|
16 |
EMQ. Kell antibodies |
|
17 |
EMQ. Mayer-Rokitansky-Küster-Hauser syndrome |
|
18 |
SBA. Quinolone antibiotics |
|
19 |
EMQ. Parvovirus |
|
20 |
EMQ. Galactosaemia |
16. EMQ. Kell
antibodies.
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 |
The TOG
questions for the Gajjar article can be found here. These are open access, so reproduced here. These are obviously MCQs with True or False options.
Regarding Kell alloimmunisation in pregnancy,
1 the
amniotic fluid bilirubin level correlates well with the degree of fetal
anaemia.
2 previous
obstetric history does not reliably predict outcome.
3 the
incidence in the obstetric population is approximately 1–2 per 1000.
4 prophylaxis
is available.
5 the
relationship between fetal middle cerebral artery peak systolic velocity
(MCA-PSV) and haemoglobin concentration is poor.
6 anti-Kell
antibodies cause fetal anaemia via the suppression of erythropoesis rather than
red cell destruction.
With regard to maternal anti-Kell antibody screening,
7 if the father of the
fetus is Kell antigen positive, the fetus is likely to be affected with severe
HDFN.
8 where the father is
heterozygous for Kell, there is a 50% chance of the fetus carrying the Kell
antigen on its fetal red cells.
9 anti-Kell antibodies
stimulated by transfusion are known to affect the fetus to the same degree as
those stimulated from a previous pregnancy.
10 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.
17. EMQ.
Mayer-Rokitansky-Küster-Hauser syndrome.
Some
of the questions are not true EMQs as there may be more than one correct answer
– this is me being lazy and saving typing.
Mayer–Rokitansky–K
¨
uster–Hauser
syndrome:
diagnosis and management
With
regard to the MRKH syndrome,
61. there is failure of development of the
mesonephric ducts. T
F
62. the
phenotype and genotype are female. T F
63.
studies have established a link between the
syndrome and the use of diethylstilbestrol in
pregnancy.
T F
With
regard to the anatomical abnormalities seen in
MRKH
syndrome,
64.
symmetrical uterovaginal aplasia is found in
type I disorders. T
F
65.
renal abnormalities are seen in more than
half of
cases. T F
66.
skeletal abnormalities are reported in up to
one-fifth
of cases. T F
67. up to one-quarter of women have a
malformed
ear or auditory canal. T F
68. the
close proximity of the m
¨
ullerian
and
wolffian
duct derivatives to the metanephric
duct in
the developing embryo explains the
higher
association of malformations of the
kidneys
with this condition. T F
69.
vaginal agenesis is caused by failure of the
caudal
part of the m
¨
ullerian duct system to
develop. T
F
Regarding
the diagnosis of MRKH syndrome,
70.
magnetic resonance imaging is the gold
standard
tool. T F
71.
two-dimensional ultrasound scanning is not
useful
for associated renal tract
abnormalities.
T F
72.
complete androgen insensitivity syndrome is
an
important differential diagnosis. T F
73. the
presence of cyclical abdominal pain will
rule
out the diagnosis, as it indicates the
presence of functioning endometrium. T F
With regard to the creation of a neovagina,
74. it
is recommended that treatment is initiated
as soon
as the diagnosis is made. T F
75. psychological support to women undergoing
this
procedure is of the utmost importance. T F
76.
vaginal dilators are acceptable as an option
for first-line therapy. T
F
77.
Ingram’s modified Frank’s technique involves
the use
of vaginal dilators. T F
With regard to the surgical creation of a neovagina,
78. in the Davydov procedure the neovagina is
lined with peritoneum. T
F
With
regard to fertility in women with the MRKH
syndrome,
79. transvaginal egg retrieval is recognised to be
difficult
during in vitro fertilisation. T F
80. the condition has been shown to be
transmissible to the offspring. T F
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.
What are the main features of MRKH? There is no option list to
make life harder.
Question
2.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
With
regard to the anatomical abnormalities seen in MRKH syndrome.
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.
Regarding
the diagnosis of MRKH syndrome,
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.
18. SBA.
Quinolone antibiotics.
Quinolone & fluoroquinolone antibacterial drugs
Not all of the
questions are true SBAs as some have more than one answer. The true SBAs have
‘is’, not ‘are’ in the wording.
Abbreviations.
FQ: fluoroquinolone.
QUI: quinolone.
Question 1.
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.
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.
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.
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.
Which, if any, of the following QUIs &
FQs is not available for prescription in the UK.
Option
List
|
A |
ciprofloxacin |
|
B |
levofloxacin |
|
C |
nalidixic acid |
|
D |
moxifloxacin |
|
E |
ofloxacin |
Question 6.
Which, if any, of the following statements
are true in relation to the quinolones and fluoroquinolones and pregnancy?
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.
Which of the following is true about the
warning issued by the FDA in 2008 in relation to QUIs?
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.
Which of the following is true about the
warning issued by the FDA in 2011 in relation to QUIs?
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.
Which of the following is true about the
warning emphasised by the FDA in 2013 in relation to QUIs?
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.
FDA issued a warning in July 2016. Which, if
any, of the following were included?
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.
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.
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 |
19. EMQ.
Parvovirus.
Parvovirus
and pregnancy. EMQ. Question.
Abbreviations.
PvB19: parvovirus B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option
list.
There are no option lists apart from the last few questions. Make
up your own answers! In the exam it is best if you decide the answer without
reference to the option list and then identify it on the list.
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?
Scenario
24.
A
woman attends the pre-pregnancy counselling clinic as she is planning her first
pregnancy.
She
wants to know what screening for parvovirus is recommended.
Scenario
25.
A pregnant woman has had a significant contact with a child with
PARV infection. She has had urgent tests for PvIgG and PvIgM. Both results were
-ve. Which of the options best fits the advice she should be given?
Option list.
|
1. |
the tests show acute parvovirus infection |
|
2. |
the tests show chronic parvovirus infection |
|
3. |
the tests show that she has not had PARV infection
and is susceptible to it |
|
4. |
the tests show no evidence of PARV infection but she
should have repeat tests in 1 month |
|
5. |
the tests show old PARV infection and immunity |
|
6. |
the tests show recent PARV infection |
|
7. |
none of the above |
Scenario
26.
A pregnant woman has had a significant contact with a child with
PARV infection. She has had urgent tests for PvIgG and PvIgM. Both results were
+ve. Which of the options best fits the advice she should be given?
Option list.
|
1. |
the tests show acute parvovirus infection |
|
2. |
the tests show chronic parvovirus infection |
|
3. |
the tests show that she has not had PARV infection
and is susceptible to it |
|
4. |
the tests show no evidence of PARV infection but she
should have repeat tests in 1 month |
|
5. |
the tests show old PARV infection and immunity |
|
6. |
the tests show recent PARV infection |
|
7. |
none of the above |
Scenario
27.
A pregnant woman has had a significant contact with a child with
PARV infection. She has had urgent tests for PvIgG and PvIgM. The results were
PvIgG +ve and PvIgM -ve. Which of the options best fits the advice she should
be given?
Option list.
|
1. |
the tests show acute parvovirus infection |
|
2. |
the tests show chronic parvovirus infection |
|
3. |
the tests show that she has not had PARV infection
and is susceptible to it |
|
4. |
the tests show no evidence of PARV infection but she
should have repeat tests in 1 month |
|
5. |
the tests show old PARV infection and immunity |
|
6. |
the tests show recent PARV infection |
|
7. |
none of the above |
Scenario
28.
A pregnant woman has had a significant contact with a child with
PARV infection. She has had urgent tests for PvIgG and PvIgM. The results were
PvIgG -ve and PvIgM +ve. Which of the options best fits the advice she should
be given?
Option list.
|
1. |
the tests show acute parvovirus infection |
|
2. |
the tests show chronic parvovirus infection |
|
3. |
the tests show that she has not had PARV infection
and is susceptible to it |
|
4. |
the tests show no evidence of PARV infection but she
should have repeat tests in 1 month |
|
5. |
the tests show old PARV infection and immunity |
|
6. |
the tests show recent PARV infection |
|
7. |
none of the above |
Scenario
29.
A pregnant woman has had a significant contact with a child with
PARV infection. What prophylaxis should be offered?
Option list.
|
1. |
acyclovir orally |
|
1. |
acyclovir i.m. |
|
2. |
acyclovir i.v. |
|
3. |
hand-washing and avoiding small children |
|
4. |
i.v. hyperimmune globulin |
|
5. |
PVV vaccine |
|
6. |
there is no proven prophylaxis |
20. EMQ. Galactosaemia.
Galactosaemia.
Some of the questions have no option
list. The technique for the exam is to decide your answer before you read the
option list. The absence of an option list forces this behaviour!
Abbreviations.
GA: galactose
GAA: galactosaemia
Scenario
1.
What is galactosemia? There is no option list.
Scenario
2.
What is the mode of inheritance? There is no option list.
Scenario
3.
Which of the following is the most common cause of galactosemia in
Caucasians?
Option
list.
|
A |
mutation of the GALE gene |
|
B |
mutation of the GALF gene |
|
C |
mutation of the GALK gene |
|
D |
mutation of the GALk1 gene |
|
E |
mutation of the GALT gene |
Scenario
4.
What is the mutation which causes Classical Galactosaemia?
Option
list.
|
A |
Q188L |
|
B |
Q188M |
|
C |
Q188R |
|
D |
R188L |
|
E |
R188M |
|
F |
R188R |
|
G |
None of the above |
Scenario
5.
What is the Duarte mutation? There is no option list.
Scenario
6.
What are the main sources of galactose? There is no option list.
Scenario
7.
What is the approximate prevalence of galactosemia? There is no
option list.
Scenario
8.
Which of the following groups has the highest prevalence of
galactosaemia?
Option
list.
|
A |
Armenians |
|
B |
Ashkenazi Jews |
|
C |
French absinthe drinkers |
|
D |
Irish campers |
|
E |
Irish travellers |
|
F |
Masai |
|
G |
Scottish campers |
|
H |
None of the above |
Scenario
9.
Which is the most common mutation in the group with the highest
incidence of galactosemia? There is no option list.
Scenario
10.
Which, if any, of the following are linked to untreated GAA in the
newborn?
Option
list.
|
A |
risk of
coagulation problems |
|
B |
risk of
congenital hypothyroidism |
|
C |
risk of
diabetes |
|
D |
risk of
diarrhoea |
|
E |
risk of
failure to thrive |
|
F |
risk of liver
failure |
|
G |
risk of renal
failure |
|
H |
risk of
staphylococcal infection |
Scenario
11.
What are the main problems associated with non-treatment of
galactosaemia in adults? There is no option list.
Scenario
12.
Which, if any, of the following statements are true in relation to
the effects of a galactose-reduced diet (GRD) on long-term complications
(LTCs)?
Option
list.
|
A |
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth |
|
B |
a GRD has a major protective effect on LTCs, but only if started
within 12 weeks of birth |
|
C |
a GRD has a major protective effect on LTCs, but only if
followed meticulously |
|
D |
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth and continued for life |
|
E |
a GRD has a major protective effect on LTCs, but only if started
within 2 weeks of birth and continued for life |
|
F |
none of the above |
Scenario
13.
Is screening for galactosaemia included in the UK neonatal screening
programme? If not, why not?
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