Website
7
|
RCOG sample questions.
There are also sample EMQs & SBAs. Go through all of them as they make
for easy marks. TOG has CPD questions in every issue. Make sure you can
answer all of them from the last 2 – 3 years.
|
8
|
SBA. Lynch
syndrome
|
9
|
EMQ. Maternal Mortality definitions
|
10
|
EMQ. Phenylketonuria
|
11
|
EMQ. Caldicott guardian
|
12
|
EMQ. Peutz-Jeghers syndrome
|
7. RCOG
sample questions.
8. Lynch syndrome.
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
HNPCC: hereditary
non-polyposis colo-rectal cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
Question
1.
Lead-in
What is
Lynch syndrome?
Option List
A
|
auto-immune
condition leading to reduced factor X levels in blood
|
B
|
hereditary condition
which increases the risk of many cancers, particularly breast
|
C
|
hereditary
condition which increases the risk of many cancers, particularly breast &
colorectal
|
D
|
hereditary
condition which increases the risk of many cancers, particularly colorectal
& endometrial
|
E
|
none of
the above
|
Question
2.
Lead-in
How is Lynch syndrome inherited?
Option List
A
|
it is an
autosomal dominant condition
|
B
|
it is an autosomal recessive
condition
|
C
|
it is an X-linked dominant
condition
|
D
|
it is an X-linked
recessive condition
|
E
|
none of the above
|
Question
3.
Lead-in
Which, if
any, of the following genes can cause Lynch syndrome?
Genes.
A
|
MLH1
|
B
|
MLH2
|
C
|
MOH1
|
D
|
MSH1
|
E
|
MSH6
|
Option List
A
|
MLH1 +
MLH2 + MOH1
|
B
|
MLH1 + MLH2 + MSH1
|
C
|
MLH1 + MLH2 + MSH6
|
D
|
MLH1 + MSH2 + MSH6
|
E
|
None of the above
|
Question
4.
Lead-in
Mutations
of which 2 of the following genes cause the majority of cases of Lynch
syndrome?
Genes.
A
|
MLH1
|
B
|
MLH2
|
C
|
MOH1
|
D
|
MSH1
|
E
|
MSH6
|
Option List
A
|
MLH1 +
MLH2
|
B
|
MLH1 + MSH1
|
C
|
MLH1 + MSH2
|
D
|
MLH2 + MSH1
|
E
|
MLH2 + MSH2
|
Question
5.
Lead-in
What is
the approximate prevalence of Ls in the UK population?
Option List
A.
|
1 in 50
|
B.
|
1 in 100
|
C.
|
1 in
1,000
|
D.
|
3 in
1,000
|
E.
|
none of the above
|
Question
6.
Lead-in
Approximately
what % of individuals with Ls have had the diagnosis established?
Option List
A.
|
< 5%
|
B.
|
5 -10%
|
C.
|
10-20%
|
D.
|
20-30%
|
E.
|
>30%
|
Question
7.
Lead-in
Which, if
any, of the following conditions are associated with an ↑
risk of Lynch syndrome?
Conditions
acromegaly
|
Addison’s
disease
|
anosmia
|
coeliac
disease
|
IBD
|
IDDM
|
Option List
A
|
acromegaly
+ Addison’s disease + coeliac disease + IBD + IDDM
|
B
|
acromegaly
+ disease + anosmia + coeliac disease + IBD
|
C
|
acromegaly
+ IBD + IDDM
|
D
|
acromegaly
+ IBD
|
E
|
Addison’s
disease + anosmia + coeliac disease + IBD + IDDM
|
F
|
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM
|
G
|
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM
|
H
|
none
|
Question
8.
Lead-in
Which 2
cancers are most likely in women with Lynch syndrome?
Cancers.
A
|
breast
|
B
|
bowel
|
C
|
cervix
|
D
|
endometrium
|
E
|
ovary
|
F
|
pancreas
|
Option List
A
|
breast +
bowel
|
B
|
breast + pancreas
|
C
|
breast + endometrium
|
D
|
bowel + cervix
|
E
|
bowel + endometrium
|
F
|
bowel + ovary
|
G
|
bowel + pancreas
|
H
|
endometrium + ovary
|
Question
9.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of colorectal cancer?
Option List
A
|
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative
|
B
|
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative
|
C
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis
|
D
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis
|
E
|
none of the above
|
Question
10.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of colorectal cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those
aged < 50 years at diagnosis
|
C
|
offer screening to those
aged < 60 years at diagnosis
|
D
|
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative
|
E
|
offer screening to those
aged < 60 years at diagnosis with + ≥ 1 affected 1st.O
relative
|
Question
11.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of thyroid cancer?
Option List
A
|
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative
|
B
|
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative
|
C
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis
|
D
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis
|
E
|
none of the above
|
Question
12.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of thyroid cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those
aged < 50 years at diagnosis
|
C
|
offer screening to those
aged < 60 years at diagnosis
|
D
|
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative
|
E
|
none of the above
|
Question
13.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of endometrial cancer?
Option List
A
|
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative
|
B
|
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative
|
C
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis
|
D
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis
|
E
|
none of the above
|
Question
14.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of endometrial cancer?
Option List
A
|
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative
|
B
|
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative
|
C
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis
|
D
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis
|
E
|
none of the above
|
Question
15.
Lead-in
What does
NICE recommend about screening for Lynch syndrome for the population with no
personal history of colorectal cancer?
Option List
A
|
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative
|
B
|
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative
|
C
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis
|
D
|
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis
|
E
|
none of the above
|
Question
16.
Lead-in
What does
NICE recommend in relation to screening for Lynch syndrome in those with a new
diagnosis of colorectal cancer?
Option List
A
|
offer
screening to everyone, regardless of age and family history
|
B
|
offer screening to those
aged < 50 years at diagnosis
|
C
|
offer screening to those
aged < 60 years at diagnosis
|
D
|
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative
|
E
|
offer screening to those
aged < 60 years at diagnosis with + ≥ 1 affected 1st.O
relative
|
Question
17.
Lead-in
What
relationship, if any, exists between Ls and acromegaly?
Option List
A
|
the risk
of Ls is ↓ in those with acromegaly compared with the
general population
|
B
|
the risk
of Ls is ↑ in those with acromegaly compared with the
general population
|
C
|
the risk
of Ls is unchanged in those with acromegaly compared with the general population
|
D
|
the risk
of Ls in unknown in those with acromegaly
|
Question
18.
Lead-in
What is
the effect of aspirin consumption on the risk of EC and CRC?
Option List
A
|
aspirin
reduces the risk of EC and CRC
|
B
|
aspirin
reduces the risk of EC but not CRC
|
C
|
aspirin
reduces the risk of CRC but not EC
|
D
|
aspirin
does not reduce the risk of EC or CRC
|
E
|
aspirin reduces the risk
of EC and CRC, but the risks outweigh the benefits
|
Question
19.
Lead-in
A healthy
woman of 35 years is diagnosed with Ls? What are the key elements of the
National Screening Programme for people with Ls?
There is
no option list – just write down everything you know.
Question 20.
Lead-in
Which, if
any, of the following were recommendations made by Monahan et al, the 30
experts who wrote to the BMJ in 2017.
Option List
A
|
creation of a national register of people with Ls
|
B
|
creation
of a post of Consultant in Ls for each NHS Trust
|
C
|
creation
of a post of Clinical Champion for Ls in each NHS Region.
|
D
|
creation
of a post of Clinical Champion for Ls in the DOH.
|
E
|
none
of the above
|
9. Maternal Mortality.
Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each
scenario.
Each option can be used once, more than once or not at
all.
Option List.
A.
Death of a woman during pregnancy and up to 6
weeks later, including accidental and incidental causes.
B.
Death of a woman during pregnancy and up to 6
weeks later, excluding accidental and incidental causes.
C.
Death of a woman during pregnancy and up to 52
weeks later, including accidental and incidental causes.
D.
Death of a woman during pregnancy and up to 52
weeks later, excluding accidental and incidental causes.
E.
A pregnancy going to 24 weeks or beyond.
F.
A pregnancy going to 24 weeks or beyond + any
pregnancy resulting in a live-birth.
G.
Maternal deaths per 100,000 maternities.
H.
Maternal deaths per 100,000 live births.
I.
Direct + indirect deaths per 100,000
maternities.
J.
Direct + indirect deaths per 100,000 live
births.
K.
Direct death.
L.
Indirect death.
M. Early
death.
N. Late
death.
O. Extra-late
death.
P.
Fortuitous death.
Q. Coincidental
death.
R.
Accidental death.
S.
Maternal murder.
T.
Not a maternal death.
U. Yes
V.
No.
W.I have no idea.
X.
None of the above.
Abbreviations.
MMR: Maternal Mortality Rate.
MMRat: Maternal Mortality Ratio.
SUDEP: Sudden Unexplained Death in Epilepsy.
Option list.
There is
none.
Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured
ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured
appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What
kind of death is it?
Scenario 5.
A woman with a 10-year-history of coronary artery disease
dies of a coronary thrombosis at 36 weeks’ gestation. What kind of death is it?
Scenario 6.
A woman has gestational
trophoblastic disease, develops choriocarcinomas and dies from it 24 months
after the GTD was diagnosed and the uterus evacuated. What kind of death
is it?
Scenario 7
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 18 months old. What kind of death is it?
Scenario 8
A woman develops puerperal
psychosis from which she makes a poor recovery. She kills herself when the baby
is 6 months old. What kind of death is it?
Scenario 9
What is a “maternity”.
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality
Ratio?
Scenario 12
A woman is diagnosed with
breast cancer. She has missed a period and a pregnancy test is +ve. She decides
to continue with the pregnancy. The breast cancer does not respond to treatment
and she dies from secondary disease at 38 weeks. What kind of death is it?
Scenario 13
A woman who has been the
subject of domestic violence is killed at 12 weeks’ gestation by her partner.
What kind of death is it?
Scenario 14
A woman is struck by lightning
as she runs across a road. As a result she falls under the wheels of a large
lorry which runs over abdomen, rupturing her spleen and provoking placental
abruption. She dies of haemorrhage, mostly from the abruption. What kind of
death is it?
Scenario 15
A woman is abducted by Martians
who are keen to study human pregnancy. She dies as a result of the treatment
she receives. As this death could only have occurred because she was pregnant,
is it a direct death?
Scenario 16
Could a maternal death from
malignancy be classified as “Direct”.
Scenario 17
Could a maternal death from
malignancy be classified as “Indirect”.
Scenario 18
Could a maternal death from
malignancy be classified as “Coincidental”?
Scenario 19.
A pregnant woman is walking on
the beach at 10 weeks when she is struck by lightning and dies. What kind of
death is this?
Scenario 20.
A woman is sitting on the beach
breastfeeding her 2-month old baby when she is struck by lightning and dies.
What kind of death is this.
10. Topic. Phenylketonuria in pregnancy
Some of these are not true EMQs –
some have no option list and you have to decide the correct answer for
yourself. This is what you are advised to do in the exam – read the question,
decide the answer and then look for
it on the option list.
Abbreviations.
BH4: tetrahydrobiopterin.
BH4D: tetrahydrobiopterin deficiency.
HPA: hyperphenylalaninaemia.
PA: phenylalanine.
PAH: phenylalanine
hydroxylase.
PKU: phenylketonuria.
Tyr: tyrosine.
Option
list.
A.
|
autosomal dominant
|
B.
|
autosomal recessive
|
C.
|
X-linked dominant
|
D.
|
X-linked recessive
|
E.
|
1 in 100,000
|
F.
|
1 in 50,000
|
G.
|
1 in 10,000
|
H.
|
1 in 5,000
|
I.
|
deficiency in phenylalanine
hydroxylase
|
J.
|
deficiency in phenylalanine
oxidase
|
K.
|
deficiency in phenylalanine
transferase
|
L.
|
deficiency in phenylketone
hydroxylase
|
M.
|
deficiency in phenylketone
oxidase
|
N.
|
raised PA levels
|
O.
|
reduced PA levels
|
P.
|
raised tyrosine levels
|
Q.
|
reduced tyrosine levels
|
R.
|
normal tyrosine levels
|
S.
|
No
|
T.
|
Yes
|
U.
|
unknown
|
What is PKU? Write your answer – there is no option list.
Question
2.
What is PKU due to? Use the
option list.
Question
3.
What levels of PA and Tyr are
typical in PKU? Use the option list. This is not a real EMQ as there are two
answers.
Question
4.
Is PKU subdivided into different
categories? If “yes”, what are the categories? Write your answer – there is no
option list.
Question
5.
How is PKU inherited? Use the
option list.
Question
6.
Which chromosome houses the gene
related to PKU transmission?
Question
7.
How many mutations of the gene
related to PKU have so far been identified?
Question
8.
Is a person with PKU likely to
have one or two mutations of the relevant gene?
Question
9.
What are the main consequences of
PKU? Write your answer – there is no option list.
Question
10.
Which, if any, of the following
are characteristic of PKU?
Option
list.
A.
|
alopecia
|
B.
|
angst
|
C.
|
facial dysmorphism
|
D.
|
facial hair in females and
pre-pubertal males
|
E.
|
kyphosis
|
F.
|
macroorchidism in post-pubertal
males
|
Question
11.
Are fetal PKU levels higher or
lower than maternal? Write your answer – there is no option list.
Question
12.
What is the approximate
prevalence of PKU in Caucasians?
Question
13.
The prevalence of PKU varies
between ethnic groups.
Match each of the following
ethnic groups to the closest prevalence given in the option list.
Option
List
1.
|
1 in 1,000
|
2.
|
1 in 2,500
|
3.
|
1 in 5,000
|
4.
|
1 in 10,000
|
5.
|
1 in 100,000
|
6.
|
1 in 150,000
|
7.
|
1 in 200,000
|
8.
|
1 in 1,000,000
|
Ethnic group
|
Prevalence
|
Turkish
|
|
Irish
|
|
Caucasian
|
|
East Asian
|
|
Japanese
|
|
Finnish
|
Question
14.
Is screening for PKU a routine
part of the neonatal screen in the UK?
Question
15.
The test for PKU used to be known
by the name of its inventor. Who was he and why did he have a particular
interest? There is no option list and no one is going to ask you except me!
Lead-in
What is the main treatment of PKU and what problems are
associated with it? There is no option list.
Question 17.
Lead-in
How long should the main treatment of PKU be continued
and why? There is no option list.
Question
18.
Lead-in
A woman with PKU is planning her
first pregnancy at the age of 22. She has been off the PKU-restricted diet
since the age of 10 and can barely remember being on it. Should she be advised
to re-start the diet? If ‘yes’, when should she start and what explanation
would you give for the advice?
Question
19.
Lead-in
Is breast-feeding advisable for
women with PKU?
Question
20.
Lead-in
Are any other therapeutic
approaches available? If ‘yes’, what are they and how do they work? If ‘yes’
use the option list for the mode of action.
There is a recent TOG article by Munyame et
al.
The linked CPD questions are here:
Send your answers and I’ll send mine.
11. 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
|
|
the
need to appoint a Caldicott Guardian
|
|
|
the need to create a Caldicott Register
|
|
|
the need to create a Caldicott Police Department
|
|
|
the need to create a link between the Caldicott Department and the DOH
|
|
|
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!
12. Peutz-Jeghers syndrome.
Scenario
1.
Which, if any, of the following
are characteristics of PJS?
Option list.
A.
|
buccal pigmentation
|
B.
|
gastro-intestinal
hamartomas
|
C.
|
perianal pigmentation
|
D.
|
increased risk of breast
cancer
|
E.
|
increased risk of
cervical adenoma malignum
|
F.
|
increased risk of colo-rectal
cancer
|
G.
|
increased risk of
endometrial cancer
|
H.
|
increased risk of ovarian
cancer
|
I.
|
increased risk of
pancreatic cancer
|
J.
|
increased risk of
prostate cancer
|
K.
|
increased risk of stomach
cancer
|
Scenario
2.
What is the approximate prevalence
of PJS?
Option list.
A.
|
< 1 in 1,000
|
B.
|
1 in 1,000 to 1 in
10,000
|
C.
|
1 in 10,000 to 1 in
100,000
|
D.
|
1 in 25,000 to 1 in
100,000
|
E.
|
1 in 25,000 to 1 in
200,000
|
F.
|
1 in 25,000 to 1 in
300,000
|
G.
|
1 in 300,000 to 1 in
500,000
|
H.
|
< 1 in 500,000
|
Scenario
3.
What is the mode of inheritance in PJS?
Option list.
A
|
autosomal dominant
|
B
|
autosomal recessive
|
C
|
X-linked dominant
|
D
|
X-linked recessive
|
E
|
Y-linked dominant
|
F
|
Y-linked recessive
|
G
|
triplet repeat
|
Scenario
4.
Which, if any, of the following statements are true of PJS?
Option list.
A
|
PJS only occurs in
families with other affected members
|
B
|
PJS mainly occurs in
families with other affected members
|
C
|
PJS may arise de-novo in
families with no other affected members
|
D
|
PJS may arise de-novo in
families with other affected members
|
E
|
PJS does not arise
de-novo in families with no other affected members
|
Scenario
5.
What is the approximate
lifetime risk of developing cancer in PJS?
Option list.
A.
|
10%
|
B.
|
20%
|
C.
|
30%
|
D.
|
40%
|
E.
|
50%
|
F.
|
60%
|
G.
|
70%
|
H.
|
80%
|
I.
|
90%
|
J.
|
>90%
|
Scenario
6.
What is the relevance of SK11
to PJS?
Option list.
A.
|
It is part of the
postcode of the Peutz-Jeghers Society
|
B.
|
It is the name of the
gene most commonly associated with PJS
|
C.
|
It is the Ornithological
Society’s code for the Orkney Skua
|
D.
|
Somatic mutations have
been found in cervical cancer
|
E.
|
None of the above
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can I get the ans key
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