53
|
EMQ. Additional
HCV questions
|
56
|
EMQ. Antepartum
haemorrhage
|
57
|
EMQ. Cervical
cancer staging
|
58
|
EMQ. Mental Capacity Act
|
59
|
EMQ. Borderline ovarian tumours
|
53. HCV and pregnancy. Extra questions.
I realised after the last tutorial that there was a
glaring omission from the list of questions.
These questions cover the relevant facts.
Scenario
1.
Which,
if any, of the following conditions is more common in women with HCV infection?
A
|
dermatitis herpetiformis
|
B
|
HELLP syndrome
|
C
|
obstetric cholestasis
|
D
|
postnatal depression
|
E
|
thrombocytopenia
|
Scenario
2.
By
how much is the risk of the condition in question 20 increased in women with
HCV?
Option list.
A
|
by
a factor of 2
|
B
|
by
a factor of 5
|
C
|
by
a factor of 20
|
D
|
by
a factor of 50
|
E
|
none
of the above
|
56. Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ART: assisted reproduction technology
FGR: fetal growth restriction
PET: pre-eclampsia
Option list.
A.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the baby
B.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the placenta.
C.
genital tract bleeding ≥ 500 ml. from 24 weeks,
or earlier if the baby is live-born, until the delivery of the baby.
D.
1
E.
2
F.
3
G.
4
H.
5
I.
6
J.
7
K.
8
L.
9
M.
10
N.
15
O.
20
P.
30
Q.
50
R.
100
S.
500
T.
1,000
U.
true
V.
false
W.
none of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml.
for minor APH
Scenario 3.
What is the upper limit in ml.
of major haemorrhage
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor
for placental abruption.
Scenario 7
List 10 risk factors for
placental abruption.
Scenario 8
List 6 risk factors for
placenta previa.
Scenario 9
In what % of pregnancies does
APH occur?
Scenario 10
With regards to steps that can be taken to reduce the
incidence of APH, what things would you include in a viva in the OSCE?
57. Cancer Cervix: staging.
Option list.
Micro-invasive cervical cancer.
Stage Ia1
Stage Ia2
Stage Ia3
Stage Ib1
Stage Ib2
Stage Ib3
Stage IIa
Stage IIb
Stage IIc
Stage IIIa
Stage IIIb
Stage IIIc
Stage IVa
Stage IVb
Stage IVc
Stage Va
Stage Vb
Stage Vc
None of the above.
This question illustrates the problems surrounding
staging. If you are not a cancer specialist, it is not something that you think
about very often, if ever. So you have to put it into your list of things to
revise in the days before the exam. If you haven’t started this list, do so
now.
Scenario 1.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 2 mm and 6 mm in width. The resection margins are tumour-free. There
is no evidence of spread outside the uterus. She is nulliparous and wishes to retain
her fertility.
Scenario 2.
A woman of 25 has a cone biopsy. The histology report
shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width.
The resection margins are tumour-free. There is no evidence of spread outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 3.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 5 mm and 6 mm in width. The resection margins are not tumour-free. There
is no evidence of spread outside the uterus. She is nulliparous and wishes to retain
her fertility.
Scenario 4.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 3 cm in width. The resection margins are tumour-free. There
is no evidence of extension outside the uterus. She is nulliparous and wishes
to retain her fertility.
Scenario 5.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 5 cm in width. The resection margins are tumour-free. She is
nulliparous and wishes to retain her fertility.
Scenario 6.
A woman of 38 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 4 mm and 6mm in width. The resection margins are tumour-free. An MR
scan shows involvement of the lymphatic nodes in the left of the pelvis.
Scenario 7.
A woman of 45 has carcinoma of
the cervix. It extends into the parametrium, but not to the pelvic side-wall.
It involves the upper 1/3 of the vagina. There is MR evidence of para-aortic
node involvement.
Scenario 8.
A woman of 55 has carcinoma of
the cervix. It extends to the pelvic side-wall. It involves the upper 1/3 of
the vagina. She has a secondary on the end of her nose.
Scenario 9.
A woman of 55 has carcinoma of
the cervix. It involves the bladder mucosa.
Scenario 10.
A woman of 35 has a proven
cancer of the cervix with extension into the right parametrium, but not to the
pelvic side-wall. Left hydroureter and left non-functioning kidney are noted on
IVP and there is no other explanation for the findings. Cystoscopy shows
bullous oedema of the bladder mucosa.
Scenario 11.
A woman of 25 has a cone
biopsy. It shows malignant melanoma. The lesion invades to a depth of 3 mm and
is 5 mm in width. The margins of the biopsy are clear. There is evidence of
lymphatic vessel involvement. There is no evidence of spread outside the
uterus.
58. Mental Capacity Act 2005.
Abbreviations.
CAD: Court-appointed Deputy.
FGR: fetal growth restriction.
LPA: Lasting Power of Attorney.
PoA: Power of Attorney.
Option list.
A.
Yes
B.
No
C.
True
D.
False
E.
Does not exist
F.
The husband
G.
A parent
H.
The child
I.
the General
Practitioner
J.
the Consultant
K.
the Registrar
L.
The Consultant
treating the patient
M.
A Consultant not
involved in treating the patient
N.
The Medical Director
O.
A person with Powers
of Attorney
P.
The sheriff or
sheriff’s deputy
Q.
Balance of
probabilities
R.
Beyond reasonable
doubt
S.
None of the above.
Scenario 1.
A person with LPA is normally
not a family member.
Scenario 2.
A Sheriff’s Deputy is normally
not a family member.
Scenario 3.
A person with PoA can consent
to treatment for the patient who lacks capacity.
Scenario 4.
A Court-appointed Deputy can consent to treatment for the
patient who lacks capacity, but must go back to the Court of Protection if
further consent is required for additional treatment.
Scenario 5.
A person with PoA can authorise
withdrawal of all care except basic care in cases of individuals with
persistent vegetative states.
Scenario 6.
An advance decision can
authorise withdrawal of all but basic care in cases of persistent vegetative
states.
Scenario 7
A person with PoA cannot
overrule an advance direction about withdrawal or withholding of
life-sustaining care.
Scenario 8
A woman is seen in the
antenatal clinic at 39 weeks’ gestation. Her blood pressure is 180/110 and she
has +++ of proteinuria on dipstick testing. She has mild epigastric pain. A scan
shows evidence of FGR with the baby on the 2nd. centile. Doppler
studies of the umbilical artery are abnormal and a non-stress CTG shows loss of
variability and variable decelerations. She is advised that she appears to have
severe pre-eclampsia and is at risk of eclampsia and of intracranial
haemorrhage. She is told of the associated risk of mortality and morbidity. She
is also advised that the baby is showing evidence of severe FGR and has
abnormal Doppler studies and CTG which could lead to death or hypoxic damage.
She declines admission or treatment. She says she trusts in God and wishes to
leave her fate and that of her baby in His hands. She is seen by a psychiatrist
who assesses her as competent under the MCA and with no evidence of mental disorder.
The obstetrician wants to apply to the COP for an order for compulsory
treatment. Can he do this?
Scenario 9
A woman is admitted at 36
weeks’ gestation with evidence of placental abruption. She is semi-comatose and
shocked. There is active bleeding and the cervical os is closed. Fetal heart
activity is present but with bradycardia and decelerations. The consultant
decides that Caesarean section is the best option to save her live and that of
the baby. When reading the notes, the registrar comes across an advance notice
drawn up by the woman and her solicitor. It states that she does not wish
Caesarean section, regardless of the risk to her and the baby. The consultant
tells the registrar that they can ignore it now that she is no longer competent
and get on with the Caesarean section for which she will be thankful
afterwards. The registrar says that the advance notice is binding. Who is
correct?
Scenario 10
An 8 year old girl is admitted
with abdominal pain. Appendicitis is diagnosed with peritonitis and surgery is
advised. The parents decline treatment on religious grounds. Can the consultant
in charge overrule the parents and give consent?
.
Some of these are not true EMQs – they have more than one
answer. I do this as it makes the document shorter and saves me some typing.
Abbreviations.
Bagade: “Management
of borderline ovarian tumours”: Bagade, Edmondson & Nayar.
BOT: borderline
ovarian tumour.
Ca125: Ca125
as iu/ml.
COC: combined
oral contraceptive.
EOT: epithelial
ovarian tumour.
IOC: invasive
ovarian cancer.
MOV: mean
ovarian volume.
MS: menopause
score.
POI: premature
ovarian insufficiency.
RMI: Risk
of Malignancy Index.
SOT: serous
ovarian tumour.
US: ultrasound
score.
Scenario 3.
Which, if any, of the following statements are true in
relation to BOTs?
Option list.
A
|
show more
proliferation than benign ovarian tumours
|
B
|
stromal
invasion is absent
|
C
|
stromal
invasion is < 5 mm from the ovarian surface
|
D
|
comprise
10-15% of EOTs
|
E
|
comprise
10-15% of GCTOs
|
F
|
comprise
10-15% of SOTs
|
Scenario 4.
Which, if any, of the following statements are true?
Option list.
A
|
BOTs
constitute 5-10% of ovarian
epithelial neoplasia
|
B
|
BOTs
constitute 10-15% of ovarian epithelial neoplasia
|
C
|
BOTs
constitute 15-20% of ovarian epithelial neoplasia
|
D
|
BOTs
constitute 5-10% of ovarian germ-cell
neoplasia
|
E
|
BOTs
constitute 10-15% of ovarian germ-cell neoplasia
|
F
|
BOTs
constitute 15-20% of ovarian germ-cell neoplasia
|
Scenario 5.
Which, if any, of the following statements are true?
Option list.
A
|
BOTs are less
common in women who have taken the COC for > 5 years
|
B
|
BOTs are less common
in women with a history of lactation
|
C
|
BOTs are more
common after the menopause
|
D
|
BOTs are more
common in multiparous women
|
E
|
BOTs are more
common in women with BRCA1 & 2 mutations
|
Scenario 6.
Which, if any, of the following statements are true in
relation to BOTs.
Option list.
A
|
p53 mutations
are more common than in invasive ovarian tumours
|
B
|
BRAF/KRAS
mutations are common than in invasive ovarian tumours
|
C
|
BRCA 1 & 2
mutations are more common in women with BOTs
|
D
|
BOTs are more
common in women from a Lynch syndrome family with a known MSH6 mutation
|
E
|
BOTs are more
common in women with red hair
|
Scenario 7.
Which, if any, of the following statements are true in
relation to BOTs.
Option list.
A
|
Brenner
tumours are the most common
|
B
|
endometrioid
tumours are the most common
|
C
|
mucinous
tumours are the most common
|
D
|
serous tumours
are the most common
|
E
|
< 10% are
bilateral
|
Scenario 8.
Which, if any, of the following statements are true in
relation to mucinous BOTs.
Option list.
A
|
are subdivided
into endocervical / Müllerian or intestinal categories
|
B
|
are subdivided
into endocervical / Müllerian, intestinal or renal categories
|
C
|
are subdivided
into endometrial or intestinal categories
|
D
|
pseudomyxoma
peritonei occurs in < 1% of cases
|
E
|
pseudomyxoma
peritonei occurs in about 10% of cases
|
Scenario 9.
Which, if any, of the following statements are true in
relation to BOTs.
Option list.
A
|
↑ Ca 125 levels are rare,
normally indicating malignancy
|
B
|
Ca 19-9 levels
are often ↑ in mucinous BOTs
|
C
|
CEA levels are
often ↑ in serous tumours
|
D
|
Ca 15-3 is
commonly ↑ in both mucinous and serous
BOTs
|
E
|
TVS and MRI
are useful in the assessment of BOTs
|
Scenario 10.
Which, if any, of the following statements are true in
relation to BOTs.
Option list.
A
|
the 5-year
survival rate is approximately 80% for stage I disease
|
B
|
the 5-year
survival rate is approximately 95% for stage I disease
|
C
|
the 5-year
survival rate is approximately 50% for stage III disease
|
D
|
the 5-year
survival rate is approximately 60% for stage III disease
|
E
|
the overall
10-year survival rate is approximately 75%
|
Scenario 11.
Which, if any, of the following statements is true in relation
to calculation of the RMI score?
Option list.
A
|
uses the
formula age x Ca125 x US
|
B
|
uses the
formula Ca125 x MS x MOV
|
C
|
uses the
formula (Ca125 + MS) x US
|
D
|
uses the
formula Ca125 + MS + US
|
E
|
uses the
formula Ca125 x MS x US
|
F
|
none of the above
|
Scenario 12.
Which, if any, of the following describes the formula used
for the calculation of the MOV as used in the RMI score?
Option list.
A
|
total ovarian
volume / 2
|
B
|
total ovarian
volume / average ovarian number
|
C
|
total ovarian
volume /
ovarian number
|
D
|
total volume
of the larger ovary
|
E
|
p x
(mean diameter)3 / 4 of the larger ovary
|
F
|
none of the
above
|
Scenario 13.
Which, if any, of the following as used in the calculation
of the MS as used in the RMI score
Option list.
A
|
prepubertal: score = 0
|
B
|
1ry.
amenorrhoea: score = 1
|
C
|
POI: score = 2
|
D
|
perimenopausal: score = 3
|
E
|
menopausal: score = 4
|
F
|
none of the
above
|
Scenario 14.
Which, if any, of the following statements is true in
relation to calculation of the RMI score?
Option list.
A
|
uses the
formula age x Ca125 x US
|
B
|
uses the
formula Ca125 x MS x MOV
|
C
|
uses the
formula (Ca125 + MS) x US
|
D
|
uses the
formula Ca125 + MS + US
|
E
|
uses the
formula Ca125 x MS x US
|
F
|
none of the
above
|
Scenario 15.
Which, if any, of the following statements are true in
relation to the RMI and BOTs.
Option list.
A
|
the RMI is
particularly useful and should always be considered in the early assessment
|
B
|
the RMI is not
particularly useful in the majority of possible BOTs
|
C
|
the strength
of the RMI in the assessment of possible BOTs lies with the elevated Ca125
levels
|
D
|
weakness of
the RMI in the assessment of possible BOTs is, in part, due to the wide range
of Ca125 levels found with BOTs
|
E
|
none of the
above
|
Scenario 16.
Which, if any, of the following statements are true in
relation to the measurement of Ca125 in calculating a RMI score.
Option list.
A
|
the units used
are mg/L
|
B
|
the units used
are mg/mL
|
C
|
the units used
are mol/L
|
D
|
the units used
are mol/mL
|
E
|
the units used
are iu/L
|
E
|
the units used
are iu/ml
|
Scenario 17.
Which, if any, of the following are part of the measurement
of US?
Option list.
A
|
ascites
|
B
|
hydrothorax
|
C
|
multilocular
cysts
|
D
|
↑ ovarian blood flow
|
E
|
↑ ovarian
number
|
E
|
↑ ovarian
volume
|
Scenario 18.
Which, if any, of the following statements describes the
best management of BOTs.
Option list.
A
|
the best
management is hysterectomy + BSO + infracolic omentectomy + lymphadenectomy +
appendicectomy + excision of extra-ovarian lesions
|
B
|
the best
management is hysterectomy + BSO + infracolic omentectomy + appendicectomy
|
C
|
the best
management is hysterectomy + BSO + appendicectomy
|
D
|
the best
initial management is ovarian cystectomy + histology of frozen section
|
E
|
chemotherapy
should be offered when the stage is > I
|
F
|
none of the
above
|
Scenario 19.
Which, if any, of the following statements describes the
recommended management of BOT in the woman who does not wish to retain her
fertility?
Option list.
A
|
the best
management is hysterectomy + BSO + infracolic omentectomy + lymphadenectomy +
appendicectomy + excision of extra-ovarian lesions
|
B
|
the best
management is hysterectomy + BSO + infracolic omentectomy + appendicectomy
|
C
|
the best
management is hysterectomy + BSO + appendicectomy
|
D
|
the best
initial management is ovarian cystectomy + histology of frozen section
|
E
|
none of the above
|
Scenario 20.
Which, if any, of the following statements describes the recommended
additional management of BOT in the woman who does not wish to retain her
fertility and whose tumour is mucinous?
Option list.
A
|
appendicectomy
|
B
|
appendicectomy
after histology of frozen section
|
C
|
removal of the
other ovary
|
D
|
removal of the
other ovary after histology of frozen section
|
E
|
bilateral
salpingectomy
|
Scenario 21.
What advice is usually given in relation to the use of
clomifene in women treated for BOTs?
Option list.
A
|
clomifene is
contraindicated
|
B
|
only offer
treatment to women < 35 years
|
C
|
only offer
treatment to women who have screened –ve for BRCA 1 & 2
|
D
|
only offer
treatment to women with stage 1 & 2 disease
|
E
|
restrict the
number of treatment cycles
|
Scenario 22.
What is the role of chemotherapy in the management of women
with BOTs?
Option list.
A
|
chemotherapy
should be offered routinely after surgery as for invasive disease
|
B
|
pre-operative
chemotherapy reduces recurrence rates
|
C
|
routine
chemotherapy is of unproven benefit
|
D
|
the main role
for chemotherapy is for recurrent disease
|
E
|
the main role
for chemotherapy is for recurrent disease unsuitable for surgery
|
Scenario 23.
Which, if any, of the following statements are true in
relation to restaging in the management of women with BOTs?
Option list.
A
|
should be
offered routinely if definitive surgery is not performed initially
|
B
|
restaging
improves 5-year recurrence rates
|
C
|
restaging
improves 10-year survival
|
D
|
restaging may
be appropriate for those with invasive implants
|
E
|
restaging may
be appropriate for those with DNA aneuploidy
|
Scenario 24.
What advice is usually given in relation to the management
of women found unexpectedly to have a BOT on histology?
Option list.
A
|
further
surgery, if needed, to remove the ovary and tube
|
B
|
adjuvant
chemotherapy
|
C
|
pelvic radiotherapy
|
D
|
close
follow-up
|
E
|
none of the
above
|
Scenario 25.
What is the role of laparoscopy in women with actual or
suspected BOT?
Option list.
A
|
laparoscopy
has replaced laparotomy in most cases
|
B
|
concerns about
the risk of recurrence limit its use
|
C
|
concerns about
worse survival limit its use
|
D
|
concerns about
port metastasis limit its used
|
E
|
none of the
above
|
Scenario 26.
What is the definition of conservative surgery in the
management of BOTs?
Option list.
A
|
surgery with
conservation of uterus and at least one ovary
|
B
|
surgery with
conservation of uterus and at least part of one ovary
|
C
|
surgery with complete
staging + conservation of uterus and at least one ovary
|
D
|
surgery with
complete staging + conservation of uterus and at least part of 1 ovary
|
E
|
complete
staging + omentectomy + conservation of uterus and at least part of 1 ovary
|
Scenario 27.
A nulliparous 24-year-old woman has a right-sided BOT. She
has opted for conservative surgery with conservation of the uterus and left
ovary and tube. She has asked about the advisability of biopsy of the left
ovary at the time of surgery. Which of the following options would reflect your
advice.
Option list.
A
|
biopsy of the
apparently normal ovary is recommended
|
B
|
biopsy of the
apparently normal ovary is not recommended
|
C
|
biopsy of the
apparently normal ovary is decided on an ad hoc basis by the MDT
|
D
|
biopsy of the
apparently normal ovary is a matter for informed consent
|
E
|
none of the
above
|
Scenario 28.
A nulliparous 24-year-old woman has a right-sided BOT. She
has conservative surgery with conservation of the uterus and left ovary and
tube. She has asked about the advisability of removal of the left ovary and
tube once she has completed her family.
Option list.
A
|
LSO is
recommended once her family is complete
|
B
|
LSO is not
recommended
|
C
|
LSO once her
family is complete is decided on an ad hoc basis by the MDT
|
D
|
LSO once her
family is complete is a matter for informed consent
|
E
|
none of the
above
|
Scenario 29.
What advice can be given about fertility rates after
conservative surgery for a BOT?
Option list.
A
|
about half of women
conceive spontaneously
|
B
|
fertility
rates are unimpaired by conservative surgery
|
C
|
fertility
rates are improved by conservative surgery
|
D
|
fertility
rates after conservative surgery are unknown
|
E
|
none of the
above
|
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