|
44. |
EMQ. Montgomery ruling |
|
45. |
Role-play. BRCA1 carrier. Risk
reduction. |
|
46. |
Viva. Enhanced recovery |
|
47. |
EMQ. Warfarin & pregnancy |
|
48. |
EMQ. Pertussis |
44. EMQ.
Montgomery ruling.
Abbreviations.
BMA: British Medical Association.
GMC: General Medical Council.
MR: Montgomery Ruling.
Question 1.
Which, if any, of the following statements is most accurate?
Lead-in
|
A |
The MR largely replaces the Bolam ruling |
|
B |
The MR largely replaces
the Chester ruling |
|
C |
The MR largely replaces
the Sidaway ruling |
|
D |
The MR is being
contested in the European Court by the GMC as it infringes doctors’ rights |
|
E |
The MR is being
contested in the European Court by the BMA as it infringes doctors’ rights |
Question 2.
Which, if any, of the following statements are true? This is not a true
EMQ as > 1 of the answers may be correct.
Lead-in
|
A |
the level of risk, however small, must be disclosed if a patient
requests it |
|
B |
the level of risk of
damage from a procedure need not be disclosed if < 1% |
|
C |
the level of risk of
damage from a procedure need not be disclosed if < 10% |
|
D |
a material risk is one
that would be reflected in damages > £100,000 if negligence were proved in
court |
|
E |
a material risk is one
that would be reflected in damages > £1,000,000 if negligence were proved
in court |
|
F |
a material risk is one
that involves anatomical damage, not emotional or psychological |
|
G |
a material risk is one
that a reasonable person in the patient’s situation would be likely to
regards as significant |
45. Role-play.
BRCA. Risk reduction.
Candidate’s instructions.
You are an SpR5 in the
gynaecology clinic and about to see Jessica Green. DOB 1 January 1990. Your
tasks are to take an appropriate history and discuss the options available to
her.
GP letter.
The Surgery,
Main Road, Anytown.
Re: Jessica Green, 25
Blether Alley, Anytown.
Dear Gynaecologist,
Please see this charming
young lady. Dr. Rosemary Ique, my very
clever young colleague, saw her last year to discuss management of anaemia and
heavy periods. There was good response to the use of a Mirena and some iron
pills, but clever Dr. Rosemary elicited a family history of cancer and referred
her to the regional Familial Genetic Cancer clinic and it turns out that she is
a carrier of an oncogenic BRCA mutation. All of this is quite new to me, I must
say, and I suspect that I might not have sparked to the importance of the
family history, or even uncovered it! There was some discussion of her options
to reduce her risk of cancer and she would very much like to explore these
further. I look forward to hearing your thoughts.
Dr. John Worthy.
46. Structured
conversation. Enhanced recovery.
Candidate's instructions.
You are a newly-appointed
consultant. The Clinical Director has asked you to develop a programme for
enhanced recovery for inpatient gynaecological surgery. As a first step, she
has asked you to deliver a talk to a unit meeting (all staff can attend) to
outline the key features of enhanced recovery. She suspects that little is
known about the subject by most of the staff and hopes that your talk will
encourage their enthusiastic participation. The examiner will ask you 9
questions pertinent to your talk.
47. EMQ.
Warfarin and pregnancy.
Some of the questions are not true EMQs as there may be > 1 correct
answer – it saves typing.
Scenario 1.
Which of the
following describe the drug category that includes warfarin?
Option list.
|
A |
anticoagulant |
|
B |
biologic |
|
C |
coumarin |
|
D |
direct-acting oral
anticoagulant |
|
E |
diuretic |
|
F |
immunomodulator |
|
G |
parenteral anticoagulant |
|
H |
platelet inhibitor |
|
I |
vitamin K derived
clotting factor inhibitor |
|
J |
none of the above |
Scenario 2.
How does
warfarin produce its anticoagulant effect? Which, if any, of the following are
true?
Option list.
|
A |
↑ levels of Protein C |
|
B |
↑ levels of Protein S |
|
C |
↓ levels of Factor I |
|
D |
↓ levels of Factor II |
|
E |
↓ levels of Factor III |
|
F |
↓ levels of Factor IV |
|
G |
↓ levels of Factor V |
|
H |
↓ levels of Factor VI |
|
I |
↓levels of Factor VII |
|
J |
↓ levels of Factor VIII |
|
K |
↓ levels of Factor IX |
|
L |
↓ levels of Factor X |
Scenario 3.
Which of the
following is used to monitor the effect of warfarin?
Option list.
|
A |
bleeding time |
|
B |
clotting time |
|
C |
factor IXa levels |
|
D |
factor Xa levels |
|
E |
international normalised
ratio |
|
F |
platelet levels |
Scenario 4.
What are the
main teratogenic effects of warfarin taken in the 1st. trimester?
There is no
option list to make things harder – just write out what you know about the
teratogenic effects.
Scenario 5.
Which, if any,
of the following statements are true in relation to the risk of warfarin?
Option list.
|
A |
warfarin embryopathy is
most likely if the drug is taken between 4 and 10 weeks |
|
B |
warfarin embryopathy is
most likely if the drug is taken between 6 and 12 weeks |
|
C |
the cut-off dose for
high and low risk of warfarin embryopathy is 3 mg. in the 1st.
trimester |
|
D |
the cut-off dose for
high and low risk of warfarin embryopathy is 5 mg. in the 1st.
trimester |
|
E |
the cut-off dose for
high and low risk of warfarin embryopathy is 7.5 mg. in the 1st.
trimester |
Scenario 6.
What is the
approximate risk of warfarin embryopathy if the drug is taken at the time of
greatest risk in the 1st. trimester?
Option list.
|
A |
1% |
|
B |
2.5% |
|
C |
5% |
|
D |
7.5% |
|
E |
≥ 10% |
Scenario 7.
Which of the
following adverse outcomes are associated with warfarin use in pregnancy?
Option list.
Option list.
|
A |
↑ risk of APH |
|
B |
↑ microcephaly |
|
C |
↑ risk of miscarriage |
|
D |
↑ risk of PPH |
|
E |
↑ risk of stillbirth |
Scenario 8.
Which, if any,
of the following statements are true in relation to warfarin and breastfeeding?
Option list.
|
A |
Warfarin is
contraindicated because of the risk of neonatal intracranial haemorrhage |
|
B |
Warfarin is
contraindicated because of the risk of PPH |
|
C |
Warfarin is
contraindicated because of its variable effects on neonatal coagulation |
|
D |
Warfarin is highly bound
to plasma proteins |
|
E |
Warfarin is not
contraindicated as insufficient transfers to breast milk to be a hazard to
the neonate |
Scenario 9.
What should be
your ‘knee-jerk’ response to a question asking which is the one condition for which
warfarin is indicated in pregnancy?
48. SBA.
Pertussis.
Question 1.
Lead-in. Why
is pertussis of current concern in obstetrics?
Option List
|
A |
Research
has linked pertussis in the 1st. trimester with an ↑
risk of congenital heart disease |
|
B |
A mini-epidemic since 2011 has
caused ↑ deaths of
mothers & of babies < 3 months |
|
C |
A mini-epidemic since 2011 has
caused ↑ deaths of
babies < 3 months |
|
D |
The infecting organism has become
increasingly drug-resistant |
|
E |
The infecting organism has become
increasingly virulent |
Question 2.
Lead-in
Which
organism causes whooping cough?
Option List
|
A |
Bordella pertussis |
|
B |
Bacteroides
pertussis |
|
C |
Rotavirus
whoopoe |
|
D |
Respiratory
syncytiovirus pertussis |
|
E |
None of the
above |
Question 3.
Lead-in
Which, if
any, of the following statements is true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space, there are more than 5 options and there may be more than
one correct answer.
Option List
|
A |
the organism is aerobic |
|
B |
the organism is anaerobic |
|
C |
the organism is capsulated |
|
D |
the organism is flagellate |
|
E |
the
organism is an obligate intra-cellular parasite |
|
F |
the organism is a Gram -ve diplococcus |
|
G |
the organism is a Gram +ve
diplococcus |
|
H |
the organism requires special
transport media |
|
I |
no one is going to ask me any of
this stuff |
Lead-in
Which of the following statements is true?
Option List
|
A |
Pertussis is no longer a significant
threat to infants |
|
B |
Pertussis remains a significant threat to infants |
|
C |
The risk of death from pertussis is eliminated by timely
antibiotic therapy |
|
D |
the risk of death from pertussis is eliminated by timely
antiviral therapy |
|
E |
None of the above |
Question 5.
Lead-in
Which of the
following statements is true?
Option List
|
A |
Pertussis is not a notifiable disease |
|
B |
Pertussis is a
notifiable disease |
|
C |
Pertussis is
not a notifiable disease, but cases should be reported to the local bacteriologist |
|
D |
Pertussis is
not a notifiable disease, but cases should be subject to audit |
Question 6.
Lead-in
What is the
main mode of spread of the organism that causes pertussis?
Option List
|
A |
contact
with contaminated surfaces |
|
B |
contaminated food |
|
C |
contaminated water |
|
D |
respiratory droplets |
|
E |
none of the above |
Question 7.
Lead-in
What is the
main reservoir of the organism that causes pertussis?
Option List
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of the above |
Question 8.
Lead-in
What is the epidemiology
of pertussis?
Option List
|
A |
the condition is endemic |
|
B |
the condition
is endemic with mini-epidemics every 3-5 years |
|
C |
the condition
is endemic with mini-epidemics most years in the winter months |
|
D |
the condition
is epidemic, with outbreaks at roughly three-year intervals |
|
E |
the condition
is epidemic, with outbreaks at unpredictable intervals |
Question 9.
Lead-in
What is the
incubation period for pertussis?
Option List
|
A |
3-6 days |
|
B |
7-10 days |
|
C |
11-14
days |
|
D |
15-18
days |
|
E |
none
of the above. |
Question 10.
Lead-in
What is the
duration of infectivity of someone with pertussis?
Option List
|
A |
2
days from exposure → 5 days after onset of paroxysms of coughing |
|
B |
3
days from exposure → 10 days after onset of paroxysms of coughing |
|
C |
4 days
from exposure → 14 days after onset of paroxysms of coughing |
|
D |
6
days from exposure → 21 days after onset of paroxysms of coughing |
|
E |
none
of the above |
Question 11.
Lead-in
What % of
non-immune, close contacts of pertussis will develop the disease?
Option List
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Lead-in
What
practical issues are current for obstetrician in relation to pertussis?
Option List
|
A |
The DOH advises that all pregnant women be immunised to
↓maternal death rates. |
|
B |
The DOH advises
that all pregnant women be immunised to ↓ deaths in babies < 3 months. |
|
C |
The DOH advises
that all babies be immunised at birth. |
|
D |
The DOH advised
that “Boostrix- IPV” should
replace “Repevax” from July 2014. |
|
E |
The DOH advises
that immunisation of pregnant women be continued until 2019 |
Question 13.
Lead-in
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routing child immunisation was
introduced?
Option List
|
A |
the
number was 10,000 |
|
B |
the
number was 5,000 |
|
C |
the
number was 4,000 |
|
D |
the
number was 3,500 |
|
E |
the
number was <1,000 |
Question 14.
Lead-in
Which, if
any, of the following statements are true in relation to pertussis vaccine.
Option List
|
A |
“Boostrix- IPV” is a vaccine for pertussis
only |
|
B |
“Repevax”
is a vaccine for pertussis only |
|
C |
“Boostrix- IPV” & “Repevax” are live, attenuated vaccines |
|
D |
“Boostrix- IPV” & “Repevax” act against diphtheria, tetanus and
polio as well as pertussis |
|
E |
“Boostrix- IPV” & “Repevax” are acellular |
Question 15.
Lead-in
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
Option List
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the above |
Question 16.
Lead-in
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 17.
Lead-in
A woman has proven pertussis in early pregnancy. Should she still be
offered vaccination?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
Question 18.
Lead-in
A pregnant woman misses out on vaccination as part of the TIPP. Should vaccination
still be offered in the puerperium?
Option List
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this subject now |
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