Thursday, 22 December 2016

Tutorial 22nd. December 2016


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



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