Role-play.
Pre-pregnancy
counselling.
|
|
40
|
Structured
discussion. WHO criteria for a screening test.
|
41
|
EMQ.
Diabetes
insipidus
|
42
|
EMQ. G6PDD & G6PD.
|
43
|
EMQ. Peutz-Jeghers syndrome.
|
39. Role-play.
Pre-pregnancy counselling.
Candidate’s instructions.
You are an SpR5. Your
consultant has asked you to see this patient as she thinks it will be good for
your preparation to become a consultant. She has said that she wishes to
discuss the station with you afterwards, but that you are to use your
initiative and knowledge to deal with the patient entirely on your own without
asking the consultant for advice.
Your task is to see the
patient and deal with her in the way that a good consultant would.
40. Structured discussion.
WHO criteria for a screening test.
Candidate’s instructions.
This is a structured
discussion about the WHO criteria for a screening test.
When you have finished a
question, you will not be allowed to return to it as later questions may
indicate the answer. If you return, no marks will be awarded, even for correct
answers.
41. EMQ.
Diabetes insipidus.
You might think this so ‘small print’ that you should ignore it. There
was a TOG article in 2018, so it is a hot topic and you need a grasp of the
basics.
Abbreviations.
ADH: antidiuretic
hormone.
Scenario 1.
What is the
origin of the word ‘diabetes’?
Option list.
A.
|
the Greek word for ‘bucket’
|
B.
|
the Greek word for ‘halitosis’
|
C.
|
the Greek word for ‘siphon’
|
D.
|
the Greek word for ‘stream’
|
E.
|
the Greek word for ‘waterfall’
|
Scenario 2.
What is the origin of the word ‘mellitus’?
Option list.
A.
|
the Latin word for ‘darling’
|
B.
|
the Latin word for ‘honeyed’
|
C.
|
the Latin word for ‘honey-pie’
|
D.
|
the Latin word for ‘sugar’
|
E.
|
the Latin word for ‘sweet’
|
Scenario 3.
What is the origin of the word
‘insipidus’?
Option list.
A.
|
the Latin
word for ‘dull’
|
B.
|
the Latin
word for ‘pale grey’
|
C.
|
the Latin
word for ‘savoury’
|
D.
|
the Latin
word for ‘spicy’
|
E.
|
the Latin
word ‘to have taste’
|
Scenario 4.
What is the
origin of the word ‘insulin’?
Option list.
A.
|
the Latin noun ‘insula’, ‘island’ to reflect its production in the
islets of Langerhans
|
B.
|
the Latin verb ‘insultare’ ‘to insult’ as this is an affront to your
intelligence
|
C.
|
the Latin verb ‘insultare’, ‘to assault’; reflecting its ability to
deal with DM
|
D.
|
the Latin verb ‘insulare’, ‘to insulate’; reflecting its ability to
protect from DM
|
E.
|
none of the above
|
What
is the definition of DI?
Option
list.
A.
|
diabetes
mellitus with low or normal blood glucose levels
|
B.
|
diabetes
mellitus with low serum osmolality
|
C.
|
diabetes
mellitus with polyuria despite low or normal blood glucose levels
|
D.
|
failure of the
renal glomeruli to conserve water
|
E.
|
failure of the
renal tubules to conserve water
|
F.
|
polyuria with
urine output > 3 litres per 24 hours
|
G.
|
polyuria with
urine output > 5 litres per 24 hours
|
H.
|
polyuria and
polydipsia due to low or absent ADH production
|
J.
|
polyuria and
polydipsia due to excess ADH production
|
K.
|
polyuria and
polydipsia due to low or absent vasopressinase production
|
L.
|
polyuria and
polydipsia due to excess ADH vasopressinase production
|
M.
|
none of the
above.
|
Scenario 6.
What is the definition of polyuria?
Option list.
A.
|
urine volume ≥ 2 l. per 24
hours
|
B.
|
urine volume ≥ 3 l. per 24
hours
|
C.
|
urine volume ≥ 4 l. per 24
hours
|
D.
|
urine volume ≥ 5 l. per 24
hours
|
E.
|
urine volume ≥ 10 l. per 24
hours
|
F.
|
urine volume > fluid intake
|
G.
|
urine volume > fluid intake minus estimated ‘imperceptible’ fluid
loss
|
H.
|
none of the above
|
Scenario 7.
What is the approximate incidence of DI in
pregnancy?
Option list.
A.
|
2-4 per million
|
B.
|
2-4 per 100,000
|
C.
|
2-4 per 10,000
|
D.
|
2-4 per 1,000
|
E.
|
none of the above
|
Scenario 8.
Which, if any, of the following are
included in the classification of DI?
Option list.
A.
|
central
|
B.
|
dipsogenic
|
C.
|
dipsomaniacal
|
D.
|
gestational
|
E.
|
neurotic
|
F.
|
nephrogenic
|
G.
|
neurogenic
|
H.
|
peripheral
|
I.
|
primary
|
J
|
psychogenic
|
K.
|
renal
|
Scenario 9.
Which, if any,
of the following are the most common type of DI in the non-pregnant? There may
be more than one correct answer as some of the terms are used synonymously.
Option list.
Use the option list from question 8.
Scenario 10.
Which, if any,
of the following are the most common type of DI in pregnancy? There may be more
than one correct answer as some of the terms are used synonymously.
Option list.
Use the option list from question 8.
Scenario 11.
Which, if any,
of the following apply to ADH?
Option list.
A.
|
it is an octapeptide
|
B.
|
it is a nonapeptide
|
C.
|
it is a decapeptide
|
D.
|
it is a glycoprotein
|
E.
|
none of the above
|
Scenario 12.
Which, if any, of the following are true
in relation to the mechanisms controlling release of ADH?
Option list.
A.
|
the main factor controlling ADH release is plasma albumin
|
B.
|
the main factor controlling ADH release is plasma albumin
|
C.
|
the main factor controlling ADH release is plasma osmolality
|
D.
|
the main factor controlling ADH release is plasma sodium
|
E.
|
the main factor controlling ADH release is plasma viscosity
|
F.
|
the main factor controlling ADH release is plasma volume
|
Scenario 13.
Which, if any, of the following is true
about the effect of ADH?
Option list.
A.
|
it ↑ the creation of aquaporins
|
B.
|
it ↑ the creation of aquapourins
|
C.
|
it ↑ the creation of aquasporrins
|
D.
|
it ↓ the creation of aquaporins
|
E.
|
it ↓ the creation of aquapourins
|
F.
|
it ↓ the creation of aquasporrins
|
G.
|
none of the above
|
Scenario 14.
Which, if any, of the following statements
are true about the V1 receptors?
Option
list.
A.
|
they are stimulated by ADH
|
B.
|
high ADH levels cause vasoconstriction
|
C.
|
high ADH levels cause vasodilatation
|
D.
|
high ADH levels ↑ reabsorption of water
|
E.
|
high ADH levels ↓ reabsorption of water
|
Scenario 15.
Which, if any, of the following statements
are true about the V2 receptors?
Option
list.
A.
|
they are stimulated by ADH
|
B.
|
high ADH levels cause vasoconstriction
|
C.
|
high ADH levels cause vasodilatation
|
D.
|
high ADH levels ↑ reabsorption of water
|
E.
|
high ADH levels ↓ reabsorption of water
|
Scenario 16.
Which, if any of the following statements
is true about ADH?
Option list.
A.
|
it is produced by the hypothalamus
|
B.
|
it is produced by the anterior pituitary
|
C.
|
it is produced by the posterior pituitary
|
D.
|
shares all but two of its peptides with oxytocin
|
E.
|
acts on the V1 renal receptors to ↑ reabsorption
of water
|
F.
|
acts on the V1 renal receptors to ↑ vasoconstriction
|
G.
|
acts on the V2 renal receptors to ↑ reabsorption of water
|
H.
|
acts on the V2 renal receptors to ↑ reabsorption of water
|
I.
|
ADH secretion increases x 4 by the 3rd. trimester
|
J.
|
has got me bored out of my head
|
Scenario 17.
Which, if any, of the following statements
best fits the changes in systemic vascular resistance?
Option list.
A.
|
it falls from the 1st. to the 3rd. trimester
|
B.
|
it falls from the 1st. to the mid-2nd. trimester
|
C.
|
it falls from the 2nd. to the 3rd. trimester
|
D.
|
it rises from the 1st. to the 3rd. trimester
|
E.
|
it rises from the 1st. to the mid-2nd. trimester
|
F.
|
it rises from the 2nd. to the 3rd. trimester
|
G.
|
none of the above
|
Scenario 18.
Which, if any, of the following are
correct in relation to vasopressinase?
Option list.
A.
|
it is mainly produced in the fetal liver
|
B.
|
it is mainly produced by trophoblasts
|
C.
|
vasopressinase activity is directly proportionate to the liquor volume
|
D.
|
vasopressinase activity is directly proportionate to the weight of the
fetus
|
E.
|
vasopressinase activity is directly proportionate to the weight of the
placenta
|
F.
|
vasopressinase activity is similar with ADH and DDAVP
|
Scenario 19.
Which, if any, of the following
investigations may be appropriate in DI in pregnancy?
Option list.
A.
|
urea & electrolytes
|
B.
|
blood glucose
|
C.
|
urine glucose
|
D.
|
blood calcium
|
E.
|
plasma osmolality
|
F.
|
urine osmolality
|
G.
|
urine specific gravity
|
H.
|
MRI scan
|
Which,
if any, of the following statements are true about DDAVP?
Option
list.
A.
|
It is also
known vasopressin
|
B.
|
it is also
known as dismopressin
|
C
|
is resistant
to vasopressinase
|
D.
|
it is believed
to be safe in pregnancy
|
E.
|
it may cause
delayed onset of labour
|
F.
|
it may cause
dysfunctional labour
|
G.
|
it may cause
hypernatraemia
|
H.
|
it may cause
precipitate labour
|
I.
|
it may
increase the risk of retention of the placenta and PPH
|
J.
|
it may
interfere with the initiation of lactation
|
K.
|
it is usually
administered nasally
|
L.
|
is the
treatment of choice for central DI
|
M.
|
is the
treatment of choice for gestational DI
|
N.
|
is the
treatment of choice for nephrogenic DI
|
O.
|
is the
treatment of choice for psychogenic DI
|
Diabetes
insipidus (DI) in pregnancy,
1. is the failure of water conservation by the
renal tubules. True / False
2. occurs in approximately 2–4 per 100 000
pregnancies. True / False
3. is associated with a mortality rate of
approximately 50%. True / False
4. usually arises in the first trimester. True / False
5. presents with oliguria. True / False
Antidiuretic
hormone (ADH),
6. acts at the kidney by stimulating V2
receptors. True / False
7. has a similar structure to oxytocin. True / False
Vasopressinase,
8. is released from the fetal renal
vasculature. True / False
9. undergoes hepatic metabolism. True / False
10. secretion is increased in multiple
pregnancies. True / False
Regarding the
pathophysiology of DI,
11. the neurogenic (central) type is caused by
either inadequate production or release of vADH from the posterior pituitary. True / False
12. in the gestational type ADH synthesis is
unaffected. True / False
13. primary polydipsia occurs as a result of
excess fluid intake with normal pituitary and renal function. True / False
Desmopressin
(1-deamino-8-D-arginine vasopressin, DDAVP),
14. is an ADH analogue. True / False
15. is a second-line treatment in pregnancy for
the non-renal type of DI. True / False
16. can be administered rectally. True / False
17. is administered intravenously. True / False
Pregnant women
with DI,
18. can be managed solely with obstetric input. True / False
19. have a good prognosis if its uncomplicated. True / False
20. will require senior clinician (obstetrics and
anaesthetics) review in < 5% of cases. True / False
42. 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
|
43. EMQ.
Peutz-Jeghers syndrome.
Abbreviations.
PJS: Peutz-Jeghers
syndrome.
Scenario 12.
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 13.
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 14.
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 15.
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 16.
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 17.
What is the
relevance of STK11 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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