Monday, 12 November 2018

Tutorial 12th. November 2018


Website


12 November 2018
46
SBA.   Coeliac disease & pregnancy
47
EMQ. Cancer incidence & mortality
48
EMQ. Zika infection in pregnancy
49
EMQ. Antenatal steroids
50
EMQ. BRCA1 & 2.

46. Coeliac disease and pregnancy.
Abbreviations.
AGA:                           anti-gliadin antibodies 
CD:                              coeliac disease.
EMA:                          anti-endomysial antibodies. 
FGR:                            Fetal growth restriction.
IgA:                             immunoglobulin A IgG. 
tTGA:                          anti-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.       
1-2 %
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.       
rectal biopsy
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 normal diet.
B.       
continue with a normal diet that includes a minimum of 5 gm. gluten daily
C.       
continue with a normal diet that includes a minimum of 10 gm. gluten daily
D.      
follow a strict gluten-free diet for at least 1 month
E.       
follow a strict gluten-free diet for at least 3 months
Question 9.
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 10.
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 11.
Which skin condition is particularly associated with CD?
Option List
A.       
atopic eczema
B.       
dermatitis herpetiformis
C.       
dermatitis multiforme
D.      
dermatographia
E.       
psoriasis
Question 12.
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 13.
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 14.
Which of the following do not contain gluten?
Option List
A.       
barley
B.       
oats
C.       
rapeseed oil
D.      
rye
E.       
wheat

47. Cancer incidence and mortality.
Abbreviations.
NHL:     non-Hodgkin Lymphoma
Question 1.
Which is the most common female cancer?
Option List
F.        
Bowel
G.      
Breast
H.      
Cervix
I.         
Endometrium
J.         
Lung
Question 2.
Which is the 2nd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.      
Endometrium
E.       
Lung
Question 3.
Which is the 3rd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.      
Endometrium
E.       
Lung
Question 4.
Which is the 4th. most common female cancer?
Option List
A.       
Bowel
B.       
Cervix
C.       
Endometrium
D.      
Lung
E.       
Pancreas
Question 5.
Which is the 5th. most common female cancer?
Option List
A.       
Cervix
B.       
Malignant melanoma
C.       
Non-Hodgkin’s lymphoma
D.      
Ovary
E.       
Vulva
Question 6.
Which is the 6th. most common female cancer?
Option List
A.       
Cervix
B.       
Malignant melanoma
C.       
Non-Hodgkin’s lymphoma
D.      
Ovary
E.       
Vulva
Question 7.
Where does cervical cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
11th.
C.       
13th.
D.      
14th.
E.       
20th.
Question 8.
Where does vulval cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
12th.
C.       
16th.
D.      
20th.
E.       
none of the above
Question 9.
Which is the most common cancer causing female death in the UK?
Option List
F.        
Breast
G.      
Bowel
H.      
Lung
I.         
Ovary
J.         
Pancreas
Question 10.
Which is the 2nd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.      
Ovary
E.       
Pancreas
Question 11.
Which is the 3rd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.      
Ovary
E.       
Pancreas
Question 12.
Which is the 4th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.      
Pancreas
E.       
Uterus
Question 13.
Which is the 5th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.      
Pancreas
E.       
Uterus
Question 14.
Which is the 6th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.      
Pancreas
E.       
Uterus
Question 15.
The incidence of cervical cancer has fallen from the late 1970s until now. What is the approximate figure for the fall?
Option List
A.       
10%
B.       
25%
C.       
50%
D.      
60%
E.       
75%
Question 16.
Which, if any, of the following statements are true in relation to CIN.
Option List
A
there were ~ 20,000 new cases of CIN in 2015
B
there were ~ 30,000 new cases of CIN in 2015
C
there were ~ 50,000 new cases of CIN in 2015
D
incidence rates for new cases of CIN are highest in women aged 19 - 24
E
incidence rates for new cases of CIN are highest in women aged 25 - 29
F
incidence rates for new cases of CIN are highest in women aged 30 - 39
G
incidence rates for new cases of CIN by ~ 10 % since the 1990s
H
incidence rates for new cases of CIN ↑ by ~ 20 % since the 1990s
I
incidence rates for new cases of CIN ↑ by ~ 30 % since the 1990s
J
incidence rates for new cases of CIN ↑ by ~ 5 % in the past decade
K
incidence rates for new cases of CIN ↑ by ~ 10 % in the past decade
L
incidence rates for new cases of CIN ↑ by ~ 15 % in the past decade
Question 17.
Which, if any, of the following statements describes the change in incidence of cervical cancer in the past decade.
Option List
A.       
↑ by 5%
B.       
↓ by 5%
C.       
↑ by 10%
D.      
↓ by 10%
E.       
↑ by 15%
F.        
↓ by 15%
G.      
↑ by 20%
H.      
↓ by 20%
I.         
↑ by 25%
J.         
↓ by 25%
Question 18.
What is the peak age at which cervical cancer is diagnosed in the UK?
Option List
A.       
20-24
B.       
25-29
C.       
30-34
D.      
35-39
E.       
40-44
F.        
45-49
G.      
50-54
H.      
55-59
I.         
60
Question 19.
What proportion of cervical cancer is diagnosed in women < 45 years?
Option List
A.       
20%
B.       
30%
C.       
40%
D.      
50%
E.       
60%
Question 20.
The mortality rate from cervical cancer has fallen from the late 1970s until now. What is the approximate figure for the fall?
Option List
A.       
10%
B.       
25%
C.       
50%
D.      
60%
E.       
75%
Question 21.
The mortality rate from cervical cancer has fallen in the past decade. What is the approximate figure for the fall?
Option List
A.       
10%
B.       
25%
C.       
50%
D.      
60%
E.       
75%
Question 22.
The mortality rate from cervical cancer has fallen in the past decade. What is the approximate figure for the fall?
Option List
F.        
10%
G.      
25%
H.      
50%
I.         
60%
J.         
75%
Question 23.
When was routine HPV vaccination of girls introduced in the UK?
Option List
A.       
2000
B.       
2002
C.       
2004
D.      
2006
E.       
2008
Question 24.
From what year might we expect to see a reduction in cervical cancer incidence as a result of the HPV vaccination programme?
Option List
A.       
2020
B.       
2025
C.       
2030
D.      
2040
E.       
2050
Question 25.
When was routine HPV vaccination of boys introduced in the UK?
Option List
A.       
2010
B.       
2011
C.       
2012
D.      
2014
E.       
None of the above

Abbreviations.
CZVS:         Congenital Zika Virus Syndrome.
FMS:          fetal medicine specialist.
HC              head circumference.
PHE:           Public Health England.
PCR:           polymerase chain reaction.
RTPCR:      Reverse transcription polymerase chain reaction
Question 1.           
What kind of virus is Zika?
A
DNA
B
DNA + RNA during intermediate stage
C
RNA
D
RNA + DNA during intermediate stage
Question 2.           
To which family of viruses does the Zika virus belong?
A
adenoviruses
B
flaviviruses
C
herpesviruses
D
orthomyxoviruses
E
parvoviruses
F
picornaviruses
G
retroviruses
H
togaviruses
Question 3.           
What other human infections are caused by viruses from this family? This is not a proper EMQ: there may be more than one correct answer.
A
bubonic plague
B
chikungunya
C
chicken pox
D
common cold
E
dengue fever
F
hepatitis C
G
Japanese encephalitis
H
malaria
I
San Francisco encephalitis
J
St. Louis encephalitis
K
West Nile virus
L
Yellow fever
Question 4.           
When was the first reported identification of Zika virus infection in an animal and what was the animal?
A
1922 in a hippopotamus
B
1928 is a giraffe
C
1935 in a macaque monkey
D
1947 in a Rhesus negative monkey
E
1950 in a chimpanzee
H
none of the above.
.
Question 5.           
Why is the virus called “Zika”?
A
it was first described as “zoonosis affecting Intestines, Kidneys and Adrenals”
B
the animal from which it was first isolated was the Zika monkey
C
it was first isolated from a monkey from the Zika area of Zambia
D
it was first isolated from a monkey from the Zika forest in Uganda
E
it was first identified in the Zika laboratory of the CDC
F
it was first identified by Dr Emily Zika, Professor of Virology, Pretoria, S Africa
G
‘Zika’ is Zulu for ‘small head’ and the association was 1st. noted in a Zulu baby
Question 6.           
What is the main reservoir of the Zika virus?
A
anteaters
B
horses
C
humans
D
marmosets
E
monkeys
F
parrots
G
rats
Question 7.           
How is the Zika virus transmitted? This is not a true EMQ as there may be > 1 correct answer.
A
Aedes aegypti mosquitos
B
Aedes albopictus: Asian tiger mosquito
C
Anopheles gambiae mosquitos
D
Culex pipiens  mosquitos
E
fleas
F
ticks
G
worms
H
none of the above.
Question 8.           
At what time of day is transmission of infection most likely?
A
afternoon
B
evening
C
morning
D
night
E
mid-morning and mid-afternoon to dusk
F
two hours after sunrise
G
two hours before sunset
H
two hours after sunset
I
two hours after sunrise and two hours before sunset
J
none of the above
Question 9.           
Where do aegypti mosquitoes breed?
Which, if any of the following
A
in large stretches of water with reed beds
B
in water near human habitation
C
in water remote from human habitation
D
in water in human habitations
E
in water with volume > 5 litres
F
in water with volume > 50 litres
G
in water with volume > 500 litres
H
none of the above.
Question 10.       
When did the current interest in the Zika virus and pregnancy begin and why?
A
Brazil reported an in microcephaly with a possible link to maternal Zika infection in 2014
B
Brazil reported an ↑ in microcephaly with a possible link to maternal Zika infection in 2015
C
Brazil reported an ↑ in microcephaly with a possible link to maternal Zika infection in 2016
D
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2014
E
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2015
F
the CDC reported 3 cases of microcephaly after proven Zika infection in pregnancy in 2016
H
none of the above
Question 11.       
How did the WHO categorise the problem and when?
A
Public Health Emergency of International Concern 2015
B
Public Health Emergency of International Concern 2016
C
Public Health Emergency of International Concern 2017
D
Public Health Emergency of International Concern 2018
E
none of the above
Question 12.       
Is Zika virus infection a notifiable condition in the UK?
A
No
B
Yes, but only if people have returned from an area with a high prevalence of Zika
C
Yes, but only if the woman and her partner have returned from an area with high prevalence of Zika
D
Yes, but only if fetal damage has occurred.
E
none of the above
Question 13.       
How is the risk of getting a Zika virus infection from travelling to a particular country categorised? Which, if any, of the following feature?
A
frightful
B
high
C
low
D
moderate
E
scary
F
none of the above
Question 14.       
How long does it take for symptoms of Zika infection to develop?
A
1 – 5 days
B
1 – 7 days
C
2 – 5 days
D
2 – 7 days
E
2 – 10 days
F
3 – 7 days
G
3 – 12 days
H
5 – 10 days
Question 15.       
How long do symptoms of Zika infection last?
A
1 – 5 days
B
1 – 7 days
C
2 – 5 days
D
2 – 7 days
E
2 – 10 days
F
3 – 7 days
G
3 – 12 days
H
5 – 10 days
Question 16.       
What are the most common symptoms of Zika infection? There is no option list – write what you think.
Question 17.       
Is Zika infection more severe in pregnancy?
A
No
B
Yes
Question 18.       
What abnormalities have been associated with Congenital Zika Virus Syndrome? There is no option list, just write as many as you can think of.
Question 19.       
What is the approximate risk of vertical transmission of the Zika virus in pregnancy?
A
10%
B
20%
C
30%
D
40%
E
50%
E
the figure is unknown
Question 20.       
Is gestation related to the risk of vertical transmission of the Zika virus? Which, if any, of the following statements are true?
A
evidence is unclear
B
evidence suggests it probably is
C
evidence suggests it probably is not
D
no
E
yes
Question 21.          
What is the risk of adverse fetal outcomes for women proven to have had Zika virus infection?
A
~   5%
B
~ 10%
C
~ 15%
D
~ 20%
E
~ 25%
F
~30%
G
> 30%
H
none of the above
Question 22.       
What advice should be given to a pregnant woman planning to travel to an area with high risk of transmission of Zika infection?
A
consider postponing travel until after the pregnancy
B
don’t go to the area
C
get vaccinated
D
stay indoors from dawn to dusk
E
take chloroquine as prophylaxis
F
take chloroquine + proguanil as prophylaxis
G
take proguanil as prophylaxis
Question 23.       
What advice should be given to a pregnant woman planning to travel to an area with moderate risk of transmission of Zika infection?
A
consider postponing travel until after the pregnancy
B
don’t go to the area
C
get vaccinated
D
stay indoors from dawn to dusk
E
take chloroquine as prophylaxis
F
take chloroquine + proguanil as prophylaxis
G
take proguanil as prophylaxis
Question 24.       
What advice should be given to a woman who decides to travel to an area of high or moderate risk?
There is no option list: jot down everything you think would be relevant.
Question 25.       
A woman returns to the UK from a high-risk Zika area? She develops symptoms suggestive of Zika infection 4 weeks later. What testing should be offered?
A
abdominal ultrasound
B
amniocentesis
C
MR scan
D
no test indicated
E
TVS
F
Zika IgA 
G
Zika IgG 
H
Zika IgG + IgM
I
Zika IgA + IgG + IgM 
J
Zika PCR
Question 26.       
A woman who wishes to be pregnant has returned to the UK from an area of high-risk for Zika infection. Her partner had remained in the UK? What advice should she be given?
A
use barrier contraception for 8 weeks
B
use effective contraception for 8 weeks
C
use barrier contraception + effective contraception for 8 weeks
D
use barrier contraception for 12 weeks
E
use effective contraception for 12 weeks
F
use barrier contraception + effective contraception for 12 weeks
Question 27.       
A man travels to an area with high-risk of Zika infection? On his return to the UK his wife is keen to start a pregnancy. What advice should be given?
A
use barrier contraception for 8 weeks
B
use effective contraception for 8 weeks
C
use effective contraception + barrier contraception for 8 weeks
D
use barrier contraception for 12 weeks
E
use effective contraception for 12 weeks
F
use effective contraception + barrier contraception for 12 weeks
G
use barrier contraception for 6 months
H
use effective contraception for 6 months
I
use effective contraception + barrier contraception for 6 months
J
none of the above.
Question 28.       
A man travels to an area with high-risk of Zika infection for two weeks? During his stay he has symptoms suggestive of Zika infection. His wife is pregnant. What testing should be offered on his return?
A
discuss with local infection specialist
B
discuss with RIPL
C
no test indicated
D
Zika IgG 
E
Zika IgG + IgM
F
Zika IgA + IgG + IgM 
G
Zika PCR
H
none of the above
Question 29.       
A woman is shown to have had a Zika infection? How useful is amniocentesis for assessing the risk to the fetus and determining if an infected fetus in affected?
A
PCR on amniocentesis is the gold standard for diagnosing fetal infection
B
PCR on amniocentesis is of unknown value for diagnosing fetal infection
C
PCR on amniocentesis is of little value for diagnosing fetal infection
D
PCR on amniocentesis is the gold standard for determining the risk of an infected fetus being affected
E
PCR on amniocentesis is of unknown value for determining the risk of an infected fetus being affected
F
PCR on amniocentesis is of little value for diagnosing fetal infection
Question 30.       
What advice and treatment should be offered to the non-pregnant individual with symptoms of Zika infection? This is not a true EMQ as more than one option could be true.
A
adequate fluids
B
acyclovir from GP
C
bed rest for 48 hours
D
emergency contraception
E
get advice from A&E centre
F
offer TOP
G
paracetamol if needed for pain
Question 31.       
A pregnant woman returns from a high-risk Zika area and develops symptoms suggestive of infection? She develops a high fever and is admitted to hospital. What particular things should be done?
A
anticoagulant prophylaxis
B
paracetamol + tepid sponging
C
exclude chikungunya
D
exclude dengue
E
exclude malaria
F
exclude UTI
G
exclude Zika
H
exclude other causes of pyrexial illness
I
offer TOP
J
none of the above
Question 32.          
A woman with possible Zika exposure has a –ve test for virus antibodies 4 weeks after the last possible exposure. Is this sufficiently long to reassure her that she has not been infected?
A
no
B
yes
C
we don’t know
Question 33.       
A pregnant woman has visited a country with high-risk for Zika exposure but been asymptomatic during her stay and for two weeks on her return? What testing should be offered?
A
baseline ultrasound + repeat at 18-20 weeks
B
baseline ultrasound + repeat at 28-30 weeks
C
baseline ultrasound + repeat at 18-20 weeks + consider repeat at 28-30 weeks
D
amniocentesis
E
MR scan
F
no test indicated
G
Zika IgG 
H
Zika IgG + IgM
I
Zika IgA + IgG + IgM 
J
Zika PCR
Question 34.       
A pregnant woman returns to the UK from an area of high risk for Zika exposure has normal ultrasound scans on her return and at 22 weeks. What further scans, if any, should be arranged? This question is in the exam database.
A
monthly scans
B
scan at 28-30 weeks
C
scan at 32 and 36 weeks
D
scan at 36 weeks
E
no further scans
F
none of the above
Question 35.       
A pregnant woman with possible Zika exposure has an ultrasound scan showing the fetal BPD to be > 2 SDs below the mean for that gestation. What should be done?
A
discuss amniocentesis to confirm fetal infection
B
discuss with the local virologist
C
offer TOP
D
refer to a fetal medicine specialist
E
screen the mother for recent Zika infection
F
none of the above
Question 36.       
A pregnant woman with possible Zika exposure has an ultrasound scan showing significant brain abnormality. What further testing should be discussed?
A
amniocentesis + PCR
B
amniocentesis + RT-PCR
C
MR scan
D
Zika IgG 
E
Zika IgG + IgM
F
Zika IgA + IgG + IgM
G
none of the above

49. Antenatal steroids and the neonate.
Abbreviations.
ANC:             antenatal corticosteroids.
ANS:             antenatal steroids.
NG25:          NICE’s Guideline 25: Preterm labour and birth. November 2015.
Lead-in.
The following scenarios relate to antenatal steroid use and the neonate.
There are no option lists and you have to decide your answers without help.
Scenario 1.
What are the benefits to the neonate of appropriate administration of antenatal steroids?
Scenario 2.
At what gestations should antenatal steroids be offered to women with singleton pregnancies who are at risk of premature labour?
Scenario 3.
At what gestations should antenatal steroids be offered to women with multiple pregnancies who are at risk of premature labour?
Scenario 4.
What advice is contained in NG25 about ANS and very early gestations?
Scenario 5.
What advice is contained in NG25 GTG about antenatal steroids and Caesarean section?
Scenario 6.
What advice is given in the NG25 about ANS in relation to the fetus with FGR at risk of premature delivery?
Scenario 7
What advice is given in NG25 about ANS for women with IDDM?
Scenario 8
What advice is in the NG25 about adverse effects of ANS on the fetus?
Scenario 9
What advice is in the GTG in relation to short-term maternal adverse effects?
Scenario 10
What contraindications to ANS are cited in NG25?
Scenario 11
What is the recommended drug regime for ANS administration?
Scenario 12.
What is the time-scale for maximum effect of ANS in reducing RDS?
Scenario 13.
When should repeat courses of ANS be given?
Scenario 14.
Who was the great pioneer of antenatal steroids to accelerate lung maturation?
Scenario 15.
Which country was this great pioneer from and which animal did he use for his early research?
Scenario 16.
Why is the story of this pioneer’s work a cautionary tale for O&G?
Scenario 17.
Which international organisation has immortalised his work in its logo?
Scenario 18.
When may antenatal steroids be beneficial to the fetus apart from accelerating lung maturation?

50. BRCA 1 & 2 carriers and risk of breast and ovarian cancer.
Option lists. Most of the questions have no option list to make you work harder.
Abbreviations.
BSO:                         bilateral salpingo-oophorectomy
EOC:                         epithelial ovarian cancer
HGSOG:                  high-grade serous ovarian cancer
LGSOG:                   low-grade serous ovarian cancer
Scenario 1.
Which, if any, of the following statements are true?
A
EOC is the most common gynaecological cancer in the developed world
B
EOC is the leading cause of death from gynaecological cancer in the developed world
C
50% of EOC is mucinoid
D
HGSOG is 20 times more common than LGSOG
E
HGSOG is the main cause of death from ovarian cancer
F
overall life time risk of EOC is 1 in 70
G
the main risk factors for EOC are cigarette smoking & older age
H
5% of ovarian cancer is due to identified hereditary genetic factors
I
BRCA1 is linked to an ↑ risk of breast, ovarian, pancreatic and prostate cancer
J
BRCA2 is linked to an ↑risk of breast, ovarian, pancreatic and prostate cancer & melanoma
K
The prevalence of BRCA1 & 2 mutations is about 1 in 400 in the general population
L
The prevalence of BRCA1 & 2 mutations is about 1 in 40 in the Ashkenazi Jewish population
M
The risk of developing ovarian cancer by 75 years is BRCA1: 50% and BRCA2: 25%
N
EOC associated with BRCA1 &2 is mostly low-grade mucinous in type
O
The risk of male breast cancer is about 7% with BRCA2, higher than with BRCA1
P
BRCA1 & 2 are DNA repair genes
Q
male breast, pancreatic and prostate cancer are more common with BRCA2 than BRCA1
Scenario 2.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 3.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 4.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2. She attends the gynaecology clinic requesting information about her lifetime risk of breast cancer. What is the approximate figure?
Scenario 5.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 6.
The woman asks for the overall figure for lifetime risk of breast cancer in UK women for comparison with her risk. What is the approximate figure?
Scenario 7.
The woman asks for the overall UK figure for lifetime risk of ovarian cancer for comparison with her risk. What is the approximate figure?
Scenario 8
Which of the following genes have mutations that increase the risk of breast cancer?
A
ATM
B
CDH1
C
CHEK1
D
FATHEAD
E
MARBELLA.
F
NBENE
G
p45
H
p53.
I
PALB2
J
PNINE
K
PTEN
L
RADON50
M
RINT1
Scenario 9
A man of 30 has two sisters who developed breast cancer before the age of 40. They and he have been proved to be carriers of BRCA2. His GP phones to ask about his lifetime risk of breast cancer. What is the approximate figure?
Scenario 10
A man of 30 has two sisters who developed breast cancer before the age of 40. They and he have been proved to be carriers of BRCA2. His GP phones to ask about his lifetime risk of ovarian cancer. What is the approximate figure?
Scenario 11
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about the value of prophylactic mastectomy. What advice will you give about efficacy?
Scenario 12
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy – her family is complete and her husband has had vasectomy. What is the approximate figure for the efficacy of BSO in relation to cancer?
Scenario 13.
Which, if any, of the following statements is true in relation to the findings by Kuchenbaecker in relation to the incidence of breast cancer in carriers of a BRCA1 mutation?
Option list.
A.       
it rises rapidly until the age of 30-40, then stays constant until age 80
B.       
it rises rapidly from puberty until the age of 30-40, then stays constant until age 80
C.       
it rises rapidly from young adulthood  until the age of 30-40, then stays constant until age 80
D.      
it rises rapidly from puberty until the age of 40-50, then stays constant until age 80
E.       
it rises rapidly from young adulthood  until the age of 40-50, then stays constant until age 80
F.        
it rises rapidly from puberty until the menopause, then stays constant until age 80
G.      
it rises rapidly from young adulthood  until the menopause, then stays constant until age 80
H.      
none of the above
Scenario 14.
Which, if any, of the following statements is true in relation to the findings by Kuchenbaecker about the incidence of breast cancer in carriers of a BRCA2 mutation?
Option list.
A.       
it rises rapidly until the age of 30-40, then stays constant until age 80
B.       
it rises rapidly from puberty until the age of 30-40, then stays constant until age 80
C.       
it rises rapidly from young adulthood  until the age of 30-40, then stays constant until age 80
D.      
it rises rapidly from puberty until the age of 40-50, then stays constant until age 80
E.       
it rises rapidly from young adulthood  until the age of 40-50, then stays constant until age 80
F.        
it rises rapidly from puberty until the menopause, then stays constant until age 80
G.      
it rises rapidly from young adulthood until the menopause, then stays constant until age 80
H.      
none of the above
Scenario 15.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy. What are the disadvantages of BSO?
Scenario 16
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy.  What alternatives should be discussed?
Scenario 17
A woman of 25 years is a known carrier of BRCA1. She has no family history of breast cancer. She has a friend who is similar in age and has similar risk factors for breast cancer, including being a BRCA1 carrier, apart from having two 1st. degree relatives with breast cancer. Which, if any of the following statements is true in relation to the risk of breast cancer for the friend compared with the woman?
A.       
her risk is the same
B.       
her risk is 2 x that of the woman
C.       
her risk is 5x that of the woman
D.      
her risk is ½ of that of the woman
E.       
none  of the above
Scenario 18
A woman of 25 years is a known carrier of BRCA2. She has no family history of breast cancer. She has a friend who is similar in age and has similar risk factors for breast cancer, including being a BRCA2 carrier, apart from having two 1st. degree relatives with breast cancer. Which, if any of the following statements is true in relation to the risk of breast cancer for the friend compared with the woman?
A.       
her risk is the same
B.       
her risk is 2 x that of the woman
C.       
her risk is 5x that of the woman
D.      
her risk is ½ of that of the woman
E.       
none  of the above