Contact us.

Website.

35.

Role-play. Teach audit

36.

EMQ. Vulval conditions

37.

Role-play. Cs on maternal request

38.

SBA. Bevacizumab

39.

SBA. Fragile X syndrome

 

35.         Role-play. Teach audit.

Candidate’s instructions.

You are the SpR on call for the labour ward.

It is a quiet afternoon: all the patients are healthy and in normal labour.

Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination.

A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it.

Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.

 

36.         EMQ. Vulval conditions.

Abbreviations.

LP:              lichen planus.

LS:              lichen sclerosus.

Option list.

A.	Acne.
B.	Behçet’s syndrome.
C.	Candidiasis.
D.	CIN 3
E.	CIN1
F.	Crohn’s disease.
G.	Dermatitis.
H.	Eczema.
I.	Genital warts.
J.	Hidradenitis suppurativa.
K.	Leprosy.
L.	Lichen planus
M.	Lichen sclerosis
N.	Lymphogranuloma venereum
O.	Normal skin.
P.	Psoriasis.
Q.	Seborrhoeic dermatitis.
R.	Type 1 diabetes mellitus
S.	Type 2 diabetes mellitus
T.	Ulcerative colitis.
U.	VIN III.

Scenario 1.

A 22 year-old woman attends the colposcopy clinic after 2 smears showing minor atypia. The cervical appearances are of aceto-white with punctation.

Scenario 2.

A 60-year old woman has an erythematous rash of the vulva extending to the inner thighs with small satellite lesions. A similar rash is noted under the breasts. She is not known to have diabetes.

Scenario 3.

A woman attends the gynaecology clinic with a vulval rash. It has is a “lacy” appearance.  

Scenario 4.

A 35-year old woman attends is noted to have a vulval fistula. She has a history of episodic diarrhoea. 

Scenario 5.

A 25-year old woman attends the gynaecology clinic with a history of intense vulval itching and soreness. The appearances are of diffuse erythema with excoriation. Diabetes, candidiasis and other local infections have been eliminated by the GP. 

Scenario 6.

A 35-year old woman attends the gynaecology clinic with vulvitis. She also has a scalp rash. Clinical examination shows scaly, pink patches with signs of excoriation. Skin samples grow Malassezia ovalis.

Scenario 7.

A 40-year old woman has evidence of chronic vulval ulceration. She has recently been seen by a dermatologist for mouth ulceration and has been started on thalidomide.

Scenario 8.

An African woman of 35 years attends the gynaecology clinic. She has a ten-year history of chronic vulval ulceration. Examination shows multiple, tender vulval and pubic subcutaneous nodules, some of which have ulcerated.

Scenario 9.

A Caucasian woman of 29 years attends the gynaecology clinic with a chronic vulval rash. Examination shows erythematous areas with clearly defined margins and white scaly patches.

Scenario 10.

A 30-year old woman attends the gynaecology clinic with vulval itching. Examination shows erythema of the labia minora and perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium with increased mitotic activity.

Scenario 11.

Which condition is described in GTG58 as presenting with polygonal lesions?

Scenario 12.

Which condition is described in GTG58 as presenting with “well-demarcated, glazed erythema around the introitus?

Scenario 13.

What is the aetiology of lichen planus?

There is no option list – just write what you think.

 

37.         Role-play. Caesarean section.

Candidate’s instructions.

You are a SpR5 in the antenatal clinic. Your consultant is feeling unwell and has gone to lie down. The midwife has just seen a primigravid woman who has requested Caesarean section.She is healthy, with no significant medical history and the pregnancy has been normal. The gestation is 36 weeks, the head is engaged and the baby seems to be of an average size. The midwife has done all the routine investigations and has asked you to see her to discuss the request for Caesarean section. Your task to discuss her request as you would in a normal clinic.

 

38.         Bevacizumab. SBA Question.

Abbreviations.

VEGF:         Vascular Endothelial Growth Factor.

Question 1.             

What type of drug is bevacizumab?

Option list.

A	antibody to VEGF
B	anti-mitotic
C	apoptosis accelerant
D	platinum derivative
E	taxane

Question 2.             

How long has it been in clinical use?

Option list.

A	since 2004
B	since 2010
C	since 2016
D	since 2017
E	since 2018

Question 3.             

Why it is causing excitement in the UK now?

Option list.

A	it has been approved by NICE as 1st. line treatment for choriocarcinoma
B	it has been approved by NICE for all cervical cancer patients with no contraindications
C	it has been approved by NICE for all ovarian cancer patients with no contraindications
D	it has been approved by NICE under the Cancer Drugs Fund for advanced  cervical  cancer in patients with no contraindications
E	it has been approved by NICE under the Cancer Drugs Fund for advanced  ovarian  cancer in patients with no contraindications

Question 4.             

What adverse effects do you know of treatment with bevacizumab? There is no option list.

Question 5.             

Are there concerns about teratogenicity in relation to bevacizumab?

Question 6.             

How long should women wait after treatment with bevacizumab before becoming pregnant?.

 

39.         SBA. Fragile X syndrome

Abbreviations.

FXS:               Fragile X syndrome

FXTAS:          Fragile X tremor ataxia syndrome

HFEA:            Human Fertilisation and Embryology Authority

PIGD:            pre-implantation genetic diagnosis.

POI:               premature ovarian insufficiency

TR:                trinucleotide repeat

Question 1.

Which, if any, of the following are features of FXS in males?

Option List

A.	autism
B.	epilepsy
C.	hyper-extensible joints
D.	learning difficulty
E.	post-pubertal macroorchidism

Question 2.

Which, if any, of the following are features of FXS in females?

Option List

A.	autism
B.	epilepsy
C.	hyper-extensible joints
D.	learning difficulty
E.	post-pubertal ovarian enlargement

Question 3.

Why are women thought to be less affected by FXS than men?

Option List

A.	two X chromosomes dilute the effect of an affected X chromosome
B.	leonisation
C.	lionisation
D.	lyonisation
E.	none of the above

Question 4.

How common is FXS in males?

Option List

A.	1 in 1,000
B.	1 in 4,000
C.	1 in 8,000
D.	1 in 20,000
E.	1 in 100.000

Question 5.

How common is FXS in females?

Option List

A.	1 in 1,000
B.	1 in 4,000
C.	1 in 8,000
D.	1 in 20,000
E.	1 in 100.000

Question 6.

Which gene is implicated in the causation of FXS?

Option List

A.	fragile X mental retardation 1
B.	fragile X mitochondrial recognition 1
C.	fragile X 1
D.	the gene has not yet been identified
E.	none of the above

Question 7.

Which is the leading hereditary cause of learning difficulty?

Option List

A.	Down’s syndrome
B.	fragile X syndrome
C.	galactosaemia
D.	homocystinuria
E.	phenylketonuria

Question 8.

Which is the most common genetic cause of autism?

Option List

A.	Down’s syndrome
B.	fragile X syndrome
C.	galactosaemia
D.	homocystinuria
E.	phenylketonuria

Question 9.

Which mode of inheritance occurs with FXS?

Option List

A.	autosomal dominant
B.	autosomal recessive
C.	X-linked dominant
D.	X-linked recessive
E.	none of the above

Question 10.

What is the story about trinucleotide repeats and FXS. What are TRs? Which TRs are involved with FXS? How are TRs categorised in relation to FXS?

There is no option list – just write your Answers.

Question 11.

What is the FXS premutation? What are its key features?

There is no option list – just write your Answers.

Question 12.

A woman has FXS. What is her approximate risk of POI?

Option List

A.	0.1%
B.	1.0%
C.	5.0%
D.	10%
E.	20%
F.	none of the above

Question 13.

A woman is a carrier of the FX pre-mutation. What is her approximate risk of POI?

Use the option list in the previous question.

Question 14.

A woman develops POI. What is the chance that she has FXS?

Option List. There is none to make you think.

Question 15.

A woman develops POI. What is the chance that she is a carrier of the FXS premutation?

Option List. There is none to make you think.

Question 16.

A woman develops POI. She has a 1^st. degree relative with POI. What is the chance that she has FXS?

Option List. There is none to make you think.

Question 17.

A woman develops POI. She has a 1^st. degree relative with POI. What is the chance that she is a carrier of the FXS premutation?

Option List. There is none to make you think.

 

The following are TOG CPD questions. They are open access, so I have produced them here. There are linked to the following article, which is also open access.

Fragile X syndrome: an overview  Bambang et al. TOG 2011. Volume 13. Issue 2

Fragile X syndrome (FXS)

1.     is the most common cause of learning difficulty.                                                      True / False

2.     is an X-linked dominant disorder.                                                                                True / False

With regard to women with FXS,

3.     the phenotype is worse than in men.                                                                          True / False

4.     if they have the full mutation, they are more likely to have a normal IQ than autistic features.

True / False

With regard to the genetics of FXS,

5.     women with 100 trinucleotide repeats are at higher risk of POI than those with 60.                                                                                                                                                               True / False

6.     equal numbers of female & male carriers of the premutation are affected by FXTAS.

True / False

With regard to POI and FXS,

7.     up to 25% of women with the fragile X premutation develop POI.                                        True / False

8.     measurement of levels of anti-Müllerian hormone is a valid test for assessing risk of POI.

True / False

9.     women with POI have a 5-10% chance of spontaneous pregnancy.                                          True / False

With regard to testing for FXS,

10.   cell-free fetal DNA testing in maternal blood at 11 weeks is available for identifying the fragile X premutation.                                                                                                               True / False

11.   cascade screening involves testing within families of affected individuals.                           True / False

12.   the HFEA allows preimplantation genetic diagnosis of FXS.                                                 True / False

With regard to fragile X tremor ataxia syndrome,

13.   Parkinson’s disease is one of the recognised differential diagnoses.                             True / False

With regard to testing for FXS,

14.   PIGD allows distinction between the pre- and full FMR-1mutations.                                         True / False

With regard to FXS,

15.   the mother and daughters of a normal transmitting father are obligate carriers.            True / False

16.   women with the syndrome are at a greater risk of developing depression compared with the general population.                                                                                                       True / False

17.   where there are larger numbers of repeat trinucleotides, there is an increased tendency for these repeats to expansion in the offspring, causing them to have earlier onset or more severe clinical effects.                                                                                                                    True / False

18.   it is a recognised cause of macro-orchidism before and after puberty.                       True / False

19.   men with the syndrome are known to have spermatozoa containing the FMR-1mutation.

  True / False

20.   in families of women with FXS, carriers of the premutation are known to have irregular menses and shorter cycles than non-carriers.                                                                          True / False