Monday 25 June 2018

Tutorial 25th. June 2018




Example Statistics Questions

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
CG137:               NICEs Clinical Guideline 137: “Epilepsies: diagnosis and management”. 2012
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.
GTG68:               RCOG’s Green-top Guideline 68: “Epilepsy in Pregnancy”. June 2016.
HDN:                   haemorrhagic disease of the newborn.
James:                High Risk Pregnancy. 4th. Edition. James et al. 2010. Elsevier.
L&K:                    Luesley & Kirby’s Obstetrics & Gynaecology: An Evidence-based Text for MRCOG”. Third Edition. 2016.
LNGIUS:              levonorgestrel intrauterine system
MDT:                  multi-disciplinary team.
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?



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