19
|
EMQ. Surrogacy
|
20
|
Viva. The
uses of MgSO4 in O&G.
|
21
|
Role-play. Neonatal screening.
|
22
|
EMQ. Phenylketonuria
|
23
|
EMQ. Caldicott
guardian
|
24
|
EMQ. Peutz-Jeghers
syndrome
|
19.
EMQ. Surrogacy.
Surrogacy.
Lead-in.
This question is
about surrogacy. For each scenario, pick the best choice from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
Option
List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman
of the HFEA
f)
Senior
judge at the Children and Family Court
g)
traditional
surrogacy
h)
gestational
surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG
Surrogacy Sub-Committee
l)
false
m)
true
n)
none of
the above
Scenario
1
List the different types of
surrogacy.
Scenario
2.
“Gestational” surrogacy has
better “take-home-baby” rates than “traditional” surrogacy.
Scenario
3.
There are approximately 1,000
surrogate pregnancies per annum in the UK.
Scenario
4.
Which national body regulates
surrogacy in England?
Scenario
5.
Privately-arranged
surrogate pregnancies are illegal and those involved are liable to up to 2
years in prison.
Scenario
6.
List the risks of
surrogacy.
Scenario
7.
Obstetricians are
legally obliged to take the CPs’ wishes into consideration in managing
pregnancy complications or problems.
Scenario
8.
The psychological outcomes of
surrogacy are fully understood.
Scenario
9.
The psychological outcomes of surrogacy are more
severe after traditional surrogacy.
Scenario
10.
Who has the right
to arrange TOP if the fetus is found to have a major congenital abnormality?
Scenario
11.
A SM decides at 10
weeks that she does not wish to be pregnant and arranges to have a TOP. The
CPs. hear about this and object strongly. To whom should they apply to have the
TOP blocked?
Scenario
12.
A woman has
hysterectomy and BSO to deal with extensive endometriosis at the age of 30. She
marries two years later and her sister offers to act as surrogate. She
undergoes IVF and 4 embryos are created. One is transferred and a successful
pregnancy ensues. The baby is adopted by the woman and her husband. The 3
remaining embryos were frozen. Four years later the woman falls out with her sister,
but finds another surrogate and wishes to proceed with another pregnancy. The
sister says she does not want her eggs to be used and that the frozen embryos
should not be transferred. Does the sister have the legal right to block the
use of the embryos?
Scenario
13.
A girl born from
donor sperm reaches the age of 16 and wishes to know the identity of her
genetic father. Does she have the right to this information?
Scenario
14.
A girl born from
donor sperm reaches the age of 18 and wins a place at Oxford University to read
medicine. Does she have the legal right to get the donor to contribute to her
fees?
Scenario
15.
A PO is active from the moment
it is completed and signed by the relevant parties.
Scenario
16.
A SM can change her mind at any
time and keep the child, even if the egg was not hers.
Scenario
17.
The CPs can change their mind,
leaving the SM as the legal mother.
Scenario
18.
A SM’s husband is the legal
father until adoption is completed or a PO comes into force.
Scenario
19.
A lesbian couple in
a stable, co-habiting relationship can be CPs and become the legal parents of
the child of a SM.
Scenario
20.
CPs are likely to
get faster legal status as the legal parents through application for a PO
rather than applying for adoption.
20.
Viva. The uses of MgSO4 in O&G.
Candidate’s
instructions.
This
is a viva station about the uses of MgSO4 in O&G. To make it
harder, the examiner will not ask questions, prompt or otherwise assist. It is
up to you to give as full an account of the uses as you can muster.
21. Role-play. Neonatal screening.
Candidate’s
instructions.
You
are a SpR in year 5.
You
are in the antenatal booking clinic and about to see Mary Eccles. She has been
booked by a midwife at 10 weeks’ gestation and all is well. She has recently
arrived in the UK from the USA and asked about the routine neonatal screening
that is done in the UK. She will be having the baby in the UK.
22.
EMQ. Phenylketonuria.
Abbreviations.
BH4: tetrahydrobiopterin.
BH4D: tetrahydrobiopterin deficiency.
HPA: hyperphenylalaninaemia.
PA: phenylalanine.
PAH: phenylalanine
hydroxylase.
PKU: phenylketonuria.
Tyr: tyrosine.
Option
list.
A.
|
autosomal dominant
|
B.
|
autosomal recessive
|
C.
|
X-linked dominant
|
D.
|
X-linked recessive
|
E.
|
1 in 100,000
|
F.
|
1 in 50,000
|
G.
|
1 in 10,000
|
H.
|
1 in 5,000
|
I.
|
deficiency in phenylalanine
hydroxylase
|
J.
|
deficiency in phenylalanine
oxidase
|
K.
|
deficiency in phenylalanine
transferase
|
L.
|
deficiency in phenylketone
hydroxylase
|
M.
|
deficiency in phenylketone
oxidase
|
N.
|
raised PA levels
|
O.
|
reduced PA levels
|
P.
|
raised tyrosine levels
|
Q.
|
reduced tyrosine levels
|
R.
|
normal tyrosine levels
|
S.
|
No
|
T.
|
Yes
|
U.
|
unknown
|
What is PKU? Write your answer – there is no option list.
Question
2.
What is PKU due to? Use the option list.
Question
3.
What levels of PA and Tyr are typical in PKU?
Use the option list. This is not a real EMQ as there are two answers.
Question
4.
Is PKU subdivided into different categories?
If “yes”, what are the categories? Write your answer – there is no option list.
Question
5.
How is PKU inherited? Use the option list.
Question
6.
Which chromosome houses the gene related to
PKU transmission?
Question
7.
How many mutations of the gene related to PKU
have so far been identified?
Question
8.
Is a person with PKU likely to have one or
two mutations of the relevant gene?
Question
9.
What are the main consequences of PKU? Write
your answer – there is no option list.
Question
10.
Which, if any, of the following are
characteristic of PKU?
Answer.
Option
list.
A.
|
alopecia
|
B.
|
angst
|
C.
|
facial dysmorphism
|
D.
|
facial hair in females and
pre-pubertal males
|
E.
|
kyphosis
|
F.
|
macroorchidism in post-pubertal
males
|
Question
11.
Are fetal PKU levels higher or lower than
maternal? Write your answer – there is no option list.
Question
12.
What is the approximate prevalence of PKU in
Caucasians?
Question
13.
The prevalence of PKU varies between ethnic
groups.
Match each of the following ethnic groups to
the closest prevalence given in the option list.
Option
List
1.
|
1 in 1,000
|
2.
|
1 in 2,500
|
3.
|
1 in 5,000
|
4.
|
1 in 10,000
|
5.
|
1 in 100,000
|
6.
|
1 in 150,000
|
7.
|
1 in 200,000
|
8.
|
1 in 1,000,000
|
Ethnic
group
|
Prevalence
|
Caucasian
|
|
East Asian
|
|
Finnish
|
|
Irish
|
|
Japanese
|
|
Turkish
|
Question
14.
Is screening for PKU a routine part of the
neonatal screen in the UK?
Question
15.
The test for PKU used to be known by the name
of its inventor. Who was he and why did he have a particular interest? There is no
option list and no one is going to ask you except me!
Lead-in
What is the main treatment of PKU and what problems are
associated with it? There is no option list.
Question 17.
Lead-in
How long should the main treatment of PKU be continued
and why? There is no option list.
Question
18.
Lead-in
A woman with PKU is planning her first pregnancy
at the age of 22. She has been off the PKU-restricted diet since the age of 10
and can barely remember being on it. Should she be advised to re-start the
diet? If ‘yes’, when should she start and what explanation would you give for
the advice?
Question
19.
Lead-in
Is breast-feeding advisable for women with
PKU?
Question
20.
Lead-in
Are any other therapeutic approaches
available? If ‘yes’, what are they and how do they work? If ‘yes’ use the
option list for the mode of action.
23.
EMQ. Caldicott guardian.
Question
1.
Which of the following statements is true of
the Caldicott Guardian?
Option
List
A
|
it is a large lizard, unique to the
Galapagos Islands
|
B
|
it is the Trust Board member
responsible for child safeguarding procedures
|
C
|
it is the Trust Board member
responsible for complaint procedures
|
D
|
it is the person within a Trust
responsible for patient confidentiality in relation to information
|
E
|
it is the person within a Trust
responsible for dealing with bullying
|
Question
2.
The Caldicott Report identified 6 basic principles.
What are they?
Option
list.
There
is none. Imagine that there is information about you stored on the computers of
the local NHS Trust. What conditions would you want to lay down about sharing
of that information within the Trust, with other NHS organisations and with
non-NHS organisations?
Question
3.
The Caldicott Report made numerous
recommendations. Which was particularly important for major NHS organisations
such as Trusts?
Option
List
A.
|
the need to appoint a Caldicott
Guardian
|
B.
|
the need to create a Caldicott Register
|
C.
|
the need to create a Caldicott Police Department
|
D.
|
the need to create a link between the Caldicott Department and
the DOH
|
E.
|
none of the above.
|
Question
4.
What is the definition of the key role
deriving from the answer to question 3?
Option
List
There is none lest it give you the answer to
question 3!
24.
EMQ. Peutz-Jeghers syndrome.
Scenario
1.
Which, if any, of the following are characteristics of PJS?
Option
list.
A.
|
buccal pigmentation
|
B.
|
gastro-intestinal hamartomas
|
C.
|
perianal pigmentation
|
D.
|
increased risk of breast cancer
|
E.
|
increased risk of cervical adenoma malignum
|
F.
|
increased risk of colo-rectal cancer
|
G.
|
increased risk of endometrial cancer
|
H.
|
increased risk of ovarian cancer
|
I.
|
increased risk of pancreatic cancer
|
J.
|
increased risk of prostate cancer
|
K.
|
increased risk of stomach cancer
|
Scenario
2.
What is the approximate prevalence of PJS?
Option
list.
A.
|
< 1 in 1,000
|
B.
|
1 in 1,000 to 1 in 10,000
|
C.
|
1 in 10,000 to 1 in 100,000
|
D.
|
1 in 25,000 to 1 in 100,000
|
E.
|
1 in 25,000 to 1 in 200,000
|
F.
|
1 in 25,000 to 1 in 300,000
|
G.
|
1 in 300,000 to 1 in 500,000
|
H.
|
< 1 in 500,000
|
Scenario
3.
What
is the mode of inheritance in PJS?
Option
list.
A
|
autosomal dominant
|
B
|
autosomal recessive
|
C
|
X-linked dominant
|
D
|
X-linked recessive
|
E
|
Y-linked dominant
|
F
|
Y-linked recessive
|
G
|
triplet repeat
|
Scenario
4.
Which,
if any, of the following statements are true of PJS?
Option
list.
A
|
PJS only occurs in families with other affected members
|
B
|
PJS mainly occurs in families with other affected members
|
C
|
PJS may arise de-novo in families with no other affected members
|
D
|
PJS may arise de-novo in families with other affected members
|
E
|
PJS does not arise de-novo in families with no other affected
members
|
Scenario
5.
What is the approximate lifetime risk of developing cancer in PJS?
Option
list.
A.
|
10%
|
B.
|
20%
|
C.
|
30%
|
D.
|
40%
|
E.
|
50%
|
F.
|
60%
|
G.
|
70%
|
H.
|
80%
|
I.
|
90%
|
J.
|
>90%
|
Scenario
6.
What is the relevance of SK11 to PJS?
Option
list.
A.
|
It is part of the postcode of the Peutz-Jeghers Society
|
B.
|
It is the name of the gene most commonly associated with PJS
|
C.
|
It is the Ornithological Society’s code for the Orkney Skua
|
D.
|
Somatic mutations have been found in cervical cancer
|
E.
|
None of the above
|
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