Fellowship Course

Candidate name

Fellowship course

Week 14–O & G

WRITTEN EXAMINATION

SHORT ANSWER QUESTIONS

EXAMINATION TIME: 36 Minutes

Question 1(14 marks) 6 minutes

Complete the following table.

Question 1 (continued)

Question 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.

1. 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.

1. List five (5) steps in the routine management of a well newborn infant. (5 marks)

1. ______
2. ______
3. ______
4. ______
5. ______

Question 2 (continued)

The placenta is still in situ. The Obstetric team is yet to arrive.

1. List five (5) steps in the management of the mother over the next 10 minutes. (5 marks)

1. ______
2. ______
3. ______
4. ______
5. ______

Question 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.

1. List five (5) steps in your management of the bleeding in the next 10 minutes. (5 marks)

1. ______
2. ______
3. ______
4. ______
5. ______

Question 3 (19 marks) 9 minutes

A 30 year old female, G1P0 who is currently 36 weeks pregnant, presents to your emergency department.

i)Listthree (3)physiological changes that you may expect to see in her ECG. (3 marks)

1. ______
2. ______
3. ______

Question 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:

BP110/ 60mmHg

RR30/ min

Oxygen saturation 98%on room air

GCS15

Temperature37.8°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. ______

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)

Question 3

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.

1. Other than a confirmed UTI, state four (4) clinical problems with this patient. (4 marks)

1. ______
2. ______
3. ______
4. ______

Question 4 (continued)

1. List 4 (4) key steps that you would undertake in this case. State one (1) justification for each step. (8 marks)

Question 4

MICROSCOPY

Leucocytes > 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

Question 5 (12 marks) 6 minutes

You 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.

1. List six (6) historical factors that are of key importance in your risk assessment. (6 marks)

1. ______
2. ______
3. ______
4. ______
5. ______
6. ______

Question 5 (Continued)

1. List four (4) issues with respect to emergency contraception for this patient. (4 marks)

1. ______
2. ______
3. ______
4. ______

1. List two (2) circumstances under which you wouldprescribe sexually transmitted infection prophylaxis immediately for this patient. (2 marks)

1. ______
2. ______