|
72 |
Role-play. Previous stillbirth. |
|
73 |
Viva. Laboratory results. |
|
74 |
EMQ. Drugs in O&G. 1 |
|
75 |
EMQ. Listeriosis and pregnancy. |
|
76 |
SBA. Pertussis. |
72. Role-play. Previous stillbirth.
Candidate's Instructions.
This is a roleplay station. You are an SpR in the booking
clinic. You are about to see a woman who is at 10 weeks’ gestation in her
second pregnancy. Her first baby was stillborn.
She has had all the routine booking, including
investigations, dealt with by the midwife who has asked you to see her to
advise about her first pregnancy and its implications for the management of
this pregnancy.
Take an appropriate history, advise about the necessary
investigations and how the history of stillbirth will influence the management
of the pregnancy.
73. Structured
discussion. Laboratory results.
Your
consultant is on annual leave. Her secretary has asked you to look through the
following results and decide what administrative action should be taken in
relation to each.
1. +ve MSSU at booking. No symptoms.
2. GTT at 34 weeks. Peak level 11.5.
3. FBC with MCV at booking.
4. Thrombocytopenia at booking. 50,000.
5. Hydatidiform mole after evacuation of suspected miscarriage.
6. Histology after ERPC for incomplete miscarriage: no
trophoblastic tissue.
7. Endometrial cancer: hysteroscopy: thickened endometrium.
Histology: Anaplastic malignancy.
8. Endometrial cancer: MR scan: reaching serosa and upper
endocervical canal.
9. Consultant does lap drainage of normal looking ovarian cyst.
Malignant cells. Nulliparous. Wants children.
10. HVS: trichomonas.
11. Clue cells on smear. 12/52 pregnant.
12. Antenatal discharge: endocervical swab:
chlamydia
13. Actinomyces on smear.
14. Herpes in pregnancy
15. Severe dyskaryosis on cervical smear at
booking.
16. Primary infertility: FSH & LH
at 25 on day 3 of cycle.
17. Primary infertility. FSH 3, LH 12 on day 3 of
cycle.
18. Treated with cabergoline for
prolactin and pituitary adenoma. +ve beta HCG.
19. 3 cm. ovarian cyst.
Ca 125.
74. Drugs in O&G 1.
Lead-in.
The following scenarios relate to drugs &
hypertension in pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ACE: angiotensin-converting
enzyme
ACEI: angiotensin-converting enzyme
inhibitor
ARA: angiotensin II receptor antagonist
HG: hyperemesis gravidarum
IUGR: intra-uterine growth retardation
LDA: low-dose aspirin
MAOI: monoamine oxidase inhibitor
Option list.
a)
False.
b)
True.
c)
5
d)
10
e)
15
f)
18
g)
20
h)
24
i)
contraindicated in the
months before pregnancy
j)
contraindicated in the
1st. trimester
k)
contraindicated in the
2nd. trimester
l)
contraindicated in the
3rd. trimester
m)
contraindicated in all
trimesters
n)
not contraindicated in
pregnancy
o)
contraindicated in
breastfeeding
p)
not contraindicated in
breastfeeding
q)
an acute, severe
illness like rheumatoid arthritis
r)
an acute, severe
illness with encephalopathy and acute fatty liver
s)
an acute, severe
illness with gastro-intestinal tract bleeding
t) there is
insufficient information to be able to provide advice
Scenario 1.
When are ACE inhibitors
contraindicated in pregnancy?
Scenario 2.
When are ARAs contraindicated
in pregnancy?
Scenario 3.
Can St. John’s Wort (SJW) be
used in pregnancy?
Scenario 4.
Methyldopa is an acceptable
option for the treatment of gestational hypertension.
Scenario 5.
Spironolactone is
contraindicated in pregnancy.
Scenario 6.
Furosemide is an acceptable
option in the management of gestational hypertension.
Scenario 7.
When and why are thiazide
diuretics contraindicated in pregnancy?
Scenario 8.
Salbutamol is contraindicated
for the management of premature labour.
Scenario 9.
Ergometrine is an integral part
of active management of the 3rd. stage.
Scenario 10.
When is aspirin contraindicated
in pregnancy & the puerperium?
Scenario 11.
When are NSAID’s
contraindicated in pregnancy and why?
Scenario 12.
Pethidine: adverse neonatal
effects are most likely if the drug is administered in the six hours before
birth.
Scenario 13.
Pethidine: what is the
half-life in the mature neonate?
Scenario 14.
Pethidine is contraindicated in those taking MOAIs or done
so in the previous 2 months.
Scenario 15.
Pethidine is relatively
contra-indicated when there is significant blood loss.
Scenario 16.
Pethidine has greater analgesic
effect in labour than Diamorphine.
Scenario 17.
What
is Reye’s syndrome and which family of drugs is particularly linked?
Scenario 18.
What
is “torsades de pointes” and when is it of importance in the management of HG?
75. EMQ. Listeriosis.
Abbreviations.
Lm: Listeria monocytogenes.
TOC: test of cure.
Scenario
1.
Which organism is responsible
for human listeriosis?
|
A |
Listeria diogenys |
|
B |
Listeria frigidaire |
|
C |
Listeria hominis |
|
D |
Listeria monocytogenes |
|
E |
Listeria xenophylus |
Scenario
2.
Which, if any, of the following
statements are true about Lm? This is not a true EMQ as there may be >1
correct answer.
Option list.
|
A |
it is a small, Gram -ve rod |
|
B |
it is a Gram +ve coccus |
|
C |
it is flagellated |
|
D |
it has no cell wall |
|
E |
it is an obligate aerobe |
|
F |
it functions within host
cells |
|
G |
it can easily be mistaken for
commensal organisms |
|
H |
none of the above |
Scenario
3.
Which of the following are
associated with an increased risk of contracting listeriosis? This is not a
true EMQ as there may be >1 correct answer.
|
A |
age > 60 years |
|
B |
age < 1 year |
|
C |
blond hair |
|
D |
pregnancy |
|
E |
strabismus |
Scenario
4.
Which of the following is true
of the susceptibility of pregnant women to Lm? This is not a true EMQ as there
may be >1 correct answer.
Option list.
|
A |
they are not more susceptible |
|
B |
they are more susceptible x 2 |
|
C |
they are more susceptible x 5 |
|
D |
they are more susceptible x
10 |
|
E |
they are more susceptible x
20 |
|
F |
they are > 20 times more
susceptible |
|
G |
none of the above. |
Scenario
5.
When does Lm most often occur?
This is not a true EMQ as there may be >1 correct answer.
Option list.
|
A |
1st. trimester |
|
B |
2nd. trimester |
|
C |
3rd trimester |
|
D |
1st. + 2nd.
trimesters |
|
E |
2nd. + 3rd
trimesters |
|
F |
all trimesters equally |
|
G |
puerperium |
|
H |
none of the above |
Scenario
6.
What is the incubation period
for Lm?.
Option list.
|
A |
7±3 days |
|
B |
7±5 days |
|
C |
10±3 days |
|
D |
10±5 days |
|
E |
14±3 days |
|
F |
14±5 days |
|
G |
none of the above. |
What is the significance of Granulomatosis Infantisepticum ?
Option list.
|
A |
it is a fabrication by the author and of no significance |
|
B |
it is pathognomonic of Lm infection |
|
C |
it is the cause of vertical transmission of Lm |
|
D |
I refuse to answer Latin questions as they make me think
of Boris Johnson |
|
E |
none of the above |
Scenario
8.
Which of the following are
accurate about cervico-vaginal infection? This is not a true EMQ as there may
be >1 correct answer.
Option list.
|
A |
Lm is as often found in the
cervix as in the bowel. |
|
B |
Lm is as often found in the vagina
as in the bowel. |
|
C |
Lm is less often found in the cervix than in the bowel. |
|
D |
Lm is less often found in the vagina than in the bowel. |
|
E |
Lm is more often found in the cervix than in the bowel. |
|
F |
Lm is more often found in the cervix than in the bowel. |
|
G |
no one knows and no one cares |
Scenario
9.
A GP phones about a
primigravida at 28 weeks’ gestation. She has possibly ingested food
contaminated by Lm. She is asymptomatic and afebrile. What advice will you
give?
Option list.
|
A |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 2
weeks |
|
B |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 4
weeks |
|
C |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 6
weeks |
|
D |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 8
weeks |
|
E |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
F |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
G |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
H |
admit to hospital for
investigation and intensive treatment if Lm infection found |
|
I |
none of the above |
Scenario
10.
A GP phones about a
primigravida at 28 weeks’ gestation. She has possibly ingested food
contaminated by Lm. She has mild symptoms but is afebrile. What advice will you
give?
Option list.
|
A |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 2
weeks |
|
B |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 4
weeks |
|
C |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 6
weeks |
|
D |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 8
weeks |
|
E |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s)
for 7 days with follow-up for TOC |
|
G |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
H |
admit to hospital for
investigation and intensive treatment if Lm infection found |
|
I |
none of the above |
A GP phones about a primigravida
at 28 weeks’ gestation. She has possibly ingested food contaminated by Lm. She
is symptomatic and her temperature is 38.2oC. What advice will you
give?
Option list.
|
A |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 2
weeks |
|
B |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 4
weeks |
|
C |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 6
weeks |
|
D |
reassure and advise her about
avoiding exposure and to reattend if she develops signs or symptoms within 8
weeks |
|
E |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s)
for 7 days with follow-up for TOC |
|
G |
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC |
|
H |
admit to hospital for
investigation and intensive treatment if Lm infection found |
|
I |
none of the above |
Scenario
12.
Which, if any, of the following
would be appropriate for consideration as 1st. line treatment of Lm
in pregnancy? This is not a true EMQ as there may be more than 1 correct
answer.
Option list.
|
A |
ampicillin |
|
B |
ampicillin + gentamycin |
|
C |
ampicillin + streptomycin |
|
D |
amoxicillin + clavulanic acid |
|
E |
clarithromycin |
|
F |
erythromycin |
|
G |
erythromycin + metronidazole |
|
H |
trimethoprim |
|
I |
none of the above |
74.
Pertussis.
Some
are not true SBAs as there may be more than 1 correct answer.
Question 1.
Lead-in.
Why is pertussis of current concern in
obstetrics?
Option
List
|
A |
Research has linked pertussis
in the 1st. trimester to ↑
risk of congenital heart disease |
|
B |
A mini-epidemic since 2011 has caused ↑ deaths of mothers & of babies
< 3 months |
|
C |
A mini-epidemic since 2011 has caused ↑ deaths of babies < 3 months |
|
D |
The infecting organism has become increasingly drug-resistant |
|
E |
The infecting organism has become increasingly virulent |
Question 2.
Lead-in
Which organism causes whooping
cough?
Option
List
|
A |
Bordella
pertussis |
|
B |
Bacteroides pertussis |
|
C |
Rotavirus whoopoe |
|
D |
Respiratory syncytiovirus pertussis |
|
E |
None of the above |
Question 3.
Lead-in
Which, if any, of the following
statements is true about the organism what causes whooping cough? This is not a
true SBA.
Option
List
|
A |
the organism is aerobic |
|
B |
the organism is anaerobic |
|
C |
the organism is capsulated |
|
D |
the organism is flagellate |
|
E |
the
organism is an obligate intra-cellular parasite |
|
F |
the organism is a Gram -ve diplococcus |
|
G |
the organism is a Gram +ve diplococcus |
|
H |
the organism requires special transport
media |
|
I |
no one is going to ask me any of this stuff |
Lead-in
Which of the following statements is true?
Option List
|
A |
Pertussis is no longer a significant threat
to infants |
|
B |
Pertussis
remains a significant threat to infants |
|
C |
The risk
of death from pertussis is eliminated by timely antibiotic therapy |
|
D |
the risk
of death from pertussis is eliminated by timely antiviral therapy |
|
E |
None of
the above |
Question 5.
Lead-in
Which of the following statements
is true?
Option
List
|
A |
Pertussis
is not a notifiable disease |
|
B |
Pertussis is a notifiable disease |
|
C |
Pertussis is not notifiable, but
should be reported to the local bacteriologist |
|
D |
Pertussis is not notifiable, but
cases should be subject to audit |
Question 6.
Lead-in
What is the main mode of spread
of the organism that causes pertussis?
Option
List
|
A |
contact with contaminated
surfaces |
|
B |
contaminated food |
|
C |
contaminated water |
|
D |
respiratory droplets |
|
E |
none of the above |
Question 7.
Lead-in
What is the main reservoir of the
organism that causes pertussis?
Option
List
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of the above |
Question 8.
Lead-in
What is the epidemiology of
pertussis?
Option
List
|
A |
the
condition is endemic |
|
B |
the condition is endemic with
mini-epidemics every 3-5 years |
|
C |
the condition is endemic with
mini-epidemics most years in the winter months |
|
D |
the condition is epidemic, with
outbreaks at roughly three-year intervals |
|
E |
the condition is epidemic, with
outbreaks at unpredictable intervals |
Question 9.
Lead-in
What is the incubation period for
pertussis?
Option
List
|
A |
3-6 days |
|
B |
7-10 days |
|
C |
11-14 days |
|
D |
15-18 days |
|
E |
none of the above. |
Question 10.
Lead-in
What is the duration of
infectivity of someone with pertussis?
Option
List
|
A |
2 days from exposure → 5 days
after onset of paroxysms of coughing |
|
B |
3 days from exposure → 10 days
after onset of paroxysms of coughing |
|
C |
4 days from exposure → 14 days
after onset of paroxysms of coughing |
|
D |
6 days from exposure → 21 days
after onset of paroxysms of coughing |
|
E |
none of the above |
Question 11.
Lead-in
What % of non-immune, close
contacts of pertussis will develop the disease?
Option
List
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Lead-in
What practical issues are current
for obstetrician in relation to pertussis?
Option
List
|
A |
The
DOH advises that all pregnant women be immunised to ↓maternal death rates. |
|
B |
The DOH advises that all pregnant
women be immunised to ↓ deaths in babies < 3 months. |
|
C |
The DOH advises that all babies be
immunised at birth. |
|
D |
The DOH advised that “Boostrix- IPV” should replace
“Repevax” from July 2014. |
|
E |
The DOH advises that immunisation of
pregnant women be continued until 2019 |
Question 13.
Lead-in
Which, if any, of the following
statements is true in relation to average annual number of deaths due to pertussis
in the years before routing child immunisation was introduced?
Option
List
|
A |
the number was 10,000 |
|
B |
the number was 5,000 |
|
C |
the number was 4,000 |
|
D |
the number was 3,500 |
|
E |
the number was <1,000 |
Question 14.
Lead-in
Which, if any, of the following
statements are true in relation to pertussis vaccine.
Option
List
|
A |
“Boostrix- IPV” is a vaccine for pertussis only |
|
B |
“Repevax” is a vaccine for pertussis
only |
|
C |
“Boostrix- IPV” &
“Repevax” are live, attenuated vaccines |
|
D |
“Boostrix- IPV” &
“Repevax” act against diphtheria, tetanus and polio & pertussis |
|
E |
“Boostrix- IPV” &
“Repevax” are acellular |
Question 15.
Lead-in
Which, if
any, of the following statements are true in relation to the JCVI’s advice of
the best time to administer pertussis vaccine in pregnancy?
Option List
|
A |
20 - 24
weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the above |
Question 16.
Lead-in
A woman
has suspected pertussis in early pregnancy. Should she still be offered
vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 17.
Lead-in
A woman
has proven pertussis in early pregnancy. Should she still be offered
vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 18.
Lead-in
A pregnant
woman misses out on vaccination as part of the TIPP. Should vaccination still
be offered in the puerperium?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
