Tutorial 21 February 2013

Tutorial.
Website.
Contact us.

This was the last tutorial before the written exam: next week is for last-minute-revision.
We usually re-start on the Monday after the exam, which will be Monday  11th. March.
I'll e-mail nearer the time.
It is important to start your OSCE practice straight away as there is a lot to do.
Don't leave it until the results of the written are published.
We managed 4 essay topics, bringing the total to 81.
We usually find that at least half of the SAQs have been covered in the tutorials.
We also managed an EMQ.
The subject matter may seem a bit specialist, but the questions are based on things that people have remembered from the exam.

With regard to uterine rupture:

1. how is uterine rupture graded?                                 2 marks

2. critically evaluate the risk factors for uterine rupture.  6 marks

3. critically evaluate the diagnosis of uterine rupture.     6 marks

4. outline the management.                                         6 marks   

You see a 25-year-old primigravida at 30 weeks’ gestation in the antenatal clinic after referral by the community midwife who feels that the uterus is large-for-dates.

1. Justify your immediate management.                                6 marks.

2. Justify the management of the remainder of the pregnancy. 4 marks

3. Justify the management of the delivery.                              6 marks

4. Justify the advice you will give post-delivery.                       4 marks    

A 53-year-old woman is referred by her GP. She wishes to discuss HRT. She is recovering well from treatment for endometrial cancer.

1. Outline the history you will take.                      4 marks

2. Justify the investigations you will arrange.         2 marks

3. Critically evaluate your management.              14 marks              

A 35 year-old woman books at 6 weeks. She has noted a left breast mass. Breast cancer is suspected.

1. What is the life-time risk of female breast cancer.         1 mark.

2. How does pregnancy affect the risks of breast cancer.  4 marks.

3. Outline the investigation.                                            5 marks.

4. Critically evaluate the management.                          10 marks.              

Lead-in.

The following scenarios relate to vulval conditions.

Choose the most likely vulval condition from the option list.

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

Scenario 1.

A 22 year-old woman attends the colposcopy clinic after 2 smears showing minor atypia. The cervical appearances are of aceto-white with punctation. 

Scenario 2.

A 60-year old woman has an erythematous rash of the vulva extending to the inner thighs. A similar rash is noted under the breasts. She is not known to have diabetes.

Scenario 3.

A woman attends the gynaecology clinic with a vulval rash. It has a “lacy” appearance.  

Scenario 4.

A 35-year old woman attends is noted to have a vulval fistula. She has a history of episodic diarrhoea. 

Scenario 5.

A 25-year old woman attends the gynaecology clinic with a history of intense vulval itching and soreness. The appearances are of diffuse erythema with excoriation. Diabetes, candidiasis and other local infections have been eliminated by the GP. 

Scenario 6.

A 35-year old woman attends the gynaecology clinic with vulvitis. She also has a scalp rash. Clinical examination shows scaly, pink patches with signs of excoriation. Skin samples grow Malassezia ovalis.

Scenario 7.

A 40-year old woman has evidence of chronic vulval ulceration. She has recently been seen by a dermatologist for mouth ulceration and has been started on thalidomide.

Scenario 8.

An African woman of 35 years attends the gynaecology clinic. She has a ten-year history of chronic vulval ulceration. Examination shows multiple, tender vulval and pubic subcutaneous nodules, some of which have ulcerated.

Scenario 9.

A Caucasian woman of 29 years attends the gynaecology clinic with a chronic vulval rash. Examination shows erythematous areas with clearly defined margins and white scaly patches. 

Scenario 10.

A 30-year old woman attends the gynaecology clinic with vulval itching. Examination shows erythema of the labia minora and perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium with increased mitotic activity.

Option list.

A.	Acne.
B.	Behçet’s syndrome.
C.	Candidiasis.
D.	CIN 3
E.	CIN1
F.	Crohn’s disease.
G.	Dermatitis.
H.	Eczema.
I.	Genital warts.
J.	Hidradenitis suppurativa.
K.	Leprosy.
L.	Lichen planus
M.	Lichen sclerosis
N.	Lymphogranuloma venereum
O.	Normal skin.
P.	Psoriasis.
Q.	Seborrhoeic dermatitis.
R.	Type 1 diabetes mellitus
S.	Type 2 diabetes mellitus
T.	Ulcerative colitis.
U.	VIN III.