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Tonight's essays were:
1. A woman is referred after her third consecutive miscarriage at 10 weeks.
1. outline the key features in the history you will take. 4 marks
2. list the main causes of recurrent miscarriage. 4 marks
3. critically evaluate the investigations you will arrange. 6 marks
4. critically evaluate the available treatments for unexplained recurrent miscarriage. 6 marks
2. A primigravid woman works in a nursery where there is an outbreak of parvovirus infection. The gestation is 10 weeks.
Critically evaluate the management.
3. With regard to choriocarcinoma.
Outline the factors influencing prognosis.
Outline the key aspects of treatment.
4. Critically evaluate screening for chlamydia.
There were two related EMQs.
Obstetric cholestasis. (OC). Definition.
Lead-in.
The following scenarios relate to the definition.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
gamma GT: gamma-glutamyl transferase
GTG: RCOG’s Green-top Guideline No. 43. April 2011.
OC: obstetric cholestasis.
Option list.
A. true
B. false
C. don’t be daft
D. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, raised bile acids and pale stools, all of which resolve postnatally
E. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids and pale stools, all of which resolve postnatally
F. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids, all of which resolve postnatally
G. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids and pale stools, all of which resolve postnatally
H. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids, all of which resolve postnatally
I. levels do not usually rise in pregnancy
J. mostly originates in the placenta
K. levels vary with the time of day
L. no information in the GTG
M. none of the above
Scenario 1.
The international definition of OC was agreed at a conference in Tokyo in 1985.
Scenario 2.
What is the GTG’s definition of OC?
Scenario 3.
Levels of bile acids commonly rise significantly after meals making fasting levels mandatory for diagnosis.
Scenario 4.
The upper limit of normal for transaminases, gamma GT and bile acids is about 20% lower in pregnancy.
Scenario 5.
Liver function tests become abnormal as soon as the pruritus is noted.
Scenario 6.
What is the overall prevalence in Eskimos?
Scenario 7.
What is the incidence of pruritus in pregnancy?
Obstetric cholestasis. (OC). Prevalence.
Lead-in.
The following scenarios relate to the prevalence of OC.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
GTG: RCOG’s Green-top Guideline No. 43. April 2011.
OC: obstetric cholestasis.
Option list.
A. 0.1%
B. 0.5%
C. 0.7%
D. 1 – 1.2%
E. 1.2% to 1.5%
F. 1.5 – 2%
G. 2.4%
H. 3 – 3.5%
I. 5%
J. 7%
K. 15%
L. white
M. brown
N. blue-green
O. red-brown, striped
P. no information in the GTG
Q. none of the above
Scenario 1.
What is the overall prevalence in the UK population?
Scenario 2.
What is the overall prevalence in the Indian and Pakistani Asian populations?
Scenario 3.
What is the overall prevalence in Scandinavia?
Scenario 4.
What is the overall prevalence in Chile?
Scenario 5.
What is the overall prevalence in Araucanian Indians?
Scenario 6.
What is the overall prevalence in Eskimos?
Scenario 7.
What is the incidence of pruritus in pregnancy?
Scenario 8.
What colour of eggs do Araucanian chickens lay?
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