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Tonight we managed an EMQ and 4 essay topics.
Essays 14 February 2013.
EMQ. Down syndrome screening.
A 55 year old
woman is referred with loss of libido.
1. Outline the key points in the history. 8 marks
2. Outline the investigations you will arrange. 4 marks
3. Critically evaluate the management. 8 marks
Discuss the
contra-indications to the use of the COC.
An 88-year-old
woman with severe Alzheimer’s disease has been admitted to the orthopaedic ward
after a fall. Vaginal bleeding has been noted. You have been asked to see her.
1. Justify the history you will take. 6 marks
2. Justify the investigations you will arrange. 2 marks
3. Justify your management.
12 marks
It is Saturday
morning. You are the on-call SpR for
gynaecology and have been asked for help by the locum Registrar in A&E.
A man has returned from Africa on a surprise visit home.
On arrival he cut his finger on a kitchen knife and has attended A&E for
treatment. He is accompanied by his
wife. His finger has been cleaned and two sutures have been inserted. Prior to
treatment he mentioned that he was found to be HIV+ve as a result of
extra-marital heterosexual activity in Africa and was started on
anti-retroviral therapy there. He refuses to disclose his HIV status to his
wife as she would “go mad” if she were to discover his infidelity. She has
asked for contraceptive advice as he was not due to return for several months
and she stopped contraception when he left 3 months before. The A&E
Consultant has gone out to a major road traffic accident and is not expected to
be available for about an hour. The husband is not prepared to await his
return. The sexually-transmitted disease STD clinic is closed and will not open
until Monday. You have spoken to your Consultant who has said he doesn’t want
to know and that you have to “get on with it”. Outline and justify your
management.
Lead-in.
The following scenarios relate to screening for Down’s
syndrome.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Scenario 1.
a.
What is the
age-related risk of DS at 20 years?
Scenario 2.
b.
What is the
age-related risk of DS at 30 years?
Scenario 3.
c.
What is the
age-related risk of DS at 35 years?
Scenario 4.
d.
What is the age-related
risk of DS at 40 years?
Scenario 5.
e.
What is the
age-related risk of DS at 45 years?
Scenario 6.
AFP levels are lower in Ds.
Scenario 7
Inhibin levels are raised in
DS.
Scenario 8
Oestriol levels are raised in
DS.
Scenario 9
β-hCG levels are raised in DS.
Scenario 10
1st. trimester PAPP-A levels are lower in DS.
Scenario 11
2nd. trimester PAPP-A levels are normal in DS.
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