Tutorial 1st. August 2016

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1 August 2016.

49	EMQ. Clue cells, koilocytes etc.
50	EMQ. Drugs in pregnancy 2.
51	EMQ. Vulval conditions.
52	EMQ. Headache and pregnancy.
53	SBA. Fetal origins of adult disease.

49.   EMQ. Clue cells, koilocytes etc.

Lead-in.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Option list.

A	Actinomyces
B	Bacterial vaginosis
C	Bacteroides
D	Chlamydia trachomatis
E	Chlamydial infection of the genital tract
F	Herpes Simplex
G	Human Papilloma Virus
H	Lymphogranuloma venereum
I	Monilia
J	Neisseria gonorrhoeae
K	Trichomonas vaginalis

Scenario 1.                

Which option or options from the option list best fit with “clue cells”

Scenario 2.                

Which option or options from the option list best fit with “fishy odour”?

Scenario 3.                

Which option or options from the option list best fit with “flagellate organisms”?

Scenario 4.                

Which option or options from the option list best fit with “inflammatory smear”?

Scenario 5.                

Which option or options from the option list best fit with “koilocytes”?

Scenario 6.                

Which option or options from the option list best fit with “non-specific urethritis in the male”?

Scenario 7.                

Which option or options from the option list best fit with “strawberry cervix”?

Scenario 8.                

Which option or options from the option list best fit with “thin grey/ white discharge”?

Scenario 9.                

Which option or options from the option list best fit with “white, curdy discharge”?

Scenario 10.            

Which option or options from the option list best fit with “frothy yellow discharge”?

Scenario 11.            

Which option or options from the option list best fit with “protozoan”?

Scenario 12.            

Which option or options from the option list best fit with “obligate intracellular organism”?

Scenario 13.            

Which option or options from the option list best fit with “blindness”?

Scenario 14.            

Which option or options from the option list best fit with “LGV”?

Scenario 15.            

Which option or options from the option list best fit with “multinucleated cells”?

Scenario 16.            

Which option or options from the option list best fit with “serotypes D–K”?

Scenario 17.            

Which option or options from the option list best fit with “serovars L1-L3”?

Scenario 18.            

Which of the following are true in relation to Amsel’s criteria?

A	used for the diagnosis of bacterial vaginosis
B	used for the diagnosis of trichomonal infection
C	clue cells present on microscopy of wet preparation of vaginal fluid
D	flagellate organism present on microscopic examination of vaginal fluid
E	pH ≤ 4.5
F	pH > 4.5
G	thin, grey-white, homogeneous discharge present
H	frothy, yellow-green discharge present
I	fishy smell on adding alkali (10%KOH)
J	fishy smell on adding acid (10%HCl)
K	koilocytes present
L	absence of vulvo-vaginal irritation

Scenario 19.            

Which of the following are true in relation to Nugent’s Amsel’s criteria?

A	used for the diagnosis of bacterial vaginosis
B	used for the diagnosis of trichomonal infection
C	clue cells present on microscopy of wet preparation of vaginal fluid
D	pH ≤ 4.5
E	pH > 4.5
F	count of lactobacilli
G	count of Gardnerella and Bacteroides
H	count of white cells

Scenario 20.            

Gardnerella vaginallis can be cultured from the vagina of what proportion of normal women?

A	< 10%
B	11 - 20%
C	21 - 30%
D	31 - 40%
E	41 - 50%
F	> 50%

50.   SBA. 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.

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?

51.   EMQ. Vulval conditions.

Lead-in.

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.	Behçet’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.

Scenario 11.

Which condition is described in GTG58 as presenting with polygonal lesions?

Scenario 12.

Which condition is described in GTG58 as presenting with “well-demarcated, glazed erythema around the introitus?

Scenario 13.

What is the aetiology of lichen planus?

There is no option list – just write what you think.

52.   EMQ. Headache & pregnancy.

Lead-in.

The following scenarios relate to headache in pregnancy.

Option list.

1.       abdominal migraine

2.       analgesia overuse headache aka medication overuse headache

3.       bacterial meningitis

4.       benign intracranial hypertension

5.       BP check

6.       cerebral venous sinus thrombosis

7.       chest X-ray

8.       cluster headache

9.       severe PET / impending eclampsia

10.   malaria

11.   meningococcal meningitis

12.   methyldopa

13.   methysergide

14.   migraine

15.   MRI brain scan

16.   nifedipine

17.   nitrofurantoin

18.   pancreatitis

19.   sinusitis

20.   subdural haematoma

21.   subarachnoid haemorrhage

22.   tension headache

23.   ultrasound scan of the abdomen

Scenario 1.

A 40-year-old para 3 is admitted at 38 weeks by ambulance with severe headache of sudden onset. She describes it as “the worst I’ve ever had”. Which diagnosis needs to be excluded urgently?

Scenario 2.

A 32-year-old para 1 has recently experienced headaches. They are worse on exercise, even mild exercise such as walking up stairs. She experiences photophobia with the headaches. Which is the most likely diagnosis?

Scenario 3.

A woman returns from a sub-Saharan area of Africa. She develops severe headache, fever and rigors. What diagnosis should particularly be in the minds of the attending doctors?

Scenario 4.

A woman at 37 weeks has headaches. They particularly occur at night without obvious triggers. They occur every few days.

Scenario 5.

A primigravida has had headaches on a regular basis for many years. They occur most days, are bilateral and are worse when she is stressed. What is the most likely diagnosis?

Scenario 6.

A woman complains of recent headaches at 36 weeks. The history reveals that the headaches started soon after she began treatment with a drug prescribed by her GP. Which is the most likely of the following drugs to be the culprit: 7.            methyldopa, methysergide, nifedipine and Nitrofurantoin?

Scenario 7

A woman is booked for Caesarean section and wishes regional anaesthesia. She had severe headache due to dural tap after a previous Caesarean section. She wants to take all possible steps to reduce the risk of having this again. Which of epidural and spinal  anaesthesia has the lower risk of causing dural tap headache?

Scenario 8

A 25-year-old primigravida complains of headaches which started two weeks before when she attends for her 20 week scan. There is no significant history of previous headache. The pain occurs behind her right eye and she describes it as severe and “stabbing” in nature. The pain is so severe that she cannot sit still and has to walk about. She has noticed that her right eye becomes reddened and “watery” during the attack and her nose is “runny”. The attacks have no obvious trigger and mostly occur a few hours after she has gone to sleep. The usually last about 20 minutes. She has no other symptoms. She smokes 20 cigarettes a day but does not take any other drugs, legal or otherwise. What is the most likely diagnosis?

Scenario 9

A woman has a 5-year history of unilateral, throbbing headache often preceded by nausea, visual disturbances, photophobia and sensitivity to loud noise. What is the most likely diagnosis?

Scenario 10

A primigravida is admitted at 38 weeks complaining of headache, abdominal pain and a sensation of flashing lights. What would be the appropriate initial investigation?

Scenario 11

A woman with BMI of 35 attends for her combined Downs syndrome screening test. She complains of pain behind her eyes. The pain is worst last thing at night before she goes to sleep or if she has to get up in the night. She has noticed she has noticed horizontal diplopia on several  occasions. She has no other symptoms. Examination shows papilloedema.

Scenario 12

A grande multip of 40 years experienced sudden-onset, severe headache, vomited several times and then collapsed, all within the space of 30 minutes. She is admitted urgently in a semi-comatose state. Examination shows neck-stiffness and left hemi-paresis.

Scenario 13.

What did the MMR include as “red flags” for headache in pregnancy? These are not on the option list – you need to dig them out of your head.

53.   EMQ. Fetal origins of adult disease.

Abbreviations.

ADHD:  attention-deficit, hyperactivity disorder

Lead in.

These questions relate to disease in adults resulting from events during fetal, infant and child development.

Scenario 1.

What eponymous title is given to the concept that adverse intra-uterine conditions predispose to the development of disease in adulthood?

Option List                               

A.	the Barker hypothesis
B.	the Baker’s dozen
C.	the Broadbank theory
D.	PIPAD: Placental Insufficiency Programmes Adult Disease
E.	SIMCARD: Stop In-utero Malnutrition to Conquer Adult-resulting Disease

Scenario 2.

Which other term is used for the concept that adverse intra-uterine conditions predispose to the development of disease in adulthood?

Option List                               

A.	FDAD: fetal determination of adult disease
B.	FIAD:   fetal influences on adult disease
C.	FIDAD: fetal and infancy determinants of adult disease
D.	FIGO:   fetal influences on genomic outcomes
E.	FP:       fetal programming

Scenario 3.

Which of the following is thought to increase the risk of adult disease?

Option List                               

A.	low birthweight
B.	low birthweight followed by poor weight gain in infancy and childhood
C.	low birthweight followed by poor weight gain in infancy but above-average weight gain in childhood
D.	above-average birthweight
E.	above-average birthweight followed by poor weight gain in infancy but above-average weight gain in childhood
F.	above-average birthweight followed by above-average weight gain in infancy and childhood

Scenario 4.

Which adult diseases are generally believed to be more likely in relation to adverse influences on the fetus, infant and child.

Diseases.

A.	asthma
B.	chronic bronchitis
C.	coronary heart disease
D.	diabetes type I
E.	diabetes type 2
F.	hypertension
G.	Mendelson’s syndrome

Option List                               

A.	A + B + C + D
B.	A + B + C + E
C.	A + B + C + E + F + G
D.	B + C + E + F + G
E.	C + E + F

Scenario 5.

What adult condition has been linked to raised maternal c-reactive protein levels?

Option List                               

A.	asthma
B.	ADHD
C.	autism
D.	inflammatory bowel disease
E.	schizophrenia