Thursday, 7 June 2018

Tutorial 7th. June 2018

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19
EMQ. Pregnancy after uterine transplant
20
EMQ. Mayer-Rokitansky-Küster-Hauser syndrome
21
EMQ. Kallmann’s syndrome
22
EMQ. Montgomery & consent
23
EMQ. Hepatitis B

19.   EMQ. Pregnancy after uterine transplant.
Abbreviations.
ET:         embryo transfer.
UT:        uterine transplant
Scenario 1.                
When was the 1st. human uterine transplant performed?
Option list.
A
2000
B
2015
C
2010
D
2011
E
2012
F
2013
G
2014
H
2015
I
2016
J
2017
Scenario 2.                
When was the 1st. livebirth after human uterine transplant?
Option list.
A
2000
B
2015
C
2010
D
2011
E
2012
F
2013
G
2014
H
2015
I
2016
J
2017
Scenario 3.                
How many live births had occurred worldwide after UT up to the end of 2017?
Option list
A
< 5
B
5 - 10
C
11 - 20
D
21 - 50
E
51 - 100
F
> 100
Scenario 4.                
For which of the following conditions is UT a possible treatment?
Option list.
A
Androgen Insensitivity syndrome. AIS.
B
Congenital Adrenal hyperplasia. CAH.
C
Kallmann’s syndrome. KS.
D
Mayer-Rokitansky-Küster-Hauser syndrome. MRKH.
E
McCune-Albright syndrome. MCAS.
F
Swyer’s syndrome. SS.
G
Turner’s syndrome. TS.
Scenario 5.                
Which, if any, of the following are commonly used for donor selection?
Option list.
A
absence of adenomyosis
B
absence of fibroids
C
age < 65 years
D
good general health
E
negative cervical smear and no high-risk HPV
F
no cancer in past 5 years
G
parous
H
vaginal length > 7 cm.
Scenario 6.                
What is the rate of graft survival at 1 year, failure being the need for hysterectomy?
Option list.
A
< 10%
B
11 – 20%
C
21 – 30%
D
31 – 40%
E
41 – 50%
F
51 – 60%
G
> 60%
H
the figure is unknown
Scenario 7.                
Which of the following statements is correct?
Option list.
A
donor surgery is more extensive than recipient surgery
B
donor surgery is less extensive than recipient surgery
C
donor surgery is as extensive as recipient surgery
Scenario 8.                
What are the risks to the donor in addition to the usual ones of bleeding,  infection, haematoma and thrombosis? There is no option list.
Scenario 9.                
Which condition has been the reason for recipients needing uterine transplant and which complication is more likely in addition to the usual ones of bleeding,  infection, haematoma and thrombosis? There is no option list.
Scenario 10.            
When is IVF and cryopreservation of eggs done?
Option list.
A
before uterine transplantation
B
at the time of uterine transplantation
C
12 months after uterine transplantation to ensure graft rejection does not occur
D
when the recipient chooses
E
none of the above
Scenario 11.            
Which maintenance therapy was used immediately before embryo transfer in the first case resulting in livebirth?
Option list.
A
azathioprine + corticosteroids + tacrolimus
B
azathioprine + ciclosporin + corticosteroids + mycophenolate mofetil
C
azathioprine + corticosteroids + mycophenolate mofetil + tacrolimus
D
azathioprine + corticosteroids + tacrolimus
E
ciclosporin + corticosteroids + mycophenolate mofetil + tacrolimus
F
ciclosporin + mycophenolate mofetil + tacrolimus
G
corticosteroids + mycophenolate mofetil + tacrolimus
H
corticosteroids + tacrolimus

20.   EMQ. Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 1.              
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 2.              
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 3.              
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 4.              
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 5.              
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 6.              
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 7.              
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 8.              
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 9.              
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 10.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 11.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 12.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 13.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 14.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F
Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 15.          
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 16.          
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 17.          
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 18.          
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 19.          
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 20.          
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 21.          
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 22.          
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 23.          
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 24.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 25.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 26.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 27.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 28.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F
Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 29.          
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 30.          
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 31.          
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 32.          
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 33.          
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 34.          
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 35.          
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 36.          
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 37.          
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 38.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 39.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 40.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 41.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 42.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F
Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 43.          
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 44.          
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 45.          
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 46.          
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 47.          
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 48.          
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 49.          
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 50.          
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 51.          
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 52.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 53.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 54.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 55.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 56.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F
Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 57.          
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 58.          
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 59.          
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 60.          
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 61.          
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 62.          
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 63.          
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 64.          
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 65.          
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 66.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 67.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 68.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 69.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 70.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F
Mayer-Rokitansky-Küster-Hauser syndrome.
Abbreviations.
AIS:          androgen insensitivity syndrome
AMH:       anti- Müllerian hormone
MRKH:     Mayer-Rokitansky-Küster-Hauser syndrome
MURCS:  Müllerian duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question 71.          
Lead-in.
What are the main features of MRKH? There is no option list to make life harder.
Question 72.          
Lead-in.
Which, if any, are the main secondary features associated with MRKH?
Option list.
A
anosmia
B
attention-deficit-hyperactivity syndrome
C
auditory anomalies
D
neural tube defects
E
renal anomalies
F
skeletal anomalies
Question 73.          
Lead-in.
How does MRKH syndrome usually present?
Option list.
A
cyclical pain due to haematometra
B
delayed puberty
C
precocious puberty
D
premature menopause
E
primary amenorrhoea
F
recurrent otitis media
G
recurrent urinary tract infection
H
secondary amenorrhoea
Question 74.          
Lead-in.
Which of the following chromosome patterns are typical of MRKH?
Option list.
A
45XO
B
45YO
C
46XX
D
46XY
E
47XXX
F
47XXY
Question 75.          
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 76.          
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
A
~ 1 in 1,000
B
~ 1 in 2,000
C
~ 1 in 4,000
D
~ 1 in 6.000
E
~ 1 in 8,000
F
~ 1 in 10,000
G
~ 1 in 100,000
H
the figure is unknown
I
it does not occur
Question 77.          
Lead-in.
Which of the following statements are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A
absent bladder
B
absent kidney
C
ectopic ureter
D
horseface kidney
E
hypospadias
F
urinary tract anomalies are not part of the syndrome
Question 78.          
Lead-in.
Which of the following statements are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A
absent thumb
B
absent big toe
C
developmental dysplasia of the hip
D
Klippel-Fiel anomaly
E
ulnar hypoplasia
F
vertebral fusion
G
skeletal anomalies are not part of the syndrome
Question 79.          
Lead-in.
Which of the following statements are correct in relation to auditory anomalies associated with MRKH?
Option list.
A
absent ear
B
absent stapes
C
acoustic neuroma
D
conductive deafness
E
inductive deafness
F
stapedial ankylosis
G
auditory anomalies are not part of the syndrome
Question 80.          
Lead-in.
What is the recommended first-line management for creation of a neovagina.
Option list.
A
digital dilatation
B
marriage to a virile husband
C
vaginal balloons
D
vaginal dilators
E
vaginoplasty
F
there is no recommended 1st. line management
Question 81.          
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 82.          
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 83.          
Lead-in.
What is what are the key features of Vecchietti vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead
Question 84.          
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
A
horseshoe perineal incision with labial flaps used to create a pouch
B
creation of space between bladder and rectum and lining it with amnion
C
creation of space between bladder and rectum and lining it with skin graft
D
creation of space between bladder and rectum and lining it with sigmoid colon
E
creation of space between bladder and rectum and lining it with peritoneum
F
traction via threads running to the abdomen from a vaginal bead

TOG CPD questions.
With regard to the MRKH syndrome.
1.     there is failure of development of the mesonephric ducts. T F
2.     the phenotype and genotype are female. T F
3.     studies have established a link between the syndrome and the use of diethylstilboestrol in pregnancy. T F.
4.     symmetrical uterovaginal aplasia is found in type I disorders. T F
5.     renal abnormalities are seen in more than half of cases. T F
6.     skeletal abnormalities are reported in up to one-fifth of cases. T F
7.     up to one-quarter of women have a malformed ear or auditory canal. T F
8.     the close proximity of the Müllerian and Wolffian duct derivatives to the duct in the developing embryo explains the higher association of malformations of the kidneys with this condition. T F
9.     vaginal agenesis is caused by failure of the caudal part of the Müllerian duct system to develop. T F
10.   magnetic resonance imaging is the gold standard tool. T F
11.   two-dimensional ultrasound scanning is not useful for associated renal tract abnormalities. T F
12.   complete androgen insensitivity syndrome is an important differential diagnosis. T F
13.   the presence of cyclical abdominal pain will rule out the diagnosis, as it indicates the presence of functioning endometrium. T F
With regard to the creation of a neovagina,
14.   it is recommended that treatment is initiated as soon as the diagnosis is made. F
15.   psychological support to women undergoing this procedure is of the utmost importance. T
16.   vaginal dilators are acceptable as an option for first-line therapy. T
17.   Ingram’s modified Frank’s technique involves the use of vaginal dilators. T
With regard to the surgical creation of a neovagina,
18.   in the Davydov procedure the neovagina is lined with peritoneum. T F
With regard to fertility in women with the MRKH syndrome,
19.   transvaginal egg retrieval is recognised to be difficult during in vitro fertilisation. T
20.   the condition has been shown to be transmissible to the offspring. T F

21.   EMQ. Kallmann’s syndrome
Kallmann’s syndrome.
Abbreviations.
Ks:         Kallmann’s syndrome
Scenario 1.                
Which of the following might be included in descriptions of Kallmann’s syndrome?
Option list.
A
hypogonadotrophic hypogonadism
B
hypogonadotrophic hypogonadism + anosmia
C
hypogonadotrophic hypogonadism + anosmia + colour-blindness.
D
hypogonadotrophic hypogonadism due to uterine agenesis
Scenario 2.                
Lead in.
Which, if any, of the following are features of the Kallmann phenotype?
A
absent or minimal breast development
B
aortic stenosis
C
blue eyes
D
blue hair
E
hot flushes
F
short stature
G
tall stature
H
vaginal agenesis
I
none of the above
Scenario 3.                
How common is Kallmann’s syndrome and what is the female: male ratio?
A
1 in 1,000 and F:M ratio 1:1
B
1 in 5,000 and F:M ratio 1:1
C
1 in 10,000 and F:M ratio 1:4
D
1 in 50,000 and F:M ratio 1:4
E
1 in 100,000 and F:M ratio 1:8
F
1 in 250,000 and F:M ration 1:10
Scenario 4.                
What is the most common mode of inheritance of Ks?
Option list.
A
hypogonadotrophic hypogonadism
B
hypogonadotrophic hypogonadism + anosmia
C
hypogonadotrophic hypogonadism due to uterine agenesis
D
autosomal dominant
E
autosomal recessive
F
X-linked recessive
G
new mutation of the ANOS1 gene
H
the most common mode of inheritance is not known
Scenario 5.                
How is Kallmann’s syndrome diagnosed?
A
abdominal and pelvic ultrasound scan
B
cell-free fetal DNA
C
chromosome analysis
D
CT scan of hypothalamus / pituitary
E
MR scan of hypothalamus / pituitary
F
none of the above.
Scenario 6.                
How is Kallmann’s syndrome treated initially?
Which of the following statements are true?
Option list.
A
GnRH analogue depot
B
pulsatile GnRH therapy
C
combined oral contraceptive
D
counselling & education re gender re-assignment
E
depot progestogen
F
none of the above
Scenario 7.                
A woman was diagnosed with Kallmann’s syndrome at 16 and had successful initial treatment. She is now 25, married and wishes to have a pregnancy. She has had pre-pregnancy assessment and counselling. Which of the following can be considered?
A
GnRH analogue depot
B
induction of ovulation with clomiphene
C
gonadotrophin therapy
D
pulsatile GnRH therapy
E
none of the above

22.   EMQ.
Montgomery Ruling.
Abbreviations.
BMA:    British Medical Association.
GMC:    General Medical Council.
Question 1.              
Which, if any, of the following statements are true?
Lead-in
A.       
The Montgomery ruling largely replaces the Bolam ruling
B.       
The Montgomery ruling largely replaces the Chester ruling
C.       
The Montgomery ruling largely replaces the Sidaway ruling
D.       
The Montgomery ruling is being contested in the European Court by the GMC as it infringes the rights of doctors
E.        
The Montgomery ruling is being contested in the European Court by the BMA as it infringes the rights of doctors
Question 2.              
Which, if any, of the following statements are true?
Lead-in
A.       
the level of risk, however small, must be disclosed if a patient requests it
B.       
the level of risk of damage from a procedure need not be disclosed if < 1%
C.       
the level of risk of damage from a procedure need not be disclosed if < 10%
D.       
a material risk is one that would be reflected in damages > £100,000 if negligence were proved in court
E.        
a material risk is one that would be reflected in damages > £1,000,000 if negligence were proved in court
F.        
a material risk is one that involves anatomical damage, not emotional or psychological
G.       
a material risk is one that a reasonable person in the patient’s situation would be likely to regards as significant

23.   EMQ. Hepatitis B.
Abbreviations.
HAV:           hepatitis A virus
HBcAg:       hepatitis B core antigen
HBeAg:       hepatitis B e antigen
HBsAg:       hepatitis B surface antigen
HBcAb:       antibody to hepatitis B core antigen
HBeAb:      antibody to hepatitis B e antigen
HBsAb:       antibody to hepatitis B surface antigen
HBIG:         hepatitis B immunoglobulin
HBV:           hepatitis B virus
HBcAg:       hepatitis B core antigen
HBeAg:       hepatitis B e antigen
HBsAg:       hepatitis B surface antigen
HBcAb:       antibody to hepatitis B core antigen
HBeAb:      antibody to hepatitis B e antigen
HBsAb:       antibody to hepatitis B surface antigen
HBIG:         hepatitis B immunoglobulin
HCV:           hepatitis C virus
HEV:           hepatitis E virus
HSV:           herpes simplex virus
VT:              vertical transmission
Option list.
A.       
acyclovir 
B.       
divorce
C.       
HBcAg +ve
D.       
HBeAg +ve
E.        
HbsAg +ve
F.        
HBsAg +ve; HBsAb –ve;  HBcAb –ve; HBeAg +ve
G.       
HBsAg +ve; HBsAb –ve on two tests six months apart
H.       
HBsAg -ve; HBsAb -ve on two tests six months apart
I.         
HBsAg -ve; HBsAb +ve; HBcAb –ve
J.         
HBsAg -ve; HBsAb +ve; HBcAb +ve
K.        
HBsAg -ve; HBsAb +ve
L.        
HBsAg +ve; HBcAg +ve
M.     
HBV vaccine
N.       
HBIG
O.      
HBV vaccine + HBIG
P.        
immune as a result of infection
Q.      
immune as a result of vaccination
R.       
not immune
S.        
chronic carrier of HBV infection
T.        
10%
U.       
30%
V.       
50%
W.     
60%
X.        
70-90%
Y.        
soap and boiling water
Z.        
10% dilution of bleach in water
AA.   
10% dilution of formaldehyde in alcohol
BB.   
ultraviolet irradiation
CC.   
yes
DD.  
no
EE.    
HAV
FF.     
HBV
GG.  
HCV
HH.  
HEV
II.       
HSV
JJ.       
none of the above
Scenario 1.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she has an acute HBV infection?
Scenario 2.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of infection?
Scenario 3.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?
Scenario 4.
An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 9 months ago. What results on routine blood testing would show that she is a chronic carrier of HBV infection?
Scenario 5.
Testing shows that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb. What does this mean in relation to his HBV status?
Scenario 6.
Testing shows that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.
What does this mean in relation to his HBV status?
Scenario 7.
How common is chronic HBV carrier status in UK pregnant women?
Scenario 8.
What is the risk of death from chronic HBV carrier status?
Scenario 9.
A primigravid woman at 8 weeks gestation is found to be non-immune to HBV. She has recently married and her husband is a chronic carrier. What should be done to protect her from infection?
Scenario 10.
A woman is a known carrier of HBV. What is the risk of vertical transmission in the first trimester?
Scenario 11.
What is the risk of the neonate who has been infected by vertical transmission becoming a carrier without treatment?
Scenario 12.
Should antiviral maternal therapy in the 3rd. trimester be considered for women with HBeAg or high viral load?
Scenario 13.
How effective is hepatitis B prophylaxis for the neonate in preventing chronic carrier status as a result of vertical transmission?
Scenario 14.
Can a woman who is a chronic HBV carrier breastfeed safely?
Scenario 15.
Hepatitis B infection is the most dangerous of the viral hepatitis infections in pregnancy.
Scenario 16.
A pregnant woman who is not immune to HBV has a partner who is a chronic carrier. Can HBV vaccine be administered safely in pregnancy?
Scenario 17.
A pregnant woman who is not immune has a partner with acute hepatitis due to HBV. He cuts his hand and bleeds onto the kitchen table. How should she clean the surface to ensure that she gets rid of the virus?
Scenario 18.
Is it true that the presence of HBeAg in maternal blood is a particular risk factor for vertical transmission? Not really a scenario, but never mind!
Scenario 19.
Does elective Cs before labour and with the membranes intact reduce the vertical transmission rate?
Scenario 20.
Which hepatitis virus normally produces a mild illness, but represents a major risk to pregnant women, with a mortality rate of up to 5%?
Scenario 21.
A pregnant woman has a history of viral hepatitis and informs the midwife at booking that she is a carrier and that she has a significant risk of cirrhosis and has been advised not to drink alcohol. Which is the most likely hepatitis virus?
Scenario 22.
Which hepatitis virus is an absolute contraindication to breastfeeding after appropriate treatment of the infected mother and prophylaxis for the baby?
Scenario 23.
Which hepatitis virus is linked to an increased risk of obstetric cholestasis?



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