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EMQ. Anti-D immunoglobulin.
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55
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Vitamin D and pregnancy.
Which conditions have been linked to low maternal vitamin D levels? 10 marks
Which women are at increased risk of having low vitamin D levels? 6 marks
What is being done in the UK to prevent low vitamin D levels in pregnancy? 4 marks.
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56
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A 25 year-old woman books at 8 weeks. She has one child, aged 3 years. He has recently had chickenpox diagnosed. Her sister is 38 weeks pregnant.
1. Justify your initial management. 8 marks.
2. Justify your management for the rest of the pregnancy. 8 marks.
3. Justify the advice you will give with regard to her sister. 4 marks.
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57
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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.
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58
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A 53-year-old woman is referred by her GP. She wishes to discuss HRT. She is recovering well from treatment for endometrial cancer.
1. Outline the history you will take. 4 marks
2. Justify the investigations you will arrange. 2 marks
3. Critically evaluate your management. 14 marks
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Lead-in.
The following scenarios relate to Rhesus prophylaxis and anti-D.
Abbreviations.
Ig: immunoglobulin.
FMF: feto-maternal haemorrhage.
RAADP: routine antenatal anti-D prophylaxis.
RBC: red blood cells.
RhAI: Rhesus D alloimmunisation.
BSE: bovine spongiform encephalopathy.
CJD: Creutzfeldt-Jakob Disease.
There is no option list to force good technique!
Scenarios.
1. What proportion of the Caucasian population in the UK has Rh –ve blood group?
2. What proportion of the Rhesus +ve Caucasian population is homozygous for RhD?
3. What is the chance of a Rh –ve woman with a Rh +ve partner having a Rh –ve child?
4. When was routine postnatal anti-D prophylaxis introduced in the UK?
5. Where does anti-D for prophylactic use come from?
6. How many deaths per 100,000 births were due to RhAI up to 1969.
7. How many deaths per 100,000 births were due to RhAI in 1990.
8. Anti-D was in short supply in 1969. Which non-sensitised Rh –ve primigravidae with Rh +ve babies would not be given anti-D as a matter of policy?
9. List the possible reasons that a Rhesus –ve mother with a Rhesus +ve baby who does not receive anti-D might not become sensitised?
10. What is the UK policy for the administration of anti-D after a term pregnancy?
11. What is the alternative name of the Kleihauer test?
12. What does the Kleihauer test do?
13. How does the Kleihauer test work and what buzz words should you have in your head?
14. When should a Kleihauer test be done after vaginal delivery?
15. What blood specimen should be sent to the laboratory for a Kleihauer test?
16. What steps should be taken to prevent sensitisation in the woman whose blood group is RhDu and whose baby is Rh +ve?
17. The Kleihauer test is of value in helping to decide if antenatal vaginal bleeding or abdominal pain are due to placental abruption, with a +ve test confirming FMH and making abruption highly probable. True/False
18. When should anti-D be offered?
19. When should a Kleihauer test be considered?
20. How often does the word “considered” feature in the GTG?
21. A Rhesus –ve woman miscarries a Rh +ve fetus at 18 week’s gestation. What should be done about Rhesus prophylaxis?
22. A Rhesus –ve woman miscarries a Rh +ve fetus at 20 week’s gestation. What should be done about Rhesus prophylaxis?
23. Which potentially sensitising events are mentioned in the GTG?
24. What factors are listed in the GTG as particularly likely to cause FMH > 4 ml
25. A woman has recurrent bleeding from 20 weeks. What should be done about Rh prophylaxis?
26. What are the key messages about giving RAADP?
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