Thursday 27 June 2013

Tutorial 27 June 2013

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EMQ. Hepatitis B and pregnancy.
Lead-in.
Each of the following scenarios relates to hepatitis B and pregnancy.
Instructions.
For each scenario, select the most appropriate option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
HBcAg:     hepatitis B core antigen
HBeAg:     hepatitis B e antigen         
HBsAg:     hepatitis B surface antigen
HBcAb:     antibody to hepatitis B core antigen
HBeAb:     antibody to hepatitis B e antigen
HBsAb:     antibody to hepatitis B surface antigen
HBIG:       hepatitis B immunoglobulin
HBV:         hepatitis B virus
Option list.
A.      acyclovir
B.      divorce
C.      HBcAg +ve
D.     HBeAg +ve
E.      HbsAg +ve
F.       HBsAg +ve; HBsAb –ve; HBcAb -ve
G.     HBsAg +ve; HBsAb –ve on two tests six months apart
H.     HBsAG –ve; HBsAb -ve on two tests six months apart
I.        HBsAg –ve; HBsAb +ve; HBcAb –ve
J.        HBsAg –ve; HBsAb +ve; HBcAb +ve
K.      HBsAg –ve; HBsAb +ve
L.       HBsAg +ve; HBcAg +ve
M.   HBV vaccine.
N.     HBIG
O.     HBV vaccine + HBIG
P.      immune as a result of infection
Q.     immune as a result of vaccination
R.      not immune
S.       chronic carrier of HBV infection
T.      10%
U.     30%
V.      50%
W.   60%
X.      70 - 90%
Y.      soap and boiling water
Z.      10% dilution of bleach in water
AA. 10% dilution of formaldehyde in alcohol
BB. ultraviolet irradiation
CC. yes
DD.no
EE.  none of the above

Scenario 1.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she has an acute infection?
Scenario 2.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of natural infection?
Scenario 3.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?
Scenario 4.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 6 months ago. What results on routine blood testing would indicate that she is a chronic carrier of HBV infection?
Scenario 5.
Testing shows that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb. What does this mean in relation to his HBV status?
Scenario 6.
Testing shows that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.
What does this mean in relation to his HBV status?
Scenario 7
A primigravid woman at 8 weeks gestation is found to be non-immune to the HBV. She has recently married and her husband is a chronic carrier. What should be done to protect her from infection?
Scenario 8
A woman is a known carrier of Hepatitis B. What is the risk of vertical transmission in the first trimester?
Scenario 9
A woman is a known carrier of Hepatitis B. What is the risk of the neonate who has been infected by vertical transmission in the third trimester becoming a carrier without treatment?
Scenario 10
How effective is hepatitis B prophylaxis in preventing chronic carrier status developing in a neonate infected as a result of vertical transmission?
Scenario 11
Can a woman who is a chronic HBV carrier breastfeed safely?
Scenario 12.
Hepatitis B infection is the most dangerous of the viral hepatitis infections in pregnancy.
Scenario 13.
A pregnant woman who is not immune to HBV has a partner who is a chronic carrier. Can HBV vaccine be administered safely in pregnancy?
Scenario 14.
A pregnant woman who is not immune has a partner with acute hepatitis due to HBV. He cuts his hand and bleeds onto the kitchen table. How should she clean the surface to ensure that she gets rid of the virus?
Scenario 15.
Is it true that the presence of HBeAg in maternal blood is a particular risk factor for vertical transmission? Not really a scenario, but never mind!




22
Critically evaluate the statement: “fortification of flour is overdue in the UK”.
23
With regard to fetal welfare in labour.
1. Critically evaluate the methods available for monitoring the fetal condition.   4 marks
2. List the criteria recommended by NICE for continuous electronic fetal monitoring.     6 marks.    
24
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.
25
You have been asked to give a lecture on the Mental Capacity Act 2005 to the junior staff of the department of O&G using illustrative examples.
Describe the types of cases you will use and the key points you will make.          

Thursday 20 June 2013

Tutorial 20 June 2013


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EMQ
Lead-in.
The following scenarios relate to ulipristal. For each, select the most appropriate from the option list.
Each option can be used once, more than once or not at all.

Scenario 1.
What type of drug is ulipristal?
Scenario 2.
How is ulipristal broken down / excreted?
Scenario 3.
What is the half-life of ulipristal?
Scenario 4.
Which drug may prolong the half-life of ulipristal?
Scenario 5.
What is the main use of ulipristal?
Scenario 6.
What is the dose of ulipristal?
Scenario 7.
What time-scale applies to the licensed use of ulipristal?
Scenario 8.
What contraceptive advice is given to those using ulipristal?
Scenario 9.
What advice is given to women who are breast-feeding?
Scenario 10.
Can treatment with ulipristal be repeated within 1 month?

Option list.
GnRH analogue.
Selective serotonin reuptake inhibitor.
19-nortestosterone derived progestagen.
21-hydroxyprogesterone-derived progestagen.
mifepristone derivative.
Selective oestrogen receptor modulator.
Selective progesterone receptor modulator.
Urinary excretion.
Metabolised by renal cytochrome P450 enzyme system.
Metabolised by hepatic cytochrome P450 enzyme system.
30 mg. with dose repeated if vomiting occurs within 3 hours.
100 mg. with dose repeated if vomiting occurs within 3 hours.
150 mg. with dose repeated if vomiting occurs within 3 hours.
phenobarbitone
valium
erythromycin
12 hours.
18 hours.
32 hours.
72 hours.
120 hours.
Depot-contraception.
Depression.
Emergency contraception.
Menorrhagia.
Termination of pregnancy.
Yes.
No.
Maybe.
Continue.
Discontinue for 36 hours.
Discontinue for 72 hours.
May interfere with contraception containing progestagen.
May interfere with contraception containing oestrogen.
No action if LARC being used.



18
With regard to Systemic Lupus Erythematosis (SLE):
1.  outline the clinical manifestations of SLE.             4 marks.
2.  outline the implications of SLE for pregnancy .    4 marks.
3.  critically evaluate how the diagnosis is made.      4 marks.
4.  critically evaluate the management in the woman wishing to be pregnant.       8 marks.
4a.critically evaluate the management of a woman booking at 8 weeks.              8 marks.
19
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.
20
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
21
A six year old girl is referred to the gynaecology clinic with a 2 month history of vaginal discharge.
1. Justify the history you will take.            5 marks
2. Justify the investigations you will do.     5 marks
3. Critically evaluate the management.     10 marks