13 August 2015.
33
|
EMQ. Confidentiality &
consent
|
34
|
EMQ. Hepatitis B
|
35
|
EMQ.
Maternal Mortality definitions
|
36
|
EMQ. Haemophilia
|
37
|
EMQ. Education
|
33. EMQ. Confidentiality & consent
Lead-in.
The following scenarios relate to confidentiality.
For each, select the number that best fits the scenario.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
This EMQ has not option list. This is to make you decide
your answers. Send them to me and I’ll send my version including what I think
an option list might have looked like.
Scenario 1.
A 15-year-old girl attends the
TOP clinic requesting TOP. She is assessed as Fraser competent. After full
discussion arrangements are made for her admission for TOP. She does not wish
her parents to be informed. Her mother attends clinic 1 hour after the child
has left. She demands full information about her daughter. The consultant has
delegated you to deal with her. Which option best fits the action you
will take?
Scenario 2.
A 17-year-old A-level student
attends the gynaecology clinic requesting TOP. She is accompanied by her
30-year-old mathematics teacher, who is her lover and wishes to give consent. Which
option best fits the action you will take?
Scenario 3.
A 12-year-old girl attends the
gynaecology clinic with her mother seeking contraceptive advice. She has an
18-year-old boyfriend whom the parents like and she wishes to start having sex.
Which option best fits the action you will take?
Scenario 4.
A 15-year-old girl who is Fraser competent is referred to
the gynaecology clinic with a complaint of vaginal discharge. She reveals that
she has been having consensual sexual intercourse for six months with her
18-year-old boyfriend. She asks for advice about suitable contraception as she
is happy in the relationship and wants to continue to have sex. Which option
best fits the action you will take?
Scenario 5.
You are the new oncology consultant and have just
operated on the wife of a local General Practitioner for suspected ovarian
cancer. The diagnosis is confirmed and you proceed with appropriate surgery. On
completion of the operation you go to the surgeon’s room for a coffee. The
senior consultant anaesthetist who was not involved in theatre but is the
Medical Director and tells you he is a close friend of the woman, asks what the
diagnosis and prognosis are. Which option best fits the action you will take?
Scenario 6.
You are phoned by a doctor
looking for information about his wife’s results from the booking clinic she
attended two weeks ago. He says that she has given consent for disclosure. She
has given a history of 2 terminations but no other pregnancies. She is Rhesus
negative, but has Rhesus antibodies. Which option best fits the action
you will take?
Scenario 7
You are phoned by a doctor
looking for information about his wife’s results from the booking clinic she
attended two weeks ago. He says that she has given consent for disclosure. Her
serology tests have proved +ve for syphilis. You have spoken to the consultant
bacteriologist who says that they have run confirmatory tests and they are +ve
too. He is sure the woman has active syphilis. Which option best fits
the action(s) you will take?
Scenario 8
A 15-year-old girl attends the
TOP clinic requesting TOP. She is assessed as Fraser competent. After full
discussion arrangements are made for her admission for TOP. She does not wish
her parents to be informed despite your best efforts to persuade her. Who will
give consent for the procedure?
Scenario 9
An immature 15-year-old girl
attends the gynaecology clinic requesting TOP. She is accompanied by her
25-year-old sister who is a lawyer with whom she has been staying since she
knew she was pregnant. She does not want her parents to be informed. The girl
is assessed as not Fraser competent. The sister says that she is happy to act
in loco parentis and to give consent. Which option best fits the
action(s) you will take?
Scenario 10
A 25-year-old woman with Down’s syndrome attends the
clinic accompanied by her mother. She has menorrhagia and copes badly with the
hygiene aspects. The menorrhagia is bad enough for her now to be on treatment
for iron-deficiency anaemia. She has tried all the standard medical methods. To
complicate the problem, she has become close friends with a young man she has
met at College, to which she travels independently each weekday. Her mother
fears that she may already be involved in sexual activity and cannot get an
accurate answer from her about it. The mother is keen for her to have
hysterectomy to deal with both problems. If you agree that the surgery is
appropriate, who can give consent?
Scenario 11
A 25-year-old woman with Down’s syndrome is admitted from
College after collapsing. The clinical features are of ectopic pregnancy and
she states that she has UPSI with her boyfriend of six months. She has
tachycardia and hypotension and it is felt that she should have urgent surgery.
You reckon that she is not competent to consent for surgery. Who can give
consent?
Scenario 12
A 25-year-old woman with Down’s syndrome is admitted from
College after collapsing. The clinical features are of ectopic pregnancy and
she states that she has UPSI with her boyfriend of six months. She has
tachycardia and hypotension and it is felt that she should have urgent surgery.
You reckon that she is not competent to consent for surgery. What limits are
there on the surgery?
Scenario 13.
You are the SpR on call and are asked to see a
10-year-old child in the A&E department. She has been brought because of
vaginal bleeding. She is accompanied by her parents who give a story of her
injuring herself falling of her bike. Examination shows vaginal bleeding and
you think the hymen looks torn. You suspect sexual abuse and don’t believe the
parents’ story. When this is discussed with the parents they say it is
impossible and that they do not want involvement of police or social workers. What
action will you take?
Scenario 14.
You are the SpR in theatre with your consultant. Mrs Mary
White, age 45, has been listed for abdominal hysterectomy and bilateral
salpingo-oophorectomy – she has a long history of menorrhagia that has not
responded to conservative measures. Her mother had ovarian cancer diagnosed at
55 and died from the disease 3 years later. A 10 cm., solid tumour of the left
ovary is found on opening the abdomen. Which of the following options is the
correct course of action?
A
|
close the abdomen, see her to explain the findings and
book a follow-up appointment in the gynaecological clinic to discuss further
management
|
B
|
close the abdomen, arrange to see her to explain the
findings and refer to the gynaecological oncologist to discuss further
management
|
C
|
continue with the operation, but don’t remove the left
ovary
|
D
|
continue with the operation, removing the uterus and
both ovaries and tubes
|
E
|
continue with the operation, removing the uterus and
both ovaries and tubes and obtaining peritoneal washings
|
F
|
ask the gynaecological oncologist to attend to perform
definitive surgery on the basis that the cyst is likely to be malignant
|
G
|
phone the legal department for advice
|
H
|
phone the Court of Protection for advice
|
Scenario 15.
You are an SpR in theatre with
your consultant.
Mrs Mary White, age 45, has
been listed for abdominal hysterectomy and bilateral salpingo-oophorectomy –
she has a long history of menorrhagia that has not responded to conservative
measures. Her mother had ovarian cancer diagnosed at 55 and died from the
disease 3 years later.
You perform examination under
anaesthesia prior to the abdomen being opened. You find a 10 cm., mass to the
left of the uterus. It feels solid. There is no evidence of ascites or other
pathology.
Which of the following options is the correct
course of action?
A
|
Cancel the operation and
arrange review in the gynaecology department in 6 weeks
|
B
|
Cancel the operation and
arrange review by the oncology team
|
C
|
Cancel the operation and
arrange an urgent scan
|
D
|
Continue with the planned
procedure
|
E
|
Ask the gynaecological
oncologist to attend theatre to examine the patient and advise
|
F
|
Perform laparoscopy to
identify the nature of the mass
|
G
|
Phone the legal department
|
34. EMQ. Hepatitis B
Lead-in.
Each of the following scenarios relates to
hepatitis B and pregnancy.
Instructions.
For each scenario, select the most appropriate
option from the option list.
Each option can be used once, more than once or
not at all.
Abbreviations.
HBcAg: hepatitis B core antigen
HBeAg: hepatitis B e antigen
HBsAg: hepatitis B surface antigen
HBcAb: antibody to hepatitis B core antigen
HBeAb: antibody to hepatitis B e antigen
HBsAb: antibody to hepatitis B surface antigen
HBIG: hepatitis B immunoglobulin
HBV: hepatitis B virus
Option list.
A.
acyclovir
B.
divorce
C.
HBcAg +ve
D.
HBeAg +ve
E.
HbsAg +ve
F.
HBsAg +ve; HBsAb –ve; HBcAb -ve
G.
HBsAg +ve; HBsAb –ve on two tests six
months apart
H.
HBsAG –ve; HBsAb -ve on two tests six
months apart
I.
HBsAg –ve; HBsAb +ve; HBcAb –ve
J.
HBsAg –ve; HBsAb +ve; HBcAb +ve
K.
HBsAg –ve; HBsAb +ve
L.
HBsAg +ve; HBcAg +ve
M.
HBV vaccine.
N.
HBIG
O.
HBV vaccine + HBIG
P.
immune as a result of infection
Q.
immune as a result of vaccination
R.
not immune
S.
chronic carrier of HBV infection
T.
10%
U.
30%
V.
50%
W.
60%
X.
70 - 90%
Y.
soap and boiling water
Z.
10% dilution of bleach in water
AA. 10%
dilution of formaldehyde in alcohol
BB. ultraviolet
irradiation
CC. yes
DD.no
EE. none
of the above
Scenario 1.
An asymptomatic primigravida books at
10 weeks. Her partner had an acute HBV infection 4 months ago. What results on
routine blood testing would indicate that she has an acute infection?
Scenario 2.
An asymptomatic primigravida books at
10 weeks. Her partner had an acute HBV infection 4 months ago. What results on
routine blood testing would indicate that she is immune to the HBV as a result
of natural infection?
Scenario 3.
An asymptomatic primigravida books at
10 weeks. Her partner had an acute HBV infection 4 months ago. What results on
routine blood testing would indicate that she is immune to the HBV as a result
of HBV vaccine?
Scenario 4.
An asymptomatic primigravida books at
10 weeks. Her partner had an acute HBV infection 6 months ago. What results on
routine blood testing would indicate that she is a chronic carrier of HBV
infection?
Scenario 5.
Testing shows that he is positive for HBsAg,
positive for HBcAb but negative for IgM HBcAb. What does this mean in relation
to his HBV status?
Scenario 6.
Testing shows that he is negative for HBsAg,
positive for HBcAb and positive for HBsAb.
What does this mean in relation to his HBV
status?
Scenario 7
A primigravid woman at 8 weeks
gestation is found to be non-immune to the HBV. She has recently married and
her husband is a chronic carrier. What should be done to protect her from
infection?
Scenario 8
A woman is a known carrier of
Hepatitis B. What is the risk of vertical transmission in the first trimester?
Scenario 9
A woman is a known carrier of
Hepatitis B. What is the risk of the neonate who has been infected by vertical
transmission in the third trimester becoming a carrier without treatment?
Scenario 10
How effective is hepatitis B
prophylaxis in preventing chronic carrier status developing in a neonate
infected as a result of vertical transmission?
Scenario 11
Can a woman who is a chronic HBV
carrier breastfeed safely?
Scenario 12.
Hepatitis B infection is the most dangerous of
the viral hepatitis infections in pregnancy.
Scenario 13.
A pregnant woman who is not immune to
HBV has a partner who is a chronic carrier. Can HBV vaccine be administered
safely in pregnancy?
Scenario 14.
A pregnant woman who is not immune
has a partner with acute hepatitis due to HBV. He cuts his hand and bleeds onto
the kitchen table. How should she clean the surface to ensure that she gets rid
of the virus?
Scenario 15.
Is it true that the presence of HBeAg in maternal
blood is a particular risk factor for vertical transmission? Not really a
scenario, but never mind!
35. EMQ. Maternal Mortality definitions
Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the task in each
scenario from the option list.
Each option can be used once, more than once or not at
all.
Option List.
A. Death
of a woman during pregnancy and up to 6 weeks later, including accidental and
incidental causes.
B. Death
of a woman during pregnancy and up to 6 weeks later, excluding accidental and
incidental causes.
C. Death
of a woman during pregnancy and up to 52 weeks later, including accidental and
incidental causes.
D. Death
of a woman during pregnancy and up to 52 weeks later, excluding accidental and
incidental causes.
E. A
pregnancy going to 24 weeks or beyond.
F. A
pregnancy going to 24 weeks or beyond + any pregnancy resulting in a
live-birth.
G. Maternal
deaths per 100,000 maternities.
H. Maternal
deaths per 100,000 live births.
I. Direct
+ indirect deaths per 100,000 maternities.
J. Direct
+ indirect deaths per 100,000 live births.
K. Direct
death.
L. Indirect
death.
M. Early
death.
N. Late
death.
O. Extra-late
death.
P. Fortuitous
death.
Q. Coincidental
death.
R. Accidental
death.
S. Maternal
murder.
T. Not
a maternal death.
U. Yes
V. No.
W. I have no
idea.
X. None
of the above.
Abbreviations.
MMR: Maternal Mortality Rate.
MMRat: Maternal Mortality Ratio.
SUDEP: Sudden Unexplained Death in Epilepsy.
Option list.
There is
none, to make it harder.
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured
ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured
appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What
kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease
dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational
trophoblastic disease, develops choriocarcinomas and dies from it 24 months
after the GTD was diagnosed and the uterus evacuated. What kind of death
is it?
Scenario 7
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality
Ratio?
Scenario 12
A woman is diagnosed with
breast cancer. She has missed a period and a pregnancy test is +ve. She decides
to continue with the pregnancy. The breast cancer does not respond to treatment
and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the
subject of domestic violence is killed at 12 weeks’ gestation by her partner.
What kind of death is it?
Scenario 14
A woman is struck by lightning
as she runs across a road. As a result she falls under the wheels of a large
lorry which runs over abdomen, rupturing her spleen and provoking placental
abruption. She dies of haemorrhage, mostly from the abruption. What kind of
death is it?
Scenario 15
A woman is abducted by Martians
who are keen to study human pregnancy. She dies as a result of the treatment
she receives. As this death could only have occurred because she was pregnant,
is it a direct death?
Scenario 16
Could a maternal death from
malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from
malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from
malignancy be classified as “Coincidental”?
36. EMQ. Haemophilia
Haemophilia 1.
Lead-in.
The following scenarios relate to haemophilia A, factor
VIII deficiency (HA).
For each, select the most appropriate answer from the option list.
Each option can be used once, more than once or not at
all.
Scenario 1.
A woman attends for
pre-pregnancy counselling. Her brother has haemophilia A. What is her risk of
being a carrier?
Scenario 2.
A woman attends for
pre-pregnancy counselling. Her father has haemophilia A. What is her risk of
being a carrier?
Scenario 3.
If she is tested and found to
be a carrier, what tests will you arrange for her partner?
Scenario 4.
If she is a carrier, what is
the risk to her male offspring?
Scenario 5.
If she is a carrier, what is
the risk to her female offspring?
Scenario 6.
If she is a carrier and her
partner has haemophilia A, what are the risks to their female offspring?
Scenario 7.
If she is a carrier and her
partner has haemophilia A, what are the risks to their male offspring?
Scenario 8.
A lady doctor has a brother with haemophilia. The brother
has a 20-year-old daughter who is planning pregnancy and phones his sister, the
doctor, to ask what the risk is of his
daughter being a carrier.
Scenario 9.
A lady doctor has a brother with haemophilia. The brother
has a 20-year-old daughter who is planning pregnancy and phones his sister, the
doctor, to ask what the risk is of his
daughter’s sons being affected.
Scenario 10.
A lady doctor has a brother with haemophilia. The brother
has a 20-year-old daughter who is planning pregnancy and phones his sister, the
doctor, to ask what the risk is of his
daughter having an affected daughter.
Scenario 11.
A lady doctor has a brother with haemophilia. She has a
pregnancy with no testing. A son in born. What is the chance that he is
affected?
Scenario 12.
A lady doctor has a brother with haemophilia. She has a
pregnancy with no testing. A son in born. What is the chance that he is not
affected?
Scenario 13.
A lady doctor has a brother with haemophilia. She has a
pregnancy with no testing. What is the chance that she will have an affected
son?
37. Education.
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.
Option list.
- brainstorming.
- brainwashing
- cream cake circle.
- Delphi technique.
- demonstration &
practice using clinical model.
- doughnut round.
- interactive lecture with
EMQs.
- lecture.
- 1 minute preceptor method.
- teaching peers / junior
colleagues
- schema activation.
- schema refinement.
- small group discussion.
- snowballing.
- snowboarding.
- true
- false
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.
No comments:
Post a Comment