Website
|
23
|
EMQ. Kell antibodies
|
|
24
|
EMQ. Mayer-Rokitansky-Küster-Hauser syndrome
|
|
25
|
EMQ. Parvovirus
|
|
26
|
SBA. Quinolone antibiotics
|
|
27
|
SBA. Kisspeptin
|
23. Kell
antibodies & pregnancy.
Abbreviations.
∆OD450: spectrophotometric
measurement of deviation in optical density at wavelength 450 nm.
FMM: feto-maternal
medicine
HDFN: haemolytic disease of the fetus and newborn.
MCAPSV: middle cerebral artery peak systolic velocity.
RBC: red
blood cell.
Scenario 1.
Which, if any, of the following
alloantibodies is the most common cause of significant HDFN?
Option list.
|
A
|
anti-D
|
|
B
|
anti-C
|
|
C
|
anti-c
|
|
D
|
anti-e
|
|
E
|
Duffy: Fya
|
|
F
|
Duffy: Fyb
|
|
G
|
Kell
|
|
H
|
Kidd: Jka
|
|
I
|
Kidd: Jkb
|
Scenario 2.
Which, if any, of the following
alloantibodies is the 2nd. most common cause of significant HDFN?
Option list. Use the
option list from Scenario 1.
Scenario 3.
Which, if any, of the following
alloantibodies is the 3rd. most common cause of significant HDFN?
Option list. Use the
option list from Scenario 1.
Scenario 4.
Which of the following
statements is true in relation to the Kell antigen?
Option list.
|
A
|
it is named after Mrs. Kelleher who was found to have
antibodies to it in 1946
|
|
B
|
it is named after Gene Kelly, the American actor,
dancer and singer as the research group who found the antigen were big fans
|
|
C
|
there are > 50 significant variants of the Kell
antigen
|
|
D
|
Kell antibodies are mainly IgA
|
|
E
|
Kell antibodies are mainly IgM
|
|
F
|
none of the above
|
Scenario 5.
What proportion of the
Caucasian population is K +ve?
Option list.
|
A
|
1%
|
|
B
|
5%
|
|
C
|
9%
|
|
D
|
15%
|
|
E
|
25%
|
|
F
|
33%
|
|
G
|
57%
|
|
H
|
none of the above
|
Scenario 6.
The Kell antigen can be
detected using cell-free fetal DNA in maternal serum. True / False.
Scenario 7.
Anti-K is thought to occur
mainly as a result of feto-maternal transfusion of Kell +ve cells during
pregnancy and delivery. True / False.
Scenario 8.
Kell HDFN resulting from
transfusion of Kell +ve blood is thought to produce more severe HDFN than that
resulting from feto-maternal transfusion. True / False.
Scenario 9.
The Kell antigen can be
detected using cell-free fetal DNA in maternal serum. True / False.
Scenario 10.
Which of the following
statements is true in relation to anti-Kell antibodies in a Kell-negative
mother with a Kell +ve pregnancy?
Option list.
|
A
|
HDND is mainly due to haemolysis of fetal RBC
|
|
B
|
HDND is mainly due to haemolysis of fetal &
neonatal RBC
|
|
C
|
HDND is mainly due to haemolysis of neonatal RBC
|
|
D
|
HDND is mainly due to sequestration of fetal RBC
|
|
E
|
HDND is mainly due to sequestration of fetal &
neonatal RBC
|
|
F
|
HDND is mainly due to sequestration of neonatal RBC
|
|
G
|
HDND is mainly due to suppression of fetal erythroid
progenitor cells
|
|
H
|
HDND is mainly due to suppression of neonatal erythroid
progenitor cells
|
|
I
|
none of the above
|
Scenario 11.
Which of the following
statements is true in relation to antenatal detection of HDFN due to anti-K
antibodies?
Option list.
|
A
|
the threshold for significant HDFN is a titre of 1 in 4
|
|
B
|
the threshold for significant HDFN is a titre of 1 in 8
|
|
C
|
the threshold for significant HDFN is a titre of 1 in
16
|
|
D
|
the threshold for significant HDFN is a titre of 1 in
32
|
|
E
|
the threshold for significant HDFN is a titre of 1 in
64
|
|
F
|
the threshold for significant HDFN is a titre of 1 in
128
|
|
G
|
the threshold for significant HDFN is a titre of 1 in
256
|
|
H
|
none of the above
|
Scenario 12.
Which of the following
statements is true in relation to antenatal detection of HDFN due to anti-K
antibodies?
Option list.
|
A
|
the threshold for significant HDFN is a level > 2
iu/L.
|
|
B
|
the threshold for significant HDFN is a level > 4 iu/L.
|
|
C
|
the threshold for significant HDFN is a level > 7.5
iu/L.
|
|
D
|
the threshold for significant HDFN is a level > 10
iu/L.
|
|
E
|
the threshold for significant HDFN is a level > 15
iu/L.
|
|
F
|
the threshold for significant HDFN is a level > 25
iu/L.
|
|
G
|
the threshold for significant HDFN is any level if
anti-E is also present.
|
|
H
|
none of the above
|
Scenario 13.
Which, if any, of the following
statements are true in relation to referral to a FMM expert when Kell
antibodies are detected?
Option list.
|
A
|
the threshold for referral is a level of anti-K > 2
iu/L.
|
|
B
|
the threshold for referral is a level of anti-K > 4
iu/L.
|
|
C
|
the threshold for referral is a level of anti-K >
7.5 iu/L.
|
|
D
|
the threshold for referral is a level of anti-K > 10
iu/L.
|
|
E
|
the threshold for referral is a level of anti-K > 15
iu/L.
|
|
F
|
the threshold for referral is a level of anti-K > 25
iu/L.
|
|
G
|
the threshold for referral is any level of anti-K.
|
|
H
|
the threshold for referral is any level of anti-K if
anti-E is also present.
|
|
I
|
none of the above
|
Scenario 14.
Which of the following
statements is true in relation to the threshold for antenatal diagnosis of
significant HDFN due to anti-K when using measurement of MCAPSV?
Option list.
|
A
|
MoM > 1.25
|
|
B
|
MoM > 1.50
|
|
C
|
MoM > 1.75
|
|
D
|
MoM > 2.00
|
|
E
|
MoM > 2.50
|
|
F
|
MoM > 3.00
|
|
G
|
none of the above
|
Scenario 15.
Which of the following
statements is true in relation to the threshold for antenatal diagnosis of
significant HDFN due to anti-K when using measurement of ∆OD450?
Option list.
|
A
|
MoM > 1.25
|
|
B
|
MoM > 1.50
|
|
C
|
MoM > 1.75
|
|
D
|
MoM > 2.00
|
|
E
|
MoM > 2.50
|
|
F
|
MoM > 3.00
|
|
G
|
none of the above
|
Scenario 16.
Which, if any, of the following
statements are true in relation to the numbers of reticulocytes in cord blood
in moderate to severe HDFN?
Option list.
|
A
|
the numbers are decreased
|
|
B
|
the numbers are increased
|
|
C
|
the numbers are normal
|
|
D
|
none of the above
|
Scenario 17.
Which, if any, of the following
statements are true in relation to the numbers of erythroblasts in cord blood
in moderate to severe HDFN?
Option list.
|
A
|
the numbers are decreased
|
|
B
|
the numbers are increased
|
|
C
|
the numbers are normal
|
|
D
|
none of the above
|
Scenario 18.
Which, if any, of the following
statements are true in relation to the level of bilirubin in cord blood in
moderate to severe HDFN?
Option list.
|
A
|
it is decreased
|
|
B
|
it is increased
|
|
C
|
it is greatly increased
|
|
D
|
none of the above
|
Scenario 19.
Which, if any, of the following
statements are true in relation to King Henry VIII and Kell?
Option list.
|
A
|
Kell may have been the cause of his subfertility
|
|
B
|
He may have had the McLeod syndrome
|
|
C
|
He may have inherited the Kell antigen from Jacquetta
Woodville
|
|
D
|
The Kell antigen may have explained his passion for
jousting
|
|
E
|
The Kell antigen may have explained his passion for
extramarital dalliance
|
TOG Questions Answer
these ‘true’ or ‘false’.
Regarding Kell alloimmunisation
in pregnancy,
25 the
amniotic fluid bilirubin level correlates well with the degree of fetal
anaemia.
26 previous
obstetric history does not reliably predict outcome.
27 the
incidence in the obstetric population is approximately 1–2 per 1000.
28 prophylaxis
is available.
29 the
relationship between fetal middle cerebral artery peak systolic velocity
(MCA-PSV) and haemoglobin concentration is poor.
30 anti-Kell
antibodies cause fetal anaemia via the suppression of erythropoesis rather than
red cell destruction.
With regard to maternal
anti-Kell antibody screening,
34 if the father of the fetus is Kell antigen
positive, the fetus is likely to be affected with severe HDFN.
35 where the father is heterozygous for Kell,
there is a 50% chance of the fetus carrying the Kell antigen on its fetal red
cells.
36 anti-Kell antibodies stimulated by
transfusion are known to affect the fetus to the same degree as those
stimulated from a previous pregnancy.
37 where the critical titre of anti-Kell
antibodies has been reached in the maternal serum, amniocentesis for spectral
analysis of amniotic fluid is a reliable means of establishing the degree and
severity of fetal anaemia.
Abbreviations.
AIS: androgen
insensitivity syndrome
AMH: anti-
Müllerian hormone
MRKH: Mayer-Rokitansky-Küster-Hauser syndrome
MURCS: Müllerian duct aplasia, renal dysplasia and
cervical somite anomaly syndrome.
Question
1.
Lead-in.
What are the main features of MRKH? There is no option list
to make life harder.
Question
2.
Lead-in.
Which, if any, are the main
secondary features associated with MRKH?
Option list.
|
A
|
anosmia
|
|
B
|
attention-deficit-hyperactivity
syndrome
|
|
C
|
auditory
anomalies
|
|
D
|
neural tube
defects
|
|
E
|
renal anomalies
|
|
F
|
skeletal
anomalies
|
Question
3.
Lead-in.
How does MRKH syndrome usually present?
Option list.
|
A
|
cyclical pain due
to haematometra
|
|
B
|
delayed puberty
|
|
C
|
precocious
puberty
|
|
D
|
premature
menopause
|
|
E
|
primary
amenorrhoea
|
|
F
|
recurrent otitis
media
|
|
G
|
recurrent urinary
tract infection
|
|
H
|
secondary
amenorrhoea
|
Question
4.
Lead-in.
Which of the following chromosome patterns are typical of
MRKH?
Option list.
|
A
|
45XO
|
|
B
|
45YO
|
|
C
|
46XX
|
|
D
|
46XY
|
|
E
|
47XXX
|
|
F
|
47XXY
|
Question
5.
Lead-in.
What is the approximate incidence of MRKH in newborn girls?
Option list.
|
A
|
~ 1 in 1,000
|
|
B
|
~ 1 in 2,000
|
|
C
|
~ 1 in 4,000
|
|
D
|
~ 1 in 6.000
|
|
E
|
~ 1 in 8,000
|
|
F
|
~ 1 in 10,000
|
|
G
|
~ 1 in 100,000
|
|
H
|
the figure is unknown
|
|
I
|
it does not occur
|
Question
6.
Lead-in.
What is the approximate incidence of MRKH in newborn boys?
Option list.
|
A
|
~ 1 in 1,000
|
|
B
|
~ 1 in 2,000
|
|
C
|
~ 1 in 4,000
|
|
D
|
~ 1 in 6.000
|
|
E
|
~ 1 in 8,000
|
|
F
|
~ 1 in 10,000
|
|
G
|
~ 1 in 100,000
|
|
H
|
the figure is unknown
|
|
I
|
it does not occur
|
Question
7.
Lead-in.
Which of the following statements are correct in relation
to urinary tract anomalies associated with MRKH?
Option list.
|
A
|
absent bladder
|
|
B
|
absent kidney
|
|
C
|
ectopic ureter
|
|
D
|
horseface kidney
|
|
E
|
hypospadias
|
|
F
|
urinary tract
anomalies are not part of the syndrome
|
Question
8.
Lead-in.
Which of the following statements are correct in relation
to skeletal anomalies associated with MRKH?
Option list.
|
A
|
absent thumb
|
|
B
|
absent big toe
|
|
C
|
developmental dysplasia
of the hip
|
|
D
|
Klippel-Feil
anomaly
|
|
E
|
ulnar hypoplasia
|
|
F
|
vertebral fusion
|
|
G
|
skeletal
anomalies are not part of the syndrome
|
Question
9.
Lead-in.
Which of the following statements are correct in relation
to auditory anomalies associated with MRKH?
Option list.
|
A
|
absent ear
|
|
B
|
absent stapes
|
|
C
|
acoustic neuroma
|
|
D
|
conductive
deafness
|
|
E
|
inductive
deafness
|
|
F
|
stapedial
ankylosis
|
|
G
|
auditory anomalies
are not part of the syndrome
|
Question
10.
Lead-in.
What is the recommended first-line management for creation
of a neovagina.
Option list.
|
A
|
digital
dilatation
|
|
B
|
marriage to a
virile husband
|
|
C
|
vaginal balloons
|
|
D
|
vaginal dilators
|
|
E
|
vaginoplasty
|
|
F
|
there is no
recommended 1st. line management
|
Question
11.
Lead-in.
What is what are the key features of Davydov vaginoplasty?
Option list.
|
A
|
horseshoe
perineal incision with labial flaps used to create a pouch
|
|
B
|
creation of space
between bladder and rectum and lining it with amnion
|
|
C
|
creation of space
between bladder and rectum and lining it with skin graft
|
|
D
|
creation of space
between bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space
between bladder and rectum and lining it with peritoneum
|
|
F
|
traction via
threads running to the abdomen from a vaginal bead
|
Question
12.
Lead-in.
What is what are the key features of McIndoe vaginoplasty?
Option list.
|
A
|
horseshoe
perineal incision with labial flaps used to create a pouch
|
|
B
|
creation of space
between bladder and rectum and lining it with amnion
|
|
C
|
creation of space
between bladder and rectum and lining it with skin graft
|
|
D
|
creation of space
between bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space
between bladder and rectum and lining it with peritoneum
|
|
F
|
traction via
threads running to the abdomen from a vaginal bead
|
Question
13.
Lead-in.
What is what are the key features of Vecchietti
vaginoplasty?
Option list.
|
A
|
horseshoe perineal
incision with labial flaps used to create a pouch
|
|
B
|
creation of space
between bladder and rectum and lining it with amnion
|
|
C
|
creation of space
between bladder and rectum and lining it with skin graft
|
|
D
|
creation of space
between bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space
between bladder and rectum and lining it with peritoneum
|
|
F
|
traction via
threads running to the abdomen from a vaginal bead
|
Question
14.
Lead-in.
What is what are the key features of Williams vaginoplasty?
Option list.
|
A
|
horseshoe
perineal incision with labial flaps used to create a pouch
|
|
B
|
creation of space
between bladder and rectum and lining it with amnion
|
|
C
|
creation of space
between bladder and rectum and lining it with skin graft
|
|
D
|
creation of space
between bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space
between bladder and rectum and lining it with peritoneum
|
|
F
|
traction via
threads running to the abdomen from a vaginal bead
|
TOG CPD questions.
Answer as true or false
With regard to the
MRKH syndrome.
1. there
is failure of development of the mesonephric ducts.
2. the
phenotype and genotype are female.
3. studies
have established a link between the syndrome and the use of diethylstilboestrol
in pregnancy.
4. symmetrical
uterovaginal aplasia is found in type I disorders.
5. renal
abnormalities are seen in more than half of cases.
6. skeletal
abnormalities are reported in up to one-fifth of cases.
7. up
to one-quarter of women have a malformed ear or auditory canal.
8. the
close proximity of the Müllerian and Wolffian duct derivatives to the duct in
the developing embryo explains the higher association of malformations of the kidneys
with this condition.
9. vaginal agenesis is caused by failure of the caudal
part of the Müllerian duct system to develop.
10. magnetic
resonance imaging is the gold standard tool.
11. two-dimensional
ultrasound scanning is not useful for associated renal tract abnormalities.
12. complete
androgen insensitivity syndrome is an important differential diagnosis.
13. the
presence of cyclical abdominal pain will rule out the diagnosis, as it
indicates the presence of functioning endometrium.
With regard to the
creation of a neovagina,
14. it
is recommended that treatment is initiated as soon as the diagnosis is made.
15. psychological
support to women undergoing this procedure is of the utmost importance.
16. vaginal
dilators are acceptable as an option for first-line therapy.
17. Ingram’s
modified Frank’s technique involves the use of vaginal dilators.
With regard to the
surgical creation of a neovagina,
18. in
the Davydov procedure the neovagina is lined with peritoneum.
With regard to
fertility in women with the MRKH syndrome,
19. transvaginal
egg retrieval is recognised to be difficult during in vitro fertilisation.
20. the
condition has been shown to be transmissible to the offspring.
25. Parvovirus
and pregnancy. Question.
Abbreviations.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There is none: make up your own
answers!
Scenario 1.
What type of virus is
parvovirus?
Scenario 2.
Is the title B19 something to do with the American B19
bomber, its potentially devastating bomb load and the comparably devastating
consequences of the parvovirus on human erythroid cell precursors?
Scenario 3.
PVB19 in the UK occurs in mini-epidemics at 3 to 4-year
intervals, usually during the summer.
Scenario 4.
Which animal acts as the main
reservoir for infection?
What is the
approximate incidence of maternal parvovirus infection in the UK?
Scenario 6.
What percentage of UK adults are immune to parvovirus
infection?
Scenario 7.
What names are given to acute
infection in the human?
Scenario 8.
What is the incubation period for parvovirus infection?
Answer: 14-21 days according to
GOVRIP.
Scenario 9.
What is the duration of infectivity for parvovirus
infection?
Scenario 10.
What are the usual symptoms of parvovirus infection in
the adult?
Scenario 11.
What is the incidence of parvovirus infection in
pregnancy?
Scenario 12.
How is recent infection diagnosed?
Scenario 13.
How long does PvIgM persist and why is this important?
Scenario 14.
What is the rate of vertical transmission of parvovirus
infection?
Scenario 15.
Are women with parvovirus infection who are asymptomatic
less likely to pass the virus to their fetuses?
Scenario 16.
To what degree is parvovirus infection teratogenic?
Scenario 17.
What proportion of pregnancies infected with parvovirus
are lost?
Scenario 18.
What is the timescale for the onset of hydrops?
Scenario 19.
Laboratories are advised to retain bloods obtained at
booking for at least 2 years for possible future reference. True or false?
Scenario 20.
What ultrasound features would trigger consideration of
cordocentesis?
Scenario 21.
Must suspected parvovirus infection be notified to the
authorities?
Scenario 22.
Possible parvovirus infection
does not need to be investigated after 20 week’s gestation. True or false?
Scenario 23.
If serum is sent to the
laboratory from a woman with a rash in pregnancy for screening for rubella, the
laboratory should automatically test for parvovirus infection too?
26. Quinolone & fluoroquinolone antibacterial drugs
Not all of the questions are true SBAs as some have more than one answer
– this reduces the amount of typing I have to do and the size of the document.
Abbreviations.
FQ: fluoroquinolone.
QUI: quinolone.
Question 1.
Lead-in
Which, if
any, of the following drugs are QUIs or FQs?
Drugs
|
A.
|
cimetidine
|
|
B.
|
ciprofloxacin
|
|
C.
|
nalidixic acid
|
|
D.
|
neomycin
|
|
E.
|
nitrofurantoin
|
Question 2.
Lead-in
Which, if
any, of the following statements are true in relation to QUIs & FQs? This
is not a true SBA as there may be more than one answer.
Statements
|
A.
|
nalidixic
acid is an older quinolone and is mainly excreted in the urine
|
|
B.
|
ciprofloxacin is effective against most Gram +ve and
–ve bacteria and 1st- line treatment for pneumococcal pneumonia.
|
|
C.
|
ciprofloxacin is contraindicated in pregnancy due to
the ↑ risk of neonatal haemolysis
|
|
D.
|
many staphylococci are resistant to quinolones
|
|
E.
|
quinolones are particularly useful in the treatment of
MRSA
|
Question 3.
Lead-in
Which was
the first QUI antibiotic?
Option List
|
A
|
acetylsalicylic
acid
|
|
B
|
nalidixic
acid
|
|
C
|
oxalic
acid
|
|
D
|
pipemidic
acid
|
|
E
|
none of
the above
|
Question 4.
Lead-in
How do QUI
and FQ antibiotics work? There is only one correct answer.
Option List
|
A
|
impair
bacterial DNA coiling
|
|
B
|
impair
bacterial DNA binding
|
|
C
|
impair
bacterial RNA action
|
|
D
|
impair
bacterial mitochondrial action
|
|
E
|
none of
the above.
|
Question 5.
Lead-in
Which, if
any, of the following QUIs & FQs is not available for prescription in the
UK. There is only one correct answer.
Option List
|
A
|
ciprofloxacin
|
|
B
|
levofloxacin
|
|
C
|
nalidixic
acid
|
|
D
|
moxifloxacin
|
|
E
|
ofloxacin
|
Question 6.
Lead-in
Which, if
any, of the following statements are true in relation to the quinolones and
fluoroquinolones and pregnancy? This is not a true SBA as there may be more
than one answer.
Option list.
|
A.
|
FQs are
newer than QUIs with better systemic spread and efficacy
|
|
B.
|
QUIs concentrate in urine but have a special affinity
for cartilage
|
|
C.
|
consumption of a FQ in the 1st. trimester is
grounds for TOP
|
|
D.
|
if an FQ is used, norfloxacin and ciprofloxacin should
be considered 1st.
|
|
E.
|
FQs are linked to a risk of discolouration of the teeth
of offspring
|
Question 7.
Lead-in
Which of
the following is true about the warning issued by the FDA in 2008 in relation
to QUIs & FQs?
Option List
|
A
|
they may
cause congenital cartilage defects
|
|
B
|
they may
cause congenital deafness
|
|
C
|
they may
cause tendonitis and tendon rupture
|
|
D
|
they may
cause prolongation of the Q-T interval
|
|
E
|
none of
the above
|
Question 8.
Lead-in
Which of
the following is true about the warning issued by the FDA in 2011 in relation
to QUIs & FQs?
Option List
|
A
|
they may
cause exacerbation of eczema
|
|
B
|
they may
cause exacerbation of hypertension
|
|
C
|
they may
cause exacerbation of multiple sclerosis
|
|
D
|
they may
cause exacerbation of myasthenia gravis
|
|
E
|
they may
cause exacerbation of SLE
|
Question 9.
Lead-in
Which of
the following is true about the warning emphasised by the FDA in 2013 in
relation to QUIs & FQs?
Option List
|
A
|
they may
cause aortic dissection
|
|
B
|
they may
cause mitral stenosis
|
|
C
|
they may
cause pancreatitis
|
|
D
|
they may
cause peripheral neuropathy
|
|
E
|
they may
cause flare of SLE
|
Question 10.
Lead-in
FDA issued
a warning in July 2016. Which, if any, of the following were included? This is
not a true SBA as there may be more than one answer.
Option List
|
A
|
the
risks generally outweigh the benefits
|
|
B
|
QUIs
& FQs should not be used for acute
sinusitis,
|
|
C
|
QUIs
& FQs should not be used for exacerbation
of chronic bronchitis
|
|
D
|
QUIs
& FQs should not be used for uncomplicated
UTI
|
|
E
|
QUIs
& FQs may be useful for anthrax and plague
|
Question 11.
Lead-in
FDA issued
a warning in July 2018 about the use of FQs in pregnancy. Which, if any, of the
following were included in the reasons for its publication?
Option List
|
A
|
to
strengthen previous warnings about hyperglycaemia and mental health risks
|
|
B
|
to
strengthen previous warnings about hypoglycaemia and mental health risks
|
|
C
|
to
strengthen previous warnings about the risk of ASD in the offspring
|
|
D
|
to
strengthen previous warnings about the risk of acute pancreatitis
|
|
E
|
to
strengthen previous warnings about the risk of PET
|
Question 12.
Lead-in
The FDA
issued a warning in December 2018 about the use of FQs in pregnancy. Which, if
any, of the following was included? This is an SBA with only one correct
answer.
Option List
|
A
|
↑ risk of atrial
fibrillation
|
|
B
|
↑ risk of aortic
aneurysm and rupture
|
|
C
|
↑ risk of
mitral stenosis
|
|
D
|
↑ risk of
pulmonary hypertension
|
|
E
|
↑ risk of
ulcerative colitis
|
27. 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
|
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