Thursday, 25 June 2015

Tutorial 25 June 2015

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25 June 2015.

24
SBA. Ovarian reserve.
25
Role-play. Communication skills: X-linked recessive inheritance. You have been asked to go over key aspects of recessive inheritance with a new FY1.
26
EMQ. Anti-D.
27
EMQ. Ulipristal

Question 24.
Topic. Ovarian reserve.

Abbreviations.
AFC:            antral follicle count
AMH:         anti-Mullerian hormone.
OR:             ovarian reserve.

Question 1.
Lead-in
What is the definition of ovarian reserve?

Option List

A.       
Sex-hormone-induced female shyness.
B.       
the number of functional oocytes per cubic centimetre of ovarian tissue
C.       
the number of oocytes per cubic centimetre of ovarian tissue
D.       
the number of remaining oocytes
E.        
the proportion of residual to primordial oocytes

Question 2.
Lead-in
What is the definition of the menopause?

Option List

A.       
the end of menstruation
B.       
the end of menstruation, but not if hysterectomy is the cause
C.       
the end of menstruation, but not if endometrial ablation is the cause
D.       
the time when periods become infrequent and finally cease
E.        
the climacteric

Question 3.
Lead-in
How many periods must be missed for the menopause to be diagnosed?

Option List

A.       
6
B.       
9
C.       
12
D.       
24
E.        
none of the above

Question 4.
Lead-in
What is the definition of the climacteric?

Option List

A.       
the same as “menopause”
B.       
the same as the “perimenopause”
C.       
the time from the start to the end of vasomotor symptoms
D.       
the time from the start of menopausal symptoms to one year after the LMP
E.        
I am never going to use this term again, so don’t ask me about it!
F.        
none of the above

Question 5.
Lead-in
What is the definition of premature menopause?

Option List

A.       
menopause occurring at an earlier age in successive generations
B.       
menopause occurring < 50 years
C.       
menopause occurring < 45 years
D.       
menopause occurring < 40 years
E.        
menopause occurring < 35 years

Question 6.
Lead-in
Which of the following conditions is not associated with premature menopause.

Conditions.

1.        
45XO/XX mosaicism
2.        
Fragile X pre-mutation carrier status
3.        
Fragile X full mutation carrier status
4.        
galactosaemia
5.        
Mayer – Rokitansky – Kuster - Hauser syndrome
6.        
Swyer’s syndrome.

Option List

A.       
1 + 2 + 4
B.       
1 + 2 +  4 + 5
C.       
1 + 2 + 4 + 6
D.       
1 + 3 + 4
E.        
3 + 4 + 5
F.        
 3 + 5 + 6
G.       
all of the conditions
H.       
some of the conditions, but I don’t know which
I.         
none of the conditions

Question 7.
Lead-in
A woman is a carrier of the Fragile X pre-mutation. What is her risk of premature ovarian failure?

Option List

A.       
5%
B.       
10%
C.       
15%
D.       
20%
E.        
25%

Question 8.
Lead-in
Where is FSH produced?

Option List

A.       
granulosa cells
B.       
hypothalamus
C.       
pineal gland
D.       
anterior pituitary
E.        
posterior pituitary

Question 9.
Lead-in
Where is LH produced?

Option List

A.       
granulosa cells
B.       
hypothalamus
C.       
pineal gland
D.       
anterior pituitary
E.        
posterior pituitary

Question 10.
Lead-in
Where is Inhibin A produced?

Option List

A.       
granulosa cells
B.       
granulosa cells of small developing follicles
C.       
granulosa cells of the dominant follicle and corpus luteum
D.       
ovarian stroma
E.        
adrenal gland

Question 11.
Lead-in
Where is Inhibin B produced?

Option List

A.       
granulosa cells
B.       
granulosa cells of small developing follicles
C.       
granulosa cells of the dominant follicle and corpus luteum
D.       
ovarian stroma
E.        
adrenal gland

Question 12.
Lead-in
Where is AMH produced?

Option List

A.       
granulosa cells
B.       
granulosa cells of small antral follicles
C.       
granulosa cells of the pre-antral follicles
D.       
dominant follicle and corpus luteum
E.        
ovarian stroma

Question 13.
Lead-in
Which if any of the following statements are true?

Statements.
1.        
AFC is based on antral follicles up to 2 mm in diameter
2.        
AFC is based on antral follicles up to 5 mm in diameter
3.        
AFC is based on antral follicles up to 10 mm in diameter
4.        
AFC is of proven superiority to AMH assay in assessing OR
5.        
AFC + AMH assay is a superior test to AMH assay alone in assessing OR

Option List

A.       
1 + 5
B.       
2 + 5
C.       
3 + 5
D.       
4
E.        
4 + 5
F.        
none of the above

Question 14.
Lead-in
Which is the best test to measure ovarian reserve?

Option List

A.       
early follicular FSH levels
B.       
luteal follicular FSH levels
C.       
early follicular-phase FSH + LH levels
D.       
early follicular-phase AMH levels
E.        
early follicular-phase AFC
F.        
none of the above


Question 25.     Roleplay.
 You are the SpR on call for the delivery unit. It is a quiet day with no-one in labour. The last patient to deliver was a woman who had been screened for an X-linked recessive disorder (XLRD). The baby had been found to be a carrier, like her.
The consultant thinks it would be a good idea for you to discuss the key points of XLRD with the new FY1.
What label might be best for most appropriate educational technique for this situation?
Option list.
1.                  brainstorming.
2.                  brainwashing
3.                  cream cake circle.
4.                  Delphi technique.
5.                  doughnut round.
6.                  1 minute preceptor method.
7.                  teaching peers / junior colleagues
8.                  schema activation.
9.                  schema refinement.
10.              small group discussion.
11.              snowballing.
12.              snowboarding.

Question 26.     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.
             
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?

Question 27.                  
Ulipristal.
Lead-in.
The following scenarios relate to ulipristal. For each, select the most appropriate from the option list.
Each option can be used once, more than once or not at all.

Option list.
A.       
GnRH analogue.
B.       
Selective serotonin reuptake inhibitor.
C.       
19-nortestosterone derived progestagen.
D.       
21-hydroxyprogesterone-derived progestagen.
E.        
mifepristone derivative.
F.        
Selective oestrogen receptor modulator.
G.       
Selective progesterone receptor modulator.
H.       
Urinary excretion.
I.         
Metabolised by renal cytochrome P450 enzyme system.
J.         
Metabolised by hepatic cytochrome P450 enzyme system.
K.        
30 mg. with dose repeated if vomiting occurs within 3 hours.
L.        
100 mg. with dose repeated if vomiting occurs within 3 hours.
M.     
150 mg. with dose repeated if vomiting occurs within 3 hours.
N.       
phenobarbitone
O.      
valium
P.        
erythromycin
Q.      
12 hours.
R.       
18 hours.
S.        
32 hours.
T.        
72 hours.
U.       
120 hours.
V.       
Depot-contraception.
W.     
Depression.
X.        
Emergency contraception.
Y.        
Menorrhagia.
Z.        
Termination of pregnancy.
AA.   
Yes.
BB.   
No.
CC.   
Maybe.
DD.  
Continue.
EE.    
Discontinue for 36 hours.
FF.     
Discontinue for 72 hours.
GG.  
May interfere with contraception containing progestogen.
HH.  
May interfere with contraception containing oestrogen.
II.       
No action if LARC being used.

Scenario 1.
What type of drug is ulipristal?
Scenario 2.
How is ulipristal broken down / excreted?
Scenario 3.
What is the half-life of ulipristal?
Scenario 4.
Which drug may prolong the half-life of ulipristal?
Scenario 5.
What is the main use of ulipristal?
Scenario 6.
What is the dose of ulipristal?
Scenario 7.
What time-scale applies to the licensed use of ulipristal?
Scenario 8.
What contraceptive advice is given to those using ulipristal?
Scenario 9.
What advice is given to women who are breast-feeding?
Scenario 10.
Can treatment with ulipristal be repeated within 1 month?



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