|
49 |
Role-play. Androgen insensitivity
syndrome |
|
50 |
Role-play. Suspected domestic abuse |
|
51 |
Discussion. Dealing with a trans patient |
|
52 |
SBA. Coeliac disease & pregnancy |
49. Role-play.
Androgen insensitivity syndrome.
The patient is
Anastasia Johnstone. She is 17 years old. She attended the gynaecology clinic 1
month ago with primary amenorrhoea. Clinical examination showed an apparently
normal young woman with normal breast development but absent pubic and axillary
hair. The external genitalia appeared normal. Vaginal examination was not
attempted.
She has come
today for the results of an ultrasound scan and blood tests. The scan shows
absence of the uterus. There are no ovaries in the pelvis. There are bilateral
groin masses. The karyotype is 46XY.
Your tasks are to
explain the results and their implications and to answer her questions.
50. Role-play. Suspected domestic abuse.
You are a 5th.
year SpR in the antenatal clinic. The Consultant in the clinic has been feeling
unwell and has gone off sick, leaving you in charge. The senior midwife comes
to see you. One of the midwives has reviewed a patient at 36 weeks in her first
pregnancy. She was referred by her community midwife who noted extensive
bruising for which the patient could give no explanation.
The GP ran tests to exclude a bleeding disorder, which were normal. Both the
community and hospital midwives suspect domestic abuse, but the patient has not
admitted that this has occurred despite being asked on
several occasions.
Your task is to
see the patient and manage the situation.
51. Discussion.
Dealing with a trans patient.
This is very topical and most people have little or no training or
experience. We will discuss how best to deal with the potential problems.
52. SBA.
Coeliac disease & pregnancy.
Coeliac disease and pregnancy.
Abbreviations.
CD: coeliac
disease.
EMA: IgG
endomysial antibodies.
IgA: immunoglobulin A.
tIgA: total immunoglobulin A.
tTGA: IgA tissue transglutaminase antibody.
Question 1. What is coeliac disease?
Option List
|
A. |
allergy to gluten |
|
B. |
malabsorption
due to large bowel inflammation |
|
C. |
an auto-immune
disorder triggered by gluten sensitivity causing villous atrophy of the
descending colon in individuals with a genetic predisposition |
|
D. |
an auto-immune
disorder triggered by gluten sensitivity causing villous atrophy of the gastric
mucosa in individuals with a genetic predisposition |
|
E. |
an auto-immune
disorder triggered by gluten sensitivity causing villous atrophy of the small
bowel in individuals with a genetic predisposition |
Question 2. What is the prevalence of coeliac disease
in women of reproductive age?
Option List
|
A. |
0.1% |
|
B. |
0.5% |
|
C. |
1% |
|
D. |
2-5% |
|
E. |
5-10% |
Question 3. Which
of the following groups have an increased risk of CD?
Option List
|
A. |
1st. degree relatives of
those with CD |
|
B. |
those with type
1 diabetes |
|
C. |
those with iron deficiency anaemia |
|
D. |
those with osteoporosis |
|
E. |
those with unexplained infertility |
Question 4. Which of the following are features of
CD in the non-pregnant population?
Option List
|
A. |
abdominal bloating and pain |
|
B. |
amenorrhoea |
|
C. |
anaemia |
|
D. |
recurrent
miscarriage |
|
E. |
unexplained
infertility |
Question 5. How do pregnant women with CD present
most commonly?
Option List
|
A |
anaemia |
|
B |
failure to gain
weight in pregnancy |
|
C |
intra-uterine
growth retardation |
|
D |
low BMI |
|
E |
no recognised
abnormality |
Question 6. Which of the following commonly occur
in pregnant women with CD?
Option List
|
anaemia |
|
|
B |
failure to gain weight in pregnancy |
|
C |
intra-uterine growth retardation |
|
D |
low BMI |
|
E |
no recognised abnormality |
Question 7. How
should the woman with suspected CD be investigated initially?
Option List
|
jejunal biopsy |
|
|
B. |
IgA EMA |
|
C. |
IgA tTGA |
|
D. |
IgA EMA + IgA tTGA |
|
E. |
tIgA + tTGA |
Question 8. Which, if any, of the following
statements are true in relation to the woman due to have testing for suspected
CD?
Option List
|
continue with a diet that includes gluten ≥ once daily for at least 1
month |
|
|
B. |
continue with a diet that includes gluten ≥
once daily for at least 6 weeks |
|
C. |
continue with a diet with ≥ 10 gm. gluten
daily for at least 1 month |
|
D. |
continue with a diet with ≥ 10 gm. gluten
daily for at least 6 weeks |
|
E. |
follow a strict gluten-free diet for at
least 3 months |
Question 9. What advice should be given to those
who have gone on to a gluten-free diet in the month before testing?
Option List
|
the gluten-free diet may render the
serological tests –ve, but not intestinal biopsy |
|
|
B. |
the gluten-free diet may render the
intestinal biopsy –ve, but not the serological tests |
|
C. |
the gluten-free diet may render all the tests -ve |
|
D. |
if she is happy with the gluten-free diet,
there is no point in testing |
|
E. |
she is not qualified to make medical
decisions and should not be so stupid on future occasions |
Question 10. Which of the following conditions
should make consideration of testing for CD sensible?
Option List
|
A. |
amenorrhoea |
|
B. |
Down’s syndrome |
|
C. |
epilepsy |
|
D. |
recurrent
miscarriage |
|
E. |
Turner’s
syndrome |
|
F. |
unexplained
infertility |
Question 11. What
recommendation does NICE make about the information to be provided to
healthcare professionals with the results of serological tests for CD?
Option List
|
the results alone should be provided |
|
|
B. |
the results with the local reference values for children, adult men
and adult women |
|
C. |
the results with the local and national reference values for children,
adult men and women |
|
D. |
the results with interpretation of their meaning |
|
E. |
the results with interpretation of their meaning + recommended actions |
Question 12. How is the diagnosis of CD confirmed
after +ve serological testing?
Option List
|
colonoscopy |
|
|
B. |
enteroscopy |
|
C. |
gastroscopy |
|
D. |
rectal biopsy |
|
E. |
small bowel biopsy |
Question 13. Which skin condition is particularly
associated with CD?
Option List
|
atopic eczema |
|
|
B. |
dermatitis herpetiformis |
|
C. |
dermatitis multiforme |
|
D. |
dermatographia |
|
E. |
psoriasis |
Question 14. Which of the following are likely to
be absorbed less well than normally in women with CD?
Option List
|
carbohydrate |
|
|
B. |
fat |
|
C. |
folic acid |
|
D. |
protein |
|
E. |
vitamins B12, D & K |
Question 15. What is the appropriate treatment of
CD?
Option List
|
antibiotics: long-term in low-dosage |
|
|
B. |
azathioprine |
|
C. |
cyclophosphamide |
|
D. |
rectal steroids |
|
E. |
none of the above |
Question 16. Which of the following do not contain
gluten?
Option List
|
barley |
|
|
B. |
oats |
|
C. |
rapeseed oil |
|
D. |
rye |
|
E. |
wheat |
