Tutorial 27 June

Podcast.
Website.
We started with 4 essays.
One had been done before - the ten top recommendations. I just put it in again to remind everyone of its importance.
And John told us that a similar essay to the one on DVT had appeared in the last exam.
When I checked, I found that I had looked into a list of exam questions that has not been updated!
It won't do any harm reviewing this topic as it will come somewhere.

Question 1.

A 35-year-old woman presents to A&E at 8 weeks’ gestation with left calf pain and leg swelling. Deep vein thrombosis is suspected.

1. critically evaluate the immediate management.           8 marks

2. critically evaluate the management of the remainder of the pregnancy and delivery.

                                                                                   8 marks                                                          

3. critically evaluate the advice you will give postnatally. 4 marks 

Question 2.

A primigravid 25-year-old woman has a routine scan at 20 weeks. Hydrops fetalis is noted. Her blood group is A Rhesus positive.

1.      Ouline the main causes of hydrops fetalis at this gestation.                                   12 marks.

2.      Outline the management in particular the management of treateable causes.    8 marks.

Pregnancy. Hydrops. Non-immune at 20 weeks. Primip.

September

1999

Question 3.

List then critically evaluate the ten top recommendations from the recent maternal mortality report.

Question 4.

A 20-year-old woman is referred to the gynaecology clinic with a complaint of hirsutism. Critically evaluate the management.

1.  Outline the necessary facts to obtain from the history.    6 marks.

2.  Justify the investigations you would arrange.                                     8 marks.

3.  Outline the key aspects of the management.                                     6 marks.

Hirsutism. 24 years old. C/o excessive hair. Mgt.	September	2002
Hirsutism. Normal hormones	March	2006

Then we had a look at an MCQ that I started to draft this afternoon.

My intention was to include all the key points from the GTG on management of VTE.

I'll try to finish it soon.

It reads as follows:

VTE in pregnancy.

AD:         aortic dissection.

APPT:    activated partial thromboplastin time.

CDU:      compression duplex ultrasound.

CTPA:    computed tomography pulmonary angiogram.

CV:         contrast venography

HIT:        heparin-induced thrombocytopenia.

IVC:        inferior vena cava.

JVP:       jugular venous pressure.

LFT:        liver function tests.

LMWH: low molecular weight heparin.

MRV:     magnetic resonance venography

PE:          pulmonary embolism.

U&E:      urea & electrolytes.

VQS:      ventilation / perfusion lung scanning.

VTE:       venous thrombo-embolism.

a.       VTE is the leading direct cause of maternal death.

b.      leucocytosis may be the only sign of DVT.              

c.       back pain may be a feature of DVT.                        

d.      CDU is the initial investigation of suspected DVT.

e.      if the initial CDU is –ve, anti-coagulants are stopped.

f.        CV is necessary when the CDU is negative in suspected DVT.

g.       CTPA or VQS should be done in all women with suspected PE.

h.      chest x-ray should be done in all women with suspected VTE.

i.         CTPS has > sensitivity and specificity than VQS in suspected PE.

j.        VQS has good negative predictive value in suspected PE.

k.       VQS delivers more radiation to the maternal breast than CPTA.

l.         CPTA delivers more radiation to the fetus that VQS.

m.    VQS is better than CPTA at identifying other pathologies such as AD.

n.      the radiation unit “Gy” is the abbreviation of “Gray”

o.      the radiation unit symbol “Gy” is the abbreviation of “Geigerλ”

p.      the ­ risk of breast cancer after VQS has been put at 13.6%.

q.      initial investigation of suspected VTE should include a thrombophilia screen.

r.        initial investigation of suspected VTE should include a coagulation screen.

s.       enoxaparin should be given in a dosage of 175 u./kg. for therapeutic effect.

t.        maternity units should have guidelines for i.v. unfractionated heparin.

u.      regional anaesthesia should not be used until at least 24 hours after stopping therapeutic doses of LMWH.

v.       therapeutic LMWH can be introduced after 3 hours after Caesarean section so long as regional anaesthesia has not been used.

w.     therapeutic LMWH can be introduced after Caesarean section so long as it is at least 6 hours since any epidural catheter.

x.       graded compression stockings should be worn for at least a year after an episode of VTE in pregnancy.