20 August 2015.
|
43
|
EMQ. Risk management /
disciplinary procedures
|
|
44
|
EMQ. Cystic fibrosis
|
|
45
|
EMQ. Anti-D
|
|
46
|
SBA. Early fetal death
reporting
|
|
47
|
EMQ. Caesarean section
|
43. EMQ. Risk management / disciplinary procedures.
Lead-in.
The following scenarios relate to risk management /
disciplinary procedures.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
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.
1 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.
1 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.
1 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,
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.
An 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
An 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
A SpR2 uploaded reflective
practice putting him in a good light after a case which had been handled
sub-optimally by him.
Scenario 15
You are 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.
Lead-in.
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?
Pick one option from the option list.
Option list.
|
A.
|
Report events to the Caldicott Guardian
|
|
B.
|
Report events to the Chief Executive
|
|
C.
|
Report events to the General Medical Council
|
|
D.
|
Report events to the NHSLA as a “never event”
|
|
E.
|
Report events to the NHSLA as a “serious incident”
|
|
F.
|
Report events to the Root Cause Analysis Team
|
|
G.
|
Report events as a serious adverse incident to the Risk
Management Team
|
|
H.
|
Report events to the Trust Information Management
Committee
|
|
I.
|
Suspend the doctor until a full investigation has been
done
|
Scenario 23.
Lead-in.
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?
Pick one option from the option list.
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.
Lead-in.
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 next?
Pick one option from the option list.
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 25.
Lead-in.
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 are
reports what has happened.
What action will you take?
Pick one option from the option list.
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 Medical Director
|
|
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
|
44. EMQ. Cystic fibrosis.
This question is about cystic fibrosis.
For
each scenario choose the option that gives the best answer.
And,
to make you behave in a model fashion, there is no option list, so you have to
decide your own best option.
Scenario 1.
A woman is 8
weeks pregnant and known to be a carrier of cystic fibrosis.
Her husband is
Caucasian.
What is the risk
of the child having cystic fibrosis?
Scenario 2.
A healthy woman
attends for pre-pregnancy counselling.
Her brother has
cystic fibrosis. Her husband is Caucasian.
He has been
screened for cystic fibrosis. The test was negative.
What is the risk
of them having a child with cystic fibrosis?
Scenario 3.
A healthy woman
is a known carrier of cystic fibrosis.
She attends for
pre-pregnancy counselling. Her husband has cystic fibrosis.
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 cystic fibrosis.
What
is her risk of being a carrier?
Scenario 5.
A woman attends
for pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk
that she is a carrier?
Scenario 6 .
A woman attends
for pre-pregnancy counselling. Her mother has cystic fibrosis.
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
known carrier of cystic fibrosis.
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 known carriers of cystic fibrosis.
What is the risk
of them having an affected child.
Scenario 10.
A woman and her
husband are known carriers of cystic fibrosis.
What can they do
to reduce the risk of having an affected child?
Scenario 11.
A woman and her
husband are known carriers of cystic fibrosis.
Can CVS exclude
an affected pregnancy?
Scenario 12.
A woman with
cystic fibrosis is planning pregnancy. Her husband is a known carriers of cystic fibrosis. What is
the risk of having an affected child?
Scenario 13.
A woman with
cystic fibrosis has a normal delivery of a healthy, 3.2 kg. 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?
Yes/No
Scenario 14.
A woman with
cystic fibrosis has a normal delivery of a healthy, 3.2 kg. 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? Yes/No
45. EMQ.
Lead-in.
The following scenarios relate to Rhesus prophylaxis and
anti-D.
Abbreviations.
Ig: immunoglobulin.
FMF: feto-maternal
haemorrhage.
RAADP: routine
antenatal anti-D prophylaxis.
RBC: red blood cells.
RhAI: Rhesus D alloimmunisation.
There is no option list to force
good technique!
Scenarios.
1)
What proportion of
the Caucasian population in the UK has Rh –ve blood group?
2)
What proportion of
the Rhesus +ve Caucasian population is homozygous for RhD?
3)
What is the chance
of a Rh –ve woman with a Rh +ve partner having a Rh –ve child?
4)
When was routine
postnatal anti-D prophylaxis introduced in the UK?
5)
Where does anti-D for prophylactic use come
from?
6)
How many deaths
per 100,000 births were due to RhAI up to 1969.
7)
How many deaths
per 100,000 births were due to RhAI in 1990.
8)
Anti-D was in
short supply in 1969. Which non-sensitised Rh –ve primigravidae with Rh +ve
babies would not be given anti-D as a matter of policy?
9)
List the possible
reasons that a Rhesus –ve mother with a Rhesus +ve baby who does not receive
anti-D might not become sensitised?
10)
What is the UK
policy for the administration of anti-D after a term pregnancy?
11)
What is the
alternative name of the Kleihauer test?
12)
What does the
Kleihauer test do?
13)
How does the
Kleihauer test work and what buzz words should you have in your head?
14)
When should a
Kleihauer test be done after vaginal delivery?
15)
What blood
specimen should be sent to the laboratory for a Kleihauer test?
16)
What steps should
be taken to prevent sensitisation in the woman whose blood group is RhDu
and whose baby is Rh +ve?
17)
The Kleihauer test is of value
in helping to decide if antenatal vaginal bleeding or abdominal pain are due to
placental abruption, with a +ve test confirming FMH and making abruption highly
probable.
True/False
18)
When should anti-D
be offered?
19)
When should a
Kleihauer test be considered?
20)
How often does the
word “considered” feature in the GTG?
21)
A Rhesus –ve woman
miscarries a Rh +ve fetus at 18 week’s gestation. What should be done about
Rhesus prophylaxis?
22)
A Rhesus –ve woman
miscarries a Rh +ve fetus at 20 week’s gestation. What should be done about
Rhesus prophylaxis?
23)
Which potentially
sensitising events are mentioned in the GTG?
24)
What factors are listed in the GTG as
particularly likely to cause FMH > 4 ml
25)
A woman has recurrent bleeding from 20
weeks. What should be done about Rh prophylaxis?
26)
What are the key messages about giving
RAADP?
46. EMQ. Early fetal deaths and reporting
Question 1.
Lead-in
A
woman goes into labour at 20 weeks’ gestation and delivers a baby with no sign
of life.
Which
of the options below best applies.
Option List
|
|
register as a miscarriage
|
|
|
register
as an early fetal death
|
|
|
register
as a live-birth
|
|
|
register
as a stillbirth
|
|
|
none
of the above.
|
Question 2.
Lead-in
A
woman goes into labour at 20 weeks’ gestation and delivers a baby which gasps
and has a faint heartbeat, but then shows no sign life. Attempted resuscitation
fails.
Which
of the options below best applies.
Option List
|
|
register
as a miscarriage
|
|
|
register
as an early fetal death
|
|
|
register
as a live-birth
|
|
|
register
as a stillbirth
|
|
|
none
of the above.
|
Question 3.
Lead-in
A
woman goes into labour at 23 weeks’ gestation and delivers a baby with no sign
of life.
Which
of the options below best applies.
Option List
|
|
register
as a miscarriage
|
|
|
register
as an early fetal death
|
|
|
register
as a live-birth
|
|
|
register
as a stillbirth
|
|
|
none
of the above.
|
Question 4.
Lead-in
A
woman goes into labour at 24 weeks’ gestation and delivers a baby with no sign
of life.
Which
of the options below best applies.
Option List
|
|
register
as a miscarriage
|
|
|
register
as an early fetal death
|
|
|
register
as a live-birth
|
|
|
register
as a stillbirth
|
|
|
none
of the above.
|
Question 5.
Lead-in
A
woman goes into labour at 24 weeks’ gestation and delivers a baby with no sign
of life.
Which
of the options below best applies in relation to MBRRACE’s enquiry into late
fetal deaths?
Option List
|
|
this
would be eligible for inclusion
|
|
|
this
would be ineligible because of the gestation
|
|
|
this
would be ineligible because the cause of death must be known
|
|
|
this
would be ineligible because I say so
|
|
|
none
of the above.
|
47. EMQ. Caesarean section.
Lead-in.
The following scenarios relate to Caesarean section.
Abbreviations.
cART: combination
anti-retroviral treatment.
CDUS: colour Doppler
ultrasound scan.
HAART: highly active
anti-retroviral therapy.
HCV: hepatitis C virus.
HSV: herpes simplex
virus.
MOD: mode of delivery.
MPA: morbid placental
adherence.
MRI: magnetic resonance
imaging.
MTCT: mother-to-child
transmission.
NVD: normal vaginal
delivery.
pCs planned Caesarean
section.
pvd planned vaginal
delivery.
PVL: plasma viral load.
SROM: spontaneous rupture of
membranes.
VBAC: vaginal birth after
Caesarean section.
Option list.
There is none, to make you think!
Scenarios.
1)
MPA is suspected on a routine 20 week scan
in a woman who has had two LSCSs. What advice should she be given in relation
to the value of colour Doppler US and MRI?
2)
What advice is
given about women who are infected with hepatitis B?
a a woman is
known to have HIV. When should a decision be taken about MOD?
b. at what
gestation should pCs be done as part of management of HIV in pregnancy?
c. at what
gestation should pCs be done in the woman with HIV, if the grounds are
obstetric or the woman’s wish, but not part of the management of HIV?
d. what advice
about MOD should be given to a woman with PVL <50 HIV RNA copies/mL at 36
weeks?
e. what advice
about MOD should be given to a woman with PVL of 200 HIV RNA copies/mL at 36
weeks?
f. what advice
about MOD should be given to a woman with PVL of 300 HIV RNA copies/mL at 36
weeks?
g. what advice
about MOD should be given to a woman with PVL of 400 HIV RNA copies/mL at 36
weeks?
h. what advice
about MOD should be given to a woman with PVL of 600 HIV RNA copies/mL at 36
weeks?
i. a woman with
HIV has been advised that normal delivery is recommended. What additional
interventions should be offered when she goes into labour?
k. what is an
elite controller?
|
1
|
member of the staff of Black
Rod in the House of Lords
|
|
2
|
crowd marshal at the Members’
Pavilion at Lord’s Cricket Ground.
|
|
3
|
Gentleman Usher at Buckingham
Palace party
|
|
4
|
one of the anti-retroviral
drugs that are essential components of HAART.
|
|
5
|
individual who is infected
with HIV but maintains low viral and healthy CD4 counts long-term with ART.
|
|
6
|
individual who is infected
with HIV but maintains low viral and healthy CD4 counts long-term without
ART.
|
l. a woman is
taking zidovudine monotherapy. Her PVL is <50 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
m. a woman is
taking zidovudine monotherapy. Her PVL is 200 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
n. a woman is
taking zidovudine monotherapy. Her PVL is 500 HIV RNA copies/mL at 36 weeks?
What advice would you give re MOD?
o. a woman is an
elite controller. What advice will you give re MOD?
3)
What advice is
given about women who are infected with hepatitis C
4)
What advice is
given about women who are infected with HIV?
5)
What advice is given about women who are
infected with HIV + hepatitis B?
6)
What advice is
given about women who are infected with HIV + hepatitis C
7)
A woman with HIV
takes HAART and has a PVL < 50 copies per ml. She wishes Caesarean section
for non-obstetric reasons. She has been counselled and Caesarean section has
been agreed. At what gestation should it be done?
8)
What advice should
be given to the woman with HSV infection in pregnancy?
9)
What is the risk
of MTCT after primary HSV infection in the 3rd. trimester?
10)
A woman presents
with genital herpes at 36 weeks’ gestation in her first pregnancy. As far as
she is aware, this is her first episode of HSV infection. What is the chance
that it is a recurrent infection?
11)
A woman presents
with genital herpes at 36 weeks’ gestation in her third pregnancy. As far as
she is aware, this is her first episode of HSV infection. What is the chance
that it is a recurrent infection?
12)
A woman presents with genital herpes at 36
weeks’ gestation in her first pregnancy. As far as she is aware, this is her
first episode of HSV infection. What test should be done to clarify whether it is
a 1ry. or recurrent infection?
13)
A woman presents with genital herpes at 36
weeks’ gestation in her first pregnancy. As far as she is aware, this is her first
episode of HSV infection. Swabs are taken from the skin lesions and blood is
taken for HSV type-specific antibodies. She goes into labour at 38 weeks before
the results of the HSV type specific antibody tests are available. What advice
should be given re mode of delivery?
14)
A woman presents
with genital herpes at 36 weeks’ gestation in her first pregnancy. As far as
she is aware, this is her first episode of HSV infection. Swabs are taken from
the skin lesions and blood is taken for HSV type-specific antibodies and
confirm 1ry. infection. She goes into labour with intact membranes at
38 weeks and declines Cs. What action should be taken with regard to anti-viral
treatment?
15)
A woman presents
in labour at 38 week’s gestation, 2 weeks after a 1ry. infection
with genital HSV. She declines Caesarean section, but opts for antiviral
treatment for her and the baby. Which drug should be considered and in what
doses?
16)
A woman presents
in labour at 38 week’s gestation, 2 weeks after a 1ry. infection
with genital HSV. She had SROM 6 hours before.
17)
A woman presents
in early labour at 38 weeks’ gestation. She has a history or recurrent genital
HSV. She has a typical herpetic blister on the vulva. What risk of neonatal
infection will you quote in the discussion?
18)
A woman presents
in labour at term with lesions and a history that are typical of 1ry.
genital HSV infection. Which invasive procedures, if any, should be avoided?
19)
A woman with a
history of recurrent genital herpes presents in labour at 40 weeks with a
typical vulval herpetic blister. Which invasive procedure, if any, should be avoided?
20)
A baby is born by
Caesarean section after maternal 1ry. genital herpes one month
before. Which, if any, of the following are appropriate?
Option
list.
A. liaise with the neonatal unit
B. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
C. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
D. lumbar puncture for evidence of HSV
E. parents to be educated re good hand hygiene
F. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
G. strict infection control procedures should be put in place
for both mother and baby.
H. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
I.
parents advised to
seek medical help if they have concerns, in particular, skin, eye or mucous
membrane lesions, lethargy, irritability or poor feeding
21)
A baby is born
normally after maternal 1ry. genital herpes one month before. The
mother had declined C section and intends to breast feed. Which, if any, of the
following are appropriate? Option list.
J.
liaise with the
neonatal unit
K. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
L. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
M. lumbar puncture for evidence of HSV
N. parents to be educated re good hand hygiene
O. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
P. strict infection control procedures should be put in place
for both mother and baby.
Q. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
R. parents advised to seek medical help if they have concerns,
in particular, skin, eye or mucous membrane lesions, lethargy, irritability or
poor feeding,
S. involvement of child protection service.
22)
A baby is born by
Caesarean section after maternal 1ry. genital herpes one month
before. Which, if any, of the following are appropriate?
Option
list.
T. liaise with the neonatal unit
U. normal postnatal care of the baby with examination at 24
hours, then discharge if well and feeding is established.
V. swabs of skin, conjunctiva, oropharynx and rectum for HSV
PCR
W. lumbar puncture for evidence of HSV
X. parents to be educated re good hand hygiene
Y. i.v. acyclovir, 20 mg/kg 8 hourly until active infection is
ruled out.
Z. strict infection control procedures should be put in place
for both mother and baby.
AA. breastfeeding should be discouraged because of the presence
of HSV in breast milk.
BB. parents advised to seek medical help if they have concerns,
in particular, skin, eye or mucous membrane lesions, lethargy, irritability or
poor feeding
23)
What proportion of
neonatal HSV infection is thought to be due to infection after birth?
24)
What steps should
be taken to reduce the risk of neonatal HSV infection?
25)
A primigravida
attends for booking. She requests Caesarean section. There are no clinical grounds.
Outline your management.
26)
A woman with BMI
> 50 should be offered Caesarean section. True/ False.
27)
When should
prophylactic antibiotics in relation to the timing of the operation?
28)
A woman has had
her 3rd. Caesarean section. She wants to know the advice you would
give re the risks of subsequent vaginal delivery.
29) What are the key aspects of induction of general
anaesthesia for unplanned Cs?
30) What should be done about thromboprophylaxis for women
having Cs?
31) Which abdominal incision is
recommended for Cs?
|
A
|
William
Fletcher Shaw
|
|
B
|
Victor
Bonney
|
|
C
|
Ignaz
Semmelweis
|
|
D
|
Joel-Cohen
|
|
E
|
Pfannenstiel
|
32) Separate scalpels should be used
for the skin and subsequent incisions to reduce infection. True/False.
33) If the lower segment is
well-formed, blunt dissection should be used to extend the initial uterine
incision. True / False.
34) What is the risk of fetal
laceration?
|
A
|
0.1%
|
|
B
|
0.5%
|
|
C
|
1%
|
|
D
|
2%
|
|
E
|
5%
|
35) Routine use of forceps to deliver
the head is acceptable practice. True / False.
36) I.v. syntometrine is the recommended
oxytocic. True / False.
37) Which of the following statements
reflects the advice in CG132 about delivery of the placenta.
|
A
|
Crede’s
manoeuvre is the recommended routine method for DOP
|
|
B
|
Leopold’s manoeuvre is the recommended routine method
for DOP
|
|
C
|
Steptoe’s
manoeuvre is the recommended routine method for DOP
|
|
D
|
CCT
is the recommended routine method for DOP
|
|
E
|
MROP
manoeuvre is the recommended routine method for DOP
|
38) Co-amoxiclav is on the list of
recommended antibiotics in CG132 for routine prophylaxis at Cs. True / False.
39) Repair of the uterus is best done
with the uterus exteriorised. True / False.
40) CG132 advises that single or
double-layer closure of the lower segment are equivalent and closure is a
matter of choice for the surgeon. True / False.
41) CG132 advises closure of both
visceral and parietal peritoneum. True / False.
42) Mass closure with a
non-absorbable suture should be used for closure of mid-line incisions. True /
False.
43) What is the suggested threshold
for closure of the subcutaneous fat?
|
|
Subcutaneous
fat thickness
|
|
A
|
1
cm.
|
|
B
|
2
cm.
|
|
C
|
3
cm.
|
|
D
|
4
cm.
|
|
E
|
≥ 5
cm.
|
44) Liberal use of subcutaneous
drains is encouraged to reduce wound infection rates. True / False.
45) When choosing an antibiotic for
prophylactic use at Cs, what infections should particularly be considered?
46) Staff should be silent
immediately before and after the birth of the baby as hearing the mother’s
voice as the first ex-utero experience encourages bonding. True / False.
No comments:
Post a Comment