Thursday, 23 January 2014

Tutorial 23 January 2014


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15
COC. Missed pills. Starting the Pill.
62
A 35 year-old woman books at 6 weeks. She has noted a left breast mass. Breast cancer is suspected.
1. What is the life-time risk of female breast cancer.         1 mark.
2. How does pregnancy affect the risks of breast cancer. 4 marks.
3. Outline the investigation.                                                    5 marks.
4. Critically evaluate the management.                               10 marks.
63
With regard to epidural anaesthesia:
1.  Outline the main differences between it and spinal anaesthesia. 4 marks.
2.  Outline the main techniques and drugs used.                                   6 marks.
2.  Evaluate the main contraindications.                                                  4 marks.
3.  Discuss the main uses.                                                                            6 marks.
64
A healthy 30-year-old woman with blood group Rh negative is found to have rhesus D antibodies at booking at 8 weeks.
Critically evaluate the management.
65
You have been asked to write guidance for the unit in relation to labour and delivery in water.
1. Outline how you will go about the task.                            8 marks.
2. Discuss the key issues to be included in the guidance. 12 marks
66
A 20 year-old woman with a known history of drug abuse attends the hospital antenatal booking clinic in her first pregnancy.
a. outline the factors determining her level of risk  4 marks.
b. outline the risks to the mother                                 6 marks.
c. outline the risks to the fetus                                      4 marks.
d. outline the risks to the neonate & infant              4 marks.
e. outline the risk to others                                             2 marks.

COC Missed pills. Starting the Pill..
Lead-in.
The following scenarios relate to the combined oral contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at all.
Abbreviations.
UPSI:     unprotected sexual intercourse.

Option list.
A.        pill that is ≥ 12 hours late.
B.        pill that is > 12 hours late.
C.        pill that is ≥ 24 hours late.
D.        pill that is > 24 hours late.
E.         two missed pills at any time in a single cycle.
F.         the first pill taken in one’s first love affair, now recalled with fond nostalgia for its effectiveness in preventing pregnancy, the Prince having been truly a loathsome toad.
G.       no additional contraception required.
H.        additional contraception required for 7 days.
I.          emergency contraception should be considered.
J.          emergency contraception should be recommended.
K.        take the missed pill immediately, but not if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
L.         take the missed pill immediately, even if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
M.      take the missed pill immediately, even if it means 2 pills in one day; additional contraception for 7 days; pill-free interval as usual.
N.       take one of the missed pills immediately, discard the other missed pills, use extra contraception for 7 days and discuss emergency contraception with your doctor.
O.       take the missed pills immediately, use extra contraception for 7 days and discuss emergency contraception with your doctor.
P.        continuous combined preparation.
Q.       bi-phasic preparation.
R.        quadriphasic preparation.
S.         cannot be answered from the data given.
T.         none of the above.


Scenario 1.
What is the definition of a missed pill?
Scenario 2.
What is the definition of two missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation. The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a 21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a 21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack. What advice should be given?
Scenario 11
What kind of preparation is Qlaira?

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