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18
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EMQ. Anti-D immunoglobulin.
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66
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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
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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
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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.
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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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