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Station 7: Antepartum Haemmorrhage.

Candidate Name: Instructions to candidate: Part A: 30s preparation, 5 minutes for History You are the F1 in A&E. Mrs White is a 30 year old accountant. She presented to the Accident and Emergency department after complaining of lower abdominal pain and vaginal bleeding. Please take a relevant obstetrics and gynaecological history from her. Part B: 30s preparation, 5 mins for BBN An abdominal ultrasound shows grade 3 placenta previa. Please inform Mrs White about this diagnosis and discuss any implications this has on her choice of delivery. Part A Mark Scheme Appropriate Introduction including name and grade Presenting Complaint Explores presenting complaint - abdominal pain-site, onsite, character, radiation, alleviating and relieving factors - Per vaginal bleeding: amount, colour, passing of clots? Passing of fetal contents - nausea and vomiting? Gynaecological history Menstrual history - LMP: 7 months ago - Menarche - Cycle: regularity, duration, menorrahagia, spotting. Contraceptive use Last cervical smear done Any past sexually transmitted infection/ PID Obstetric History Gravidity and parity Birth history - mode of delivery - intrapartum complications - weight of baby Miscarriage and termination of pregnancy Other History Past medical and surgical history Past family history Medications and allergies Social History - Smoking/ Alcohol? - Recreational Drug use Summarises Differential diagnosis Antepartum haemmorhage Ruptured ectopic pregnancy Threatened miscarriage Surgical/medical causes Complete (2) Partial (1) Not Done (0)

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Part B Breaking bad news Establishes patients ideas, concerns, expectation Checks patients prior understanding of investigations Warning shot Shows appropriate skills in breaking bad news 1. Breaks bad news appropriately and sympathetically 2. Pauses after BBN 3. Checks patient is ok- allows patient to speak and address any concerns 4. Answer patients questions appropriately Maintain patient-centred approach throughout consultation- do not overload information- allow patient to take control of consultation Is clear, empathic but firm on the diagnosis. Appropriate use of body language and tone of voice Acknowledges patients feelings/ concerns and responds appropriately Establish patients plans- anything they wish to do, show appropriate support and offers help Listens effectively, appropriate silence Summarises consultation and checks patient understanding Offers leaflet and arranges patient follow up Organised and systematic approach Professionalism throughout

Examiners Global Score: 4 Clear pass 3 Pass 2 Borderline 1 Fail

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