21st. August 2017.
61
|
SBA. Pertussis & pregnancy
|
62
|
EMQ. Cervical smears, colposcopy &
referral
|
63
|
SBA. Needle-stick and related injuries
|
61. Pertussis & pregnancy.
Question 1.
Lead-in. Why is pertussis of current concern in obstetrics?
Option List
A
|
Recent
research has linked pertussis in the 1st. trimester with an ↑risk
of congenital heart disease
|
B
|
There has been a mini-epidemic of pertussis since 2011
with an increase in maternal deaths and deaths of babies < 3 months
|
C
|
There has been a mini-epidemic of pertussis since 2011
with an increase in deaths of babies < 3 months
|
D
|
The infecting organism causing pertussis has become
increasingly drug-resistant
|
E
|
Pertussis in the 2nd. trimester doubles the
risk of premature delivery < 32 weeks
|
Question 2.
Lead-in
Which of
the following statements is true?
Option List
A
|
Pertussis
is not a notifiable disease
|
B
|
Pertussis is a notifiable disease
|
C
|
Pertussis is not a notifiable disease, but cases should
be reported to the local bacteriologist
|
D
|
Pertussis is not a notifiable disease, but cases should
be subject to audit
|
Question 3.
Lead-in
Which
organism causes whooping cough?
Option List
A
|
Bordella
pertussis
|
B
|
Bacteroides pertussis
|
C
|
Rotavirus whoopoe
|
D
|
Respiratory syncytial virus pertussis
|
E
|
None of the above
|
Question 4.
Lead-in
What is
the origin of the name of the infecting organism?
Option List
A
|
It is
named after one of doctors who first isolated it
|
B
|
It is named after the town where the first recorded
outbreak occurred
|
C
|
The organism was first isolated from the staff of a
bordello in Madrid
|
D
|
None of the above
|
E
|
I refuse to answer this stupid question
|
Question 5.
Lead-in
What is
the main reservoir of the organism that causes pertussis?
Option List
A
|
pigs
|
B
|
pigeons
|
C
|
budgerigars
|
D
|
humans
|
E
|
none of the above
|
Question 6.
Lead-in
What is
the epidemiology of pertussis?
Option List
A
|
the
condition is endemic
|
B
|
the condition is endemic with mini-epidemics every 3-5
years
|
C
|
the condition is endemic with mini-epidemics most years
in the winter months
|
D
|
the condition is epidemic, with outbreaks at roughly
three-year intervals
|
E
|
the condition is epidemic, with outbreaks at
unpredictable intervals
|
Question 7.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis infection in
unvaccinated but otherwise healthy pregnant women?
Statements
A
|
< 10%
will need to be admitted to hospital
|
B
|
20-30% will need to be admitted to hospital
|
C
|
> 50%
will need to be admitted to hospital
|
D
|
20% will get pneumonia
|
E
|
1% will die of the infection
|
Option List
1
|
A + C + D + E
|
2
|
A + C + E
|
3
|
B + C + D
|
4
|
B + D + E
|
5
|
B + E
|
Question 8.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis infection in
unvaccinated but otherwise healthy babies < 2 months old?
Statements
A
|
< 10%
will need to be admitted to hospital
|
B
|
20-30% will need to be admitted to hospital
|
C
|
> 50%
will need to be admitted to hospital
|
D
|
20% will get pneumonia
|
E
|
1% will die of the infection
|
Option List
1
|
A + D
|
2
|
B + E
|
3
|
A + D + E
|
4
|
B + D + E
|
5
|
C + D + E
|
Question 9.
Lead-in
What is
the incubation period for pertussis?
Option list
A
|
<6
days
|
B
|
6-10 days
|
C
|
6-20 days
|
D
|
10-20 days
|
E
|
none of the above
|
Question 10.
Lead-in
The
following statements relate to practical issues that are current for
obstetricians in relation to pertussis?
Statements
A
|
The DOH
has advised that all pregnant women be immunised to reduce maternal death
rates.
|
B
|
The DOH has advised that all pregnant women be
immunised to reduce deaths in babies < 3 months.
|
C
|
The DOH has advised that all babies be immunised at
birth.
|
D
|
The DOH advised that “Boostrix- IPV” would replace “Repevax” for use in pregnancy from July
2014.
|
E
|
The DOH has advised that immunisation of pregnant women
be continued until 2019
|
Option List
1
|
A + C + D + E
|
2
|
A + C + E
|
3
|
B + C + D
|
4
|
B + D + E
|
5
|
B + E
|
Question 11.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis vaccine.
Option List
A
|
“Boostrix- IPV” is a vaccine for pertussis
only
|
B
|
“Repevax” is a
vaccine for pertussis only
|
C
|
“Boostrix-
IPV”& “Repevax” are live, attenuated vaccines
|
D
|
“Boostrix- IPV”
& “Repevax” are vaccines against diphtheria, tetanus and polio as well as
pertussis
|
E
|
“Boostrix-
IPV” & “Repevax” are acellular
|
Question 12.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis vaccine.
Statements
A
|
The
currently recommended vaccine is a live vaccine using a strain that does not
produce pertussis toxin but generates a strong immune response
|
B
|
The
currently recommended vaccine is an activated vaccine
|
C
|
The
currently recommended vaccine is an inactivated vaccine
|
D
|
The
currently recommended vaccine is acellular
|
E
|
The
currently recommended vaccine is made using recombinant technology
|
Option List
1
|
A + B +
C + D +E
|
2
|
A + B +
C + D +E
|
3
|
A + B +
C + D +E
|
4
|
A + B +
C + D +E
|
5
|
A + B +
C + D +E
|
Question 13.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis vaccine.
Statements
A
|
adult
antibody response to a pertussis booster peaks after two weeks
|
B
|
adult antibody response to a pertussis booster declines
significantly in the months after it peaks
|
C
|
adult antibody response to a pertussis booster declines
gradually from about 1 year after it peaks
|
D
|
mother-baby antibody transfer occurs at the same rate
at all gestations after 16 weeks
|
E
|
mother-baby antibody transfer occurs maximally from
about 28 weeks
|
Option List
1
|
A + B
|
2
|
A + B +
D
|
3
|
A + C +
D
|
4
|
B + D
|
5
|
C + E
|
Question 14.
Lead-in
Which, if
any, of the following statements are true in relation to the JCVI’s advice of
the best time to administer pertussis vaccine in pregnancy?
Option List
A
|
20 - 24
weeks
|
B
|
25- 28 weeks
|
C
|
28 - 32 weeks
|
D
|
28 - 34 weeks
|
E
|
30 - 36 weeks
|
62. Cervical smears, colposcopy & referral. Triage &
“test of cure”.
Lead-in.
Abbreviations.
ALOs: actinomyces-like
organisms
ART: antiretroviral
therapy
ASCUS: atypical
squamous cells of undetermined significance.
BCE: borderline
change in endocervical cells
BCC: borderline
change in squamous cells
cART: combination
antiretroviral therapy, now preferred to the term “HAART”.
CIN: cervical
intraepithelial abnormality
CGIN: cervical
glandular intraepithelial abnormality
?GNE: ?
glandular neoplasia of endocervical type
?GNNC: ?
glandular neoplasia (non-cervical)
GUM clinic: genito-urinary
medicine clinic
HAART: highly active antiretroviral therapy
HGD: high-grade dyskaryosis (? invasive
squamous carcinoma)
HGD?I: high-grade dyskaryosis (? invasive
squamous carcinoma)
HGDM: high-grade dyskaryosis (moderate)
HGDS: high-grade dyskaryosis (severe)
HPV: human papilloma virus
HPVT: HPV
triage
HRHPV: high-risk
HPV
LBC: liquid-based
cytology
LGD: low-grade
dyskaryosis
LLETZ: large
loop excision of the transformation zone
MDT: multi-disciplinary
team
NEC: normal
endometrial cell
POP: progesterone-only
Pill
SCJ: squamo-columnar
junction
SIL: squamous
intraepithelial lesion
TZ: transformation
zone
VaIN: vaginal
intraepithelial neoplasia
Lead-in.
The following questions relate to the management of
cervical smears.
Option list.
A.
repeat the test
B.
repeat the test after
6 months
C.
repeat the test at 6
and 12 months
D.
repeat the test at 6
and 12 months and then annually until she has had 10 years’ follow-up followed
by repeat tests at the normal intervals for her age
E.
repeat the test after
3 or 5 years according to her age as per routine follow-up
F.
repeat the test after
HPV testing
G.
management according
to HRHPV triage
H.
repeat the test after
giving an appropriate antibiotic
I.
repeat the test after
removing her IUCD.
J.
repeat the test after
removing the IUCD and giving an appropriate antibiotic
K.
repeat the test after
treating the TZ with diathermy
L.
repeat the test after
treating the TZ with cryocautery
M. discharge from follow-up
N.
refer for colposcopy
O.
refer for colposcopy
within 2 weeks
P.
refer for colposcopy
within 8 weeks
Q.
refer for colposcopy
within 12 weeks
R.
refer for colposcopy
only if she has other significant signs or symptoms
S.
refer for cone biopsy
T.
refer for fractional
curettage
U.
refer for “see and
treat” LLETZ
V.
refer to GUM clinic
W. recommend that she go back to America
X.
there is insufficient
information to formulate a management plan
Y.
false
Z.
true
AA. none of the above
BB. age 24 years
CC. age 24.5 years
DD. age 25 years
Question 1.
At what age is the first
invitation to have a smear test sent?
Option list.
A
|
20 years
|
B
|
22 years
|
C
|
24 years
|
D
|
24.5 years
|
E
|
25 years
|
Question 2.
Which of the following
statements is used by the NHSCSP to justify not offering routine screening to
younger women?
Option list.
A
|
most low-grade changes in
younger women regress spontaneously
|
B
|
most high-grade changes in
younger women regress spontaneously
|
C
|
HPV induced changes are
common in younger women and screening would cause large numbers of
unnecessary colposcopy referrals and be prohibitively expensive
|
D
|
colposcopic treatments may
cause pre-term labour in subsequent pregnancies
|
E
|
there is no evidence that
screening younger women reduces incidence of cervical cancer or resulting
mortality.
|
Question 3.
How often should women of 30
have routine smear tests?
Option list.
A
|
every year
|
B
|
every 2 years
|
C
|
every 3 years
|
D
|
every 4 years
|
E
|
every 5 years
|
Question 4.
A woman of 30 years is due to
have a routine smear. How long after the previous smear should the invitation
be sent?
Option list.
A
|
34 months
|
B
|
36 months
|
C
|
58 months
|
D
|
60 months
|
E
|
none of the above
|
Question 5.
How often should women of 50
have routine smear tests?
Option list.
A
|
every year
|
B
|
every 2 years
|
C
|
every 3 years
|
D
|
every 4 years
|
E
|
every 5 years
|
Question 6.
A woman of 50 years is due to
have a routine smear. How long after the previous smear should the invitation
be sent?
Option list.
A
|
34 months
|
B
|
36 months
|
C
|
58 months
|
D
|
60 months
|
E
|
none of the above
|
Question 7.
Which, if any, of the following
are grounds for continuing smear tests beyond the age of 64?
Option list.
A
|
no adequate screening test after
the age of 50
|
B
|
no adequate screening test
after the age of 55
|
C
|
no adequate screening test
after the age of 60
|
D
|
patient’s request due to
family history of fatal cervical cancer
|
E
|
presence of genital warts
|
Question 8.
Which, if any, of the following
are grounds for smear tests in addition to routine tests?
Option list.
A
|
history of heavy cigarette
consumption
|
B
|
1st. use of the
combined oral contraceptive
|
C
|
diagnosis of genital warts
involving the cervix
|
D
|
new sexual partner
|
E
|
multiple sexual partners
|
Question 9.
Which, if any, of the following
are grounds for smear tests in addition to routine tests in the GUM clinic?
Option list.
A
|
1st. attendance at
a GUM clinic
|
B
|
any attendance at a GUM clinic with proven STI
|
C
|
diagnosis of genital warts
involving the cervix
|
D
|
new sexual partner with
history of STI
|
E
|
multiple sexual partners –
simultaneous
|
F
|
multiple sexual partners –
not simultaneous
|
Question 10.
Which, if any, of the following
are true of cervical cytology as a means of diagnosing STIs?
Option list.
A
|
cervical cytology can be used
to diagnose chlamydial infections
|
B
|
cervical cytology can be used
to diagnose gonococcal infections
|
C
|
cervical cytology can be used
to diagnose herpes
|
D
|
cervical cytology can be used
to diagnose syphilis
|
E
|
cervical cytology can be used
to diagnose trichomonal infections
|
Question 11.
Which of the following should
be used in the initial investigation of the woman, younger than the age for
inclusion in the NHSCSP programme, who presents with a three month history of
intermenstrual and postcoital bleeding?
Option list.
A
|
inspection of the cervix
using a speculum
|
B
|
inspection of the cervix
using a colposcope
|
C
|
pregnancy test
|
D
|
screening for chlamydia
|
E
|
cervical smear
|
Question 12.
Which, if any, of the following
statements are true with regard to HRHPV as primary screening.
Option list.
A
|
HRHPV is about 10% more
sensitive than LBC in detecting borderline or worse changes
|
B
|
HRHPV is about 25% more
sensitive than LBC in detecting borderline or worse changes
|
C
|
HRHPV detects > 70% of
CIN2, CIN3 and invasive cancer
|
D
|
HRHPV detects > 90% of
CIN2, CIN3 and invasive cancer
|
E
|
HRHPV is about 6% less
specific in detecting borderline or worse changes
|
Question 13.
Approximately how much of the
NHSCSP was covered by the six sentinel sites used to evaluate modern approaches
to cervical screening?
Option list.
A
|
1%
|
B
|
5%
|
C
|
10%
|
D
|
15%
|
E
|
20%
|
Question 14.
Which of the following
statements are true in relation to the data obtained from the six sentinel
sites?
Option list.
A
|
16% of women with low-grade
dyskaryosis were HRHPV –ve and returned to routine screening
|
B
|
26% of women with low-grade
dyskaryosis were HRHPV –ve and returned to routine screening
|
C
|
45% of women with borderline
changes were HRHPV –ve and returned to routine screening
|
D
|
65% of women with borderline
changes were HRHPV –ve and returned to routine screening
|
E
|
colposcopy referral rates
increased by > 60%
|
Question 15.
Which, if any, of the following
statements are true in relation to the NHSCSP in the year ending 31 March 2015?
Statements.
A
|
85% of eligible women were
screened in the year up to 31 March 2015
|
B
|
72% of eligible women aged
25-49 years were screened
|
C
|
78% of eligible women aged
50-64 years were screened
|
D
|
4.31 million women were invited
for screening & 3.12 million women were tested
|
E
|
98% of women should receive
their smear reports within 2/52, but only 91% did
|
F
|
3.2 million samples were
examined by the laboratories
|
G
|
198,216 referrals were made
to colposcopy, a 0.6% ↓ from the previous year
|
H
|
2.5% of smears were
inadequate
|
Question 16.
Which, if any, of the following
statements are true in relation to LBC and the traditional cervical smear?
Statements.
A
|
both involve drying the slide
on which the smear is made in air by the person taking the smear
|
B
|
the sensitivity of LBC is
superior
|
C
|
the specificity of LBC is
superior
|
D
|
inadequate smears ↓ from
about 9% with traditional smears to 1-2% with LBC
|
E
|
LBC is now the NHSCSP
standard for cervical screening
|
F
|
HPV testing cannot be done on
routine LBC samples
|
Question 17.
Lead in.
Which, if any, of the following
statements are true in relation to inadequate smears?
A
|
inadequate smears are defined
as those showing insufficient squamous cells
|
B
|
inadequate smears are defined
as those showing inflammatory changes
|
C
|
a smear should not be defined
as inadequate if there are borderline or dyskaryotic changes
|
D
|
a repeat LBC sample should be
obtained within 1 month of an initial inadequate sample
|
E
|
a repeat LBC sample should be
obtained within 2 months of an initial inadequate sample
|
F
|
a repeat LBC sample should be
obtained after an initial inadequate sample, but not within 3 months
|
G
|
referral for colposcopy is
required after 2 consecutive inadequate cervical smear reports
|
H
|
referral for colposcopy is
required after 3 consecutive inadequate cervical smear reports
|
I
|
referral for colposcopy is
required after 4 consecutive inadequate cervical smear reports
|
J
|
the appointment for initial
colposcopy after inadequate smears should be within 6/52 of referral
|
K
|
the appointment for initial
colposcopy after inadequate smears should be within 12/52 of referral
|
L
|
referral for colposcopy after
inadequate smears is to exclude invasive cancer
|
Question 18.
A woman with no previous
abnormal smears has a routine smear showing an inadequate sample . What
management will you suggest?
Question 19.
A woman with no previous
abnormal smears has had a smear showing borderline nuclear changes. What management will you suggest?
Question 20.
A woman with no previous
abnormal smears has had a smear showing borderline nuclear changes. Cervical
ectopy is noted. What management will
you suggest?
Question 21.
A woman with no previous
abnormal smears has had a smear showing borderline cells of endocervical
origin. What management will you suggest?
Question 22.
A woman with no previous
abnormal smears has had a smear showing inflammatory changes. What management will you suggest?
Question 23.
A woman with no previous
abnormal smears has had a smear showing inflammatory changes and ALOs. What
management will you suggest?
Question 24.
A woman with no previous
abnormal smears has had a smear showing inflammatory changes. She takes the COC
for contraception. What management will you suggest?
Question 25.
A woman with no previous
abnormal smears has had a smear showing inflammatory changes. She has a copper
IUCD. What management will you suggest?
Question 26.
A woman with no previous
abnormal smears has had a smear showing inflammatory changes and ALOs. She has
had hysteroscopic sterilisation with ESSURE. What management will you suggest?
Question 27.
A woman with no previous
abnormal smears had a smear showing borderline changes. A repeat smear after 6
months was normal. A repeat smear after 3 years showed mild atypia. A repeat
smear after 6 months was normal. A recent repeat smear, 3 years after the
previous one, showed borderline changes. What management will you suggest?
Question 28.
A woman with no previous
abnormal smears has had a smear showing mild dyskaryosis of squamous cells.
What management will you suggest?
Question 29.
A woman with no previous
abnormal smears has had a smear showing moderate dyskaryosis of squamous cells.
What management will you suggest?
Question 30.
A woman with no previous
abnormal smears has had a smear showing severe dyskaryosis of squamous cells.
What management will you suggest?
Question 31.
A woman with no previous
abnormal smears has had a smear suggestive of invasive disease. What management
will you suggest?
Question 32.
A woman with no previous
abnormal smears has had a smear showing borderline nuclear changes in glandular
cells. What management will you suggest?
Question 33.
A woman with no previous
abnormal smears has had a smear showing ? glandular neoplasia. What management
will you suggest?
Question 34.
A 30-year-old woman with no
previous abnormal smears has had a smear showing ? glandular neoplasia. She is
nulliparous and would like to have children. Colposcopic appearances suggest
high-grade CGIN. What management will you suggest?
Question 35.
A 50-year-old woman with no
previous abnormal smears has had a smear showing ? glandular neoplasia. Colposcopic
appearances suggest high-grade CGIN. What management will you suggest?
Question 36.
A 50-year-old woman with no
previous abnormal smears has had a smear showing ? glandular neoplasia.
Colposcopic appearances suggest high-grade CGIN. An appropriate excisional
biopsy is taken which shows no abnormality. What management will you suggest?
Question 37.
A
woman with no previous abnormal smears has had a smear showing normal endometrial cells. What management will you suggest?
Question 38.
A
woman with no previous abnormal smears has had a smear showing atypical endometrial cells. What management will you suggest?
Question 39.
A woman with no previous
abnormal smears and no symptoms has had a smear with a normal result. Clinical
examination was normal, but contact bleeding was noted when the smear was
taken. The Practice Nurse who took the smear phones you for advice about her
management. What advice will you give?
Question 40.
An American woman with no
previous abnormal smears has been used to having annual smears. She has had a
smear with a normal result and requests a repeat in 12 months. What management
will you suggest?
Question 41.
A woman with no previous
abnormal smears is on renal dialysis and has had a smear with a normal result.
What management will you suggest?
Question 42.
Which, if any, of the following
statements are true in relation to women who are HIV +ve compared to those who
are HIV -ve?
A
|
there is an increased
incidence of false –ve smear reports
|
B
|
there is an increased
incidence of false +ve smear reports
|
C
|
the prevalence of SILs is
10-20%, 10 times higher than for HIV-ve women
|
D
|
the prevalence of SILs is
20-40%, 10 times higher than for HIV-ve women
|
E
|
HIV +ve women taking HAART
have higher rates of abnormal cytology than HIV –ve women
|
F
|
HAART may reduce the
prevalence of squamous intraepithelial lesions
|
G
|
LGD is less likely to regress
|
H
|
LGD is more likely to regress
|
I
|
HGD responds less well to
standard treatments
|
J
|
HGD responds better to
standard treatments
|
K
|
Close co-operation between
the HIV medical team and colposcopists / smear takers is essential
|
Question 43.
A woman recently diagnosed as
HIV +ve has had a smear with a normal result. Previous smears have been normal.
Which, if any, of the following statements are true?
A
|
twice yearly smears should be
arranged
|
B
|
annual smears should be
arranged
|
C
|
colposcopy should be arranged
if resources permit as part of the initial assessment
|
D
|
annual colposcopy should be
arranged if resources permit
|
E
|
ablation of low-grade CIN
should be offered as such lesions are more likely to progress than in HIV –ve
women
|
F
|
surgical removal of the
cervix should be offered if high-grade CIN is diagnosed
|
G
|
screening should continue
until at least the age of 75
|
H
|
women with good response to
HAART and normal cytology can safely return to routine screening
|
Question 44.
A woman with no previous
abnormal smears has had a smear with a normal result. She smokes 20 cigarettes
daily and has a long history of recurrent genital warts. What management will
you suggest?
Question 45.
A woman of 70 presents with
postmenopausal bleeding. She had smears at the recommended intervals from the age
of 22. All were normal. The last was taken at the age of 64. What is your
management in relation to taking a smear?
Question 46.
A woman of 55 presents with hot
flushes since her periods stopped at the age of 54. She wishes to go on HRT and
there are no contraindications. She had smears at the recommended intervals
from the age of 25. All were normal. The last was taken two years ago. What is
your management in relation to taking a smear?
Question 47.
Which, if any, of the following statements are true about
women who have been treated for CIN compared to women who have not been
treated?
A
|
their risk of developing
cervical cancer is increased by a factor of 2 – 5 compared to women who have
not been treated
|
B
|
women should be returned to
community-based recall
|
C
|
women should have a cervical
sample taken for cytology at 6 months, but only if the excision margins were
clear. Where the excision margin was, or may have been involved, colposcopy
should be done at 6 months
|
D
|
if the 6 months cytology is
normal, borderline or low-grade and the HRHPV test is –ve, women should
return to routine recall based on their age
|
E
|
if the 6 months cytology is
normal, borderline or low-grade and the HRHPV test is –ve, women should have
repeat cytology at 3 years, regardless of their age
|
F
|
if the 6 months cytology
shows changes worse than low-grade, colposcopy should be done and HRHPV
testing is not required
|
G
|
if “test of cure” cytology is
done in hospital, it should be in a cytology clinic, not the colposcopy
clinic
|
Question 48.
More than 50% of
women who develop cervical cancer have been lost to follow-up. True or false?
Question 49.
Which of the following statements are true and which
false in relation to treatment of CIN?
a. cone biopsy is linked to ↓risk of recurrence
compared to LLETZ.
b. the Tz must be seen in its entirety if
ablative techniques are to be used
c. excision margins that are not CIN-free ↑ the
risk of recurrence, with endocervical margins that are not CIN-free posing a
greater risk that similar ectocervical margins.
d. age > 35 years increases the risk of
recurrent disease.
e. the “see and treat” policy should no longer be
used.
f. excisional treatments should be used in women
> 50 years.
d. follow-up after treatment for CIN should start
between 3 & 6 months from the time of treatment.
e. the initial follow-up examination after
treatment for CIN should be with colposcopy plus cytology.
f. a failure to achieve negative results in the
year after treatment means cone biopsy should be done.
g. a required standard for treatment success is
that ≥ 90% of women should have no evidence of dyskaryosis in the year after
treatment.
h. a required standard for treatment success is
that there should be ≤ 5% of histologically-confirmed treatment failures by 1
year after treatment.
Question 50
Women who have had normal follow-up results for 2 years
after treatment of CIN 1 can revert to the routine recall. True / False.
Question 51.
Follow-up should continue with increased frequency for 5
years after treatment of CIN 2 & 3, after which recall at routine intervals
is OK if all the follow-up has been normal. True or false?
Question 52.
A woman with LLETZ for CIN3
twelve months ago had a normal smear 6 months later. A smear taken 12 months
after treatment is also normal. What management will you suggest?
Question 53.
A woman with LLETZ for CIN3
twelve months ago had a normal smear 6 months later. A smear taken 12 months
after treatment shows mild dyskaryosis. What management will you suggest?
Question 54.
A woman on normal recall has
hysterectomy for menorrhagia. There is no evidence of CIN on histology. What
follow-up would you recommend?
Question 55.
A woman who was not on normal
recall has hysterectomy for menorrhagia. There is no evidence of CIN on
histology. What follow-up would you recommend?
Question 56.
Women who have had hysterectomy
and require follow-up with vault smears cannot be managed within the NHSCSP.
True or False?
Question 57.
A woman who was not on normal
recall has hysterectomy for menorrhagia. There is evidence of completely
excised CIN3 on histology. What follow-up would you recommend?
Question 58.
A woman who was not on normal
recall has hysterectomy for menorrhagia. There is evidence of incompletely
excised CIN3 on histology. What follow-up would you recommend?
Question 59.
A woman is referred with severe dyskaryosis, but
colposcopy is normal. What follow-up should be recommended?
Question 60.
A woman has FIGO stage 1a1 cervical cancer. She wishes to
retain her fertility. Which of the following treatments should be offered?
A
|
brachytherapy
|
B
|
cone biopsy
|
C
|
cryocautery
|
D
|
laser ablation
|
E
|
LLETZ
|
F
|
radical trachelectomy
|
G
|
simple trachelectomy
|
Question 61.
A woman has local excision for early cervical cancer.
What follow-up should be arranged by the NHSCSP?
A
|
colposcopy and smears six monthly for 1 year, then
annually for 9 years
|
B
|
colposcopy and smears six monthly for 2 years, then
annually for 8 years
|
C
|
smears six monthly for 1 year, then annually for 9
years
|
D
|
smears six monthly for 2 years, then annually for 8
years
|
E
|
smears six monthly for 5 years, then annually for 5
years
|
F
|
none of the above
|
Question 62.
A woman has conservative treatment for early stage cancer
of the cervix. What follow-up should be recommended?
Question 63.
Which, if any, of the following statements are true in
relation to pregnancy?
A
|
routine smear tests should be deferred until after
delivery
|
B
|
colposcopy requires more expertise than in the
non-pregnant
|
C
|
all smears suggesting CIN should have initial colposcopic
assessment in late 1st. or early 2nd. trimester
|
D
|
women with low-grade changes who have been referred to
colposcopy because of a +ve HPV test can had colposcopy delayed until after
delivery
|
E
|
if CIN1 is diagnosed, follow-up can be delayed until after
delivery
|
F
|
“test of cure” appointments after treatment of CIN 2 or
3 can be deferred until after delivery
|
G
|
follow-up assessment after treatment of CGIN can be
left until after the delivery if the excision margins were disease-free.
|
63. Needle-stick, sharps and related risks.
Abbreviations.
CMV: cytomegalovirus
GBCV: GB virus C
HAV: hepatitis A virus
HBV: hepatitis B virus
HCV: hepatitis C virus
HDV: hepatitis
D virus
SOE: significant occupational exposure to
blood-borne infective agent.
VL: viral load.
Question 1.
Lead-in
Approximately
how many SOEs are reported annually in the UK?
Option List
A.
|
~ 100
|
B.
|
~ 250
|
C.
|
~ 500
|
D.
|
~ 1,000
|
E.
|
~ 5,000
|
Question 2.
Lead-in
Who was Ignac
Phillip Semmelweis?
Option List
A.
|
the
person credited with demonstrating the infective nature of puerperal sepsis
|
B.
|
the horticulturist who first grew the white flower
subsequently popularised in the musical, “The sound of music”, naming it
after his first wife, Eidel.
|
C.
|
the person who first used antisepsis in aerosol form to
reduce the risk of infection during C.
section.
|
D.
|
the inventor of catgut sutures
|
E.
|
the inventor of the Dalkon shield
|
Question 3.
Lead-in
Why does
the name of Semmelweis’s colleague Kotecha live on in medical history?
Option List
A.
|
he was
the first doctor to perform hysterectomy
|
B.
|
he was the first doctor know to undergo transgender
surgery
|
C.
|
he died of infection akin to puerperal sepsis after a
SOE
|
D.
|
he performed the first successful repair of a 3rd.
degree perineal tear
|
E.
|
none of the above
|
Question 4.
Lead-in
Which of
the following have been described as causing infection after a SOE.
Infective agents
1.
|
hepatitis
A virus
|
2.
|
hepatitis
B virus
|
3.
|
hepatitis C virus
|
4.
|
human T cell leukaemia virus
|
5.
|
malaria parasites
|
Option List
A.
|
1 + 2 + 3 + 4 + 5
|
B.
|
1 + 2 + 3 + 5
|
C.
|
2 + 3 + 4 + 5
|
D.
|
2 + 3 + 4
|
E.
|
2 + 3 + 5
|
Question 5.
Lead-in
Which are
the main causes of infection to cause concern in the UK in relation to SOEs?
Infective agents.
1.
|
hepatitis A virus
|
2.
|
hepatitis B virus
|
3.
|
hepatitis C virus
|
4.
|
HIV
|
5.
|
treponema pallidum
|
Option List
A.
|
1 + 2 + 3 + 4 + 5
|
B.
|
1 + 2 + 3 + 4
|
C.
|
1 + 2 + 3 + 5
|
D.
|
2 + 3 + 4 + 5
|
E.
|
2 + 3 + 4
|
Question 6.
Lead-in
Which
group features most in the list of those reporting SOEs?
Option List
A.
|
doctors
|
B.
|
midwives
|
C.
|
phlebotomists
|
D.
|
nurses
|
E.
|
other healthcare workers
|
Question 7.
Lead-in
Which clinical
activity generates most SOEs?
Option List
A.
|
acupuncture
|
B.
|
assisting in the operating theatre
|
C.
|
intramuscular drug / vaccine injection
|
D.
|
subcutaneous drug / vaccine injection
|
E.
|
venepuncture
|
Question 8.
Lead-in
Approximately
how many cases of HIV seroconversion after SOE were recorded in the UK between
2004 and 2013?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 9.
Lead-in
Rate the
following body fluids as: high or low risk in relation to infectivity.
Option List
A.
|
amniotic
fluid
|
|
B.
|
blood
|
|
C.
|
breast milk
|
|
D.
|
cerebro-spinal fluid
|
|
E.
|
faeces
|
|
F.
|
peritoneal fluid
|
|
G.
|
saliva
|
|
H.
|
urine
|
|
I.
|
urine – blood stained
|
|
J.
|
vaginal fluid
|
|
K.
|
vomit
|
Question 10.
Lead-in
Rate the following types of
contact with body fluids as:
high-risk
low-risk
minimal
or zero risk
Answer
A.
|
exposure to faeces: not bloodstained
|
|
B.
|
exposure to saliva: not bloodstained
|
|
C.
|
exposure to urine: not bloodstained
|
|
D.
|
exposure to vomit: not bloodstained
|
|
E.
|
exposure via broken skin
|
|
F.
|
exposure via intact skin
|
|
G.
|
injury deep, percutaneous
|
|
H.
|
exposure via mucosa
|
|
I.
|
injury superficial
|
|
J.
|
needle not used on source’s blood vessels
|
|
K.
|
needle used on source’s blood vessels
|
|
L.
|
sharps old
|
|
M.
|
sharps recently used
|
|
N.
|
sharps with blood not visible
|
|
O.
|
sharps with blood visible sharps
|
Question 11.
Lead-in
Rate the
following types of sources of potentially infective body fluids as:
high-risk
low-risk
minimal or
zero risk
Answer
A.
|
infected but VL and treatment details unknown
|
|
B.
|
recent blood test negative for all relevant viruses
|
|
C.
|
source has known risk factors but recent tests negative
|
|
D.
|
viral status not known but source has known risk
factors
|
|
E.
|
viral status not known but source has no known risk
factors
|
|
F.
|
VL detectable
|
|
G.
|
VL not detectable
|
|
H.
|
VL unknown but on treatment with good adherence
|
Question 12.
Lead-in
Approximately
how many cases of HBV seroconversion after SOE have been recorded in the UK
since 1997?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 13.
Lead-in
Approximately
how many cases of HCV seroconversion after SOE have been recorded in the UK
since 1997?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 14.
Lead-in
What is
the estimated risk of transmission of infection of HBV in a SOE involving
sharps in a patient +ve for HBe antigen?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 15.
Lead-in
What is
the estimated risk of transmission of infection of HCV in a SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 16.
Lead-in
What is
the estimated risk of transmission of infection of HIV in a SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 17.
Lead-in
What is
the estimated risk of transmission of infection of HIV in a SOE involving
mucosal splashing?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 18.
Lead-in
Which of
the following carries the highest risk of transmission of an infective agent
after a SOE.
Option List
A.
|
a bite
on the bottom by an HIV-infected patient who finds your buttocks irresistible
|
B.
|
deep injury from a scalpel wielded by a psychopathic
surgeon
|
C.
|
deep
needle-stick after venepuncture
|
D.
|
spitting by a patient with HIV
|
E.
|
splash SOE from beating a disagreeable patient round
the head with a frozen turkey because you are sick to death of their
whingeing and perennial misery
|
Question 19.
Lead-in
List the
steps you would take in relation to immediate first aid, including the things
that might be suggested but you know are contraindicated.
Question 20.
Lead-in
Which
tests should be performed on the source after obtaining consent?
List what
you think should be done.
Option List
A.
|
HBV
surface antigen
|
B.
|
HCV
antibody
|
C.
|
HCV RNA
|
D.
|
HIV
antigen and antibody (fourth generation HIV immunoassay)
|
E.
|
TTV
antibody
|
Question 21.
Lead-in
What consent is required from
the source individual?
Option List
A.
|
consent
to having the tests
|
B.
|
consent
to having the results given to the occupational health department
|
C.
|
consent
to having the results given to the person who sustained the SOE
|
D.
|
consent
to having the results given to the hospital’s legal team
|
E.
|
consent
to notifying the hospital staff if the results are +ve.
|
Question 22.
Lead-in
What tests
should be done on the person who has sustained the SOE and there is a
significant risk of infection?
Option List
A.
|
a
baseline sample should be taken and stored for possible future use
|
B.
|
HBV surface antibody
|
C.
|
HCV antibody
|
D.
|
HIV antigen and antibody
|
Question 23.
Lead-in
If there
is a significant risk of HIV transmission, which of the following statements are
correct in relation to when should PEP be given?
Option List
A.
|
before
the results of the tests done on the source are available
|
B.
|
after the results of the tests done on the source are
available
|
C.
|
as soon as is practical
|
D.
|
within 24 hours
|
E.
|
within 72 hours
|
Question 24.
Lead-in
What are
the recommended drugs for PEP in the UK?
Option List
A.
|
Kaletra (200 mg lopinavir and 50 mg ritonavir)
|
B.
|
Raltegravir
400 mg twice daily
|
C.
|
Rifampicin 450-600mg daily as a single dose
|
D.
|
Tenofovir
+ lamivudine or emtricitabine
|
E.
|
Truvada
(245 mg tenofovir disoproxil fumarate and 200 mg emtricitabine)
|
Question 25.
Lead-in
Which of
the following statements are correct in relation to PEP in early pregnancy
Option List
A.
|
PEP is
contraindicated until after 12 weeks
|
B.
|
PEP should be started as for the non-pregnant
|
C.
|
PEP should be started, but TOP should be offered
|
D.
|
PEP should be started, but not until the puerperium
|
Question 26.
Lead-in
Which of
the following statements is true in relation to reducing the risk of HCV
infection.
Option List
A.
|
HCV
vaccine is safe in pregnancy and should be offered immediately
|
B.
|
HCV vaccine is a live vaccine and contraindicated in
pregnancy
|
C.
|
acyclovir is an effective drug for prophylaxis
|
D.
|
there is no known effective prophylactic drug
|
E.
|
early treatment of HCV infection is effective, so SOE
staff should be closely followed up for evidence of infection.
|
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