34
|
EMQ.
Surrogacy
|
35
|
EMQ. Chickenpox & pregnancy
|
36
|
EMQ. Appendicitis & pregnancy
|
37
|
EMQ. Down’s syndrome
|
38
|
Roleplay. Communication skills.
|
34. EMQ. Surrogacy.
Abbreviations.
ART: assisted reproductive technology
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
SSAEW: Surrogacy Supervisory Authority England and Wales.
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.
True/False
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. True / False
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 SM decides at 10 weeks that she does not wish to be pregnant and
arranges to have a TOP. The CPs. hear about this and object strongly. To whom
should they apply to have the TOP blocked?
Scenario 12.
A woman has hysterectomy and BSO to deal with extensive endometriosis at
the age of 30. She marries two years later and her sister offers to act as
surrogate. She undergoes IVF and 4 embryos are created. One is transferred and
a successful pregnancy ensues. The baby is adopted by the woman and her
husband. The 3 remaining embryos were frozen. Four years later the woman falls
out with her sister, but finds another surrogate and wishes to proceed with
another pregnancy. The sister says she does not want her eggs to be used and
that the frozen embryos should not be transferred. Does the sister have the
legal right to block the use of the embryos? Yes / No.
Scenario 13.
A girl born from donor sperm reaches the age of 16 and wishes to know the
identity of her genetic father. Does she have the right to this
information? Yes / No.
Scenario 14.
A girl born from donor sperm reaches the age of 18 and wins a place at
Oxford University to read medicine. Does she have the legal right to get the
donor to contribute to her fees? Yes / No.
Scenario 15.
A PO is
active from the moment it is completed and signed by the relevant parties. True/False
Scenario 16.
A SM can
change her mind at any time and keep the child, even if the egg was not hers. True/False
Scenario 17.
The CPs can
change their mind, leaving the SM as the legal mother. True/False
Scenario 18.
A SM’s
husband is the legal father until adoption is completed or a PO comes into
force. True/False
Scenario 19.
A lesbian couple in a stable, co-habiting relationship can be CPs and
become the legal parents of the child of a SM. True/False
Scenario 20.
CPs are likely to get faster legal status as the legal parents through
application for a PO rather than applying for adoption. True/False
35. EMQ. Chickenpox + pregnancy.
Abbreviations.
FVS: fetal varicella syndrome
NPV: negative predictive value
PPV: positive predictive value
VZV: varicella-zoster virus.
Question 1.
Lead-in What type of virus causes chickenpox?
Option List
A.
|
avian
virus
|
B.
|
herpes
virus
|
C.
|
retrovirus
|
D.
|
picovirus
|
E.
|
pox
virus
|
Question 2.
Lead-in
Which of
the following best describes the chickenpox virus
Option List
A.
|
DNA
virus
|
B.
|
RNA virus
|
C.
|
Prion
|
D.
|
All of the above
|
E.
|
None of the above
|
Question 3.
Lead-in
What is
the main reservoir of the chickenpox virus?
Option List
A.
|
domestic
chickens
|
B.
|
chickens in battery farms
|
C.
|
sparrows
|
D.
|
humans
|
E.
|
earthworms
|
Question 4.
Lead-in
How is the chickenpox virus spread?
Pick the option from option list that best fits.
Possible modes of spread.
A.
respiratory
droplets
B.
direct contact with the fluid from the vesicles
C.
contact with fomites
D.
contact with stalactites
E.
from lavatory seats
Option List.
1.
|
A
|
2.
|
A + B
|
3.
|
A + C
|
4.
|
A + B + C
|
5.
|
A + B + C + D + E
|
Question 5.
Lead-in
Fomites -
which of the following statements are true?
Statements.
A.
|
fomites
are bedclothes infested with bed bugs which can carry the chickenpox virus
|
B.
|
“fomites”
in Latin is the plural of “fomes”, the noun meaning “tinder” in English
|
C.
|
fomites
are inanimate objects that can effect the transfer of communicable diseases
from the infected person to someone who is not infected
|
D.
|
fomites
are horizontal stalagmites, particularly found in the Dolomite mountains and
capable of fostering the growth of viruses, including the chickenpox virus
|
E.
|
fomites
are the viral particles in vomit that form the aerosols particularly
associated with the respiratory spread of viruses such as the chickenpox
virus.
|
Option List
1.
|
A + B + C + D + E
|
2.
|
A + B + C + E
|
3.
|
A + B + C + D
|
4.
|
B + C + D
|
5.
|
B + C + E
|
6.
|
B + C
|
Question 6.
Lead-in
Which of
the following are listed in GTG13 as examples of fomites?
A.
bathtubs
used by person with chickenpox at the infectious stage
B.
bedding
C.
blood,
fresh or dried, from person with chickenpox at the infectious stage
D.
clothing
E.
hair
F.
paper
money
G.
skin
cells
H.
viral
remnants in vomit from person with chickenpox at the infectious stage
Option List
1.
|
A + B + C + D + E + F + G + H
|
2.
|
A + B + C + D + E + F
|
3.
|
B + C + D + E + F + G
|
4.
|
B + C + E + G
|
5.
|
None of the above
|
Question 7.
Lead-in
With
regard to the epidemiology of chickenpox in the UK, which of the following
statements are true?
A
|
Chickenpox
is endemic
|
B
|
Chickenpox
is endemic with mini-epidemics every 3-4 years in the early part of the year
|
C
|
The main
reservoir is chickens, particularly those that are reared intensively
|
D
|
The main
reservoir is human sensory nerve root ganglia after primary infection
|
E
|
The main
reservoir is fomites
|
Option List
1
|
A
|
3
|
A + C
|
4
|
A + D
|
5
|
A + E
|
2
|
B
|
6
|
B + C
|
7
|
B + C + D + E
|
7
|
B + C + D + E
|
Question 8
Lead-in
What
proportion of the ante-natal population of the UK is immune to chickenpox?
Option List
A.
|
50%
|
B.
|
60%
|
C.
|
70%
|
D.
|
80%
|
E.
|
90%
|
F.
|
≥ 90%
|
Question 9.
Lead-in
Which
population of immigrant women is least likely to have immunity to chickenpox?
Option List
A.
|
Middle-Eastern
|
B.
|
Those from Antarctica
|
C.
|
Those from the EEC
|
D.
|
Those from tropical and sub-tropical Africa
|
E.
|
One-eyed Mongolians with the bad habit of spitting in
public
|
Question 10.
Lead-in
What is
the incidence of chickenpox in pregnancy in the UK?
Option List
A.
|
1 in
1,000
|
B.
|
3 in 1,000
|
C.
|
5 in 1,000
|
D.
|
8 in 1,000
|
E.
|
14 in 1,000
|
F.
|
20 in 1,000
|
Question 11.
Lead-in
What is
the usual presentation of chickenpox in a child?
Option List
A.
|
Mild
fever with malaise then vesicles which
appear after 2 days and disappear
after 4 – 5 days
|
B.
|
Mild
fever with malaise then vesicles which
appear after 2 days and disappear
after about 7 days
|
C.
|
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 5 days
|
D.
|
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 7 days
|
E.
|
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 10 days
|
Question 12.
Lead-in
What is
the duration of infectivity after primary infection?
Option List
A.
|
From the
onset of fever until 48 hours after the vesicles form
|
B.
|
From the onset of fever until 5 days after the vesicles
form
|
C.
|
From 48 hours before the development of the vesicles
until 5 days later.
|
D.
|
From 48 hours before the development of the vesicles
until they crust over
|
E.
|
From the development of the vesicles until 5 days
later.
|
F.
|
From the development of the vesicles until they crust
over
|
Question 13.
Lead-in
A woman
books at 8 weeks. Her 6-year-old son lives with her and has recently developed
chickenpox? She is tested and found to be non-immune. What is her risk of
infection from the domestic contact with her son?
Option List
A.
|
50%
|
B.
|
60%
|
C.
|
70%
|
D.
|
80%
|
E.
|
90%
|
Question 14.
Lead-in
Which of
the following contacts with a case of chickenpox would be significant?
I.
contact
with the mother of a child who has just developed the typical chickenpox rash
II.
contact
with the mother of a child who has not developed the typical chickenpox rash
III.
a
four-hour journey on a school bus with 20 children, one of whom develops the
typical chickenpox rash the next day
IV.
having
a coffee with a neighbour who is having chemotherapy and has just developed
shingles
V.
visiting
a neighbour who has developed ophthalmic shingles and has been admitted to an
old-fashioned 20-bed ward
VI.
having
a coffee with an 80-year-old neighbour
who is in good health but has just had recurrence of thoracic shingles.
Option List
|
|
all of the
above
|
|
|
I + III + IV + V
|
|
|
I + III + IV + V
|
|
|
II + III + IV + VI
|
|
|
III + IV + V
|
Question 15.
Lead-in
In
relation to shingles, which of the following statements are true ?
A.
|
Shingles is due to reactivation of the virus which has
lain dormant in the sensory nerve root ganglia
|
B.
|
Shingles is due to reactivation of the virus which has
lain dormant in the motor nerve root ganglia
|
C.
|
Shingles is due to reactivation of the virus which has
lain dormant in the autonomic nerve root ganglia
|
D.
|
Shingles should always be regarded as infectious.
|
E.
|
Shingles in the immuno-compromised should always be
regarded as infectious.
|
F.
|
Ophthalmic shingles should always be regarded as
infections
|
Option List
1.
|
A + D
|
2.
|
A + E
|
3.
|
A + E + F
|
4.
|
B + D
|
5.
|
C + E + F
|
Question 16. This is about chickenpox vaccine.
Lead-in
Which of
the following statements are true? Pick the best option from the option list.
Statements.
A. Chickenpox
vaccine does not exist.
B. Chickenpox
vaccine uses a killed virus of the Okra strain.
C. Chickenpox
vaccine uses an attenuated virus of the Oka strain.
D. All
children who have not had chickenpox should be offered the vaccine after 1 year
of age.
E. Women
should be screened for immune status as part of pre-pregnancy counselling or
fertility treatment with ART
Option List
1.
|
A.
|
2.
|
B.
|
3.
|
C.
|
4.
|
B + D
|
5.
|
B + D + E
|
6.
|
C + D
|
7.
|
C + D + E
|
8.
|
None
|
Question 17. This relates to vaccination in early pregnancy
Lead-in
A
25-year-old woman is given varicella vaccine. Her period is due the next day,
but does not occur. A pregnancy test a few days later is +ve. What should be
the management?
Option List
A.
|
She
should be advised that there is a 5% risk of congenital varicella syndrome
and be offered TOP.
|
B.
|
She should be advised that there is a 10% risk of
congenital varicella syndrome and be offered TOP.
|
C.
|
She should be advised that the level of risk of
congenital varicella syndrome after vaccination in early pregnancy is unknown
and be offered TOP.
|
D.
|
She should be advised that the level of risk of
congenital varicella syndrome after vaccination in early pregnancy is unknown
and be offered referral to a feto-maternal medicine expert.
|
E.
|
She should be advised that the manufacturer has
monitored occurrences of inadvertent vaccination for nearly 20 years and that
no increase of the risk of congenital varicella syndrome has been identified
after inadvertent vaccination in early pregnancy.
|
F.
|
She should be advised that the vaccine contains no live
virus and cannot cause fetal infection.
|
Question 18.
Lead-in
A woman
has been referred to the booking clinic by her GP. Screening for immunity to
chickenpox showed her to be seronegative. What advice would you give her?
Option List
A.
|
Advise
her that there is no risk unless she comes into contact with a case of chickenpox
or shingles and to speak to GP or midwife if possible contact occurs..
|
B.
|
Advise her to have the chickenpox vaccine because of
the 10% risk and high mortality associated with varicella in pregnancy.
|
C.
|
Advise her to have VZIG to reduce her risk of infection.
|
D.
|
Advise her to take oral acyclovir until two weeks
post-delivery.
|
E.
|
None of the above.
|
Question 19.
Lead-in
A woman is
referred to the booking clinic by her GP for urgent assessment as she was in
contact with a case of chickenpox two days before. What action should be taken?
Possible actions.
I.
take
a detailed history to determine the significance of the contact and her history
of and likely immunity to chickenpox.
II.
check
for VZV immunity if there is a history of a significant contact and possibility
that she is not immune.
III.
if
the contact was significant and the tests for VZV immunity show her to be
seronegative, offer oral acyclovir
IV.
if
the contact was significant and the tests for VZV immunity show her to be
seronegative, offer VZIG.
V.
if
the contact was significant and the tests for VZV show her to be seronegative,
discuss TOP.
Option List
A.
|
I + II +
III
|
B.
|
I + II +
III + IV
|
C.
|
I + II +
III + V
|
D.
|
I +
II + IV
|
E.
|
V
|
Question 20.
Lead-in
Which, if
any, of the following statements about VZIG are correct?
I.
VZIG
is manufactured using recombinant technology
II.
VZIG is effective in pregnancy when given within
10 days of the contact
III.
If VZIG is given, the woman is potentially
infectious for up to 28 days
IV.
Repeat doses of VZIG should not be given in the
event of repeated significant contact
V.
There are reliable supplies of VZIG and no
problems regarding availability
Option List
A.
|
I + II +
III
|
B.
|
I + II +
III + IV
|
C.
|
I + II +
III + IV + V
|
D.
|
II + III
|
E.
|
II + III + V
|
Question 21.
Lead-in
How does
the administration of VZIG affect the duration of infectivity for the woman?
Option List
A.
|
With no
VZIG the woman is potentially infectious from day 8 to 28.
|
B.
|
VZIG destroys virus and the woman is potentially
infections from day 8 to 21.
|
C.
|
VZIG does not alter the period in which the woman is
potentially infections.
|
D.
|
VZIG reduces the risk of shingles in later life
|
E.
|
None of the above
|
Question 22.
Lead-in
With
regard to established varicella in pregnancy, which, if any, of the following
statements are true? Choose the best option from the option list.
I.
the
main risk to the mother comes from pneumonia, with an incidence of about 10%
II.
the main risk to the mother comes from
pneumonia, with an incidence of about 40%
III.
hepatitis and encephalitis are more common
compared to the non-pregnant state
IV.
mortality from varicella pneumonia have fallen
to < 15%
V.
the death rate from varicella pneumonia is
estimated to be 5 times greater than in the non-pregnant
Option List
A.
|
I + III + IV + V
|
B.
|
II + III
+ IV + V
|
C.
|
I + IV +
V
|
D.
|
II + IV
+ V
|
E.
|
I + IV
|
Question 23.
Lead-in
A GP
phones to say that a patient of his at 10 weeks’ gestation has developed the
typical rash of chickenpox. Her son had proven chickenpox a couple of weeks
previously. She had been tested and found to be non-immune, but declined VZIG.
Which, if any of the following statements would you include in your advice to
the GP.
I.
admit
the woman for assessment, VZIG and acyclovir after counselling re risks and
benefits.
II.
arrange
for her to be seen in the next antenatal clinic.
III.
advise
re prevention of secondary bacterial infection of the lesions
IV.
advise
about her avoiding contact with susceptible individuals until at least 7 days
after the lesions crust over
V.
advise
the GP of the criteria for hospital admission and the need for the woman to be
informed of them.
VI.
advise
the GP to discuss the risks and benefits of acyclovir 800mg five times daily
for seven days and to prescribe it if the woman agrees.
VII.
advise
that acyclovir is contraindicated once the rash appears
VIII.
advise
that VZIG is ineffectual once the rash has appeared
Question 24.
Lead-in
What kind
of drug is aciclovir?
There is
no option list
Question 25.
Lead-in
How
effective is aciclovir?
There is no option list.
Question 26.
Lead-in
Which, if
any, of the following statements are true in relation to the diagnosis of fetal
varicella syndrome?
Option List
A.
|
detailed
ultrasound examination by a fetal medicine expert should be offered
|
B.
|
fetal MRI is superior to US examination and should be
the 1ry test if available
|
C.
|
amniocentesis should be offered as detection of
varicella DNA makes FVS probable
|
D.
|
amniocentesis should be done as early as possible,
avoiding any varicella lesions
|
E.
|
PCR which is –ve for varicella DNA in amniotic fluid
has a strong NPV for FVS
|
F.
|
PCR which is +ve for varicella DNA in amniotic fluid
has a strong PPV for FVS
|
Question 27.
Lead-in
Which, if
any, of the following statements are true in relation to fetal varicella
syndrome?
Option List
A.
|
FVS
occurs in relation to 1ry. infection in-utero
|
B.
|
FVS occurs in relation to 2ry. infection in-utero
|
C.
|
the risk of FVS is ~ 5% when 1ry. infection
in-utero occurs < 13 weeks
|
D.
|
the risk of FVS is ~ 10% when 1ry. infection
in-utero occurs between 13 and 20 weeks
|
E.
|
the risk of FVS is greatest when 1ry. infection
in-utero occurs within 4 weeks of birth
|
Question 28.
Lead-in
Which, if
any, of the following statements are true in relation to administration of
varicella vaccine in pregnancy.
Option List
A.
|
varicella
vaccine is a recombinant vaccine and licensed for use in pregnancy
|
B.
|
varicella vaccine contains a live, attenuated vaccine
and is contraindicated in pregnancy
|
C.
|
varicella vaccine contains a live, attenuated vaccine
and is safe to use after 12 weeks
|
D.
|
varicella vaccine should not be given to women who are
breastfeeding
|
E.
|
TOP should be advised if varicella vaccine is given in
the 1st. trimester
|
F.
|
VZV immunoglobulin should be given if varicella vaccine
is given in the 1st. trimester
|
Question 29.
Lead-in
Which, if
any, of the following statements are true in relation to neonatal varicella
(NV)
Option List
A.
|
the risk
of NV is 90% with fetal infection in the 1st. trimester
|
B.
|
the risk of NV is 50% with fetal infection in the 2nd.
trimester
|
C.
|
the risk of NV is 10% with fetal infection in the 4
weeks before delivery
|
D.
|
planned delivery should be delayed, if safe, until 7
days after start of the maternal rash
|
E.
|
women with active chickenpox should not breastfeed
until 10 days after the lesions crust
|
36. EMQ. Topic. Appendicitis in pregnancy (AIP)
Abbreviations.
AIP
|
Appendicitis
in pregnancy
|
CRP
|
C
reactive protein
|
CT
|
computed
tomography, also known as computerised tomography
|
RLQP
|
right
lower quadrant pain
|
RUQP
|
right
upper quadrant pain
|
Question 1.
Lead-in
What is
the approximate incidence of appendicitis in pregnancy?
Option List
F.
|
1 in 500
|
G.
|
1 in 1,000
|
H.
|
1 in 2,000
|
I.
|
1 in 5,000
|
J.
|
1 in 10,000
|
Question 2.
Lead-in
When is
appendicitis in pregnancy most common?
Option List
A.
|
first
trimester
|
B.
|
second trimester
|
C.
|
trimester
|
D.
|
1st. and 2nd. stages of labour
|
E.
|
in the hours after the 3rd. stage of labour
|
F.
|
during the puerperium
|
Question 3.
Lead-in
What
eponymous title is given to the surface marker for the appendix?
Option List
F.
|
McBarney’s
point
|
G.
|
MacBurney’s point
|
H.
|
McBurney’s point
|
I.
|
MacBorney’s point
|
J.
|
McBorney’s point
|
Question 4.
Lead-in
Where is
the point referred to in the above question?
Option List
A.
|
1/3 of
the way along the line joining the anterior superior iliac spine and
umbilicus
|
B.
|
1/2 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
C.
|
2/3 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
D.
|
1/3 of the way along the line joining the left and
right anterior superior iliac spines
|
E.
|
1/2 of the way along the line joining the left and
right anterior superior iliac spines
|
Question 5.
Lead-in
Which, if
any, of the following statements are true about the person after whom the point
in the above questions is named?
Statements
A.
|
he spent
2 years as a postgraduate working in Berlin, London, Paris and Vienna
|
B.
|
he was
Professor of surgery at the Roosevelt hospital, New York from 1889 to 1894
|
C.
|
he presented his classical paper on appendicitis to the
NY Surgical Society in 1889
|
D.
|
he was a transvestite
|
E.
|
he died of a heart attack while on a hunting trip
|
Question 6.
Lead-in.
Pick the
best option from the list below in relation to right lower quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RLQP is
as common in the pregnant as in the non-pregnant
|
C
|
RLQP is
less common in the pregnant
|
D
|
RLQP is more common in the pregnant
|
E
|
RLQP is rare in pregnancy
|
Question 7.
Lead-in.
Pick the
best option from the list below in relation to right upper quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RUQP is
½ as common in the pregnant as in the non-pregnant
|
C
|
RUQP is
as common in the pregnant as in the non-pregnant
|
D
|
RUQP is
twice as common in the pregnant as in the non-pregnant
|
E
|
RUQP is
four times as common in the pregnant as in the non-pregnant
|
Question 8.
Lead-in.
Pick the
best option from the list below in relation to nausea in AIP in the pregnant
and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
nausea
is as common in the pregnant as in the non-pregnant
|
C
|
nausea
is less common in the pregnant
|
D
|
nausea is more common in the pregnant
|
E
|
nausea is rare in pregnancy
|
Question 9.
Lead-in.
Which
condition did CMACE say should be excluded in women presenting acutely with
gastrointestinal symptoms?
Option List
A
|
aortic dissection
|
B
|
appendicitis
|
C
|
Caesarean
section scar pregnancy
|
D
|
ectopic pregnancy
|
E
|
pancreatitis
|
F
|
ovarian torsion
|
Question 10.
Lead-in.
Pick the
best option from the list below in relation to abdominal guarding in AIP in the
pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
abdominal
guarding is as common in the pregnant as in the non-pregnant
|
C
|
abdominal
guarding is less common in the pregnant
|
D
|
abdominal
guarding is more common in the pregnant
|
E
|
abdominal
guarding is rare in pregnancy
|
Question 11.
Lead-in.
Pick the
best option from the list below in relation to rebound tenderness in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
rebound tenderness is as common in the pregnant as in
the non-pregnant
|
C
|
rebound tenderness is less common in the pregnant
|
D
|
rebound tenderness is more common in the pregnant
|
E
|
rebound tenderness is rare in pregnancy
|
Question 12.
Lead-in.
Pick the
best option from the list below in relation to fever in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
fever is
as common in the pregnant as in the non-pregnant
|
C
|
fever is
less common in the pregnant
|
D
|
fever
is more common in the pregnant
|
E
|
fever
is rare in pregnancy
|
Question 13.
Lead-in
How useful
is the finding of leucocytosis in making the diagnosis of AIP?
Option List
G.
|
sine qua
non
|
H.
|
very useful
|
I.
|
not very useful
|
J.
|
I don’t know
|
Question 14.
How useful
is the finding of a raised CRP level the diagnosis of AIP?
Option List
A.
|
sine qua
non
|
B.
|
very useful
|
C.
|
not very useful
|
D.
|
I don’t know
|
Question 15.
Lead-in
What are
the ultrasound features of appendicitis?
Option List
A
|
appendix
with diameter > 0.6 mm.
|
B
|
appendix with diameter > 1 cm.
|
C
|
blind-ending tubular structure
|
D
|
non-compressible
tubular structure
|
E
|
none of the above
|
Question 16.
Lead-in
What
figures do W&M give for sensitivity & specificity for US diagnosis of
appendicitis?
Option List
Sensitivity
|
Specificity
|
|
A
|
≥65%
|
≥80%
|
B
|
≥75%
|
≥85%
|
C
|
≥86%
|
≥97%
|
D
|
≥91%
|
≥98%
|
E
|
≥95%
|
≥95%
|
Question 17.
Lead-in
Which, if
any, of the following statements are true about CT scanning for the diagnosis
of AIP?
Option List
A
|
CT
scanning has sensitivity > 85% and specificity >95%
|
B
|
CT scanning exposes mother and fetus to radiation doses
of little concern
|
C
|
CT scanning has replaced ultrasound scanning for AIP
|
D
|
CT scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
CT scanning is of proven value and most useful after inconclusive ultrasound scanning
|
Question 18.
Lead-in
Which, if
any, of the following statements are true about MRI scanning for the diagnosis
of AIP?
Option List
A
|
MRI
scanning has sensitivity > 90% and specificity >97%
|
B
|
MRI scanning exposes mother and fetus to radiation
doses of little concern
|
C
|
MRI scanning has replaced ultrasound scanning for AIP
|
D
|
MRI scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
MRI scanning is of proven value and most useful after inconclusive ultrasound scanning
|
Question 19
Lead-in
Which, if
any, of the following statements are true about the complications of AIP?
Option List
A
|
fetal
loss rate in uncomplicated AIP is about 1.5%
|
B
|
fetal loss rate in AIP complicated by peritonitis is
about 6%
|
C
|
fetal
loss rate in AIP complicated by perforation of the appendix is up to 36%
|
D
|
pre-term delivery rates increase in AIP complicated by
perforation of the appendix
|
E
|
a low level of suspicion should apply to the diagnosis
of AIP in relation to surgical intervention
|
Question 20
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparotomy
should be done through a grid-iron incision with the mid-point the surface
marker for the appendix in the right iliac fossa
|
B
|
laparotomy should be done through a right paramedian
incision starting at the level of the umbilicus
|
C
|
about
35% of laparotomies show no evidence of appendicitis
|
D
|
the appendix should be removed even if it looks normal
|
E
|
antibiotic therapy is an alternative to surgery in
early cases of AIP
|
Question 21
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparotomy
should be done through a grid-iron incision with the mid-point the surface
marker for the appendix in the right iliac fossa
|
B
|
laparotomy should be done through a right paramedian
incision starting at the level of the umbilicus
|
C
|
about
35% of laparotomies show no evidence of appendicitis
|
D
|
the appendix should be removed even if it looks normal
|
E
|
antibiotic therapy is an alternative to surgery in
early cases of acute AIP
|
Question 22
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparoscopic
appendicectomy is an acceptable alternative to laparotomy, but only in the 1st.
trimester
|
B
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, but only in the 1st. & 2nd.
trimesters
|
C
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, at all gestations
|
D
|
there is evidence that laparoscopic appendicectomy is
associated with doubling of the rate of fetal loss
|
37. EMQ.
Lead-in.
The following scenarios relate to screening for Down’s
syndrome.
Pick one option from the option list. Each option can be
used once, more than once or not at all.
Option list.
a. 1 in 2
b. 1 in 5
c. 1 in 10
d. 1 in 20
e. 1 in 40
f.
1 in 250
g. 1 in 400
h. 1 in 1,000
i.
5 mm.
j.
6 mm.
k. 7 mm.
l.
8 mm.
m. 10 mm.
n. 1%
o. 2%
p. 5%
q. 10%
r.
80%
s. 95%
t.
90%
u. 95%
v. higher
w. lower
x. true
y. false
z. none of the above.
Scenario 1.
What is the age-related risk of
DS at 20 years?
Scenario 2.
What is the age-related risk of
DS at 30 years?
Scenario 3.
What is the age-related risk of
DS at 35 years?
Scenario 4.
What is the age-related risk of
DS at 40 years?
Scenario 5.
What is the age-related risk of
DS at 45 years?
Scenario 6.
AFP levels are lower in Ds.
Scenario 7
Inhibin levels are raised in
DS.
Scenario 8
Oestriol levels are raised in DS.
Scenario 9
β-hCG levels are raised in DS.
Scenario 10
1st. trimester PAPP-A levels are lower in DS.
Scenario 11
2nd. trimester PAPP-A levels are normal in DS.
Scenario 12
What
characteristic is described in relation to the occipital hairline in DS?
Scenario 13
What
characteristic is described in relation to the frontal hairline in DS?
Scenario 14
What is the
incidence of congenital heart anomaly in DS?
Scenario 15
Which is the most
common congenital heart anomaly in DS?
Scenario 16
Which major haematological
condition is more common in those with DS?
Scenario 17
Which major
neurological condition is more common in middle
age in those with DS?
Scenario 18
Which spinal
anomaly is more common in DS and of concern to anaesthetists?
38. Roleplay. Communication skills: You have been asked to see a woman who is planning her
first pregnancy. Her brother has cystic fibrosis. The consultant has told you
to explain the mode of inheritance and the implications for her and any
pregnancy.
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