Thursday 28 April 2022

Tutorial 28th. April 2022

 

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49

Role-play. Androgen insensitivity syndrome

50

Role-play. Suspected domestic abuse

51

Discussion.   Dealing with a trans patient

52

SBA.   Coeliac disease & pregnancy


49.   Role-play. Androgen insensitivity syndrome.

Candidate's Instructions.

The patient is Anastasia Johnstone. She is 17 years old. She attended the gynaecology clinic 1 month ago with primary amenorrhoea. Clinical examination showed an apparently normal young woman with normal breast development but absent pubic and axillary hair. The external genitalia appeared normal. Vaginal examination was not attempted.

She has come today for the results of an ultrasound scan and blood tests. The scan shows absence of the uterus. There are no ovaries in the pelvis. There are bilateral groin masses. The karyotype is 46XY.

Your tasks are to explain the results and their implications and to answer her questions.

 

50.   Role-play. Suspected domestic abuse.

Candidate's Instructions.

You are a 5th. year SpR in the antenatal clinic. The Consultant in the clinic has been feeling unwell and has gone off sick, leaving you in charge. The senior midwife comes to see you. One of the midwives has reviewed a patient at 36 weeks in her first pregnancy. She was referred by her community midwife who noted extensive bruising for which the patient could give no explanation. The GP ran tests to exclude a bleeding disorder, which were normal. Both the community and hospital midwives suspect domestic abuse, but the patient has not admitted that this has occurred despite being asked on several occasions.

Your task is to see the patient and manage the situation.

 

51.   Discussion.   Dealing with a trans patient.

This is very topical and most people have little or no training or experience. We will discuss how best to deal with the potential problems.

 

52.   SBA.   Coeliac disease & pregnancy.

Coeliac disease and pregnancy.

Abbreviations.

CD:          coeliac disease.

EMA:       IgG endomysial antibodies. 

IgA:          immunoglobulin A. 

tIgA:        total immunoglobulin A.

tTGA:       IgA tissue transglutaminase antibody.

Question 1. What is coeliac disease?

Option List

A.

allergy to gluten

B.

malabsorption due to large bowel inflammation

C.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition

D.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition

E.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the small bowel in individuals with a genetic predisposition

Question 2. What is the prevalence of coeliac disease in women of reproductive age?

Option List

A.

0.1%

B.

0.5%

C.

1%

D.

2-5%

E.

5-10%

Question 3. Which of the following groups have an increased risk of CD?

Option List

A.

1st. degree relatives of those with CD

B.

those with type 1 diabetes

C.

those with iron deficiency anaemia

D.

those with osteoporosis

E.

those with unexplained infertility

Question 4. Which of the following are features of CD in the non-pregnant population?

Option List

A.

abdominal bloating and pain

B.

amenorrhoea

C.

anaemia

D.

recurrent miscarriage

E.

unexplained infertility

Question 5. How do pregnant women with CD present most commonly?

Option List

A

anaemia

B

failure to gain weight in pregnancy

C

intra-uterine growth retardation

D

low BMI

E

no recognised abnormality

Question 6. Which of the following commonly occur in pregnant women with CD?

Option List

A

anaemia

B

failure to gain weight in pregnancy

C

intra-uterine growth retardation

D

low BMI

E

no recognised abnormality

Question 7. How should the woman with suspected CD be investigated initially?

Option List

A.

jejunal biopsy

B.

IgA EMA

C.

IgA tTGA

D.

IgA EMA + IgA tTGA

E.

tIgA + tTGA

Question 8. Which, if any, of the following statements are true in relation to the woman due to have testing for suspected CD?

Option List

A.

continue with a diet that includes gluten ≥ once daily for at least 1 month

B.

continue with a diet that includes gluten ≥ once daily for at least 6 weeks

C.

continue with a diet with ≥ 10 gm. gluten daily for at least 1 month

D.

continue with a diet with ≥ 10 gm. gluten daily for at least 6 weeks

E.

follow a strict gluten-free diet for at least 3 months

Question 9. What advice should be given to those who have gone on to a gluten-free diet in the month before testing?

Option List

A.

the gluten-free diet may render the serological tests –ve, but not intestinal biopsy

B.

the gluten-free diet may render the intestinal biopsy –ve, but not the serological tests

C.

the gluten-free diet may render all the tests -ve

D.

if she is happy with the gluten-free diet, there is no  point in testing

E.

she is not qualified to make medical decisions and should not be so stupid on future occasions

Question 10. Which of the following conditions should make consideration of testing for CD sensible?

Option List

A.

amenorrhoea

B.

Down’s syndrome

C.

epilepsy

D.

recurrent miscarriage

E.

Turner’s syndrome

F.

unexplained infertility

Question 11. What recommendation does NICE make about the information to be provided to healthcare professionals with the results of serological tests for CD?

Option List

A.

the results alone should be provided

B.

the results with the local reference values for children, adult men and adult women

C.

the results with the local and national reference values for children, adult men and women

D.

the results with interpretation of their meaning

E.

the results with interpretation of their meaning + recommended actions

Question 12. How is the diagnosis of CD confirmed after +ve serological testing?

Option List

A.

colonoscopy

B.

enteroscopy

C.

gastroscopy

D.

rectal biopsy

E.

small bowel biopsy

Question 13. Which skin condition is particularly associated with CD?

Option List

A.

atopic eczema

B.

dermatitis herpetiformis

C.

dermatitis multiforme

D.

dermatographia

E.

psoriasis

Question 14. Which of the following are likely to be absorbed less well than normally in women with CD?

Option List

A.

carbohydrate

B.

fat

C.

folic acid

D.

protein

E.

vitamins B12, D & K

Question 15. What is the appropriate treatment of CD?

Option List

A.

antibiotics: long-term in low-dosage

B.

azathioprine

C.

cyclophosphamide

D.

rectal steroids

E.

none of the above

Question 16. Which of the following do not contain gluten?

Option List

A.

barley

B.

oats

C.

rapeseed oil

D.

rye

E.

wheat