Website
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18
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SBA. Fitz-Hugh Curtis syndrome.
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19
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EMQ. Caldicott guardian
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20
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EMQ. Hepatitis B
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21
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EMQ. Peutz-Jeghers syndrome
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22
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EMQ. G6PDD & G6PD
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18. SBA. Fitz-Hugh–Curtis
Syndrome. FHCs.
Scenario
1.
Lead-in
Which one
of the following best fits with FHCs?
Option List
|
A
|
It is a complication of Caesarean section
|
|
B
|
It is a complication of Crohn’s disease
|
|
C
|
It is a complication of ovarian fibroma
|
|
D
|
It is a complication of pelvic inflammatory disease
|
|
E
|
None of the above.
|
Scenario
2.
Lead-in
Which of
the following is a key feature of FHCs?
Option List
|
A
|
ascites + unilateral hydrothorax
|
|
B
|
anlagen
|
|
C
|
synechiae
|
|
D
|
unilateral ‘Coast of Maine’ pigmentation
|
|
E
|
none of the above
|
Scenario
3.
Lead-in
Which of
the following is a common feature of the development of FHCs?
Option List
|
A
|
auto-immunity
|
|
B
|
Chlamydia trachomatis infection
|
|
C
|
Mycoplasma genitalium infection
|
|
D
|
TB
|
|
E
|
none of the above
|
19. EMQ. 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
|
A.
|
the need
to appoint a Caldicott Guardian
|
|
B.
|
the need to create a Caldicott Register
|
|
C.
|
the need to create a Caldicott Police Department
|
|
D.
|
the need to create a link between the Caldicott
Department and the DOH
|
|
E.
|
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!
20. EMQ. Topic. Hepatitis B and pregnancy.
Lead-in.
Abbreviations.
HAV: hepatitis
A virus
HBcAg: hepatitis
B core antigen
HBeAg: hepatitis
B e antigen
HBsAg: hepatitis
B surface antigen
HBcAb: antibody
to hepatitis B core antigen
HBeAb: antibody
to hepatitis B e antigen
HBsAb: antibody
to hepatitis B surface antigen
HBIG: hepatitis
B immunoglobulin
HBV: hepatitis
B virus
HBcAg: hepatitis
B core antigen
HBeAg: hepatitis
B e antigen
HBsAg: hepatitis
B surface antigen
HBcAb: antibody
to hepatitis B core antigen
HBeAb: antibody
to hepatitis B e antigen
HBsAb: antibody
to hepatitis B surface antigen
HBIG: hepatitis
B immunoglobulin
HCV: hepatitis
C virus
HEV: hepatitis
E virus
HSV: herpes
simplex virus
VT: vertical
transmission
Option list.
|
A.
|
acyclovir
|
|
B.
|
divorce
|
|
C.
|
HBcAg
+ve
|
|
D.
|
HBeAg
+ve
|
|
E.
|
HbsAg
+ve
|
|
F.
|
HBsAg
+ve; HBsAb –ve; HBcAb –ve; HBeAg +ve
|
|
G.
|
HBsAg
+ve; HBsAb –ve on two tests six months apart
|
|
H.
|
HBsAg
-ve; HBsAb -ve on two tests six months apart
|
|
I.
|
HBsAg
-ve; HBsAb +ve; HBcAb –ve
|
|
J.
|
HBsAg
-ve; HBsAb +ve; HBcAb +ve
|
|
K.
|
HBsAg
-ve; HBsAb +ve
|
|
L.
|
HBsAg
+ve; HBcAg +ve
|
|
M.
|
HBV
vaccine
|
|
N.
|
HBIG
|
|
O.
|
HBV
vaccine + HBIG
|
|
P.
|
immune
as a result of infection
|
|
Q.
|
immune
as a result of vaccination
|
|
R.
|
not
immune
|
|
S.
|
chronic
carrier of HBV infection
|
|
T.
|
10%
|
|
U.
|
30%
|
|
V.
|
50%
|
|
W.
|
60%
|
|
X.
|
70-90%
|
|
Y.
|
soap
and boiling water
|
|
Z.
|
10%
dilution of bleach in water
|
|
AA.
|
10%
dilution of formaldehyde in alcohol
|
|
BB.
|
ultraviolet
irradiation
|
|
CC.
|
yes
|
|
DD.
|
no
|
|
EE.
|
HAV
|
|
FF.
|
HBV
|
|
GG.
|
HCV
|
|
HH.
|
HEV
|
|
II.
|
HSV
|
|
JJ.
|
none
of the above
|
Scenario 1.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she has an acute HBV infection?
Scenario 2.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she is immune to the HBV as a result of infection?
Scenario 3.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she is immune to the HBV as a result of HBV vaccine?
Scenario 4.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 9 months ago. What results on routine blood testing would show that
she is a chronic carrier of HBV infection?
Scenario 5.
Testing shows
that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb.
What does this mean in relation to his HBV status?
Scenario 6.
Testing shows
that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.
What does this
mean in relation to his HBV status?
Scenario 7.
How
common is chronic HBV carrier status in UK pregnant women?
Scenario 8.
What
is the risk of death from chronic HBV carrier status?
Scenario 9.
A
primigravid woman at 8 weeks gestation is found to be non-immune to HBV. She
has recently married and her husband is a chronic carrier. What should be done
to protect her from infection?
Scenario 10.
A
woman is a known carrier of HBV. What is the risk of vertical transmission in
the first trimester?
Scenario 11.
What
is the risk of the neonate who has been infected by vertical transmission becoming
a carrier without treatment?
Scenario 12.
Should
antiviral maternal therapy in the 3rd. trimester be considered for
women with HBeAg or high viral load?
Scenario 13.
How
effective is hepatitis B prophylaxis for the neonate in preventing chronic carrier
status as a result of vertical transmission?
Scenario 14.
Can
a woman who is a chronic HBV carrier breastfeed safely?
Scenario 15.
Hepatitis B
infection is the most dangerous of the viral hepatitis infections in pregnancy.
Scenario 16.
A
pregnant woman who is not immune to HBV has a partner who is a chronic carrier.
Can HBV vaccine be administered safely in pregnancy?
Scenario 17.
A
pregnant woman who is not immune has a partner with acute hepatitis due to HBV.
He cuts his hand and bleeds onto the kitchen table. How should she clean the
surface to ensure that she gets rid of the virus?
Scenario 18.
Is it true
that the presence of HBeAg in maternal blood is a particular risk factor for
vertical transmission? Not really a scenario, but never mind!
Scenario 19.
Does
elective Cs before labour and with the membranes intact reduce the vertical
transmission rate?
Scenario 20.
Which
hepatitis virus normally produces a mild illness, but represents a major risk
to pregnant women, with a mortality rate of up to 5%?
Scenario 21.
A
pregnant woman has a history of viral hepatitis and informs the midwife at
booking that she is a carrier and that she has a significant risk of cirrhosis
and has been advised not to drink alcohol. Which is the most likely hepatitis
virus?
Scenario 22.
Which
hepatitis virus is an absolute contraindication to breastfeeding after
appropriate treatment of the infected mother and prophylaxis for the baby?
Scenario 23.
Which
hepatitis virus is linked to an increased risk of obstetric cholestasis?
21. EMQ. 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
|
22. EMQ. Glucose-6-phosphate dehydrogenase deficiency.
Abbreviations.
G6PD: glucose-6-phosphatase deficiency
G6PDD: glucose-6-phosphate dehydrogenase deficiency
Scenario
1.
What is G6PDD? There is no
option list.
Scenario
2.
What categories are applied to
G6PDD by the WHO? There is no option list.
Scenario
3.
What other names are commonly
used for G6PDD? There is no option list.
Scenario
4.
Which, if any, of the following
statements are true in relation to G6PDD?
Option list.
|
A
|
it is the most common enzyme defect in humans
|
|
B
|
it is the most common RBC enzyme defect in humans
|
|
C
|
it is the most common cause of neonatal jaundice
|
|
D
|
it is the most common cause of sickling crises
|
|
E
|
is a glycogen storage disorder
|
|
F
|
most of those with G6PDD have chronic anaemia
|
Scenario
5.
Approximately how many people
are affected by G6PDD worldwide?
Option list.
|
A
|
1,000 million
|
|
B
|
800 million
|
|
C
|
600 million
|
|
D
|
400 million
|
|
E
|
100 million
|
|
F
|
50 million
|
|
G
|
20 million
|
|
H
|
10 million
|
|
I
|
none of the above
|
Scenario
6.
Which population has the
highest prevalence of G6PDD?
Option list.
|
A
|
American Amish
|
|
B
|
Asians
|
|
C
|
Ashkenazi Jews
|
|
D
|
Eskimos
|
|
E
|
Irish Travellers
|
|
F
|
Kurdistan Jews
|
|
G
|
Sub-Saharan Africans
|
|
H
|
Turks
|
|
I
|
Uzbekistan albinos
|
|
J
|
None of the above
|
Which, if any, of the following is the mode of inheritance
of G6PDD?
Option list.
|
A
|
autosomal
dominant
|
|
B
|
autosomal
recessive
|
|
C
|
mitochondrial
pattern
|
|
D
|
X-linked
dominant
|
|
E
|
X-linked
recessive
|
|
F
|
Y-linked
|
Scenario 8.
Approximately how many mutations of the G6PDD gene have
been identified? There is no option list.
Scenario 9.
Which, if any, of the following is the mode of inheritance
of G6PD?
Option list.
|
A
|
autosomal
dominant
|
|
B
|
autosomal
recessive
|
|
C
|
mitochondrial
pattern
|
|
D
|
X-linked
dominant
|
|
E
|
X-linked
recessive
|
|
F
|
Y-linked
|
Scenario
10.
Which foodstuff can trigger
haemolysis in G6PDD and gives us one of the alternative names for the condition?
What is the common name for the foodstuff? Which pest particularly attacks it? There
is no option list.
Scenario
11.
Which, if any, of the following
drugs may cause haemolysis in those with G6PDD?
Option list.
|
A
|
aspirin
|
|
B
|
diphenhydramine
|
|
C
|
nalidixic acid
|
|
D
|
nitrofurantoin
|
|
E
|
paracetamol
|
|
F
|
phenytoin
|
|
G
|
sulphamethoxazole
|
|
H
|
trimethoprim
|
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