Website
1
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How to prepare. What to
read. Revision system. Study buddies. Statistics. Urogynaecology.
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2
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EMQ. Mycoplasma
genitalium
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3
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EMQ. Cystic fibrosis.
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4
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EMQ. Montgomery &
consent.
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5
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SBA.
Cowden syndrome.
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6
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EMQ. Uterine
transplant.
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1. How to prepare.
2. Mycoplasma genitalium. Question.
Lead-in.
Many of
the questions are not true EMQs as they have more than one correct answer.
Abbreviations.
BASHHMG: British
Association for Sexual Health and HIV’s “National
guideline for the management of infection with Mycoplasma genitalium”. 2018
BASHHNGU: British
Association for Sexual Health and HIV’s. “ UK National
Guideline on the management of non-gonococcal urethritis”. 2015, updated 2018.
MG: Mycoplasma
genitalium.
MP: Mycoplasma
pneumoniae.
PCB: postcoital
bleeding.
PMB: postmenopausal
bleeding.
PID: pelvic
inflammatory disease.
PTB: preterm
birth.
SARA: Sexually-Acquired
Reactive Arthritis.
Which, if any, of the following statements are true in
relation to MG? This is not a true EMQ as there may be more that one correct
answer.
Option list.
A
|
MG was first isolated in 2001
|
B
|
MG was first isolated from men with non-gonococcal
urethritis (NGU)
|
C
|
MG belongs to the Cutemollies class
|
D
|
MG is the smallest known yeast with the ability to
self-replicate
|
E
|
MG is the smallest known bacterium with the ability
to self-replicate
|
F
|
MG has an unusual, double-layered cell wall
|
G
|
MG has an unusual protrusion at one end
|
H
|
MG’s protrusion enables it to adhere to epithelial
cells
|
I
|
MG’s protrusion enables it to invade epithelial
cells
|
J
|
MG is best seen on a Gram stain
|
Scenario
2.
Which, if any, of the following
statements are true in relation to Mycoplasmas?
Option list.
A
|
are the largest known
bacteria
|
B
|
have no cell wall
|
C
|
have no nuclei
|
D
|
are resistant to ß-lactam
antibiotics
|
E
|
are resistant to
sulphonamides
|
F
|
colonies show a ‘scrambled
egg’ appearance on culture on agar
|
Scenario
3.
Which, if any, of the following
statements are true in relation to Mg?
Option list.
A
|
when the organism was
originally found, culture took 50 days
|
B
|
Mg is facetious
|
C
|
Mg is a facultative
aerobe
|
D
|
Mg is a facultative
anaerobe
|
E
|
Mg is a facultative
aerobe & anaerobe
|
F
|
Mg is fastidious
|
Scenario
4.
Which, if any, of the following
are true in relation to the approximate prevalence of MG?
Option list.
A
|
it is ~ 0.1%
|
B
|
it is ~ 1.0%
|
C
|
it is ~ 5.0%
|
D
|
it is ~ 5-10%
|
E
|
it is > 10%
|
F
|
none of the above
|
Scenario
5.
Which, if any, of the following
is true in relation to screening for MG? This is a true EMQ with only one
correct answer.
Option list.
A
|
screening for MG is now
included in the NCSP
|
B
|
screening for MG is now offered
as part of the NHSCS
|
C
|
screening should be
offered to all sexually active women < 30 years old
|
D
|
screening should only be
offered to those with symptoms suggestive of infection
|
E
|
screening should be
offered to all partners of those with MG infection
|
F
|
none of the above
|
Scenario
6.
Which, if any, of the following
are included in BASHHMG as risk factors for infection with MG?
Option list.
A
|
Cigarette smoking
|
B
|
Multiple dancing
partners
|
C
|
Multiple sexual partners
|
D
|
Non-white ethnicity
|
E
|
Younger age
|
F
|
None of the above
|
Scenario
7.
Which of the following
statements is true in relation to MG and co-infection with other organisms?
Option list.
A
|
MG excretes bactericidal
toxins and co-infection is rare
|
B
|
MG co-infection is most
often with chlamydia
|
C
|
MG co-infection is most
often with E. coli
|
D
|
MG co-infection is most
often with HIV
|
E
|
MG co-infection is most
often with TB
|
F
|
None of the above
|
Scenario
8.
Which of the following
statements is true in relation to MG and men?
Option list.
A
|
It is the most common
cause of NGU
|
B
|
It is the most common
cause of epididymitis
|
C
|
It is the most common
cause of prostatitis
|
D
|
It is a well-recognised
cause of male sub-fertility
|
E
|
Most men with MG
infection are asymptomatic
|
E
|
None of the above
|
Scenario
9.
Which, if any, of the following
statements are true in relation to MG and women?
Option list.
A
|
MG is linked to an ↑ risk of cervicitis
|
B
|
MG is linked to an ↑ risk of endometritis
|
C
|
MG is linked to an ↑ risk of female infertility
|
D
|
MG is linked to an ↑ risk of miscarriage
|
E
|
MG is linked to an ↑ risk of otitis media
|
F
|
MG is linked to an ↑ risk of pelvic inflammatory disease
|
G
|
MG is linked to an ↑ risk of postcoital bleeding
|
H
|
MG is linked to an ↑ risk of postmenopausal bleeding
|
I
|
MG is linked to an ↑ risk of preterm birth
|
J
|
MG is linked to an ↑ risk of damage to Fallopian tube cilia
|
K
|
MG is linked to an ↑ risk of puerperal psychosis
|
L
|
MG is linked to an ↑ risk of puerperal sepsis
|
M
|
Most infected women are
asymptomatic
|
N
|
None of the above
|
Scenario
10.
Which, if any, of the following
statements are true in relation to current concerns about Mg?
Option list.
A
|
It could become a
‘superbug’, resistant to most antibiotics, within a decade
|
B
|
Infection is often
misdiagnosed as chlamydia with ↑ risk of antibiotic
resistance
|
C
|
‘superbug’ status would
be likely to lead to an ↑ in renal failure
|
D
|
‘superbug’ status would
be likely to lead to an ↑ in female
infertility
|
E
|
‘superbug’ status would
be likely to lead to an ↑ in male infertility
|
Scenario
11.
Which, if any, of the following
methods are used in the recommended test for MG infection in women?
Option list.
A
|
blood testing for MG IgG
|
B
|
blood testing for MG IgM
|
C
|
cervical smears checked
microscopically for the diagnostic intracellular inclusion bodies
|
D
|
culture and sensitivity
of cervical swab specimens using MG-specific culture medium
|
E
|
culture and sensitivity
of 1st. void MSSU using MG-specific culture medium
|
F
|
culture and sensitivity
of vaginal swab specimens using MG-specific culture medium
|
G
|
NAATs that detect the MG
G-antigen
|
H
|
NAATs that detect MG DNA
|
I
|
NAATs that detect MG RNA
|
J
|
serum testing for
MG-specific antigen
|
K
|
vaginal swabs taken by
the woman
|
L
|
none of the above
|
Scenario
12.
Which, if any, of the following
statements are true in relation to testing for antibiotic resistance after
initial tests are +ve for MG?
Option list.
A
|
test for resistance to
cephalosporins
|
B
|
test for resistance to
macrolides
|
C
|
test for resistance to penicillin
|
D
|
test for resistance to
quinolones
|
E
|
test for resistance to
macrolides
|
F
|
test for resistance to streptomycin
|
F
|
test for resistance to sulphonamides
|
F
|
test for resistance to tetracyclines
|
G
|
None of the above
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Which, if any, of the following statements are true in
relation to estimates of antibiotic resistance in current strains of MG in the
UK?
Option list.
A
|
20% are resistant to cephalosporins
|
B
|
40% are resistant to macrolides
|
C
|
50% are resistant to penicillin
|
D
|
50% are resistant to quinolones
|
E
|
10% are resistant to streptomycin
|
F
|
90% are resistant to sulphonamides
|
F
|
40% are resistant to tetracyclines
|
F
|
None of the above
|
Scenario
14.
Which, if any, of the following
is BASHHMG’s recommended 1st. line treatment of uncomplicated MG?
Option list.
A
|
azithromycin 1 gram
daily for 7 days
|
B
|
doxycycline 100 mg twice
daily for 7 days
|
C
|
doxycycline 100 mg twice
daily for 10 days
|
D
|
doxycycline 100 mg twice
daily for 7 days
|
E
|
doxycycline 100 mg twice
daily for 7 days then azithromycin 1 gram daily for 2 days
|
F
|
moxifloxacin 400mg
orally once daily for 7 days
|
G
|
moxifloxacin 400mg orally
once daily for 10 days
|
H
|
none of the above
|
Scenario
15.
Lead-in
Which, if any, of the following
is BASHHMG’s recommended 1st. line treatment of complicated MG?
Option list.
A
|
doxycycline 100 mg twice
daily for 10 days
|
B
|
doxycycline 100 mg twice
daily for 14 days
|
C
|
moxifloxacin 400mg
orally once daily for 10 days
|
D
|
moxifloxacin 400mg
orally once daily for 14 days
|
E
|
none of the above
|
Scenario
16.
Lead-in
This is not an EMQ or SBA!
Fill in the gaps in the table
below, using option list.
Option list.
A
|
aminoglycoside
|
B
|
cephalosporin
|
C
|
macrolide
|
D
|
penicillin
|
E
|
quinolone
|
F
|
tetracycline
|
Table.
Drug name
|
Category of drug
|
azithromycin
|
|
doxycycline
|
|
moxifloxacin
|
Scenario
17.
Which, if any, of the following
statements is true in relation to test of cure (TOC) after treatment of MG?
Option list.
A
|
TOC should be offered to
everyone who has been treated for MG
|
B
|
TOC should only be
offered to those who had signs of infection before treatment
|
C
|
TOC should only be
offered to those who had symptoms of infection before treatment
|
D
|
TOC should only be
offered to those who had signs and symptoms before treatment
|
E
|
TOC should only be
offered to those who continue to have signs or symptoms two weeks or more
after the start of treatment
|
F
|
none of the above
|
Scenario
18.
Which, if any, of the following
statements are true in relation to the timing of test of cure (TOC) after
treatment of MG?
Option list.
A
|
TOC is best done at 3
weeks after start of treatment
|
B
|
TOC is best done at 4
weeks after start of treatment
|
C
|
TOC is best done at 5
weeks after start of treatment
|
D
|
TOC is best done at 6
weeks after start of treatment
|
E
|
TOC should not be done
< 2 weeks from the start of treatment
|
F
|
TOC should not be done
< 3 weeks from the start of treatment
|
G
|
TOC should not be done
< 4 weeks from the start of treatment
|
3. This question is about cystic fibrosis.
And, to
make you behave in a model fashion, there is no option list, so you have to
decide the correct answer without help.
Question 1.
A woman is 8 weeks
pregnant and known to be a carrier of cystic fibrosis.
Her husband is
Caucasian. What is the risk of the child having cystic fibrosis?
Question 2.
A healthy woman
attends for pre-pregnancy counselling. Her brother has cystic fibrosis.
Her husband is
Caucasian. He has been screened for cystic fibrosis. The test was negative.
What is the
approximate risk of them having a child with cystic fibrosis?
Question 3.
A healthy woman is
a known carrier of cystic fibrosis. She attends for pre-pregnancy counselling.
Her husband has cystic fibrosis.What is the risk of them having a child with
CF?
Question 4.
A
healthy woman attends for pre-pregnancy counselling. Her sister has had a child
with cystic fibrosis. What is her risk of being a carrier?
Question 5.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk
that she is a carrier?
Question 6.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
The partner’s risk
of being a carrier is 1 in X. What is the risk that she will have a child with
CF?
Question 7.
A healthy Caucasian
woman is 10 weeks pregnant. Her husband is a known carrier of cystic fibrosis.
Which test would
you arrange?
Question 8.
A woman attends for
pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from
maternal blood. Is it possible to test for CF in this way?
Question 9.
A woman and her
husband are known carriers of cystic fibrosis.
What is the risk of
them having an affected child?
Question 10.
A woman and her
husband are known carriers of cystic fibrosis.
What can they do to
reduce the risk of having an affected child?
Question 11.
A woman and her
husband are known carriers of cystic fibrosis.
Can CVS exclude an
affected pregnancy?
Question 12.
A woman with cystic
fibrosis is planning pregnancy. Her husband is a carrier of cystic fibrosis.
What is the risk of having an affected child?
Question 13.
A woman with cystic
fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been
advised not to breastfeed because her breast milk will be protein-deficient due
to malabsorption.
Is this advice
correct?
Question 14.
A woman with cystic
fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been
advised not to breastfeed because her breast milk will contain abnormally low
levels of sodium.
Is this advice
correct?
4. Montgomery Ruling.
Abbreviations.
BMA: British Medical Association.
GMC: General Medical Council.
Question
1.
Which, if
any, of the following statements are true?
Lead-in
A.
|
The
Montgomery ruling largely replaces the Bolam ruling
|
B.
|
The Montgomery ruling
largely replaces the Chester ruling
|
C.
|
The Montgomery ruling
largely replaces the Sidaway ruling
|
D.
|
The Montgomery ruling is
being contested in the European Court by the GMC as it infringes the rights
of doctors
|
E.
|
The Montgomery ruling is
being contested in the European Court by the BMA as it infringes the rights
of doctors
|
Question
2.
Which, if
any, of the following statements are true?
Lead-in
A.
|
the
level of risk, however small, must be disclosed if a patient requests it
|
B.
|
the level of risk of
damage from a procedure need not be disclosed if < 1%
|
C.
|
the level of risk of
damage from a procedure need not be disclosed if < 10%
|
D.
|
a material risk is one
that would be reflected in damages > £100,000 if negligence were proved in
court
|
E.
|
a material risk is one
that would be reflected in damages > £1,000,000 if negligence were proved
in court
|
F.
|
a material risk is one
that involves anatomical damage, not emotional or psychological
|
G.
|
a material risk is one
that a reasonable person in the patient’s situation would be likely to
regards as significant
|
5. Cowden syndrome.
Scenario 1.
Lead in.
Which
feature is associated with Cowden syndrome?
Option list.
A. albinism
B. hamartoma
C. hammer-toe
D. hypertrichosis
E. stammer
Scenario 2.
Lead in. Which condition has the highest risk
of occurrence in women with Cs?
Option list.
A. breast
cancer
B. bowel
cancer
C. congenital
absence of Müllerian tract derivatives
D. hypertension
E. hypothyroidism
Scenario 3.
Lead in. Which gynaecological cancer is a
particular risk for women with Cs?
Option list.
A. Bartholin’s
gland cancer
B. cervical
cancer
C. choriocarcinoma
D. endometrial
cancer
E. vulval
cancer
Scenario 4.
Lead in. Which cancer is more common in men
with Cs?
Option list.
A. breast
cancer
B. colon
cancer
C. melanoma
D. renal
cancer
E. thyroid
cancer
F. all
of the above
6. Uterine
transplant.
Abbreviations.
ET: embryo
transfer.
UT: uterine
transplant
Scenario
1.
When was the 1st.
human uterine transplant performed?
Option list.
A
|
2000
|
B
|
2015
|
C
|
2010
|
D
|
2011
|
E
|
2012
|
F
|
2013
|
G
|
2014
|
H
|
2015
|
I
|
2016
|
J
|
2017
|
Scenario
2.
When was the 1st.
livebirth after human uterine transplant?
Option list.
A
|
2000
|
B
|
2015
|
C
|
2010
|
D
|
2011
|
E
|
2012
|
F
|
2013
|
G
|
2014
|
H
|
2015
|
I
|
2016
|
J
|
2017
|
Scenario
3.
How many live births had
occurred worldwide after UT up to the end of 2018?
Option list
A
|
< 5
|
B
|
5 - 10
|
C
|
11 - 20
|
D
|
21 - 50
|
E
|
51 - 100
|
F
|
> 100
|
Scenario
4.
For which of the following
conditions is UT a possible treatment?
Option list.
A
|
Androgen Insensitivity
syndrome. AIS.
|
B
|
Congenital Adrenal
hyperplasia. CAH.
|
C
|
Kallmann’s syndrome. KS.
|
D
|
Mayer-Rokitansky-Küster-Hauser
syndrome. MRKH.
|
E
|
McCune-Albright syndrome.
MCAS.
|
F
|
Swyer’s syndrome. SS.
|
G
|
Turner’s syndrome. TS.
|
Scenario
5.
Which, if any, of the following
are commonly used for donor selection?
Option list.
A
|
absence of adenomyosis
|
B
|
absence of fibroids
|
C
|
age < 65 years
|
D
|
good general health
|
E
|
negative cervical smear
and no high-risk HPV
|
F
|
no cancer in past 5
years
|
G
|
parous
|
H
|
vaginal length > 7
cm.
|
Scenario
6.
Has successful transplant
occurred using a dead donor?
Option list.
A
|
No
|
B
|
Yes
|
Scenario
7.
What is the rate of graft
survival at 1 year, failure being the need for hysterectomy?
Option list.
A
|
< 10%
|
B
|
11 – 20%
|
C
|
21 – 30%
|
D
|
31 – 40%
|
E
|
41 – 50%
|
F
|
51 – 60%
|
G
|
> 60%
|
H
|
the figure is unknown
|
Scenario
8.
Which of the following
statements is correct?
Option list.
A
|
donor surgery is more extensive
than recipient surgery
|
B
|
donor surgery is less
extensive than recipient surgery
|
C
|
donor surgery is as extensive
as recipient surgery
|
Scenario
9.
What are the risks to the donor
in addition to the usual ones of bleeding, infection, haematoma and thrombosis?
There is no option list.
Scenario
10.
Which condition has been the
reason for recipients needing uterine transplant and which complication is more
likely in addition to the usual ones of bleeding, infection, haematoma and
thrombosis? There is no option list.
Scenario
11.
When is IVF and
cryopreservation of eggs done?
Option list.
A
|
before uterine
transplantation
|
B
|
at the time of uterine
transplantation
|
C
|
12 months after uterine
transplantation to ensure graft rejection does not occur
|
D
|
when the recipient chooses
|
E
|
none of the above
|
Scenario
12.
Which maintenance therapy was
used immediately before embryo transfer in the first case resulting in
livebirth?
Option list.
A
|
azathioprine +
corticosteroids + tacrolimus
|
B
|
azathioprine +
ciclosporin + corticosteroids + mycophenolate mofetil
|
C
|
azathioprine +
corticosteroids + mycophenolate mofetil + tacrolimus
|
D
|
azathioprine +
corticosteroids + tacrolimus
|
E
|
ciclosporin +
corticosteroids + mycophenolate mofetil + tacrolimus
|
F
|
ciclosporin +
mycophenolate mofetil + tacrolimus
|
G
|
corticosteroids +
mycophenolate mofetil + tacrolimus
|
H
|
corticosteroids +
tacrolimus
|
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