Tutorial 3 January 2013

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Tonight we answered  EMQs on diabetes and pregnancy A and discussed 4 essay plans.
 Send me your version of the answers and I'll send mine.
You must do your answers under exam conditions otherwise you are wasting your time.

Diabetes in pregnancy.

Lead-in.

The following scenarios relate to diabetes in pregnancy.

For each, select the action from the option 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.

Abbreviations.

ACE:       angiotensin converting enzyme.

ARA:      angiotensin II receptor antagonist.

GDM:    gestational diabetes mellitus.

OGTT:   oral glucose tolerance test.

I have not given an option list so that you can decide what you would do without distraction.

Scenario 1.

A woman with type II diabetes attends for pre-pregnancy counselling. Her HbA1c is 10.6 %. Her health is good. She last had screening for retinopathy 8 months ago. What is the most important advice you will give?

Scenario 2.

A woman with type II diabetes attends for pre-pregnancy counselling. Her HbA1c is 5.4 %. She last had screening for retinopathy 8 months ago. What advice will you give about retinopathy screening?

Scenario 3.

A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her HbA1c is 4.8%. Her pregnancy was 2 years ago and was normal. The baby weighed 3.5 kg. at 40 weeks and is healthy. Her serum creatinine is 125 micromol/ litre.

Scenario 4.

A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her HbA1c is 4.8%. Her pregnancy was 2 years ago and was normal. The baby weighed 3.5 kg. at 40 weeks and is healthy. Her GFR is 60 ml./minute. What advice will you give about referral to a nephrologist?

Scenario 5.

A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her blood sugar levels are well controlled with diet and metformin. What advice will you give about metformin?

Scenario 6.

A 38 year-old woman attends the booking clinic at 8 weeks. GDM was diagnosed at 34 weeks in the 1^st. pregnancy. Despite good glycaemic control, the baby weighed 5.2 kg. and required Caesarean section for delivery after a prolonged 2^nd. stage. She is keen to have the earliest possible diagnosis of recurrence.

Scenario 7

A 38 year-old woman attends the booking clinic at 8 weeks. GDM was diagnosed at 34 weeks in the 1^st. pregnancy. Despite good glycaemic control, the baby weighed 5.2 kg. and required Caesarean section for delivery after a prolonged 2^nd. stage. She is keen to have the earliest possible diagnosis of recurrence but has needle phobia and an aversion to self-monitoring.

Scenario 8

A 25-year-old primigravida books at 10 weeks. Her health is good but her BMI is 28. What screening for hyperglycaemia will you arrange.

Scenario 9

A healthy para 1 books at 10 weeks. She takes a statin because of elevated cholesterol and triglyceride levels. Her blood pressure is 130/85. Otherwise she is well. What advice will you give about the statin?

With regard to cervical cancer:

1.  Critically evaluate the FIGO staging classification.     8 marks

Describe the FIGO staging.                                         12 marks       

With regard to fetal welfare in labour.

1. Critically evaluate the methods available for monitoring the fetal condition. 14 marks

2. List the criteria recommended by NICE for continuous electronic fetal monitoring. 6 marks     

You have been asked to give a lecture on the Mental Capacity Act 2005 to the junior staff of the department of O&G using illustrative examples.

Describe the types of cases you will use and the key points you will make.          

A 41-year-old woman attends for review after a normal hysteroscopy. She now wishes treatment for her incapacitating heavy periods which have not responded to medical management.

1. Outline the history you will take.                   4 marks.   

2. Outline the investigations you will consider.   4 marks.

3. Critically evaluate your advice on the available management options.   12 marks