3rd. August 2017.
56
|
EMQ. APH
|
57
|
EMQ. Drugs in O&G 2
|
58
|
EMQ. Menopause. NG23.
Definition & diagnosis
|
59
|
SBA. Flu and
pregnancy
|
60
|
EMQ. Kallmann’s
syndrome
|
56. Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Abbreviations.
ART: assisted reproduction technology
FGR: fetal growth restriction
PET: pre-eclampsia
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?
57. Drugs in Pregnancy 2.
Lead-in.
The following scenarios relate to some common drugs used
in pregnancy.
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?
58. Menopause NG23. Diagnosis & definitions.
Abbreviations.
AFC: antral follicle count.
AMH: anti-Müllerian hormone.
POF: premature ovarian failure.
POI: premature ovarian insufficiency.
Question 1.
Which
adjective did NICE use in relation to ideal care in recommendation 1.1.1 of
NG23?
Option List
A.
|
best
|
B.
|
holistic
|
C.
|
individualised
|
D.
|
personalised
|
E.
|
privatised
|
Question 2.
What is
the average age at the menopause?
Option List
A.
|
49 years
|
B.
|
50 years
|
C.
|
51 years
|
D.
|
52 years
|
E.
|
53 years
|
Question 3.
What age limit is used for the diagnosis of premature
ovarian insufficiency?
Option List
A.
|
30 years
|
B.
|
35 years
|
C.
|
37 years
|
D.
|
40 years
|
E.
|
45 years
|
Question 4.
What is
the approximate incidence of premature ovarian insufficiency?
Option List
A.
|
0.1%
|
B.
|
0.5%
|
C.
|
1%
|
D.
|
2%
|
E.
|
5%
|
Question 5.
What is the definition of the perimenopause?
Question 6.
What is
the definition of the postmenopause?
Question 7.
What is
the definition of premature ovarian insufficiency?
Question 8.
A healthy
physics teacher of 35 is diagnosed as menopausal. There is no obvious
explanation. Which of the following conditions could be the undiagnosed hereditary
cause?
Option List
A.
|
Cystic
fibrosis carrier status
|
B.
|
Elliptocytosis
|
C.
|
Fragile X carrier status
|
D.
|
Galactosaemia
|
E.
|
Polycythaemia vera
|
Question 9.
A healthy
woman of 52 presents with amenorrhoea for 15 months and vasomotor symptoms. She
is not taking any drugs. What tests should be done to confirm the diagnosis of
the menopause.
Option List.
A.
|
FSH
|
B.
|
FSH & LH
|
C.
|
FSH & oestradiol
|
D.
|
AMH
|
E.
|
None of the above
|
Question 10.
A healthy
woman of 46 presents with vasomotor symptoms and irregular periods. She is not
taking any drugs. What tests should be done to confirm the diagnosis of the
menopause?
Option List.
A.
|
FSH
|
B.
|
FSH & LH
|
C.
|
FSH & oestradiol
|
D.
|
AMH
|
E.
|
None of the above
|
Question 11.
Which
tests does NICE say should not be used to diagnose the menopause and
perimenopause in women > 45 years?
List of possible investigations.
A.
|
AFCA
|
B.
|
MH
|
C.
|
CT scan of pituitary fossa
|
D.
|
inhibin A
|
E.
|
inhibin B
|
F.
|
oestradiol
|
G.
|
ovarian volume
|
H.
|
prolactin
|
I.
|
thyroid function tests
|
Question 12.
What does
NICE recommend with regard to the use of FSH in relation to diagnosis of the
menopause?
Question 13.
What does
NICE recommend with regard to the use of FSH in relation to diagnosis of the
perimenopause?
Question 14.
What does
NICE say about the cost of FSH assay?
Question 15.
Which of
the following statements, if any, are true in relation to the advice from NICE
about the diagnosis of the menopause?
Option List
A
|
diagnose
without lab tests in healthy women > 45 years with menopausal symptoms
|
B
|
diagnose
without lab tests in healthy women > 50 years with menopausal symptoms
|
C
|
diagnose
without lab tests in women > 50 years with amenorrhoea > 6/12 and not
taking hormones
|
D
|
diagnose
without lab tests in women > 55 years with amenorrhoea > 6/12 and not
taking hormones
|
E
|
diagnose
on symptoms without lab tests in women > 45 years who have had
hysterectomy and are not taking hormones
|
F
|
none of
the above
|
Question 16.
Which of
the following statements is true in relation to the advice from NICE about the
diagnosis of the perimenopause?
Option List
A
|
diagnose
without lab tests in healthy women > 45 years with menopausal symptoms
|
B
|
diagnose
without lab tests in healthy women > 50 years with menopausal symptoms
|
C
|
diagnose
without lab tests in women > 50 years with amenorrhoea > 6/12 and not
taking hormones
|
D
|
diagnose
without lab tests in women > 55 years with amenorrhoea > 6/12 and not
taking hormones
|
E
|
diagnose
on symptoms without lab tests in women > 45 years who have had
hysterectomy and are not taking hormones
|
F
|
none of
the above
|
Question 17.
What does
NICE recommend with regard to the use of oestradiol assay in relation to
diagnosis of the menopause and perimenopause?
Question 18.
What does
NICE recommend in relation to the diagnosis of POI?
Question 19.
NICE uses
the term “urogenital atrophy” for the changes that may accompany the menopause.
There is now a preferred term – what is it?
Question 20.
NICE
describes 3 ‘challenges’, parts of NG23 that could have ‘a big impact on
practice’ but be ‘challenging to implement’.
Which, if
any, of the following are included in the ‘challenges’.
Possible ‘challenges’
A
|
increasing
the uptake of HRT or non-hormonal alternatives to ↓ the burdens caused by
osteoporosis in an ageing population
|
B
|
increasing
the uptake of HRT to ↓ the burdens caused by Alzheimer’s disease in an ageing
population
|
C
|
reducing
unnecessary use of FSH tests in the diagnosis of the menopause
|
D
|
providing
better information about the long-term benefits and risks of HRT
|
E
|
providing
adequate specialist services for an ageing population
|
F
|
encouraging
GPs to discuss the benefits and risks of HRT with all of their menopausal
patients
|
Option List
1
|
A + B +
C + D + E + F
|
2
|
A + B +
C + D + E
|
3
|
B + D +
E + F
|
4
|
C + D +
E
|
5
|
C +
D + F
|
59. Flu and pregnancy
Question 1.
Lead-in
What did
MBRRACE say about flu & pregnancy in its first report in 2014?
Option List
Pick the
best option from the following list.
F.
|
1 in 11
women died from flu
|
G.
|
1 in 11 women died from flu and flu vaccination could
have prevented ½ of the deaths
|
H.
|
1 in 21 women died from flu
|
I.
|
1 in 21 women died from flu and flu vaccination could
have prevented ½ of the deaths
|
J.
|
1 in 51 women died from flu
|
K.
|
1 in 51 women died from flu and flu vaccination could
have prevented ½ of the deaths
|
Question 2.
Lead-in
How many
types of flu virus are recognised?
Pick the
best option from the following list.
Option List
F.
|
3
|
G.
|
5
|
H.
|
10
|
I.
|
15
|
J.
|
>100
|
Question 3.
Lead-in
Why can’t
we have a universal flu vaccine?
Pick the statements
from the following list that are true.
List of statements.
A.
|
The main
surface antigens are haemagglutinin and neuraminidase
|
B.
|
The main surface antigens are haemolysin and neuroxidase
|
C.
|
The main surface antigens frequently
|
D.
|
The main core antigens change frequently, rendering
existing vaccines impotent
|
E.
|
The big drug companies avoid making a universal vaccine
for financial reasons.
|
Option List
1.
|
A + C + D + E
|
2.
|
A + C
|
3.
|
A + D + E
|
4.
|
B + C
|
5.
|
B + D + E
|
Question 4.
Lead-in
When is
flu’ most often a problem in the UK?
Pick the
best option from the following list.
Option List
A.
|
Spring
|
B.
|
Summer
|
C.
|
Autumn
|
D.
|
Winter
|
E.
|
None of the above.
|
Question 5.
Lead-in
How is flu
spread?
Pick the
best option from the following list.
Option List
A.
|
via
aerosol or droplets from respiratory tract of an infected person
|
B.
|
via aerosol or droplets from respiratory tract or
direct contact with respiratory secretions of an infected person
|
C.
|
from getting drenched in cold winter showers
|
D.
|
from thinking lascivious thoughts
|
E.
|
from toilet seats
|
Question 6.
Lead-in
What is
the incubation period for flu?
Pick the
best option from the following list.
Option List
A.
|
1 – 3
days
|
B.
|
1 – 7 days
|
C.
|
5 – 10 days
|
D.
|
up to 2 weeks
|
E.
|
up to 3 weeks
|
Question 7.
Lead-in
Who
decides which viruses will be used in the vaccine for seasonal flu?
Pick the
best option from the following list.
Option List
|
|
DOH
|
|
|
JCVI
|
|
|
the Prime Minister
|
|
|
the vaccine manufacturers
|
|
|
WHO
|
Question 8.
Lead-in
How long
has flu vaccination been recommended in the UK?
Pick the
best option from the following list.
Option List
A.
|
since
the 1950s
|
B.
|
since the 1960s
|
C.
|
since the 1970s
|
D.
|
since the 1980s
|
E.
|
since the 1990s
|
Question 9.
Lead-in
What is
the recommendation about when the vaccine should be given?
Pick the
best option from the following list.
Option List
A.
|
May -
July
|
B.
|
June - August
|
C.
|
July - September
|
D.
|
August - October
|
E.
|
September - November
|
Question 10.
Lead-in
What
advice is given about vaccination in pregnancy?
Pick the
best option from the following list.
Option List
A.
|
flu
vaccine is potentially teratogenic and should be avoided before 16 weeks
|
B.
|
the vaccine contains an attenuated virus with no
evidence of risk in pregnancy
|
C.
|
the vaccine recommended for pregnancy has no live viral
material and all pregnant women are encouraged to have the seasonal vaccine
|
D.
|
flu vaccine contains an attenuated virus with minimal
risk, but the anti-viral drug Tamiflu is given with the vaccine to eliminate
any risk of harm
|
Question 11.
Lead-in
What is
the H1N1 virus?
Pick the
best option from the following list.
Option List
A.
|
The
avian virus which causes outbreaks of “bird flu”
|
B.
|
The virus associated with “swine” flu, which caused a
pandemic in 2009
|
C.
|
The virus associate with MERS, currently causing deaths
particularly in Saudi Arabia
|
D.
|
The virus associated with simian flu
|
E.
|
The virus associated with the pandemic of 1915.
|
Question 12.
Lead-in
What
advice should be given to pregnant women about protection against the H1N1
virus?
Pick the
best option from the following list.
Option List
F.
|
to have
vaccination against H1N1 in addition to the seasonal vaccine
|
G.
|
to have vaccination against H1N1 in preference to the
seasonal vaccine
|
H.
|
to await evidence of epidemic H1N1 flu and then have
vaccination against H1N1
|
I.
|
to have the seasonal vaccine as it gives good
protection against H1N1
|
J.
|
not to have any flu vaccination, but to take antiviral
drugs if symptoms of flu occur
|
Question 13.
Lead-in
Pick the
best option from the following list.
Which of the following conditions have been linked to flu in
pregnancy?
Conditions.
A.
|
risk of flu complications for the mother
|
B.
|
risk of low birthweight
|
C.
|
risk of maternal death
|
D.
|
risk of perinatal death
|
E.
|
risk of
prematurity
|
Option List
1
|
A + C+ D
+ E
|
2
|
A + B + C+ D
|
3
|
A + C + D
|
4
|
A + C+ D + E
|
5
|
A + B + C+ D + E
|
Question 14.
Lead-in
What is
the estimated uptake of flu vaccination by pregnant women in the UK?
Pick the
best option from the following list.
Option List
A.
|
20-30%
|
B.
|
30-40%
|
C.
|
40-50%
|
D.
|
50-60%
|
E.
|
> 60%
|
Question 15.
Lead-in
How many
maternal deaths from flu were reported by MBRRACE for the years 2012 - 2013?
Pick the
best option from the following list.
Option List
A.
|
0
|
B.
|
5
|
C.
|
10
|
D.
|
15
|
E.
|
20
|
Question 16.
Lead-in
With
regard to the probable explanation for the numbers of maternal deaths from ‘flu
in 2012 and 2013, which of the
following statements is true?
Option List
A.
|
the
numbers reflected increased prevalence of ‘flu
|
B.
|
the numbers reflected reduced prevalence of ‘flu
|
C.
|
the numbers reflected improved uptake of ‘flu vaccine
in pregnancy
|
D.
|
the numbers reflected the introduction of Tamiflu for
pregnant women with ‘flu
|
E.
|
none of the above
|
60. Kallmann’s syndrome.
Lead-in.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
Ks: Kallmann’s syndrome
Scenario 1.
Which of the following might be
included in descriptions of Kallmann’s syndrome?
Option list.
A
|
hypogonadotrophic hypogonadism
|
B
|
hypogonadotrophic hypogonadism + anosmia
|
C
|
hypogonadotrophic hypogonadism + anosmia +
colour-blindness.
|
D
|
hypogonadotrophic hypogonadism due to uterine agenesis
|
Scenario 2.
Lead in.
Which, if any, of the following are features of the Kallmann
phenotype?
A
|
absent or minimal breast development
|
B
|
aortic stenosis
|
C
|
blue eyes
|
D
|
blue hair
|
E
|
hot flushes
|
F
|
short stature
|
G
|
tall stature
|
H
|
vaginal agenesis
|
I
|
none of the above
|
Scenario 3.
How common is Kallmann’s syndrome and what is the
female: male ratio?
A
|
1 in 1,000 and F:M ratio 1:1
|
B
|
1 in 5,000 and F:M ratio 1:1
|
C
|
1 in 10,000 and F:M ratio 1:4
|
D
|
1 in 50,000 and F:M ratio 1:4
|
E
|
1 in 100,000 and F:M ratio 1:8
|
F
|
1 in 250,000 and F:M ration 1:10
|
Scenario 4.
What is the most common mode of
inheritance of Ks?
Option list.
A
|
hypogonadotrophic hypogonadism
|
B
|
hypogonadotrophic hypogonadism + anosmia
|
C
|
hypogonadotrophic hypogonadism due to uterine agenesis
|
D
|
autosomal dominant
|
E
|
autosomal recessive
|
F
|
X-linked recessive
|
G
|
new mutation of the ANOS1 gene
|
H
|
the most common mode of inheritance is not known
|
Scenario 5.
How is Kallmann’s syndrome
diagnosed?
A
|
abdominal and pelvic
ultrasound scan
|
B
|
cell-free fetal DNA
|
C
|
chromosome analysis
|
D
|
CT scan of hypothalamus /
pituitary
|
E
|
MR scan of hypothalamus /
pituitary
|
F
|
none of the above.
|
Scenario 6.
How is Kallmann’s syndrome
treated initially?
Which of the following
statements are true?
Option list.
A
|
GnRH analogue depot
|
B
|
pulsatile GnRH therapy
|
C
|
combined oral contraceptive
|
D
|
counselling & education
re gender re-assignment
|
E
|
depot progestogen
|
F
|
none of the above
|
Scenario 7.
A woman was diagnosed with
Kallmann’s syndrome at 16 and had successful initial treatment. She is now 25,
married and wishes to have a pregnancy. She has had pre-pregnancy assessment
and counselling. Which of the following can be considered?
A
|
GnRH analogue depot
|
B
|
induction of ovulation with
clomiphene
|
C
|
gonadotrophin therapy
|
D
|
pulsatile GnRH therapy
|
E
|
none of the above
|
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