|
22 |
Role-play. Postnatal depression. |
|
23 |
SBA. Lynch syndrome |
|
24 |
Template. Gynae history |
|
25 |
Template. Obstetric history |
|
26 |
EMQ. Hepatitis E and pregnancy |
22. Postnatal depression.
Candidate’s instructions.
You are an SpR5 in the
antenatal clinic. A midwife has booked Mary Merridew. She found that she had
had postnatal depression and was not confident about advising her. She has
asked you to deal with this. Your tasks are to take an appropriate history, discuss
the situation with Mary and agree a management plan.
23. Lynch syndrome.
Abbreviations
CRC: colorectal cancer.
EC: endometrial cancer.
HNPCC: hereditary non-polyposis colo-rectal
cancer.
IBD: inflammatory bowel disease:
Crohn’s & ulcerative colitis.
IDDM: insulin-dependent diabetes mellitus.
Ls: Lynch syndrome.
Question 1.
Lead-in
What is Lynch syndrome?
Option List
|
A |
auto-immune condition leading to reduced factor X levels in blood |
|
B |
hereditary condition
which increases the risk of many cancers, particularly breast |
|
C |
hereditary condition which increases the risk of many cancers,
particularly breast & colorectal |
|
D |
hereditary condition which increases the risk of many cancers,
particularly colorectal & endometrial |
|
E |
none of the above |
Question 2.
Lead-in
How is Lynch syndrome inherited?
Option List
|
A |
it is an autosomal dominant condition |
|
B |
it is an autosomal recessive
condition |
|
C |
it is an X-linked dominant
condition |
|
D |
it is an X-linked
recessive condition |
|
E |
none of the above |
Question 3.
Lead-in
Which, if any, of the following genes can cause Lynch syndrome?
Option List
|
A |
MLH1 + MLH2 + MOH1 |
|
B |
MLH1 + MLH2 + MSH1 |
|
C |
MLH1 + MLH2 + MSH6 |
|
D |
MLH1 + MSH2 + MSH6 |
|
E |
None of the above |
Question 4.
Lead-in
Mutations of which 2 of the following genes cause the majority of cases
of Lynch syndrome?
Option List
|
A |
MLH1 + MLH2 |
|
B |
MLH1 + MSH1 |
|
C |
MLH1 + MSH2 |
|
D |
MLH2 + MSH1 |
|
E |
MLH2 + MSH2 |
Question 5.
Lead-in
What is the approximate prevalence of Ls in the UK population?
Option List
|
A. |
1 in 50 |
|
B. |
1 in 100 |
|
C. |
1 in 1,000 |
|
D. |
3 in 1,000 |
|
E. |
none of the above |
Question 6.
Lead-in
Approximately what % of individuals with Ls have had the diagnosis
established?
Option List
|
A. |
< 5% |
|
B. |
5 -10% |
|
C. |
10-20% |
|
D. |
20-30% |
|
E. |
>30% |
Question 7.
Lead-in
Which, if any, of the following conditions are associated with an ↑ risk of Lynch syndrome?
Conditions
|
acromegaly |
|
Addison’s disease |
|
anosmia |
|
coeliac disease |
|
IBD |
|
IDDM |
Option List
|
A |
acromegaly + Addison’s disease + coeliac disease + IBD + IDDM |
|
B |
acromegaly + disease + anosmia + coeliac disease + IBD |
|
C |
acromegaly + IBD + IDDM |
|
D |
acromegaly + IBD |
|
E |
Addison’s disease + anosmia + coeliac disease + IBD + IDDM |
|
F |
acromegaly + Addison’s disease + anosmia + coeliac disease + IBD + IDDM |
|
G |
acromegaly + Addison’s disease + anosmia + coeliac disease + IBD + IDDM |
|
H |
none |
Question 8.
Lead-in
Which 2 cancers are most likely in women with Lynch syndrome?
Cancers.
|
A |
breast |
|
B |
bowel |
|
C |
cervix |
|
D |
endometrium |
|
E |
ovary |
|
F |
pancreas |
Option List
|
A |
breast + bowel |
|
B |
breast + pancreas |
|
C |
breast + endometrium |
|
D |
bowel + cervix |
|
E |
bowel + endometrium |
|
F |
bowel + ovary |
|
G |
bowel + pancreas |
|
H |
endometrium + ovary |
Question 9.
Lead-in
What does NICE recommend about screening for Lynch syndrome for the
population with no personal history of colorectal cancer?
Option List
|
A |
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative |
|
B |
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative |
|
C |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis |
|
D |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis |
|
E |
none of the above |
Question 10.
Lead-in
What does NICE recommend in relation to screening for Lynch syndrome in
those with a new diagnosis of colorectal cancer?
Option List
|
A |
offer screening to everyone, regardless of age and family history |
|
B |
offer screening to those
aged < 50 years at diagnosis |
|
C |
offer screening to those
aged < 60 years at diagnosis |
|
D |
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative |
|
E |
offer screening to those
aged < 60 years at diagnosis with + ≥ 1 affected 1st.O
relative |
Question 11.
Lead-in
What does NICE recommend about screening for Lynch syndrome for the population
with no personal history of thyroid cancer?
Option List
|
A |
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative |
|
B |
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative |
|
C |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis |
|
D |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis |
|
E |
none of the above |
Question 12.
Lead-in
What does NICE recommend in relation to screening for Lynch syndrome in
those with a new diagnosis of thyroid cancer?
Option List
|
A |
offer screening to everyone, regardless of age and family history |
|
B |
offer screening to those
aged < 50 years at diagnosis |
|
C |
offer screening to those
aged < 60 years at diagnosis |
|
D |
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative |
|
E |
none of the above |
Question 13.
Lead-in
What does NICE recommend about screening for Lynch syndrome for the
population with no personal history of endometrial cancer?
Option List
|
A |
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative |
|
B |
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative |
|
C |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis |
|
D |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis |
|
E |
none of the above |
Question 14.
Lead-in
What does NICE recommend in relation to screening for Lynch syndrome in
those with a new diagnosis of endometrial cancer?
Option List
|
A |
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative |
|
B |
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative |
|
C |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis |
|
D |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis |
|
E |
none of the above |
Question 15.
Lead-in
What does NICE recommend about screening for Lynch syndrome for the
population with no personal history of colorectal cancer?
Option List
|
A |
offer screening to those
aged < 50 years with ≥ 1 affected 1st.O relative |
|
B |
offer screening to those
aged < 60 years with ≥ 1 affected 1st.O relative |
|
C |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 50 years at
diagnosis |
|
D |
offer screening to those
with ≥ 1 affected 1st.O relative aged < 60 years at
diagnosis |
|
E |
none of the above |
Question 16.
Lead-in
What does NICE recommend in relation to screening for Lynch syndrome in
those with a new diagnosis of colorectal cancer?
Option List
|
A |
offer screening to everyone, regardless of age and family history |
|
B |
offer screening to those
aged < 50 years at diagnosis |
|
C |
offer screening to those
aged < 60 years at diagnosis |
|
D |
offer screening to those
aged < 50 years at diagnosis with + ≥ 1 affected 1st.O
relative |
|
E |
offer screening to those
aged < 60 years at diagnosis with + ≥ 1 affected 1st.O
relative |
Question 17.
Lead-in
What relationship, if any, exists between Ls and acromegaly?
Option List
|
A |
the risk of Ls is ↓ in those with
acromegaly compared with the general population |
|
B |
the risk of Ls is ↑ in those with
acromegaly compared with the general population |
|
C |
the risk of Ls is unchanged in those with acromegaly compared with the
general population |
|
D |
the risk of Ls in unknown in those with acromegaly |
Question 18.
Lead-in
What is the effect of aspirin consumption on the risk of EC and CRC?
Option List
|
A |
aspirin reduces the risk of EC and
CRC |
|
B |
aspirin reduces the risk of EC but not CRC |
|
C |
aspirin reduces the risk of CRC but not EC |
|
D |
aspirin does not reduce the risk of EC or CRC |
|
E |
aspirin reduces the risk
of EC and CRC, but the risks outweigh the benefits |
Question 19.
Lead-in
A healthy woman of 35 years is diagnosed with Ls? What are the key
elements of the National Screening Programme for people with Ls?
There is no option list – just write down everything you know.
Question 20.
Lead-in
Which, if any, of the following were recommendations made by Monahan et
al, the 30 experts who wrote to the BMJ in 2017?
Option List
|
A |
creation of a national register of people with Ls |
|
B |
creation of a post of
Consultant in Ls for each NHS Trust |
|
C |
creation of a post of
Clinical Champion for Ls in each NHS Region. |
|
D |
creation of a post of
Clinical Champion for Ls in the DOH. |
|
E |
none of the above |
24. Gynaecology history.
Candidate’s
instructions.
Sketch the headlines you
would use when taking a gynaecological history and present them to the
examiner.
25. Obstetric history.
Candidate’s
instructions.
You are to conduct a
tutorial with hospital’s junior obstetricians and midwives about how to take an
obstetric history. Prepare the headlines you use for a model obstetric history
and consider how you would conduct the tutorial.
Then you will have a viva
with the examiner.
The examiner will ask 4
questions.
1. What are your headings?
2. What clinical situations do you envisage covering?
3. What teaching methods would you consider for use in the tutorial?
4. Which methods would be most suitable and why?
26. Hepatitis E.
Abbreviations.
Gt: genotype
PPROM: preterm, prelabour rupture of membranes.
Question
1.
Which, if any, of the following is the
most common cause of acute viral hepatitis in the UK?
Option list.
|
A |
hepatitis A virus |
|
B |
hepatitis B virus |
|
C |
hepatitis C virus |
|
D |
hepatitis D virus |
|
E |
hepatitis E virus |
|
F |
herpes simplex virus |
|
G |
HIV |
Question
2.
Which, if any, of the following are
correct about HEV.
Option list.
|
A |
it is a DNA virus |
|
B |
it belongs to the genus
Hippieviridae |
|
C |
it belongs to the genus
Hepeviridae |
|
D |
it belongs to the genus
Hoppieviridae |
|
E |
there are six main
genotypes |
|
F |
genotype 3 is the one of
greatest importance in the UK |
|
G |
the main reservoir of
genotype 3 is intensively-reared chickens |
|
H |
the main reservoir of
genotype 3 is domestic cats |
|
I |
a vaccine exists but is
only licensed in Russia |
|
J |
none of the above |
Question
3.
Which, if any, of the following statements
about HEV and pregnancy are true?
Option list.
|
A |
pregnant women are more
susceptible to HEV infection |
|
B |
pregnant women are more
likely to develop serious disease that the non-pregnant |
|
C |
the main risk is neonatal
death due to vertical transmission |
|
D |
the main risk is
maternal death |
|
E |
the risk of maternal
death is highest with infection in the 1st. trimester |
|
F |
↑
rates
of preterm birth have been reported |
|
G |
↑ rates of stillbirth have been reported |
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