Tutorial 14th. February 2011

Podcast.

Website.

Tonight's topics were:

First an EMQ.

Lead-in.
The following scenarios relate to haemophilia A, factor VIII deficiency (HA).
For each, select the most appropriate answer from the option list.
Each option can be used once, more than once or not at all.

Scenario 1.
A woman attends for pre-pregnancy counselling. Her brother has haemophilia A. What is her risk of being a carrier?
Scenario 2 .
A woman attends for pre-pregnancy counselling. Her father has haemophilia A. What is her risk of being a carrier?
Scenario 3.
If she is tested and found to be a carrier, what tests will you arrange for her partner?
Scenario 4.
If she is a carrier, what is the risk to her male offspring?
Scenario 5.
If she is a carrier, what is the risk to her female offspring?
Scenario 6.
If she is a carrier and her partner tests has haemophilia A, what are the risks to their female offspring?
Scenario 7.
If she is a carrier and her partner has haemophilia A, what are the risks to their male offspring?
Send me your answers and I'll send my version with explanation. I wrote the EMQ just before the tutorial and haven't had time to do an option list, so just work out what the answer should be. Good EMQ technique, anyway, as this is what you are advised to do first, then to check the option list.

Then we did some essays:
68 An obese woman of 25 is referred to the gynaecology clinic with oligomenorrhoea and a scan showing polycystic ovaries.
1. What are the diagnostic criteria for PCOS? 2 marks
2. What investigations will you arrange to confirm that she has PCOS and to help you advise about management? 4 marks
3. Justify your management if PCOS is diagnosed. 14 marks

69 With regard to gestational diabetes:
1. what are the diagnostic criteria? 2 marks
2. justify your views on screening for gestational diabetes. 4 marks
3. outline the key aspects of management 14 marks

70 A woman of 75 is referred to the gynaecology clinic with prolapse of the vaginal vault. She had hysterectomy some years before.
1. Outline the key elements of the history. 4 marks
2. Justify the investigations you will arrange. 6 marks
3. Justify the discussion you will have with her about the treatment options. 10 marks
The RCOG likes this topic. It came in the essays in 2001, 2005 and 2008.
There is a Green-top from 2007.

71 You have been asked to write a protocol for the diagnosis and management of umbilical cord prolapse.
1. Justify the steps you will take. 6 marks
2. Justify the key advice you will include in the protocol. 14 marks
Cord prolapse has not come in the essays, but there is a Green-top guideline from 2008.

72 Describe the pre-conceptual counselling that you would offer a 25- year-old nulliparous woman whose natural father suffers from Haemophilia A (Factor VIII deficiency).
This essay, worded as above, came in 1997.

We didn't manage numbers 70 and 72, but will do so next time.

There is a Green-top guideline on vault prolapse.