Thursday, 13 February 2014

Tutorial 13 February 2014


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19
EMQ. Vulval conditions
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Feb
2014
20
EMQ. Down’s syndrome screening
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Feb
2014
21
EMQ. Drugs in O&G.
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Feb
2014
84
With regard to adhesions that result from abdominal surgery.
1. Outline the incidence and possible adverse consequences of adhesion formation after surgery.                                          8 marks.
2. How may the incidence of surgical adhesions be reduced? 12 marks.
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Feb
2014
85
With regard to Gestational Trophoblastic Neoplasia.
Outline the factors influencing prognosis.
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Feb
2014
86
Ovarian torsion.
1. Critically evaluate the diagnosis of ovarian torsion.        8 marks.
2. Justify your management of ovarian torsion.                  12 marks.
13
Feb
2014

Lead-in.
The following scenarios relate to vulval conditions.
Choose the most likely vulval condition from the option list.
Each option can be used once, more than once or not at all.

Scenario 1.
A 22 year-old woman attends the colposcopy clinic after 2 smears showing minor atypia. The cervical appearances are of aceto-white with punctation. 
Scenario 2.
A 60-year old woman has an erythematous rash of the vulva extending to the inner thighs. A similar rash is noted under the breasts. She is not known to have diabetes.
Scenario 3.
A woman attends the gynaecology clinic with a vulval rash. It has a “lacy” appearance. 
Scenario 4.
A 35-year old woman attends is noted to have a vulval fistula. She has a history of episodic diarrhoea. 
Scenario 5.
A 25-year old woman attends the gynaecology clinic with a history of intense vulval itching and soreness. The appearances are of diffuse erythema with excoriation. Diabetes, candidiasis and other local infections have been eliminated by the GP. 
Scenario 6.
A 35-year old woman attends the gynaecology clinic with vulvitis. She also has a scalp rash. Clinical examination shows scaly, pink patches with signs of excoriation. Skin samples grow Malassezia ovalis.
Scenario 7.
A 40-year old woman has evidence of chronic vulval ulceration. She has recently been seen by a dermatologist for mouth ulceration and has been started on thalidomide.
Scenario 8.
An African woman of 35 years attends the gynaecology clinic. She has a ten-year history of chronic vulval ulceration. Examination shows multiple, tender vulval and pubic subcutaneous nodules, some of which have ulcerated.
Scenario 9.
A Caucasian woman of 29 years attends the gynaecology clinic with a chronic vulval rash. Examination shows erythematous areas with clearly defined margins and white scaly patches. 
Scenario 10.
A 30-year old woman attends the gynaecology clinic with vulval itching. Examination shows erythema of the labia minora and perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium with increased mitotic activity.

Option list.
A.
Acne.
B.
Behçet’s syndrome.
C.
Candidiasis.
D.
CIN 3
E.
CIN1
F.
Crohn’s disease.
G.
Dermatitis.
H.
Eczema.
I.
Genital warts.
J.
Hidradenitis suppurativa.
K.
Leprosy.
L.
Lichen planus
M.
Lichen sclerosis
N.
Lymphogranuloma venereum
O.
Normal skin.
P.
Psoriasis.
Q.
Seborrhoeic dermatitis.
R.
Type 1 diabetes mellitus
S.
Type 2 diabetes mellitus
T.
Ulcerative colitis.
U.
VIN III.



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.

Abbreviations.
DS.         Down’s syndrome.
FASC:    Fetal Anomaly Screening Programme.
NSC:      National Screening Committee
Suggested reading.

Option list.
a.       1 in 2
b.      1 in 5
c.       1 in 10
d.      1 in 20
e.      1 in 40
f.        1 in 250
g.       1 in 400
h.      1 in 1,000
i.         5 mm.
j.        6 mm.
k.       7 mm.
l.         8 mm.
m.    10 mm.
n.      1%
o.      2%
p.      5%
q.      10%
r.        80%
s.       95%
t.        90%
u.      95%
v.       higher
w.     lower
x.       true
y.       false
z.       none of the above.

Scenario 1.
What is the age-related risk of DS at 20 years?
Scenario 2.
What is the age-related risk of DS at 30 years?
Scenario 3.
What is the age-related risk of DS at 35 years?
Scenario 4.
What is the age-related risk of DS at 40 years?
Scenario 5.
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.
Scenario 12
 What characteristic is described in relation to the occipital hairline in DS?
Scenario 13
 What characteristic is described in relation to the frontal hairline in DS?
Scenario 14
 What is the incidence of congenital heart anomaly in DS?
Scenario 15
 Which is the most common congenital heart anomaly in DS?
Scenario 16
 Which major haematological condition is more common in those with DS?
Answer. 
Scenario 17
 Which major neurological condition is more common in middle age in those with DS?
Scenario 18
 Which spinal anomaly is more common in DS and of concern to anaesthetists?

Drugs in Pregnancy. 2
Lead-in.
The following scenarios relate to some common drugs used in pregnancy.
Pick one option from the option list. Each option can be used once, more than once or not at all.
Abbreviations.
NSAID.  non-steroidal anti-inflammatory drug.

Option list.
I have not given one to make you think! And, in the exam, you should be deciding your answer before you check the option list.
Scenario 1.
What is the generic name for Prostin?
Scenario 2.
What kind of drug is Prostin?
Scenario 3.
What is the generic name for Misoprostol?
Scenario 4.
What kind of drug is Misoprostol?
Scenario 5.
What is the generic name for Gemeprost?
Scenario 6.
What kind of drug is Gemeprost?
Scenario 7
What is the generic name for Mifepristone?
Scenario 8
What king of drug is Mifepristone?
Scenario 9
What are the constituents of a 1 ml. ampoule of Syntometrine?
Scenario 10
What is the generic name for Carbetocin?
Scenario 11
What kind of drug is Carbetocin?
Scenario 12
What is the generic name for Hemabate?
Scenario 13
What kind of drug is Hemabate?
Scenario 14
What is the generic name for Atosiban?
Scenario 15
What kind of drug is atosiban?
Scenario 16
What if the generic name for Cervagem?
Scenario 17
What kind of drug is Cervagem?
Scenarion 18
What is the cost of 1mg. of Prostin E2 gel and what are its storage requirements?
Scenarion 19
What is the cost of a 1mg. Gemeprost pessary and what are its storage requirements?
Scenarion 20
What is the cost of 200 mcg. of misoprostol and what are its storage requirements?

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