Website
60
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EMQ. Semmelweis,
Gordon and Holmes
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61
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SBA. Placenta accreta, increta & percreta
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62
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Roleplay. Cystic
fibrosis. Brother has cystic fibrosis.
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63
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Viva. Cochrane
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64
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SBA. Androgen
insensitivity syndrome
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60. EMQ. Semmelweis, Gordon and Holmes.
Semmelweis, Gordon & Holmes.
Lead-in.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Which, if any, of the following statements are true in
relation to Semmelweis?
Option list.
A
|
his full name was
Ignác Fülöp Semmelweis, but he was known to friends as "Naci".
|
B
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he lived from
1818 to 1865
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C
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he
revolutionised understanding of ‘childbed fever’
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D
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he
revolutionised understanding of rheumatic fever
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E
|
he
revolutionised understanding of tuberculosis
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F
|
he pioneered
proton beam therapy
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G
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his
professional ‘Damascene moment’ came after the death of his colleague,
Kolletscha, at the hands of a medical student in 1847
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H
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his work was
vilified by the majority of his professional contemporaries
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I
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he died in a
lunatic asylum
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J
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he died in a
road traffic accident
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K
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he died at
home in bed with his mistress
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Which, if any, of the following statements are true in
relation to Gordon?
Option list.
A
|
his full name was
Hamish Gordon, but he was known to friends as "Hamy".
|
B
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he lived from
1801 to 1864
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C
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he
revolutionised understanding of ‘childbed fever’
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D
|
he
revolutionised understanding of rheumatic fever
|
E
|
he
revolutionised understanding of tuberculosis
|
F
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he pioneered
proton beam therapy
|
G
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his
professional ‘Damascene moment’ came after epidemics of erysipelas and
puerperal fever in Aberdeen in the late 18th. century
|
H
|
his work was
vilified by the majority of his professional contemporaries
|
I
|
he died in a
lunatic asylum
|
J
|
he died in a
road traffic accident
|
K
|
he died at
home in bed with his mistress
|
Scenario
3.
Which, if any, of the following
statements are true in relation to Wendell Holmes?
Option list.
A
|
his full name was Wendell Holmes, but he was known to
friends as "Wellie".
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B
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he lived from 1801 to 1864
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C
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he revolutionised understanding of ‘childbed fever’
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D
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he revolutionised understanding of rheumatic fever
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E
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he revolutionised understanding of tuberculosis
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F
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he pioneered proton beam therapy
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G
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he was a fan of the work of Gordon.
|
H
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his work on childbed fever was vilified by the majority
of his professional contemporaries
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I
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he died in a lunatic asylum
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J
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he died in a road traffic accident
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K
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he died at home in bed with his mistress
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61. SBA. Placenta
accreta, increta & percreta.
This topic
has been chosen to remind you of the existence of UKOSS and the various Reports
Question 1.
Lead-in
Choose the
best option from the option list for the definition of placenta accreta.
Option List
A.
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Placenta which is difficult to remove, but can be
separated digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 2.
Lead-in
Choose the
best option from the option list for the definition of placenta increta.
Option List
A.
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Placenta is difficult to remove, but can be separated
digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 3.
Lead-in
Choose the
best option from the option list for the definition of placenta percreta.
Option List
A.
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Placenta is difficult to remove, but can be separated
digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 4.
Lead-in
What is
the approximate incidence of placenta creta in the UK?
Option List
A.
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1-2 per 1,000
deliveries
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B.
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1-2 per 1,000
maternities
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C.
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1-2 per 5,000
deliveries
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D.
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1-2 per 5,000 maternities
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E.
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1-2 per 10,000 deliveries
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F.
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1-2 per 10,000 maternities
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Question 5.
You need
to be able to define “maternity” and know why it is important.
What is a
“maternity”?
Option List
A.
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Any pregnancy, including ectopic pregnancy
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B.
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Any pregnancy, excluding ectopic pregnancy
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C.
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Any pregnancy resulting in a live birth
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D.
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Any pregnancy resulting in live birth or stillbirth
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E.
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Any pregnancy ending from 24 completed weeks plus any
pregnancy resulting in a live birth.
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Question 6.
Lead-in
Why is the
term “maternity” important.
Option List
A.
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We should take best possible care of our pregnant
patients
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B.
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It is used as the denominator in calculations of the
maternal mortality rate
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C.
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It is used as the numerator in calculations of the
maternal mortality rate
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D.
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It is used as the denominator in calculations of the
maternal mortality ratio
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E.
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It is used as the numerator in calculations of the maternal
mortality ratio
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Question 7.
This
question relates to risk factors for placenta accreta
Lead-in
Match each
of the risk factors listed below with an adjusted odds ratio from the Option
List. Each option can be used once, more than once or not at all.
Note that
some of the adjusted odds ratios show a reduced risk.
Risk factors and adjusted odds
ratio.
Risk factor
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Adjusted odds ratio
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BMI > 30
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Cigarette smoking in pregnancy
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Ethnic group non-white
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IVF pregnancy
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Maternal age > 35
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Parity ≥ 2
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PIH or PET
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Placenta previa diagnosed pre-delivery
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Previous Caesarean section > 1
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Previous Caesarean section x 1
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Previous uterine surgery – not C. section
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Option List
Adjusted odds ratio
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0.53
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0.57
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0.66
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0.9
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1.0
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2.0
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3.06
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3.4
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3.48
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10
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14
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16.31
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32.13
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65.02
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102
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Question 8.
Lead-in
This
question relates to estimated incidence of placenta creta for various risk
factors.
Match the
risk factors with the estimated incidence in the option list. Each option can
be used once, more than once or not at all.
Risk factors and estimated
incidence per 10,000 maternities.
Risk factor
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Estimated incidence
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No previous C section
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≥ 1 C section
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Placenta previa not diagnosed pre-delivery
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Placenta previa diagnosed pre-delivery
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Previous C section but pl previa not diagnosed pre-delivery
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Previous C section + pl previa diagnosed
pre-delivery
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Option List
0.3
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0.6
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1
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3
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5
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9
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108
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577
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1,000
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62. Roleplay. Cystic fibrosis. Brother has cystic fibrosis.
Candidate's Instructions.
This is a roleplay station. You are a year 4 SpR and are
in the gynaecology clinic.
The consultant has just left you in charge as she is
feeling unwell and has gone to lie down.
Your task is to deal with the patient as you would in
real life.
GP referral letter.
Best
Medical Centre,
High Road,
Anytown.
Practice Manager: Mary Wright. B.SC., RGN.
Phone: 01882 78998 ext. 23.
Re. Mrs.
Bonnie Black,
25 Low
Road,
Anytown.
DOB: 28
January 1990.
Phone:
07889 888 132.
Dear
Doctor,
Please see
Mrs Black who is planning her first pregnancy. Her main concern is that her brother
has cystic fibrosis.
This was
the first time I had met her although she has been registered with us for 5
years – her health is good and she has no history of serious illness or
surgery.
I have
explained that I don’t know much about the implications of the brother’s cystic
fibrosis for her potential pregnancies and that she needs to talk to an expert.
I have stressed that the risk of her having a child with cystic fibrosis is
high and that she needs to be aware that there is a distinct likelihood that
any pregnancy would be likely to be affected and need TOP.
Yours
sincerely,
John P.
Clatter.
63. Viva. Cochrane.
Candidate’s instructions.
This is a viva about the Cochrane Collaboration.
The examiner will ask 8 questions and give one
instruction.
64. SBA. Androgen insensitivity syndrome. AIS.
Question 1.
Lead-in
What is
the estimated prevalence of AIS?
Option List
F.
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2-5 per
100,000 boys at birth
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G.
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5-10 per 100,000 girls at birth
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H.
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2-5 per 100,000 genetic males at birth
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I.
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5-10 per 100,000 genetic females at birth
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J.
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none of the above.
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Question 2.
Lead-in
Which of
the following sub-types of AIS do not exist?
Sub-types
1.
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complete
AIS
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2.
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incomplete AIS
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3.
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mild AIS
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4.
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partial AIS
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5.
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total AIS
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Option List
A.
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1
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B.
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2
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C.
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3
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D.
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4
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E.
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5
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F.
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1 + 3
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G.
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2 + 3
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H.
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2 + 5
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I.
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3 + 5
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J.
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4 + 5
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Question 3.
Lead-in
How common
is partial AIS?
Option List
A.
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at least
as common as complete AIS
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B.
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at least as common as total AIS
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C.
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less common than mild AIS
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D.
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as common as incomplete AIS
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E.
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none of the above.
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Question 4.
Lead-in
How common
is incomplete AIS?
Option List
A.
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at least
as common as complete AIS
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B.
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at least as common as total AIS
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C.
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less common than mild AIS
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D.
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as common as partial AIS
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E.
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none of the above.
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Question 5.
Lead-in
How common
is mild AIS?
Option List
A.
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at least
as common as complete AIS
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B.
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at least
as common as total AIS
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C.
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less
common than complete AIS
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D.
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as
common as partial AIS
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E.
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none of
the above.
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Question 6.
Lead-in
No more
prevalence!!
What is
the mode of inheritance of AIS?
Option List
A.
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autosomal
dominant
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B.
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autosomal
recessive
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C.
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X-linked
dominant
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D.
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X-linked
recessive
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E.
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mitochondrial
|
Question 7.
Lead-in
What
proportion of AIS is due to new mutations?
Option List
A.
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0%
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B.
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1 – 20%
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C.
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21 – 40%
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D.
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41-60%
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E.
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61-80%
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Question 8.
Lead-in
Which gene
is involved in AIS?
Option List
A.
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androgen
receptor gene
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B.
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aromatase receptor gene
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C.
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androstenedione gene
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D.
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oestrogen receptor gene
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E.
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none of the above
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Question 9.
Lead-in
How many
mutations have been described of the gene which is involved in AIS?
Option List
A.
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0-10
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B.
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11-100
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C.
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101-200
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D.
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201-300
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E.
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>300
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Question 10.
Lead-in
Which is
the most common clinical presentation in AIS?
Option List
A.
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ambiguous
genitalia
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B.
|
precocious
puberty
|
C.
|
premature
menopause
|
D.
|
primary
amenorrhoea
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E.
|
secondary
amenorrhoea
|
Question 11.
Lead-in
Which of
the following are more common in AIS?
Option List
A.
|
anlagen
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B.
|
coarctation of the aorta
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C.
|
“coast of Maine” pigmentation pattern
|
D.
|
renal tract anomalies
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E.
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none of the above.
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Question 12.
Lead-in
A woman of
20 is found to have AIS. She has a pre-pubertal sister. What is the chance that
the sister also has AIS, assuming that the condition is not due to a new
mutation in the elder sister?
Option List
A.
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1 in 1
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B.
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1 in 2
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C.
|
1 in 3
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D.
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1 in 4
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E.
|
1 in 16
|
Question 13.
Lead-in
What is
the risk of the gonads becoming malignant in AIS?
Option List
A.
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10%
|
B.
|
20%
|
C.
|
30%
|
D.
|
> 30%
|
E.
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accurate risk not known
|
