Monday, 16 February 2015

16 February 2015

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There was no tutorial tonight.
The materials I would have used are below.
Send your answers and I'll send mine.




58
EMQ. Turner’s syndrome
59
EMQ. Vulval conditions
60
EMQ. Drugs in O&G 1
61
EMQ. Drugs in O&G 2

58. Turner’s  syndrome.
Turner’s  syndrome.
This is supposed to be an EMQ, but some of the questions are MCQs with “True” and “False” answers. But it includes everything I think you might be asked about Turner’s.
Abbreviations.
CHD
congenital heart disease
DDH
developmental dysplasia of the hip
Option list.
There is none to make your life more difficult.
Questions.
1.         TS is due to 45XO.                                                                                                            True /False
2.         What is the incidence of TS?                                                                                          True /False
3.         The incidence of TS rises with maternal age?            .                                                True /False
4.         Most cases of TS are due to loss of a paternal chromosome.                                True /False
5.         How common is monosomy X in TS?                         
6.         How common is monosomy Y in TS?                         
7.         What % of miscarriages are due to TS?                     
8.         What % of TS pregnancies miscarry?                         
9.         ↑ NT is a feature of TS                                                                                                    True /False
10.     ↑ NT is more common in foetuses with CHD?                                                          True /False
11.     Low birth weight is a feature of TS.                                                                              True /False.
12.     If TS is suspected, but the neonate’s karyotype  is normal, the diagnosis is Noonan’s syndrome.                                                                                                                                              True /False.
13.     Neonates with TS are at normal risk of DDH.                                                             True /False
14.     Immune hydrops is more common in TS.                                                                   True /False
15.     Cystic hygroma is more common in TS.                                                                       True /False
16.     What is the approximate risk of malignancy if there is XY mosaicism in TS?             
17.     How common is webbing of the neck in TS?                           
18.     How common is a low occipital hairline in TS?                       
19.     How common is congenital heart disease in TS?     
20.     Dissecting aortic aneurysm is more common in TS.                                                  True /False
21.     How common is lymphoedema in TS?                       
22.     How common is kidney disease in TS?                       
23.     Short stature in TS has been linked to the TS gene.                                                 True /False
24.     What % of adolescents with TS have scoliosis.         .
25.     Inverted nipples are more common in TS.                                                                 True /False
26.     1ry. amenorrhoea occurs in all cases.                                                                          True /False
27.     Adrenarche occurs at a normal time.                                                                           True /False
28.     Cubitus valgus is more common in TS.                                                                        True /False
29.     Cleft palate if a feature of TS.                                                                                        True /False
30.     Micrognathia is a feature of TS.                                                                                    True /False
31.     Abnormalities of teeth and nails are more common in TS.                                    True /False
32.     Otitis media is more common in TS.                                                                                           True /False
33.     Intelligence is usually lower in TS, especially verbal skills.                                      True /False
34.     Women with TS have higher mortality rates than other women.                          True /False
35.     Oestrogen should be started on diagnosis to promote bone growth.                     True /False
36.     Oestrogen-only HRT is appropriate for bone protection.                                       True /False
37.     Women with TS have an risk of hypertension.                                                     True /False
38.     Women with TS have an risk of coeliac disease.                                                   True /False
39.     Women with TS have an increased risk of Crohn’s disease and ulcerative colitis.         True /False
40.     Women with TS have an ↑ risk of diabetes                                                                              True /False
41.     Women with TS have an ↑ risk of hyperthyroidism.             True /False                                   True /False
42.     Women with TS have an ↑ risk of deafness.            .                                                True /False
43.     Women with TS have an ↑ risk of osteoporosis.                                                      True /False
44.     Women with TS have similar rates of red-green colour blindness to men.                      True /False
45.     Women with TS have a normal incidence of ptosis.                                                  True /False
46.     Women with TS cannot have children.                                                                        True /False
47.     The “short stature homeobox” (SHOX) gene has been implicated in TS.                    True /False

59. Vulval conditions.
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.
Option list.
A.
Acne.
B.
Beh├žet’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.

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.

60.  Drugs in O&G 1.
Lead-in.
The following scenarios relate to drugs & hypertension in pregnancy.
Pick one option from the option list. Each option can be used once, more than once or not at all.
Some questions are MCQs with True / False answers.
Abbreviations.
ACE:              angiotensin-converting enzyme.
ACEI:             angiotensin-converting enzyme inhibitor.
ARA:              angiotensin II receptor antagonist.
MAOI:           monoaminoxidase inhibitor.
Option list.
a)         False.
b)        True.
c)         5
d)        10
e)         15
f)          18
g)         20
h)        24
i)           contraindicated in the months before pregnancy
j)           contraindicated in the 1st. trimester
k)         contraindicated in the 2nd. trimester
l)           contraindicated in the 3rd. trimester
m)      contraindicated in all trimesters
n)        not contraindicated in pregnancy
o)        contraindicated in breastfeeding
p)        not contraindicated in breastfeeding
q)        an acute, severe illness like rheumatoid arthritis
r)          an acute, severe illness with encephalopathy and acute fatty liver
s)         an acute, severe illness with gastro-intestinal tract bleeding.

Scenario 1.
When are ACE inhibitors contraindicated in pregnancy?
Scenario 2.
When are ARAs contraindicated in pregnancy?
Scenario 3.
Can St. John’s Wort (SJW) be used in pregnancy?
Scenario 4.
Methyl dopa is an acceptable option for the treatment of gestational hypertension. True / False.
Scenario 5.
Spironolactone is contraindicated in pregnancy. True/False
Scenario 6.
Furosemide is an acceptable option in the management of gestational hypertension. True / False.
Scenario 7.
When are thiazide diuretics contraindicated in pregnancy?
Scenario 8.
Salbutamol is contraindicated for the management of premature labour. True / False.
Scenario 9.
Ergometrine is an integral part of active management of the 3rd. stage.  True / False.
Scenario 10.
When is aspirin contraindicated in pregnancy & the puerperium?
Scenario 11.
When are NSAID’s contraindicated in pregnancy and why?
Scenario 12.
Pethidine: adverse neonatal effects are most likely if the drug is administered in the six hours before birth. True / False.
Scenario 13.
Pethidine: what is the half-life in the mature neonate?
Scenario 14.
Pethidine: is contraindicated in those taking MOAIs or who have taken them in the previous 2 months.   True / False.
Scenario 15.
Pethidine: is relatively contra-indicated when there is significant blood loss.  True / False.
Scenario 16.
Pethidine: has greater analgesic effect in labour than Diamorphine.   True / False.
Scenario 17.  What is Reye’s syndrome?

61 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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