Monday, 21 January 2013

21 January 2013


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Essays 21st. January 2013.

1. 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         

2. Question. Critically evaluate HPV vaccine and its uses.           


3. A healthy, 25-year-old, nulliparous woman books at 8 weeks. She wishes to know what particular advice is relevant to her as she is married to a farmer.
1. outline the history you will take.                   6 marks
2. outline the investigations you will arrange.    4 marks
3. justify the advice you will give.                   10 marks.      

4. A 25 year-old woman books at 8 weeks. She has one child, aged 3 years. He has recently had chickenpox diagnosed. Her sister is 38 weeks pregnant.
1.  Justify your initial management.                                     8 marks.
2.  Justify your management for the rest of the pregnancy.  8 marks.
3.  Justify the advice you will give with regard to her sister.  4 marks.        


Missed pills. Starting the Pill. COC.
Lead-in.
The following scenarios relate to the combined oral contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at all.
Abbreviations.
UPSI:     unprotected sexual intercourse.

Option list.
A.        pill that is ≥ 12 hours late.
B.        pill that is > 12 hours late.
C.        pill that is ≥ 24 hours late.
D.        pill that is > 24 hours late.
E.         two missed pills at any time in a single cycle.
F.         the first pill taken in one’s first love affair, now recalled with fond nostalgia for its effectiveness in preventing pregnancy, the Prince having been truly a loathsome toad.
G.       no additional contraception required.
H.        additional contraception required for 7 days.
I.          emergency contraception should be considered.
J.          emergency contraception should be recommended.
K.        take the missed pill immediately, but not if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
L.         take the missed pill immediately, even if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
M.      take the missed pill immediately, even if it means 2 pills in one day; additional contraception for 7 days; pill-free interval as usual.
N.       take one of the missed pills immediately, discard the other missed pills, use extra contraception for 7 days and discuss emergency contraception with your doctor.
O.       take the missed pills immediately, use extra contraception for 7 days and discuss emergency contraception with your doctor.
P.        continuous combined preparation.
Q.       bi-phasic preparation.
R.        quadriphasic preparation.
S.         cannot be answered from the data given.
T.         none of the above.


Scenario 1.
What is the definition of a missed pill?
Scenario 2.
What is the definition of two missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation. The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a 21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a 21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack. What advice should be given?
Scenario 11
What kind of preparation is Qlaira?

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