19 November 2020
|
11 |
EMQ.
Hepatitis
B. |
|
12 |
EMQ. Peutz-Jeghers
syndrome. |
|
13 |
EMQ Tranexamic
acid. |
|
14 |
EMQ.
G6PDD
& G6PD |
|
15 |
EMQ.
Caldicott
guardian |
11. EMQ. Hepatitis B and
pregnancy.
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 |
Question
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?
Question
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?
Question
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?
Question
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?
Question
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?
Question
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?
Question
7.
How
common is chronic HBV carrier status in UK pregnant women?
Question
8.
What
is the risk of death from chronic HBV carrier status?
Question
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?
Question
10.
A
woman is a known carrier of HBV. What is the risk of vertical transmission in
the first trimester?
Question
11.
What
is the risk of the neonate who has been infected by vertical transmission
becoming a carrier without treatment?
Question
12.
Should
antiviral maternal therapy in the 3rd. trimester be considered for
women with HBeAg or high viral load?
Question
13.
How
effective is hepatitis B prophylaxis for the neonate in preventing chronic
carrier status as a result of vertical transmission?
Question
14.
Can a
woman who is a chronic HBV carrier breastfeed safely?
Question
15.
Hepatitis B
infection is the most dangerous of the viral hepatitis infections in pregnancy.
Question
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?
How long can HBV survive
outside the body?
Option list.
|
A |
< 1 hour |
|
B |
up to 6 hours |
|
C |
up to 12 hours |
|
D |
up to 24 hours |
|
E |
up to 2 days |
|
F |
up to 5 days |
|
G |
at least 7 days |
Question
18.
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?
Question
19.
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!
Question 20.
What does 5 log10
copies /mL mean?
|
A |
> 10 copies
/ mL |
|
B |
> 100 copies
/ mL |
|
C |
> 1,000
copies / mL |
|
D |
> 10,000
copies / mL |
|
E |
> 100,000
copies / mL |
|
F |
this has scared
me witless and I am going straight home to complain to my Mum |
Question 21.
Which,
if any, of the following statements are true about amniocentesis and CVS and
the risk of vertical transmission if the mother is HbsAg+ve?
Option list.
|
A |
they
are contraindicated |
|
B |
they
should be done with cover with HBIG |
|
C |
they
should be done with cover with a drug that is
effective for HBV and safe in pregnancy. |
|
D |
none
of the above |
Question
22.
Which,
if any, of the following statements are true about treatment in the third
trimester to reduce the risk of vertical transmission?
Option list.
|
A |
women
who are HbsAg+ve should be offered testing for HBV DNA levels in the 3rd.
trimester |
|
B |
there
is no effective treatment for HBV in the 3rd. trimester |
|
C |
the
risks of treatment for HBV in the 3rd. trimester outweigh the
benefits |
|
D |
drug
treatment for HBV in the 3rd. trimester adds nothing
beneficial to the normal use of HBIG +
HB vaccination of the neonate |
|
E |
none
of the above. |
Question
23.
Which,
if any, of the following drugs is recommended for use in the third trimester to
reduce the risk of vertical transmission?
Option list.
|
A |
acyclovir |
|
B |
lamivudine |
|
C |
telbivudine |
|
D |
tenofovir |
Question
24.
Does
elective Cs before labour and with the membranes intact reduce the vertical transmission
rate?
Question
25.
Which
hepatitis virus normally produces a mild illness, but represents a major risk
to pregnant women, with a mortality rate of up to 5%?
Question
26.
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?
Question
27.
Which
hepatitis virus is an absolute contraindication to breastfeeding after
appropriate treatment of the infected mother and prophylaxis for the baby?
Question
28.
Which
hepatitis virus is linked to an increased risk of obstetric cholestasis?
12. EMQ. Peutz-Jeghers
syndrome.
Abbreviations.
PJS: 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 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 |
13. Tranexamic acid.
Tranexamic acid.
This topic featured in the exam in 2019.
Abbreviations.
GOH: Goh E et al: “Perioperative management
of women on oral anticoagulants and antiplatelet agents undergoing
gynaecological procedures”.
TOG. 2020.
Vol 22, Issue 2; Pages 131-6.
TA: tranexamic acid.
Scenario
1.
Which,
if any, of the following describe the main mode of action of tranexamic acid?
This is not a true EMQ as there may be more than one correct answer.
Option list.
|
A |
inhibition of
conversion of plasminogen to plasmin |
|
B |
inhibition of
fibrinolysis |
|
C |
inhibition of
factor Xa |
|
D |
inhibition of
heparin activity |
|
E |
inhibition of
plasmin activity |
|
F |
promotion of conversion
of fibrinogen to fibrin |
|
G |
promotion of
conversion of prothrombin to thrombin |
|
H |
promotion of
platelet activation |
|
I |
promotion of
platelet production |
Scenario
2.
Which,
if any, of the following statements are true in relation to GOH?
Option list.
|
A |
GOH says that
TA should be considered when an apixaban antagonist is required |
|
B |
GOH says that
TA should be considered when a clopidogrel antagonist is required |
|
C |
GOH says that
TA should be considered when a factor Xa agonist is required |
|
E |
GOH says that TA
should be considered when a factor Xa antagonist is required |
|
F |
GOH says that
TA should be considered when a heparin
antagonist is required |
|
G |
GOH says that
TA should be considered when Protein C is deficient |
|
H |
GOH says that
TA should be considered when Protein S is deficient |
|
I |
none of the
above |
Scenario
3.
Which,
if any, of the following statements are true in relation to TA? This is not a
true EMQ as there may be more than one correct answer.
Option list.
|
A |
TA is
teratogenic in rats and should be avoided in the first trimester |
|
B |
TA has not been
shown to be teratogenic and is safe to use in pregnancy |
|
C |
TA is excreted
is contraindicated in breastfeeding as the levels equate to maternal levels |
|
D |
TA levels in
breast milk are one hundredth of maternal levels |
|
E |
none of the
above. |
Scenario
4.
Which,
if any, of the following statements are listed by eMC as contraindications?
Option list.
|
A |
asthma |
|
B |
barbiturate use |
|
C |
consumption
coagulopathy |
|
D |
convulsions |
|
E |
severe renal impairment |
14. 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 |
15. 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 in 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!
.
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