Thursday, 24 July 2014

Tutorial 21 July 2014

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Only one person attended, so there was no tutorial.
The topics we would have discussed are below.

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13
EMQ Haemophilia A. Prepregnancy counselling.
43
You are the SpR in the fertility clinic.
A couple have been referred by their General Practitioner after basic investigation of their three years of infertility. She has a 5-year-old daughter by a previous partner. The pregnancy, delivery and puerperium were normal. Her menstrual cycle is normal and a serum progesterone has confirmed ovulation.
He has never made a partner pregnant and the GP letter states that he has a low sperm count.
1. Justify the history you will take.                                4 marks
2. How do you categorise male infertility?                  4 marks
2. Justify the investigations you will arrange.             4 marks
3. Outline the management and available options.   8 marks
44
A 55-year-old woman is referred to the gynaecology clinic. A friend of the same age has recently been found to have osteopenia and has been started on a bisphosphonate drug. She wishes to discuss her risk of osteoporosis and what she can do to reduce it.
1. Discuss how her risk of osteoporosis can be assessed.                        6 marks
2. Critically evaluate the steps that can be taken to reduce her risk.  14 marks
45
With regard to cervical cancer:
1.  Critically evaluate the FIGO staging classification.       8 marks
Describe the FIGO staging.                                                  12 marks
46
A 25-year-old midwife sustains a needle-stick injury during a normal delivery and requests advice.
1. Which potential infections are of concern in needle-stick injuries? 2 marks.
2. What characteristics of needle-stick or “splash” exposure increase the risk of infection? 4 marks.
3. What history will you take? 6 marks.
4. What should be done to minimise the risks?  8 marks.

Lead-in.
The following scenarios relate to haemophilia A and pre-pregnancy counselling.
For each, select the most appropriate risk from the option list.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Scenario 1.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has mild haemophilia A.
Scenario 2.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has severe haemophilia A.
Scenario 3.
A para 3, 30-year-old wishes to know the risk of her being a carrier as her mother is a carrier.
Scenario 4.
A para 0+4, 25-year-old wishes to know the risk of her being a carrier as her sister has an affected son.
Scenario 5.
 A para 6, 40-year-old wishes to know the risk of her being a carrier as her daughter has had an affected baby.
Scenario 6.
 A nulliparous woman wishes to know the risk of a son having haemophilia as she is a carrier.
Scenario 7.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband has haemophilia A.
Scenario 8.
A nulliparous woman wishes to know the risk of a daughter being a carrier as she is a carrier.
Scenario 9.
A nulliparous woman wishes to know the risk of a daughter being a carrier as her husband has haemophilia A.
Scenario 10.
A nulliparous woman wishes to know the risk of a son having haemophilia as her paternal grandfather had haemophilia A.
Scenario 11.
A nulliparous woman wishes to know the risk of a son having haemophilia as her maternal grandfather had haemophilia A.
Scenario 12.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s paternal grandfather had haemophilia A.
Scenario 13.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s maternal grandfather had haemophilia A.
Scenario 14.
A nulliparous woman wishes to know the risk of a son having haemophilia as her mother’s brother has haemophilia A.
Scenario 15.
A nulliparous woman wishes to know her risk of being a carrier as she has read about it in a magazine. There is no family history of haemophilia A.



Option list.

A.
0 %
B.
0.1 %
C.
1 %
D.
12.5 %
E.
13.3%
F.
20 %
G.
25 %
H.
33 %
I.
50 %
J.
66.6%
K.
68 %
L.
75 %
M.
80 %
N.
90 %
O.
100 %
P.
200 %


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