Monday, 12 August 2013

Tutorial 12 August 2013

Tutorial.
Website.
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https://soundcloud.com/drtmcf/12-august-2013

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18
EMQ. Anti-D immunoglobulin.
66
With regard to vulval cancer.
1. critically evaluate screening.                                                       2 marks.
2. outline the FIGO staging system.                                                6 marks.
3. critically evaluate the modern approach to management.             12 marks
67
With regard to adhesions that result from abdominal surgery.
1. Outline the incidence and possible adverse consequences of adhesion formation after surgery.                                                                            8 marks.
2. How may the incidence of surgical adhesions be reduced?   12 marks.
68
A nulliparous woman notices reduced fetal movements at 37 weeks and phones the delivery unit for advice.
1.   Outline the immediate management.     14 marks
2.   Justify the subsequent management.       6 marks.
69
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.
70
With regard to smoking in pregnancy:
1. outline the hazards to the mother.          4 marks
2. outline the hazards to the fetus / child.   6 marks
3. critically evaluate how smoking cessation programmes can be made more effective. 
                                                                           10 marks                                   


Lead-in.
The following scenarios relate to Rhesus prophylaxis and anti-D.

Abbreviations.
Ig:        immunoglobulin.
FMF:    feto-maternal haemorrhage.
RAADP:            routine antenatal anti-D prophylaxis.
RBC:    red blood cells.
RhAI:    Rhesus D alloimmunisation.
BSE:     bovine spongiform encephalopathy.
CJD:     Creutzfeldt-Jakob Disease.
           
There is no option list to force good technique!

Scenarios.
1)      What proportion of the Caucasian population in the UK has Rh –ve blood group?        
2)      What proportion of the Rhesus +ve Caucasian population is homozygous for RhD?    
3)      What is the chance of a Rh –ve woman with a Rh +ve partner having a Rh –ve child?
4)      When was routine postnatal anti-D prophylaxis introduced in the UK? 
5)      Where does anti-D for prophylactic use come from?
6)      How many deaths per 100,000 births were due to RhAI up to 1969.    
7)      How many deaths per 100,000 births were due to RhAI in 1990.
8)      Anti-D was in short supply in 1969. Which non-sensitised Rh –ve primigravidae with Rh +ve babies would not be given anti-D as a matter of policy?    
9)      List the possible reasons that a Rhesus –ve mother with a Rhesus +ve baby who does not receive anti-D might not become sensitised?                                                                                                                        
10)  What is the UK policy for the administration of anti-D after a term pregnancy?
a)       
11)  What is the alternative name of the Kleihauer test?
12)  What does the Kleihauer test do?
13)  How does the Kleihauer test work and what buzz words should you have in your head?
14)  When should a Kleihauer test be done after vaginal delivery?
15)  What blood specimen should be sent to the laboratory for a Kleihauer test?
16)  What steps should be taken to prevent sensitisation in the woman whose blood group is RhDu and whose baby is Rh +ve?
17)  The Kleihauer test is of value in helping to decide if antenatal vaginal bleeding or abdominal pain are due to placental abruption, with a +ve test confirming FMH and making abruption highly probable.  True/False
18)  When should anti-D be offered
19)  When should a Kleihauer test be considered?                                                                               
20)  How often does the word “considered” feature in the GTG?
21)  A Rhesus –ve woman miscarries a Rh +ve fetus at 18 week’s gestation. What should be done about Rhesus prophylaxis?
22)  A Rhesus –ve woman miscarries a Rh +ve fetus at 20 week’s gestation. What should be done about Rhesus prophylaxis?
23)  Which potentially sensitising events are mentioned in the GTG?
24)  What factors are listed in the GTG as particularly likely to cause FMH > 4 ml
25)  A woman has recurrent bleeding from 20 weeks. What should be done about Rh prophylaxis?
26)  What are the key messages about giving RAADP? Answer:

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