7
|
SBA. Lynch
syndrome
|
8
|
EMQ. Coroner 1-3
|
9
|
EMQ.
Maternal Mortality definitions
|
10
|
Basic communication skills
|
11
|
EMQ. Parvovirus
|
12
|
EMQ. Antepartum
haemorrhage
|
Julie Morris will give a
tutorial on basic medical statistics on Monday 25th. June.
7. SBA. Lynch syndrome.
Lynch syndrome.
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
HNPCC: hereditary
non-polyposis colo-rectal cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
Question
1.
Lead-in
What is
Lynch syndrome?
Option List
A
|
auto-immune
condition leading to reduced factor X levels in blood
|
B
|
hereditary condition which increases the risk of many
cancers, particularly breast
|
C
|
hereditary
condition which increases the risk of many cancers, particularly breast &
colorectal
|
D
|
hereditary
condition which increases the risk of many cancers, particularly colorectal
& endometrial
|
E
|
none of
the above
|
Question
2.
Lead-in
How is Lynch syndrome inherited?
Option List
A
|
it is an
autosomal dominant condition
|
B
|
it is an autosomal recessive condition
|
C
|
it is an X-linked dominant condition
|
D
|
it is an X-linked recessive condition
|
E
|
none of the above
|
Question
3.
Lead-in
Which, if
any, of the following genes can cause Lynch syndrome?
Genes.
A
|
MLH1
|
B
|
MLH2
|
C
|
MOH1
|
D
|
MSH1
|
E
|
MSH6
|
Option List
A
|
MLH1 +
MLH2 + MOH1
|
B
|
MLH1 + MLH2 + MSH1
|
C
|
MLH1 + MLH2 + MSH6
|
D
|
MLH1 + MSH2 + MSH6
|
E
|
None of the above
|
Question
4.
Lead-in
Mutations
of which 2 of the following genes cause the majority of cases of Lynch
syndrome?
Genes.
A
|
MLH1
|
B
|
MLH2
|
C
|
MOH1
|
D
|
MSH1
|
E
|
MSH6
|
Option List
A
|
MLH1 +
MLH2
|
B
|
MLH1 + MSH1
|
C
|
MLH1 + MSH2
|
D
|
MLH2 + MSH1
|
E
|
MLH2 + MSH2
|
Question
5.
Lead-in
What is
the approximate prevalence of Ls in the UK population?
Option List
A.
|
1 in 50
|
B.
|
1 in 100
|
C.
|
1 in
1,000
|
D.
|
3 in
1,000
|
E.
|
none of the above
|
Question
6.
Lead-in
Approximately
what % of individuals with Ls have had the diagnosis established?
Option List
A.
|
< 5%
|
B.
|
5 -10%
|
C.
|
10-20%
|
D.
|
20-30%
|
E.
|
>30%
|
Question
7.
Lead-in
Which, if
any, of the following conditions are associated with an ↑
risk of Lynch syndrome?
Conditions
acromegaly
|
Addison’s
disease
|
anosmia
|
coeliac
disease
|
IBD
|
IDDM
|
Option List
A
|
acromegaly
+ Addison’s disease + coeliac disease + IBD + IDDM
|
B
|
acromegaly
+ disease + anosmia + coeliac disease + IBD
|
C
|
acromegaly
+ IBD + IDDM
|
D
|
acromegaly
+ IBD
|
E
|
Addison’s
disease + anosmia + coeliac disease + IBD + IDDM
|
F
|
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM
|
G
|
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM
|
H
|
none
|
Question
8.
Lead-in
Which 2 cancers
are most likely in women with Lynch syndrome?
Cancers.
A
|
breast
|
B
|
bowel
|
C
|
cervix
|
D
|
endometrium
|
E
|
ovary
|
F
|
pancreas
|
Option List
A
|
breast +
bowel
|
B
|
breast + pancreas
|
C
|
breast + endometrium
|
D
|
bowel + cervix
|
E
|
bowel + endometrium
|
F
|
bowel + ovary
|
G
|
bowel + pancreas
|
H
|
endometrium + ovary
|
Question
9.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of colorectal cancer?
Option List
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
B
|
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
E
|
none of the above
|
Question
10.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of colorectal cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those aged < 50 years at
diagnosis
|
C
|
offer screening to those aged < 60 years at
diagnosis
|
D
|
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative
|
E
|
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative
|
Question
11.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of thyroid cancer?
Option List
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
B
|
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
E
|
none of the above
|
Question
12.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of thyroid cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those aged < 50 years at
diagnosis
|
C
|
offer screening to those aged < 60 years at
diagnosis
|
D
|
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative
|
E
|
none of the above
|
Question
13.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of endometrial cancer?
Option List
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
B
|
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
E
|
none of the above
|
Question
14.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of endometrial cancer?
Option List
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
B
|
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
E
|
none of the above
|
Question
15.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of colorectal cancer?
Option List
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
B
|
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
E
|
none of the above
|
Question
16.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of colorectal cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those aged < 50 years at
diagnosis
|
C
|
offer screening to those aged < 60 years at
diagnosis
|
D
|
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative
|
E
|
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative
|
Question
17.
Lead-in
What relationship,
if any, exists between Ls and acromegaly?
Option List
A
|
the risk
of Ls is ↓ in those with acromegaly compared with the
general population
|
B
|
the risk
of Ls is ↑ in those with acromegaly compared with the
general population
|
C
|
the risk
of Ls is unchanged in those with acromegaly compared with the general
population
|
D
|
the risk
of Ls in unknown in those with acromegaly
|
Question
18.
Lead-in
What is
the effect of aspirin consumption on the risk of EC and CRC?
Option List
A
|
aspirin
reduces the risk of EC and CRC
|
B
|
aspirin
reduces the risk of EC but not CRC
|
C
|
aspirin
reduces the risk of CRC but not EC
|
D
|
aspirin
does not reduce the risk of EC or CRC
|
E
|
aspirin reduces the risk of EC and CRC, but the risks
outweigh the benefits
|
Question
19.
Lead-in
A healthy woman
of 35 years is diagnosed with Ls? What are the key elements of the National Screening
Programme for people with Ls?
There is
no option list – just write down everything you know.
8. Coroner
The Coroner. Question 1.
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Suggested reading.
I will put all you need to know into the answer to MCQ
Paper 13, question 5.
Option list.
A.
an independent
judicial officer
B.
a barrister acting for
the Local Police Authority
C.
the regional
representative of the Home Office
D.
the regional
representative of the Queen.
E.
an employee of the
High Court.
F.
the Local Authority
G.
the Local Police
Authority
H.
the Home Office
I.
the High Court
J.
the Queen
Scenario 1.
What is the best description of
the status of the Coroner?
Scenario 2.
Who appoints the Coroner?
Scenario 3.
Who pays for the Coroner and
the coronial service?
The Coroner. Question 2.
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
must have had
experience as a detective in the police force with rank of Inspector or above
B.
must be a barrister,
lawyer or doctor with at least 5 years’ experience
C.
must be a legally
qualified individual with at least 5 years’ experience
D.
must be a trained
bereavement counsellor
E.
must be able to play
the bagpipes
F.
Monday - Friday; 09.00 - 17.00 hours, including bank
holidays
G.
Monday - Friday; 09.00
- 17.00 hours, excluding bank holidays
H.
All the time
I.
to arrest people
suspected of unlawful killing
J.
to manage traffic in
the vicinity of the Coroner’s court
K.
to make enquiries on
behalf of the Coroner
L.
to make enquiries on
behalf of the Coroner and provide administrative support
M.
to play bagpipes at
coronial funerals
Scenario 1.
What qualifications must the
Coroner have?
Scenario 2.
What are the hours of
availability of the Coroner?
Scenario 3.
What is the role of the
Coroner’s Officers?
The Coroner. Question 3.
Lead-in.
The following scenarios relate to the role of the
Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A.
the death must be
reported to the Coroner
B.
the death does not
need to be reported to the Coroner
C.
the Coroner must order
the return of the body for an inquest
D.
the Coroner must order
a post-mortem examination
E.
the Coroner must hold
an inquest
F.
the Coroner should
arrange for the death to be investigated by the Home Office
G.
the death must be
reported to the authorities of the country in which it took place in order that
a certificate of death can be issued
H.
a certificate of live
birth
I.
a certificate of
stillbirth
J.
a certificate of
miscarriage
K.
yes
L.
no
M.
none of the above
Scenario 1.
A resident of Manchester dies suddenly while visiting the
town of his birth in Scotland. His family decides that he will be buried there.
His body is held at the premises of a local funeral director. What actions
should be taken with regard to the Manchester coroner?
Scenario 2.
A resident of London dies suddenly while visiting
Manchester, where he was born. His family decides that he will be buried in
Manchester. His body is held at the premises of a Manchester funeral director.
What actions should be taken with regard to the Manchester coroner?
Scenario 3.
A resident of Manchester dies
on holiday in his native Greece. The family decide that he will be buried in
Greece. What steps must be taken to obtain a valid death certificate?
Scenario 4.
A man of 65 dies of terminal
lung cancer. The GP visited daily until going on holiday three weeks before the
death. He has now returned and says that he will sign a death certificate, but
needs to visit the funeral director to see the body first. Will this be a valid death certificate?
Scenario 5.
A man of 65 dies of terminal
lung cancer. The GP, who visited daily up to the day of his death and attended
to confirm the death, is on holiday. He says that he will sign a death
certificate and put it in the post, so that it will arrive in the morning. Will
this be a valid death certificate?
Scenario 6.
A man of 65 dies of terminal
lung cancer. The GP, who visited daily up to the day before his death, has been
on holiday since. However, he says that he will sign a death certificate and
put it in the post, so that it will arrive in the morning. Will this be a valid
death certificate?
Scenario 7.
A 65-year-old man dies suddenly
12 hours after admission to the local coronary care unit with chest pain,
despite the apparently satisfactory insertion of a coronary artery stent after
a diagnosis of coronary artery thrombosis. What action should be taken with
regard to the Coroner?
Scenario 8.
A 16-year-old girl is admitted
at 36 weeks’ gestation in her first
pregnancy with placental abruption. She is given the best possible care but
develops DIC and hypovolaemic shock and dies after 48 hours. What action should
be taken with regard to the coroner?
Scenario 9.
A 28-year-old woman is admitted
with placental abruption at 36 weeks. She has bruising on the abdominal wall
and the admitting midwife suspects that she has been the victim of domestic
violence, though the woman denies it. Despite best possible care she dies as a
consequence of bleeding. What action should be taken with regard to the
coroner?
Scenario 10.
A 30-year-old woman delivers
normally at home attended by her husband, but has a PPH. The husband practises
herbal medicine. He applies various potions but her condition deteriorates. She
is admitted to hospital by emergency ambulance some hours later in a shocked
condition. She is given the best possible care and is admitted to the ICU. She
dies 7 days later of multi-organ failure and ARDS attributed to hypovolaemic
shock. What action should be taken with regard to the coroner?
Scenario 11.
A woman is admitted at 23 weeks
in premature labour. There is evidence of fetal heart activity throughout the
labour, with the last record being 5 minutes before the baby delivers. The baby
shows no evidence of life at birth. The mother requests a death certificate so
that she can register the birth and arrange a funeral. What form of certificate
should be issued?
Scenario 12.
A woman is admitted at 26
weeks’ gestation in premature labour. The presentation is footling breech. At 8
cm. cervical dilatation the trunk is delivered and the cord prolapses. There is
good evidence of fetal life with fetal movements and pulsation of the cord. The
head is trapped and it takes 5 minutes to deliver it. The baby is pulseless,
apnoeic and without visible movement at birth. Intubation and CPR are carried
out for 20 minutes when the baby is declared dead. What action should be taken
with regard to the coroner?
Scenario 13.
A 65-year-old man dies 2 hours after
admission to hospital with an apparent stroke. The coroner requests access to
the notes. What access should be provided?
Option list.
A
|
provide access to the records by the
Coroner in person
|
B
|
provide unrestricted access to the medical
records by the coroner’s officers
|
C
|
provide a copy of the hospital records to
the coroner or her officers
|
D
|
provide a medical report, but no access to
the medical records
|
E
|
provide a copy of the letter to the GP
about the recent admission
|
F
|
none of the above
|
9. Maternal mortality
definitions.
Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each
scenario.
Each option can be used once, more than once or not at
all.
Option List.
A.
Death of a woman during pregnancy and up to 6
weeks later, including accidental and incidental causes.
B.
Death of a woman during pregnancy and up to 6
weeks later, excluding accidental and incidental causes.
C.
Death of a woman during pregnancy and up to 52
weeks later, including accidental and incidental causes.
D.
Death of a woman during pregnancy and up to 52
weeks later, excluding accidental and incidental causes.
E.
A pregnancy going to 24 weeks or beyond.
F.
A pregnancy going to 24 weeks or beyond + any
pregnancy resulting in a live-birth.
G.
Maternal deaths per 100,000 maternities.
H.
Maternal deaths per 100,000 live births.
I.
Direct + indirect deaths per 100,000
maternities.
J.
Direct + indirect deaths per 100,000 live
births.
K.
Direct death.
L.
Indirect death.
M. Early
death.
N.
Late death.
O.
Extra-late death.
P.
Fortuitous death.
Q.
Coincidental death.
R.
Accidental death.
S.
Maternal murder.
T.
Not a maternal death.
U.
Yes
V.
No.
W. I
have no idea.
X.
None of the above.
Abbreviations.
MMR: Maternal Mortality Rate.
MMRat: Maternal Mortality Ratio.
SUDEP: Sudden Unexplained Death in Epilepsy.
Option list.
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured
ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured
appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What
kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease
dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational
trophoblastic disease, develops choriocarcinomas and dies from it 24 months
after the GTD was diagnosed and the uterus evacuated. What kind of death
is it?
Scenario 7
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality
Ratio?
Scenario 12
A woman is diagnosed with
breast cancer. She has missed a period and a pregnancy test is +ve. She decides
to continue with the pregnancy. The breast cancer does not respond to treatment
and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the
subject of domestic violence is killed at 12 weeks’ gestation by her partner.
What kind of death is it?
Scenario 14
A woman is struck by lightning
as she runs across a road. As a result she falls under the wheels of a large
lorry which runs over abdomen, rupturing her spleen and provoking placental
abruption. She dies of haemorrhage, mostly from the abruption. What kind of
death is it?
Scenario 15
A woman is abducted by Martians
who are keen to study human pregnancy. She dies as a result of the treatment
she receives. As this death could only have occurred because she was pregnant,
is it a direct death?
Scenario 16
Could a maternal death from
malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from
malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from
malignancy be classified as “Coincidental”?
Scenario 19.
A pregnant woman is walking on
the beach at 10 weeks when she is struck by lightning and dies. What kind of
death is this?
Scenario 20.
A woman is sitting on the beach
breastfeeding her 2-month old baby when she is struck by lightning and dies.
What kind of death is this.
10. Basic communication
skills.
Now is the time to start practising
communication skills, which are so important in the Part 3 exam. There is
advice on my website: http://www.drcog-mrcog.info/MRCOG.htm. Click
on the header ‘Topics like CNST and communication”. You have a lot of things to
get polished before the exam – you don’t want to be trying to explain recessive
inheritance for the 1st. time in front of an examiner!
11. Parvovirus.
Lead-in.
The following scenarios relate to parvovirus infection
Abbreviations.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There is none: make up your own
answers!
Scenario 1.
What type of virus is
parvovirus?
Scenario 2.
Is the title B19 something to do with the American B19
bomber, its potentially devastating bomb load and the comparably devastating
consequences of the parvovirus on human erythroid cell precursors?
Scenario 3.
PVB19 in the UK occurs in mini-epidemics at 3 – 4 year
intervals, usually during the summer months.
Scenario 4.
Which animal acts as the main
reservoir for infection?
Scenario 5.
What percentage of UK adults are immune to parvovirus
infection?
Scenario 6.
What names are given to acute
infection in the human?
Scenario 7.
What is the incubation period for parvovirus infection?
Scenario 8
What is the duration of infectivity for parvovirus
infection?
Scenario 9.
What are the usual symptoms of parvovirus infection in
the adult?
Scenario 10.
What is the incidence of parvovirus infection in
pregnancy?
Scenario 11.
How is recent infection diagnosed?
Scenario 12.
How long does PvIgM persist and why is this important?
Scenario 13.
What is the rate of vertical transmission of parvovirus
infection?
Scenario 14.
Are women with parvovirus infection who are asymptomatic
less likely to pass the virus to their fetuses?
Scenario 15.
To what degree is parvovirus infection teratogenic?
Scenario 16.
What proportion of pregnancies infected with parvovirus are
lost?
Scenario 17.
What is the timescale for the onset of hydrops?
Scenario 18.
Laboratories are advised to retain bloods obtained at
booking for at least 2 years for possible future reference. True or false?
Scenario 19.
What ultrasound features would trigger consideration of
cordocentesis?
Scenario 20.
Must suspected parvovirus infection be notified to the
authorities? Yes or No.
Scenario 21.
Possible parvovirus infection
does not need to be investigated after 20 week’s gestation. True or false?
Scenario 22
If serum is sent to the
laboratory from a woman with a rash in pregnancy for screening for rubella, the
laboratory should automatically test for parvovirus infection too. True or false?
12. Antepartum haemorrhage
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
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?
