Website
Viva. Obstructive sleep apnoea
|
|
23
|
EMQ. Renal transplant
|
24
|
SBA. Endometrial hyperplasia
|
25
|
EMQ.
Headache
|
26
|
EMQ.
Abortion
Act
|
27
|
SBA. Kisspeptin
|
The examiner will
ask you 11 questions.
23. EMQ.
Renal transplant & pregnancy.
Abbreviations.
AST: American
Society for Transplantation
Question 1
Approximately how
many women who have had renal transplant have pregnancies annually in the UK?
Option list.
A
|
10-20
|
B
|
30-40
|
C
|
50-100
|
D
|
100-200
|
E
|
200-300
|
F
|
300-400
|
G
|
400-500
|
H
|
>500
|
Question 2
Which, if any, of
the following statements are true about the findings of the UKOSS survey of
renal transplant in pregnancy?
Option list.
A
|
the
incidence of PET was ~ 25%, roughly six times higher than the general
population
|
B
|
the
incidence of PET was ~ 25%, roughly ten times higher than the general
population
|
C
|
the
incidence of PET was ~ 50%, roughly ten times higher than the general
population
|
D
|
the
incidence of PET was ~ 50%, roughly twenty times higher than the general
population
|
E
|
none of the
above
|
Question 3
Various sources,
such as AST, give factors linked to reduced risks associated with pregnancy
after RT. A lot of this is common sense. Write down all the factors that would
be in your list.
Question 4
What is the risk
of graft rejection in the year after RT?
Option list.
A
|
< 5%
|
B
|
10-15%
|
C
|
15-20%
|
D
|
20-25%
|
E
|
unknown
|
Question 5
Which of the
following factors are the 3 main ones affecting pregnancy outcome?
Factors
1
|
anaemia
|
2
|
diabetes
|
3
|
hypertension
|
4
|
number of
immunosuppressive drugs being used
|
5
|
obesity
|
6
|
pre-pregnancy
graft function
|
7
|
proteinuria
|
8
|
urinary
tract infection
|
Option list.
A
|
1 + 2 + 3
|
B
|
1 + 2 + 6
|
C
|
2 + 3 + 4
|
D
|
2 + 4 + 6
|
E
|
3 + 6 +7
|
F
|
3 + 6 + 8
|
G
|
4 + 5 + 6
|
H
|
4 + 6 + 8
|
Question 6
Which of the
following statements is true in relation to the prevalence of hypertension in
women after RT?
Option list.
A
|
> 20%
have hypertension
|
B
|
> 30%
have hypertension
|
C
|
> 40%
have hypertension
|
D
|
> 50 %
have hypertension
|
E
|
none of the
above
|
Question 7
State whether
these drugs are regarded as safe or unsafe in pregnancy.
|
|
Drug
|
Safe / unsafe
|
A
|
ACE inhibitor
|
Safe / unsafe
|
B
|
angiotensin receptor antagonist
|
Safe / unsafe
|
C
|
azathioprine
|
Safe / unsafe
|
D
|
ciclosporin
|
Safe / unsafe
|
E
|
clopidogrel
|
Safe / unsafe
|
F
|
erythropoietin
|
Safe / unsafe
|
G
|
hydroxychloroquine
|
Safe / unsafe
|
H
|
mycophenolate
|
Safe / unsafe
|
I
|
prednisolone
|
Safe / unsafe
|
J
|
tacrolimus
|
Safe / unsafe
|
K
|
warfarin
|
Safe / unsafe
|
TOG CPD
With regard to renal transplant,
1. most recipients
have a successful pregnancy outcome. T F
2. pregnancy is
associated with a 10% reduction in GFR in recipients with prepregnancy eGFR
>90 ml/ min/1.73m2 . T F
3. hypertension
complicates pregnancy in over 50% of recipients who did not require
antihypertensive treatment prior to pregnancy. T F
4. proteinuria is
a predictor of poor pregnancy outcome in recipients. T F
5. the risk of
damage to the allograft at caesarean delivery is about 1%. T F
6. a positive
serological screening test for aneuploidy in recipients is a recognised
consequence of impaired renal function. T F
7. superimposed
pre-eclampsia in recipients has defined diagnostic criteria. T F
8. erythropoietin
requirements in recipients fall in pregnancy. T F
9. breastfeeding
is safe in recipients on angiotensin converting enzyme inhibitors. T F
10. conception is not
advised within the first year following transplantation. T F
11. continuous
electronic fetal monitoring is recommended during labour in recipients. T F
12. the progesterone
implant is a safe form of postpartum contraception in recipients. T F
Women who have donated a kidney,
13. are at increased
risk of gestational hypertension. T F
Combined kidney-pancreas transplant recipients,
14. have a higher
risk of gestational diabetes than kidney transplant recipients. T F
Liver transplant recipients,
15. have a lower risk
of pregnancy complications than renal transplant recipients. T F
With regard to pregnancy in cardiothoracic transplant
recipients,
16. lung transplant
recipients have the highest risk of adverse outcome of all solid organ
transplants. T F
17. due to
denervation, the transplanted heart responds poorly to the physiological
changes of pregnancy. T F
18. cardiothoracic
transplant recipients should be delivered by caesarean section. T F
Regarding medications prescribed in patients with solid
organ transplants,
19. tacrolimus levels
require monitoring during pregnancy. T F
20. warfarin is safe
for breastfeeding mothers. T F
24. EMQ.
Endometrial
hyperplasia.
Abbreviations.
BSO: bilateral
salpingo-oophorectomy
c.f. compared
with
EC: endometrial
cancer
EH: endometrial
hyperplasia
ES: endometrial
surveillance
Question 1.
What is the definition of endometrial
hyperplasia?
Option List
|
A.
|
endometrial thickness ≥ twice that of proliferative endometrium
|
|
B.
|
endometrial thickness ≥ twice that of proliferative
endometrium in the absence of oestrogenic stimulation
|
|
C.
|
premenopausal endometrial thickness
≥ 6 mm; postmenopausal thickness ≥ 4 mm.
|
|
D.
|
proliferation of endometrial glands with ↑ gland to
stroma ratio c.f. proliferative endometrium
|
|
E.
|
proliferation of endometrial stroma with ↑ stroma to
gland ratio c.f. proliferative endometrium
|
Question 2.
Approximately how many cases of
endometrial cancer are diagnosed annually in the UK?
Option List
|
|
≤ 1,000
|
|
|
1,000 - ≤
1,500
|
|
|
1,500 - ≤
3,000
|
|
|
3,000 - ≤
5,000
|
|
|
5,000 - ≤ 10,000
|
Question 3.
Where does endometrial cancer rank in
the list of gynaecological cancers by incidence?
Option List
|
A.
|
1st.
|
|
B.
|
2nd.
|
|
C.
|
3rd.
|
|
D.
|
4th.
|
|
E.
|
5th.
|
Question 4.
Where does endometrial cancer rank in
the list of gynaecological cancers causing death?
Option List
|
A.
|
1st.
|
|
B.
|
2nd.
|
|
C.
|
3rd.
|
|
D.
|
4th.
|
|
E.
|
5th.
|
Question 5.
What is the prevalence of EH compared
with that of EC.?
Option List
|
A.
|
~ ¼
|
|
B.
|
~ ½
|
|
C.
|
similar
|
|
D.
|
> double
|
|
E.
|
> treble
|
Question 6.
What classification system does the
RCOG recommend for EH?
Option List
|
A.
|
BSGE 2015 classification based on
endometrial thickness
|
|
B.
|
FIGO 2000 classification based on risk of malignancy
assessment
|
|
C.
|
FIGO 2005 classification based on histological
grading
|
|
D.
|
WHO 2014 classification based on endometrial
thickness
|
|
E.
|
WHO 2014 classification based on cytological atypia
|
Question 7.
A 48-year-old woman presents with
erratic bleeding and menopausal symptoms. Endometrial histology shows hyperplasia
with no cytological anomaly. What is the risk of progression to endometrial
cancer in the next 10 years?
Option List
|
A.
|
< 1%
|
|
B.
|
≤ 5%
|
|
C.
|
5% - ≤ 10%
|
|
D.
|
10% - ≤ 15%
|
|
E.
|
> 15%
|
Question 8.
A 48-year-old woman presents with
menopausal symptoms. Endometrial histology shows hyperplasia with no
cytological anomaly. What is the chance of spontaneous regression of the
endometrial hyperplasia?
Option List
|
A.
|
< 1%
|
|
B.
|
1% - ≤ 10%
|
|
C.
|
10% - ≤ 15%
|
|
D.
|
15% - ≤ 25%
|
|
E.
|
> 25%
|
Question 9.
A 48-year-old woman presents with
erratic bleeding and menopausal symptoms. An outpatient endometrial sample
shows atypical hyperplasia. What is her lifetime risk of EC?
Option List
|
A.
|
≤ 5%
|
|
B.
|
5% - ≤ 10%
|
|
C.
|
10% - ≤ 25%
|
|
D.
|
25% - ≤ 50%
|
|
E.
|
> 50%
|
Question 10.
Which of the following are risk
factors for the development of endometrial hyperplasia?
Option List
|
A.
|
aromatase inhibitors
|
|
B.
|
clomiphene used for induction of
ovulation
|
|
C.
|
continuous combined HRT
|
|
D.
|
obesity
|
|
E.
|
tamoxifen
|
Question 11.
Which of the following should be used
for the diagnosis of endometrial hyperplasia?
Option List
|
A.
|
endometrial histology
|
|
B.
|
CT scan
|
|
C.
|
hystero-salpingography
|
|
D.
|
MRI scan
|
|
E.
|
trans-vaginal ultrasound scan
|
Question 12.
Which of the following are true of the
management of endometrial hyperplasia without cytological abnormality?
Option List
|
A.
|
identified risk factors should be
discussed with the woman
|
|
B.
|
observation with follow-up endometrial biopsies is
acceptable
|
|
C.
|
progestogens improve the chance of regression
|
|
D.
|
progestogen should not be used when women show no
regression after B
|
|
E.
|
progestogen should not be used when women have
abnormal bleeding
|
Question 13.
Which of the following are true of the
management of endometrial hyperplasia without cytological abnormality?
Option List
|
A.
|
brachytherapy is the recommended 1st.
line treatment in the GTG
|
|
B.
|
cyclical oral progestogen therapy is
the recommended 1st. line treatment in the GTG
|
|
C.
|
intra-cavity methotrexate is the
recommended 1st. line treatment in the GTG
|
|
D.
|
the COC is the recommended 1st.
line treatment in the GTG
|
|
E.
|
the LNG-IUS is the recommended 1st.
line treatment in the GTG
|
Question 14.
Which of the following statements are
true in relation to the management of endometrial hyperplasia without
cytological abnormality?
Option List
|
A.
|
treatment should be for a minimum of
6 months
|
|
B.
|
women should be encouraged to continue with the
LNG-IUS for at least 3 years
|
|
C.
|
endometrial surveillance with biopsy should be
provided at a minimum of 12 monthly
|
|
D.
|
review schedules should be individualised
|
|
E.
|
two consecutive 6-monthly biopsies should be
negative before discharge is considered
|
Question 15.
Which of the following are true in
relation to hysterectomy as management of endometrial hyperplasia without
cytological abnormality?
Option List
|
A.
|
treatment to achieve regression
should be for at least 6 months before surgery is considered
|
|
B.
|
treatment to achieve regression should be for at
least 12 months before surgery is considered
|
|
C.
|
treatment to achieve regression should be for at
least 24 months before surgery is considered
|
|
D.
|
recurrence of endometrial hyperplasia without
cytological abnormality after progestogen therapy is grounds for considering
hysterectomy
|
|
E.
|
hysterectomy should be recommended to the woman who
declines surveillance
|
Question 16.
Which of the following statements are true in
relation to women with endometrial hyperplasia without cytological atypia for
whom hysterectomy is being considered?
Option List
|
A.
|
post-menopausal women should have
bilateral salpingo-oophorectomy
|
|
B.
|
pre-menopausal women should have bilateral salpingo-oophorectomy
|
|
C.
|
bilateral salpingectomy should be offered to all
women not having BSO
|
|
D.
|
laparoscopic hysterectomy should be offered in
preference to abdominal
|
|
E.
|
the GTG uses the term “total hysterectomy” which is
really stupid
|
Question 17.
Which of the following are true in
relation to the management of atypical hyperplasia of the endometrium?
Option List
|
A.
|
endometrial ablation is satisfactory
if ES can be done for at least 5 years
|
|
B.
|
brachytherapy is satisfactory if ES can be done for
at least 5 years
|
|
C.
|
hysterectomy ± BSO or bilateral salpingectomy should be offered
|
|
D.
|
frozen section should be done at the time of
hysterectomy to determine the need for lymphadenectomy
|
|
E.
|
continuous oral progestogen therapy should be given
for at least 12 months post-op
|
Question 18.
A woman with atypical hyperplasia of
the endometrium wishes to retain her fertility. Which of the following are
true?
Option List
|
A.
|
endometrial and ovarian cancer must
be ruled out to start with
|
|
B.
|
the MDT should decide management after reviewing the
results of the histology, imaging and tumour markers
|
|
C.
|
the woman should be advised is that medical advice
is to have hysterectomy because of the risk of cancer
|
|
D.
|
the LNG-IUS is the first-line preference for
conservative management
|
|
E.
|
oral progestogens should not be used
|
|
F.
|
she should have at least one clear endometrial
biopsy before conceiving
|
|
G.
|
referral to a fertility specialist should be
arranged to discuss ART
|
Question 19.
What follow-up should be offered to
the woman with atypical hyperplasia of the endometrium who wishes conservative
management?
Option List
|
A.
|
surveillance includes endometrial
biopsy
|
|
B.
|
surveillance should be at intervals of not more than
6 months until 2 consecutive, clear biopsies have been obtained
|
|
C.
|
surveillance should be at intervals of not more than
3 months until 2 consecutive, clear biopsies have been obtained
|
|
D.
|
long-term follow-up after 2 consecutive, clear
biopsies have been obtained can be at 6 – 12 month intervals
|
|
E.
|
long-term follow-up after 2 consecutive, clear
biopsies have been obtained can be at 12 – 24 month intervals
|
Question 20.
A woman who has had successful
conservative treatment for atypical hyperplasia of the endometrium wishes to go
onto HRT. Which of the following are true?
Option List
|
A.
|
continuous progestogen therapy is
necessary regardless of the type or mode of administration of oestrogen
replacement
|
|
B.
|
LNG-IUS or depot progestogens are preferred to oral
therapy
|
|
C.
|
hysterectomy should be recommended if not already
done
|
|
D.
|
six-months TV scans should be done for endometrial
thickness
|
|
E.
|
none of the above
|
Question 21.
Which of the following are true in
relation to the woman with endometrial hyperplasia who has been treated for
breast cancer and are taking tamoxifen or aromatase inhibitors.
Option List
|
A.
|
she should be informed that
tamoxifen ↑the risk of endometrial cancer
|
|
B.
|
she should be informed that aromatase inhibitors ↑the
risk of endometrial cancer
|
|
C.
|
she should be informed that the LNG-IUS ↓ the risk
of endometrial cancer for women on tamoxifen
|
|
D.
|
she should be informed that the LNG-IUS ↓ the risk
of endometrial cancer for women on aromatase inhibitors
|
|
E.
|
she should be informed that the effect of the LNG-IUS
on the risk of breast cancer recurrence is unknown and that it is not
recommended as a result
|
Question 22.
A woman is found to have endometrial
hyperplasia on an endometrial polyp. Which of the following are true of the
best management?
Option List
|
A.
|
complete removal of the polyp must
be checked
|
|
B.
|
hysteroscopy and curettage must be done to check the
endometrium
|
|
C.
|
an LNG-IUS should be recommended
|
|
D.
|
hysterectomy should be recommended
|
|
E.
|
none of the above.
|
25. EMQ.
Headache.
Lead-in.
The following
scenarios relate to headache in pregnancy.
Pick one option
from the option list.
Each option can
be used once, more than once or not at all.
Option list.
1. abdominal migraine
2. analgesia overuse aka medication overuse
3. bacterial meningitis
4. benign intracranial hypertension
5. BP check
6. cerebral venous sinus thrombosis
7. chest X-ray
8. cluster
9. severe PET / impending eclampsia
10. malaria
11. meningococcal meningitis
12. methyldopa
13. methysergide
14. migraine
15. MRI brain scan
16. nifedipine
17. nitrofurantoin
18. pancreatitis
19. sinusitis
20. subdural haematoma
21. subarachnoid haemorrhage
22. tension
23. ultrasound scan of the abdomen
Scenario 1.
A 40-year-old para 3 is admitted at 38 weeks by ambulance
with severe headache of sudden onset. She
describes it as “the worst I’ve ever had”. Which diagnosis needs to be excluded
urgently?
Scenario 2.
A 32-year-old para 1 has recently experienced headaches. They are worse on exercise, even mild exercise such as
walking up stairs. She experiences photophobia with the headaches. Which is the most likely diagnosis?
Scenario 3.
A woman returns from a sub-Saharan area of Africa. She
develops severe headache, fever and rigors.
What diagnosis should particularly be in the minds of the attending doctors?
Scenario 4.
A woman at 37
weeks has s. They particularly occur at night without obvious triggers. They
occur every few days.
Scenario 5.
A primigravida
has had s on a regular basis for many years. They occur most days, are
bilateral and are worse when she is stressed. What is the most likely
diagnosis?
Scenario 6.
A woman complains of recent headaches at 36 weeks. The history reveals that they started soon
after she began treatment with a drug prescribed by her GP. Which is the most
likely of the following drugs to be the culprit: methyldopa, methysergide, nifedipine
or nitrofurantoin?
Scenario 7
A woman is booked for Caesarean section and wishes regional
anaesthesia. She had severe headache due to dural tap after a previous
Caesarean section. She wants to take all possible steps to reduce the risk of
having this again. Which of epidural / spinal anaesthesia has the lower risk of
causing dural tap?
Scenario 8
A 25-year-old primigravida attends for her 20-week scan and
complains of headache which started two weeks before. There is no significant
history. The pain occurs behind her right eye and she describes it as severe
and “stabbing” in nature. The pain is so severe that she cannot sit still and
has to walk about. She has noticed that her right eye becomes reddened and
“watery” during the attack and her nose is “runny”. The attacks have no obvious
trigger and mostly occur a few hours after she has gone to sleep. The usually
last about 20 minutes. She has no other symptoms. She smokes 20 cigarettes a
day but does not take any other drugs, legal or otherwise. What is the most
likely diagnosis?
Scenario 9
A woman has a 5-year history of unilateral, throbbing
headache often preceded by nausea, visual disturbances, photophobia and
sensitivity to loud noise. What is the most likely diagnosis?
Scenario 10
A primigravida
is admitted at 38 weeks complaining of headache, abdominal pain and a sensation
of flashing lights. What would be the appropriate initial investigation?
Scenario 11
A woman with BMI
of 35 attends for her combined Downs syndrome screening test. She complains of
pain behind her eyes. The pain is worst last thing at night before she goes to
sleep or if she has to get up in the night. She has noticed she has noticed
horizontal diplopia on several occasions. She has no other symptoms.
Examination shows papilloedema.
Scenario 12
A grande multip
of 40 years experienced sudden-onset, severe headache, vomited several times
and then collapsed, all within the space of 30 minutes. She is admitted
urgently in a semi-comatose state. Examination shows neck-stiffness and left
hemi-paresis.
Scenario 13.
What did the MMR include as “red flags” for headache in pregnancy? These are not on the option list – you need
to dig them out of your head.
Questions from TOG article by
Revell & Moorish. 2014. This is open access, so read it.
Headaches in pregnancy
Red flag features for headaches include:
1. headache that changes with posture True / False
2. associated vomiting True / False
3. occipital location True / False
4. associated visual disturbance. True / False
Migraine is classically,
5. bilateral. True / False
6. pulsating. True / False
7. aggravated by physical exercise. True / False
With regard to migraine headaches in pregnancy,
8. there is an increase in the frequency of
attacks without aura. True / False
9. women who suffer from this have not been
shown to have an increase in the risk of pre-eclampsia. True / False
10. the 5HT1-receptor sumatriptan has been shown
to be teratogenic. True
/ False
11. women presenting with an aura for the first
time are not at an increased risk of intracranial disease. True / False Posterior
reversible encephalopathy syndrome,
12. is associated with an impairment of the
autoregulatory mechanism which maintains constant cerebral blood flow where
there are blood pressure fluctuations. True / False
13. when it is associated with pre-eclampsia,
management should follow the pathway for managing severe pre-eclampsia. True / False
With regard to cerebral venous thrombosis,
14. the incidence in western countries in
pregnancy ranges from 1 in 2500 deliveries to 1 in 10 000 deliveries. True / False
15. the greatest risk in pregnancy is mainly in
the last four weeks. True / False
16. the most common site is the sagittal sinus. True / False
17. a plain computed tomography is a highly
sensitive investigation. True / False
18. T2-weighted magnetic resonance imaging has
been shown to have limited value in diagnosis. True / False
19. the outcome is better when it is associated
with pregnancy and the puerperium compared to that occurring outside pregnancy.
True / False
20. when it occurs in pregnancy, it is a
contraindication for future pregnancies. True / False
26. EMQ. Abortion Act & TOP.
Scenario 1
Lead in.
How many
abortions were performed on residents of E&W aged 15-44 in 2016?
Option list
A
|
about 50,000
|
B
|
about 100,000
|
C
|
about 150,000
|
D
|
about 200,000
|
E
|
about 250,000
|
F
|
> 250,000
|
Scenario 2
Lead in.
What was the
approximate rate of abortion in E&W residents in 2016?
Option list
A
|
1 per 1,000 resident women aged 15-44
|
B
|
10 per 1,000 resident women aged 15-44
|
C
|
15 per 1,000 resident women aged 15-44
|
D
|
20 per 1,000 resident women aged 15-44
|
E
|
50 per 1,000 resident women aged 15-44
|
F
|
100 per 1,000 resident women aged 15-44
|
Scenario 3
Lead in.
The rate of
abortion has declined by >20% in residents of E&W in the past ten years.
Pick the answer
from the option list that best matches the above statement.
Option list
A
|
False
|
B
|
Haven’t a clue
|
C
|
Maybe
|
D
|
No data exist
|
E
|
True
|
Scenario 4
Lead in.
What proportion
of TOPs were performed at gestations <10 weeks in E&W in 2016?
Option list
A
|
50%
|
B
|
60%
|
C
|
70%
|
D
|
80%
|
E
|
90%
|
Scenario 5
Lead in.
There has been a
significant improvement in the proportion of TOPs performed early in the past
decade.
Option list
A
|
False
|
B
|
Haven’t a clue
|
C
|
Maybe
|
D
|
No data exist
|
E
|
True
|
Scenario 6
Lead in.
What % of
abortions were performed after 24 weeks?
Option list
A
|
< 1%
|
B
|
1 - 3%
|
C
|
4 – 6%
|
D
|
7 – 9%
|
E
|
≥ 10%
|
Scenario 7
Lead in.
What proportion
of TOPs were performed using medical, not surgical techniques?
Option list
A
|
20%
|
B
|
30%
|
C
|
40%
|
D
|
50%
|
E
|
60%
|
F
|
70%
|
G
|
80%
|
Scenario 8
Lead in.
Which age had the
highest rate of TOP?
Option list
A
|
18
|
B
|
19
|
C
|
20
|
D
|
21
|
E
|
22
|
F
|
23
|
G
|
24
|
H
|
25
|
Scenario 9
Lead in.
What happened to
the rate of TOP in 2016 for girls <18 years compared with 2013?
Option list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario 10
Lead in.
What happened to
the rate of TOP in 2015 for girls <16 years compared with 2006?
Option list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario 11
Lead in.
What happened to
the rate of TOP in 2016 for girls <16 years compared with 2015?
Option list
A
|
the rate was much lower
|
B
|
the rate was slightly lower
|
C
|
the rate was much higher
|
D
|
the rate was slightly higher
|
E
|
the rate was unchanged
|
Scenario 12
Lead in
Approximately
what proportion of women having TOP in 2016 had previously had one or more
TOPs?
Option list
A
|
1%
|
B
|
5%
|
C
|
10%
|
D
|
20%
|
E
|
30%
|
F
|
40%
|
G
|
50%
|
Scenario 13
Lead in
What age group
of women 1n 2016 were most likely to have had previous TOP?
Option list
|
|
Age
|
A
|
< 18
|
B
|
18-19
|
C
|
20-24
|
D
|
25-29
|
E
|
30-34
|
F
|
≥ 35
|
Scenario 14
Lead in
There were 185,824
TOPs in 2015. How many deaths occurred?
Option list
A
|
0 - 9
|
B
|
10 – 19
|
C
|
20 – 39
|
D
|
40 - 59
|
E
|
≥ 60
|
Scenario 15
Lead in
There were 185,824
TOPs in 2015. What was the rate of significant complications?
Option list
A
|
<1%
|
B
|
1%
|
C
|
3%
|
D
|
5%
|
E
|
10%
|
Scenario 16
Lead in
The RCOG
recommends that women having TOP should have chlamydia screening. What
proportion of women had this done in 2016?
Option list
A
|
<10%
|
B
|
10- 24%
|
C
|
25- 49%
|
D
|
50- 79%
|
E
|
80- 89%
|
F
|
≥ 90%
|
Scenario 17
Lead in.
The Abortion Act
gives a number of legal grounds for TOP. Which of the following is listed as “1
(1) a”?
Option list
1
|
that the pregnancy has not exceeded its 24th.
week and that the continuance of the pregnancy would involve risk, greater
than if the pregnancy were terminated, of injury to the physical or mental
health of the pregnant woman or any existing children of her family
|
2
|
the pregnancy has not exceeded its 24th.
week and that the continuance of the pregnancy would involve risk, greater
than if the pregnancy were terminated, of injury to the physical or mental
health of any existing children of the family of the pregnant woman
|
3
|
the continuance of the pregnancy would involve risk
to the life of the pregnant woman greater than if the pregnancy were terminated
|
4
|
the termination is necessary to prevent grave
permanent injury to the physical or mental health of the pregnant woman
|
5
|
there is a substantial risk that if the child were
born it would suffer from such physical or mental abnormalities as to be seriously
handicapped
|
Scenario 18
Lead in.
The Abortion Act
gives a number of legal grounds for TOP. Which of the following is listed as “1
(1) b”?
Option list
1
|
that the pregnancy has not exceeded its 24th. week
and that the continuance of the pregnancy would involve risk, greater than if
the pregnancy were terminated, of injury to the physical or mental health of
the pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk
to the life of the pregnant woman greater than if the pregnancy were
terminated
|
3
|
the termination is necessary to prevent grave
permanent injury to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were
born it would suffer from such physical or mental abnormalities as to be
seriously handicapped
|
5
|
none of the above
|
Scenario 19
Lead in.
The Abortion Act
gives a number of legal grounds for TOP. Which of the following is listed as “1
(1) c.
Option list
1
|
that the pregnancy has not exceeded its 24th. week
and that the continuance of the pregnancy would involve risk, greater than if
the pregnancy were terminated, of injury to the physical or mental health of
the pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk
to the life of the pregnant woman greater than if the pregnancy were
terminated
|
3
|
the termination is necessary to prevent grave
permanent injury to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were
born it would suffer from such physical or mental abnormalities as to be
seriously handicapped
|
5
|
none of the above
|
Scenario 20
Lead in.
The Abortion Act
gives a number of legal grounds for TOP. Which of the following is listed as “1
(1) d”?
Option list
1
|
that the pregnancy has not exceeded its 24th. week
and that the continuance of the pregnancy would involve risk, greater than if
the pregnancy were terminated, of injury to the physical or mental health of
the pregnant woman or any existing children of her family
|
2
|
the continuance of the pregnancy would involve risk
to the life of the pregnant woman greater than if the pregnancy were
terminated
|
3
|
the termination is necessary to prevent grave
permanent injury to the physical or mental health of the pregnant woman
|
4
|
there is a substantial risk that if the child were
born it would suffer from such physical or mental abnormalities as to be
seriously handicapped
|
5
|
none of the above
|
Scenario 21
Lead in.
The Abortion Act
gives a number of legal grounds for TOP. Which of the following is listed as “1
(1) e”?
Option list
1
|
the pregnancy has not exceeded its 24th.
week and that the continuance of the pregnancy would involve risk, greater than
if the pregnancy were terminated, of injury to the physical or mental health
of the pregnant woman
|
2
|
the pregnancy has not exceeded its 24th.
week and that the continuance of the pregnancy would involve risk, greater
than if the pregnancy were terminated, of injury to the physical or mental
health of any existing children of the family of the pregnant woman
|
3
|
the continuance of the pregnancy would involve risk
to the life of the pregnant woman greater than if the pregnancy were
terminated
|
4
|
the termination is necessary to prevent grave
permanent injury to the physical or mental health of the pregnant woman
|
5
|
there is a substantial risk that if the child were
born it would suffer from such physical or mental abnormalities as to be
seriously handicapped
|
6
|
none of the above
|
Scenario 22
Lead in.
With regard to
the wording of the Abortion Act and grounds “F” and “G”. Which of the following
statements are true?
1
|
“F” & “G” are grounds for TOP in an emergency
with only one doctor needing to sign the legal form necessary for the TOP to
take place
|
2
|
“F” & “G”
are grounds for TOP after 24 weeks.
|
3
|
“F” relates to TOP to save the woman’s life
|
4
|
“F” relates to TOP to prevent grave permanent injury
her physical or mental health
|
5
|
“F” & “G” do not exist.
|
Option list
A
|
1 + 3
|
B
|
1 + 4
|
C
|
2 + 3
|
D
|
2 + 4
|
E
|
5
|
Scenario 23
Lead in
In relation to
terms such as “substantial risk”, “grave permanent injury” and “seriously
handicapped”, which of the following is true?
Option list
A
|
The terms were defined by a Parliamentary
sub-committee, examples were given and are included in Appendix 2 (b) to the
Act.
|
B
|
The terms were defined by a Parliamentary
sub-committee, examples were given and are included in Appendix 2 (c) to the
Act.
|
C
|
The terms were defined by the General Medical
Council, examples were given and the information can be downloaded from the
GMC website.
|
D
|
The terms were defined by the RCOG, examples were
given and the information can be downloaded from the RCOG website.
|
E
|
The terms have not been defined.
|
Scenario 24
Lead in
Which of the
following statement is true about the most common grounds for TOP?
Option list
1
|
TOP is most commonly done on ground A from
Certificate A.
|
2
|
TOP is most commonly done on ground B from Certificate
A.
|
3
|
TOP is most commonly done on ground C from
Certificate A.
|
4
|
TOP is most commonly done on ground D from
Certificate A.
|
5
|
TOP is most commonly done on ground E from
Certificate A.
|
6
|
TOP is most commonly done on ground F from
Certificate A.
|
7
|
TOP is most commonly done on ground G from
Certificate A.
|
8
|
TOP is most commonly done on ground H from
Certificate A.
|
Scenario 25
Lead in
Which of the
following statements is true in relation to the upper gestational limit for TOP
to be legal in the UK?
1
|
Termination of pregnancy is legal to 24 weeks
|
2
|
Termination of pregnancy is legal after 24 weeks if
the mother is at serious risk of death or grave, permanent injury or there is
a major risk of the fetus having a serious anomaly.
|
3
|
Termination of pregnancy is legal after 24 weeks if
the mother’s life is at serious risk or there is a major risk of the fetus
having a serious anomaly, but only if approved by the Department of Health’s
“Late Termination of Pregnancy Assessment Panel”.
|
4
|
Termination of pregnancy is illegal after 24 weeks,
but is still done if the mother’s life is at serious risk or there is a major
risk of the fetus having a serious anomaly and there is a long-standing
agreement that the police and legal authorities will “turn a blind eye”.
|
Option list
A
|
1 + 2
|
B
|
1 + 3
|
C
|
1 + 4
|
D
|
2 + 4
|
E
|
5
|
Scenario 26
Lead in
Which of the
following statement are true in relation to TOP after 24 weeks?
Statements
1
|
TOP is illegal after 24 weeks
|
2
|
The mother must agree to feticide pre-TOP
|
3
|
Feticide must be offered
|
4
|
There must be very serious grounds for the TOP
|
5
|
Gender-selection TOP is unacceptable
|
Option list
A
|
1
|
B
|
1 + 2
|
C
|
2 + 3 + 5
|
D
|
3 + 4
|
E
|
3 + 4 + 5
|
Scenario 27
Lead in
TOPs done under ground E are those done at any gestation
because of fetal abnormality. The anomalies are coded using ICD10. The HSA4
notification form relating to each TOP should have details of the ICD10 code
for the fetal anomaly.
Which of the following statements is the most accurate in
relation to the percentage of HSA4 forms that contain the required information?
A
|
0- 24%
|
B
|
25- 49%
|
C
|
50- 59%
|
D
|
60- 69%
|
E
|
≥ 70%
|
Scenario 28
Lead in
TOPs done under ground E are those done at any gestation
because of fetal abnormality. Which, if any, of the following statements are
true of TOPs under ground E in 2015?
A
|
the average of
the woman was 34, compared to 21 for the average for all grounds
|
B
|
congenital
malformations were the grounds in > 80% of cases
|
C
|
Down’s
syndrome was the most common reason for ground E TOP
|
D
|
fetal cardiac
anomalies were the most common reason for ground E TOP
|
E
|
fetal nervous
system anomalies were the most common reason for ground E TOP
|
Scenario 29
Lead in
Which form
relates to certifying that a woman requesting a TOP can have it done legally?
Option list
A
|
HSA1
|
B
|
HSA2
|
C
|
HSA3
|
D
|
HSA4
|
E
|
HSA5
|
Scenario 30
Lead in
Which form must
the practitioner performing the TOP complete to notify the Department of Health
that a TOP has been done?
Option list
A
|
HSA1
|
B
|
HSA2
|
C
|
HSA3
|
D
|
HSA4
|
E
|
HSA5
|
Scenario 31
Lead in
A doctor signing
the form giving the grounds for a TOP must have seen the woman.
Option list
A
|
True
|
B
|
False
|
C
|
Sometimes
|
D
|
Don’t know & don’t care
|
Scenario 32
Lead in
A doctor
performing a TOP must be one of the doctors who signed the initial form giving
the grounds for the TOP.
Option list
A
|
True
|
B
|
False
|
C
|
Sometimes
|
D
|
Don’t know & don’t care
|
Scenario 33
Lead in
What is the time
scale for the return of the form notifying that a TOP has taken place?
Option list
A
|
3 working days
|
B
|
5 working days
|
C
|
1 week
|
D
|
2 weeks
|
E
|
1 month
|
Scenario 34
Lead in.
A woman seeks 1st. trimester TOP on social
grounds which she declines to discuss in detail.
Which of the following statements apply?
Option List
A
|
TOP can be
done under clause A of Certificate A
|
B
|
TOP can be
done under clause B of Certificate A
|
C
|
TOP can be
done under clause C of Certificate A
|
D
|
TOP can be
done under clause D of Certificate A
|
E
|
TOP can be
done under clause E of Certificate A
|
F
|
TOP can be
done under clause F of Certificate A
|
G
|
TOP can be
done under clause G of Certificate A
|
F
|
there is no
clause authorising TOP on social grounds
|
Scenario 35
A woman seeks 1st. trimester TOP. She has pulmonary
hypertension and has been advised of the risks of pregnancy by her
cardiologist. Which of the following statements apply?
Use the Option
list for Question 34.
Scenario 36
A woman books at 26 weeks. She has an unplanned pregnancy.
She has pulmonary hypertension and has been advised of the risks of pregnancy
by her cardiologist.
Which of the following statements apply?
Use the Option
list for Question 34.
27. EMQ.
Kisspeptin.
Lead in.
Pick the best
answer from the list below about kisspeptin.
Option list.
A
|
is a pheromone released by the salivary glands
during passionate embraces
|
B
|
is a digestive enzyme released by the salivary
glands during passionate embraces
|
C
|
is a digestive enzyme found in human carnivores but
not vegetarians
|
D
|
is thought necessary for trophoblastic invasion and
low levels have been linked to miscarriage, recurrent miscarriage and ↑ risk
of PET
|
E
|
is named after “Kiss me quick” chocolate
|
F
|
does not exist and this question is a very poor joke
by someone who should know better
|
