51
|
EMQ. Anatomy
of fetal skull and maternal pelvis
|
52
|
EMQ. Kallmann’s syndrome
|
53
|
EMQ. HCV and pregnancy
|
54
|
SBA. Appendicitis
in pregnancy
|
55
|
EMQ. Caldicott
guardian
|
51. Anatomy of fetal skull and maternal pelvis.
Scenario
1.
How many bones make up the
vault of the skull?
Option list.
A.
|
3
|
B.
|
5
|
C.
|
6
|
D.
|
7
|
E.
|
8
|
Scenario
2.
What is the origin of the word
“bregma”?
Option list.
A.
|
the Greek word meaning “arrow”
|
B.
|
the Greek word meaning “front of the head”
|
C.
|
the Greek word meaning “top of the head”
|
D.
|
the Greek word meaning “where lines intersect”
|
E.
|
none of the above
|
Scenario
3.
What is the origin of the word
“lambdoid”?
Option list.
A.
|
it is derived from “lambda”, the 11th.
letter of the Greek alphabet, with the symbol “λ”
|
B.
|
it is derived from the shape of the rear end of a
newborn lamb, with legs apart for balance in the shape of an inverted “V”
|
C.
|
it derives from the Norse noun “lam” meaning to hit
|
Scenario
4.
What is the origin of the word
“sagittal”?
Option list.
A.
|
it derives from the Latin verb “sagire” meaning to be
wise
|
B.
|
it derives from the Latin noun “sagitta” meaning
“arrow”
|
C.
|
it derives from the Latin adjective “sagitta” meaning
“pointing north”
|
D.
|
it derives from the Latin adjective “sagitta” meaning
“lacking tension”
|
Scenario
5.
What is the meaning of the word
“coronal”.
Option list.
A.
|
it is the 11th. letter of the Greek alphabet
|
B.
|
it derives from the Latin “corona” meaning “crown”.
|
C.
|
it derives from the sun’s corona, meaning equator
|
Scenario
6.
What is the definition of
“vertex”?
Option list.
A.
|
the most prominent part of the occiput
|
B.
|
the area around the posterior fontanelle
|
C.
|
the area bounded by the anterior fontanelle and the
posterior fontanelle
|
D.
|
the area bounded by the anterior & posterior
fontanelles and the parietal bones
|
E.
|
the area bounded by the anterior & posterior
fontanelles and the parietal eminences
|
F.
|
the area bounded by the anterior & posterior
fontanelles and the parietal cardinals
|
Scenario
7.
What is the definition of the
anterior fontanelle?
Option list.
A.
|
the anterior end of the sagittal suture
|
B.
|
the area where the sagittal and coronal sutures meet
|
C.
|
the area between the frontal and parietal bones
|
D.
|
the posterior end of the sagittal suture
|
E.
|
the area between the parietal bones and the occiput
|
Scenario
8.
What is the definition of the posterior
fontanelle?
Option list.
A.
|
the anterior end of the
sagittal suture
|
B.
|
the area where the sagittal
and lambda sutures meet
|
C.
|
the area between the frontal
and parietal bones
|
D.
|
the posterior end of the
sagittal suture
|
E.
|
the area between the parietal
bones and the occiput
|
Scenario
9.
How many other fontanelles are
there?
A.
|
0
|
B.
|
2
|
C.
|
3
|
D.
|
4
|
E.
|
6
|
Scenario
10.
What is the falx cerebri?
Option list.
A.
|
an area of dura mater at the back of the skull like a
roof over the cerebellum
|
B.
|
is an artefact on ultrasound suggesting the presence of
cerebral tissue where there is none
|
C.
|
is the horizontal fibrous platform on which the
cerebellum rests
|
D.
|
is a crescent-shaped fold of dura mater separating the
cerebral hemispheres
|
Scenario
11.
What is the importance of the
falx cerebri in relation to delivery, particularly breech delivery?
Option list.
A.
|
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears
and intracranial bleeding
|
B.
|
the falx cerebri is inserted into the bone of base of
the skull and traction on the base of the skull may lead to tears of the falx
and intracranial bleeding
|
C.
|
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears leaving
the cerebellum unsupported and liable to trauma
|
Scenario
12.
What diameter presents to the
pelvis with vertex presentation?
Option list.
A.
|
suboccipito-bregmatic
|
B.
|
suboccipito-frontal
|
C.
|
occipito-frontal
|
D.
|
mento-vertical
|
E.
|
submento-bregmatic
|
Scenario
13.
What diameter presents to the
pelvis with typical occipito-posterior position?
Option list.
A.
|
suboccipito-bregmatic
|
B.
|
suboccipito-frontal
|
C.
|
occipito-frontal
|
D.
|
mento-vertical
|
E.
|
submento-bregmatic
|
Scenario
14.
What diameter presents to the
pelvis with brow presentation?
Option list.
A.
|
suboccipito-bregmatic
|
B.
|
suboccipito-frontal
|
C.
|
occipito-frontal
|
D.
|
mento-vertical
|
E.
|
submento-bregmatic
|
Scenario
15.
What diameter presents to the
pelvis with mento-anterior face presentation?
Option list.
A.
|
suboccipito-bregmatic
|
B.
|
suboccipito-frontal
|
C.
|
occipito-frontal
|
D.
|
mento-vertical
|
E.
|
submento-bregmatic
|
Scenario
16.
What diameter presents to the
pelvis with mento-posterior face presentation?
Option list.
A.
|
suboccipito-bregmatic
|
B.
|
suboccipito-frontal
|
C.
|
occipito-frontal
|
D.
|
mento-vertical
|
E.
|
submento-bregmatic
|
Scenario
17.
What is the average length of
the suboccipito-bregmatic diameter in a term baby?
Option list.
A.
|
9.0 cm.
|
B.
|
9.5 cm.
|
C.
|
10.0 cm.
|
D.
|
10.5 cm.
|
E.
|
11.0 cm.
|
F.
|
11.5 cm.
|
G.
|
12.0 cm.
|
H.
|
12.5 cm.
|
I.
|
13.0 cm.
|
J.
|
13.5 cm.
|
K.
|
14.0 cm.
|
Scenario
18.
What is the average length of
the suboccipito-frontal diameter in a term baby?
Option list.
A.
|
9.0 cm.
|
B.
|
9.5 cm.
|
C.
|
10.0 cm.
|
D.
|
10.5 cm.
|
E.
|
11.0 cm.
|
F.
|
11.5 cm.
|
G.
|
12.0 cm.
|
H.
|
12.5 cm.
|
I.
|
13.0 cm.
|
J.
|
13.5 cm.
|
K.
|
14.0 cm.
|
Scenario
19.
What is the average length of
the occipito-frontal diameter in a term baby?
Option list.
A.
|
9.0 cm.
|
B.
|
9.5 cm.
|
C.
|
10.0 cm.
|
D.
|
10.5 cm.
|
E.
|
11.0 cm.
|
F.
|
11.5 cm.
|
G.
|
12.0 cm.
|
H.
|
12.5 cm.
|
I.
|
13.0 cm.
|
J.
|
13.5 cm.
|
K.
|
14.0 cm.
|
Scenario
20.
What is the average length of
the mento-vertical diameter in a term baby?
Option list.
A.
|
9.0 cm.
|
B.
|
9.5 cm.
|
C.
|
10.0 cm.
|
D.
|
10.5 cm.
|
E.
|
11.0 cm.
|
F.
|
11.5 cm.
|
G.
|
12.0 cm.
|
H.
|
12.5 cm.
|
I.
|
13.0 cm.
|
J.
|
13.5 cm.
|
K.
|
14.0 cm.
|
Scenario
21.
What is the average length of
the submento-bregmatic diameter in a term baby?
Option list.
A.
|
9.0 cm.
|
B.
|
9.5 cm.
|
C.
|
10.0 cm.
|
D.
|
10.5 cm.
|
E.
|
11.0 cm.
|
F.
|
11.5 cm.
|
G.
|
12.0 cm.
|
H.
|
12.5 cm.
|
I.
|
13.0 cm.
|
J.
|
13.5 cm.
|
K.
|
14.0 cm.
|
52. 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
|
53. Hepatitis C & pregnancy.
HCV.
Lead-in.
Pick one
option from the option list. Each option can be used once, more than once or
not at all.
Some of the questions are not true EMQs as
more than one of the options is true. I arrange things this way as it makes the
answers shorter and reduces the amount of typing and the amount of paper needed
for printing. Some are not EMQs at all as there is no option list and you have
to come up with your own answers.
Abbreviations.
HBcAg: Hepatitis B core antigen
HCV: Hepatitis C
virus.
HCAb: Hepatitis C
antibody.
MTCT: mother-to-child
transmission.
NICU: neonatal
intensive-care unit,
PTB: preterm
birth,
STD: sexually-transmitted
disease.
Scenario
22.
Which,
if any, of the following statements are true?
Option list.
A
|
Hepatitis
kills more people world-wide than HIV
|
B
|
Hepatitis
kills more people world-wide than TB
|
C
|
Hepatitis B
kills more people world-wide that Hepatitis C
|
D
|
Hepatitis B
kills more people world-wide than TB
|
E
|
None of the
above
|
Scenario
23.
Which,
if any, of the following statements are true in relation to HCV?
Option list.
A
|
It is a DNA
virus
|
B
|
It is a RNA
virua
|
C
|
It is a
member of the Flaviviridae family
|
D
|
it is a
member of the Hepadnaviridae family
|
E
|
it is a
member of the Herpesviridae family
|
F
|
most
infections are due to genotypes 1 & 3
|
G
|
most
infections are due to genotypes 2 & 4
|
Scenario
24.
What
is the approximate prevalence of HCV infection in the UK?
Option list.
A
|
0.1 per
1,000
|
B
|
0.3 per
1,000
|
C
|
0.5 per
1,000
|
D
|
1 per 1,000
|
E
|
3 per 1,000
|
F
|
5 per 1,000
|
G
|
10 per 1,000
|
H
|
13 per 1,000
|
I
|
15 per 1,000
|
J
|
None of the
above
|
Scenario
25.
What
are the key aspects of the WHO’s Global Health Sector Strategy in relation to
HCV infection?
Option list.
A
|
elimination
as a as a major public health threat by 2020
|
B
|
elimination
as a as a major public health threat by 2030
|
C
|
elimination
as a as a major public health threat by 2040
|
D
|
reduction in
incidence by 50% by 2030
|
E
|
reduction in
incidence by 75% by 2030
|
E
|
reduction in
incidence by 80% by 2030
|
F
|
reduction in
mortality by 50% by 2030
|
G
|
reduction in
mortality by 65% by 2030
|
H
|
reduction in
mortality by 70% by 2030
|
Scenario
26.
What
is the incubation period of HCV infection?
Option list.
A
|
6 weeks
|
B
|
2 months
|
C
|
up to 3
months
|
D
|
up to 4
months
|
E
|
up to 6
months
|
F
|
up to 12
months
|
G
|
none of the
above
|
Scenario
27.
What
symptoms are most common in acute HCV infection? There is no option list.
Scenario
28.
How
is acute HCV infection diagnosed?
Option list.
A
|
clinically
|
B
|
presence of HCV
antibody
|
C
|
presence of HCV
IgM
|
D
|
presence of HCV
IgG
|
E
|
presence of HCV
RNA
|
F
|
none of the
above
|
Scenario
29.
What
proportion of those with acute HCV infection are asymptomatic?
Option list.
A
|
10%
|
B
|
20%
|
C
|
50%
|
D
|
60%
|
D
|
70%
|
E
|
> 80%
|
Scenario
30.
When
does continuing infection after initial exposure become defined as chronic
infection?
Option list.
A
|
after 6
weeks
|
B
|
after 2
months
|
C
|
after 3 months
|
D
|
after 4
months
|
E
|
after 6
months
|
F
|
after 12
months
|
G
|
none of the
above
|
Scenario
31.
Approximately
how many of those with acute HCV infection will go on to chronic infection?
Option list.
A
|
10%
|
B
|
20%
|
C
|
40%
|
D
|
50%
|
E
|
>50%
|
F
|
>70%
|
Scenario
32.
A
woman is found to have HCV antibodies. Which, if any, of the following
statements could be true?
Option list.
A
|
she could
have acute HCV infection
|
B
|
she could
have chronic infection
|
C
|
she could
have had HCV infection that has cleared spontaneously
|
D
|
she could
have had HCV infection that has responded to drug therapy
|
E
|
she could
have a false +ve test result
|
F
|
she could
have chronic HBV infection due to cross reaction with HBcAg
|
G
|
she is
immune to HCV
|
H
|
the
antibodies could result from HCV vaccine
|
I
|
the antibodies
could result from yellow fever vaccine
|
J
|
none of the
above
|
Scenario
33.
Which,
if any, of the following statements reflect current thinking about the
mechanisms of damage in chronic HCV infection?
Option list.
A
|
hepatic
damage is proportional to the duration of HCV infection
|
B
|
hepatic
damage is a direct result of HCV replication within hepatocytes
|
C
|
hepatic
damage is proportional to the level of detectable HCV RNA in maternal blood
|
D
|
hepatic damage is
immune-mediated
|
E
|
hepatic
damage is due to progressive biliary tract infection, scarring and stenosis
|
F
|
hepatic
damage mostly occurs in women who abuse alcohol
|
G
|
hepatic
damage is worse in women with co-existing HIV infection
|
H
|
hepatitis D
is end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating
from the original name: ‘deadly-stage’ HCV disease
|
Scenario
34.
How
common is vertical transmission? There is no option list.
Scenario
35.
Which,
if any, of the following statements are true in relation to the hepatitides?.
A
|
acute
hepatitis is notifiable
|
B
|
chronic
hepatitis is notifiable
|
C
|
hepatitis
A is notifiable as the main route of spread is faecal contamination of food
& water
|
D
|
hepatitis
D is notifiable as the main source of infection is infected food and water
|
E
|
hepatitis
E is notifiable as the main source of infection in the UK is raw or
undercooked pork
|
F
|
none
of the above
|
Scenario
36.
What
anti-viral treatment is recommended for pregnancy? There is no option list.
Scenario
37.
Which,
if any, of the following are true about Ribavirin?
Option list.
A
|
it is the
least expensive of the new DAADs for HCV
|
B
|
it is the
least toxic of the new DAADs for HCV
|
C
|
it is the
most effective of the new DAADs for HCV
|
D
|
it is
contraindicated in pregnancy because of fears of teratogenicity
|
E
|
can
cause sperm abnormalities
|
F.
|
can persist
in humans for up to 6 months
|
G.
|
none of the
above
|
Scenario
38.
A
woman with chronic HCV wishes to breastfeed. What advice would you give? There
is no option list.
Scenario
39.
How
is neonatal infection diagnosed? There is no option list.
Scenario
40.
How
is neonatal infection treated? There is no option list.
54. Topic. Appendicitis in pregnancy (AIP)
Abbreviations.
AIP
|
Appendicitis
in pregnancy
|
CRP
|
C
reactive protein
|
CT
|
computed
tomography, also known as computerised tomography
|
EFHRM
|
electronic
fetal heart rate monitoring
|
RLQP
|
right
lower quadrant pain
|
RUQP
|
right upper
quadrant pain
|
Question 1.
Lead-in
What is
the approximate incidence of appendicitis in pregnancy?
Option List
A.
|
1 in 500
|
B.
|
1 in 1,000
|
C.
|
1 in 2,000
|
D.
|
1 in 5,000
|
E.
|
1 in 10,000
|
Question 2.
Lead-in
When is appendicitis
in pregnancy most common?
Option List
A.
|
first
trimester
|
B.
|
second trimester
|
C.
|
trimester
|
D.
|
1st. and 2nd. stages of labour
|
E.
|
in the hours after the 3rd. stage of labour
|
F.
|
during the puerperium
|
Question 3.
Lead-in
What
eponymous title is given to the surface marker for the appendix?
Option List
A.
|
McBarney’s
point
|
B.
|
MacBurney’s point
|
C.
|
McBurney’s point
|
D.
|
MacBorney’s point
|
E.
|
McBorney’s point
|
Question 4.
Lead-in
Where is
the point referred to in the above question?
Option List
A.
|
1/3 of
the way along the line joining the anterior superior iliac spine and
umbilicus
|
B.
|
1/2 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
C.
|
2/3 of the way along the line joining the anterior
superior iliac spine and umbilicus
|
D.
|
1/3 of the way along the line joining the left and
right anterior superior iliac spines
|
E.
|
1/2 of the way along the line joining the left and
right anterior superior iliac spines
|
Question 5.
Lead-in
Which, if
any, of the following statements are true about the person after whom the point
in the above questions is named?
Statements
A.
|
he spent
2 years as a postgraduate working in Berlin, London, Paris and Vienna
|
B.
|
he was
Professor of surgery at the Roosevelt hospital, New York from 1889 to 1894
|
C.
|
he presented his classical paper on appendicitis to the
NY Surgical Society in 1889
|
D.
|
he was a transvestite
|
E.
|
he died of a heart attack while on a hunting trip
|
Question 6.
Lead-in.
Pick the
best option from the list below in relation to right lower quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RLQP is
as common in the pregnant as in the non-pregnant
|
C
|
RLQP is
less common in the pregnant
|
D
|
RLQP is more common in the pregnant
|
E
|
RLQP is rare in pregnancy
|
Question 7.
Lead-in.
Pick the
best option from the list below in relation to right upper quadrant pain in AIP
in the pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
RUQP is
½ as common in the pregnant as in the non-pregnant
|
C
|
RUQP is
as common in the pregnant as in the non-pregnant
|
D
|
RUQP is
twice as common in the pregnant as in the non-pregnant
|
E
|
RUQP is
four times as common in the pregnant as in the non-pregnant
|
Question 8.
Lead-in.
Pick the
best option from the list below in relation to nausea in AIP in the pregnant
and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
nausea
is as common in the pregnant as in the non-pregnant
|
C
|
nausea
is less common in the pregnant
|
D
|
nausea is more common in the pregnant
|
E
|
nausea is rare in pregnancy
|
Question 9.
Lead-in.
Which
condition did CMACE say should be excluded in women presenting acutely with
gastrointestinal symptoms?
Option List
A
|
aortic dissection
|
B
|
appendicitis
|
C
|
Caesarean
section scar pregnancy
|
D
|
ectopic pregnancy
|
E
|
pancreatitis
|
F
|
ovarian torsion
|
Question 10.
Lead-in.
Pick the
best option from the list below in relation to abdominal guarding in AIP in the
pregnant and non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
abdominal
guarding is as common in the pregnant as in the non-pregnant
|
C
|
abdominal
guarding is less common in the pregnant
|
D
|
abdominal
guarding is more common in the pregnant
|
E
|
abdominal
guarding is rare in pregnancy
|
Question 11.
Lead-in.
Pick the
best option from the list below in relation to rebound tenderness in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
rebound tenderness is as common in the pregnant as in
the non-pregnant
|
C
|
rebound tenderness is less common in the pregnant
|
D
|
rebound tenderness is more common in the pregnant
|
E
|
rebound tenderness is rare in pregnancy
|
Question 12.
Lead-in.
Pick the
best option from the list below in relation to fever in AIP in the pregnant and
non-pregnant.
Option List
A
|
comparative figures for the pregnant and non-pregnant
are unknown due to the rarity of appendicitis in pregnancy
|
B
|
fever is
as common in the pregnant as in the non-pregnant
|
C
|
fever is
less common in the pregnant
|
D
|
fever
is more common in the pregnant
|
E
|
fever
is rare in pregnancy
|
Question 13.
Lead-in
How useful
is the finding of leucocytosis in making the diagnosis of AIP?
Option List
A.
|
sine qua
non
|
B.
|
very useful
|
C.
|
not very useful
|
D.
|
I don’t know
|
Question 14.
How useful
is the finding of a raised CRP level in the diagnosis of AIP?
Option List
A.
|
sine qua
non
|
B.
|
very useful
|
C.
|
not very useful
|
D.
|
I don’t know
|
Question 15.
Lead-in
What are
the ultrasound features of appendicitis?
Option List
A
|
appendix
with diameter > 6 mm.
|
B
|
appendix with diameter > 1 cm.
|
C
|
blind-ending tubular structure
|
D
|
non-compressible
tubular structure
|
E
|
none of the above
|
Question 16.
Lead-in
What
figures do W&M give for sensitivity & specificity for US diagnosis of
appendicitis?
Option List
Sensitivity
|
Specificity
|
|
A
|
≥65%
|
≥80%
|
B
|
≥75%
|
≥85%
|
C
|
≥86%
|
≥97%
|
D
|
≥91%
|
≥98%
|
E
|
≥95%
|
≥95%
|
Question 17.
Lead-in
Which, if
any, of the following statements are true about CT scanning for the diagnosis
of AIP?
Option List
A
|
CT
scanning has sensitivity > 85% and specificity >95%
|
B
|
CT scanning exposes mother and fetus to radiation doses
of little concern
|
C
|
CT scanning has replaced ultrasound scanning for AIP
|
D
|
CT scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
CT scanning is of proven value and most useful after
inconclusive ultrasound scanning
|
Question 18.
Lead-in
Which, if
any, of the following statements are true about MRI scanning for the diagnosis
of AIP?
Option List
A
|
MRI
scanning has sensitivity > 90% and specificity >97%
|
B
|
MRI scanning exposes mother and fetus to radiation
doses of little concern
|
C
|
MRI scanning has replaced ultrasound scanning for AIP
|
D
|
MRI scanning is not of proven value after inconclusive
ultrasound scanning
|
E
|
MRI scanning is of proven value and most useful after
inconclusive ultrasound scanning
|
Question 19
Lead-in
Which, if
any, of the following statements are true about the complications of AIP?
Option List
A
|
fetal
loss rate in uncomplicated AIP is about 1.5%
|
B
|
fetal loss rate in AIP complicated by peritonitis is
about 6%
|
C
|
fetal
loss rate in AIP complicated by perforation of the appendix is up to 36%
|
D
|
pre-term delivery rates increase in AIP complicated by
perforation of the appendix
|
E
|
a low level of suspicion should apply to the diagnosis
of AIP in relation to surgical intervention
|
Question 20
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparotomy
should be done through a grid-iron incision with the mid-point the surface marker
for the appendix in the right iliac fossa
|
B
|
laparotomy should be done through a right paramedian
incision starting at the level of the umbilicus
|
C
|
about
35% of laparotomies show no evidence of appendicitis
|
D
|
the appendix should be removed even if it looks normal
|
E
|
antibiotic therapy is an alternative to surgery in
early cases of acute AIP
|
Question 21
Lead-in
Which, if
any, of the following statements are true about surgery for AIP?
Option List
A
|
laparoscopic
appendicectomy is an acceptable alternative to laparotomy, but only in the 1st.
trimester
|
B
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, but only in the 1st. & 2nd.
trimesters
|
C
|
laparoscopic appendicectomy is an acceptable
alternative to laparotomy, at all gestations
|
D
|
there is evidence that laparoscopic appendicectomy is
associated with doubling of the rate of fetal loss
|
Question 22
Lead-in
Which, if
any, of the following statements are true about C section in relation to AIP?
Option List
A
|
C
section is rarely necessary
|
B
|
C
section increases the risk of uterine infection if peritonitis is present
|
C
|
C
section should be offered if elective C section is planned
|
D
|
C
section should be considered if the woman is critically ill
|
Question 23
Lead-in
Which, if
any, of the following statements are true about the fetal heart rate?
Option List
A
|
EFHRM
should be done pre and post-operatively in surgery for AIP
|
B
|
EFHRM should always be done intra-operatively in
surgery for AIP
|
C
|
the drugs used for GA tend to cause fetal tachycardia
|
D
|
the drugs used for GA commonly cause a sinusoidal
pattern
|
E
|
C section should be done if abnormal EFHRM patters
occur
|
F
|
fetal scalp pH sampling should be done if abnormal
EFHRM patters occur
|
G
|
fetal blood sampling should be done if abnormal EFHRM
patters occur
|
TOG questions. Answer ‘True’ of ‘False’.
Make sure you have read the article:
“Appendicitis in
pregnancy: how to manage and whether to deliver.”
Polly Weston & Paul Moroz. h TOG.
April 2015. Vol 17, Issue 2; Pages 105–10.
It is now open-access.
Appendicitis is a likely
diagnosis in pregnancy when,
1. ultrasound
shows a non-compressible blind-ending tube in the right iliac fossa measuring
10 mm in diameter.
2. a
patient presents with right-sided abdominal pain, constipation and malaise.
In the diagnosis of appendicitis in pregnancy,
3.
ultrasound is the best method for imaging in a morbidly obese patient.
4. MRI
has the greatest specificity of all imaging modalities.
With regard to the management of a pregnant patient with
appendicitis,
5. it
should be operative if the diagnosis is certain.
6. it
should primarily aim to reduce any delay in surgical intervention.
7. it
should not involve appendicectomy if the appendix appears normal at the time of
surgery.
8. it
should include delivery of the fetus regardless of gestation if the patient is critically
ill.
9. some
cases may be treated with antibiotics alone.
General anaesthesia for pregnant women undergoing
appendicetomy,
10. carries
an approximately 25-fold increased risk of complications than regional
anaesthesia.
11. has
temporary effects on the fetus as all induction and maintenance agents cross the
placenta.
12. has
a uterotonic effect.
Surgery for appendicetomy in pregnancy,
13. increases
the rate of miscarriage.
14. has
the lowest risk to the fetus when performed in the second trimester.
15. should
be delayed until antenatal corticosteroids are given (in the absence of severe
maternal
sepsis) if the gestation is critical.
Concerning acute appendicitis in pregnancy,
16. it
is the most common cause of acute surgical abdomen.
17. it
most commonly occurs in the first trimester.
18. it
has a fetal loss rate exceeding 50% if the appendix perforates.
With regard to imaging as an investigation for appendicitis
in pregnancy,
19. the
primary goal is to rule out differential diagnoses.
20. the
secondary goal is to reduce the negative appendicectomy rate.
55. Caldicott Guardian.
Question 1.
Lead-in
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.
Lead-in
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.
Lead-in
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.
Lead-in
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!
