1. Weight gain in pregnancy was measured in a
sample of 1000 women. Summary statistics of the weight gain were
calculated. (Answer yes/no to each
statement)-
A The
median is the weight gain value which occurs most frequently
B If
weight gain was found to have a positively skewed distribution, the mean will
be less than the median.
C The
interquartile range is unaffected by outliers
D A
large positive outlier will increase the mean
E The
median is affected by outliers
2. For a cohort of babies, birthweight was
considered to be Normally distributed with a mean of 3000g and a standard
deviation of 500g. It follows that: (Answer yes/no to each statement)-
A All
birthweights must be less than 4500g
B The
distribution of birthweights is skewed
C About
50% of birthweights are above 3000g
D About
2.5% of birthweights are below 2000g
E About
95% of birthweights are between 2500g and 3500g
3. Theme: Summary statistics
A mean E interquartile range
B standard deviation F percentage
C range G mode
D median H standard error
For each type of data description
given below choose the SINGLE most appropriate summary statistic. Each option
may be used once, more than once, or not at all.
1. The
variability of length of hospital stay for 230 mothers following a caesarean,
where length of stay is Normally distributed.
2. The
extremes of length of hospital stay for 230 mothers following a caesarean,
where length of stay is Normally distributed
3.
The
elective caesarean section rate in a hospital for 2011
4. To assess the effectiveness of a new
antenatal screening test, 100 pregnant women over 45 years of age, were
screened. 25 women subsequently had
babies with mild congenital problems. 20 of these 25 women had a positive
screening test result. 65 of those with normal babies had a negative test
result. (Answer yes/no to each statement).
A The
predictive value of a positive test result
as a marker for congenital problems is 20/35
B The
sensitivity of the test will not depend upon the prevalence of congenital
problems in the cohort of women to which it is applied
C The
sensitivity of the screening test is 20/100
D The
specificity of the screening test is 65/75
E Specificity
= 1-sensitivity
5. In a study looking at the relationship
between blood pressure during pregnancy and fetal growth, 130 women had their
24-hour blood pressure readings taken in mid-pregnancy. The size of the baby
was recorded at birth. The Pearson correlation between blood pressure and
birthweight was found to equal -0.70 with an associated p-value of p<0.001.
(Answer yes/no to each statement):
A Blood
pressure explains 70% of the variability
in birthweight
B We
can conclude that increasing blood pressure is a cause of low birthweight
C A
correlation of zero is interpreted as showing no association between two
variables
D The
correlation between blood pressure and birthweight can be different from the
correlation between birthweight and blood pressure
E There
is a significant negative linear relationship between blood pressure and birthweight
6. In a study of 75 infants with median
gestational age 30 weeks (range 25 to 42 weeks), lung area was calculated from
chest radiographs and lung volume from measurements of FRC. The aim of the
study was to see whether lung area would predict lung volume in neonates. (choose just one).
A Chi-square
test
B Correlation
coefficient
C Mann-Whitney
U-test
D Regression
analysis
E Two-sample
t-test
7. A cohort of women experiencing nausea
and vomiting in pregnancy were given acid-reducing medication. The
Pregnancy-Unique Quantification of Emesis and nausea (PUQUE) score was recorded
before and after treatment. The clinical effect of the medication could be
evaluated using: (Answer yes or no to each statement):
A The
Student paired t-test
B The
Spearman correlation coefficient
C The
Wilcoxon matched-pairs test
D The
Sign test
E The
Mann-Whitney U-test
8. Theme:
Statistical significance tests
A Chi-square
test F Spearman correlation
B Two-sample
t-test G Mann-Whitney
U-test
C Pearson
correlation H Wilcoxon test
D Fisher’s
Exact test I Paired
t-test
E Linear
regression J ANOVA
For each of the studies described
below choose the SINGLE most appropriate statistical test. Each option may be
used once, more than once, or not at all.
1.
A comparison of two audits (2011 vs 2006) of
smoking habits of pregnant women looking at the percentage of current smokers.
2.
In a cohort of 500 pregnant women, maternal
cotinine levels (an indicator of exposure to cigarette smoke) were measured.
The aim of the study was to see whether high maternal cotinine levels were
related to subsequent birthweight. It was assumed that cotinine levels would
have a highly skewed distribution.
3.
Adrenaline
concentrations were measured in 30 mechanically-ventilated babies at 1 hour and
24 hours to assess whether there had been a significant change. The adrenaline
concentrations cannot be assumed to follow a Normal distribution.
9. In a study of diet and epithelial ovarian
cancer, 128 women with cancer and 251 women without cancer were asked about
their consumption of dairy products. 50% of cancer patients and 10% of controls
reported consuming yoghurt regularly: (Answer yes or no to each statement):
A This
is a cohort study
B The
odds ratio is 9
C The
odds ratio is 5
D The
relative risk can be estimated by an odds ratio if the disease is rare and the
cases and controls are random samples from the same population.
E An
odds ratio of 0 indicates no difference between cancer patients and controls in
the consumption of yoghurt.
10. In a study of the effect of a new antibiotic
therapy for bacterial vaginosis in pregnancy, the infection response rate for
women on the new antibiotics was 0.4, whereas it was 0.2 in the control group (p=0.03). (Answer yes or
no to each statement):
A The
infection response rate was significantly lower in the control group.
B The
NNT is the difference in the number of infection-free women in the treated
group compared to the control group
C The
NNT=5
D The
NNT=2
E The
NNT is the number of women needed to receive the intervention to see one
additional occurrence of the outcome in the treatment group
25 June 2018
39
|
Julie Morris. Medical statistics
|
40
|
EMQ. Epilepsy
|
41
|
EMQ. BRCA1 & 2
|
39. Julie Morris.
Medical statistics.
40. EMQ. Epilepsy.
Epilepsy & Pregnancy. Question.
Some of the questions are not
SBAs as there is more than one correct answer – it should be obvious when this
is the case. I have tried to squeeze in all of the facts that might score
points in the exam and having several in one question makes the document a bit
shorter and saves me a lot of typing.
In the exam there will only be
one correct answer.
Lead in.
Use the option list below unless the question comes with
its own.
Abbreviations.
AED: anti-epileptic drug.
APS: antiphospholipid syndrome
BF: breastfeeding
Cs: Caesarean section.
CuIUCD: copper intrauterine contraceptive
device
EEG: electroencephalography.
EFM: electronic fetal heart
monitoring.
Entonox: nitrous oxide + oxygen.
FACS: fetal anticonvulsant syndrome.
FASD: fetal alcohol spectrum
disorder.
HDN: haemorrhagic disease of the
newborn.
L&K: Luesley & Kirby’s “Obstetrics
& Gynaecology: An Evidence-based Text for MRCOG”. Third Edition. 2016.
LNGIUS: levonorgestrel intrauterine system
MDT: multi-disciplinary team.
MMR14 Saving Lives, Improving Mothers’ Care Lessons
learned to inform future maternity care from the UK and Ireland Confidential
Enquiries into Maternal Deaths and Morbidity 2009-012. The 1st. maternal mortality report from
MBRRACE. Published December 2014.
MMR15: Saving
Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK
2011-13 and lessons learned to inform maternity care from the UK and Ireland
Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. The 2nd.
maternal mortality report from MBRRACE. December 2015.
MPA: medroxy-progesterone acetate
NEAD: non-epileptic attack disorder.
NTD: neural tube defect.
PFI: pill-free interval.
SUDEP: sudden, unexplained death in
epilepsy.
TENS: transcutaneous electrical
nerve stimulation.
TTP: thrombotic thrombocytopenic
purpura.
VPA: valproic acid. Often known
as “valproate” and “sodium valproate”.
WWE: women with epilepsy.
Option list.
a.
benzodiazepine
b.
carbamazepine
c.
coumarin
d.
diazepam
e.
lamotrigine
f.
levetiracetam
g.
phenobarbitone
h.
phenothiazine
i.
phenytoin
j.
primidone
k.
valproate
l.
< 0.5%
m. 0.5
- ≤1%
n.
1%
o.
2%
p.
3%
q.
4%
r.
5%
s.
10%
t.
20%
u.
50%
v.
true
w. false
x.
none of the above.
Scenario
1.
What is the incidence of epilepsy in pregnancy?
Scenario
2.
Who, if any, of the following should make the diagnosis
of epilepsy in pregnancy?
Option list
A
|
general practitioner
|
B
|
medical practitioner
|
C
|
medical practitioner with
expertise in epilepsy
|
D
|
MDT
|
E
|
nurse practitioner
|
F
|
nurse practitioner with
expertise in epilepsy
|
Scenario
3.
With regard to the effect of pregnancy on seizures in
WWE, which, if any, of the following statements are true?
Option list
A
|
about 1/2 experience
worsening of seizures
|
B
|
about 1/3 experience
worsening of seizures
|
C
|
about 2/3 experience
worsening of seizures
|
D
|
the time the woman has been
free from seizures is the best indicator of the risk of seizure deterioration
|
E
|
a 1st. trimester
EEG is the best indicator of the risk of seizure deterioration
|
F
|
women who have been
seizure-free for > 9/12 have a > 70% chance of remaining seizure-free
during pregnancy
|
G
|
women with idiopathic
generalised epilepsy are less likely to remain seizure-free in pregnancy than
those with focal epilepsy
|
H
|
women with one of more
seizures in the pre-conception year require close monitoring
|
I
|
status epilepticus is more
common in WWE when pregnant
|
M
|
status epilepticus in the 1st.
trimester is the biggest risk factor for the increased incidence of
congenital anomaly in the offspring of WWE
|
Scenario
4.
What is the approximate incidence of seizures in labour?
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
5.
What is the approximate incidence of seizures in the 24
hours after delivery?
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
6.
Which, if any, of the following are more common in WWE in
pregnancy compared to women who do not have epilepsy?
Option list
A
|
APH
|
B
|
anaemia
|
C
|
fetal growth restriction
|
D
|
Caesarean section
|
E
|
hypertension
|
F
|
induction of labour
|
G
|
instrumental delivery
|
H
|
low Apgar score at 1 minute
|
I
|
miscarriage
|
J
|
neonatal care unit admission
|
K
|
PPH
|
L
|
pre-term delivery
|
M
|
puerperal psychosis
|
Scenario
7.
Which, if any, of the following are more common in WWE
taking AEDs in pregnancy compared to women who do not take AEDs?
Option list
A
|
APH
|
B
|
anaemia
|
C
|
fetal growth restriction
|
D
|
Caesarean section
|
E
|
hypertension
|
F
|
induction of labour
|
G
|
instrumental delivery
|
H
|
low Apgar score at 1 minute
|
I
|
miscarriage
|
J
|
neonatal care unit admission
|
K
|
PPH
|
L
|
pre-term delivery
|
M
|
puerperal psychosis
|
Scenario
8.
Which, if any, of the following does GTG68 say are more
common in WWE taking AEDs in pregnancy as polytherapy compared to monotherapy?
Option list
A
|
APH
|
B
|
anaemia
|
C
|
fetal growth restriction
|
D
|
Caesarean section
|
E
|
hypertension
|
F
|
induction of labour
|
G
|
instrumental delivery
|
H
|
low Apgar score at 1 minute
|
I
|
miscarriage
|
J
|
neonatal care unit admission
|
K
|
PPH
|
L
|
pre-term delivery
|
M
|
puerperal psychosis
|
Scenario
9.
What is the incidence of epilepsy in those with FASD?
Scenario
10.
Approximately how many babies are born annually in the UK
to women with epilepsy (WWE)?
Option list
A
|
1,000
|
B
|
2,500
|
C
|
5,000
|
D
|
7,500
|
E
|
10,000
|
Scenario
11.
What is the MMR for WWE compared to those who do not have
epilepsy?
Option list
A
|
decreased by a factor of 2
|
B
|
decreased by a factor of 5
|
C
|
decreased by a factor of 10
|
D
|
increased by a factor of 2
|
E
|
increased by a factor of 5
|
F
|
increased by a factor of 10
|
G
|
roughly the same
|
H
|
none of the above
|
Scenario
12.
Write down the classification you would use in the exam
for seizures in pregnancy?
Scenario
13.
Which, if any, of the following women can be considered
no longer to have epilepsy?
Conditions
A
|
A woman who has been
seizure-free for 15 years
|
B
|
A woman who has been
seizure-free for 15 years & has not
taken AEDs for 2 years
|
C
|
A woman who has been
seizure-free for 10 years & has not taken AEDs for 5 years
|
D
|
A woman who has been
seizure-free for 5 years & has not taken AEDs for 3 years
|
E
|
A 30-year-old woman diagnosed
with a childhood epilepsy syndrome
|
F
|
A 25-year-old woman diagnosed
with a childhood epilepsy syndrome who has not had a seizure for 15 years
|
G
|
A woman who had excision of
an area of brain scarring, thought to be the origin of focal seizures, two
years ago and has not had a seizure since
|
H
|
your fiancée, with whom you
are besotted, has been off AEDs for 5 years and remained seizure-free is keen
to have you certify that she can have his driving licence renewed
|
I
|
None of the above
|
Scenario
14.
Which WWE in pregnancy can be managed as low-risk?
I have not given an option list as that would make it too
easy. Here we have one of the “buzz phrases” that are worth memorising for the
exam.
Scenario
15.
List the conditions you would consider in the
differential diagnosis of epilepsy in pregnancy?
I have not given an option list as it would make this too
easy.
GTG68 deals with this in section 4.3.
Scenario
16.
Which, if any, of the following
statements are true in relation to non-epileptic attack disorder?
Option list.
A
|
about 5% of those with NEAD
also have epilepsy
|
B
|
about 15% of those with NEAD
also have epilepsy
|
C
|
about 25% of those with NEAD
also have epilepsy
|
D
|
about 40% of those with NEAD
also have epilepsy
|
E
|
about 50% of those with NEAD
also have epilepsy
|
Scenario
17.
Which, if any, of the following
statements are true in relation to distinguishing non-epileptic attack disorder
from epilepsy in pregnancy?
Option list.
A
|
NEAD is more likely with
extensor plantar reflexes
|
B
|
NEAD is more likely with a
+ve conjunctival reflex
|
C
|
NEAD is more likely with
resistance to eye-opening
|
D
|
NEAD is more likely with
seizures but no cyanosis
|
E
|
NEAD is more likely with
elevated post-ictal prolactin levels
|
Scenario
18.
Which, if any, of the following
does GTG 68 say should be considered in the differential diagnosis of a seizure
in pregnancy.
Option list.
A
|
cerebral malaria
|
B
|
cerebral venous sinus thrombosis
|
C
|
meningitis
|
D
|
posterior reversible
leucoencephalopathy syndrome
|
E
|
reversible cerebral
vasoconstriction syndrome
|
F
|
space-occupying lesions
|
Scenario
19.
Which, if any, of the following
does GTG 68 say should be considered in the differential diagnosis of a seizure
in pregnancy.
Option list.
A
|
aortic regurgitation
|
B
|
aortic stenosis
|
C
|
atrial fibrillation
|
D
|
atrial septal defect
|
E
|
carotid sinus sensitivity
|
Scenario
20.
Which, if any, of the following
does GTG 68 say should be considered in the differential diagnosis of a seizure
in pregnancy.
Option list.
A
|
Addisonian crisis
|
B
|
asthma
|
C
|
hypoglycaemia
|
D
|
hypomagnesaemia
|
E
|
hyponatraemia
|
F
|
renal failure
|
Scenario
21.
What classification is used in the MMRs for deaths due to
epilepsy?
Option list
A
|
accidental
|
B
|
coincidental
|
C
|
direct
|
D
|
fortuitous
|
E
|
inevitable
|
F
|
indirect
|
G
|
late
|
Scenario
22.
How many maternal deaths were caused by epilepsy from
2011-13?
Option list
A
|
0
|
B
|
1
|
C
|
5
|
D
|
7
|
E
|
15
|
F
|
22
|
G
|
34
|
Scenario
23.
What is the relative risk of maternal death for WWE
compared with women without epilepsy?
Option list
A
|
0.5
|
B
|
0.75
|
C
|
1
|
D
|
1.5
|
E
|
2
|
F
|
5
|
G
|
10
|
Scenario
24.
What is the main cause of maternal death due to epilepsy?
Option list
A
|
asphyxia
|
B
|
aspiration of vomit
|
C
|
drowning
|
D
|
falling from a height
|
E
|
intracranial haemorrhage
|
F
|
SODEP
|
G
|
SUDEP
|
Scenario
25.
Which, if any, of the following are risk factors for
SUDEP?
Option list
A
|
anaemia
|
B
|
late age of onset of epilepsy
|
C
|
higher number of seizures
|
D
|
higher number of AEDs
|
E
|
high IQ
|
F
|
PET
|
Scenario
26.
Which type of epilepsy is most often associated with
maternal death?
Option list
A
|
grand mal epilepsy
|
B
|
petit mal epilepsy
|
C
|
frontal lobe epilepsy
|
D
|
drug-related epilepsy
|
E
|
post-traumatic epilepsy
|
F
|
none of the above
|
Scenario
27.
Which, if any, of the following statements are true in
relation to WWE in pregnancy and the puerperium?
Option list
A
|
ideally they should be accommodated in single rooms to
reduce noise and stress
|
B
|
they should not be accommodated in single rooms
|
C
|
they should have shorter visiting times to reduce
stress
|
D
|
existing children should not be allowed to visit
|
E
|
partners should not be allowed to visit
|
Scenario
28.
AEDs are used in the treatment of which, if any, of the
listed conditions?
Conditions
A
|
asthma
|
B
|
adolescent depression
|
C
|
bipolar disorder
|
D
|
chronic pain
|
E
|
leprosy
|
F
|
migraine
|
G
|
NEPD
|
H
|
tinnitus
|
Option list
1
|
A + B + C + D + E + F + G + H
|
2
|
A + B + C + D + E + F + G
|
3
|
B + C + D + E + F + G + H
|
4
|
B + C + D + F + G
|
5
|
C + D + E + F
|
6
|
C + D + G
|
7
|
C + D
|
Scenario
29.
A primigravida with no history of epilepsy is admitted at
38 weeks after a seizure. This had been witnessed by her sister, a trained
nurse, who described it as tonic / clonic with loss of consciousness. She is
now drowsy but can be roused and has no recollection of events. It is not clear
that this is a first manifestation of epilepsy. What should the immediate
management be?
Option list
A
|
arrange brain CT scan
|
B
|
arrange brain MR scan
|
C
|
call for the on-call neurologist to attend urgently
|
D
|
lumbar puncture
|
E
|
start eclampsia protocol
|
F
|
urgent blood sugar assay
|
G
|
urgent urea / electrolytes assay
|
H
|
urgent clotting screen
|
Scenario
30.
Which of the listed drugs are enzyme-inducing drugs (EIDs)?
Option list
Drug
|
Yes
|
No
|
|
A.
|
carbamazepine
|
||
B.
|
clonazepam
|
||
C.
|
diazepam
|
||
D.
|
eslicarbazepine
|
||
E.
|
ethosuximide
|
||
F.
|
gabapentin
|
||
G.
|
lamotrigine
|
||
H.
|
levetiracetam
|
||
I.
|
oxcarbazepine
|
||
J.
|
phenobarbital
|
||
K.
|
phenytoin
|
||
L.
|
primidone
|
||
M.
|
topiramate
|
||
N.
|
valproic acid
|
Scenario
31.
Classify the following drugs as “new” or “old” AEDs.
Option list
A
|
carbamazepine
|
|
B
|
clonazepam
|
|
C
|
eslicarbazepine
|
|
D
|
ethosuximide
|
|
E
|
gabapentin
|
|
F
|
lamotrigine
|
|
G
|
levetiracetam
|
|
H
|
oxcarbazepine
|
|
I
|
phenobarbital
|
|
J
|
phenytoin
|
|
K
|
pregabalin
|
|
L
|
topiramate,
|
|
M
|
valproic acid
|
|
N
|
vigabatrin
|
Scenario
32.
Which, if any, of the
following statements are true in relation to AEDs & pregnancy.
Option list
A
|
levels of most AEDs fall in pregnancy
|
B
|
levels should be measured monthly until within the
recommended levels for pregnancy
|
C
|
once normal levels have been attained, levels should be
checked at 28 & 36 weeks
|
D
|
levels should be checked on day 10 of the puerperium to
reduce the risk of toxicity
|
E
|
levels of carbamazepine are particularly likely to fall
below recommended levels
|
Scenario
33.
The GTG mentions one study that gives a figure for the
percentage of WWE who stop their AEDs in pregnancy.
Pick the option from the list below that is closest to the
figure cited.
Option list.
A
|
1%
|
B
|
5%
|
C
|
7.5%
|
D
|
10%
|
E
|
15%
|
F
|
20%
|
Scenario
34.
Which, if any, of the
following are listed in GTG68 as signs of AED toxicity.
Option list
A
|
diplopia
|
B
|
drowsiness
|
C
|
strabismus
|
D
|
tremor
|
E
|
unsteadiness
|
Scenario
35.
Which, if any, of the
following are features of the fetal anticonvulsant syndrome.
Option list
A
|
anomalies of distal phalanges
|
B
|
cleft palate
|
C
|
developmental dysplasia of the hip
|
D
|
fetal growth restriction
|
E
|
hypoplasia of the mid-face
|
F
|
microcephaly
|
G
|
talipes equinovarus
|
Scenario
36.
Which, if any, of the following statements are true in
relation to WWE and the puerperium?
Option list
A
|
seizure frequency is higher in the early puerperium
compared with pregnancy
|
B
|
seizure frequency occurs at a low rate in the early
puerperium
|
C
|
the risk of postpartum seizures is highest in women who
had seizures in the 1st. trimester
|
D
|
AED dosage should be reviewed in the 1st. 7
days if changed during pregnancy
|
E
|
depression is no more common in WWE compared to women
without epilepsy
|
Scenario
37.
Which AED is particularly associated with reduced levels
in pregnancy of potential clinical significance and with need for monitoring.
Option list
A
|
carbamazepine
|
B
|
clonazepam
|
C
|
lamotrigine
|
D
|
levetiracetam
|
E
|
phenytoin
|
F
|
pregabalin
|
G
|
topiramate,
|
H
|
valproic acid
|
Scenario
38.
By how much are the levels of this drug reduced in
pregnancy?
Option list
A
|
up to 20%
|
B
|
up to 30%
|
C
|
up to 40%
|
D
|
up to 50%
|
E
|
up to 60%
|
F
|
up to 70%
|
Scenario
39.
What advice does GTG 68 give about the dosage of
antenatal steroids in WWE who take enzyme-inducing AEDs and are at sufficient
risk of premature delivery that steroids would normally be recommended?
Option list
A
|
the dosage should be halved
|
B
|
the dosage should be doubled
|
C
|
the dosage should be trebled
|
D
|
the dosage should be unaltered
|
E
|
the course of steroids should be repeated after 1 week
|
Scenario
40.
How many maternal deaths from 2011-13 were caused by
epilepsy?
Option list
A
|
2
|
B
|
5
|
C
|
7
|
D
|
15
|
E
|
36
|
Scenario
41.
What is the approximate risk of a child developing
epilepsy if its mother has epilepsy
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
42.
What is the approximate risk of a child developing
epilepsy if its father has epilepsy
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
43.
What is the approximate risk of a child developing
epilepsy if its father & mother have epilepsy
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
44.
What is the approximate risk of
a child developing epilepsy if it has a sibling with epilepsy
Option list
A
|
1%
|
B
|
2.5%
|
C
|
5%
|
D
|
10%
|
E
|
15%
|
F
|
≥ 15%
|
Scenario
45.
Which, if any, of the following methods of analgesia are appropriate
for pain relief in labour for WWE?
Option list
A
|
diamorphine
|
B
|
Entonox
|
C
|
epidural anaesthesia
|
D
|
pethidine
|
E
|
TENS
|
Scenario
46.
Which, if any, of the following statements are true about
the use of pethidine for WWE in labour?
Option list
A
|
diamorphine is preferable to pethidine
|
B
|
pethidine should be avoided or used with caution
|
C
|
pethidine should not be used
|
D
|
pethidine is epileptogenic
|
E
|
pethidine is metabolised to norpethidine, which is
epileptogenic
|
Scenario
47.
Which, if any, of the following statements is correct in
relation to the administration of vitamin K to WWE?
Option list
A
|
vitamin K should only be considered for women on EIDs
|
B
|
vitamin K is used to reduce the risk of PPH
|
C
|
vitamin K is used to reduce the risk of HDN
|
D
|
vitamin K as a single, 1 mg. i.m. shot should be
offered for babies born to WWE on EIDs
|
E
|
there is little evidence from clinical trials to
support the use of vitamin K to reduce the risk of HDN
|
F
|
there is little evidence from clinical trials to
support the use of vitamin K to reduce the risk of PPH
|
Scenario
48.
Which, if any, of the following statements are true in
relation to AEDs and congenital anomaly?
Option list
A
|
drug dosage is not a significant risk factor
|
B
|
older drugs generally carry more risk
|
C
|
older maternal age is the greatest risk factor
|
D
|
polypharmacy significantly increases the risk
|
E
|
the commonest congenital anomaly is reduced IQ.
|
Scenario
49.
What is the risk of major congenital anomaly for WWE who
do not take AEDs compared with the background population risk?
Option list
A
|
about half
|
B
|
about the same
|
C
|
roughly doubled
|
D
|
roughly trebled
|
E
|
roughly quadrupled
|
Scenario
50.
What are the major risk
factors for major congenital anomaly in babies born to WWE?
There is no option list
to make things harder.
Just write what you
know.
Scenario
51.
What does GTG68 say are
factors that may reduce the risk of major congenital anomaly?
There is no option list.
Scenario
52.
Which, if any, of the
following are listed in GTG68 as the most common major congenital anomalies
linked to AED use?
Option list
A
|
cleft palate
|
B
|
congenital heart anomaly
|
C
|
gluten sensitivity
|
D
|
exomphalos
|
E
|
Hirschsprung’s disease
|
F
|
NTD
|
G
|
sacro-coccygeal tumour
|
H
|
skeletal anomaly
|
I
|
urinary tract infection
|
Scenario
53.
Which of the following
are particularly associated with carbamazepine consumption in the 1st.
trimester?.
A
|
cleft lip
|
B
|
cleft palate
|
C
|
congenital heart anomaly
|
D
|
gluten sensitivity
|
E
|
exomphalos
|
F
|
Hirschsprung’s disease
|
G
|
hypospadias
|
H
|
microcephaly
|
I
|
NTD
|
J
|
sacro-coccygeal tumour
|
K
|
skeletal anomaly
|
L
|
urinary tract anomaly
|
Scenario
54.
Which of the following
are particularly associated with phenobarbital consumption in the 1st.
trimester? Use the option list for question 54.
Scenario
55.
Which of the following
are particularly associated with phenytoin consumption in the 1st.
trimester? Use the option list for question 54.
Scenario
56.
Which of the following
are particularly associated with valproate consumption in the 1st.
trimester?
Use the option list for
question 54.
Scenario
57.
Match the following drugs to the % risk of major
congenital anomaly in the option list.
Drug
Drug
|
% risk
|
Carbamazepine
|
|
Lamotrigine
|
|
Levetiracetam
|
|
Oxcarbazepine
|
|
Phenobarbital
|
|
Phenytoin
|
|
Topiramate
|
|
Valproic
acid
|
Option list
4.7
- 10
|
4.2
- 7.7
|
5.5
- 7.4
|
2.9
- 6.7
|
2.6
- 5.6
|
2.0
–3.4
|
1.8
- 3.3
|
0 - 2.4
|
Scenario
58.
Match the following drugs to the most common types of
congenital anomaly in the option list.
Drug
Drug
|
Anomaly
|
Carbamazepine
|
|
Lamotrigine
|
|
Levetiracetam
|
|
Oxcarbazepine
|
|
Phenobarbital
|
|
Phenytoin
|
|
Topiramate
|
|
Valproic
acid
|
Option list
cardiac
abnormalities
|
cardiac
abnormalities, hypospadias
|
cardiac
abnormalities, hypospadias, NTDs
|
cardiac
abnormalities, NTDs
|
cardiac
abnormalities, oro-facial clefts
|
NTDs
|
oro-facial
clefts
|
Scenario
59.
Which, if any, of the following are recommended in the
immediate management of epileptic seizures in pregnancy?
Option list
A
|
use of the recovery position
|
B
|
use of i.v. phenobarbitone to end the seizure
|
C
|
induction of labour
|
D
|
Caesarean section
|
E
|
continuous EFM until delivery
|
F
|
expedite delivery if FHR anomaly for > 10 minutes
|
G
|
use tocolytic drug to reduce fetal hypoxia
|
Scenario
60.
What should be done if
the initial drug treatment fails to control the seizures?
Option list
A
|
consider i.v. pethidine
|
B
|
consider i.v. phenytoin
|
C
|
consider i.v. fosphenotoin
|
D
|
consider general anaesthesia
|
E
|
consider general anaesthesia + transfer to ICU
|
Scenario
61.
When does GTG68
recommend that clobazam around the time of delivery?
There is no option list.
Scenario
62.
What should be done if
the initial drug treatment fails to control the seizures?
Option list
A
|
consider i.v. pethidine
|
B
|
consider i.v. phenytoin
|
C
|
consider i.v. fosphenotoin
|
D
|
consider general anaesthesia
|
E
|
consider general anaesthesia + transfer to ICU
|
Scenario
63.
Which, if any, of the
following statements is true in relation to breastfeeding (BF) for WWE taking
AEDs?
Option list
A
|
BF is contraindicated
|
B
|
carbamazepine & lamotrigine produce similar
umbilical cord and maternal serum levels
|
C
|
inconsolable crying is seen in babies
|
D
|
inconsolable crying is seen in mothers
|
E
|
lamotrigine transfers more readily to the baby than
valproate
|
F
|
psychomotor development is only impaired until the age
of 2 years
|
Scenario
64.
Which, if any of the
following methods of contraception should be promoted for WWE taking AEDs
according to GTG68?
Option list
A
|
COC in normal dose
|
B
|
COC with 50 microgram dose of oestrogen
|
C
|
CuIUCD
|
D
|
LNGIUS
|
E
|
MPA injections
|
Scenario
65.
Which, if any, of the
following statements are true in relation to WWE taking EIDs?
Option list
A
|
the failure rate of COCs is ~ 3 times greater
|
B
|
the failure rate of COCs is ~ 7 times greater
|
C
|
↑ the
dose of oestrogen in a COC to 50 micrograms restores its efficacy
|
D
|
↑ the pill-free interval to 10 days restores its
efficacy
|
E
|
motorcycling restores its efficacy
|
F
|
the POP is unaffected
|
G
|
barrier contraception in should be advised in addition
if oral contraception is used
|
Scenario
66.
Which, if any, of the
following statements are true in relation to progesterone contraception in WWE
on EIDs?
Option list
A
|
the efficacy of Implanon may be reduced
|
B
|
the efficacy of Nexplanon is unaffected
|
C
|
the efficacy of the LNGIUS is believed to be unaffected
|
D
|
the efficacy of the POP is unaffected
|
E
|
the efficacy of the POP is increased
|
Scenario
67.
What is advised in
relation to COC and lamotrogine?
TOG
questions.
Management
of women with epilepsy during pregnancy
The
following statements about antiepileptic drugs (AEDs) in pregnancy are true:
51
Approximately 0.5% of pregnancies are exposed to AEDs. T F
52
The adverse outcomes reported in pregnant women with epilepsy are mainly
attributable to AEDs. T h F h
53 No
long-term adverse effects have been described following AED exposure in utero.
T F
Maternal
risks during pregnancy in women with epilepsy include
54 an increase in the seizure frequency in over
40% of women. T F
55 an increased caesarean section rate. T F
56 a fall in total serum AED levels. T F
Risks
to the fetus in women with epilepsy taking AEDs include
57 a 10-fold increase in fetal loss. T F
58 a 2 to 3-fold increase in major
malformations. T F
59 a lower birth weight. T F
60 developmental delay in the first two years of
life. T F
The
following statements about risks to the fetus in women with epilepsy taking
AEDs are true:
61 The risks are equal in all three trimesters.
T F
62 There is an increased risk from convulsive
compared with non-convulsive seizures. T
F
The
following statements regarding major fetal malformations are correct:
63 They are not increased through polytherapy
exposure in utero. T F
64 The risk is highest with phenytoin exposure.
T F
65 They are significantly reduced in women
taking 0.4 mg folic acid in the first trimester. T F
66 Orofacial clefts are more likely to be associated
with valproate. T F
The
following statements about the dosage of AEDs in pregnancy are true:
67 Lower doses of AEDs are associated with lower
risks. T F
68 Withdrawal of medication is best planned
several months before conception. T F
With
regard to neonatal care and delivery,
69 approximately 40% of women with epilepsy will
experience a tonic-clonic seizure during delivery and the first 24 hours after
delivery. T F
70 breastfeeding is not recommended in women who
continue to take AEDs.
41. EMQ. BRCA1
& 2 carriers and risk of breast and ovarian cancer.
There is no option list – you have to produce your own
numbers.
Scenario 1.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 2.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 3.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 4.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 5
The woman asks for the overall figure for lifetime risk
of breast cancer in UK women for comparison with her risk.
What is the approximate figure?
Scenario 6
The woman asks for the overall UK figure for lifetime
risk of ovarian cancer for comparison with her risk.
What is the approximate figure?
Scenario 7
Which of
the following genes have mutations that increase the risk of female breast
cancer?
Answer.
A
|
ATM
|
B
|
CDH1
|
C
|
CHEK1
|
D
|
FATHEAD
|
E
|
MARBELLA
|
F
|
NBENE
|
G
|
p45
|
H
|
p53.
|
I
|
PALB2
|
J
|
PNINE
|
K
|
PTEN
|
L
|
RADON50
|
M
|
RINT1
|
Scenario 8
A man of 30 has two sisters who developed breast cancer before
the age of 40. They and he have been proved to be carriers of BRCA2.
His GP phones to ask about his lifetime risk of breast cancer.
What is the approximate figure?
Scenario 9
A man of 30 has two sisters who developed breast cancer before
the age of 40. They and he have been proved to be carriers of BRCA2.
His GP phones to ask about his lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 10
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about the value of prophylactic mastectomy. What advice will you give about efficacy?
Scenario 11
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy – her family is
complete and her husband has had vasectomy. What is the approximate figure for
the efficacy of salpingo-oophorectomy in relation to cancer?
Scenario 12
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy. What are the
disadvantages of BSO?
Scenario 13
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy. What alternatives should be discussed?
Scenario 14
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
Which drugs are of proven value in reducing breast cancer
risk for women like her?
Scenario 15
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
Which drugs are of proven value in reducing breast cancer
risk for women like her?
Scenario 16
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
Which drugs are of proven value in reducing ovarian
cancer risk for women like her?
Scenario 17
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
Which drugs are of proven value in reducing ovarian
cancer risk for women like her?
