25 June 2015.
24
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SBA. Ovarian reserve.
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25
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Role-play. Communication skills: X-linked recessive
inheritance. You have been asked to go over key aspects of recessive
inheritance with a new FY1.
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26
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EMQ. Anti-D.
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27
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EMQ. Ulipristal
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Question 24.
Topic. Ovarian reserve.
Abbreviations.
AFC: antral
follicle count
AMH: anti-Mullerian
hormone.
OR: ovarian
reserve.
Question 1.
Lead-in
What is
the definition of ovarian reserve?
Option List
A.
|
Sex-hormone-induced
female shyness.
|
B.
|
the number of functional oocytes per cubic centimetre
of ovarian tissue
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C.
|
the number of oocytes per cubic centimetre of ovarian
tissue
|
D.
|
the number of remaining oocytes
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E.
|
the proportion of residual to primordial oocytes
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Question 2.
Lead-in
What is
the definition of the menopause?
Option List
A.
|
the end
of menstruation
|
B.
|
the end of menstruation, but not if hysterectomy is the
cause
|
C.
|
the end of menstruation, but not if endometrial
ablation is the cause
|
D.
|
the time when periods become infrequent and finally
cease
|
E.
|
the climacteric
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Question 3.
Lead-in
How many
periods must be missed for the menopause to be diagnosed?
Option List
A.
|
6
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B.
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9
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C.
|
12
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D.
|
24
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E.
|
none of the above
|
Question 4.
Lead-in
What is
the definition of the climacteric?
Option List
A.
|
the same
as “menopause”
|
B.
|
the same as the “perimenopause”
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C.
|
the time from the start to the end of vasomotor
symptoms
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D.
|
the time from the start of menopausal symptoms to one
year after the LMP
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E.
|
I am never going to use this term again, so don’t ask
me about it!
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F.
|
none of the above
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Question 5.
Lead-in
What is
the definition of premature menopause?
Option List
A.
|
menopause
occurring at an earlier age in successive generations
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B.
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menopause occurring < 50 years
|
C.
|
menopause occurring < 45 years
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D.
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menopause occurring < 40 years
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E.
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menopause occurring < 35 years
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Question 6.
Lead-in
Which of
the following conditions is not associated with premature menopause.
Conditions.
1.
|
45XO/XX mosaicism
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2.
|
Fragile
X pre-mutation carrier status
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3.
|
Fragile X full mutation carrier status
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4.
|
galactosaemia
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5.
|
Mayer – Rokitansky – Kuster - Hauser syndrome
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6.
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Swyer’s syndrome.
|
Option List
A.
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1 + 2 + 4
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B.
|
1 + 2
+ 4 + 5
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C.
|
1 + 2 + 4 + 6
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D.
|
1 + 3 + 4
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E.
|
3 + 4 + 5
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F.
|
3 + 5 + 6
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G.
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all of the conditions
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H.
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some of the conditions, but I don’t know which
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I.
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none of the conditions
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Question 7.
Lead-in
A woman is
a carrier of the Fragile X pre-mutation. What is her risk of premature ovarian
failure?
Option List
A.
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5%
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B.
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10%
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C.
|
15%
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D.
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20%
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E.
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25%
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Question 8.
Lead-in
Where is
FSH produced?
Option List
A.
|
granulosa cells
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B.
|
hypothalamus
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C.
|
pineal gland
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D.
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anterior
pituitary
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E.
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posterior pituitary
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Question 9.
Lead-in
Where is
LH produced?
Option List
A.
|
granulosa cells
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B.
|
hypothalamus
|
C.
|
pineal gland
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D.
|
anterior
pituitary
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E.
|
posterior pituitary
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Question 10.
Lead-in
Where is
Inhibin A produced?
Option List
A.
|
granulosa
cells
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B.
|
granulosa cells of small developing follicles
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C.
|
granulosa cells of the dominant follicle and corpus
luteum
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D.
|
ovarian stroma
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E.
|
adrenal gland
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Question 11.
Lead-in
Where is
Inhibin B produced?
Option List
A.
|
granulosa
cells
|
B.
|
granulosa cells of small developing follicles
|
C.
|
granulosa cells of the dominant follicle and corpus
luteum
|
D.
|
ovarian stroma
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E.
|
adrenal gland
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Question 12.
Lead-in
Where is
AMH produced?
Option List
A.
|
granulosa
cells
|
B.
|
granulosa cells of small antral follicles
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C.
|
granulosa cells of the pre-antral follicles
|
D.
|
dominant follicle and corpus luteum
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E.
|
ovarian stroma
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Question 13.
Lead-in
Which if
any of the following statements are true?
Statements.
1.
|
AFC is
based on antral follicles up to 2 mm in diameter
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2.
|
AFC is based on antral follicles up to 5 mm in diameter
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3.
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AFC is based on antral follicles up to 10 mm in
diameter
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4.
|
AFC is of proven superiority to AMH assay in assessing
OR
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5.
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AFC + AMH assay is a superior test to AMH assay alone
in assessing OR
|
Option List
A.
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1 + 5
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B.
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2 + 5
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C.
|
3 + 5
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D.
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4
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E.
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4 + 5
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F.
|
none of the above
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Question 14.
Lead-in
Which is
the best test to measure ovarian reserve?
Option List
A.
|
early
follicular FSH levels
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B.
|
luteal follicular FSH levels
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C.
|
early follicular-phase FSH + LH levels
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D.
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early follicular-phase AMH levels
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E.
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early follicular-phase AFC
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F.
|
none of the above
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Question 25. Roleplay.
You are the SpR on call for the delivery unit.
It is a quiet day with no-one in labour. The last patient to deliver was a
woman who had been screened for an X-linked recessive disorder (XLRD). The baby
had been found to be a carrier, like her.
The
consultant thinks it would be a good idea for you to discuss the key points of
XLRD with the new FY1.
What label
might be best for most appropriate educational technique for this situation?
Option list.
1.
brainstorming.
2.
brainwashing
3.
cream cake circle.
4.
Delphi technique.
5.
doughnut round.
6.
1 minute preceptor method.
7.
teaching peers / junior colleagues
8.
schema activation.
9.
schema refinement.
10.
small group discussion.
11.
snowballing.
12.
snowboarding.
Question 26. 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.
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?
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?
Question 27.
Ulipristal.
Lead-in.
The
following scenarios relate to ulipristal. For each, select the most appropriate
from the option list.
Each
option can be used once, more than once or not at all.
Option list.
A.
|
GnRH analogue.
|
B.
|
Selective serotonin reuptake inhibitor.
|
C.
|
19-nortestosterone derived progestagen.
|
D.
|
21-hydroxyprogesterone-derived progestagen.
|
E.
|
mifepristone derivative.
|
F.
|
Selective oestrogen receptor modulator.
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G.
|
Selective progesterone receptor modulator.
|
H.
|
Urinary excretion.
|
I.
|
Metabolised by renal cytochrome P450 enzyme system.
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J.
|
Metabolised by hepatic cytochrome P450 enzyme system.
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K.
|
30 mg. with dose repeated if vomiting occurs within 3
hours.
|
L.
|
100 mg. with dose repeated if vomiting occurs within 3
hours.
|
M.
|
150 mg. with dose repeated if vomiting occurs within 3
hours.
|
N.
|
phenobarbitone
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O.
|
valium
|
P.
|
erythromycin
|
Q.
|
12 hours.
|
R.
|
18 hours.
|
S.
|
32 hours.
|
T.
|
72 hours.
|
U.
|
120 hours.
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V.
|
Depot-contraception.
|
W.
|
Depression.
|
X.
|
Emergency contraception.
|
Y.
|
Menorrhagia.
|
Z.
|
Termination of pregnancy.
|
AA.
|
Yes.
|
BB.
|
No.
|
CC.
|
Maybe.
|
DD.
|
Continue.
|
EE.
|
Discontinue for 36 hours.
|
FF.
|
Discontinue for 72 hours.
|
GG.
|
May interfere with contraception containing progestogen.
|
HH.
|
May interfere with contraception containing oestrogen.
|
II.
|
No action if LARC being used.
|
Scenario 1.
What
type of drug is ulipristal?
Scenario 2.
How
is ulipristal broken down / excreted?
Scenario 3.
What
is the half-life of ulipristal?
Scenario 4.
Which
drug may prolong the half-life of ulipristal?
Scenario 5.
What is the main use of ulipristal?
Scenario 6.
What is the dose of ulipristal?
Scenario 7.
What time-scale applies to the licensed use of ulipristal?
Scenario 8.
What contraceptive advice is given to those using ulipristal?
Scenario 9.
What advice is given to women who are breast-feeding?
Scenario 10.
Can treatment with ulipristal be repeated within 1 month?
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