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17 February 2014
22
|
EMQ.
Ante-partum haemorrhage
|
23
|
EMQ. DSDs: AIS, MRKH and Swyer’s syndrome
|
24
|
EMQ.
Endometrial cancer & FIGO
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87
|
A 73-year-old woman is referred with
vault prolapse 5 years after hysterectomy.
1. Discuss the steps that can be taken during
and after hysterectomy to reduce the risk of vault prolapse. 4
marks
2. Justify the history you will obtain. 4 marks
3. Evaluate the management options. 12 marks
|
88
|
Home birth.
A
woman books at 10 weeks’ gestation and states that she is keen to have a home
birth.
1.
What are the key legal issues in relation to home birth? 2 marks
2.
Justify the history you will take. 4 marks
3.
Critically evaluate the advice you will give re the risks & benefits of
home
birth. 6 marks
4.
Justify your management plan. 8
marks
|
89
|
A primigravida collapses 1 hour after
normal vaginal delivery.
1.
Critically evaluate the differential diagnosis of maternal collapse. 6 marks.
2.
How may impending maternal collapse be recognised. 4 marks.
3.
Critically evaluate the management of this woman. 10 marks.
|
90
|
A primigravid woman attends the
antenatal booking clinic at 5 weeks’ gestation. She smells strongly of
alcohol. She admits to consuming at least ½ bottle of vodka each day.
1.
Critically evaluate the public health advice available in the UK about
alcohol and
pregnancy. 4 marks.
2.
Critically evaluate screening for alcohol abuse in pregnancy. 4 marks.
3.
Critically evaluate the risks to the fetus and child of the mother who abuses
alcohol in
pregnancy. 6 marks.
4.
Justify the management you would arrange for this patient. 6 marks.
|
Antepartum haemorrhage.
Lead-in.
The
following scenarios relate to APH.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
ART: assisted reproduction technology
FGR: fetal growth restriction
PET: pre-eclampsia
Option list.
A.
genital tract bleeding ≥ 500 ml. from 24 weeks until the
delivery of the baby
B.
genital tract bleeding ≥ 500 ml. from 24 weeks until the
delivery of the placenta.
C.
genital tract bleeding ≥ 500 ml. from 24 weeks, or earlier
if the baby is live-born, until the delivery of the baby.
D.
1
E.
2
F.
3
G. 4
H.
5
I.
6
J.
7
K.
8
L.
9
M. 10
N. 15
O. 20
P.
30
Q. 50
R.
100
S.
500
T.
1,000
U. true
V.
false
W. none of
the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml. for minor APH
Scenario 3.
What is the upper limit in ml. of major haemorrhage
Scenario 4.
What
is the % risk of recurrence after 1 abruption?
Scenario 5.
What
is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor for placental abruption.
Scenario 7
List 10 risk factors for placental abruption.
Scenario 8
List 6 risk factors for placenta previa.
Scenario 9
In what % of pregnancies does APH occur?
Scenario 10
With
regards to steps that can be taken to reduce the incidence of APH, what things
would you include in an essay?
DSDs: AIS, MRKH and Swyer’s
syndrome
Lead-in.
The
following scenarios relate to disorders of sexual development.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
AIS: androgen insensitivity syndrome.
AMH: anti-Mullerian hormone.
CAH: congenital adrenal hyperplasia.
CAI: complete androgen insensitivity syndrome.
DSD: disorder of sexual differentiation.
KS: Kallmann’s syndrome.
LMB: Laurence-Moon-Biedl syndrome.
MRKH: Mayer-Rokitansky-Kuster-Hauser syndrome.
PAI: partial androgen insensitivity syndrome.
PW: Prader-Willi syndrome.
SW: Swyer’s syndrome.
TU: Turner’s syndrome.
Suggested reading.
Option list 1.
A.
a uterus of normal size for her age is present.
B.
a uterus that is hypoplastic for her age is
present.
C.
a vestigial uterus (anlagen) is present.
D.
no uterus is present.
E.
esthiomene commonly occurs
F.
I don’t know.
G. the question makes no sense.
H.
none of the above.
I.
Scenario 1.
a.
at the start of puberty in a girl with
congenital adrenal hyperplasia.
b.
at the start of puberty in a girl with complete
androgen insensitivity syndrome.
c.
at the start of puberty in a girl with a
disorder of sexual differentiation.
d.
at the start of puberty in a girl with
Kallmann’s syndrome.
e.
at the start of puberty in a girl with
Laurence-Moon-Biedl syndrome.
f.
at the start of puberty in a girl with
Mayer-Rokitansky-Kuster-Hauser syndrome.
g.
at the start of puberty in a girl with partial
androgen insensitivity syndrome.
h.
at the start of puberty in a girl with
Prader-Willi syndrome.
i.
at the start of puberty in a girl with Swyer’s
syndrome.
j.
at the start of puberty in a girl with Turner’s
syndrome.
Endometrial cancer &
FIGO.
Lead-in.
The
following scenarios relate to endometrial cancer.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Option list.
Scenario 1.
A histology report on endometrial curetting is of 95%
adenocarcinoma with 5% solid, non-squamous areas. What is the FIGO grade?
Scenario 2.
A histology report on endometrial curetting is of 90%
adenocarcinoma with 10% solid, non-squamous areas. What is the FIGO grade?
Scenario 3.
A histology report on endometrial curetting is of 50%
adenocarcinoma with 50% solid, non-squamous areas. What is the FIGO grade?
Scenario 4.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 5% myometrial invasion. What
is the FIGO staging?
Answer.
Scenario 5.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 25% myometrial invasion. What
is the FIGO staging?
Scenario 6.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 60% myometrial invasion. What
is the FIGO staging?
Scenario 7
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the uterus. There is no myometrial invasion, but there is
extension to the endocervical endothelium. What is the FIGO staging?
Scenario 8
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the uterus. There is no myometrial invasion, but there is
extension to the stroma of the cervix. What is the FIGO staging?
Scenario 9
A
woman undergoes surgery for carcinoma of the endometrium. Peritoneal washings
are +ve but there is no other evidence of spread outside the uterus. There is
no myometrial invasion. There is extension to the stroma of the cervix. What is
the FIGO staging?
Scenario 10
A
woman undergoes surgery for carcinoma of the endometrium. There is no evidence
of extension outside the uterus. There is myometrial invasion through to and
including the serosa. What is the FIGO staging?
Scenario 11
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. There is no evidence of disease
elsewhere. What is the FIGO staging?
Scenario 12
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. Positive pelvic nodes are found, but
no other lymphatic involvement. There is no distant spread. What is the FIGO
staging?
Scenario 13
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. The tumour involves the mucosa of the
bladder. There is no lymphatic or distant spread. What is the FIGO staging?
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