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19 February 2015.
62
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EMQ.
Surrogacy.
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63
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EMQ.
Endometrial cancer & FIGO.
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64
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EMQ.
Epidural anaesthesia.
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65
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EMQ. Gp
B streptococcus.
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66
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EMQ.
Puerperal mental illness.
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67
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EMQ.
Fertility & NICE.
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68
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EMQ.
GTD.
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69
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EMQ.
Obesity.
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62 Surrogacy.
Lead-in.
This question is about surrogacy. For each scenario, pick the best choice
from the option list. Each option can be used once, more than once or not at
all.
Abbreviations.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
Option List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman of the HFEA
f)
Senior judge at the Children and Family Court
g)
traditional surrogacy
h)
gestational surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG Surrogacy Sub-Committee
l)
false
m)
true
n)
none of the above
Scenario 1
List the
different types of surrogacy.
Scenario 2.
“Gestational”
surrogacy has better “take-home-baby” rates than “traditional” surrogacy.
Scenario 3.
There are
approximately 1,000 surrogate pregnancies per annum in the UK. True/False
Scenario 4.
Which
national body regulates surrogacy in England?
Scenario 5.
Privately-arranged surrogate pregnancies are illegal and those involved
are liable to up to 2 years in prison. True/False
Scenario 6.
List the risks of surrogacy.
Scenario 7.
Obstetricians are legally obliged to take the CPs’ wishes into
consideration in managing pregnancy complications or problems.
Scenario 8.
The
psychological outcomes of surrogacy are fully understood. True/False.
Scenario 9.
The psychological
outcomes of surrogacy are more severe after traditional surrogacy. True/False
Scenario 10.
Who has the
right to arrange TOP if the fetus is found to have a major congenital
abnormality?
Scenario 11.
A PO is
active from the moment it is completed and signed by the relevant parties. True/False
Scenario 12.
A SM can
change her mind at any time and keep the child, even if the egg was not hers. True/False
Scenario 13.
The CPs can
change their mind, leaving the SM as the legal mother. True/False
Scenario 14.
A SM’s
husband is the legal father until adoption is completed or a PO comes into
force.
Scenario 15.
A lesbian couple is a stable, co-habiting relationship can be CPs and
become the legal parents of the child of a SM.
Scenario 16.
CPs are likely to get faster legal status as the legal parents through
application for a PO rather than applying for adoption.
63 Endometrial cancer.
Lead-in.
The following scenarios relate to endometrial cancer.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list. There is none to make you work harder.
Scenario 1.
A histology report on
endometrial curetting is of 95% adenocarcinoma with 5% solid, non-squamous
areas. What is the FIGO grade?
Scenario 2.
A histology report on
endometrial curetting is of 90% adenocarcinoma with 10% solid, non-squamous
areas. What is the FIGO grade?
Scenario 3.
A histology report on
endometrial curetting is of 50% adenocarcinoma with 50% solid, non-squamous
areas. What is the FIGO grade?
Scenario 4.
A woman undergoes surgery for carcinoma of the
endometrium. Histology shows the tumour is confined to the body of the uterus
with 5% myometrial invasion. What is the FIGO staging?
Answer.
Scenario 5.
A woman undergoes surgery for carcinoma of the
endometrium. Histology shows the tumour is confined to the body of the uterus
with 25% myometrial invasion. What is the FIGO staging?
Scenario 6.
A woman undergoes surgery for carcinoma of the
endometrium. Histology shows the tumour is confined to the body of the uterus
with 60% myometrial invasion. What is the FIGO staging?
Scenario 7
A woman undergoes surgery for carcinoma of the
endometrium. Histology shows the tumour is confined to the uterus. There is no myometrial
invasion, but there is extension to the endocervical endothelium. What is the
FIGO staging?
Scenario 8
A woman undergoes surgery for carcinoma of the
endometrium. Histology shows the tumour is confined to the uterus. There is no
myometrial invasion, but there is extension to the stroma of the cervix. What
is the FIGO staging?
Scenario 9
A woman undergoes surgery for carcinoma of the
endometrium. Peritoneal washings are +ve but there is no other evidence of
spread outside the uterus. There is no myometrial invasion. There is extension
to the stroma of the cervix. What is the FIGO staging?
Scenario 10
A woman undergoes surgery for carcinoma of the
endometrium. There is no evidence of extension outside the uterus. There is
myometrial invasion through to and including the serosa. What is the FIGO
staging?
Scenario 11
A woman undergoes surgery for carcinoma of the
endometrium. There is myometrial invasion. Tumour is noted in the vagina. There
is no evidence of disease elsewhere. What is the FIGO staging?
Scenario 12
A woman undergoes surgery for carcinoma of the
endometrium. There is myometrial invasion. Tumour is noted in the vagina. Positive
pelvic nodes are found, but no other lymphatic involvement. There is no distant
spread. What is the FIGO staging?
Scenario 13
A woman undergoes surgery for carcinoma of the
endometrium. There is myometrial invasion. Tumour is noted in the vagina. The
tumour involves the mucosa of the bladder. There is no lymphatic or distant
spread. What is the FIGO staging?
64 Epidural anaesthesia.
Lead-in.
The following scenarios relate to epidural anaesthesia.
For each, select the answer that best fits the scenario.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
True
B.
False
C.
≥ 1 in 10
D.
1 in 10 to 1 in 100.
E.
1 in 100 to 1 in 1,000
F.
1 in 1,000 to 1 in
50,000
G.
1 in 50,000 to 1 in
100,000
H.
1 in 100,000 or less
I.
T8 - T12
J.
T10 – L1
K.
L2 - L8.
L.
L8 - S1
M. S1 – S4
N.
S2 – S4
O.
S3 – S5
P.
10%
Q.
20%
R.
20 – 50%
S.
50 – 70%
T. 80 – 90%
U. 90 – 100%
V. I have no idea, I don’t care and I am going
to the pub to drown my sorrows!
W. None of the above.
Scenario 1.
Which spinal level(s) conduct
pain sensation from the uterus and cervix?
Scenario 2.
Which spinal level(s) conduct
pain from the perineum?
Scenario 3.
Which spinal level(s) conduct
pain from the left big toe and what does it signify?
Scenario 4.
Maternal pyrexia is a complication of epidural
anaesthesia.
Scenario 5.
Spinal anaesthesia is effective more rapidly than
epidural anaesthesia.
Scenario 6.
Adding an opioid to the local
anaesthetic drug increased the potency of epidural anaesthesia.
Scenario 7
Epidural anaesthesia increases
the Caesarean section rate.
Scenario 8
Epidural anaesthesia increases
the length of labour.
Scenario 9
What is the rate of incomplete
block with epidural anaesthesia?
65 Group B Streptococcus 1.
Lead-in.
The following scenarios relate to Group B Streptococcal
disease.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
EOGBS: early-onset GBS disease.
GBS: Group B streptococcus.
IAP: intrapartum antibiotic
prophylaxis.
Option list.
1. Streptococcus agaractiae
2. Streptococcus intergalacticae
3. Streptococcus agalactiae
4. Streptococcus ubernastiae
5. Lancelot
6. Lanceforth
7. Lanceford
8. Landscape
9. 0.01%
10. 0.02%
11. 0.023%
12. 0.025%
13. 0.05%
14. 0.1%
15. 0.5%
16. 0.53%
17. 0.54%
18. 0.6%
19. 0.63%
20. 0.75%
21. 0.9%
22. 1%
23. 2%
24. 2.3%
25. 2.4%
26. 2.5%
27. 5%
28. 10%
29. 15%
30. 20%
31. 25%
32. 26.3%
33. 21%
34. 30%
35. 35%
36. 1
37. 2
38. 3
39. 5
40. 6
41. 9
42. 10
43. True
44. False
45. you are driving me mad with all these percentages
Scenario 1.
What is the scientific name for
GBS?
Scenario 2.
Which animal is the main
reservoir of GBS in relation to neonatal GBS?
Scenario 2.
What system is used for
grouping streptococci?
Scenario 3.
Where does GBS disease feature
in the list of serious early-onset neonatal infection?
Scenario 4.
What is the upper limit in days
for time of onset in the definition of “early-onset” disease?
Scenario 5.
GBS is a gram-negative,
capsulated organism.
Scenario 6.
What is the incidence of EOGBS
in the UK in the babies of women who have not been screened for GBS or had IAP?
Scenario 7
What is the incidence of EOGBS
in the babies of American women who have had antenatal GBS screening and IAP if
screen+ve?
Scenario 8
What is the mortality rate of
EOGBS in the UK?
66 Puerperal mental illness.
Lead-in.
The following scenarios relate to puerperal mental
illness.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
If I had put all the answers into the option list it
would have been enormous. So there are quite a few where you need to decide
what your answer would be. Opting for “none of the above” is not exercising
your brain – make sure you come up with an answer.
Option list.
a.
arrange admission to
hospital under Section 5 of the Mental Health Act
b.
send a referral letter
to the perinatal psychiatrist requesting an urgent appointment.
c.
send an e-mail to the
perinatal psychiatrist requesting an urgent appointment.
d.
phone the community
psychiatric team.
e.
phone the on-call
psychiatrist.
f.
arrange to see the patient
in the next ante-natal clinic.
g.
arrange to see the
patient urgently.
h.
send a referral letter
to the social services department.
i.
phone the fire
brigade.
j.
phone the police.
k.
there is no such
thing.
l.
4 weeks
m. 6 weeks
n.
12 weeks
o.
26 weeks
p.
1 year
q.
<1%
r.
1-5%
s.
5-10%
t.
10-20%
u.
25%
v.
50%
w. 60%
x.
70%
y.
80%
z.
True
aa. False
bb. none of the above.
Scenario 1
What is the internationally
agreed classification for postpartum psychiatric disease?
Scenario 2
What time limits does DSM-IV
use for postpartum psychiatric disorders?
Scenario 3
What time limits does ICD-10
use pro postpartum psychiatric disorders?
Scenario 4
What clinical classification
would you use in a viva or SAQ?
Scenario 5
What is the incidence of
suicide in relation to pregnancy and the puerperium?
Scenario 6
What are the main conditions
associated with suicide in pregnancy and the postnatal period?
Scenario 7
Most suicides occur in single
women of low social class who have poor education. True / False
Scenario 8
The preferred method of suicide
reported in recent MMRs was drug overdose. True / False.
Scenario 9
When are women with Social
Services involvement particularly at risk of suicide.
Scenario 10
Which women have the highest
risk for puerperal psychosis and what is the risk?
Scenario 11.
What is the risk of puerperal
psychosis for a primigravida with BPD?
Scenario 12
What is the risk of PP in a
woman with no history of psychiatric illness but who has a FH of PP?
Scenario 13
Should screening include the
identification of women with no history of psychiatric illness but who has a FH
of PP?
Scenario 14
What do the Confidential Enquiries into Maternal Deaths
say about the use of the term “postnatal depression”?
Scenario 15
Women with schizophrenia have a
≥ 25% risk of puerperal recurrence. True / False
Scenario 16
If lithium therapy for BPD is
stopped in pregnancy, there is an increased risk of severe puerperal illness.
True / False.
Scenario 17
You are the on-call SpR for obstetrics. A woman has just
had a normal delivery of a 30 week baby that requires resuscitation. The mother
says that the baby must be left alone and not resuscitated. The paediatric SpR
and midwives are uncertain about what to do. What action will you take?
Scenario 18
You are the on-call SpR for obstetrics. The midwife on
the postnatal ward phones for advice. A primigravida who delivered yesterday
has stated that the baby is not hers and is refusing to care for it. What
action will you take?
Scenario 19
You are the on-call Consultant in O&G. The community
midwife has phoned for advice. She was asked to visit a primiparous woman who
had a normal delivery seven days before. The husband reports that she has
struck him several times. The woman tells her that voices have informed her
that this man is not her husband and that she should drive him away in case he
rapes her. What action will you take?
Scenario 20
You are the on-call Consultant in O&G. The community
midwife has phoned. She has just been phoned by a woman who had a Caesarean
section for breech presentation four weeks ago. She has been told by God that
breech babies are the spawn of the Devil and she is going to the local
multi-storey car park to jump off with the baby so that the baby cannot grow up
and harm people and so that she cannot have more Devil babies. What action will
you advise?
67 Fertility & NICE.
Lead-in.
The following scenarios relate to fertility. Pick one
option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ART: assisted reproduction
techniques.
Option list.
A. 1%
B. 2.5%
C. 5%
D. 10%
E. 15%
F. 20%
G. 25%
H. 26-50%
I.
> 50%
J.
none of the above.
Scenario 1.
What is the approximate
incidence of infertility in heterosexual couples in the UK?
Scenario 2.
What % of couples
have an ovulatory disorder?
Scenario 3.
What% of couples
have a male infertility factor?
Scenario 4.
What % of couples
have tubal damage?
Scenario 5.
What % of couples
have uterine or peritoneal disorders?
Scenario 6.
What % of couples
have unexplained infertility?
Scenario 7.
Ovulatory (25%) +
male factor (30%) + tubal damage (20%) + uterine/peritoneal (10%) + unexplained
(25%) add to 110%. How can this be? No answer in option list – we will discuss
it.
Scenario 8.
Nice lists 6 main
tasks in investigating the couple after taking a full history. What are these?
No answer in the option list – we will discuss it.
Scenario 9.
NICE lists 3 main
treatment types once a diagnosis has been made. What are they? No answer in the
option list – we will discuss it.
Scenario 10.
NICE CG156
includes advice about the “off-label” use of some drugs, i.e. use for which the
drug does is not licensed in the UK. What is the advice? No answer in option list – we will discuss
it.
68 Gestational Trophoblastic Disease (GTD)
Lead-in.
The following scenarios relate to GTD. For each, select the
number that best fits the scenario. Pick one option from the option list. Each
option can be used once, more than once or not at all.
Option list.
A.
|
100%.
|
B.
|
20%.
|
C.
|
15%.
|
D.
|
10%.
|
E.
|
5%.
|
F.
|
2.5%.
|
G.
|
1.5%.
|
H.
|
0.5%.
|
I.
|
1 in 35.
|
J.
|
1 in 55.
|
K.
|
1 in 65.
|
L.
|
1 in 700.
|
M.
|
1 in 1,000.
|
N.
|
Ö64.
|
O.
|
pr2.
|
P.
|
increased.
|
Q.
|
reduced.
|
R.
|
increased by a factor of 2.
|
S.
|
increased by a factor of 5.
|
T.
|
increased by a factor of 10.
|
U.
|
increased by a factor of 20.
|
V.
|
increased by a factor of 30.
|
W.
|
increased by a factor of > 100.
|
X.
|
hydatidiform mole, both partial and complete.
|
Y.
|
hydatidiform mole, both partial and complete and
placental site tumour.
|
Z.
|
partial mole, complete mole, invasive and metastatic
mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid
trophoblastic tumour.
|
AA.
|
choriocarcinoma invasive and metastatic mole and epithelioid
trophoblastic tumour.
|
BB.
|
true
|
CC.
|
false
|
DD.
|
None of the above.
|
Abbreviations.
GTD: gestational
trophoblastic disease
GTN: gestational
trophoblastic neoplasia.
PSTT: placental site
trophoblastic tumour
Scenario 1.
What is the incidence of GTD in
the UK?
Scenario 2
What is the difference between GTD and GTN?
Scenario 3
A woman had a complete mole in her first pregnancy. She
is pregnant for the second time. What is the risk that it is another molar
pregnancy?
Scenario 4.
A woman has had two molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 5
A woman has had three molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 6
Cystic placental spaces in the placenta and a ratio of
transverse to anterioposterior
measurements of the gestation sac < 1.5 are strongly
suggestive of a partial mole. True / False
Scenario 7.
What is the risk of persistent GTD after a complete mole?
Scenario 8.
What is the risk
of requiring chemotherapy after a complete mole?
Scenario 9.
What is the risk of persistent
GTD after a partial mole?
Scenario 10
What is the risk of requiring chemotherapy
after a partial mole?
Scenario 11
What is the risk of requiring
chemotherapy with hCG level > 20,000 i.u. one month after evacuation?
Scenario 12
What is the overall risk of
requiring chemotherapy after molar pregnancy in the UK?
Scenario 13
What is the risk of requiring
chemotherapy in the USA compared with the UK?
Scenario 14
What is the risk of molar
pregnancy at age 15 compared to age 30?
Scenario 15
What is the risk of molar
pregnancy at age 45 compared to age 30?
69 Obesity and pregnancy
Lead-in.
The following scenarios relate to obesity in pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
BMI: body mass index.
FP clinic: family planning clinic
GDM: gestational diabetes mellitus.
IOL induction of labour.
NNU: neonatal
unit.
PET: pre-eclampsia.
PPH: post-partum
haemorrhage.
Option list.
A.
|
Yes
|
B.
|
No
|
C.
|
weight in kg. divided by
estimated total surface area
|
D.
|
weight in kg. divided be the
square of estimated total surface area
|
E.
|
weight in kg. divided by the
square of the height in metres
|
F.
|
weight in kg. divided by the
square root of the height in metres
|
G.
|
Pre-pregnancy BMI > 25
|
H.
|
Pre-pregnancy BMI > 30
|
I.
|
Pre-pregnancy BMI > 35
|
J.
|
Pre-pregnancy BMI > 40
|
K.
|
Class 1
|
L.
|
Class 2
|
M.
|
Class 3
|
N.
|
Class 4
|
O.
|
BMI > 30 but < 35.
|
P.
|
BMI ≥ 30 kg./m2
but < 40 kg./m2 but
|
Q.
|
BMI > 35 kg./m2
but < 40 kg./m2.
|
R.
|
BMI ≥ 40 kg./m2
but < 45 kg./m2.
|
S.
|
BMI ≥ 45 kg./m2.
|
T.
|
BMI ≥ 45 kg./m2.
|
U.
|
BMI ≥ 50 kg./m2.
|
V.
|
True.
|
W.
|
False.
|
X.
|
Everyone.
|
Y.
|
No-one.
|
Z.
|
Women who look overweight.
|
AA.
|
None of the above.
|
Scenario 1.
What does CMRCOG give as the
usual definition of obesity in pregnancy?
Scenario 2.
How is the value of the BMI
derived?
Scenario 3.
A woman attends for
pre-pregnancy counselling. Her BMI is 35 kg./m2. What class of
obesity does this value come into?
Scenario 4. Approximately
one woman in 4 in the UK is obese. True
/ False.
Scenario 5.
List 6 maternal complications /
adverse outcomes associated with obesity.
List 6 fetal complications /
adverse outcomes associated with obesity.
Scenario 6.
Which women should have BMI
noted at booking?
Scenario 7
All women should have repeat
BMI calculation in the 3rd. trimester. True / False.
