35 |
EMQ. Antenatal steroids |
36 |
SBA. Coeliac disease & pregnancy |
37 |
EMQ. HCV and pregnancy |
38 |
EMQ.
Kallmann’s syndrome |
39 |
SBA. Fetal origins of adult disease |
35. EMQ. Antenatal
steroids.
Abbreviations.
ANC: antenatal corticosteroids.
ANS: antenatal steroids.
NG25: NICE’s Guideline 25: “Preterm
labour and birth”. November 2015.
Lead-in.
The
following scenarios relate to antenatal steroid use and the neonate.
There
are no option lists and you have to decide your answers without help.
Scenario
1.
What are the benefits to the neonate of appropriate administration
of antenatal steroids?
Scenario
2.
At what gestations should antenatal steroids be offered to women
with singleton pregnancies who are at risk of premature labour?
Scenario
3.
At what gestations should antenatal steroids be offered to women
with multiple pregnancies who are at risk of premature labour?
Scenario
4.
What advice is contained in NG25 about ANS and very early
gestations?
Scenario
5.
What
advice is contained in NG25 GTG about antenatal steroids and Caesarean section?
Scenario
6.
What advice is given in the NG25 about ANS in relation to the
fetus with FGR at risk of premature delivery?
Scenario
7
What advice is given in NG25 about ANS for women with IDDM?
Scenario
8
What advice is in the NG25 about adverse effects of ANS on the
fetus?
Scenario
9
What advice is in the GTG in relation to short-term maternal
adverse effects?
Scenario
10
What
contraindications to ANS are cited in NG25?
Scenario
11
What
is the recommended drug regime for ANS administration?
Scenario 12.
What is the time-scale for maximum
effect of ANS in reducing RDS?
Scenario 13.
When should repeat courses of ANS be
given?
Scenario 14.
Who was the great pioneer of antenatal
steroids to accelerate lung maturation?
Scenario 15.
Which country was this great pioneer
from and which animal did he use for his early research?
Scenario 16.
Why is the story of this pioneer’s work
a cautionary tale for O&G?
Scenario 17.
Which international organisation has
immortalised his work in its logo?
Scenario 18.
When may antenatal steroids be
beneficial to the fetus apart from accelerating lung maturation?
36. SBA.
Coeliac disease & pregnancy.
Abbreviations.
AGA: anti-gliadin antibodies
CD: coeliac disease.
DGP: IgG deamidated gliadin peptide.
EMA: IgG endomysial antibodies.
FGR: Fetal growth restriction.
HLA: Human leucocyte antigen.
IgA: immunoglobulin A.
tIgA: total immunoglobulin A.
tTGA: IgA tissue transglutaminase antibody.
vLBW: very low birth weight.
vPTB: very pre-term birth (<30/52).
Question
1.
What is coeliac disease?
Option
List
A. |
allergy to gluten |
B. |
malabsorption due to large bowel inflammation |
C. |
an auto-immune disorder triggered by gluten sensitivity causing
villous atrophy of the descending colon in individuals with a genetic
predisposition |
D. |
an auto-immune disorder triggered by gluten sensitivity causing
villous atrophy of the gastric mucosa in individuals with a genetic
predisposition |
E. |
an auto-immune disorder triggered by gluten sensitivity causing
villous atrophy of the small bowel in individuals with a genetic
predisposition |
Question
2.
What is the prevalence of coeliac disease in
women of reproductive age?
Option
List
A. |
0.1% |
B. |
0.5% |
C. |
1% |
D. |
2-5% |
E. |
5-10% |
Question
3.
Which
of the following groups have an increased risk of CD?
Option
List
A. |
1st. degree
relatives of those with CD |
B. |
those with type 1 diabetes |
C. |
those with iron deficiency
anaemia |
D. |
those with osteoporosis |
E. |
those with unexplained
infertility |
Question
4.
Which of the following are features of CD in
the non-pregnant population?
Option
List
A. |
abdominal bloating and pain |
B. |
amenorrhoea |
C. |
anaemia |
D. |
recurrent miscarriage |
E. |
unexplained infertility |
Question
5.
How do pregnant women with CD present most
commonly?
Option
List
A |
anaemia |
B |
failure to gain weight in pregnancy |
C |
intra-uterine growth retardation |
D |
low BMI |
E |
no recognised abnormality |
Question
6.
Which of the following commonly occur in pregnant
women with CD?
Option
List
anaemia |
|
B |
failure to gain
weight in pregnancy |
C |
intra-uterine
growth retardation |
D |
low BMI |
E |
no recognised
abnormality |
Question
7.
How
should the woman with suspected CD be investigated initially?
Option
List
jejunal biopsy |
|
B. |
IgA EMA |
C. |
IgA tTGA |
D. |
IgA EMA + IgA tTGA |
E. |
tIgA + tTGA |
Question
8.
Which, if any, of the following statements
are true in relation to the woman due to have testing for suspected CD?
Option
List
continue with a diet that includes gluten ≥ once daily
for at least 1 month |
|
B. |
continue with a
diet that includes gluten ≥ once daily for at least 6 weeks |
C. |
continue with a
diet with ≥ 10 gm. gluten daily for at least 1 month |
D. |
continue with a
diet with ≥ 10 gm. gluten daily for at least 6 weeks |
E. |
follow a strict
gluten-free diet for at least 3 months |
Question
9.
What advice should be given to those who have
gone on to a gluten-free diet in the month before testing?
Option
List
the gluten-free
diet may render the serological tests –ve, but not intestinal biopsy |
|
B. |
the gluten-free
diet may render the intestinal biopsy –ve, but not the serological tests |
C. |
the gluten-free diet may render all the tests -ve |
D. |
if she is happy
with the gluten-free diet, there is no
point in testing |
E. |
she is not
qualified to make medical decisions and should not be so stupid on future
occasions |
Question
10.
Which of the following conditions should make
consideration of testing for CD sensible?
Option
List
A. |
amenorrhoea |
B. |
Down’s syndrome |
C. |
epilepsy |
D. |
recurrent miscarriage |
E. |
Turner’s syndrome |
F. |
unexplained infertility |
Question
11.
What
recommendation does NICE make about the information to be provided to
healthcare professionals with the results of serological tests for CD?
Option
List
the results alone should be provided |
|
B. |
the results with the local reference values for children,
adult men and adult women |
C. |
the results with the local and national reference
values for children, adult men and women |
D. |
the results with interpretation of their meaning |
E. |
the results with interpretation of their meaning +
recommended actions |
Question
12.
How is the diagnosis of CD confirmed after
+ve serological testing?
Option
List
colonoscopy |
|
B. |
enteroscopy |
C. |
gastroscopy |
D. |
rectal biopsy |
E. |
small bowel biopsy |
Question
13.
Which skin condition is particularly
associated with CD?
Option
List
atopic eczema |
|
B. |
dermatitis herpetiformis |
C. |
dermatitis
multiforme |
D. |
dermatographia |
E. |
psoriasis |
Question
14.
Which of the following are likely to be
absorbed less well than normally in women with CD?
Option
List
carbohydrate |
|
B. |
fat |
C. |
folic acid |
D. |
protein |
E. |
vitamins B12,
D & K |
Question
15.
What is the appropriate treatment of CD?
Option
List
antibiotics: long-term in low-dosage |
|
B. |
azathioprine |
C. |
cyclophosphamide |
D. |
rectal steroids |
E. |
none of the
above |
Question
16.
Which of the following do not contain gluten?
Option
List
barley |
|
B. |
oats |
C. |
rapeseed oil |
D. |
rye |
E. |
wheat |
37. EMQ. HCV
and pregnancy.
Some of the questions are not true EMQs as more than one of the options
is true.
Abbreviations.
DAAD: Direct-acting, antiviral drug.
HBcAg: Hepatitis B core antigen
HCV: Hepatitis C virus.
HCAb: Hepatitis C antibody.
MTCT: mother-to-child transmission.
NICU: neonatal intensive-care unit,
PTB: preterm birth,
STD: sexually-transmitted disease.
Scenario 1.
Which,
if any, of the following statements are true?
Option list.
A |
Hepatitis kills
more people world-wide than HIV |
B |
Hepatitis kills
more people world-wide than TB |
C |
Hepatitis B
kills more people world-wide that Hepatitis C |
D |
Hepatitis B
kills more people world-wide than TB |
E |
None of the
above |
Scenario 2.
Which,
if any, of the following statements are true in relation to HCV?
Option list.
A |
It is a DNA
virus |
B |
It is a RNA
virua |
C |
It is a member
of the Flaviviridae family |
D |
it is a member
of the Hepadnaviridae family |
E |
it is a member
of the Herpesviridae family |
F |
most infections
are due to genotypes 1 & 3 |
G |
most infections
are due to genotypes 2 & 4 |
Scenario 3.
What is
the approximate prevalence of HCV infection in the UK?
Option list.
A |
0.1 per 1,000 |
B |
0.3 per 1,000 |
C |
0.5 per 1,000 |
D |
1 per 1,000 |
E |
3 per 1,000 |
F |
5 per 1,000 |
G |
10 per 1,000 |
H |
13 per 1,000 |
I |
15 per 1,000 |
J |
None of the
above |
Scenario 4.
What are
the key aspects of the WHO’s Global Health Sector Strategy in relation to HCV
infection?
Option list.
A |
elimination as
a as a major public health threat by 2020 |
B |
elimination as
a as a major public health threat by 2030 |
C |
elimination as
a as a major public health threat by 2040 |
D |
reduction in
incidence by 50% by 2030 |
E |
reduction in
incidence by 75% by 2030 |
E |
reduction in
incidence by 80% by 2030 |
F |
reduction in mortality
by 50% by 2030 |
G |
reduction in
mortality by 65% by 2030 |
H |
reduction in
mortality by 70% by 2030 |
Scenario 5.
What
is the incubation period of HCV infection?
Option list.
A |
6 weeks |
B |
2 months |
C |
up to 3 months |
D |
up to 4 months |
E |
up to 6 months |
F |
up to 12 months |
G |
none of the
above |
Scenario 6.
What
symptoms are most common in acute HCV infection? There is no option list.
Scenario 7.
How
is acute HCV infection diagnosed?
Option list.
A |
clinically |
B |
presence of HCV
antibody |
C |
presence of HCV
IgM |
D |
presence of HCV
IgG |
E |
presence of HCV
RNA |
F |
none of the
above |
Scenario 8.
What
proportion of those with acute HCV infection are asymptomatic?
Option list.
A |
10% |
B |
20% |
C |
50% |
D |
60% |
D |
70% |
E |
> 80% |
Scenario 9.
When
does continuing infection after initial exposure become defined as chronic infection?
Option list.
A |
after 6 weeks |
B |
after 2 months |
C |
after 3 months |
D |
after 4 months |
E |
after 6 months |
F |
after 12 months |
G |
none of the
above |
Scenario 10.
Approximately
how many of those with acute HCV infection will go on to chronic infection?
Option list.
A |
10% |
B |
20% |
C |
40% |
D |
50% |
E |
>50% |
F |
>70% |
Scenario 11.
A
woman is found to have HCV antibodies. Which, if any, of the following
statements could be true?
Option list.
A |
she could have
acute HCV infection |
B |
she could have
chronic infection |
C |
she could have
had HCV infection that has cleared spontaneously |
D |
she could have
had HCV infection that has responded to drug therapy |
E |
she could have
a false +ve test result |
F |
she could have
chronic HBV infection due to cross reaction with HBcAg |
G |
she is immune
to HCV |
H |
the antibodies
could result from HCV vaccine |
I |
the antibodies
could result from yellow fever vaccine |
J |
none of the
above |
Scenario 12.
Which,
if any, of the following statements reflect current thinking about the
mechanisms of damage in chronic HCV infection?
Option list.
A |
hepatic damage
is proportional to the duration of HCV infection |
B |
hepatic damage
is a direct result of HCV replication within hepatocytes |
C |
hepatic damage
is proportional to the level of detectable HCV RNA in maternal blood |
D |
hepatic damage is immune-mediated |
E |
hepatic damage
is due to progressive biliary tract infection, scarring and stenosis |
F |
hepatic damage
mostly occurs in women who abuse alcohol |
G |
hepatic damage
is worse in women with co-existing HIV infection |
H |
hepatitis D is
end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating from
the original name: ‘deadly-stage’ HCV disease |
Scenario 13.
How
common is vertical transmission? There is no option list.
Scenario 14.
Which,
if any, of the following statements are true in relation to the hepatitides?.
A |
acute
hepatitis is notifiable |
B |
chronic
hepatitis is notifiable |
C |
hepatitis
A is notifiable as the main route of spread is faecal contamination of food
& water |
D |
hepatitis
D is notifiable as the main source of infection is infected food and water |
E |
hepatitis
E is notifiable as the main source of infection in the UK is raw or
undercooked pork |
F |
none
of the above |
Scenario 15.
What
anti-viral treatment is recommended for pregnancy? There is no option list.
Scenario 16.
Which,
if any, of the following are true about Ribavirin?
Option list.
A |
it is the least
expensive of the new DAADs for HCV |
B |
it is the least
toxic of the new DAADs for HCV |
C |
it is the most
effective of the new DAADs for HCV |
D |
it is contraindicated
in pregnancy because of fears of teratogenicity |
E |
can cause sperm
abnormalities |
F. |
can persist in humans
for up to 6 months |
G. |
none of the
above |
Scenario 17.
A
woman with chronic HCV wishes to breastfeed. What advice would you give? There
is no option list.
Scenario 18.
How
is neonatal infection diagnosed? There is no option list.
Scenario 19.
How
is neonatal infection treated? There is no option list.
Scenario
20.
Which, if any, of the following conditions is more common in women
with HCV infection?
A |
dermatitis
herpetiformis |
B |
HELLP
syndrome |
C |
obstetric
cholestasis |
D |
postnatal
depression |
E |
thrombocytopenia |
Scenario
21.
By how much is the risk of the condition in question 20 increased
in women with HCV?
Option
list.
A |
by a factor of 2 |
B |
by a factor of 5 |
C |
by a factor of 20 |
D |
by a factor of 50 |
E |
none of the above |
Scenario
22.
Which, if any, of the following statements is true about HCV and
the Nobel Prize?
Option
list.
A |
the Nobel Prize was awarded to Alter, Houghton &
Rice in 2020 |
B |
the Nobel Prize was awarded to Alter, Hogg & Rice
in 2020 |
C |
the Nobel Prize was awarded to Alter, Houghton &
Rees in 2020 |
D |
the Nobel Prize was awarded to Change, Houghton &
Rice in 2020 |
E |
the Nobel Prize was awarded to Change, Hogg & Rice
in 2020 |
F |
the Nobel Prize was awarded to Change, Hogg & Barleycorn
in 2020 |
G |
the Nobel Prize has not been awarded for work on HCV |
38. EMQ. Kallmann’s syndrome.
Scenario
23.
Which of the following might be included in descriptions of Kallmann’s
syndrome?
Option
list.
A |
hypogonadotrophic hypogonadism |
B |
hypogonadotrophic hypogonadism + anosmia |
C |
hypogonadotrophic hypogonadism + anosmia + colour-blindness. |
D |
hypogonadotrophic hypogonadism due to uterine agenesis |
Scenario
24.
Which,
if any, of the following are features of the Kallmann phenotype?
A |
absent or minimal breast development |
B |
aortic stenosis |
C |
blue eyes |
D |
blue hair |
E |
hot flushes |
F |
short stature |
G |
tall stature |
H |
vaginal agenesis |
I |
none of the above |
Scenario
25.
How common is Kallmann’s
syndrome and what is the female: male ratio?
A |
1 in 1,000 and F:M ratio 1:1 |
B |
1 in 5,000 and F:M ratio 1:1 |
C |
1 in 10,000 and F:M ratio 1:4 |
D |
1 in 50,000 and F:M ratio 1:4 |
E |
1 in 100,000 and F:M ratio 1:8 |
F |
1 in 250,000 and F:M ration 1:10 |
Scenario
26.
What is the most common mode of inheritance of Ks?
Option
list.
A |
hypogonadotrophic hypogonadism |
B |
hypogonadotrophic hypogonadism + anosmia |
C |
hypogonadotrophic hypogonadism due to uterine agenesis |
D |
autosomal dominant |
E |
autosomal recessive |
F |
X-linked recessive |
G |
new mutation of the ANOS1 gene |
H |
the most common mode of inheritance is not known |
Scenario
27.
How is Kallmann’s syndrome diagnosed?
A |
abdominal and pelvic ultrasound scan |
B |
cell-free fetal DNA |
C |
chromosome analysis |
D |
CT scan of hypothalamus / pituitary |
E |
MR scan of hypothalamus / pituitary |
F |
none of the above. |
Scenario
28.
How is Kallmann’s syndrome treated initially? Which of the following
statements are true?
Option
list.
A |
GnRH analogue depot |
B |
pulsatile GnRH therapy |
C |
combined oral contraceptive |
D |
counselling & education re gender re-assignment |
E |
depot progestogen |
F |
none of the above |
Scenario
29.
A woman was diagnosed with Kallmann’s syndrome at 16 and had successful
initial treatment. She is now 25, married and wishes to have a pregnancy. She
has had pre-pregnancy assessment and counselling. Which of the following should
be considered?
A |
GnRH analogue depot |
B |
induction of ovulation with clomiphene |
C |
gonadotrophin therapy |
D |
pulsatile GnRH therapy |
E |
none of the above |
39. SBA.
Fetal origins of adult disease .
Abbreviations.
ADHD: attention-deficit, hyperactivity disorder
Lead
in.
These questions relate to disease in adults
resulting from events during fetal, infant and child development.
Scenario
1.
What eponymous title is given to the concept
that adverse intra-uterine conditions predispose to the development of disease
in adulthood?
Option
List
A.
|
the Barker hypothesis |
B.
|
the Baker’s dozen |
C.
|
the Broadbank theory |
D.
|
PIPAD: Placental Insufficiency Programmes Adult Disease |
E.
|
SIMCARD: Stop In-utero Malnutrition to Conquer Adult-resulting
Disease |
Scenario
2.
Which other term is used for the concept that
adverse intra-uterine conditions predispose to the development of disease in
adulthood?
Option
List
A.
|
FDAD: fetal determination of adult disease |
B.
|
FIAD: fetal influences
on adult disease |
C.
|
FIDAD: fetal and infancy determinants of adult disease |
D.
|
FIGO: fetal influences
on genomic outcomes |
E.
|
FP: fetal
programming |
Scenario
3.
Which of the following is thought to increase
the risk of adult disease?
Option
List
A.
|
low birthweight |
B.
|
low birthweight followed by poor weight gain in infancy and
childhood |
C.
|
low birthweight followed by poor weight gain in infancy but
above-average weight gain in childhood |
D.
|
above-average birthweight |
E.
|
above-average birthweight followed by poor weight gain in
infancy but above-average weight gain in childhood |
F.
|
above-average birthweight followed by above-average weight gain
in infancy and childhood |
Scenario
4.
Which adult diseases are generally believed
to be more likely in relation to adverse influences on the fetus, infant and
child.
Diseases.
A. |
asthma |
B. |
chronic bronchitis |
C. |
coronary heart disease |
D. |
diabetes type I |
E. |
diabetes type 2 |
F. |
hypertension |
G. |
Mendelson’s syndrome |
Option
List
A.
|
A + B + C + D |
B.
|
A + B + C + E |
C.
|
A + B + C + E + F + G |
D.
|
B + C + E + F + G |
E.
|
C + E + F |
Scenario
5.
What adult condition has been linked to
raised maternal c-reactive protein levels?
Option
List
A.
|
asthma |
B.
|
ADHD |
C.
|
autism |
D.
|
inflammatory bowel disease |
E.
|
schizophrenia |
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