
G |
report the anaesthetic registrar to the GMC |
|
H |
resign from being Clinical Director to avoid stress |
|
I |
summon the anaesthetic registrar to give him a severe telling-off |
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