Podcast.
Tonight we managed an EMQ and 4 essay plans.
They are below.
Send me your versions and I'll send mine.
The EMQ was written hastily in the half hour or so before the tutorial, so it needs a bit of polish.
But at least it has some ideas.
Diabetes in pregnancy.
Lead-in.
The following scenarios relate to diabetes in pregnancy.
For each, select the action from the option that best fits the scenario.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
ACE: angiotensin converting enzyme.
ARA: angiotensin II receptor antagonist.
GDM: gestational diabetes mellitus.
OGTT: oral glucose tolerance test.
Scenario 1.
A woman with type II diabetes attends for pre-pregnancy counselling. Her HbA1c is 10.6 %. Her health is good. She last had screening for retinopathy 8 months ago. What is the most important advice you will give?
Scenario 2.
A woman with type II diabetes attends for pre-pregnancy counselling. Her HbA1c is 5.4 %. She last had screening for retinopathy 8 months ago. What advice will you give about retinopathy screening?
Scenario 3.
A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her HbA1c is 4.8%. Her pregnancy was 2 years ago and was normal. The baby weighed 3.5 kg. at 40 weeks and is healthy. Her serum creatinine is 125 micromol/ litre.
Scenario 4.
A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her HbA1c is 4.8%. Her pregnancy was 2 years ago and was normal. The baby weighed 3.5 kg. at 40 weeks and is healthy. Her GFR is 60 ml./minute. What advice will you give about referral to a nephrologist?
Scenario 5.
A 35 year-old para 1 with type II diabetes attends for pre-pregnancy counselling. Her health is good. Her blood sugar levels are well controlled with diet and metformin. What advice will you give about metformin?
Scenario 6.
A 38 year-old woman attends the booking clinic at 8 weeks. GDM was diagnosed at 34 weeks in the 1st. pregnancy. Despite good glycaemic control, the baby weighed 5.2 kg. and required Caesarean section for delivery after a prolonged 2nd. stage. She is keen to have the earliest possible diagnosis of recurrence.
Scenario 7
A 38 year-old woman attends the booking clinic at 8 weeks. GDM was diagnosed at 34 weeks in the 1st. pregnancy. Despite good glycaemic control, the baby weighed 5.2 kg. and required Caesarean section for delivery after a prolonged 2nd. stage. She is keen to have the earliest possible diagnosis of recurrence but has needle phobia and an aversion to self-monitoring.
Scenario 8
A 25-year-old primigravida books at 10 weeks. Her health is good but her BMI is 28. What screening for hyperglycaemia will you arrange.
Scenario 9
A healthy para 1 books at 10 weeks. She takes a statin because of elevated cholesterol and triglyceride levels. Her blood pressure is 130/85. Otherwise she is well.
Scenario 10
A woman
Scenario 11
Option list.
A. advise postponement of pregnancy.
B. normal antenatal care.
C. refer to a joint diabetic / antenatal clinic.
D. refer to the next joint diabetic / antenatal clinic.
E. refer for a diabetic opinion.
F. refer to a nephrologist.
G. refer to a clinical psychologist.
H. arrange referral for screening for diabetic retinopathy.
I. screen for microalbuminuria.
J. stop ACE inhibitor / ARA drugs and arrange for safer substitutes.
K. advise to continue statin.
L. asvise to stop statin.
M. prescribe folic acid 5mg. daily and advise HbA1c , 6.1%, if not associated with untoward symptoms.
N. stop oral hypoglycaemic drug and start insulin.
O. discuss pros and cons of oral hypoglycaemic drug, but allow her to continue to take it.
P. arrange fasting plasma glucose level and repeat monthly.
Q. arrange HbA1c assay and repeat monthly.
R. arrange a 75 gram OGTT now.
S. arrange a 75 gram OGTT at 16 weeks
T. arrange a 75 gram OGTT at 28 weeks.
U. arrange a 100 gram OGTT now.
V. arrange a 100 gram OGTT at 16 weeks
W. arrange a 100 gram OGTT at 28 weeks.
X. Resign, buy a yacht and sail to Bali.
Y. none of the above
Question 1.
A healthy, 25-year-old, nulliparous woman books at 8 weeks. She wishes to know what particular advice is relevant to her as she is married to a farmer.
1. outline the history you will take. 6 marks
2. outline the investigations you will arrange. 4 marks
3. justify the advice you will give. 10 marks.
Question 2.
A six-year-old girl is referred to the gynaecology clinic with a 2 month history of vaginal discharge.
1. Justify the history you will take. 5 marks
2. Justify the investigations you will do. 5 marks
3. Critically evaluate the management. 10 marks
Question 3.
Critically evaluate the problems linked to adolescent pregnancy in the UK and the steps that can be taken to reduce its prevalence.
Question 4.
Outline the FIGO classification system for endometrial cancer and how staging influences treatment.
Question 1.
This has not featured in the exam. It would be a killer if it did. If there is a consultant on the exam committee from a farming district, it could feature. I have heard the subject discussed from time to time at conferences over the years and there used to be references to it in Dewhurst. Luesley & Baker has one line in a section pneumonia.
Question 2.
This has not featured in the exam essays but there was a TOG article in 2007. It is fully covered in the MCQs: paper 1, question 23 and paper 11, question 36.
Question 3.
This has not features in the essays, but I remember hearing a presentation on it at the last British Congress and there was a TOG article in 2007.OGRM has had two articles: one on management in 2010 and one of prevention in 2011.
Question 4.
Endometrial cancer turns up every few years, but not in the past 6. It is overdue!
There was a TOG article on the FIGO staging last year.
| Cancer: endometrial cancer & HRT | September | 1997 |
| Cancer: endometrial hyperplasia. 49. Menstrual problems | March | 2001 |
| Cancer: endometrial hyperplasia. Age 50. Abnormal bleeding | March | 2004 |
| Cancer: endometrial. | March | 2005 |
