Monday 19 December 2016

Tutorial 19th. December 2016

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19 December  2016.

46
EMQ. Abortion Act.
47
SBA.   EMQ. BRCA 1 & 2
48
EMQ. Androgen insensitivity syndrome
49
EMQ. APH

46.         Abortion Act & TOP.
Lead-in.
TOP and the Abortion Act are likely to feature in every written exam.
Question 1
Lead in.
What was the approximate rate of abortion in the UK in 2015?
Option list
A
1 per 1,000 resident women aged 15-44
B
10 per 1,000 resident women aged 15-44
C
15 per 1,000 resident women aged 15-44
D
20 per 1,000 resident women aged 15-44
E
50 per 1,000 resident women aged 15-44
F
100 per 1,000 resident women aged 15-44
Question 2
Lead in.
The rate of abortion has declined by > 20% in the UK in the past ten years.
Option list
A
False
B
Haven’t a clue
C
Maybe
D
No data exist
E
True
Question 3
Lead in.
What proportion of TOPs were performed at gestations < 10 weeks in 2015?
Option list
A
50%
B
60%
C
70%
D
80%
E
90%
Question 4
Lead in.
There has been a significant improvement in the proportion of TOPs performed early in the past decade.
Option list
A
False
B
Haven’t a clue
C
Maybe
D
No data exist
E
True
Question 5
Lead in.
What % of abortions were performed after 24 weeks?
Option list
A
< 1%
B
1 - 3%
C
4 – 6%
D
7 – 9%
E
≥ 10%
Question 6
Lead in.
What proportion of TOPs were performed using medical, not surgical techniques?
Option list
A
20%
B
30%
C
40%
D
50%
E
60%
F
70%
G
80%
Question 7
Lead in.
Which age had the highest rate of TOP?
Option list
A
18
B
19
C
20
D
21
E
22
F
23
G
24
H
25
Question 8
Lead in.
What happened to the rate of TOP in 2014 for girls < 18 years compared with 2013?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged
Question 9
Lead in.
What happened to the rate of TOP in 2015 for girls < 16 years compared with 2014?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged
Question 10
Lead in.
What happened to the rate of TOP in 2015 for girls < 16 years compared with 2004?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged
Question 11
Lead in
Approximately what proportion of women having TOP in 2014 had previously had one or more TOPs?
Option list
A
1%
B
5%
C
10%
D
20%
E
30%
F
40%
G
50%
Question 12
Lead in
What age group of women 1n 2015 were most likely to have had previous TOP?
Option list
Age
A
< 18
B
18-19
C
20-24
D
25-29
E
30-34
F
≥ 35
Question 13
Lead in
There were 185,824 TOPs in 2015. How many deaths occurred?
Option list
A
0 - 9
B
10 – 19
C
20 – 39
D
40 - 59
E
≥ 60
Question 14
Lead in
There were 185,824 TOPs in 2015. What was the rate of significant complications?
Option list
A
<1%
B
1%
C
3%
D
5%
E
10%
Question 15
Lead in
The RCOG recommends that women having TOP should have chlamydia screening. What proportion of women had this done in 2015?
Option list
A
<10%
B
10- 24%
C
25- 49%
D
50- 79%
E
80- 89%
F
≥ 90%
Question 16
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) a”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Question 17
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) b”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above
Question 18
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) c.
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above
Question 19
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) d”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above
Question 20
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) e”?
Option list
1
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
2
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
6
none of the above
Question 21
Lead in.
With regard to the he Abortion Act and grounds “F” and “G”. Which of the following statements are true?
1
“F” & “G” are grounds for TOP in an emergency with only one doctor needing to sign the legal form necessary for the TOP to take place
2
 “F” & “G” are grounds for TOP after 24 weeks.
3
“F” relates to TOP to save the woman’s life
4
“F” relates to TOP to prevent grave permanent injury her physical or mental health
5
“F” & “G” do not exist.
Option list
A
1  + 3
B
1  + 4
C
2 + 3
D
2 + 4
E
5
Question 22
Lead in
In relation to terms such as “substantial risk”, “grave permanent injury” and “seriously handicapped”, which of the following is true?
Option list
A
The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (b) to the Act.
B
The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (c) to the Act.
C
The terms were defined by the General Medical Council, examples were given and the information can be downloaded from the GMC website.
D
The terms were defined by the RCOG, examples were given and the information can be downloaded from the RCOG website.
E
The terms have not been defined.
Question 23
Lead in
Which of the following statement is true about the most common grounds for TOP?
Option list
1
TOP is most commonly done on ground A from Certificate A.
2
TOP is most commonly done on ground B from Certificate A.
3
TOP is most commonly done on ground C from Certificate A.
4
TOP is most commonly done on ground D from Certificate A.
5
TOP is most commonly done on ground E from Certificate A.
6
TOP is most commonly done on ground F from Certificate A.
7
TOP is most commonly done on ground G from Certificate A.
8
TOP is most commonly done on ground H from Certificate A.
Question 24
Lead in
Which of the following statements is true in relation to the upper gestational limit for TOP to be legal in the UK.
1
Termination of pregnancy is legal to 24 weeks
2
Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly.
3
Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly, but only if approved by the Department of Health’s “Late Termination of Pregnancy Assessment Panel”.
4
Termination of pregnancy is illegal after 24 weeks, but is still done if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly and there is a long-standing agreement that the police and legal authorities will “turn a blind eye”.
Option list
A
1 + 2 
B
1 + 3
C
1 + 4
D
2 + 4
E
5
Question 25
Lead in
Which of the following statement are true in relation to TOP after 24 weeks?
Statements
1
TOP is illegal after 24 weeks
2
The mother must agree to feticide pre-TOP
3
Feticide must be offered
4
There must be very serious grounds for the TOP
5
Gender-selection TOP is unacceptable
Option list
A
1
B
1 + 2
C
2 + 3 + 5
D
3 + 4
E
3 + 4 + 5
Question 26
Lead in
TOPs done under ground E are those done at any gestation because of fetal abnormality. The anomalies are coded using ICD10. The HSA4 notification form relating to each TOP should have details of the ICD10 code for the fetal anomaly.
Which of the following statements is the most accurate in relation to the percentage of HSA4 forms that contain the required information..
A
0- 24%
B
25- 49%
C
50- 59%
D
60- 69%
E
≥ 70%
Question 27
Lead in
TOPs done under ground E are those done at any gestation because of fetal abnormality. Which, if any, of the following statements are true of TOPs under ground E in 2015?
A
the average of the woman was 34, compared to 21 for the average for all grounds
B
congenital malformations were the grounds in > 80% of cases
C
Down’s syndrome was the most common reason for ground E TOP
D
fetal cardiac anomalies were the most common reason for ground E TOP
E
fetal nervous system anomalies were the most common reason for ground E TOP
Question 28
Lead in
Which form relates to certifying that a woman requesting a TOP can have it done legally?
Option list
A
HSA1
B
HSA2
C
HSA3
D
HSA4
E
HSA5
Question 29
Lead in
Which form must the practitioner performing the TOP complete to notify the Department of Health that a TOP has been done?
Option list
A
HSA1
B
HSA2
C
HSA3
D
HSA4
E
HSA5
Question 30
Lead in
A doctor signing the form giving the grounds for a TOP must have seen the woman.
Option list
A
True
B
False
C
Sometimes
D
Don’t know & don’t care
Question 31
Lead in
A doctor performing a TOP must be one of the doctors who signed the initial form giving the grounds for the TOP.
Option list
A
True
B
False
C
Sometimes
D
Don’t know & don’t care
Question 32
Lead in
What is the time scale for the return of the form notifying that a TOP has taken place?
Option list
A
3 working days
B
5 working days
C
1 week
D
2 weeks
E
1 month
Question 33
Lead in.
A woman seeks 1st. trimester TOP on social grounds which she declines to discuss in detail.
Which of the following statements apply?
Option List
A
TOP can be done under clause A of Certificate A
B
TOP can be done under clause B of Certificate A
C
TOP can be done under clause C of Certificate A
D
TOP can be done under clause D of Certificate A
E
TOP can be done under clause E of Certificate A
F
TOP can be done under clause F of Certificate A
G
TOP can be done under clause G of Certificate A
F
there is no clause authorising TOP on social grounds
Question 34
A woman seeks 1st. trimester TOP. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.
Which of the following statements apply?
A
TOP can be done under clause A of Certificate A
B
TOP can be done under clause B of Certificate A
C
TOP can be done under clause C of Certificate A
D
TOP can be done under clause D of Certificate A
E
TOP can be done under clause E of Certificate A
F
TOP can be done under clause F of Certificate A
G
TOP can be done under clause G of Certificate A
F
there is no clause authorising TOP on these grounds
Question 35
A woman books at 26 weeks. She has an unplanned pregnancy. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.
Which of the following statements apply?
A            TOP should be offered under clause A of Certificate A
B            TOP should be offered under clause B of Certificate A
C            TOP should be offered under clause C of Certificate A
D            TOP should be offered under clause D of Certificate A
E            TOP should be offered under clause E of Certificate A
F            TOP should be offered under clause F of Certificate A
G            TOP should be offered under clause G of Certificate A
F            there is no clause authorising TOP on these grounds

47.         BRCA1 & 2 carriers and risk of breast and ovarian cancer.
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?
Answer.
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.
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 14
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?

48.         Topic. Androgen insensitivity syndrome.
Abbreviations.
AIS:             androgen insensitivity syndrome
Question 1.
Lead-in
What is the estimated prevalence of AIS?
Option List
A.       
2-5 per 100,000 boys at birth
B.       
5-10 per 100,000 girls at birth
C.       
2-5 per 100,000 genetic males at birth
D.       
5-10 per 100,000 genetic females at birth
E.        
none of the above.
Question 2.
Lead-in
Which of the following sub-types of AIS do not exist?
Sub-types
1.        
complete AIS
2.        
incomplete AIS
3.        
mild AIS
4.        
partial AIS
5.        
total AIS
Option List
A.       
1
B.       
2
C.       
3
D.       
4
E.        
5
F.        
1 + 3
G.       
2 + 3
H.       
2 + 5
I.         
3 + 5
J.         
4 + 5
Question 3.
Lead-in
How common is partial AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than mild AIS
D.       
as common as incomplete AIS
E.        
none of the above.
Question 4.
Lead-in
How common is incomplete AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than mild AIS
D.       
as common as partial AIS
E.        
none of the above.
Question 5.
Lead-in
How common is mild AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than complete AIS
D.       
as common as partial AIS
E.        
none of the above.
Question 6.
Lead-in
What is the mode of inheritance of AIS?
Option List
A.       
autosomal dominant
B.       
autosomal recessive
C.       
X-linked dominant
D.       
X-linked recessive
E.        
mitochondrial
Question 7.
Lead-in
What proportion of AIS is due to new mutations?
Option List
A.       
0%
B.       
1 – 20%
C.       
21 – 40%
D.       
41-60%
E.        
61-80%
Question 8.
Lead-in
Which gene is involved in AIS?
Option List
A.       
androgen receptor gene
B.       
aromatase receptor gene
C.       
androstenedione gene
D.       
oestrogen receptor gene
E.        
none of the above
Question 9.
Lead-in
How many mutations have been described of the gene which is involved in AIS?
Option List
A.       
0-10
B.       
11-100
C.       
101-200
D.       
201-300
E.        
>300
Question 10.
Lead-in
Which is the most common clinical presentation in AIS?
Option List
A.       
ambiguous genitalia
B.       
precocious puberty
C.       
premature menopause
D.       
primary amenorrhoea
E.        
secondary amenorrhoea
Question 11.
Lead-in
Which of the following are more common in AIS?
Option List
A.       
anlagen
B.       
coarctation of the aorta
C.       
“coast of Maine” pigmentation pattern
D.       
renal tract anomalies
E.        
none of the above.
Question 12.
Lead-in
A woman of 20 is found to have AIS. She has a pre-pubertal sister. What is the chance that the sister also has AIS, assuming that the condition is not due to a new mutation in the elder sister?
Option List
A.       
1 in 1
B.       
1 in 2
C.       
1 in 3
D.       
1 in 4
E.        
1 in 16
Question 13.
Lead-in
What is the risk of the gonads becoming malignant in AIS?
Option List
A.       
10%
B.       
20%
C.       
30%
D.       
> 30%
E.        
accurate risk not known

49.         Antepartum haemorrhage.
Option list.
A.        genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the baby
B.         genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the placenta.
C.         genital tract bleeding ≥ 500 ml. from 24 weeks, or earlier if the baby is live-born, until the delivery of the baby.
D.        1
E.         2
F.         3
G.        4
H.        5
I.           6
J.          7
K.         8
L.          9
M.      10
N.        15
O.        20
P.         30
Q.        50
R.         100
S.         500
T.         1,000
U.        true
V.        false
W.      none of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml. for minor APH
Scenario 3.
What is the upper limit in ml. of major haemorrhage
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor for placental abruption.
Scenario 7
List 10 risk factors for placental abruption.
Scenario 8
List 6 risk factors for placenta previa.
Scenario 9
In what % of pregnancies does APH occur?
Scenario 10
With regards to steps that can be taken to reduce the incidence of APH, what things would you include in a viva in the OSCE?





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2 comments:

  1. Unknown3 January 2017 at 11:31

    Please mention from where we read the topics.

    ReplyDelete
    Replies
    1. drtmcf3 January 2017 at 11:51

      I want you to answer the questions without any preparation - this is what you have to do in the exam. The idea behind the tutorials is that it gives you the opportunity to practise what you will face in the exam. Send the answers. My answers will usually give you all the information you need and any links to sources. Tom.

      Delete

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