22 December 2016.
|
50
|
SBA. Classification of urgency of C.
section
|
|
51
|
EMQ. Drugs in O&G 2
|
|
52
|
SBA. Fetal origins of adult disease
|
|
53
|
SBA. Endometrial cancer & obesity
|
|
54
|
SBA. ART, infertility treatment and
cancer
|
50. Classification
of urgency of Caesarean section.
Abbreviations.
DDI: decision-to-delivery
interval
GP11. RCOG’s
Good Practice 11. 2010. “Classification
of urgency of Caesarean section – a continuum of risk.“
Question 1.
Lead-in
How many
categories are included in the classification of urgency in GP11?
Option List
|
A.
|
3
|
|
B.
|
4
|
|
C.
|
5
|
|
D.
|
6
|
|
E.
|
7
|
Question 2.
Lead-in
What are
the definitions used for the categories?
There is
no option list! Just write your answers.
Question 3.
Lead-in
What
additional aid is included in GP11 in relation to the classification of
urgency?
Option List
|
A.
|
a colour
scale in the form of a spectrum
|
|
B.
|
“red flag” numbering system
|
|
C.
|
a table of the 10 most common reasons for high urgency
classification
|
|
D.
|
a table of the 10 most common reasons for low urgency
classification
|
|
E.
|
the web address of an app that automatically decides
the urgency classification
|
Question 4.
Lead-in
What does
GP11 say is the purpose of the additional aid?
Option List
|
A.
|
it
allows automatic, uniform classification
|
|
B.
|
it highlights the degree of urgency to encourage
efficient action by staff
|
|
C.
|
it assists staff in learning the correct classifications
|
|
D.
|
it encourages reflective learning
|
|
E.
|
it reinforces the concept of ‘continuum of urgency’
|
Question 5.
Lead-in
GP11 says:
“Good communication is central to timely delivery of the fetus, while avoiding
unnecessary risk to the mother”.
What does
it say is a critical indicator of the DDI?
Option List
|
A.
|
the
grade of the senior anaesthetist
|
|
B.
|
the grade of the senior obstetrician
|
|
C.
|
the time from the delivery decision being taken until
the theatre staff and anaesthetist have been fully informed
|
|
D.
|
the time from the delivery decision being taken until
the consent form is completed
|
|
E.
|
the time for the woman to reach the operating theatre
|
Question 6.
Lead-in
GP11
devotes a section to communication. It makes 5 points. How many can you conjure
up (useful for an OSCE station)?
Question 7.
Lead-in
GP11 gives
a target DDI for C section for “fetal compromise” of 30 minutes. What it the
rationale for this?
Option List
|
A.
|
research
shows that DDI ≤ 30 minutes is associated with best fetal outcomes
|
|
B.
|
research shows that DDI ≤ 30 minutes is associated with
best maternal outcomes
|
|
C.
|
research shows that DDI ≤ 30 minutes is associated with
best educational and neuro-developmental outcomes at age 7 years
|
|
D.
|
it is an accepted audit tool that tests the efficiency
of the delivery team
|
|
E.
|
the NHSLA’s CNST requires that ≥ 90% of category 1 C
sections have a DDI ≤ 30 minutes
|
Question 8.
Lead-in
GP11 had a
concluding section entitled “Recommendations”, of which there were three. What
were they?
Question 9.
Lead-in
Give two examples of clinical cases
for each of the categories of risk.
51. Drugs
in Pregnancy. 2
Lead-in.
The following scenarios relate to some common drugs used
in pregnancy.
Pick one option from the option list. Each option can be
used once, more than once or not at all.
Abbreviations.
NSAID. non-steroidal
anti-inflammatory drug.
Option list.
I have not given one to make
you think! And, in the exam, you should be deciding your answer before you
check the option list.
Scenario 1.
What is the generic name for
Prostin?
Scenario 2.
What kind of drug is Prostin?
Scenario 3.
What is the generic name for
Misoprostol?
Scenario 4.
What kind of drug is Misoprostol?
Scenario 5.
What is the generic name for Gemeprost?
Scenario 6.
What kind of drug is Gemeprost?
Scenario 7
What is the generic name for
Mifepristone?
Scenario 8
What king of drug is
Mifepristone?
Scenario 9
What are the constituents of a
1 ml. ampoule of Syntometrine?
Scenario 10
What is the generic name for Carbetocin?
Scenario 11
What kind of drug is
Carbetocin?
Scenario 12
What is the generic name for
Hemabate?
Scenario 13
What kind of drug is Hemabate?
Scenario 14
What is the generic name for
Atosiban?
Scenario 15
What kind of drug is atosiban?
Scenario 16
What if the generic name for Cervagem?
Scenario 17
What kind of drug is Cervagem?
Scenarion 18
What is the cost of 1mg. of Prostin E2 gel and what are
its storage requirements?
Scenarion 19
What is the cost of a 1mg. Gemeprost pessary and what are
its storage requirements?
Scenarion 20
What is the cost of 200 mcg. of misoprostol and what are
its storage requirements?
52. Fetal
origins of adult disease.
Abbreviations.
ADHD: attention-deficit,
hyperactivity disorder
Lead in.
These
questions relate to disease in adults resulting from events during fetal,
infant and child development.
Scenario 1.
What
eponymous title is given to the concept that adverse intra-uterine conditions
predispose to the development of disease in adulthood?
Option List
|
F.
|
the Barker hypothesis
|
|
G.
|
the Baker’s dozen
|
|
H.
|
the Broadbank theory
|
|
I.
|
PIPAD: Placental Insufficiency Programmes Adult Disease
|
|
J.
|
SIMCARD: Stop In-utero Malnutrition to Conquer
Adult-resulting Disease
|
Scenario 2.
Which
other term is used for the concept that adverse intra-uterine conditions
predispose to the development of disease in adulthood?
Option List
|
A.
|
FDAD: fetal determination of adult disease
|
|
B.
|
FIAD: fetal
influences on adult disease
|
|
C.
|
FIDAD: fetal and infancy determinants of adult disease
|
|
D.
|
FIGO: fetal
influences on genomic outcomes
|
|
E.
|
FP: fetal
programming
|
Scenario 3.
Which of
the following is thought to increase the risk of adult disease?
Option List
|
A.
|
low birthweight
|
|
B.
|
low birthweight followed by poor weight gain in infancy
and childhood
|
|
C.
|
low birthweight followed by poor weight gain in infancy
but above-average weight gain in childhood
|
|
D.
|
above-average birthweight
|
|
E.
|
above-average birthweight followed by poor weight gain
in infancy but above-average weight gain in childhood
|
|
F.
|
above-average birthweight followed by above-average
weight gain in infancy and childhood
|
Scenario 4.
Which
adult diseases are generally believed to be more likely in relation to adverse
influences on the fetus, infant and child.
Diseases.
|
A.
|
asthma
|
|
B.
|
chronic
bronchitis
|
|
C.
|
coronary
heart disease
|
|
D.
|
diabetes
type I
|
|
E.
|
diabetes
type 2
|
|
F.
|
hypertension
|
|
G.
|
Mendelson’s
syndrome
|
Option List
|
A.
|
A + B + C + D
|
|
B.
|
A + B + C + E
|
|
C.
|
A + B + C + E + F + G
|
|
D.
|
B + C + E + F + G
|
|
E.
|
C + E + F
|
Scenario 5.
What adult
condition has been linked to raised maternal c-reactive protein levels?
Option List
|
A.
|
asthma
|
|
B.
|
ADHD
|
|
C.
|
autism
|
|
D.
|
inflammatory bowel disease
|
|
E.
|
schizophrenia
|
53. Endometrial
cancer & obesity.
Question 1.
Lead-in
What % of
endometrial cancer is attributed to obesity?
Option List
|
K.
|
5%
|
|
L.
|
15%
|
|
M.
|
20%
|
|
N.
|
30%
|
|
O.
|
50%
|
Question. 2
Lead-in
What is the incidence of endometrial cancer compared with
other female cancers?
Option List
|
A.
|
It is
the most common.
|
|
B.
|
It is the second most common.
|
|
C.
|
It is the fourth most common.
|
|
D.
|
It is the tenth most common.
|
|
E.
|
It is the fifteenth most common.
|
Question 3.
Lead-in
Where does
endometrial cancer appear in the list of cancers causing female deaths in the
UK?
Option List
|
A.
|
It is
the most common.
|
|
B.
|
It is the second most common.
|
|
C.
|
It is the fourth most common.
|
|
D.
|
It is the ninth most common.
|
|
E.
|
It is the fifteenth most common.
|
Question 4.
Lead-in
What
proportion of the female population of the UK is obese?
Option List
|
F.
|
10%
|
|
G.
|
15%
|
|
H.
|
25%
|
|
I.
|
30%
|
|
J.
|
40%
|
Question 5.
Lead-in
Which
option is correct in relation to the type of endometrial cancer associated with
obesity?
i.
type 1.
ii.
type 2.
iii.
type 3.
iv.
adeno-squamous
Option List
|
F.
|
i
|
|
G.
|
ii
|
|
H.
|
iii
|
|
I.
|
iv
|
|
J.
|
i + iv
|
Question 6.
Lead-in
Pick the
correct option from the option list in relation to the following statements.
Statements
i.
the
risk of EC increases significantly with BMI > 25
ii.
the
risk of EC increases significantly with BMI > 30
iii.
the
risk of EC increases significantly with BMI > 35
iv.
the
risk of EC increases significantly with BMI > 40
v.
the
risk of EC increases significantly with BMI > 45
Option List
|
A.
|
i
|
|
B.
|
ii
|
|
C.
|
iii
|
|
D.
|
iv
|
|
E.
|
v
|
Question 7.
Lead-in
Which of the following statements is correct?
Statements
i.
the
risk of EC rises linearly in relation to increasing BMI
ii.
the
risk of EC rises exponentially in relation to increasing BMI.
iii.
the
risk of EC rises according to the following formula:
R = 0.7 x BMI x Y. Where R = lifetime
risk, Y = duration of significant BMI in years.
iv.
the
risk of EC doubles with BMI> 30 and trebles with BMI > 40
v.
the
risk of EC in relation of obesity has not been defined
Option List
|
F.
|
i
|
|
G.
|
ii
|
|
H.
|
iii
|
|
I.
|
iv
|
|
J.
|
v
|
Question 8.
Lead-in
Which, if
any, of the following statements are true?
Statements
i.
the
incidence of endometrial cancer increased by 20% between 1975 and 1993
ii.
the
incidence of endometrial cancer increased by 20% between 1993 and 2007
iii.
the
incidence of endometrial cancer increased by 40% between 1993 and 2007
iv.
the
greatest increase in EC has been in the 50 - ≥60 years age band
v.
the
greatest increase in EC has been in the 60 - 79 years age band
Option List
|
A.
|
i + ii
|
|
B.
|
i + iii
|
|
C.
|
i + iv
|
|
D.
|
ii + iv
|
|
E.
|
iii + v
|
Question 9.
Lead-in
Which of
the following best indicates current overall 5-year survival rates for women treated
for EC.
Option List
|
A.
|
55%
|
|
B.
|
60%
|
|
C.
|
65%
|
|
D.
|
70%
|
|
E.
|
75%
|
Question 10.
Lead-in
The
surgical technique of choice for EC is:
Option List
|
A.
|
Abdominal
hysterectomy + BSO
|
|
B.
|
Abdominal hysterectomy + BSO + lymphadenectomy
|
|
C.
|
Laparoscopic hysterectomy + BSO
|
|
D.
|
Laparoscopic hysterectomy + BSO + lymphadenectomy
|
|
E.
|
Vaginal hysterectomy + BSO
|
Question 11.
Lead-in
Which, if
any, of the following statements are true in relation to laparoscopic
hysterectomy + BSO by experienced laparoscopic surgeons compared to open hysterectomy
+ BSO in obese women with EC?
Statements.
|
i.
|
Rates of
conversion to laparotomy are likely to exceed 50%
|
|
ii.
|
Intra-operative complication rates are roughly doubled
|
|
iii.
|
Duration of hospital stay and early complications are
reduced
|
|
iv.
|
Patient-reported outcomes at 6 months are superior.
|
|
v.
|
5-year survival rates are superior
|
Option List
|
A.
|
i + ii
|
|
B.
|
i + iii
|
|
C.
|
iii
|
|
D.
|
iii + iv
|
|
E.
|
iv + v
|
Question 12.
Lead-in
Which, if any, of
the following statements are true in relation to radiotherapy?
Option List
|
A.
|
radiotherapy
should be recommended if there are significant co-morbidities
|
|
B.
|
external beam
radiotherapy is the recommended modality
|
|
C.
|
brachytherapy
is the recommended modality
|
|
D.
|
recurrence
rates of up to 18% have been reported
|
|
E.
|
none of the
above
|
Question 13.
Lead-in
Which, if any, of
the following statements are true in relation to progestogen therapy?
Option List
|
A.
|
high-dose
progestogen therapy from the time of the initial endometrial biopsy to
definitive surgery improves 5-year survival
|
|
B.
|
the 52 mg IUS is
of proven efficacy and safety for women with endometrial hyperplasia with
cytological atypia who wish to retain their fertility
|
|
C.
|
the 52 mg IUS
is of proven efficacy and safety for women with endometrial hyperplasia with early
endometrial cancer
|
|
D.
|
high-dose
progestogen therapy is effective in palliative care in 50% of cases in reducing tumour size and
bleeding
|
|
E.
|
none of the
above
|
54. ART,
infertility treatment and cancer.
Question 1.
Lead-in
Which, if
any, of the following statements are true?
Statements
|
P.
|
infertile,
nulliparous women are at increased risk of breast cancer
|
|
Q.
|
infertile, nulliparous women are at increased risk of
cervical cancer
|
|
R.
|
infertile, nulliparous women are at increased risk of ovarian
cancer
|
|
S.
|
infertile, nulliparous women are at increased risk of uterine
cancer
|
|
T.
|
infertile, nulliparous women are at increased risk of vaginal
cancer
|
Option List
|
I.
|
A + B +
C + D + E
|
|
II.
|
A + B + C + D
|
|
III.
|
A + B + D + E
|
|
IV.
|
A + C +
D
|
|
V.
|
B + C +
D
|
Question 2.
Lead-in
Which, if
any, of the following statements are true of breast cancer?
Statements
|
F.
|
early age at menarche is a recognised risk factor for
breast cancer
|
|
G.
|
increasing parity is a recognised risk factor for breast
cancer
|
|
H.
|
consumption of alcohol and use of tobacco increase the
risk of breast cancer
|
|
I.
|
the combined oral contraceptive increases the risk of
breast cancer
|
|
J.
|
HRT with oestrogen + progestogen increases the risk of
breast cancer
|
Option List
|
I.
|
A + B +
C + D + E
|
|
II.
|
A + C + D
|
|
III.
|
A + B + D + E
|
|
IV.
|
A + C +
D
|
|
V.
|
A + C +
D + E
|
Question 3.
Lead-in
Which, if
any, of the following statements are true of ovarian cancer?
Statements
|
A.
|
early age at menarche is a recognised risk factor for
ovarian cancer
|
|
B.
|
increasing parity is a recognised risk factor for
ovarian cancer
|
|
C.
|
nulligravidas who fail to conceive after ART are at
increased risk of ovarian cancer compared with nulligravidas who conceive
after ART
|
|
D.
|
tubal
ligation increases the risk of ovarian cancer
|
|
E.
|
use of the LNGIUS for > 5 years is a recognised risk
factor for ovarian cancer
|
Option List
|
I.
|
A + B +
C + D + E
|
|
II.
|
A + B + C + D
|
|
III.
|
A + C
|
|
IV.
|
A + C +
D
|
|
V.
|
B + C +
D + E
|
Question 4.
Lead-in
Which, if
any, of the following statements are true of uterine cancer?
Option List
|
A.
|
early age at menarche is a recognised risk factor for uterine
cancer
|
|
B.
|
increasing parity is a recognised risk factor for uterine
cancer
|
|
C.
|
nulligravidas who fail to conceive after ART are at
increased risk of uterine cancer compared with nulligravidas who conceive
after ART
|
|
D.
|
tubal
ligation increases the risk of uterine cancer
|
|
E.
|
use of the LNGIUS for > 5 years is a recognised risk
factor for uterine cancer
|
Option List
|
I.
|
A
|
|
II.
|
A + B
|
|
III.
|
A + C
|
|
IV.
|
A + C +
D
|
|
V.
|
A + C +
D + E
|
Question 5.
Which, if
any, of the following statements are true in relation to cancer in the offspring
of women who have had ART?
Option List
|
A.
|
ART doubles the risk of breast cancer when the female offspring
reach adulthood
|
|
B.
|
ART doubles the risk of clear cell adenocarcinoma of
the vagina, though the condition remains very rare
|
|
C.
|
ART doubles the risk of melanoma both in childhood and
adulthood
|
|
D.
|
ART
doubles the risk of retinoblastoma, though the condition remains very rare
|
|
E.
|
ART doubles the risk of thyroid cancer when the
offspring reach adulthood
|
|
F.
|
none of the above
|
Option List
|
I.
|
A + B +
C + D + E
|
|
II.
|
A + C + D
|
|
III.
|
A + B + D + E
|
|
IV.
|
A + C +
D
|
|
V.
|
none of
the above
|
