Monday, 27 June 2016

Tutorial 27th. June 2016

Website.

27 June 2016.

25
MgSO4 use in O&G. List all the points you think might get a mark in the exam. Think main headings for uses then key points for each. Think EMQ, SBA and viva.
26
SBA. Ovarian reserve
27
EMQ. Anti-D.
28
Roleplay. Communication skills: X-linked recessive inheritance. You have been asked to go over the key aspects of recessive inheritance with a new FY1.
29
EMQ. Maternal Mortality definitions

25.         Magnesium sulphate use in O&G.
MgSO4 use in O&G. List all the points you think might get a mark in the exam. Think main headings for uses then key points for each. Think EMQ, SBA and viva.

26.   EMQ. 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

27.   EMQ. Anti-D.
Anti-D prophylaxis.
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?

28.   Roleplay. Communication skills: X-linked recessive inheritance. You have been asked to go over the key aspects of recessive inheritance with a new FY1.

29.   EMQ. Maternal Mortality.
Lead-in.
The following scenarios relate to maternal mortality. Pick the option that best answers the question in each scenario. Each option can be used once, more than once or not at all.
Option List.
A.   Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.
B.    Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.
C.    Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.
D.   Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.
E.    A pregnancy going to 24 weeks or beyond.
F.    A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.
G.   Maternal deaths per 100,000 maternities.
H.   Maternal deaths per 100,000 live births.
I.      Direct + indirect deaths per 100,000 maternities.
J.     Direct + indirect deaths per 100,000 live births.
K.    Direct death.
L.     Indirect death.
M. Early death.
N.   Late death.
O.   Extra-late death.
P.    Fortuitous death.
Q.   Coincidental death.
R.    Accidental death.
S.    Maternal murder.
T.    Not a maternal death.
U.   Yes
V.   No.
W. I have no idea.
X.    None of the above.
Abbreviations.
MMR:      Maternal Mortality Rate.
MMRat:  Maternal Mortality Ratio.
SUDEP:    Sudden Unexplained Death in Epilepsy.           
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational trophoblastic disease, develops choriocarcinomas and dies from it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?
Scenario 7
A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself when the baby is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality Ratio?
Scenario 12
A woman is diagnosed with breast cancer. She has missed a period and a pregnancy test is +ve. She decides to continue with the pregnancy. The breast cancer does not respond to treatment and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the subject of domestic violence is killed at 12 weeks’ gestation by her partner. What kind of death is it?
Scenario 14
A woman is struck by lightning as she runs across a road. As a result she falls under the wheels of a large lorry which runs over abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?
Scenario 15
A woman is abducted by Martians who are keen to study human pregnancy. She dies as a result of the treatment she receives. As this death could only have occurred because she was pregnant, is it a direct death?
Scenario 16
Could a maternal death from malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from malignancy be classified as “Coincidental”?


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