12
November 2018
|
46
|
SBA. Coeliac disease & pregnancy
|
|
47
|
EMQ. Cancer incidence & mortality
|
|
48
|
EMQ. Zika infection in pregnancy
|
|
49
|
EMQ. Antenatal
steroids
|
|
50
|
EMQ. BRCA1
& 2.
|
46. Coeliac disease and pregnancy.
Abbreviations.
AGA: anti-gliadin antibodies
CD: coeliac disease.
EMA: anti-endomysial
antibodies.
FGR: Fetal growth
restriction.
IgA: immunoglobulin A
IgG.
tTGA: anti-tissue
transglutaminase antibody.
Question 1.
What is
coeliac disease?
Option List
|
A.
|
allergy
to gluten
|
|
B.
|
malabsorption due to large bowel inflammation
|
|
C.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the descending colon in individuals with a genetic
predisposition
|
|
D.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the gastric mucosa in individuals with a genetic
predisposition
|
|
E.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the small bowel in individuals with a genetic
predisposition
|
Question 2.
What is
the prevalence of coeliac disease in women of reproductive age?
Option List
|
A.
|
0.1%
|
|
B.
|
0.5%
|
|
C.
|
1-2 %
|
|
D.
|
2-5%
|
|
E.
|
5-10%
|
Question 3.
Which of the following groups have an increased risk of
CD?
Option List
|
A.
|
1st.
degree relatives of those with CD
|
|
B.
|
those with type 1 diabetes
|
|
C.
|
those with
iron deficiency anaemia
|
|
D.
|
those
with osteoporosis
|
|
E.
|
those
with unexplained infertility
|
Question 4.
Which of
the following are features of CD in the non-pregnant population?
Option List
|
A.
|
abdominal
bloating and pain
|
|
B.
|
amenorrhoea
|
|
C.
|
anaemia
|
|
D.
|
recurrent miscarriage
|
|
E.
|
unexplained infertility
|
Question 5.
How do
pregnant women with CD present most commonly?
Option List
|
A
|
anaemia
|
|
B
|
failure to gain weight in pregnancy
|
|
C
|
intra-uterine growth retardation
|
|
D
|
low BMI
|
|
E
|
no recognised abnormality
|
Question 6.
Which of
the following commonly occur in pregnant women with CD?
Option List
|
A
|
anaemia
|
|
B
|
failure to gain weight in pregnancy
|
|
C
|
intra-uterine growth retardation
|
|
D
|
low BMI
|
|
E
|
no recognised abnormality
|
Question 7.
How should the woman with suspected CD be investigated
initially?
Option List
|
A.
|
jejunal
biopsy
|
|
B.
|
IgA EMA
|
|
C.
|
IgA tTGA
|
|
D.
|
IgA EMA
+ IgA tTGA
|
|
E.
|
rectal
biopsy
|
Question 8.
Which, if
any, of the following statements are true in relation to the woman due to have
testing for suspected CD?
Option List
|
A.
|
continue
with a normal diet.
|
|
B.
|
continue with a normal diet that includes a minimum of
5 gm. gluten daily
|
|
C.
|
continue with a normal diet that includes a minimum of
10 gm. gluten daily
|
|
D.
|
follow a strict gluten-free diet for at least 1 month
|
|
E.
|
follow a strict gluten-free diet for at least 3 months
|
Question 9.
Which of
the following conditions should make consideration of testing for CD sensible?
Option List
|
A.
|
amenorrhoea
|
|
B.
|
Down’s syndrome
|
|
C.
|
epilepsy
|
|
D.
|
recurrent miscarriage
|
|
E.
|
Turner’s syndrome
|
|
F.
|
unexplained infertility
|
Question 10.
How is the
diagnosis of CD confirmed after +ve serological testing?
Option List
|
A.
|
colonoscopy
|
|
B.
|
enteroscopy
|
|
C.
|
gastroscopy
|
|
D.
|
rectal biopsy
|
|
E.
|
small
bowel biopsy
|
Question 11.
Which skin
condition is particularly associated with CD?
Option List
|
A.
|
atopic
eczema
|
|
B.
|
dermatitis herpetiformis
|
|
C.
|
dermatitis multiforme
|
|
D.
|
dermatographia
|
|
E.
|
psoriasis
|
Question 12.
Which of
the following are likely to be absorbed less well than normally in women with
CD?
Option List
|
A.
|
carbohydrate
|
|
B.
|
fat
|
|
C.
|
folic acid
|
|
D.
|
protein
|
|
E.
|
vitamins B12, D & K
|
Question 13.
What is
the appropriate treatment of CD?
Option List
|
A.
|
antibiotics:
long-term in low-dosage
|
|
B.
|
azathioprine
|
|
C.
|
cyclophosphamide
|
|
D.
|
rectal steroids
|
|
E.
|
none of the above
|
Question 14.
Which of
the following do not contain gluten?
Option List
|
A.
|
barley
|
|
B.
|
oats
|
|
C.
|
rapeseed oil
|
|
D.
|
rye
|
|
E.
|
wheat
|
47. Cancer incidence and mortality.
Abbreviations.
NHL: non-Hodgkin Lymphoma
Question 1.
Which is
the most common female cancer?
Option List
|
F.
|
Bowel
|
|
G.
|
Breast
|
|
H.
|
Cervix
|
|
I.
|
Endometrium
|
|
J.
|
Lung
|
Question 2.
Which is
the 2nd. most common female cancer?
Option List
|
A.
|
Bowel
|
|
B.
|
Breast
|
|
C.
|
Cervix
|
|
D.
|
Endometrium
|
|
E.
|
Lung
|
Question 3.
Which is
the 3rd. most common female cancer?
Option List
|
A.
|
Bowel
|
|
B.
|
Breast
|
|
C.
|
Cervix
|
|
D.
|
Endometrium
|
|
E.
|
Lung
|
Question 4.
Which is
the 4th. most common female cancer?
Option List
|
A.
|
Bowel
|
|
B.
|
Cervix
|
|
C.
|
Endometrium
|
|
D.
|
Lung
|
|
E.
|
Pancreas
|
Question 5.
Which is
the 5th. most common female cancer?
Option List
|
A.
|
Cervix
|
|
B.
|
Malignant melanoma
|
|
C.
|
Non-Hodgkin’s lymphoma
|
|
D.
|
Ovary
|
|
E.
|
Vulva
|
Question 6.
Which is
the 6th. most common female cancer?
Option List
|
A.
|
Cervix
|
|
B.
|
Malignant melanoma
|
|
C.
|
Non-Hodgkin’s lymphoma
|
|
D.
|
Ovary
|
|
E.
|
Vulva
|
Question 7.
Where does
cervical cancer feature in the list of the most common female cancers?
Option List
|
A.
|
10th.
|
|
B.
|
11th.
|
|
C.
|
13th.
|
|
D.
|
14th.
|
|
E.
|
20th.
|
Question 8.
Where does
vulval cancer feature in the list of the most common female cancers?
Option List
|
A.
|
10th.
|
|
B.
|
12th.
|
|
C.
|
16th.
|
|
D.
|
20th.
|
|
E.
|
none of the above
|
Question 9.
Which is
the most common cancer causing female death in the UK?
Option List
|
F.
|
Breast
|
|
G.
|
Bowel
|
|
H.
|
Lung
|
|
I.
|
Ovary
|
|
J.
|
Pancreas
|
Question 10.
Which is
the 2nd. most common cancer causing female death in the UK?
Option List
|
A.
|
Breast
|
|
B.
|
Bowel
|
|
C.
|
Lung
|
|
D.
|
Ovary
|
|
E.
|
Pancreas
|
Question 11.
Which is
the 3rd. most common cancer causing female death in the UK?
Option List
|
A.
|
Breast
|
|
B.
|
Bowel
|
|
C.
|
Lung
|
|
D.
|
Ovary
|
|
E.
|
Pancreas
|
Question 12.
Which is
the 4th. most common cancer causing female death in the UK?
Option List
|
A.
|
Brain
|
|
B.
|
Oesophagus
|
|
C.
|
Ovary
|
|
D.
|
Pancreas
|
|
E.
|
Uterus
|
Question 13.
Which is
the 5th. most common cancer causing female death in the UK?
Option List
|
A.
|
Brain
|
|
B.
|
Oesophagus
|
|
C.
|
Ovary
|
|
D.
|
Pancreas
|
|
E.
|
Uterus
|
Question 14.
Which is
the 6th. most common cancer causing female death in the UK?
Option List
|
A.
|
Brain
|
|
B.
|
Oesophagus
|
|
C.
|
Ovary
|
|
D.
|
Pancreas
|
|
E.
|
Uterus
|
Question 15.
The
incidence of cervical cancer has fallen from the late 1970s until now. What is
the approximate figure for the fall?
Option List
|
A.
|
10%
|
|
B.
|
25%
|
|
C.
|
50%
|
|
D.
|
60%
|
|
E.
|
75%
|
Question 16.
Which, if
any, of the following statements are true in relation to CIN.
Option List
|
A
|
there were ~ 20,000 new cases of CIN in 2015
|
|
B
|
there
were ~ 30,000 new cases of CIN in 2015
|
|
C
|
there were ~ 50,000 new cases of CIN in 2015
|
|
D
|
incidence rates for new cases of CIN are highest in women
aged 19 - 24
|
|
E
|
incidence rates for new cases of CIN are highest in
women aged 25 - 29
|
|
F
|
incidence rates for new cases of CIN are highest in
women aged 30 - 39
|
|
G
|
incidence rates for new cases of CIN ↑
by ~ 10 % since the 1990s
|
|
H
|
incidence rates for new cases of CIN ↑ by ~ 20 % since
the 1990s
|
|
I
|
incidence rates for new cases of CIN ↑ by ~ 30 % since
the 1990s
|
|
J
|
incidence rates for new cases of CIN ↑ by ~ 5 % in the
past decade
|
|
K
|
incidence rates for new cases of CIN ↑ by ~ 10 % in the
past decade
|
|
L
|
incidence rates for new cases of CIN ↑ by ~ 15 % in the
past decade
|
Question 17.
Which, if
any, of the following statements describes the change in incidence of cervical
cancer in the past decade.
Option List
|
A.
|
↑ by 5%
|
|
B.
|
↓ by 5%
|
|
C.
|
↑ by 10%
|
|
D.
|
↓ by 10%
|
|
E.
|
↑ by 15%
|
|
F.
|
↓ by 15%
|
|
G.
|
↑ by 20%
|
|
H.
|
↓ by 20%
|
|
I.
|
↑ by 25%
|
|
J.
|
↓ by 25%
|
Question 18.
What is
the peak age at which cervical cancer is diagnosed in the UK?
Option List
|
A.
|
20-24
|
|
B.
|
25-29
|
|
C.
|
30-34
|
|
D.
|
35-39
|
|
E.
|
40-44
|
|
F.
|
45-49
|
|
G.
|
50-54
|
|
H.
|
55-59
|
|
I.
|
≥60
|
Question 19.
What
proportion of cervical cancer is diagnosed in women < 45 years?
Option List
|
A.
|
20%
|
|
B.
|
30%
|
|
C.
|
40%
|
|
D.
|
50%
|
|
E.
|
60%
|
Question 20.
The
mortality rate from cervical cancer has fallen from the late 1970s until now.
What is the approximate figure for the fall?
Option List
|
A.
|
10%
|
|
B.
|
25%
|
|
C.
|
50%
|
|
D.
|
60%
|
|
E.
|
75%
|
Question 21.
The
mortality rate from cervical cancer has fallen in the past decade. What is the
approximate figure for the fall?
Option List
|
A.
|
10%
|
|
B.
|
25%
|
|
C.
|
50%
|
|
D.
|
60%
|
|
E.
|
75%
|
Question 22.
The
mortality rate from cervical cancer has fallen in the past decade. What is the
approximate figure for the fall?
Option List
|
F.
|
10%
|
|
G.
|
25%
|
|
H.
|
50%
|
|
I.
|
60%
|
|
J.
|
75%
|
Question 23.
When was
routine HPV vaccination of girls introduced in the UK?
Option List
|
A.
|
2000
|
|
B.
|
2002
|
|
C.
|
2004
|
|
D.
|
2006
|
|
E.
|
2008
|
Question 24.
From what
year might we expect to see a reduction in cervical cancer incidence as a
result of the HPV vaccination programme?
Option List
|
A.
|
2020
|
|
B.
|
2025
|
|
C.
|
2030
|
|
D.
|
2040
|
|
E.
|
2050
|
Question 25.
When was
routine HPV vaccination of boys introduced in the UK?
Option List
|
A.
|
2010
|
|
B.
|
2011
|
|
C.
|
2012
|
|
D.
|
2014
|
|
E.
|
None of the above
|
Abbreviations.
CZVS: Congenital Zika Virus Syndrome.
FMS: fetal medicine specialist.
HC head circumference.
PCR: polymerase chain reaction.
RTPCR: Reverse transcription polymerase chain
reaction
Question 1.
What kind of virus is Zika?
|
A
|
DNA
|
|
B
|
DNA + RNA during
intermediate stage
|
|
C
|
RNA
|
|
D
|
RNA + DNA
during intermediate stage
|
Question 2.
To which family of viruses does the Zika virus belong?
|
A
|
adenoviruses
|
|
B
|
flaviviruses
|
|
C
|
herpesviruses
|
|
D
|
orthomyxoviruses
|
|
E
|
parvoviruses
|
|
F
|
picornaviruses
|
|
G
|
retroviruses
|
|
H
|
togaviruses
|
Question 3.
What other human infections are caused by viruses from this
family? This is not a proper EMQ: there may be more than one correct answer.
|
A
|
bubonic plague
|
|
B
|
chikungunya
|
|
C
|
chicken pox
|
|
D
|
common cold
|
|
E
|
dengue fever
|
|
F
|
hepatitis C
|
|
G
|
Japanese encephalitis
|
|
H
|
malaria
|
|
I
|
San Francisco encephalitis
|
|
J
|
St. Louis encephalitis
|
|
K
|
West Nile virus
|
|
L
|
Yellow fever
|
Question 4.
When was the first reported identification of Zika virus infection
in an animal and what was the animal?
|
A
|
1922 in a hippopotamus
|
|
B
|
1928 is a giraffe
|
|
C
|
1935 in a macaque monkey
|
|
D
|
1947 in a Rhesus negative monkey
|
|
E
|
1950 in a chimpanzee
|
|
H
|
none of the above.
|
.
Question 5.
Why is the virus called “Zika”?
|
A
|
it was first described
as “zoonosis affecting Intestines, Kidneys and Adrenals”
|
|
B
|
the animal
from which it was first isolated was the Zika monkey
|
|
C
|
it was first
isolated from a monkey from the Zika area of Zambia
|
|
D
|
it was first
isolated from a monkey from the Zika forest in Uganda
|
|
E
|
it was first
identified in the Zika laboratory of the CDC
|
|
F
|
it was first
identified by Dr Emily Zika, Professor of Virology, Pretoria, S Africa
|
|
G
|
‘Zika’ is Zulu
for ‘small head’ and the association was 1st. noted in a Zulu baby
|
Question 6.
What is the main reservoir of the Zika virus?
|
A
|
anteaters
|
|
B
|
horses
|
|
C
|
humans
|
|
D
|
marmosets
|
|
E
|
monkeys
|
|
F
|
parrots
|
|
G
|
rats
|
Question 7.
How is the Zika virus transmitted? This is not a true EMQ
as there may be > 1 correct answer.
|
A
|
Aedes aegypti mosquitos
|
|
B
|
Aedes
albopictus: Asian tiger mosquito
|
|
C
|
Anopheles
gambiae mosquitos
|
|
D
|
Culex pipiens mosquitos
|
|
E
|
fleas
|
|
F
|
ticks
|
|
G
|
worms
|
|
H
|
none of the
above.
|
Question 8.
At what time of day is transmission of infection most
likely?
|
A
|
afternoon
|
|
B
|
evening
|
|
C
|
morning
|
|
D
|
night
|
|
E
|
mid-morning
and mid-afternoon to dusk
|
|
F
|
two hours
after sunrise
|
|
G
|
two hours
before sunset
|
|
H
|
two hours
after sunset
|
|
I
|
two hours after
sunrise and two hours before sunset
|
|
J
|
none of the
above
|
Question 9.
Where do aegypti mosquitoes breed?
Which, if any of the following
|
A
|
in large
stretches of water with reed beds
|
|
B
|
in water near
human habitation
|
|
C
|
in water
remote from human habitation
|
|
D
|
in water in
human habitations
|
|
E
|
in water with
volume > 5 litres
|
|
F
|
in water with
volume > 50 litres
|
|
G
|
in water with
volume > 500 litres
|
|
H
|
none of the
above.
|
Question 10.
When did the current interest in the Zika virus and
pregnancy begin and why?
|
A
|
Brazil
reported an ↑ in microcephaly with a possible
link to maternal Zika infection in 2014
|
|
B
|
Brazil
reported an ↑ in microcephaly with a possible link to maternal Zika infection
in 2015
|
|
C
|
Brazil
reported an ↑ in microcephaly with a possible link to maternal Zika infection
in 2016
|
|
D
|
the CDC
reported 3 cases of microcephaly after proven Zika infection in pregnancy in
2014
|
|
E
|
the CDC
reported 3 cases of microcephaly after proven Zika infection in pregnancy in
2015
|
|
F
|
the CDC
reported 3 cases of microcephaly after proven Zika infection in pregnancy in
2016
|
|
H
|
none of the
above
|
Question 11.
How did the WHO categorise the problem and when?
|
A
|
Public Health
Emergency of International Concern 2015
|
|
B
|
Public Health
Emergency of International Concern 2016
|
|
C
|
Public Health
Emergency of International Concern 2017
|
|
D
|
Public Health
Emergency of International Concern 2018
|
|
E
|
none of the
above
|
Question 12.
Is Zika virus infection a notifiable condition in the UK?
|
A
|
No
|
|
B
|
Yes, but only
if people have returned from an area with a high prevalence of Zika
|
|
C
|
Yes, but only
if the woman and her partner have returned from an area with high prevalence
of Zika
|
|
D
|
Yes, but only
if fetal damage has occurred.
|
|
E
|
none of the
above
|
Question 13.
How is the risk of getting a Zika virus infection from
travelling to a particular country categorised? Which, if any, of the following
feature?
|
A
|
frightful
|
|
B
|
high
|
|
C
|
low
|
|
D
|
moderate
|
|
E
|
scary
|
|
F
|
none of the
above
|
Question 14.
How long does it take for symptoms of Zika infection to
develop?
|
A
|
1 – 5 days
|
|
B
|
1 – 7 days
|
|
C
|
2 – 5 days
|
|
D
|
2 – 7 days
|
|
E
|
2 – 10 days
|
|
F
|
3 – 7 days
|
|
G
|
3 – 12 days
|
|
H
|
5 – 10 days
|
Question 15.
How long do symptoms of Zika infection last?
|
A
|
1 – 5 days
|
|
B
|
1 – 7 days
|
|
C
|
2 – 5 days
|
|
D
|
2 – 7 days
|
|
E
|
2 – 10 days
|
|
F
|
3 – 7 days
|
|
G
|
3 – 12 days
|
|
H
|
5 – 10 days
|
Question 16.
What are the most common symptoms of Zika infection? There
is no option list – write what you think.
Question 17.
Is Zika infection more severe in pregnancy?
|
A
|
No
|
|
B
|
Yes
|
Question 18.
What abnormalities have been associated with Congenital
Zika Virus Syndrome? There is no option list, just write as many as you can
think of.
Question 19.
What is the approximate risk of vertical transmission of
the Zika virus in pregnancy?
|
A
|
10%
|
|
B
|
20%
|
|
C
|
30%
|
|
D
|
40%
|
|
E
|
≥ 50%
|
|
E
|
the figure is
unknown
|
Question 20.
Is gestation related to the risk of vertical transmission
of the Zika virus? Which, if any, of the following statements are true?
|
A
|
evidence is
unclear
|
|
B
|
evidence
suggests it probably is
|
|
C
|
evidence
suggests it probably is not
|
|
D
|
no
|
|
E
|
yes
|
Question 21.
What is the risk of adverse fetal outcomes for women proven
to have had Zika virus infection?
|
A
|
~ 5%
|
|
B
|
~ 10%
|
|
C
|
~ 15%
|
|
D
|
~ 20%
|
|
E
|
~ 25%
|
|
F
|
~30%
|
|
G
|
> 30%
|
|
H
|
none of the
above
|
Question 22.
What advice should be given to a pregnant woman planning to
travel to an area with high risk of transmission of Zika infection?
|
A
|
consider
postponing travel until after the pregnancy
|
|
B
|
don’t go to
the area
|
|
C
|
get vaccinated
|
|
D
|
stay indoors
from dawn to dusk
|
|
E
|
take chloroquine
as prophylaxis
|
|
F
|
take
chloroquine + proguanil as prophylaxis
|
|
G
|
take proguanil
as prophylaxis
|
Question 23.
What advice should be given to a pregnant woman planning to
travel to an area with moderate risk of transmission of Zika infection?
|
A
|
consider
postponing travel until after the pregnancy
|
|
B
|
don’t go to
the area
|
|
C
|
get vaccinated
|
|
D
|
stay indoors
from dawn to dusk
|
|
E
|
take chloroquine
as prophylaxis
|
|
F
|
take
chloroquine + proguanil as prophylaxis
|
|
G
|
take proguanil
as prophylaxis
|
Question 24.
What advice should be given to a woman who decides to
travel to an area of high or moderate risk?
There is no option list: jot down everything you think
would be relevant.
Question 25.
A woman returns to the UK from a high-risk Zika area? She
develops symptoms suggestive of Zika infection 4 weeks later. What testing
should be offered?
|
A
|
abdominal
ultrasound
|
|
B
|
amniocentesis
|
|
C
|
MR scan
|
|
D
|
no test
indicated
|
|
E
|
TVS
|
|
F
|
Zika IgA
|
|
G
|
Zika IgG
|
|
H
|
Zika IgG + IgM
|
|
I
|
Zika IgA + IgG
+ IgM
|
|
J
|
Zika PCR
|
Question 26.
A woman who wishes to be pregnant has returned to the UK
from an area of high-risk for Zika infection. Her partner had remained in the
UK? What advice should she be given?
|
A
|
use barrier
contraception for 8 weeks
|
|
B
|
use effective
contraception for 8 weeks
|
|
C
|
use barrier
contraception + effective contraception for 8 weeks
|
|
D
|
use barrier
contraception for 12 weeks
|
|
E
|
use effective
contraception for 12 weeks
|
|
F
|
use barrier
contraception + effective contraception for 12 weeks
|
Question 27.
A man travels to an area with high-risk of Zika infection?
On his return to the UK his wife is keen to start a pregnancy. What advice
should be given?
|
A
|
use barrier
contraception for 8 weeks
|
|
B
|
use effective
contraception for 8 weeks
|
|
C
|
use effective
contraception + barrier contraception for 8 weeks
|
|
D
|
use barrier
contraception for 12 weeks
|
|
E
|
use effective
contraception for 12 weeks
|
|
F
|
use effective
contraception + barrier contraception for 12 weeks
|
|
G
|
use barrier
contraception for 6 months
|
|
H
|
use effective
contraception for 6 months
|
|
I
|
use effective
contraception + barrier contraception for 6 months
|
|
J
|
none of the
above.
|
Question 28.
A man travels to an area with high-risk of Zika infection
for two weeks? During his stay he has symptoms suggestive of Zika infection.
His wife is pregnant. What testing should be offered on his return?
|
A
|
discuss with
local infection specialist
|
|
B
|
discuss with
RIPL
|
|
C
|
no test
indicated
|
|
D
|
Zika IgG
|
|
E
|
Zika IgG + IgM
|
|
F
|
Zika IgA + IgG
+ IgM
|
|
G
|
Zika PCR
|
|
H
|
none of the
above
|
Question 29.
A woman is shown to have had a Zika infection? How useful
is amniocentesis for assessing the risk to the fetus and determining if an
infected fetus in affected?
|
A
|
PCR on
amniocentesis is the gold standard for diagnosing fetal infection
|
|
B
|
PCR on
amniocentesis is of unknown value for diagnosing fetal infection
|
|
C
|
PCR on
amniocentesis is of little value for diagnosing fetal infection
|
|
D
|
PCR on
amniocentesis is the gold standard for determining the risk of an infected
fetus being affected
|
|
E
|
PCR on
amniocentesis is of unknown value for determining the risk of an infected
fetus being affected
|
|
F
|
PCR on
amniocentesis is of little value for diagnosing fetal infection
|
Question 30.
What advice and treatment should be offered to the non-pregnant
individual with symptoms of Zika infection? This is not a true EMQ as more than
one option could be true.
|
A
|
adequate
fluids
|
|
B
|
acyclovir from
GP
|
|
C
|
bed rest for
48 hours
|
|
D
|
emergency contraception
|
|
E
|
get advice
from A&E centre
|
|
F
|
offer TOP
|
|
G
|
paracetamol if
needed for pain
|
Question 31.
A pregnant woman returns from a high-risk Zika area and
develops symptoms suggestive of infection? She develops a high fever and is
admitted to hospital. What particular things should be done?
|
A
|
anticoagulant
prophylaxis
|
|
B
|
paracetamol +
tepid sponging
|
|
C
|
exclude
chikungunya
|
|
D
|
exclude dengue
|
|
E
|
exclude
malaria
|
|
F
|
exclude UTI
|
|
G
|
exclude Zika
|
|
H
|
exclude other
causes of pyrexial illness
|
|
I
|
offer TOP
|
|
J
|
none of the
above
|
Question 32.
A woman with possible Zika exposure has a –ve test for
virus antibodies 4 weeks after the last possible exposure. Is this sufficiently
long to reassure her that she has not been infected?
|
A
|
no
|
|
B
|
yes
|
|
C
|
we don’t know
|
Question 33.
A pregnant woman has visited a country with high-risk for
Zika exposure but been asymptomatic during her stay and for two weeks on her
return? What testing should be offered?
|
A
|
baseline
ultrasound + repeat at 18-20 weeks
|
|
B
|
baseline ultrasound
+ repeat at 28-30 weeks
|
|
C
|
baseline
ultrasound + repeat at 18-20 weeks + consider repeat at 28-30 weeks
|
|
D
|
amniocentesis
|
|
E
|
MR scan
|
|
F
|
no test
indicated
|
|
G
|
Zika IgG
|
|
H
|
Zika IgG + IgM
|
|
I
|
Zika IgA + IgG
+ IgM
|
|
J
|
Zika PCR
|
Question 34.
A pregnant woman returns to the UK from an area of high risk
for Zika exposure has normal ultrasound scans on her return and at 22 weeks. What
further scans, if any, should be arranged? This question is in the exam
database.
|
A
|
monthly scans
|
|
B
|
scan at 28-30
weeks
|
|
C
|
scan at 32 and
36 weeks
|
|
D
|
scan at 36
weeks
|
|
E
|
no further
scans
|
|
F
|
none of the
above
|
Question 35.
A pregnant woman with possible Zika exposure has an ultrasound
scan showing the fetal BPD to be > 2 SDs below the mean for that gestation.
What should be done?
|
A
|
discuss
amniocentesis to confirm fetal infection
|
|
B
|
discuss with
the local virologist
|
|
C
|
offer TOP
|
|
D
|
refer to a
fetal medicine specialist
|
|
E
|
screen the
mother for recent Zika infection
|
|
F
|
none of the
above
|
Question 36.
A pregnant woman with possible Zika exposure has an
ultrasound scan showing significant brain abnormality. What further testing
should be discussed?
|
A
|
amniocentesis
+ PCR
|
|
B
|
amniocentesis
+ RT-PCR
|
|
C
|
MR scan
|
|
D
|
Zika IgG
|
|
E
|
Zika IgG + IgM
|
|
F
|
Zika IgA + IgG
+ IgM
|
|
G
|
none of the
above
|
49. Antenatal steroids and the neonate.
Abbreviations.
ANC: antenatal corticosteroids.
ANS: antenatal steroids.
Lead-in.
The following scenarios relate to antenatal steroid use
and the neonate.
There are no option lists and you have to decide your
answers without help.
Scenario 1.
What are the benefits to the
neonate of appropriate administration of antenatal steroids?
Scenario 2.
At what gestations should
antenatal steroids be offered to women with singleton pregnancies who are at
risk of premature labour?
Scenario 3.
At what gestations should
antenatal steroids be offered to women with multiple pregnancies who are at
risk of premature labour?
Scenario 4.
What advice is contained in NG25
about ANS and very early gestations?
Scenario 5.
What advice is contained in NG25 GTG about antenatal
steroids and Caesarean section?
Scenario 6.
What advice is given in the NG25
about ANS in relation to the fetus with FGR at risk of premature delivery?
Scenario 7
What advice is given in NG25 about
ANS for women with IDDM?
Scenario 8
What advice is in the NG25 about
adverse effects of ANS on the fetus?
Scenario 9
What advice is in the GTG in
relation to short-term maternal adverse effects?
Scenario 10
What contraindications to ANS are cited in NG25?
Scenario 11
What is the recommended drug regime for ANS
administration?
Scenario 12.
What
is the time-scale for maximum effect of ANS in reducing RDS?
Scenario 13.
When
should repeat courses of ANS be given?
Scenario 14.
Who was
the great pioneer of antenatal steroids to accelerate lung maturation?
Scenario 15.
Which
country was this great pioneer from and which animal did he use for his early
research?
Scenario 16.
Why is
the story of this pioneer’s work a cautionary tale for O&G?
Scenario 17.
Which
international organisation has immortalised his work in its logo?
Scenario 18.
When may
antenatal steroids be beneficial to the fetus apart from accelerating lung
maturation?
50. BRCA 1 & 2 carriers and risk of breast and ovarian
cancer.
Option lists. Most of the questions have no option list to make you
work harder.
Abbreviations.
BSO: bilateral
salpingo-oophorectomy
EOC: epithelial ovarian
cancer
HGSOG: high-grade serous ovarian
cancer
LGSOG: low-grade serous ovarian
cancer
Scenario 1.
Which, if any, of the following statements are true?
|
A
|
EOC is the most common gynaecological cancer in the
developed world
|
|
B
|
EOC is the leading cause of death from gynaecological
cancer in the developed world
|
|
C
|
50% of EOC is mucinoid
|
|
D
|
HGSOG is 20 times more common than LGSOG
|
|
E
|
HGSOG is the main cause of death from ovarian cancer
|
|
F
|
overall life time risk of EOC is 1 in 70
|
|
G
|
the main risk factors for EOC are cigarette smoking
& older age
|
|
H
|
5% of ovarian cancer is due to identified hereditary
genetic factors
|
|
I
|
BRCA1 is linked to an ↑ risk of breast, ovarian,
pancreatic and prostate cancer
|
|
J
|
BRCA2 is linked to an ↑risk of breast, ovarian,
pancreatic and prostate cancer & melanoma
|
|
K
|
The prevalence of BRCA1 & 2 mutations is about 1 in
400 in the general population
|
|
L
|
The prevalence of BRCA1 & 2 mutations is about 1 in
40 in the Ashkenazi Jewish population
|
|
M
|
The risk of developing ovarian cancer by 75 years is
BRCA1: 50% and BRCA2: 25%
|
|
N
|
EOC associated with BRCA1 &2 is mostly low-grade
mucinous in type
|
|
O
|
The risk of male breast cancer is about 7% with BRCA2,
higher than with BRCA1
|
|
P
|
BRCA1 & 2 are DNA repair genes
|
|
Q
|
male breast, pancreatic and prostate cancer are more common
with BRCA2 than BRCA1
|
Scenario 2.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 3.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 4.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2. She
attends the gynaecology clinic requesting information about her lifetime risk
of breast cancer. What is the approximate figure?
Scenario 5.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 6.
The woman asks for the overall figure for lifetime risk
of breast cancer in UK women for comparison with her risk. What is the
approximate figure?
Scenario 7.
The woman asks for the overall UK figure for lifetime risk
of ovarian cancer for comparison with her risk. What is the approximate figure?
Scenario 8
Which of
the following genes have mutations that increase the risk of breast cancer?
|
A
|
ATM
|
|
B
|
CDH1
|
|
C
|
CHEK1
|
|
D
|
FATHEAD
|
|
E
|
MARBELLA.
|
|
F
|
NBENE
|
|
G
|
p45
|
|
H
|
p53.
|
|
I
|
PALB2
|
|
J
|
PNINE
|
|
K
|
PTEN
|
|
L
|
RADON50
|
|
M
|
RINT1
|
Scenario 9
A man of 30 has two sisters who developed breast cancer before
the age of 40. They and he have been proved to be carriers of BRCA2. His GP
phones to ask about his lifetime risk of breast cancer. What is the approximate
figure?
Scenario 10
A man of 30 has two sisters who developed breast cancer before
the age of 40. They and he have been proved to be carriers of BRCA2. His GP
phones to ask about his lifetime risk of ovarian cancer. What is the
approximate figure?
Scenario 11
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about the value of prophylactic mastectomy. What advice will you give about
efficacy?
Scenario 12
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy – her family is
complete and her husband has had vasectomy. What is the approximate figure for
the efficacy of BSO in relation to cancer?
Scenario 13.
Which, if any, of the following statements is true in relation
to the findings by Kuchenbaecker in relation to the incidence of breast cancer
in carriers of a BRCA1 mutation?
Option list.
|
A.
|
it rises rapidly until the age of 30-40, then stays
constant until age 80
|
|
B.
|
it rises rapidly from puberty until the age of 30-40,
then stays constant until age 80
|
|
C.
|
it rises rapidly from young adulthood until the age of 30-40, then stays constant
until age 80
|
|
D.
|
it rises rapidly from puberty until the age of 40-50,
then stays constant until age 80
|
|
E.
|
it rises rapidly from young adulthood until the age of 40-50, then stays constant
until age 80
|
|
F.
|
it rises rapidly from puberty until the menopause, then
stays constant until age 80
|
|
G.
|
it rises rapidly from young adulthood until the menopause, then stays constant
until age 80
|
|
H.
|
none of the above
|
Scenario 14.
Which, if any, of the following statements is true in
relation to the findings by Kuchenbaecker about the incidence of breast cancer
in carriers of a BRCA2 mutation?
Option list.
|
A.
|
it rises rapidly until the age of 30-40, then stays
constant until age 80
|
|
B.
|
it rises rapidly from puberty until the age of 30-40,
then stays constant until age 80
|
|
C.
|
it rises rapidly from young adulthood until the age of 30-40, then stays constant
until age 80
|
|
D.
|
it rises rapidly from puberty until the age of 40-50,
then stays constant until age 80
|
|
E.
|
it rises rapidly from young adulthood until the age of 40-50, then stays constant
until age 80
|
|
F.
|
it rises rapidly from puberty until the menopause, then
stays constant until age 80
|
|
G.
|
it rises rapidly from young adulthood until the menopause,
then stays constant until age 80
|
|
H.
|
none of the above
|
Scenario 15.
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy. What are the
disadvantages of BSO?
Scenario 16
A woman of 30 has two sisters who developed breast cancer
before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information
about the benefits of prophylactic salpingo-oophorectomy. What alternatives should be discussed?
Scenario 17
A woman of 25 years is a known carrier of BRCA1. She has
no family history of breast cancer. She has a friend who is similar in age and
has similar risk factors for breast cancer, including being a BRCA1 carrier,
apart from having two 1st. degree relatives with breast cancer.
Which, if any of the following statements is true in relation to the risk of
breast cancer for the friend compared with the woman?
|
A.
|
her risk is the same
|
|
B.
|
her risk is 2 x that of the woman
|
|
C.
|
her risk is 5x that of the woman
|
|
D.
|
her risk is ½ of that of the woman
|
|
E.
|
none of the
above
|
Scenario 18
A woman of 25 years is a known carrier of BRCA2. She has
no family history of breast cancer. She has a friend who is similar in age and
has similar risk factors for breast cancer, including being a BRCA2 carrier,
apart from having two 1st. degree relatives with breast cancer.
Which, if any of the following statements is true in relation to the risk of
breast cancer for the friend compared with the woman?
|
A.
|
her risk is the same
|
|
B.
|
her risk is 2 x that of the woman
|
|
C.
|
her risk is 5x that of the woman
|
|
D.
|
her risk is ½ of that of the woman
|
|
E.
|
none of the
above
|
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