5 August 2024.
Role-players:
|
17 |
Role-play. Candidate’s instructions will
be emailed minutes before the tutorial |
|
18 |
Structured conversation. Labour ward
scenario 1 |
|
19 |
EMQ. Cystic fibrosis |
|
20 |
EMQ. Arrive trial |
17.
Role-play.
18. Labour Ward Scenario 1.
You are the registrar on duty and responsible for the labour and gynae
wards. You have just had the handover. Your task is to discuss the overall
management of the wards with the examiner, to prioritise the patients and
decide the allocation of staff to care for them.
This station was written for the first tutorial I ran for the OSCE
exam when it was introduced more than 20 years ago. There are phrases and
concepts that reveal this distant origin, but I have retained them for
nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call
and used what was happening on the labour and gynae wards that day. You won’t
be asked about gynae patients in a labour ward station!
Labour Ward. Sunday 13.00 hours.
|
1 |
Mrs JH |
Primigravida. T+8. In labour. 6 cms.
|
|
2 |
Mrs AH |
Primigravida at T. In labour. 5 cms. |
|
3 |
Mrs. BH |
Para 2. 30 days post-delivery. 2ry. PPH >
1,000 ml. Hb. 9.3. |
|
4 |
Mrs SB |
Primigravida. 32/52 gestation. Admitted 30
minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ -
not draining since this morning. Low placenta on 20 week scan. |
|
5 |
Mrs KW |
Para 1. In labour. Cx. 5 cm. Ceph at spines. |
|
6 |
Mrs KT |
Para 0+1. 38 weeks. SROM. Ceph 2 cm.
above spines. Clear liquor. |
|
7 |
Mrs TB |
Para 1. T+4. Clinically big baby. Cx
fully dilated for 1 hour. Early decelerations. |
|
8 |
Mrs RJ |
Primigravida. Epidural. RIF pain. Cx fully
dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++.
BP /105. ++ protein. Urine output 50 ml in past 4 hours. |
|
9 |
Mrs KC |
Transfer from ICU. 13 days after delivery of 32
week twins. Laparotomy on day 7 for pelvic pain and fever. Infected
endometriotic cyst removed. IV antibiotics changed to oral. |
Gynaecology ward.
8 major post-operative cases who have been seen on the morning ward
round and are stable. The husband of a patient who had Wertheim
|
1 |
Mrs JB |
10 week incomplete miscarriage. Hb. 10.8.
Moderate fresh bleeding. |
|
2 |
Ms AS |
19 years old. Nulliparous. Just admitted with
left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst. |
Medical staff:
Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.
Midwifery staff:
Senior Sister. Trained to
take theatre cases. Able to site IV infusions and suture episiotomies and
tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV
infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.
19. Cystic fibrosis. EMQ. Questions.
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. there
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
20.
ARRIVE
Trial. EMQ.
Abbreviations.
EBL: estimated blood loss.
IOL: induction of labour.
Question 1.
What does the acronym ‘ARRIVE’ mean?
Option
list.
|
A |
a randomised
review of intravenous ergometrine for the prevention of PPH |
|
B |
a randomised
review of IVF efficacy |
|
C |
a retrospective
review of IVF efficacy |
|
D |
a randomised
review of IOL at term versus expectant management of high-risk pregnancy |
|
E |
a randomised
review of IOL at 39 weeks versus expectant management of high-risk pregnancy |
|
F |
a randomised
trial of IOL at term versus expectant management of low-risk pregnancy |
|
G |
a randomised
trial of IOL at 39 weeks versus expectant management of low-risk pregnancy |
|
H |
none of the
above |
Question 2.
What was the primary outcome of the trial?
|
A |
C section and
instrumental delivery rates versus the spontaneous delivery rate |
|
B |
cost-effectiveness
of IVF |
|
C |
composite
outcome of perinatal death or severe neonatal complications |
|
D |
estimated blood
loss using low-dose ergometrine versus oxytocin for the 3rd. stage |
|
E |
frequency and
severity of perineal trauma |
|
F |
length of
labour |
|
G |
maternal
satisfaction |
|
H |
urinary
incontinence severity score at 3 months postpartum |
|
I |
none of the
above |
Question 3.
Which, if any, of the following were the important conclusions of
the trial?
|
A |
C section and
instrumental delivery rates were significantly ↓ with IOL at 39/52 |
|
B |
C section rate
but not instrumental delivery rate was significantly ↓with IOL at 39/52 |
|
C |
instrumental
delivery rate but not C section rate was significantly ↓ with IOL at 39/52 |
|
D |
C section and
instrumental delivery rates were significantly ↑ with IOL at 39/52 |
|
E |
C section rate
but not instrumental delivery rate was significantly ↑ with IOL at 39/52 |
|
F |
instrumental
delivery rate but not C section rate was significantly ↑ with IOL at 39/52 |
|
G |
C section and
instrumental delivery rates were unchanged |
|
H |
IVF was cost-effective |
|
I |
IVF
was not cost-effective |
|
J |
composite
perinatal outcome was better with IOL |
|
K |
composite
perinatal outcome was unchanged with IOL |
|
L |
composite
perinatal outcome was worse with IOL |
|
M |
EBL
using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓ |
|
N |
EBL
using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓ but with
↑↑ BP |
|
O |
frequency
and severity of perineal trauma ↑ with IOL |
|
P |
length
of labour was ↑↑ with IOL |
|
Q |
maternal
satisfaction was higher with IOL |
|
R |
urinary
incontinence at 3 months was reduced by IOL |
|
S |
none
of the above |
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