Tutorial 31st. August 2011

Tutorial.
Website.

Tonight we had the long-awaited statistics tutorial from Julia Morris from the Medical Statistics Department at the University and it was well worth the wait.
She has suggested that everyone go through the basic statistics tutorials on their website: 
http://www.south.manchester.ac.uk/medicalstatistics/information.asp.
I e-mailed the questions she was going to discuss a few days ago.
If you haven't got them, send me an e-mail - you can get it from the website if you don't have it.
Send me your answers and I'll send the answers Julie has prepared.
As it is the exam next Tuesday, there will be no tutorial next week.
We will restart with OSCE practice on Monday 12th. September.

My best wishes go to all of you who are sitting the exam.

Tutorial 29 August 2011.

Website.
Tutorial.
Tonight Claire Candelier took the tutorial and it was very good.
She followed the script she had prepared.
I e-mailed this, but if you don't have it, let me know.

Tutorial 22 August 2011.

Website: http://www.drcog-mrcog.info/
Tonight we kicked off with a tutorial on modes of inheritance. A lot of questions on this are common in the exam and it is another "last minute revision" topic. I hope the EMQ helps with this. Then we discussed how to tackle 4 essays.

Mode of inheritance.

Lead-in.

The following questions relate to the mode of inheritance.

For each question, choose the answer from the option list that best matches. Each option can be used once, more than once or not at all.

List of questions.

1.         achondroplasia

2.         adreno-genital syndrome

3.         androgen insensitivity syndrome

4.         Angelman syndrome. Dandy-Walker syndrome

5.         Dandy-Walker syndrome

6.         Down’s syndrome

7.         Duchenne muscular dystrophy

8.         Edward’s syndrome

9.         Ehlers-Danlos syndrome

10.     Fitz-Hugh-Curtis syndrome

11.     Fragile X syndrome

12.     Glucose-6-phosphate dehydrogenase deficiency X-linked recessive

13.     haemophilia A

14.     haemophilia B

15.     Lynch syndrome (HNPCC). Marfan’s syndrome

16.     Marfan’s syndrome

17.     Mayer-Rokitansky-Kuster-Hauser syndrome

18.     Noonan syndrome.

19.     Prader-Willi syndrome

20.     Potter’s syndrome

21.     Sickle cell disease

22.     Tay-Sach’s disease

23.     thalassaemia

24.     Triple X syndrome

25.     Turner’s syndrome

26.     Swyer’s syndrome

27.     VACTERL

28.     von Willebrand’s disease

29.     A mother has spina bifida. What is the risk of a child being affected?

30.     A mother has had a child with spina bifida, what is the risk of the next child being affected?

31.     A mother has had two children with spina bifida. What is the risk of the next child being affected?

32.     A mother has grand-mal epilepsy. What is the risk of her child having epilepsy?

33.     A mother and her partner both have grand-mal epilepsy. What is the risk of their child having epilepsy?

34.     A mother has insulin-dependent diabetes mellitus. What is the risk of a child being affected?

35.     A mother and her partner have insulin-dependent diabetes mellitus. What is the risk of a child being affected?

Essays 22 August 2011.

Question 1.

A nulliparous woman attends the antenatal clinic at 36 weeks. She has no health problems and the pregnancy has been normal. The presentation is cephalic and the head is engaged. She states that she wishes Caesarean section. Outline your management.  

Question 2.

2. A primigravid woman has a normal delivery of a baby with the facial features of Down’s syndrome. She has recognised that the baby has Down’s syndrome. The paediatricians are all busy in the A&E department due to a crash involving a school bus and you have been asked to see her. Outline your management.      

Question 3.

A primigravid woman is admitted with severe abdominal pain at 36 weeks. Outline how you will go about establishing a diagnosis.

Question 4.

A nulliparous woman is admitted to the Early Pregnancy Unit with abdominal pain and bleeding. Her hCG is 2,000 i.u. per litre. An ultrasound scan shows an empty uterus and a left adnexal mass.

1.  Discuss the differential diagnosis.   4 marks.

2.  Discuss the treatment options.      10 marks.

3.  Discuss the advice you will give for when she has recovered. 6 marks.              

Tutorial 1 August 2011

Website.
Podcast.
Tonight we managed an EMQ and 4 essay plans.
I wrote the EMQ last week before going off to Scotland for a wedding and a family reunion. Both were great fun, but left no time for polishing the EMQ. I wrote the option list before the questions, but should really have done it the other way round. So, ignore the option list. Go through the scenarios and send me what you think the answer should be. I'll try to write a more sensible option list over the next coupld of days and send it with my version of the answer.
The EMQ reads:

Confidentiality.

 Lead-in. The following scenarios relate to confidentiality.

For each, select the number that best fits the scenario.

Pick one option from the option list.

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

Option list.

A.        True.

B.        False.

C.        Provide full information orally.

D.        Provide full information in writing.

E.         Provide full information in code.

F.         Provide full information through the hospital lawyer.

G.       Refuse to speak to the parents

H.        Advise obtaining information from the General Practitioner.

I.          Explain the law on confidentiality and how it applies to this case, i.e. no information can be given without her consent.

J.          Explain the child is not Fraser competent but her confidentiality must be protected.

K.        Explain the child is Fraser competent and the parents must get her permission for disclosure of information.

L.         Get verbal consent from the woman / child to disclose information.

M.      Get written consent from the woman / child to disclose information.

N.       Consult with the Child Protection Lead.

O.       Deal with the clinical issues, but discuss the case with the hospital lawyer.

P.        Ask the mother to wait while you phone the hospital lawyer for advice.

Q.       The child can give consent.

R.        The sister can give consent as she is a lawyer.

S.         A parent must give consent.

T.         Two consultants can give consent, if both have interviewed the patient.

U.       Consent must come from the Court of Protection.

V.        None of the above.

Scenario 1.

A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed. Her mother attends clinic 1 hour after the child has left. She demands full information about her daughter. The consultant has delegated you to deal with her. Which option best fits the action you will take?

Scenario 2.

A 17-year-old A-level student attends the gynaecology clinic requesting TOP. She is accompanied by her 30-year-old mathematics teacher, who is her lover and wishes to give consent. Which option best fits the action you will take?

Scenario 3.

A 12-year-old girl attends the gynaecology clinic with her mother seeking contraceptive advice. She has an 18-year-old boyfriend whom the parents like and she wishes to start having sex. Which option best fits the action you will take?

Scenario 4.

A 15-year-old girl who is Fraser competent is referred to the gynaecology clinic with a complaint of vaginal discharge. She reveals that she has been having consensual sexual intercourse for six months with her 18-year-old boyfriend. She asks for advice about suitable contraception as she is happy in the relationship and wants to continue to have sex. Which option best fits the action you will take?

Scenario 5.

You are the new oncology consultant and have just operated on the wife of a local General Practitioner for suspected ovarian cancer. The diagnosis is confirmed and you proceed with appropriate surgery. On completion of the operation you go to the surgeon’s room for a coffee. The senior consultant anaesthetist who was not involved in theatre but is the Medical Director and tells you he is a close friend of the woman, asks what the diagnosis and prognosis are. Which option best fits the action you will take?

Scenario 6.

You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. She has given a history of 2 terminations but no other pregnancies. She is Rhesus negative, but has Rhesus antibodies. Which option best fits the action you will take?

Scenario 7

You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. Her serology tests have proved +ve for syphilis. You have spoken to the consultant bacteriologist who says that they have run confirmatory tests and they are +ve too. He is sure the woman has active syphilis. Which option best fits the action(s) you will take?

Scenario 8

A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed despite your best efforts to persuade her. Who will give consent for the procedure?

Scenario 9

An immature 15-year-old girl attends the gynaecology clinic requesting TOP. She is accompanied by her 25-year-old sister who is a lawyer with whom she has been staying since she knew she was pregnant. She does not want her parents to be informed. The girl is assessed as not Fraser competent. The sister says that she is happy to act in loco parentis and to give consent. Which option best fits the action(s) you will take?

Scenario 10

A 25-year-old woman with Down’s syndrome attends the clinic accompanied by her mother. She has menorrhagia and copes badly with the hygiene aspects. The menorrhagia is bad enough for her now to be on treatment for iron-deficiency anaemia. She has tried all the standard medical methods. To complicate the problem, she has become close friends with a young man she has met at College, to which she travels independently each weekday. Her mother fears that she may already be involved in sexual activity and cannot get an accurate answer from her about it. The mother is keen for her to have hysterectomy to deal with both problems. If you agree that the surgery is appropriate, who can give consent?

Scenario 11

A 25-year-old woman with Down’s syndrome is admitted from College after collapsing. The clinical features are of ectopic pregnancy and she states that she has UPSI with her boyfriend of six months. She has tachycardia and hypotension and it is felt that she should have urgent surgery. You reckon that she is not competent to consent for surgery. Who can give consent and what limits are there on the surgery?

 The essay topics were:

Question 1.

With regard to gynaecological surgery:

1. outline the main complications that may occur    8 marks

2. critically evaluate how the incidence of complications can be reduced.                                                             12 marks

Question 2.

You are the SpR in the fertility clinic. A couple have been referred by their General Practitioner after basic investigation of their three years of infertility. She has never been pregnant; he has never had a partner become pregnant. A sperm test has shown azoospermia.

1.            Justify the history you will take.                            4 marks

2.            Justify the investigations you will arrange.              6 marks

3.  Outline the management and available options.              10 marks

Question 3.

A 28-year-old woman is referred to the gynaecology clinic with suspected premature ovarian failure. She has “hot flushes”, has not menstruated for 8 months and a FSH level was found to be 40 i.u./l.

1.  Outline the main causes of premature ovarian failure.   10 marks

2.  Critically evaluate the management options.                 10 marks

Question 4.

Critically evaluate the management of Gp B Streptococcal infection in pregnancy.