Tutorial 17 January 2013

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Tonight we had five essays, two of them similar.
And confusion over the EMQs.
I e-mailed one on Hepatitis B, only to be told that we had done it already.
It is in the tutorial for the 13th. December, so look there if you have not done it.
I added one on maternal death definitions - these can be tricky.
The essays were:

1.      Critically evaluate neonatal screening.

2.      Discuss the key aspects of neonatal jaundice.

a. why it is important.                        4 marks.

b. the causes of neonatal jaundice. 8 marks.

c. the management.                           8 marks.

3.      A nulliparous woman is found to have hydrops fetalis on a routine 20 week anomaly scan.

1. List the main causes of hydrops fetalis.      12 marks.

2. Outline the key investigations.                        8 marks.

4.      46  A woman of 48 is referred with erratic vaginal bleeding for six months. She has had an IUCD in place for five years. She has occasional hot flushes.

1. Justify the things you will focus on in taking her history.  6 marks

2. Justify the investigations you will perform.                          6 marks

3. Justify the advice you will give.                                               8 marks

5.      A woman of 38 is referred to the gynaecology clinic as the tail of her IUCD could not be seen when she recently had a routine cervical smear.

1.  Outline the history you will take.                      6 marks.

2.  Justify the investigations you will arrange.      4 marks.

3.  Justify your management.                                 10 marks.

Essays 1 & 2 have not featured in the exam. There have been a lot of changes in neonatal screening and I think it would make a good topic. Neonatal topics are legitimate and I am surprised that jaundice has not featured.

Hydrops fetalis came in 1998, but not since and, I am sure, will return one day. It is a technical essay, so you need a model.

Maternal Mortality.

Lead-in.

The following scenarios relate to maternal mortality.

Pick the option that best answers the task in each scenario from the option list.

Each option can be used once, more than once or not at all.

Option List.

A.   Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.

B.    Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.

C.    Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.

D.   Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.

E.    A pregnancy going to 24 weeks or beyond.

F.    A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.

G.   Maternal deaths per 100,000 maternities.

H.   Maternal deaths per 100,000 live births.

I.      Direct + indirect deaths per 100,000 maternities.

J.     Direct + indirect deaths per 100,000 live births.

K.    Direct death.

L.     Indirect death.

M. Early death.

N.   Late death.

O.   Extra-late death.

P.    Fortuitous death.

Q.   Coincidental death.

R.    Accidental death.

S.    Maternal murder.

T.    Not a maternal death.

U.   Yes

V.   No.

W. I have no idea.

X.    None of the above.

Abbreviations.

MMR:      Maternal Mortality Rate.

MMRat:  Maternat Mortality Ratio.

SUDEP:    Sudden Unexplained Death in Epilepsy.            

Option list.

Scenario 1.

What is a Maternal Death?

Scenario 2.

A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?

Scenario 3.

A woman dies from a ruptured appendix at 10 weeks’ gestation. What kind of death is it?

Scenario 4.

A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?

Scenario 5.

A woman with a 10-year-history of coronary artery disease dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?

Scenario 6.

A woman has gestational trophoblastic disease, develops choriocarcinomas and dies from it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?

Scenario 7

A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 18 months old. What kind of death is it?

Scenario 8

A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 6 months old. What kind of death is it?

Scenario 9

What is a “maternity”.

Scenario 10

What is the definition of the Maternal Mortality Rate?

Scenario 11

What is the Maternal Mortality Ratio?

Scenario 12

A woman is diagnosed with breast cancer. She has missed a period and a pregnancy test is +ve. She decides to continue with the pregnancy. The breast cancer does not respond to treatment and she dies from secondary disease at 38 weeks. What kind of death is it?

Scenario 13

A woman who has been the subject of domestic violence is killed at 12 weeks’ gestation by her partner. What kind of death is it?

Scenario 14

A woman is struck by lightning as she runs across a road. As a result she falls under the wheels of a large lorry which runs over abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?

Scenario 15

A woman is abducted by Martians who are keen to study human pregnancy. She dies as a result of the treatment she receives. As this death could only have occurred because she was pegnant, is it a direct death?

Scenario 16

Could a maternal death from malignancy be classified as “Direct”.

Scenario 17

Could a maternal death from malignancy be classified as “Indirect”.

Scenario 18

Could a maternal death from malignancy be classified as “Coincidental”?