|
12
|
Viva. C
section scar pregnancy. 2
|
|
13
|
EMQ. Uterine
transplant.
|
|
14
|
Role-play. Break bad news. Primigravida.
8 weeks. Some bleeding.
|
|
15
|
EMQ. Clue
cells, koilocytes etc.
|
|
16
|
SBA. Lynch syndrome
|
|
17
|
EMQ. Maternal
Mortality definitions
|
12. C
section scar pregnancy 2.
This
is a continuation of last week’s viva. The examiner will ask 12 questions.
13. 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
|
14.
Break bad news. Primigravida. 8 weeks. Some bleeding..
Candidate’s instructions.
You
are the SpR in the ante-natal clinic. The Consultant who was in clinic has been
asked to assist her Consultant colleague in the labour ward theatre. She is unlikely
to return for some time as the case is one of massive PPH and hysterectomy may
be necessary.
One
of the midwives asks you to see a patient who has just had a scan in the EPU. She is primigravid and the gestation is 8 weeks.
She has had some bleeding.
An
ultrasound scan = IUP. CRL = 12 mm. No fetal heart activity. No adnexal masses.
15. Clue
cells, koilocytes etc.
Lead-in.
Pick one option
from the option list. Each option can be used once, more than once or not at
all.
Abbreviations.
Ct: Chlamydia
trachomatis
HSV: Herpes
simplex virus
LGV: lymphogranuloma
venereum
Ng: Neisseria
gonorrhoeae
Tv: Trichomonas
vaginalis
Option
list.
|
A
|
Actinomyces
|
|
B
|
Bacterial
vaginosis
|
|
C
|
Bacteroides
|
|
D
|
Chlamydia
trachomatis
|
|
E
|
Chlamydial
infection of the genital tract
|
|
F
|
Herpes Simplex
|
|
G
|
Human Papilloma
Virus
|
|
H
|
Lymphogranuloma
venereum
|
|
I
|
Monilia
|
|
J
|
Neisseria
gonorrhoeae
|
|
K
|
Trichomonas
vaginalis
|
Scenario 1
Which
option or options from the option list best fit with “clue cells”
Scenario 2
Which option or options from the option list best fit with “fishy
odour”?
Scenario 3
Which option or options from the option list best fit with
“flagellate organisms”?
Scenario 4
Which option or options from the option list best fit with
“inflammatory smear”?
Scenario 5
Which option or options from the option list best fit with
“koilocytes”?
Scenario 6
Which option or options from the option list best fit with
“non-specific urethritis in the male”?
Scenario 7
Which option or options from the option list best fit with
“strawberry cervix”?
Scenario 8
Which option or options from the option list best fit with “thin
grey/ white discharge”?
Scenario 9
Which option or options from the option list best fit with “white,
curdy discharge”?
Scenario 10
Which option or options from the option list best fit with “frothy
yellow discharge”?
Scenario 11
Which option or
options from the option list best fit with “protozoan”?
Scenario 12
Which option or
options from the option list best fit with “obligate intracellular organism”?
Scenario 13
Which option or
options from the option list best fit with “blindness”?
Scenario 14
Which option or options
from the option list best fit with “LGV”?
Scenario 15
Which option or
options from the option list best fit with “multinucleated cells”?
Scenario 16
Which option or
options from the option list best fit with “serotypes D–K”?
Scenario 17
Which option or
options from the option list best fit with “serovars L1-L3”?
Scenario 18
Which of the
following are true in relation to Amsel’s criteria?
|
A
|
used
for the diagnosis of bacterial vaginosis
|
|
B
|
used
for the diagnosis of trichomonal infection
|
|
C
|
clue
cells present on microscopy of wet preparation of vaginal fluid
|
|
D
|
flagellate
organism present on microscopic examination of vaginal fluid
|
|
E
|
pH
≤ 4.5
|
|
F
|
pH
> 4.5
|
|
G
|
thin,
grey-white, homogeneous discharge present
|
|
H
|
frothy,
yellow-green discharge present
|
|
I
|
fishy
smell on adding alkali (10%KOH)
|
|
J
|
fishy
smell on adding acid (10%HCl)
|
|
K
|
koilocytes
present
|
|
L
|
absence
of vulvo-vaginal irritation
|
Scenario 19
Which of the
following are true in relation to Nugent’s Amsel’s criteria?
|
A
|
used
for the diagnosis of bacterial vaginosis
|
|
B
|
used
for the diagnosis of trichomonal infection
|
|
C
|
clue
cells present on microscopy of wet preparation of vaginal fluid
|
|
D
|
pH
≤ 4.5
|
|
E
|
pH
> 4.5
|
|
F
|
count
of lactobacilli
|
|
G
|
count
of Gardnerella and Bacteroides
|
|
H
|
count
of white cells
|
Scenario 20
Garnerella vaginallis can be cultured from the vagina
of what proportion of normal women?
|
A
|
<
10%
|
|
B
|
11
- 20%
|
|
C
|
21
- 30%
|
|
D
|
31
- 40%
|
|
E
|
41
- 50%
|
|
F
|
>
50%
|
16.
Lynch syndrome.
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
HNPCC: hereditary
non-polyposis colo-rectal cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
Question
1.
Lead-in
What is Lynch syndrome?
Option
List
|
A
|
auto-immune condition leading
to reduced factor X levels in blood
|
|
B
|
hereditary condition which increases the risk of many cancers,
particularly breast
|
|
C
|
hereditary condition which
increases the risk of many cancers, particularly breast & colorectal
|
|
D
|
hereditary condition which
increases the risk of many cancers, particularly colorectal & endometrial
|
|
E
|
none of the above
|
Question
2.
Lead-in
How is
Lynch syndrome inherited?
Option
List
|
A
|
it is an autosomal dominant
condition
|
|
B
|
it is an autosomal recessive condition
|
|
C
|
it is an X-linked dominant condition
|
|
D
|
it is an X-linked recessive condition
|
|
E
|
none of the above
|
Question
3.
Lead-in
Which, if any, of the following genes can
cause Lynch syndrome?
Genes.
|
A
|
MLH1
|
|
B
|
MLH2
|
|
C
|
MOH1
|
|
D
|
MSH1
|
|
E
|
MSH6
|
Option
List
|
A
|
MLH1 + MLH2 + MOH1
|
|
B
|
MLH1 + MLH2 + MSH1
|
|
C
|
MLH1 + MLH2 + MSH6
|
|
D
|
MLH1 + MSH2 + MSH6
|
|
E
|
None of the above
|
Question
4.
Lead-in
Mutations of which 2 of the following genes
cause the majority of cases of Lynch syndrome?
Genes.
|
A
|
MLH1
|
|
B
|
MLH2
|
|
C
|
MOH1
|
|
D
|
MSH1
|
|
E
|
MSH6
|
Option
List
|
A
|
MLH1 + MLH2
|
|
B
|
MLH1 + MSH1
|
|
C
|
MLH1 + MSH2
|
|
D
|
MLH2 + MSH1
|
|
E
|
MLH2 + MSH2
|
Question
5.
Lead-in
What is the approximate prevalence of Ls in
the UK population?
Option
List
|
A.
|
1 in 50
|
|
B.
|
1 in 100
|
|
C.
|
1 in 1,000
|
|
D.
|
3 in 1,000
|
|
E.
|
none of the above
|
Question
6.
Lead-in
Approximately what % of individuals with Ls
have had the diagnosis established?
Option
List
|
A.
|
< 5%
|
|
B.
|
5 -10%
|
|
C.
|
10-20%
|
|
D.
|
20-30%
|
|
E.
|
>30%
|
Question
7.
Lead-in
Which, if any, of the following conditions
are associated with an ↑ risk of Lynch syndrome?
Conditions
|
acromegaly
|
|
Addison’s disease
|
|
anosmia
|
|
coeliac disease
|
|
IBD
|
|
IDDM
|
Option
List
|
A
|
acromegaly + Addison’s disease
+ coeliac disease + IBD + IDDM
|
|
B
|
acromegaly + disease + anosmia
+ coeliac disease + IBD
|
|
C
|
acromegaly + IBD + IDDM
|
|
D
|
acromegaly + IBD
|
|
E
|
Addison’s disease + anosmia +
coeliac disease + IBD + IDDM
|
|
F
|
acromegaly + Addison’s disease
+ anosmia + coeliac disease + IBD + IDDM
|
|
G
|
acromegaly + Addison’s disease
+ anosmia + coeliac disease + IBD + IDDM
|
|
H
|
none
|
Question
8.
Lead-in
Which 2 cancers are most likely in women with
Lynch syndrome?
Cancers.
|
A
|
breast
|
|
B
|
bowel
|
|
C
|
cervix
|
|
D
|
endometrium
|
|
E
|
ovary
|
|
F
|
pancreas
|
Option
List
|
A
|
breast + bowel
|
|
B
|
breast + pancreas
|
|
C
|
breast + endometrium
|
|
D
|
bowel + cervix
|
|
E
|
bowel + endometrium
|
|
F
|
bowel + ovary
|
|
G
|
bowel + pancreas
|
|
H
|
endometrium + ovary
|
Question
9.
Lead-in
What does NICE recommend about screening for
Lynch syndrome for the population with no personal history of colorectal
cancer?
Option
List
|
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
|
B
|
offer screening to those aged < 60 years with ≥ 1 affected 1st.O
relative
|
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
|
E
|
none of the above
|
Question
10.
Lead-in
What does NICE recommend in relation to
screening for Lynch syndrome in those with a new diagnosis of colorectal
cancer?
Option
List
|
A
|
offer screening to everyone,
regardless of age and family history
|
|
B
|
offer screening to those aged < 50 years at diagnosis
|
|
C
|
offer screening to those aged < 60 years at diagnosis
|
|
D
|
offer screening to those aged < 50 years at diagnosis with +
≥ 1 affected 1st.O relative
|
|
E
|
offer screening to those aged < 60 years at diagnosis with +
≥ 1 affected 1st.O relative
|
Question
11.
Lead-in
What does NICE recommend about screening for
Lynch syndrome for the population with no personal history of thyroid cancer?
Option
List
|
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
|
B
|
offer screening to those aged < 60 years with ≥ 1 affected 1st.O
relative
|
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
|
E
|
none of the above
|
Question
12.
Lead-in
What does NICE recommend in relation to
screening for Lynch syndrome in those with a new diagnosis of thyroid cancer?
Option
List
|
A
|
offer screening to everyone,
regardless of age and family history
|
|
B
|
offer screening to those aged < 50 years at diagnosis
|
|
C
|
offer screening to those aged < 60 years at diagnosis
|
|
D
|
offer screening to those aged < 50 years at diagnosis with +
≥ 1 affected 1st.O relative
|
|
E
|
none of the above
|
Question
13.
Lead-in
What does NICE recommend about screening for
Lynch syndrome for the population with no personal history of endometrial
cancer?
Option
List
|
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
|
B
|
offer screening to those aged < 60 years with ≥ 1 affected 1st.O
relative
|
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
|
E
|
none of the above
|
Question
14.
Lead-in
What does NICE recommend in relation to
screening for Lynch syndrome in those with a new diagnosis of endometrial
cancer?
Option
List
|
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
|
B
|
offer screening to those aged < 60 years with ≥ 1 affected 1st.O
relative
|
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
|
E
|
none of the above
|
Question
15.
Lead-in
What does NICE recommend about screening for
Lynch syndrome for the population with no personal history of colorectal
cancer?
Option
List
|
A
|
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative
|
|
B
|
offer screening to those aged < 60 years with ≥ 1 affected 1st.O
relative
|
|
C
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis
|
|
D
|
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis
|
|
E
|
none of the above
|
Question
16.
Lead-in
What does NICE recommend in relation to
screening for Lynch syndrome in those with a new diagnosis of colorectal
cancer?
Option
List
|
A
|
offer screening to everyone,
regardless of age and family history
|
|
B
|
offer screening to those aged < 50 years at diagnosis
|
|
C
|
offer screening to those aged < 60 years at diagnosis
|
|
D
|
offer screening to those aged < 50 years at diagnosis with +
≥ 1 affected 1st.O relative
|
|
E
|
offer screening to those aged < 60 years at diagnosis with +
≥ 1 affected 1st.O relative
|
Question
17.
Lead-in
What relationship, if any, exists between Ls
and acromegaly?
Option
List
|
A
|
the risk of Ls is ↓ in those
with acromegaly compared with the general population
|
|
B
|
the risk of Ls is ↑ in those
with acromegaly compared with the general population
|
|
C
|
the risk of Ls is unchanged in
those with acromegaly compared with the general population
|
|
D
|
the risk of Ls in unknown in
those with acromegaly
|
Question
18.
Lead-in
What is the effect of aspirin consumption on
the risk of EC and CRC?
Option
List
|
A
|
aspirin reduces the risk of EC
and CRC
|
|
B
|
aspirin reduces the risk of EC
but not CRC
|
|
C
|
aspirin reduces the risk of CRC
but not EC
|
|
D
|
aspirin does not reduce the
risk of EC or CRC
|
|
E
|
aspirin reduces the risk of EC and CRC, but the risks outweigh
the benefits
|
Question
19.
Lead-in
A healthy woman of 35 years is diagnosed with
Ls? What are the key elements of the National Screening Programme for people
with Ls?
There is no option list – just write down
everything you know.
17.
Maternal mortality definitions.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each scenario.
Each option can be used once, more than once or not at all.
Option List.
A.
Death of a woman during pregnancy and up
to 6 weeks later, including accidental and incidental causes.
B.
Death of a woman during pregnancy and up
to 6 weeks later, excluding accidental and incidental causes.
C.
Death of a woman during pregnancy and up
to 52 weeks later, including accidental and incidental causes.
D.
Death of a woman during pregnancy and up
to 52 weeks later, excluding accidental and incidental causes.
E.
A pregnancy going to 24 weeks or beyond.
F.
A pregnancy going to 24 weeks or beyond +
any pregnancy resulting in a live-birth.
G.
Maternal deaths per 100,000 maternities.
H.
Maternal deaths per 100,000 live births.
I.
Direct + indirect deaths per 100,000
maternities.
J.
Direct + indirect deaths per 100,000 live
births.
K.
Direct death.
L.
Indirect death.
M.
Early death.
N.
Late death.
O.
Extra-late death.
P.
Fortuitous death.
Q.
Coincidental death.
R.
Accidental death.
S.
Maternal murder.
T.
Not a maternal death.
U.
Yes
V.
No.
W.
I have no idea.
X.
None of the above.
Abbreviations.
MMR: Maternal
Mortality Rate.
MMRat: Maternal
Mortality Ratio.
SUDEP: Sudden
Unexplained Death in Epilepsy.
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured ectopic pregnancy at 10
weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured appendix at 10 weeks’
gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What kind of death is
it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease dies of a
coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational trophoblastic disease,
develops choriocarcinomas and dies from it 24 months after the GTD was
diagnosed and the uterus evacuated. What kind of death is it?
Scenario 7
A woman develops puerperal psychosis from which she
makes a poor recovery. She kills herself when the baby is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal psychosis from which she
makes a poor recovery. She kills herself when the baby is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality Ratio?
Scenario 12
A woman is diagnosed with breast cancer. She has
missed a period and a pregnancy test is +ve. She decides to continue with the
pregnancy. The breast cancer does not respond to treatment and she dies from
secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the subject of domestic violence
is killed at 12 weeks’ gestation by her partner. What kind of death is it?
Scenario 14
A woman is struck by lightning as she runs across a
road. As a result she falls under the wheels of a large lorry which runs over
abdomen, rupturing her spleen and provoking placental abruption. She dies of
haemorrhage, mostly from the abruption. What kind of death is it?
Scenario 15
A woman is abducted by Martians who are keen to study
human pregnancy. She dies as a result of the treatment she receives. As this
death could only have occurred because she was pregnant, is it a direct death?
Scenario 16
Could a maternal death from malignancy be classified
as “Direct”.
Scenario 17
Could a maternal death from malignancy be classified
as “Indirect”.
Scenario 18
Could a maternal death from malignancy be classified
as “Coincidental”?
Scenario 19.
A pregnant woman is walking on the beach at 10 weeks
when she is struck by lightning and dies. What kind of death is this?
Scenario 20.
A woman is sitting on the beach breastfeeding her
2-month old baby when she is struck by lightning and dies. What kind of death
is this.
