Tutorial 15 August 2013

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Tonight we had two EMQs and 4 SAQs.

Essays & EMQ 15 August 2013

19	EMQ . Education.
20	EMQ. Vulval conditions.
71	A 25-year-old attends the A&E department at 36 weeks’ gestation complaining of headache. 1.            List the differential diagnosis.          6 marks 2.            Justify the history you will obtain.   6 marks 3.  Evaluate the management options.        8 marks
72	A woman is admitted for a gynaecological procedure. 1. Outline why VTE is important and the strategies that hospital should employ to reduce their patients’ risks.                                                                                  4 marks. 2. Discuss how risk assessment should be done for this woman.    8 marks. 3. Outline the steps you will take to reduce her risk of VTE.            8 marks.
73	A woman is referred to the pre-pregnancy counselling clinic. She had Caesarean section with her previous pregnancy. 1.  Outline the history you will take.                     6 marks. 2.  Justify the investigations you will arrange.    4 marks. 3.  Justify the advice you will give.                      10 marks.
74	It is Saturday morning.  You are the on-call SpR for gynaecology and have been asked for help by the locum Registrar in A&E. A man has returned from Africa on a surprise visit home. On arrival he cut his finger on a kitchen knife and has attended A&E for treatment.  He is accompanied by his wife. His finger has been cleaned and two sutures have been inserted. Prior to treatment he mentioned that he was found to be HIV+ve as a result of extra-marital heterosexual activity in Africa and was started on anti-retroviral therapy there. He refuses to disclose his HIV status to his wife as she would “go mad” if she were to discover his infidelity. She has asked for contraceptive advice as he was not due to return for several months and she stopped contraception when he left 3 months before. The A&E Consultant has gone out to a major road traffic accident and is not expected to be available for about an hour. The husband is not prepared to await his return. The sexually-transmitted disease STD clinic is closed and will not open until Monday. You have spoken to your Consultant who has said he doesn’t want to know and that you have to “get on with it”. Outline and justify your management.

Education.

I am not an expert in this topic and offer this as some help to working out answers if you get a question on teaching methods, which apparently has happened. If you are an expert and can help to improve what follows, that will be much appreciated.

If you get a question in the exam, please try to remember as much as possible, particularly the option list and send it to me.

There are often a variety of different techniques that could be used. I would guess that the exam committee will take care to restrict the option list so that it is clear which is the best option.

Lead-in.

The following scenarios relate to medical education

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Abbreviations.

EMQ:    extended, matching question.

PBL:       problem-based learning.

Scenario 1.

A woman is admitted with an eclamptic seizure. The acute episode is dealt with and she is put on an appropriate protocol. You wish to use the case to outline key aspects of PET and eclampsia to the two medical students who are on the labour ward with you. Which would be the most appropriate approach?

Scenario 2.

You have been asked to provide a summary of the key aspects of the recent Maternal Mortality Meeting to the annual GP refresher course. There are likely to be 100 attendees. Which would be the most appropriate approach?

Scenario 3.

You have been asked to teach a new trainee the use of the ventouse. Which would be the most appropriate approach?

Scenario 4.

You have been asked to teach a group of medical students about PPH. To your surprise you find that they have good basic knowledge. Which technique will you apply to get the most from the teaching session?

Scenario 5.

Your consultant has asked you to get the unit’s medical students to prepare some questions about breech delivery which they can ask of their peers when they next meet. Which technique will you use?

Scenario 6.

You have been asked to discuss 2ry. amenorrhoea with your unit’s medical students. You are uncertain about the amount of basic physiology and endocrinology they remember from basic science teaching. Which technique will you use?

Scenario 7

The RCOG has asked you to chair a Green-top Guideline development committee. You find that there is very little by way of research evidence to help with the process. The College has assembled a team of consultants with expertise and interest in the subject. Which technique would be best to reach consensus on the various elements of the GTG?

Scenario 8

Which of the listed teaching techniques is least likely to lead to deep learning?

Scenario 9

An interactive lecture with EMQs is the best method of teaching. True or false.

Scenario 10

Only 20% of what is taught in a lecture is retained. True or false.

Scenario 11.

The main role of the teacher is information provision. True or false.

Scenario 12.

The main role of the teacher is to be a role model.  True or false.

Option list.

1. brainstorming.
2. brainwashing
3. cream cake circle.
4. Delphi technique.
5. demonstration & practice using clinical model.
6. doughnut round.
7. interactive lecture with EMQs.
8. lecture.
9. 1 minute preceptor method.
10. teaching peers / junior colleagues
11. schema activation.
12. schema refinement.
13. small group discussion.
14. snowballing.
15. snowboarding.
16. true
17. false

Lead-in.

The following scenarios relate to vulval conditions.

Choose the most likely vulval condition from the option list.

Each option can be used once, more than once or not at all.

Scenario 1.

A 22 year-old woman attends the colposcopy clinic after 2 smears showing minor atypia. The cervical appearances are of aceto-white with punctation. 

Scenario 2.

A 60-year old woman has an erythematous rash of the vulva extending to the inner thighs. A similar rash is noted under the breasts. She is not known to have diabetes.

Scenario 3.

A woman attends the gynaecology clinic with a vulval rash. It has a “lacy” appearance. 

Scenario 4.

A 35-year old woman attends is noted to have a vulval fistula. She has a history of episodic diarrhoea. 

Scenario 5.

A 25-year old woman attends the gynaecology clinic with a history of intense vulval itching and soreness. The appearances are of diffuse erythema with excoriation. Diabetes, candidiasis and other local infections have been eliminated by the GP. 

Scenario 6.

A 35-year old woman attends the gynaecology clinic with vulvitis. She also has a scalp rash. Clinical examination shows scaly, pink patches with signs of excoriation. Skin samples grow Malassezia ovalis.

Scenario 7.

A 40-year old woman has evidence of chronic vulval ulceration. She has recently been seen by a dermatologist for mouth ulceration and has been started on thalidomide.

Scenario 8.

An African woman of 35 years attends the gynaecology clinic. She has a ten-year history of chronic vulval ulceration. Examination shows multiple, tender vulval and pubic subcutaneous nodules, some of which have ulcerated.

Scenario 9.

A Caucasian woman of 29 years attends the gynaecology clinic with a chronic vulval rash. Examination shows erythematous areas with clearly defined margins and white scaly patches. 

Scenario 10.

A 30-year old woman attends the gynaecology clinic with vulval itching. Examination shows erythema of the labia minora and perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium with increased mitotic activity.

Option list.

A.	Acne.
B.	Behçet’s syndrome.
C.	Candidiasis.
D.	CIN 3
E.	CIN1
F.	Crohn’s disease.
G.	Dermatitis.
H.	Eczema.
I.	Genital warts.
J.	Hidradenitis suppurativa.
K.	Leprosy.
L.	Lichen planus
M.	Lichen sclerosis
N.	Lymphogranuloma venereum
O.	Normal skin.
P.	Psoriasis.
Q.	Seborrhoeic dermatitis.
R.	Type 1 diabetes mellitus
S.	Type 2 diabetes mellitus
T.	Ulcerative colitis.
U.	VIN III.