10. Annual breast exam conducted at Hooters.
9. Directions to your doctor’s office include, “take a left when you enter the trailer park.”
8. Tongue depressors taste faintly of Fudgesicle.
7. Only proctologist in the plan is “Gus” from Roto-Rooter.
6. Only item listed under Preventive Care feature of coverage is “an apple a day”.
5. Your “primary care physician” is wearing the pants you gave to Goodwill last month.
4. “Patient responsible for 200% of out-of-network charges” is not a typo.
3. The only expense covered 100% is embalming.
2. With your last HMO, your heart pills didn’t come in different colors with little “M”’s on them.
1. You ask for Viagra. You get a popsicle stick and duct tape.
Sunday, December 26, 2010
Saturday, August 21, 2010
Conjunctivitis Spreadinf in New Delhi
Its the monsoon season again and the water seems to be pouring down in Delhi.
The water gives rise to a lot of diseases and the current epidemic to hit Delhi is viral and allergic conjunctivitis.
Without getting into the details,
the best course of preventive as well as treatment course is to use good antibiotic eye drops which are available OTC (Over the counter) such as Festive or Ciplox.
Put them in 2 times a day and be SAFE.
Dr Harkeerat
The water gives rise to a lot of diseases and the current epidemic to hit Delhi is viral and allergic conjunctivitis.
Without getting into the details,
the best course of preventive as well as treatment course is to use good antibiotic eye drops which are available OTC (Over the counter) such as Festive or Ciplox.
Put them in 2 times a day and be SAFE.
Dr Harkeerat
Gastric Bypass
Gastric bypass
Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.
The most common gastric bypass surgery is a Roux-en-Y gastric bypass.
In normal digestion, food passes through the stomach and enters the small intestine , where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
See a picture of a Roux-en-Y gastric bypass .
What To Expect After Surgery
Most people can return to their normal activities in 3 to 5 weeks.
After surgery, you'll need to make big, permanent changes in how you eat:
* You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
* You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
* You won't be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won't be room in your stomach for both drinks and solid food.
* You probably will need to take vitamins and supplements.
* You may have to avoid foods that contain simple sugars-like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.
Why It Is Done
Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.
The following conditions may also be required or are at least considered:
* You have been obese for at least 5 years.
* You do not have an ongoing problem with alcohol.
* You do not have untreated depression or another major psychiatric disorder.
* You are between 18 and 65 years of age.
All surgeries have risk. And it is important for you and your doctor to discuss your treatment options to decide what is best for you.
How Well It Works
Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years. Some of the lost weight may be regained.
The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.
Risks
Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.
Fewer than 10 out of 1000 people die after weight-loss surgery.
After a Roux-en-Y gastric bypass:
* An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
* The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
* Ulcers develop 5% to 15% of the time.
* The staples may pull loose.
* Hernia may develop.
* The bypassed stomach may enlarge, resulting in hiccups and bloating.
What To Think About
Gastric bypass surgery may increase your chances of living longer. Some studies show that people who have weight-loss surgery have a smaller chance of dying of heart problems, diabetes, or cancer.
In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take extra vitamin B12 as pills, shots, or nasal spray.
There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.
Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and postsurgery complications.
Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.
The most common gastric bypass surgery is a Roux-en-Y gastric bypass.
In normal digestion, food passes through the stomach and enters the small intestine , where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
See a picture of a Roux-en-Y gastric bypass .
What To Expect After Surgery
Most people can return to their normal activities in 3 to 5 weeks.
After surgery, you'll need to make big, permanent changes in how you eat:
* You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
* You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
* You won't be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won't be room in your stomach for both drinks and solid food.
* You probably will need to take vitamins and supplements.
* You may have to avoid foods that contain simple sugars-like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.
Why It Is Done
Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.
The following conditions may also be required or are at least considered:
* You have been obese for at least 5 years.
* You do not have an ongoing problem with alcohol.
* You do not have untreated depression or another major psychiatric disorder.
* You are between 18 and 65 years of age.
All surgeries have risk. And it is important for you and your doctor to discuss your treatment options to decide what is best for you.
How Well It Works
Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years. Some of the lost weight may be regained.
The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.
Risks
Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.
Fewer than 10 out of 1000 people die after weight-loss surgery.
After a Roux-en-Y gastric bypass:
* An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
* The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
* Ulcers develop 5% to 15% of the time.
* The staples may pull loose.
* Hernia may develop.
* The bypassed stomach may enlarge, resulting in hiccups and bloating.
What To Think About
Gastric bypass surgery may increase your chances of living longer. Some studies show that people who have weight-loss surgery have a smaller chance of dying of heart problems, diabetes, or cancer.
In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take extra vitamin B12 as pills, shots, or nasal spray.
There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.
Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and postsurgery complications.
Tuesday, February 9, 2010
Objective Structured Clinical Examination (OSCE) (PLAB PART 2)
Objective Structured Clinical Examination (OSCE) (PLAB PART 2)
PLAB part 2
Centre is now only GMC centre london with a capacity of 13000 exams a year!!
The aim of the OSCE is to test your clinical and communication skills. It is designed so that an examiner can observe you putting these skills into practice.
Overall nature of Exam
When you enter the examination room, you will find a series of booths, known as 'stations'. Each station requires you to undertake a particular task. Some tasks will involve talking to or examining patients, some will involve demonstrating a procedure on an anatomical model. Details of the tasks are explained below under 'Content'.
There will also be two rest stations in the circuit. Sometimes these stations will contain instructions asking you to read or write something about the station you are about to go to or the station you have just left. If there are no instructions, you should remain quietly in the booth until the bell rings signalling the end of that station.
You will be required to perform all tasks. You will be told the number of the station at which you should begin when you enter the examination room. Each task will last five minutes.
Your instructions will be posted outside the station. You should read these instructions carefully to ensure that you follow them exactly. An example might be:
'Mr McKenzie has been referred to you in a rheumatology clinic because he has joint pains. Please take a short history to establish supportive evidence for a differential diagnosis.'
A bell will ring. You may then enter the station. There will be an examiner in each station. However, unlike in the oral examination, you will not be required to have a conversation with the examiner; you should only direct your remarks to him or her if the instructions specifically ask you to do so. You should undertake the task as instructed. A bell will ring after four minutes 30 seconds to warn you that you are nearly out of time. Another bell will ring when the five minutes are up. At this point, you must stop immediately and go and wait outside the next station. If you finish before the end, you must wait inside the station but you should not speak to the examiner or to the patient during this time.
You will wait outside the next station for one minute. During this time you should read the instructions for the task in this station. After one minute a bell will ring. You should then enter the station and undertake the task as instructed.
You should continue in this way until you have completed all the tasks. You will then have finished the OSCE.
Content of the stations
Each station consists of a scenario. An examiner will be present and will observe you at work.
The scenario could be drawn from any medical specialty appropriate to a Senior House Officer (SHO).
Although the tasks you will be instructed to do will involve a number of skills, one skill will predominate.
The skills to be tested are set out below. They will not necessarily be tested in the order given here. Under each skill area you will find some examples. Please note that these are only examples; other topics will be tested.
History taking
Your candidate instructions will set the scene. You will be asked to take a history from an actor pretending to be a patient (a simulated patient). The actor will have been given all the necessary information to be able to answer your questions accurately. You should treat him or her just as you would a real patient.
Examples: abdominal pains, rectal bleeding, amenorrhoea, severe headache, pneumonia
Examination skills
You will be asked to examine a particular part of the body. You may have to examine a simulated or real patient or perform the examination on an anatomical model. Although you should talk to the patient or model as you would to a patient in real life, you should only take a history or give a diagnosis if the instructions require you to do so. You may be asked to explain your actions to the examiner as you go along.
Examples: breast examination, cardiovascular examination, examination of abdomen, hip examination, knee examination
Practical skills/use of equipment
This is to assess some of the practical skills an SHO needs. The stations concerned will normally involve anatomical models rather than patients.
Examples: IV cannulation, cervical smear, suturing, blood pressure
Emergency management
These stations will test whether you know what to do in an emergency situation. You may have to explain what you are doing to the patient or to the examiner. Your instructions will make this clear.
Examples: resuscitation, chest pain, trauma
Communication skills
There will be a communication skills element in most stations. However, in some stations this skill will be the principal skill tested. Areas tested may include interviewing (including appropriate questioning, active listening, explaining clearly, checking understanding) and building rapport (including showing empathy and respect, sensitivity to others' emotions and coping with strong emotions in others).
Examples: instructions for discharge from hospital, explaining treatment, consent for autopsy, ectopic pregnancy explanation
PLAB part 2
Centre is now only GMC centre london with a capacity of 13000 exams a year!!
The aim of the OSCE is to test your clinical and communication skills. It is designed so that an examiner can observe you putting these skills into practice.
Overall nature of Exam
When you enter the examination room, you will find a series of booths, known as 'stations'. Each station requires you to undertake a particular task. Some tasks will involve talking to or examining patients, some will involve demonstrating a procedure on an anatomical model. Details of the tasks are explained below under 'Content'.
There will also be two rest stations in the circuit. Sometimes these stations will contain instructions asking you to read or write something about the station you are about to go to or the station you have just left. If there are no instructions, you should remain quietly in the booth until the bell rings signalling the end of that station.
You will be required to perform all tasks. You will be told the number of the station at which you should begin when you enter the examination room. Each task will last five minutes.
Your instructions will be posted outside the station. You should read these instructions carefully to ensure that you follow them exactly. An example might be:
'Mr McKenzie has been referred to you in a rheumatology clinic because he has joint pains. Please take a short history to establish supportive evidence for a differential diagnosis.'
A bell will ring. You may then enter the station. There will be an examiner in each station. However, unlike in the oral examination, you will not be required to have a conversation with the examiner; you should only direct your remarks to him or her if the instructions specifically ask you to do so. You should undertake the task as instructed. A bell will ring after four minutes 30 seconds to warn you that you are nearly out of time. Another bell will ring when the five minutes are up. At this point, you must stop immediately and go and wait outside the next station. If you finish before the end, you must wait inside the station but you should not speak to the examiner or to the patient during this time.
You will wait outside the next station for one minute. During this time you should read the instructions for the task in this station. After one minute a bell will ring. You should then enter the station and undertake the task as instructed.
You should continue in this way until you have completed all the tasks. You will then have finished the OSCE.
Content of the stations
Each station consists of a scenario. An examiner will be present and will observe you at work.
The scenario could be drawn from any medical specialty appropriate to a Senior House Officer (SHO).
Although the tasks you will be instructed to do will involve a number of skills, one skill will predominate.
The skills to be tested are set out below. They will not necessarily be tested in the order given here. Under each skill area you will find some examples. Please note that these are only examples; other topics will be tested.
History taking
Your candidate instructions will set the scene. You will be asked to take a history from an actor pretending to be a patient (a simulated patient). The actor will have been given all the necessary information to be able to answer your questions accurately. You should treat him or her just as you would a real patient.
Examples: abdominal pains, rectal bleeding, amenorrhoea, severe headache, pneumonia
Examination skills
You will be asked to examine a particular part of the body. You may have to examine a simulated or real patient or perform the examination on an anatomical model. Although you should talk to the patient or model as you would to a patient in real life, you should only take a history or give a diagnosis if the instructions require you to do so. You may be asked to explain your actions to the examiner as you go along.
Examples: breast examination, cardiovascular examination, examination of abdomen, hip examination, knee examination
Practical skills/use of equipment
This is to assess some of the practical skills an SHO needs. The stations concerned will normally involve anatomical models rather than patients.
Examples: IV cannulation, cervical smear, suturing, blood pressure
Emergency management
These stations will test whether you know what to do in an emergency situation. You may have to explain what you are doing to the patient or to the examiner. Your instructions will make this clear.
Examples: resuscitation, chest pain, trauma
Communication skills
There will be a communication skills element in most stations. However, in some stations this skill will be the principal skill tested. Areas tested may include interviewing (including appropriate questioning, active listening, explaining clearly, checking understanding) and building rapport (including showing empathy and respect, sensitivity to others' emotions and coping with strong emotions in others).
Examples: instructions for discharge from hospital, explaining treatment, consent for autopsy, ectopic pregnancy explanation
Professional and Linguistic assessment exam (PLAB)
PLAB test details for overseas doctors
Professional and Linguistic assessment exam (PLAB)
More Details about PLAB part 1 examination
Skills of PLAB part 1 test.
Four groups of skills will be tested in approximately equal proportions:
a. Diagnosis: Given the important facts about a patient (such as age, sex, nature of presenting symptoms, duration of symptoms) you are asked to select the most likely diagnosis from a range of possibilities.
b. Investigations: This may refer to the selection or the interpretation of diagnostic tests. Given the important facts about a patient, you will be asked to select the investigation which is most likely to provide the key to the diagnosis. Alternatively, you may be given the findings of investigations and asked to relate these to a patient's condition or to choose the most appropriate next course of action.
c. Management : Given the important facts about a patient's condition, you will be asked to choose from a range of possibilities the most suitable course of treatment. In the case of medical treatments you will be asked to choose the correct drug therapy and will be expected to know about side effects.
d. Others: These may include:
i. Explanation of disease process: The natural history of disease will be tested with reference to basic physiology and pathology.
ii. Legal/ethical : You are expected to know the major legal and ethical principles set out in the GMC publication Duties of a Doctor.
iii. Practice of evidence based medicine: Questions on diagnosis, investigations and management may draw upon recent evidence published in peer-reviewed journals. In addition, there may be questions on the principles and practice of evidence-based medicine.
iv. Understanding of epidemiology: You may be tested on the principles of epidemiology, and on the prevalence of important diseases in the UK.
v. Health promotion: The prevention of disease through health promotion and knowledge of risk factors.
vi. Awareness of multicultural society: You may be tested on your appreciation of the impact on the practice of medicine of the health beliefs and cultural values of the major cultural groups represented in the UK population.
vii. Application of scientific understanding to medicine
Content of part 1 of PLAB exam (new format since 2004 September)
The content to be tested is, for the most part, defined in terms of patient presentations. Where appropriate, the presentation may be either acute or chronic. Questions in Part 1 will begin with a title which specifies both the skill and the content, for example, The management of varicose veins.
You will be expected to know about conditions that are common or important in the United Kingdom for all of the systems outlined below. Examples of the cases that may be asked about are given under each heading and may appear under more than one heading.
These examples are for illustration and the list is not exhaustive. Other similar conditions might appear in the examination.
a. Accident and emergency medicine (to include trauma and burns)
Examples: Abdominal injuries, abdominal pain, back pain, bites and stings, breathlessness/wheeze, bruising and purpura, burns, chest pain, collapse, coma, convulsions, diabetes, epilepsy, eye problems, fractures, dislocations, head injury, loss of consciousness, non-accidental injury, sprains and strains, testicular pain.
b. Blood (to include coagulation defects)
Examples: Anemia's, bruising and purpura.
c. Cardiovascular system (to include heart and blood vessels and blood pressure)
Examples: Aortic aneurysm, chest pain, deep vein thrombosis (DVT), diagnosis and management of hypertension, heart failure, ischaemic limbs, myocardial infarction, myocardial ischaemic, stroke, varicose veins.
d. Dermatology, allergy, immunology and infectious diseases
Examples: Allergy, fever and rashes, influenza/pneumonia, meningitis, skin cancers.
e. ENT and eyes
Examples: Earache, hearing problems, hoarseness, difficulty in swallowing, glaucoma, ‘red eyes’, sudden visual loss.
f. Female reproductive system (to include obstetrics, gynecology and breast)
Examples: Abortion/sterilization, breast lump, contraception, infertility, menstrual disorders, menopausal symptoms, normal pregnancy, postnatal problems, pregnancy complications, vaginal disorders.
g. Gastrointestinal tract, liver and biliary system, and nutrition
Examples: Abdominal pain, constipation, diarrhea, difficulty in swallowing, digestive disorders, gastrointestinal bleeding, jaundice, rectal bleeding/pain, vomiting, weight problems.
h. Metabolism, endocrinology and diabetes
Examples: Diabetes mellitus, thyroid disorders, weight problems.
i. Nervous system (both medical and surgical)
Examples: Coma, convulsions, dementia, epilepsy, eye problems, headache, loss of consciousness, vertigo.
j. Orthopedics and rheumatology
Examples: Back pain, fractures, dislocations, joint pain/swelling, sprains and strains.
k. Psychiatry (to include substance abuse)
Examples: Alcohol abuse, anxiety, assessing suicidal risk, dementia, depression, drug abuse, overdoses and self harm, panic attacks, postnatal problems.
l. Renal System (to include urinary tract and genitourinary medicine)
Examples: Haematuria, renal and ureteric calculi, renal failure, sexual health, testicular pain, urinary infections.
m. Respiratory system
Examples: Asthma, breathlessness/wheeze, cough, hemoptysis, hoarseness, influenza/pneumonia.
n. Disorders of childhood (to include non-accidental injury and child sexual abuse; fetal medicine; growth and development)
Examples: Abdominal pain, asthma, child development, childhood illnesses, earache, epilepsy, eye problems, fever and rashes, joint pain/swelling, loss of consciousness, meningitis, non-accidental injury, testicular pain, urinary disorders.
o. Disorders of the elderly (to include palliative care)
Examples: Breathlessness, chest pain, constipation, dementia, depression, diabetes, diarrhoea, digestive disorders, headache, hearing problems influenza/pneumonia, jaundice, joint pain/swelling, loss of consciousness, pain relief, terminal care, trauma, urinary disorders, vaginal disorders, varicose veins, vertigo, vomiting.
p. Peri-operative management
Examples: Pain relief, shock,
How to approach the extended matching question examination (part 1 plab-EMQ)
The examination paper will contain 200 questions in the extended matching and SBA (single best answer ) format., divided into a number of themes.
Each theme has a heading which tells you what the questions are about, in terms both of the clinical problem area (e.g. chronic joint pain) and the skill required (e.g. diagnosis).
Within each theme there are several numbered items, usually between four and six. These are the questions the problems you have to solve. There are examples below.
Begin by reading carefully the instruction which precedes the numbered items. The instruction is very similar throughout the paper and typically reads ‘For each scenario below, choose the SINGLE most discriminating investigation from the above list of options. Each option may be used once, more than once or not at all.’
Consider each of the numbered items and decide what you think the answer is. You should then look for that answer in the list of options (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed.
For each numbered item, you must choose ONE, and only one, of the options. You may feel that there are several possible answers to an item, but you must choose the one most likely from the option list. If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones.
In each theme there are more options than items, so not all the options will be used as answers. This is why the instruction says that some options may not be used at all.
A given option may provide the answer to more than one item. For example, there might be two items which contain descriptions of patients, and the most likely diagnosis could be the same in both instances. In this case the option would be used more than once.
You will be awarded one mark for each item answered correctly.
SBA section
From september 2004, SBA s will make 30 % of the paper. An SBA or single best answer or MCQ (multiple choice answer)or BOF (best of five) is one and the same thing. In such questions you have to choose one single most appropriate answer to the given question. AIPPG forums are well known for carrying the latest papers / SBA;s discussions.
These days some questions are picture questions : common ECGs, X Rays and skin problems are commonly asked in such questions.
Marks are not deducted for incorrect answers nor for failure to answer. The total score on the paper is the number of correct answers given. You should, therefore, attempt all items in part one of PLAB examination.
Professional and Linguistic assessment exam (PLAB)
More Details about PLAB part 1 examination
Skills of PLAB part 1 test.
Four groups of skills will be tested in approximately equal proportions:
a. Diagnosis: Given the important facts about a patient (such as age, sex, nature of presenting symptoms, duration of symptoms) you are asked to select the most likely diagnosis from a range of possibilities.
b. Investigations: This may refer to the selection or the interpretation of diagnostic tests. Given the important facts about a patient, you will be asked to select the investigation which is most likely to provide the key to the diagnosis. Alternatively, you may be given the findings of investigations and asked to relate these to a patient's condition or to choose the most appropriate next course of action.
c. Management : Given the important facts about a patient's condition, you will be asked to choose from a range of possibilities the most suitable course of treatment. In the case of medical treatments you will be asked to choose the correct drug therapy and will be expected to know about side effects.
d. Others: These may include:
i. Explanation of disease process: The natural history of disease will be tested with reference to basic physiology and pathology.
ii. Legal/ethical : You are expected to know the major legal and ethical principles set out in the GMC publication Duties of a Doctor.
iii. Practice of evidence based medicine: Questions on diagnosis, investigations and management may draw upon recent evidence published in peer-reviewed journals. In addition, there may be questions on the principles and practice of evidence-based medicine.
iv. Understanding of epidemiology: You may be tested on the principles of epidemiology, and on the prevalence of important diseases in the UK.
v. Health promotion: The prevention of disease through health promotion and knowledge of risk factors.
vi. Awareness of multicultural society: You may be tested on your appreciation of the impact on the practice of medicine of the health beliefs and cultural values of the major cultural groups represented in the UK population.
vii. Application of scientific understanding to medicine
Content of part 1 of PLAB exam (new format since 2004 September)
The content to be tested is, for the most part, defined in terms of patient presentations. Where appropriate, the presentation may be either acute or chronic. Questions in Part 1 will begin with a title which specifies both the skill and the content, for example, The management of varicose veins.
You will be expected to know about conditions that are common or important in the United Kingdom for all of the systems outlined below. Examples of the cases that may be asked about are given under each heading and may appear under more than one heading.
These examples are for illustration and the list is not exhaustive. Other similar conditions might appear in the examination.
a. Accident and emergency medicine (to include trauma and burns)
Examples: Abdominal injuries, abdominal pain, back pain, bites and stings, breathlessness/wheeze, bruising and purpura, burns, chest pain, collapse, coma, convulsions, diabetes, epilepsy, eye problems, fractures, dislocations, head injury, loss of consciousness, non-accidental injury, sprains and strains, testicular pain.
b. Blood (to include coagulation defects)
Examples: Anemia's, bruising and purpura.
c. Cardiovascular system (to include heart and blood vessels and blood pressure)
Examples: Aortic aneurysm, chest pain, deep vein thrombosis (DVT), diagnosis and management of hypertension, heart failure, ischaemic limbs, myocardial infarction, myocardial ischaemic, stroke, varicose veins.
d. Dermatology, allergy, immunology and infectious diseases
Examples: Allergy, fever and rashes, influenza/pneumonia, meningitis, skin cancers.
e. ENT and eyes
Examples: Earache, hearing problems, hoarseness, difficulty in swallowing, glaucoma, ‘red eyes’, sudden visual loss.
f. Female reproductive system (to include obstetrics, gynecology and breast)
Examples: Abortion/sterilization, breast lump, contraception, infertility, menstrual disorders, menopausal symptoms, normal pregnancy, postnatal problems, pregnancy complications, vaginal disorders.
g. Gastrointestinal tract, liver and biliary system, and nutrition
Examples: Abdominal pain, constipation, diarrhea, difficulty in swallowing, digestive disorders, gastrointestinal bleeding, jaundice, rectal bleeding/pain, vomiting, weight problems.
h. Metabolism, endocrinology and diabetes
Examples: Diabetes mellitus, thyroid disorders, weight problems.
i. Nervous system (both medical and surgical)
Examples: Coma, convulsions, dementia, epilepsy, eye problems, headache, loss of consciousness, vertigo.
j. Orthopedics and rheumatology
Examples: Back pain, fractures, dislocations, joint pain/swelling, sprains and strains.
k. Psychiatry (to include substance abuse)
Examples: Alcohol abuse, anxiety, assessing suicidal risk, dementia, depression, drug abuse, overdoses and self harm, panic attacks, postnatal problems.
l. Renal System (to include urinary tract and genitourinary medicine)
Examples: Haematuria, renal and ureteric calculi, renal failure, sexual health, testicular pain, urinary infections.
m. Respiratory system
Examples: Asthma, breathlessness/wheeze, cough, hemoptysis, hoarseness, influenza/pneumonia.
n. Disorders of childhood (to include non-accidental injury and child sexual abuse; fetal medicine; growth and development)
Examples: Abdominal pain, asthma, child development, childhood illnesses, earache, epilepsy, eye problems, fever and rashes, joint pain/swelling, loss of consciousness, meningitis, non-accidental injury, testicular pain, urinary disorders.
o. Disorders of the elderly (to include palliative care)
Examples: Breathlessness, chest pain, constipation, dementia, depression, diabetes, diarrhoea, digestive disorders, headache, hearing problems influenza/pneumonia, jaundice, joint pain/swelling, loss of consciousness, pain relief, terminal care, trauma, urinary disorders, vaginal disorders, varicose veins, vertigo, vomiting.
p. Peri-operative management
Examples: Pain relief, shock,
How to approach the extended matching question examination (part 1 plab-EMQ)
The examination paper will contain 200 questions in the extended matching and SBA (single best answer ) format., divided into a number of themes.
Each theme has a heading which tells you what the questions are about, in terms both of the clinical problem area (e.g. chronic joint pain) and the skill required (e.g. diagnosis).
Within each theme there are several numbered items, usually between four and six. These are the questions the problems you have to solve. There are examples below.
Begin by reading carefully the instruction which precedes the numbered items. The instruction is very similar throughout the paper and typically reads ‘For each scenario below, choose the SINGLE most discriminating investigation from the above list of options. Each option may be used once, more than once or not at all.’
Consider each of the numbered items and decide what you think the answer is. You should then look for that answer in the list of options (each of which is identified by a letter of the alphabet). If you cannot find the answer you have thought of, you should look for the option which, in your opinion, is the best answer to the problem posed.
For each numbered item, you must choose ONE, and only one, of the options. You may feel that there are several possible answers to an item, but you must choose the one most likely from the option list. If you enter more than one answer on the answer sheet you will gain no mark for the question even though you may have given the right answer along with one or more wrong ones.
In each theme there are more options than items, so not all the options will be used as answers. This is why the instruction says that some options may not be used at all.
A given option may provide the answer to more than one item. For example, there might be two items which contain descriptions of patients, and the most likely diagnosis could be the same in both instances. In this case the option would be used more than once.
You will be awarded one mark for each item answered correctly.
SBA section
From september 2004, SBA s will make 30 % of the paper. An SBA or single best answer or MCQ (multiple choice answer)or BOF (best of five) is one and the same thing. In such questions you have to choose one single most appropriate answer to the given question. AIPPG forums are well known for carrying the latest papers / SBA;s discussions.
These days some questions are picture questions : common ECGs, X Rays and skin problems are commonly asked in such questions.
Marks are not deducted for incorrect answers nor for failure to answer. The total score on the paper is the number of correct answers given. You should, therefore, attempt all items in part one of PLAB examination.
Thursday, January 14, 2010
Rh Disease
Rh Disease
Rh disease (also known as Rh (D) disease, Rhesus disease, RhD Hemolytic Disease of the Newborn, Rhesus D Hemolytic Disease of the Newborn or RhD HDN) is one of the causes of hemolytic disease of the newborn (also known as HDN). The disease ranges from mild to severe. When the disease is mild the fetus may have mild anaemia with reticulocytosis. When the disease is moderate or severe the fetus can have a more marked anaemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe it can cause morbus haemolyticus neonatorum, hydrops fetalis, or stillbirth.
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal red blood cells leading to development Rh disease. It may thus be regarded as insufficient immune tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases). Sensitizing events during pregnancy include miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy, abdominal trauma and external cephalic version.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus negative woman, would result in still births or extremely sick babies and many babies who managed to survive would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants of rhesus negative woman. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is massively reduced .
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation. Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72 hours - the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
* The Kleihauer-Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood that has passed into the maternal circulation.
* The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
* The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic anemia.
* Full blood count - the hemoglobin level and platelet count are important
* Bilirubin (total and indirect)
Management
Antenatal
* Ultrasound - to detect and monitor hydrops fetalis
* Quantitative analysis of maternal anti-RhD antibodies - an increasing level is a sign of fetal Rh disease
* Intrauterine blood transfusion
o Intraperitoneal transfusion - blood transfused into fetal abdomen
o Intravascular transfusion - blood transfused into fetal umbilical vein - This is more modern and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion.
* Early delivery (usually after about 36 wks gestation)
Postnatal
* Phototherapy for neonatal jaundice in mild disease
* Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched against the mothers serum)
History of medical advances in Rh disease
The rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby who died of hemolytic disease of the newborn. The mother was aged 25 and it was her second pregnancy and she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there must be a previously undiscovered blood group antigen that was present on the husband's RBCs but was not present on the mother's RBCs and that the mother had formed antibodies against the new blood group antigen. This suggested for the first time that a mother could make blood group antibodies because of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Dr. Alexander S. Wiener. That procedure was further refined by Dr, Harry Wallerstein, a transfusionist. Although the most effective method of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had already been done. Children with severe motor damage and/or retardation could result. However, it is estimated that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center, having come to the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility with antibody provided by Ortho, obtained by a fractionation technique developed by Dr Pollack (who also provided Dr. Finn with several vials of antibody during a visit by Dr. Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model, named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Dr. Pollack's team to gain experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under Dr. Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Dr. Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964. Clinical trials set up by Dr. Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in 1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth, Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition, Dr. John M. Bowman, one of the researchers at the University of Manitoba, and Dr Freda pushed to allow antepartum use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the 1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated in the developed world. In 1980 Drs. Pollack, Gorman, Freda, and Finn shared the Albert Lasker Award for their work on Rh disease.
Two of the Canadian researchers from the University of Manitoba, Dr. Bruce Chown and Dr. John M. Bowman, licensed a version of the vaccine, known as WinRho SD, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into blood related diseases. Dr. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with erythroblastosis fetalis.
Rh disease (also known as Rh (D) disease, Rhesus disease, RhD Hemolytic Disease of the Newborn, Rhesus D Hemolytic Disease of the Newborn or RhD HDN) is one of the causes of hemolytic disease of the newborn (also known as HDN). The disease ranges from mild to severe. When the disease is mild the fetus may have mild anaemia with reticulocytosis. When the disease is moderate or severe the fetus can have a more marked anaemia and erythroblastosis (erythroblastosis fetalis). When the disease is very severe it can cause morbus haemolyticus neonatorum, hydrops fetalis, or stillbirth.
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal red blood cells leading to development Rh disease. It may thus be regarded as insufficient immune tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases). Sensitizing events during pregnancy include miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy, abdominal trauma and external cephalic version.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus negative woman, would result in still births or extremely sick babies and many babies who managed to survive would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants of rhesus negative woman. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is massively reduced .
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation. Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72 hours - the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
* The Kleihauer-Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood that has passed into the maternal circulation.
* The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
* The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic anemia.
* Full blood count - the hemoglobin level and platelet count are important
* Bilirubin (total and indirect)
Management
Antenatal
* Ultrasound - to detect and monitor hydrops fetalis
* Quantitative analysis of maternal anti-RhD antibodies - an increasing level is a sign of fetal Rh disease
* Intrauterine blood transfusion
o Intraperitoneal transfusion - blood transfused into fetal abdomen
o Intravascular transfusion - blood transfused into fetal umbilical vein - This is more modern and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion.
* Early delivery (usually after about 36 wks gestation)
Postnatal
* Phototherapy for neonatal jaundice in mild disease
* Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched against the mothers serum)
History of medical advances in Rh disease
The rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby who died of hemolytic disease of the newborn. The mother was aged 25 and it was her second pregnancy and she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there must be a previously undiscovered blood group antigen that was present on the husband's RBCs but was not present on the mother's RBCs and that the mother had formed antibodies against the new blood group antigen. This suggested for the first time that a mother could make blood group antibodies because of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Dr. Alexander S. Wiener. That procedure was further refined by Dr, Harry Wallerstein, a transfusionist. Although the most effective method of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had already been done. Children with severe motor damage and/or retardation could result. However, it is estimated that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center, having come to the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility with antibody provided by Ortho, obtained by a fractionation technique developed by Dr Pollack (who also provided Dr. Finn with several vials of antibody during a visit by Dr. Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model, named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Dr. Pollack's team to gain experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under Dr. Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Dr. Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964. Clinical trials set up by Dr. Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in 1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth, Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition, Dr. John M. Bowman, one of the researchers at the University of Manitoba, and Dr Freda pushed to allow antepartum use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the 1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated in the developed world. In 1980 Drs. Pollack, Gorman, Freda, and Finn shared the Albert Lasker Award for their work on Rh disease.
Two of the Canadian researchers from the University of Manitoba, Dr. Bruce Chown and Dr. John M. Bowman, licensed a version of the vaccine, known as WinRho SD, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into blood related diseases. Dr. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with erythroblastosis fetalis.
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