44
|
SBA. ART, infertility treatment and
cancer
|
45
|
SBA. Endometrial cancer & obesity
|
46
|
SBA. Coeliac disease & pregnancy
|
47
|
EMQ. Cancer incidence
and mortality
|
48
|
EMQ. Drugs in O&G 1
|
44. EMQ. ART, infertility treatment and cancer
Question 1.
Lead-in
Which, if
any, of the following statements are true?
Statements
A.
|
infertile,
nulliparous women are at increased risk of breast cancer
|
B.
|
infertile, nulliparous women are at increased risk of
cervical cancer
|
C.
|
infertile, nulliparous women are at increased risk of ovarian
cancer
|
D.
|
infertile, nulliparous women are at increased risk of uterine
cancer
|
E.
|
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
A.
|
early age at menarche is a recognised risk factor for
breast cancer
|
B.
|
increasing parity is a recognised risk factor for breast
cancer
|
C.
|
consumption of alcohol and use of tobacco increase the
risk of breast cancer
|
D.
|
the combined oral contraceptive increases the risk of
breast cancer
|
E.
|
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
|
45. SBA. Endometrial cancer & obesity
Question 1.
Lead-in
What % of
endometrial cancer is attributable to obesity?
Option List
F.
|
5%
|
G.
|
15%
|
H.
|
20%
|
I.
|
30%
|
J.
|
50%
|
Question. 2
Lead-in
What is the incidence of endometrial cancer compared with
other female cancers?
Option List
F.
|
It is
the most common.
|
G.
|
It is the second most common.
|
H.
|
It is the fourth most common.
|
I.
|
It is the tenth most common.
|
J.
|
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
A.
|
10%
|
B.
|
15%
|
C.
|
25%
|
D.
|
30%
|
E.
|
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
A.
|
i
|
B.
|
ii
|
C.
|
iii
|
D.
|
iv
|
E.
|
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
A.
|
i
|
B.
|
ii
|
C.
|
iii
|
D.
|
iv
|
E.
|
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
|
46. EMQ. SBA. Coeliac disease & pregnancy
Question 1.
Lead-in
What is
coeliac disease?
Option List
K.
|
allergy
to gluten
|
L.
|
malabsorption due to large bowel inflammation
|
M.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the descending colon in individuals with a genetic
predisposition
|
N.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the gastric mucosa in individuals with a genetic
predisposition
|
O.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the small bowel in individuals with a genetic
predisposition
|
Question 2.
Lead-in
What is
the prevalence of coeliac disease in women of reproductive age?
Option List
K.
|
0.1%
|
L.
|
0.5%
|
M.
|
1-2 %
|
N.
|
2-5%
|
O.
|
5-10%
|
Question 3.
Lead-in
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.
Lead-in
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.
Lead-in
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.
Lead-in
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
F.
|
jejunal
biopsy
|
G.
|
IgA EMA
|
H.
|
IgA tTGA
|
I.
|
IgA EMA
+ IgA tTGA
|
J.
|
rectal
biopsy
|
Question 8.
Lead-in
Which, if
any, of the following statements are true in relation to the woman due to have
testing for suspected CD?
Option List
F.
|
continue
with a normal diet.
|
G.
|
continue with a normal diet that includes a minimum of
5 gm. gluten daily
|
H.
|
continue with a normal diet that includes a minimum of
10 gm. gluten daily
|
I.
|
follow a strict gluten-free diet for at least 1 month
|
J.
|
follow a strict gluten-free diet for at least 3 months
|
Question 9.
Lead-in
Which of
the following conditions should make consideration of testing for CD sensible?
Option List
F.
|
amenorrhoea
|
G.
|
Down’s syndrome
|
H.
|
epilepsy
|
I.
|
recurrent miscarriage
|
J.
|
Turner’s syndrome
|
K.
|
unexplained infertility
|
Question 10.
Lead-in
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.
Lead-in
Which skin
condition is particularly associated with CD?
Option List
F.
|
atopic
eczema
|
G.
|
dermatitis herpetiformis
|
H.
|
dermatitis multiforme
|
I.
|
dermatographia
|
J.
|
psoriasis
|
Question 12.
Lead-in
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.
Lead-in
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.
Lead-in
Which of
the following do not contain gluten?
Option List
A.
|
barley
|
B.
|
oats
|
C.
|
rapeseed oil
|
D.
|
rye
|
E.
|
wheat
|
47. EMQ. Cancer incidence and mortality.
We did this question in an earlier tutorial, but are
doing it again to reflect the latest data.
Abbreviations.
NHL: non-Hodgkin Lymphoma
Question 1.
Lead-in
Which is
the most common female cancer?
Option List
P.
|
Bowel
|
Q.
|
Breast
|
R.
|
Cervix
|
S.
|
Endometrium
|
T.
|
Lung
|
Question 2.
Lead-in
Which is
the 2nd. most common female cancer?
Option List
A.
|
Bowel
|
B.
|
Breast
|
C.
|
Cervix
|
D.
|
Endometrium
|
E.
|
Lung
|
Question 3.
Lead-in
Which is
the 3rd. most common female cancer?
Option List
A.
|
Bowel
|
B.
|
Breast
|
C.
|
Cervix
|
D.
|
Endometrium
|
E.
|
Lung
|
Question 4.
Lead-in
Which is
the 4th. most common female cancer?
Option List
A.
|
Bowel
|
B.
|
Breast
|
C.
|
Cervix
|
D.
|
Endometrium
|
E.
|
Lung
|
Question 5.
Lead-in
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.
Lead-in
Which is
the 6th. most common female cancer?
Option List
A.
|
Cervix
|
B.
|
Non-Hodgkin’s lymphoma
|
C.
|
Ovary
|
D.
|
Skin
|
E.
|
Vulva
|
Question 7.
Lead-in
Where does
cervical cancer feature in the list of the most common female cancers?
Option List
A.
|
10th.
|
B.
|
11th.
|
C.
|
15th.
|
D.
|
20th.
|
E.
|
24th.
|
Question 8.
Lead-in
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.
Lead-in
Which is
the most common cancer causing female death in the UK?
Option List
K.
|
Breast
|
L.
|
Bowel
|
M.
|
Lung
|
N.
|
Ovary
|
O.
|
Pancreas
|
Question 10.
Lead-in
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.
Lead-in
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.
Lead-in
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.
Lead-in
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.
Lead-in
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.
Lead-in
The
incidence of cervical cancer fell in the past decade. What is the approximate
figure for the fall?
Option List
A.
|
5%
|
B.
|
10%
|
C.
|
15%
|
D.
|
20%
|
E.
|
25%
|
Question 17.
Lead-in
What proportion of cervical
cancer is diagnosed in women < 45 years?
Option List
A.
|
20%
|
B.
|
30%
|
C.
|
40%
|
D.
|
50%
|
E.
|
60%
|
Question 18.
Lead-in
When was
routine HPV vaccination of girls introduced in the UK?
Option List
A.
|
2000
|
B.
|
2002
|
C.
|
2004
|
D.
|
2006
|
E.
|
2008
|
Question 19.
Lead-in
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 20.
Lead-in
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
|
48. EMQ. Drugs
in O&G 1.
Lead-in.
The following scenarios relate to drugs &
hypertension in pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ACE: angiotensin-converting
enzyme
ACEI: angiotensin-converting enzyme
inhibitor
ARA: angiotensin II receptor antagonist
HG: hyperemesis gravidarum
IUGR: intra-uterine growth retardation
LDA: low-dose aspirin
MAOI: monoamine oxidase inhibitor
Option list.
a)
False.
b)
True.
c)
5
d)
10
e)
15
f)
18
g)
20
h)
24
i)
contraindicated in the
months before pregnancy
j)
contraindicated in the
1st. trimester
k)
contraindicated in the
2nd. trimester
l)
contraindicated in the
3rd. trimester
m) contraindicated in all trimesters
n)
not contraindicated in
pregnancy
o)
contraindicated in
breastfeeding
p)
not contraindicated in
breastfeeding
q)
an acute, severe
illness like rheumatoid arthritis
r)
an acute, severe
illness with encephalopathy and acute fatty liver
s)
an acute, severe
illness with gastro-intestinal tract bleeding
t) there is
insufficient information to be able to provide advice
Scenario 1.
When are ACE inhibitors
contraindicated in pregnancy?
Scenario 2.
When are ARAs contraindicated
in pregnancy?
Scenario 3.
Can St. John’s Wort (SJW) be
used in pregnancy?
Scenario 4.
Methyldopa is an acceptable
option for the treatment of gestational hypertension. True / False.
Scenario 5.
Spironolactone is
contraindicated in pregnancy. True/False
Scenario 6.
Furosemide is an acceptable
option in the management of gestational hypertension. True / False.
Scenario 7.
When are thiazide diuretics
contraindicated in pregnancy?
Scenario 8.
Salbutamol is contraindicated
for the management of premature labour. True / False.
Scenario 9.
Ergometrine is an integral part
of active management of the 3rd. stage. True / False.
Scenario 10.
When is aspirin contraindicated
in pregnancy & the puerperium?
Scenario 11.
When are NSAID’s
contraindicated in pregnancy and why?
Scenario 12.
Pethidine: adverse neonatal
effects are most likely if the drug is administered in the six hours before
birth. True / False.
Scenario 13.
Pethidine: what is the
half-life in the mature neonate?
Scenario 14.
Pethidine is contraindicated in those taking MOAIs or who
have taken them in the previous 2 months.
Scenario 15.
Pethidine is relatively
contra-indicated when there is significant blood loss. True / False.
Scenario 16.
Pethidine has greater analgesic
effect in labour than Diamorphine. True / False.
Scenario 17.
What
is Reye’s syndrome and which family of drugs is particularly linked?
Scenario 18.
What
is “torsades de pointes” and when is it of importance in the management of HG?
