Thursday, 20 December 2012

Tutorial 20 December 2012

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Tonight we answered 2 EMQs on haemophilia A and discussed 4 essay plans.


EMQ. Haemophilia A. Two questions.    


EMQ1.
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 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?


EMQ2. Haemophilia A. Pre-pregnancy counselling.

Lead-in.
The following scenarios relate to haemophilia A and pre-pregnancy counselling.
For each, select the most appropriate risk from the option list.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Scenario 1.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has mild haemophilia A.
Scenario 2.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has severe haemophilia A.
Scenario 3.
A para 3, 30-year-old wishes to know the risk of her being a carrier as her mother is a carrier.
Scenario 4.
A para 0+4, 25-year-old wishes to know the risk of her being a carrier as her sister has an affected son.
Scenario 5.
 A para 6, 40-year-old wishes to know the risk of her being a carrier as her daughter has had an affected baby.
Scenario 6.
 A nulliparous woman wishes to know the risk of a son having haemophilia as she is a carrier.
Scenario 7.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband has haemophilia A.
Scenario 8.
A nulliparous woman wishes to know the risk of a daughter being a carrier as she is a carrier.
Scenario 9.
A nulliparous woman wishes to know the risk of a daughter being a carrier as her husband has haemophilia A.
Scenario 10.
A nulliparous woman wishes to know the risk of a son having haemophilia as her paternal grandfather had haemophilia A.
Scenario 11.
A nulliparous woman wishes to know the risk of a son having haemophilia as her maternal grandfather had haemophilia A.
Scenario 12.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s paternal grandfather had haemophilia A.
Scenario 13.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s maternal grandfather had haemophilia A.
Scenario 14.
A nulliparous woman wishes to know the risk of a son having haemophilia as her mother’s brother has haemophilia A.
Scenario 15.
A nulliparous woman wishes to know her risk of being a carrier as she has read about it in a magazine. There is no family history of haemophilia A.



Option list.

A.
0 %
B.
0.1 %
C.
1 %
D.
12.5 %
E.
13.3%
F.
20 %
G.
25 %
H.
33 %
I.
50 %
J.
66.6%
K.
68 %
L.
75 %
M.
80 %
N.
90 %
O.
100 %
P.
200 %



1.      A 28-year-old woman is referred to the gynaecology clinic with suspected premature ovarian failure. She has “hot flushes”, has not menstruated for 8 months and a FSH level was found to be 40 iu/l.
1. Outline the main causes of premature ovarian failure. 10 marks
2. Critically evaluate the management options.              10 marks    

2.      A nulliparous woman of 30 years attends for pre-pregnancy counselling. Her father is a carrier of the Fragile X premutation. Her paternal uncle has Fragile X syndrome. Critically evaluate the management.

3.      With regard to endometrial cancer.
1. Outline the key features of Type 1 and Type 2 cancers.         4 marks
2. Outline the FIGO histological grading system.                      2 marks
3. Critically evaluate the FIGO staging for endometrial cancer.    6 marks
4. Detail the FIGO staging system for endometrial cancer.         8 marks.        

4.      Critically evaluate the statement: “fortification of flour is overdue in the UK”.      
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Monday, 17 December 2012

Tutorial 17 December 2012

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Tonight we answered an EMQ on antenatal steroids and discussed 5 essay plans.


Antenatal steroids and the neonate.

Lead-in.
The following scenarios relate to antenatal steroid use and the neonate.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
ANS:      antenatal steroids.
FGR:      fetal growth restriction.
GTG:     Green-Top Guideline No 7 from the RCOG. “Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality.”
RDS:      respiratory distress syndrome. Now better known as “surfactant-deficient lung disease of the new-born”.
Option list.
As before, there is no option list.
I want you to come up with your answers.
I’ll produce one and send it once I have seen your answers.
Scenario 1.
What are the benefits to the neonate of appropriate administration of antenatal steroids?
Scenario 2.
At what gestations should antenatal steroids be offered to women with singleton pregnancies who are at risk of premature labour?
Scenario 3.
At what gestations should antenatal steroids be offered to women with multiple pregnancies who are at risk of premature labour?
Scenario 4.
What advice is contained in the GTG in relation to very early gestations, threatened premature labour and the use of antenatal steroids.
Scenario 5.
What advice is contained in the GTG in relation to antenatal steroids and Caesarean section?
Scenario 6.
What advice is given in the GTG about ANS in relation to the fetus with FGR at risk of premature delivery?
Scenario 7
What advice is given in the GTG in relation to ANS for women with IDDM?
Scenario 8
What advice is in the GTG in relation to adverse effects of ANS on the fetus?
Scenario 9
What advice is in the GTG in relation to short-term maternal adverse effects?
Scenario 10
What contraindications to ANS are cited in the GTG?
Scenario 11
What is the recommended drug regime for ANS administration?
Scenario 12.
What is the time-scale for maximum effect of ANS in reducing RDS?
Scenario 13.
When should repeat courses of ANS be given?


1.      With regard to the Clinical Negligence Scheme for Trusts.
a.            What it the CNST?                                                         8 marks
b.            Describe the impact of the CNST on obstetric practice.    12 marks

2.      Critically evaluate vitamin supplementation in pregnancy.

3.      You have been put in charge of introducing a policy in the antenatal clinic for the management of domestic violence. Your recommendations have been accepted by the senior staff in the department and the launch date for the new policy in is 3 months. You have been asked to give a lecture to the midwives detailing the important issues relating to the introduction of the policy. Critically evaluate the topics you will include in the lecture.

4.      With regard to precocious puberty.
a.            What is the definition?                                                              4 marks.
b.            Critically evaluate the main causes in a girl.                               6 marks.
c.            Outline the investigation of a girl with PP.                                   4 marks.
d.            Outline the main issues in the management of a girl with PP.       6 marks.

In relation to diagnostic laparoscopy, critically evaluate:
1.       the issues to be discussed in obtaining informed consent            4 marks.
2.       the factors that increase the incidence of entry-related injury       4 marks.
3.       how entry-related injuries may be minimised                             12 marks.

 

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