Monday, 31 July 2017

Tutorial 31st. July 2017

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53
Julie Morris: Medical statistics.
54
EMQ Peutz-Jeghers syndrome
55
EMQ. Abortion Act

53. Topic. Julie Morris. Medical statistics.
1.        Weight gain in pregnancy was measured in a sample of 1000 women. Summary statistics of the weight gain were calculated.  (Answer yes/no to each statement)-
         A       The median is the weight gain value which occurs most frequently
B       If weight gain was found to have a positively skewed distribution, the mean will be less than the median.
C       The interquartile range is unaffected by outliers
D       A large positive outlier will increase the mean
E       The median is affected by outliers
2.        For a cohort of babies, birthweight was considered to be Normally distributed with a mean of 3000g and a standard deviation of 500g. It follows that: (Answer yes/no to each statement)-
A       All birthweights must be less than 4500g
B       The distribution of birthweights is skewed
C       About 50% of birthweights are above 3000g
D       About 2.5% of birthweights are below 2000g
E       About 95% of birthweights are between 2500g and 3500g
3.        Theme: Summary statistics
           A       mean                                                      E            interquartile range
           B       standard deviation                                  F             percentage
           C       range                                                      G            mode
           D       median                                                   H            standard error
           For each type of data description given below choose the SINGLE most appropriate summary statistic. Each option may be used once, more than once, or not at all.   
1.     The variability of length of hospital stay for 230 mothers following a caesarean, where length of stay is Normally distributed.
2.     The extremes of length of hospital stay for 230 mothers following a caesarean, where length of stay is Normally distributed
3.       The elective caesarean section rate in a hospital for 2011
4.        To assess the effectiveness of a new antenatal screening test, 100 pregnant women over 45 years of age, were screened.  25 women subsequently had babies with mild congenital problems. 20 of these 25 women had a positive screening test result. 65 of those with normal babies had a negative test result. (Answer yes/no to each statement).
A       The predictive value of a positive test result  as a marker for congenital problems is 20/35
B       The sensitivity of the test will not depend upon the prevalence of congenital problems in the cohort of women to which it is applied
C       The sensitivity of the screening test is 20/100
D       The specificity of the screening test is 65/75
E       Specificity=1-sensitivity
5.        In a study looking at the relationship between blood pressure during pregnancy and fetal growth, 130 women had their 24-hour blood pressure readings taken in mid-pregnancy. The size of the baby was recorded at birth. The Pearson correlation between blood pressure and birthweight was found to equal -0.70 with an associated p-value of  p<0.001.
           (Answer yes/no to each statement):
A       Blood pressure  explains 70% of the variability in birthweight
B       We can conclude that increasing blood pressure is a cause of low birthweight
C       A correlation of zero is interpreted as showing no association between two variables
D       The correlation between blood pressure and birthweight can be different from the correlation between birthweight and blood pressure
E       There is a significant negative linear  relationship between blood pressure and birthweight
6.        In a study of 75 infants with median gestational age 30 weeks (range 25 to 42 weeks), lung area was calculated from chest radiographs and lung volume from measurements of FRC. The aim of the study was to see whether lung area would predict lung volume in neonates.  (choose just one).
A       Chi-square test
B       Correlation coefficient
C       Mann-Whitney U-test
D       Regression analysis
         E       Two-sample t-test
7.        A cohort of women experiencing nausea and vomiting in pregnancy were given acid-reducing medication. The Pregnancy-Unique Quantification of Emesis and nausea (PUQUE) score was recorded before and after treatment. The clinical effect of the medication could be evaluated using: (Answer yes or no to each statement):
         A       The Student paired t-test
B       The Spearman correlation coefficient
C       The Wilcoxon matched-pairs test
D       The Sign test
E       The Mann-Whitney U-test
8.        Theme: Statistical significance tests
           A       Chi-square test                                         F             Spearman correlation
           B       Two-sample t-test                                    G            Mann-Whitney U-test
           C       Pearson correlation                                  H            Wilcoxon test
           D      Fisher’s Exact test                                    I             Paired t-test
           E       Linear regression                                      J             ANOVA
           For each of the studies described below choose the SINGLE most appropriate statistical test. Each option may be used once, more than once, or not at all.   
1.        A comparison of two audits (2011 vs 2006) of smoking habits of pregnant women looking at the percentage of current smokers.
2.       In a cohort of 500 pregnant women, maternal cotinine levels (an indicator of exposure to cigarette smoke) were measured. The aim of the study was to see whether high maternal cotinine levels were related to subsequent birthweight. It was assumed that cotinine levels would have a highly skewed distribution.
3.       Adrenaline concentrations were measured in 30 mechanically-ventilated babies at 1 hour and 24 hours to assess whether there had been a significant change. The adrenaline concentrations cannot be assumed to follow a Normal distribution.
9.        In a study of diet and epithelial ovarian cancer, 128 women with cancer and 251 women without cancer were asked about their consumption of dairy products. 50% of cancer patients and 10% of controls reported consuming yoghurt regularly: (Answer yes or no to each statement):
         A       This is a cohort study
B       The odds ratio is 9
C       The odds ratio is 5
D       The relative risk can be estimated by an odds ratio if the disease is rare and the cases and controls are random samples from the same population.
E       An odds ratio of 0 indicates no difference between cancer patients and controls in the consumption of yoghurt.
10.      In a study of the effect of a new antibiotic therapy for bacterial vaginosis in pregnancy, the infection response rate for women on the new antibiotics was 0.4, whereas it was 0.2  in the control group (p=0.03). (Answer yes or no to each statement):
         A       The infection response rate was significantly lower in the control group.
B       The NNT is the difference in the number of infection-free women in the treated group compared to the control group
C       The NNT=5
D       The NNT=2
E       The NNT is the number of women needed to receive the intervention to see one additional occurrence of the outcome in the treatment group


54. Topic. EMQ Peutz-Jeghers syndrome
Peutz-Jeghers syndrome.
Scenario 1.                
Which, if any, of the following are characteristics of PJS?
Option list.
A.       
buccal pigmentation
B.       
gastro-intestinal hamartomas
C.       
perianal pigmentation
D.       
increased risk of breast cancer
E.        
increased risk of cervical adenoma malignum
F.        
increased risk of colo-rectal cancer
G.       
increased risk of endometrial cancer
H.       
increased risk of ovarian cancer
I.         
increased risk of pancreatic cancer
J.         
increased risk of prostate cancer
K.        
increased risk of stomach cancer
Scenario 2.                
What is the approximate prevalence of PJS?
Option list.
A.       
< 1 in 1,000
B.       
1 in 1,000 to 1 in 10,000
C.       
1 in 10,000 to 1 in 100,000
D.       
1 in 25,000 to 1 in 100,000
E.        
1 in 25,000 to 1 in 200,000
F.        
1 in 25,000 to 1 in 300,000
G.       
1 in 300,000 to 1 in 500,000
H.       
< 1 in 500,000
Scenario 3.                
What is the mode of inheritance in PJS?
Option list.
A
autosomal dominant
B
autosomal recessive
C
X-linked dominant
D
X-linked recessive
E
Y-linked dominant
F
Y-linked recessive
G
triplet repeat
Scenario 4.                
Which, if any, of the following statements are true of PJS?
Option list.
A
PJS only occurs in families with other affected members
B
PJS mainly occurs in families with other affected members
C
PJS may arise de-novo in families with no other affected members
D
PJS may arise de-novo in families with other affected members
E
PJS does not arise de-novo in families with no other affected members
Scenario 5.                
What is the approximate lifetime risk of developing cancer in PJS?
Option list.
A.       
10%
B.       
20%
C.       
30%
D.       
40%
E.        
50%
F.        
60%
G.       
70%
H.       
80%
I.         
90%
J.         
>90%
Scenario 6.                
What is the relevance of SK11 to PJS?
Option list.
A.       
It is part of the postcode of the Peutz-Jeghers Society
B.       
It is the name of the gene most commonly associated with PJS
C.       
It is the Ornithological Society’s code for the Orkney Skua
D.       
Somatic mutations have been found in cervical cancer
E.        
None of the above


55, Topic. EMQ. Abortion Act
Scenario 1
Lead in.
How many abortions were performed on residents of E&W aged 15-44 in 2016?
Option list
A
about 50,000
B
about 100,000
C
about 150,000
D
about 200,000
E
about 250,000
F
> 250,000
Scenario 2
Lead in.
What was the approximate rate of abortion in E&W residents in 2016?
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
Scenario 3
Lead in.
The rate of abortion has declined by >20% in residents of E&W in the past ten years.
Pick the answer from the option list that best matches the above statement.
Option list
A
False
B
Haven’t a clue
C
Maybe
D
No data exist
E
True
Scenario 4
Lead in.
What proportion of TOPs were performed at gestations <10 weeks in E&W in 2016?
Option list
A
50%
B
60%
C
70%
D
80%
E
90%
Scenario 5
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
Scenario 6
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%
Scenario 7
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%
Scenario 8
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
Scenario 9
Lead in.
What happened to the rate of TOP in 2016 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
Scenario 10
Lead in.
What happened to the rate of TOP in 2015 for girls <16 years compared with 2006?
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
Scenario 11
Lead in.
What happened to the rate of TOP in 2016 for girls <16 years compared with 2015?
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
Scenario 12
Lead in
Approximately what proportion of women having TOP in 2016 had previously had one or more TOPs?
Option list
A
1%
B
5%
C
10%
D
20%
E
30%
F
40%
G
50%
Scenario 13
Lead in
What age group of women 1n 2016 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
Scenario 14
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
Scenario 15
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%
Scenario 16
Lead in
The RCOG recommends that women having TOP should have chlamydia screening. What proportion of women had this done in 2016?
Option list
A
<10%
B
10- 24%
C
25- 49%
D
50- 79%
E
80- 89%
F
≥ 90%
Scenario 17
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
Scenario 18
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
Scenario 19
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
Scenario 20
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
Scenario 21
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
Scenario 22
Lead in.
With regard to the wording of the 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
Scenario 23
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.
Scenario 24
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.
Scenario 25
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 is at serious risk of death or grave, permanent injury 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
Scenario 26
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
Scenario 27
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%
Scenario 28
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
Scenario 29
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
Scenario 30
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
Scenario 31
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
Scenario 32
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
Scenario 33
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
Scenario 34
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
Scenario 35
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
Scenario 36
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





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