27 June 2016.
25
|
MgSO4 use in O&G. List all the points you think might get
a mark in the exam. Think
main headings for uses then key points for each. Think EMQ, SBA and viva.
|
26
|
SBA. Ovarian reserve
|
27
|
EMQ. Anti-D.
|
28
|
Roleplay. Communication skills: X-linked
recessive inheritance. You have been asked to go over the key aspects of
recessive inheritance with a new FY1.
|
29
|
EMQ.
Maternal Mortality definitions
|
25. Magnesium
sulphate use in O&G.
MgSO4 use in O&G.
List all the points you think might get a mark
in the exam. Think main headings for uses then key points for each. Think EMQ,
SBA and viva.
26. EMQ. 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
|
C.
|
the number of oocytes per cubic centimetre of ovarian
tissue
|
D.
|
the number of remaining oocytes
|
E.
|
the proportion of residual to primordial oocytes
|
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
|
Question 3.
Lead-in
How many
periods must be missed for the menopause to be diagnosed?
Option List
A.
|
6
|
B.
|
9
|
C.
|
12
|
D.
|
24
|
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”
|
C.
|
the time from the start to the end of vasomotor
symptoms
|
D.
|
the time from the start of menopausal symptoms to one
year after the LMP
|
E.
|
I am never going to use this term again, so don’t ask
me about it!
|
F.
|
none of the above
|
Question 5.
Lead-in
What is
the definition of premature menopause?
Option List
A.
|
menopause
occurring at an earlier age in successive generations
|
B.
|
menopause occurring < 50 years
|
C.
|
menopause occurring < 45 years
|
D.
|
menopause occurring < 40 years
|
E.
|
menopause occurring < 35 years
|
Question 6.
Lead-in
Which of
the following conditions is not associated with premature menopause.
Conditions.
1.
|
45XO/XX mosaicism
|
2.
|
Fragile
X pre-mutation carrier status
|
3.
|
Fragile X full mutation carrier status
|
4.
|
galactosaemia
|
5.
|
Mayer – Rokitansky – Kuster - Hauser syndrome
|
6.
|
Swyer’s syndrome.
|
Option List
A.
|
1 + 2 + 4
|
B.
|
1 + 2
+ 4 + 5
|
C.
|
1 + 2 + 4 + 6
|
D.
|
1 + 3 + 4
|
E.
|
3 + 4 + 5
|
F.
|
3 + 5 + 6
|
G.
|
all of the conditions
|
H.
|
some of the conditions, but I don’t know which
|
I.
|
none of the conditions
|
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.
|
5%
|
B.
|
10%
|
C.
|
15%
|
D.
|
20%
|
E.
|
25%
|
Question 8.
Lead-in
Where is
FSH produced?
Option List
A.
|
granulosa cells
|
B.
|
hypothalamus
|
C.
|
pineal gland
|
D.
|
anterior
pituitary
|
E.
|
posterior pituitary
|
Question 9.
Lead-in
Where is
LH produced?
Option List
A.
|
granulosa cells
|
B.
|
hypothalamus
|
C.
|
pineal gland
|
D.
|
anterior
pituitary
|
E.
|
posterior pituitary
|
Question 10.
Lead-in
Where is
Inhibin A 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
|
E.
|
adrenal gland
|
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
|
E.
|
adrenal gland
|
Question 12.
Lead-in
Where is
AMH produced?
Option List
A.
|
granulosa
cells
|
B.
|
granulosa cells of small antral follicles
|
C.
|
granulosa cells of the pre-antral follicles
|
D.
|
dominant follicle and corpus luteum
|
E.
|
ovarian stroma
|
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
|
2.
|
AFC is based on antral follicles up to 5 mm in diameter
|
3.
|
AFC is based on antral follicles up to 10 mm in
diameter
|
4.
|
AFC is of proven superiority to AMH assay in assessing
OR
|
5.
|
AFC + AMH assay is a superior test to AMH assay alone
in assessing OR
|
Option List
A.
|
1 + 5
|
B.
|
2 + 5
|
C.
|
3 + 5
|
D.
|
4
|
E.
|
4 + 5
|
F.
|
none of the above
|
Question 14.
Lead-in
Which is
the best test to measure ovarian reserve?
Option List
A.
|
early
follicular FSH levels
|
B.
|
luteal follicular FSH levels
|
C.
|
early follicular-phase FSH + LH levels
|
D.
|
early follicular-phase AMH levels
|
E.
|
early follicular-phase AFC
|
F.
|
none of the above
|
27. EMQ. Anti-D.
Anti-D prophylaxis.
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?
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?
28. Roleplay. Communication skills: X-linked recessive inheritance. You
have been asked to go over the key aspects of recessive inheritance with a new
FY1.
29. EMQ. Maternal
Mortality.
Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each scenario. Each option
can be used once, more than once or not at all.
Option List.
A. Death
of a woman during pregnancy and up to 6 weeks later, including accidental and
incidental causes.
B. Death
of a woman during pregnancy and up to 6 weeks later, excluding accidental and
incidental causes.
C. Death
of a woman during pregnancy and up to 52 weeks later, including accidental and
incidental causes.
D. Death
of a woman during pregnancy and up to 52 weeks later, excluding accidental and
incidental causes.
E. A
pregnancy going to 24 weeks or beyond.
F. A
pregnancy going to 24 weeks or beyond + any pregnancy resulting in a
live-birth.
G. Maternal
deaths per 100,000 maternities.
H. Maternal
deaths per 100,000 live births.
I. Direct
+ indirect deaths per 100,000 maternities.
J. Direct
+ indirect deaths per 100,000 live births.
K. Direct
death.
L. Indirect
death.
M. Early
death.
N. Late
death.
O. Extra-late
death.
P. Fortuitous
death.
Q. Coincidental
death.
R. Accidental
death.
S. Maternal
murder.
T. Not
a maternal death.
U. Yes
V. No.
W. I have no
idea.
X. None
of the above.
Abbreviations.
MMR: Maternal Mortality Rate.
MMRat: Maternal Mortality Ratio.
SUDEP: Sudden Unexplained Death in Epilepsy.
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured
ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured
appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What
kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease
dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational
trophoblastic disease, develops choriocarcinomas and dies from it 24 months
after the GTD was diagnosed and the uterus evacuated. What kind of death
is it?
Scenario 7
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal psychosis
from which she makes a poor recovery. She kills herself when the baby is 6
months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality
Ratio?
Scenario 12
A woman is diagnosed with
breast cancer. She has missed a period and a pregnancy test is +ve. She decides
to continue with the pregnancy. The breast cancer does not respond to treatment
and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the
subject of domestic violence is killed at 12 weeks’ gestation by her partner.
What kind of death is it?
Scenario 14
A woman is struck by lightning
as she runs across a road. As a result she falls under the wheels of a large
lorry which runs over abdomen, rupturing her spleen and provoking placental
abruption. She dies of haemorrhage, mostly from the abruption. What kind of
death is it?
Scenario 15
A woman is abducted by Martians
who are keen to study human pregnancy. She dies as a result of the treatment
she receives. As this death could only have occurred because she was pregnant,
is it a direct death?
Scenario 16
Could a maternal death from
malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from
malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from
malignancy be classified as “Coincidental”?
No comments:
Post a Comment