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Fellowship course Week 14 – O & G
WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS
EXAMINATION TIME: 36 Minutes
Candidate nameQuestion 1 (14 marks) 6 minutes
Complete the following table.
Non specific vulvovaginitis
Trichomonas Bacterial vaginosis
Candidiasis
Sexually transmittedYes/No(2 marks)
Discharge quality(2 marks)
Other symptoms(2 marks)
Examination findings(2 marks
Candidate nameQuestion 1 (continued)
Non specific vulvovaginitis
Trichomonas Bacterial vaginosis
Candidiasis
LaboratoryDiagnosisMethod(2 marks)
Treatment
(Doses not required)
(2 marks)
Male partner treatmentYes/ No(2 marks)
Candidate nameQuestion 2 (18 marks) 9 minutes
You are working in a Tertiary emergency department with obstetric and paediatric services on site. A 24 year-old multiparous woman who is 36 weeks pregnant presents to triage in suspected labour.
a. Define the stages of labour. State the start and finish of each stage. (3 marks)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
The patient appears to be having frequent contractions and is in severe pain. She is transferred directly to the resuscitation room. On examination you note that the head is on view. The baby is successfully delivered within minutes. The cord is clamped and cut.
b. List five (5) steps in the routine management of a well newborn infant. (5 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
Candidate nameQuestion 2 (continued)
The placenta is still in situ. The Obstetric team is yet to arrive.
c. List five (5) steps in the management of the mother over the next 10 minutes. (5 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
Candidate nameQuestion 2 (continued)
You successfully develop the placenta. The patient continues to have on-going, heavy per vaginal bleeding. An assistant has notified the obstetric service who are still at least 10 minutes away.
d. List five (5) steps in your management of the bleeding in the next 10 minutes. (5 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
Candidate nameQuestion 3 (19 marks) 9 minutes
A 30 year old female, G1P0 who is currently 36 weeks pregnant, presents to your emergency department.
i) List three (3) physiological changes that you may expect to see in her ECG. (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Candidate nameQuestion 3 (Continued)
This patient presented with a concern of 1 week of increasing dyspnoea and chest discomfort. Her pregnancy is otherwise progressing normally. She is previously well, with no significant past history and she takes no medications.Her observations on arrival are:
BP 110/ 60 mmHg
RR 30 / min
Oxygen saturation 98% on room air
GCS 15
Temperature 37.8°C
An ECG is taken on arrival.
ii) State five (5) abnormalities shown in this ECG. (5 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. _______________________________________________________________________
4. ______________________________________________________________________
5. ________________________________________________________________________
iii) Interpret this ECG for this patient. List two (2) points of interpretation. (2 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
Candidate name
Question 3 (Continued)
iv) Complete the table below by stating three (3) investigation options that may assist with confirmation of the diagnosis in this patient. For each investigation state one significant pro and one significant con for each investigation for this patient. (9 marks)
Investigation that may assist with diagnosis
confirmation(3 marks)
Pro(3 marks)
Con(3 marks)
1
2
3
Candidate nameQuestion 3
Candidate name
Question 4 (12 marks) 6 minutes
During your routine pathology result checking you notice a MSU result of a patient seen by another doctor in your emergency department two days ago.
MSU result is available.
The patient records show:
35 year old female, 15 weeks pregnant with left flank pain and dysuria.No allergies.Rx trimethoprim. F/U prn.
a. Other than a confirmed UTI, state four (4) clinical problems with this patient. (4 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
Candidate nameQuestion 4 (continued)
b. List 4 (4) key steps that you would undertake in this case. State one (1) justification for each step. (8 marks)
Step
(4 marks)
Justification
(4 marks)
1.
2.
3.
4.
Candidate name
Question 4
MICROSCOPYLeucocytes > 1000 x 10^6/L (<2x10^6/L )Red Blood Cells 220 x 10^6/L (<13x10^6/L )Squamous Epithelial Cells +
STANDARD BACTERIAL CULTURE
1. Escherichia coli >10^9 cfu/L
SENSITIVITIES: 1
Ampicillin SAugmentin SCefotaxime SCephalothin SCotrimoxazole SGentamicin SNitrofurantoin STrimethoprim R
Candidate name
Question 5 (12 marks) 6 minutesYou are the supervising emergency physician in a suburban emergency department. The Triage Nurse brings to your attention a distressed 16 year old girl he has just triaged. She is requesting the“morning after pill”. You attend the patient. She reports that she was sexually assaulted the previous day by a male acquaintance.
a. List six (6) historical factors that are of key importance in your risk assessment. (6 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
6. _______________________________________________________________________
Candidate nameQuestion 5 (Continued)
b. List four (4) issues with respect to emergency contraception for this patient. (4 marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
c. List two (2) circumstances under which you would prescribe sexually transmitted infection prophylaxis immediately for this patient. (2 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
