4
October 2018
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25
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Viva. Obstructive
sleep apnoea
|
|
Role-play. Complaint. Mis-filed combined Ds test
report.
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|
|
27
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Viva. Neonatal
jaundice.
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|
28
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|
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29
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EMQ. Galactosaemia
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25. Viva.
Obstructive sleep apnoea.
Candidate's
Instructions.
This
is a viva station, now called a ‘structured discussion’. The examiner will ask
you 11 questions.
When
you have answered a question and moved to the next, you are not allowed to
return as later questions may give answers to earlier ones.
26. Role-play.
Complaint. Mis-filed combined Ds test report.
Candidate's
Instructions.
You
are the SpR in the ante-natal clinic. The consultant has been called to the
labour ward to help with a case of placenta accreta and you have been put in
charge of the clinic.
Mrs
Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of
1: 40. The report had been filed in the notes in error by a clerk without being
shown to any of the medical or midwifery staff. She attended today for the
routine 20 week scan. The ultrasonographer found the report in the notes,
realised that no action had been taken and made arrangements for the patient to
see you today.
27. Viva.
Neonatal jaundice.
Candidate's
Instructions.
This
is a viva station. The examiner will ask you 6 questions.
28.
EMQ. Renal transplant.
Abbreviations.
AST: American Society for Transplantation
eGFR: estimated glomerular filtration rate
Question
1
Approximately how many women who have had renal transplant have
pregnancies annually in the UK?
Option
list.
|
A
|
10-20
|
|
B
|
30-40
|
|
C
|
50-100
|
|
D
|
100-200
|
|
E
|
200-300
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|
F
|
300-400
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|
G
|
400-500
|
|
H
|
>500
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Question
2
Which, if any, of the following statements are true about the
findings of the UKOSS survey of renal transplant in pregnancy?
Option
list.
|
A
|
the incidence of PET was ~ 25%, roughly six times higher than
the general population
|
|
B
|
the incidence of PET was ~ 25%, roughly ten times higher than
the general population
|
|
C
|
the incidence of PET was ~ 50%, roughly ten times higher than
the general population
|
|
D
|
the incidence of PET was ~ 50%, roughly twenty times higher than
the general population
|
|
E
|
none of the above
|
Question
3
Various sources, such as AST, give factors linked to reduced risks
associated with pregnancy after RT. A lot of this is common sense. Write down
all the factors that would be in your list.
Question
4
What is the risk of graft rejection in the year after RT?
Option
list.
|
A
|
< 5%
|
|
B
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10-15%
|
|
C
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15-20%
|
|
D
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20-25%
|
|
E
|
unknown
|
Question
5
Which of the following factors are the 3 main ones affecting
pregnancy outcome?
Factors
|
1
|
anaemia
|
|
2
|
diabetes
|
|
3
|
hypertension
|
|
4
|
number of immunosuppressive drugs being used
|
|
5
|
obesity
|
|
6
|
pre-pregnancy graft function
|
|
7
|
proteinuria
|
|
8
|
urinary tract infection
|
Option
list.
|
A
|
1 + 2 + 3
|
|
B
|
1 + 2 + 6
|
|
C
|
2 + 3 + 4
|
|
D
|
2 + 4 + 6
|
|
E
|
3 + 6 +7
|
|
F
|
3 + 6 + 8
|
|
G
|
4 + 5 + 6
|
|
H
|
4 + 6 + 8
|
Question
6
Which of the following statements is true in relation to the
prevalence of hypertension in women after RT?
Option
list.
|
A
|
> 20% have hypertension
|
|
B
|
> 30% have hypertension
|
|
C
|
> 40% have hypertension
|
|
D
|
> 50 % have hypertension
|
|
E
|
none of the above
|
Question
7
State whether these drugs are regarded as safe or unsafe in
pregnancy.
|
|
Drug
|
Safe
/ unsafe
|
|
A
|
ACE inhibitor
|
Safe / unsafe
|
|
B
|
angiotensin receptor antagonist
|
Safe / unsafe
|
|
C
|
azathioprine
|
Safe / unsafe
|
|
D
|
ciclosporin
|
Safe / unsafe
|
|
E
|
clopidogrel
|
Safe / unsafe
|
|
F
|
erythropoietin
|
Safe / unsafe
|
|
G
|
hydroxychloroquine
|
Safe / unsafe
|
|
H
|
mycophenolate
|
Safe / unsafe
|
|
I
|
prednisolone
|
Safe / unsafe
|
|
J
|
tacrolimus
|
Safe / unsafe
|
|
K
|
warfarin
|
Safe / unsafe
|
TOG
CPD
With
regard to renal transplant,
1. most recipients have a successful pregnancy
outcome. T F
2. pregnancy is associated with a 10% reduction
in GFR in recipients with prepregnancy eGFR >90 ml/ min/1.73m2. T
F
3. hypertension complicates pregnancy in over
50% of recipients who did not require antihypertensive treatment prior to
pregnancy. T F
4. proteinuria is a predictor of poor pregnancy
outcome in recipients. T F
5. the risk of damage to the allograft at
caesarean delivery is about 1%. T F
6. a positive serological screening test for
aneuploidy in recipients is a recognised consequence of impaired renal
function. T F
7. superimposed pre-eclampsia in recipients has
defined diagnostic criteria. T F
8. erythropoietin requirements in recipients
fall in pregnancy. T F
9. breastfeeding is safe in recipients on
angiotensin converting enzyme inhibitors. T F
10. conception is not advised in recipients within
the 1st. year following transplantation. T F
11. continuous electronic fetal monitoring is
recommended during labour in recipients. T F
12. the progesterone implant is a safe form of
postpartum contraception in recipients. T F
Women
who have donated a kidney,
13. are at increased risk of gestational
hypertension. T F
Combined
kidney-pancreas transplant recipients,
14. have a higher risk of gestational diabetes
than kidney transplant recipients. T F
Liver
transplant recipients,
15. have a lower risk of pregnancy complications
than renal transplant recipients. T F
With
regard to pregnancy in cardiothoracic transplant recipients,
16. lung transplant recipients have the highest
risk of adverse outcome of all solid organ transplants. T F
17. due to denervation, the transplanted heart
responds poorly to the physiological changes of pregnancy. T F
18. cardiothoracic transplant recipients should be
delivered by caesarean section. T F
Regarding
medications prescribed in patients with solid organ transplants,
19. tacrolimus levels require monitoring during
pregnancy. T F
20. warfarin is safe for breastfeeding mothers. T
F
29.
EMQ. Galactosaemia.
Galactosaemia.
Abbreviations.
GA: galactose
GAA: galactosaemia
Scenario
1.
What is galactosemia? There is no option list.
Scenario
2.
What is the mode of inheritance? There is no option list.
Scenario
3.
Which of the following is the most common cause of galactosemia in
Caucasians?
Option
list.
|
A
|
mutation of the GALE gene
|
|
B
|
mutation of the GALF gene
|
|
C
|
mutation of the GALK gene
|
|
D
|
mutation of the GALk1 gene
|
|
E
|
mutation of the GALT gene
|
Scenario
4.
What is the mutation which causes Classical Galactosaemia?
Option
list.
|
A
|
Q188L
|
|
B
|
Q188M
|
|
C
|
Q188R
|
|
D
|
R188L
|
|
E
|
R188M
|
|
F
|
R188R
|
|
G
|
None of the above
|
Scenario
5.
What is the Duarte mutation? There is no option list.
Scenario
6.
What are the main sources of galactose? There is no option list.
Scenario
7.
What is the approximate prevalence of galactosemia? There is no
option list.
Scenario
8.
Which of the following groups has the highest prevalence of
galactosaemia?
Option
list.
|
A
|
Armenians
|
|
B
|
Ashkenazi Jews
|
|
C
|
French absinthe drinkers
|
|
D
|
Irish campers
|
|
E
|
Irish travellers
|
|
F
|
Masai
|
|
G
|
Scottish campers
|
|
H
|
None of the above
|
Scenario
9.
Which is the most common mutation in the group with the highest incidence
of galactosemia? There is no option list.
Scenario
10.
Which, if any, of the following are linked to untreated GAA in the
newborn?
Option
list.
|
A
|
risk of
coagulation problems
|
|
B
|
risk of
congenital hypothyroidism
|
|
C
|
risk of
diabetes
|
|
D
|
risk of
diarrhoea
|
|
E
|
risk of
failure to thrive
|
|
F
|
risk of liver
failure
|
|
G
|
risk of renal
failure
|
|
H
|
risk of
staphylococcal infection
|
Scenario
11.
What are the main problems associated with non-treatment of
galactosaemia in adults? There is no option list.
Scenario
12.
Which, if any, of the following statements are true in relation to
the effects of a galactose-reduced diet (GRD) on long-term complications
(LTCs)?
Option
list.
|
A
|
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth
|
|
B
|
a GRD has a major protective effect on LTCs, but only if started
within 12 weeks of birth
|
|
C
|
a GRD has a major protective effect on LTCs, but only if
followed meticulously
|
|
D
|
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth and continued for life
|
|
E
|
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth and continued for life
|
|
F
|
none of the above
|
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