Monday, 17 February 2014

Tutorial 17 February 2014

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17 February 2014


22
EMQ. Ante-partum haemorrhage
23
EMQ. DSDs: AIS, MRKH and Swyer’s syndrome
24
EMQ. Endometrial cancer & FIGO
87
A 73-year-old woman is referred with vault prolapse 5 years after hysterectomy.
1. Discuss the steps that can be taken during and after hysterectomy to reduce the risk of vault prolapse.                                4 marks
2. Justify the history you will obtain.      4 marks
3. Evaluate the management options.   12 marks
88
Home birth.
A woman books at 10 weeks’ gestation and states that she is keen to have a home birth.
1. What are the key legal issues in relation to home birth?   2 marks
2. Justify the history you will take.                                      4 marks
3. Critically evaluate the advice you will give re the risks & benefits of home 
     birth.                                                                            6 marks
4. Justify your management plan.                                        8 marks
89
A primigravida collapses 1 hour after normal vaginal delivery.
1. Critically evaluate the differential diagnosis of maternal collapse.    6 marks.
2. How may impending maternal collapse be recognised.                  4 marks.
3. Critically evaluate the management of this woman.                      10 marks.
90
A primigravid woman attends the antenatal booking clinic at 5 weeks’ gestation. She smells strongly of alcohol. She admits to consuming at least ½ bottle of vodka each day.
1. Critically evaluate the public health advice available in the UK about alcohol and 
     pregnancy.                                                                           4 marks.
2. Critically evaluate screening for alcohol abuse in pregnancy.   4 marks.
3. Critically evaluate the risks to the fetus and child of the mother who abuses alcohol in 
    pregnancy.                                                                             6 marks.
4. Justify the management you would arrange for this patient.       6 marks.



Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Abbreviations.
ART:      assisted reproduction technology
FGR:      fetal growth restriction
PET:       pre-eclampsia

Option list.
A.        genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the baby
B.        genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the placenta.
C.        genital tract bleeding ≥ 500 ml. from 24 weeks, or earlier if the baby is live-born, until the delivery of the baby.
D.        1
E.         2
F.         3
G.       4
H.        5
I.          6
J.          7
K.        8
L.         9
M.      10
N.       15
O.       20
P.        30
Q.       50
R.        100
S.         500
T.         1,000
U.       true
V.        false
W.      none of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml. for minor APH
Scenario 3.
What is the upper limit in ml. of major haemorrhage
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor for placental abruption.
Scenario 7
List 10 risk factors for placental abruption.
Scenario 8
List 6 risk factors for placenta previa.
Scenario 9
In what % of pregnancies does APH occur?
Scenario 10
With regards to steps that can be taken to reduce the incidence of APH, what things would you include in an essay?

DSDs: AIS, MRKH and Swyer’s syndrome
Lead-in.
The following scenarios relate to disorders of sexual development.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Abbreviations.
AIS:        androgen insensitivity syndrome.
AMH:    anti-Mullerian hormone.
CAH:      congenital adrenal hyperplasia.
CAI:       complete androgen insensitivity syndrome.
DSD:      disorder of sexual differentiation.
KS:         Kallmann’s syndrome.
LMB:     Laurence-Moon-Biedl syndrome.
MRKH:  Mayer-Rokitansky-Kuster-Hauser syndrome.
PAI:       partial androgen insensitivity syndrome.
PW:       Prader-Willi syndrome.
SW:        Swyer’s syndrome.
TU:         Turner’s syndrome.
Suggested reading.

Option list 1.
A.        a uterus of normal size for her age is present.
B.        a uterus that is hypoplastic for her age is present.
C.        a vestigial uterus (anlagen) is present.
D.        no uterus is present.
E.         esthiomene commonly occurs
F.         I don’t know.
G.       the question makes no sense.
H.        none of the above.
I.           
Scenario 1.
a.         at the start of puberty in a girl with congenital adrenal hyperplasia.
b.        at the start of puberty in a girl with complete androgen insensitivity syndrome.
c.         at the start of puberty in a girl with a disorder of sexual differentiation.
d.        at the start of puberty in a girl with Kallmann’s syndrome.
e.        at the start of puberty in a girl with Laurence-Moon-Biedl syndrome.
f.          at the start of puberty in a girl with Mayer-Rokitansky-Kuster-Hauser syndrome.
g.         at the start of puberty in a girl with partial androgen insensitivity syndrome.
h.        at the start of puberty in a girl with Prader-Willi syndrome.
i.           at the start of puberty in a girl with Swyer’s syndrome.
j.          at the start of puberty in a girl with Turner’s syndrome.

Endometrial cancer & FIGO.

Lead-in.
The following scenarios relate to endometrial cancer.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Option list.
Scenario 1.
A histology report on endometrial curetting is of 95% adenocarcinoma with 5% solid, non-squamous areas. What is the FIGO grade?
Scenario 2.
A histology report on endometrial curetting is of 90% adenocarcinoma with 10% solid, non-squamous areas. What is the FIGO grade?
Scenario 3.
A histology report on endometrial curetting is of 50% adenocarcinoma with 50% solid, non-squamous areas. What is the FIGO grade?
Scenario 4.
A woman undergoes surgery for carcinoma of the endometrium. Histology shows the tumour is confined to the body of the uterus with 5% myometrial invasion. What is the FIGO staging?
Answer.
Scenario 5.
A woman undergoes surgery for carcinoma of the endometrium. Histology shows the tumour is confined to the body of the uterus with 25% myometrial invasion. What is the FIGO staging?
Scenario 6.
A woman undergoes surgery for carcinoma of the endometrium. Histology shows the tumour is confined to the body of the uterus with 60% myometrial invasion. What is the FIGO staging?
Scenario 7
A woman undergoes surgery for carcinoma of the endometrium. Histology shows the tumour is confined to the uterus. There is no myometrial invasion, but there is extension to the endocervical endothelium. What is the FIGO staging?
Scenario 8
A woman undergoes surgery for carcinoma of the endometrium. Histology shows the tumour is confined to the uterus. There is no myometrial invasion, but there is extension to the stroma of the cervix. What is the FIGO staging?
Scenario 9
A woman undergoes surgery for carcinoma of the endometrium. Peritoneal washings are +ve but there is no other evidence of spread outside the uterus. There is no myometrial invasion. There is extension to the stroma of the cervix. What is the FIGO staging?
Scenario 10
A woman undergoes surgery for carcinoma of the endometrium. There is no evidence of extension outside the uterus. There is myometrial invasion through to and including the serosa. What is the FIGO staging?
Scenario 11
A woman undergoes surgery for carcinoma of the endometrium. There is myometrial invasion. Tumour is noted in the vagina. There is no evidence of disease elsewhere. What is the FIGO staging?
Scenario 12
A woman undergoes surgery for carcinoma of the endometrium. There is myometrial invasion. Tumour is noted in the vagina. Positive pelvic nodes are found, but no other lymphatic involvement. There is no distant spread. What is the FIGO staging?
 Scenario 13
A woman undergoes surgery for carcinoma of the endometrium. There is myometrial invasion. Tumour is noted in the vagina. The tumour involves the mucosa of the bladder. There is no lymphatic or distant spread. What is the FIGO staging?


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