Web-site.
Contact us.
Ahmed Yassin will hold a tutorial at Stepping Hill on Thursday 2nd. August on uro-gynaecology.
He is an excellent teacher, so don't miss it.
It will not be on Skype as the room he uses does not have internet access, but it will be available as a podcast.
I'll send the various print-outs he uses beforehand.
Julie Morris will hold a tutorial on medical statistics on Monday the 6th. August.
To get the most of it you need to have gone through her on-line tutorials, "Statistics I" and "Statistics II".
http://www.south.manchester.ac.uk/medicalstatistics/information.asp.
A bit of effort will be rewarded with all the available marks in the MCQs and EMQs.
She, too, is an excellent teacher, so don't miss the session.
I have also asked Claire Candelier to talk on diabetes in pregnancy and infection, Alex Heazell (20th. August) on perinatal mortality and IUGR and Suku George on cancer.
They are also good teachers and these are important topics.
I'll provide more details later.
Tonight we had 2 EMQs then 4 essays.
Obstetric cholestasis. (OC). Prevalence.
Lead-in.
The following scenarios relate to the prevalence of OC.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
GTG: RCOG’s Green-top Guideline No. 43. April 2011.
OC: obstetric cholestasis.
Option list.
A. 0.1%
B. 0.5%
C. 0.7%
D. 1 – 1.2%
E. 1.2% to 1.5%
F. 1.5 – 2%
G. 2.4%
H. 3 – 3.5%
I. 5%
J. 7%
K. 15%
L. white
M. brown
N. blue-green
O. red-brown, striped
P. no information in the GTG
Q. none of the above
Scenario 1.
What is the overall prevalence in the UK population?
Scenario 2.
What is the overall prevalence in the Indian and Pakistani Asian populations?
Scenario 3.
What is the overall prevalence in Scandinavia?
Scenario 4.
What is the overall prevalence in Chile?
Scenario 5.
What is the overall prevalence in Araucanian Indians?
Scenario 6.
What is the overall prevalence in Eskimos?
Scenario 7.
What is the incidence of pruritus in pregnancy?
Scenario 8.
What colour of eggs do Araucanian chickens lay?
Obstetric cholestasis. (OC). Diagnosis.
Lead-in.
The following scenarios relate to the definition and diagnosis.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
gamma GT: gamma-glutamyl transferase
GTG: RCOG’s Green-top Guideline No. 43. April 2011.
OC: obstetric cholestasis.
Option list.
A. true
B. false
C. don’t be daft
D. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, raised bile acids and pale stools, all of which resolve postnatally
E. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids and pale stools, all of which resolve postnatally
F. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids, all of which resolve postnatally
G. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids and pale stools, all of which resolve postnatally
H. pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids, all of which resolve postnatally
I. levels do not usually rise in pregnancy
J. mostly originates in the placenta
K. levels vary with the time of day
L. no information in the GTG
M. none of the above
Scenario 1.
The international definition of OC was agreed at a conference in Tokyo in 1985.
Scenario 2.
What is the GTG’s definition of OC?
Scenario 3.
What is the incidence of pruritus in pregnancy?
Scenario 4.
Hepatitis B and C, but not hepatitis A, may cause pruritus and abnormal LFTs in pregnancy.
Scenario 5.
Infection with the Ebstein Barr virus may cause pruritus and abnormal LFTs in pregnancy.
Scenario 6.
The cytomegalovirus may cause pruritus and abnormal LFTs in pregnancy.
Scenario 7.
The herpes zoster virus may cause pruritus and abnormal LFTs in pregnancy.
Scenario 8.
Chronic active hepatitis and secondary biliary cirrhosis are included in the GTG’s list of conditions to be considered in the differential diagnosis.
Scenario 9.
Bilirubin levels are normally elevated in the early stages of OC and remain elevated until the condition resolves after delivery.
Scenario 10.
Liver function tests become abnormal as soon as the pruritus is noted.
Scenario 11.
Levels of bile acids commonly rise significantly after meals making fasting levels mandatory for diagnosis.
Scenario 12.
The upper limit of normal for transaminases, gamma GT and bile acids is about 20% lower in pregnancy.
Scenario 13.
Once a diagnosis of OC has been made, tests of liver function should not be repeated until the puerperium
Scenario 14.
LFTs should be checked weekly until they have returned to normal after delivery of the baby in a case of OC.
Scenario 15.
Once a diagnosis of OC has been made, the activated partial thromboplastin time (APTT) should be measured and a full coagulation screen done if it is prolonged.
Scenario 16.
Delivery at 37 weeks should be recommended because of the risk of FDIU in the later weeks of pregnancy.
Scenario 17.
What additional pre-labour monitoring of fetal welfare is advisable in the third trimester?
Scenario 18.
Prophylactic steroids should be offered at 28 weeks because of the risk of spontaneous premature labour.
Essays.
With regard to endometrial cancer.
1. Outline the key features of Type 1 and Type 2 cancers. 4 marks
2. Outline the FIGO histological grading system. 2 marks
3. Critically evaluate the FIGO staging for endometrial cancer. 6 marks
4. Detail the FIGO staging system for endometrial cancer. 8 marks.
Your consultant is on leave. The Secretary gives you an histology report relating to a 24-year-old woman who had suction evacuation for incomplete miscarriage 10 days before. The histology report is diagnostic of a complete hydatidiform mole.
1. Justify your immediate management. 8 marks
2. Detail the subsequent management. 12 marks.
You are the SpR in the antenatal clinic. The consultant is absent due to illness and no other consultant is available. A midwife asks you to see a woman whose scan has shown anencephaly.
1. What steps will you take before seeing the woman? 6 marks
2. Justify the approach you will use during the interview. 10 marks
3. What will you do when the interview is over? 4 marks
A woman attends the antenatal clinic at 10 weeks. Her son developed chickenpox two days ago. Her sister is 38 weeks pregnant. Critically evaluate the management.
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