|
57. |
Role-play. Teach FY1 about trisomy
screening. |
|
58. |
EMQ. Mycoplasma genitalium |
|
59. |
Roleplay. Booking. Previous SB. |
|
60. |
EMQ. Gestational trophoblastic
disease. |
57. Fetal
anomaly screening programme. Role-play .
Candidate’s
instructions.
You are an SP5. It is a
quiet day on the labour ward. A woman has just had a baby which the midwives
suspect has Down’s syndrome despite a combined 1st. trimester test
which gave a risk of 1 in 466 of Ds. The paediatricians have confirmed their
suspicion, spoken to the parents about the probably diagnosis and arranged
chromosome analysis.
The consultant on-call
says this is an opportune moment for you to give a teaching session to the new
FY2 trainee about screening for trisomy in routine antenatal care.
58. EMQ.
Mycoplasma genitalium..
Lead-in.
Many of the questions are not true EMQs as
they have more than one correct answer. I have tried to include all the facts I
think might feature in the exam and packing more than one into a question
reduces the total number of questions and makes the document a bit more
manageable. It also reduces the amount of typing I have to do.
Abbreviations.
BASSH: British Association for Sexual Health and HIV.
BASHHMG: British Association for Sexual Health and HIV’s
“National
guideline for the management of infection with Mycoplasma genitalium”. 2018
MG: Mycoplasma genitalium.
NHSCS: NHS Cervical
Screening Programme
Which,
if any, of the following statements are true in relation to MG? This is not a true
EMQ as there may be more than one correct answer.
Option list.
|
A |
MG was first
isolated in 2001 |
|
B |
MG was first
isolated from men with non-gonococcal urethritis (NGU) |
|
C |
MG belongs to
the Cutemollies class |
|
D |
MG is the smallest
known yeast with the ability to self-replicate |
|
E |
MG is the smallest
known bacterium with the ability to self-replicate |
|
F |
MG has an unusual,
double-layered cell wall |
|
G |
MG has an
unusual protrusion at one end |
|
H |
MG’s protrusion
enables it to adhere to epithelial cells |
|
I |
MG’s
protrusion enables it to invade epithelial cells |
|
J |
MG is best
seen on a Gram stain |
Scenario 2.
Which, if any, of the following statements
are true in relation to Mycoplasmas?
Option
list.
|
A |
are the largest known bacteria |
|
B |
have no cell wall |
|
C |
have no nuclei |
|
D |
are resistant to ß-lactam antibiotics |
|
E |
are resistant to sulphonamides |
|
F |
colonies show a ‘scrambled egg’ appearance on culture
on agar |
|
G |
particularly affect mucosal surfaces |
Scenario 3.
Which, if any, of the following statements
are true in relation to Mg?
Option
list.
|
A |
when the organism was originally found, culture took
50 days |
|
B |
Mg is facetious |
|
C |
Mg is a facultative aerobe |
|
D |
Mg is a facultative anaerobe |
|
E |
Mg is a facultative aerobe & anaerobe |
|
F |
Mg is fastidious |
Scenario 4.
Which, if any, of the following are true in
relation to the approximate prevalence of MG?
Option
list.
|
A |
it is ~ 0.1% |
|
B |
it is ~ 1.0% |
|
C |
it is ~ 5.0% |
|
D |
it is ~ 5-10% |
|
E |
it is > 10% |
|
F |
none of the above |
Scenario 5.
Which, if any, of the following is true in
relation to screening for MG? This is a true EMQ with only one correct answer.
Option
list.
|
A |
screening for MG is now included in the NCSP |
|
B |
screening for MG is now offered as part of the NHSCS |
|
C |
screening should be offered to all sexually active
women < 30 years old |
|
D |
screening should only be offered to those with symptoms
suggestive of infection |
|
E |
screening should be offered to all partners of those
with MG infection |
|
F |
none of the above |
Scenario 6.
Which, if any, of the following are
included in BASHHMG as risk factors for infection with MG?
Option
list.
|
A |
Cigarette smoking |
|
B |
Multiple dancing partners |
|
C |
Multiple sexual partners |
|
D |
Non-white ethnicity |
|
E |
Younger age |
|
F |
None of the above |
Scenario 7.
Which of the following statements is true
in relation to MG and co-infection with other organisms?
Option
list.
|
A |
MG excretes bactericidal toxins and co-infection is
rare |
|
B |
MG co-infection is most often with chlamydia |
|
C |
MG co-infection is most often with E. coli |
|
D |
MG co-infection is most often with HIV |
|
E |
MG co-infection is most often with TB |
|
F |
None of the above |
Scenario 8.
Which of the following statements is true
in relation to MG and men?
Option
list.
|
A |
It is the most common cause of NGU |
|
B |
It is the most common cause of epididymitis |
|
C |
It is the most common cause of prostatitis |
|
D |
It is a well-recognised cause of male sub-fertility |
|
E |
Most men with MG infection are asymptomatic |
|
E |
None of the above |
Scenario 9.
Which, if any, of the following statements
are true in relation to MG and women?
Option
list.
|
A |
MG is linked to an ↑ risk of cervicitis |
|
B |
MG is linked to an ↑ risk of endometritis |
|
C |
MG is linked to an ↑ risk of female infertility |
|
D |
MG is linked to an ↑ risk of miscarriage |
|
E |
MG is linked to an ↑ risk of otitis media |
|
F |
MG is linked to an ↑ risk of pelvic inflammatory disease |
|
G |
MG is linked to an ↑ risk of postcoital bleeding |
|
H |
MG is linked to an ↑ risk of postmenopausal bleeding |
|
I |
MG is linked to an ↑ risk of preterm birth |
|
J |
MG is linked to an ↑ risk of damage to Fallopian tube cilia |
|
K |
MG is linked to an ↑ risk of puerperal psychosis |
|
L |
MG is linked to an ↑ risk of puerperal sepsis |
|
M |
Most infected women are asymptomatic |
|
N |
None of the above |
Scenario 10.
Which, if any, of the following statements
are true in relation to current concerns about Mg?
Option
list.
|
A |
It could become a ‘superbug’, resistant to most
antibiotics, within a decade |
|
B |
Infection is often misdiagnosed as chlamydia with ↑ risk of antibiotic resistance |
|
C |
‘superbug’ status would be likely to lead to an ↑ in renal failure |
|
D |
‘superbug’ status would be likely to lead to an ↑ in female infertility |
|
E |
‘superbug’ status would be likely to lead to an ↑ in male infertility |
Scenario 11.
Which, if any, of the following are used
in the recommended test for MG infection in women?
Option
list.
|
A |
blood testing for MG IgG |
|
B |
blood testing for MG IgM |
|
C |
cervical smears checked microscopically for the
diagnostic intracellular inclusion bodies |
|
D |
culture and sensitivity of cervical swab specimens
using MG-specific culture medium |
|
E |
culture and sensitivity of 1st. void MSSU using MG-specific
culture medium |
|
F |
culture and sensitivity of vaginal swab specimens
using MG-specific culture medium |
|
G |
NAATs that detect the MG G-antigen |
|
H |
NAATs that detect MG DNA |
|
I |
NAATs that detect MG RNA |
|
J |
serum testing for MG-specific antigen |
|
K |
vaginal swabs taken by the woman |
|
L |
none of the above |
Scenario 12.
Which, if any, of the following statements
are true in relation to testing for antibiotic resistance after initial tests
are +ve for MG?
Option
list.
|
A |
test for resistance to cephalosporins |
|
B |
test for resistance to macrolides |
|
C |
test for resistance to penicillin |
|
D |
test for resistance to quinolones |
|
E |
test for resistance to macrolides |
|
F |
test for resistance to streptomycin |
|
F |
test for resistance to sulphonamides |
|
F |
test for resistance to tetracyclines |
|
G |
None of the above |
Which,
if any, of the following statements are true in relation to estimates of antibiotic
resistance in current strains of MG in the UK?
Option list.
|
A |
20% are
resistant to cephalosporins |
|
B |
40% are
resistant to macrolides |
|
C |
50% are
resistant to penicillin |
|
D |
50% are
resistant to quinolones |
|
E |
10% are
resistant to streptomycin |
|
F |
90% are
resistant to sulphonamides |
|
F |
40% are
resistant to tetracyclines |
|
F |
None of the
above |
Scenario 14.
Which, if any, of the following is BASHHMG’s
recommended 1st. line treatment of uncomplicated MG?
Option
list.
|
A |
azithromycin 1 gram daily for 7 days |
|
B |
doxycycline 100 mg twice daily for 7 days |
|
C |
doxycycline 100 mg twice daily for 10 days |
|
D |
doxycycline 100 mg twice daily for 7 days |
|
E |
doxycycline 100 mg twice daily for 7 days then azithromycin
1 gram daily for 2 days |
|
F |
moxifloxacin 400mg orally once daily for 7 days |
|
G |
moxifloxacin 400mg orally once daily for 10 days |
|
H |
none of the above |
Scenario 15.
Lead-in
Which, if any, of the following is BASHHMG’s
recommended 1st. line treatment of complicated MG?
Option
list.
|
A |
doxycycline 100 mg twice daily for 10 days |
|
B |
doxycycline 100 mg twice daily for 14 days |
|
C |
moxifloxacin 400mg orally once daily for 10 days |
|
D |
moxifloxacin 400mg orally once daily for 14 days |
|
E |
none of the above |
Scenario 16.
Lead-in
This is not an EMQ or SBA!
Fill in the gaps in the table below, using
option list.
Option
list.
|
A |
aminoglycoside |
|
B |
cephalosporin |
|
C |
macrolide |
|
D |
penicillin |
|
E |
quinolone |
|
F |
tetracycline |
Table.
|
Drug
name |
Category
of drug |
|
azithromycin |
|
|
doxycycline |
|
|
moxifloxacin |
|
Scenario 17.
Which, if any, of the following statements
is true in relation to test of cure (TOC) after treatment of MG?
Option
list.
|
A |
TOC should be offered to everyone who has been
treated for MG |
|
B |
TOC should only be offered to those who had signs of
infection before treatment |
|
C |
TOC should only be offered to those who had symptoms
of infection before treatment |
|
D |
TOC should only be offered to those who had signs
and symptoms before treatment |
|
E |
TOC should only be offered to those who continue to
have signs or symptoms two weeks or more after the start of treatment |
|
F |
none of the above |
Scenario 18.
Which, if any, of the following statements
are true in relation to the timing of test of cure (TOC) after treatment of MG?
Option
list.
|
A |
TOC is best done at 3 weeks after start of treatment |
|
B |
TOC is best done at 4 weeks after start of treatment |
|
C |
TOC is best done at 5 weeks after start of treatment |
|
D |
TOC is best done at 6 weeks after start of treatment |
|
E |
TOC should not be done < 2 weeks from the start
of treatment |
|
F |
TOC should not be done < 3 weeks from the start
of treatment |
|
G |
TOC should not be done < 4 weeks from the start
of treatment |
59. Role-play.
Previous stillborn baby.
Candidate's Instructions.
This is a roleplay station.
You are an SpR in the booking clinic. You are about to see a woman who is at 10
weeks’ gestation in her second pregnancy. Her first baby was stillborn.
She has had all the routine
booking, including investigations, dealt with by the midwife who has asked you
to see her to advise about her first pregnancy and its implications for the
management of this pregnancy.
Take an appropriate
history, advise about the necessary investigations and how the history of
stillbirth will influence the management of the pregnancy.
60. EMQ.
Gestational Trophoblastic Disease (GTD).
Abbreviations.
APSN: atypical
placental site nodule.
CHM: complete
hydatidiform mole.
COC: combined
oral contraceptive.
GI: gastro-intestinal.
GTD: gestational
trophoblastic disease.
GTN: Gestational
trophoblastic neoplasia.
HM: hydatidiform
mole.
PHM: partial
hydatidiform mole.
POC: products
of conception.
PSTT: placental
site trophoblastic tumour.
TTC: trophoblastic tumour centre
Option list.
|
A. |
100%. |
|
B. |
20%. |
|
C. |
15%. |
|
D. |
10%. |
|
E. |
5%. |
|
F. |
2.5%. |
|
G. |
1.5%. |
|
H. |
0.5%. |
|
I.
|
1 in 35. |
|
J. |
1 in 55. |
|
K. |
1 in 65. |
|
L. |
1 in 700. |
|
M. |
1 in 1,000. |
|
N. |
Ö64. |
|
O. |
pr2. |
|
P. |
increased. |
|
Q. |
reduced. |
|
R. |
increased by a factor of
2. |
|
S. |
increased by a factor of
5. |
|
T. |
increased by a factor of
10. |
|
U. |
increased by a factor of
20. |
|
V. |
increased by a factor of
30. |
|
W. |
increased by a factor of
> 100. |
|
X. |
hydatidiform mole, both
partial and complete. |
|
Y. |
hydatidiform mole, both
partial and complete and placental site tumour. |
|
Z. |
partial mole, complete
mole, invasive and metastatic mole, choriocarcinoma, placental site
trophoblastic tumour and epithelioid trophoblastic tumour. |
|
AA. |
choriocarcinoma invasive
and metastatic mole and epithelioid trophoblastic tumour. |
|
BB. |
true |
|
CC. |
false |
|
DD. |
None of the above. |
Scenario 1.
List the
conditions included in the term GTD. There is no option list, just make a list.
Scenario 2.
What is the difference
between GTD and GTN? Pick one option from the list below.
Option list.
|
A |
GTD comprises the non-malignant
conditions, i.e. complete and partial moles. GTN comprises the
malignant conditions: invasive mole, choriocarcinoma and PSTT |
|
B |
GTD comprises all the
trophoblastic conditions; GTN comprises the malignant conditions |
|
C |
GTD comprises all the
trophoblastic conditions; GTN comprises persistent GTD |
|
D |
GTD comprises all the
trophoblastic conditions; GTN comprises malignant and potentially malignant
conditions, including atypical placental site nodules |
|
E |
none of the above |
Scenario 3.
What is the
incidence of GTD in the UK?
Scenario 4.
Which of the
following statements, if any, are true of complete hydatidiform molar pregnancy?
|
A |
are usually
diploid and with all the chromosomal material of paternal origin |
|
B |
are usually
triploid, with 2 sets of paternal haploid genes + 1 set of maternal haploid
genes |
|
C |
are usually
triploid, with 1 set of paternal haploid genes + 2 sets of maternal haploid
genes |
|
D |
are tetraploid
or mosaics in up to 10% of cases |
|
E |
up to 80%
are due to duplication of a single sperm in an egg devoid of maternal chromosomes |
|
F |
up to 80%
are due to duplication of a single sperm in a normal egg |
|
G |
usually result
from dispermic fertilisation of a normal egg |
|
H |
usually
result from dispermic fertilisation of an egg devoid of maternal chromosomes |
|
I |
usually has
46XX makeup |
|
J |
usually has
46XY makeup |
|
K |
the presence
of fetal red blood cells defines a mole as partial |
|
L |
mitochondrial
DNA is maternal |
|
M |
mitochondrial
DNA is paternal |
Scenario 5.
Which of the
following statements, if any, are true of partial hydatidiform molar pregnancy?
Option list.
|
A |
are usually
diploid and with paternal chromosomal material |
|
B |
are usually
triploid, with 2 sets of paternal haploid genes + 1 set of maternal haploid
genes |
|
C |
are usually
triploid, with 1 set of paternal haploid genes + 2 sets of maternal haploid
genes |
|
D |
are
tetraploid or mosaics in up to 10% of cases |
|
E |
up to 80%
are due to duplication of a single sperm in an egg devoid of maternal
chromosomes |
|
F |
up to 80%
are due to duplication of a single sperm in a normal egg |
|
G |
usually
result from dispermic fertilisation of a normal egg |
|
H |
usually result
from dispermic fertilisation of an egg devoid of maternal chromosomes |
|
I |
usually has 46XX
makeup |
|
J |
usually has
46XY makeup |
|
K |
the presence
of fetal red blood cells defines a mole as partial |
|
L |
mitochondrial
DNA is maternal |
|
M |
mitochondrial
DNA is paternal |
Scenario 6.
What is the ratio
of complete: partial moles?
Scenario 7.
What is the
risk of molar pregnancy at age < 15 compared to age 30?
What is the risk of molar pregnancy at age
> 45 compared to age 30?
Scenario 9.
What is the
risk of molar pregnancy in a subsequent pregnancy after a complete mole?
Option list.
|
A |
< 1% |
|
B |
1-2% |
|
C |
3-5% |
|
D |
6-10% |
|
E |
11-20% |
|
F |
> 20% |
Scenario 10.
What is the
risk of molar pregnancy in a subsequent pregnancy after a partial mole?
Use the option
list from the previous question.
Scenario 11.
Which, if any,
of the following are more common in pregnancy after a molar pregnancy? This is
not a true EMQ as there may be > 1 correct answer.
Option list.
|
A |
anaemia |
|
B |
eclampsia /
severe PET |
|
C |
intrauterine
growth retardation |
|
D |
miscarriage |
|
E |
pulmonary
embolism |
|
F |
PPH |
|
G |
none of the
above |
Scenario 12.
What is the
risk of molar pregnancy in a subsequent pregnancy for the woman who has had two
molar pregnancies?
Scenario 13.
Which, if any,
of the following statements about hCG are true?
|
A |
is a
glycoprotein |
|
B |
shares its α
sub-unit with FSH, LH & TSH |
|
C |
shares its α
sub-unit with FSH & LH but not TSH |
|
D |
shares its β
sub-unit with FSH, LH & TSH |
|
E |
shares its β
sub-unit with FSH & LH but not TSH |
|
F |
β-core exists
as a sub-type of β-hCG |
|
G |
nicked
free-β exists as a sub-type of β-hCG |
|
H |
c-terminal
peptide exists as a sub-type of β-hCG |
|
I |
hCG β core
fragment may lead to false –ve results with urine pregnancy tests |
|
J |
heterophile
antibodies may give false +ve hCG results |
|
K |
heterophile
antibodies are not found in urine |
Scenario 14.
Which, if any,
of the following statements are true in relation to the diagnosis of molar pregnancy?
|
A |
definite
diagnosis is usually made by ultrasound |
|
B |
definitive
diagnosis requires a +ve test for P57KIP2 |
|
C |
definitive
diagnosis requires an hCG level > twice the median value for gestation |
|
D |
definite
diagnosis requires histological examination |
|
E |
none of the
above |
Scenario 15.
Cystic placental spaces in
the placenta and a ratio of transverse to anterioposterior
measurements of the
gestation sac <1.5 are strongly suggestive of a partial mole. True / False.
Which, if any, of the following statements
are true about preparation of the cervix before evacuation of molar pregnancy?
|
A |
medical preparation is of proven
efficacy in making suction evacuation easier |
|
B |
medical preparation with prostaglandins ↑ trophoblastic
embolisation |
|
C |
medical
preparation with prostaglandins ↑ the risk of needing chemotherapy |
|
D |
GTG 38 recommends the use of laminaria
tents |
|
E |
none of the above |
Scenario 17.
Which, if any, of the following statements
are true about evacuation of molar pregnancies?
|
A |
medical management is recommended for
both CMs and PMs to ↓ the risk of bleeding |
|
B |
medical management is recommended for
both CMs and PMs to ↓ the risk of dissemination of trophoblastic tissue |
|
C |
medical management is recommended for both
CMs and PMs to ↓
the risk of uterine perforation |
|
D |
suction evacuation is recommended for
both CMs and PMs |
|
E |
suction evacuation is recommended for CMs |
|
F |
suction evacuation is recommended for PMs
so long as fetal parts are not too big |
|
G |
mifepristone + misoprostol treatment is
an acceptable alternative to suction evacuation. |
|
H |
oxytocin administration after suction
evacuation is recommended to ↓
bleeding |
|
I |
none of the above |
Scenario 18.
Which, if any,
of the following statements are true about urinary hCG testing in relation to molar
pregnancy?
|
A |
testing
should be done 3 weeks after medical evacuation of complete moles |
|
B |
testing
should be done 3 weeks after surgical evacuation of complete moles |
|
C |
testing
should be done 3 weeks after medical evacuation of partial moles |
|
D |
testing
should be done 3 weeks after surgical evacuation of complete moles |
|
E |
testing
should be done 3 weeks after medical evacuation of ‘failed’ pregnancy |
|
F |
testing
should be done 3 weeks after surgical evacuation of ‘failed’ pregnancy |
|
G |
testing should
be done 3 weeks after medical evacuation of ‘failed’ pregnancy, but only if POC
have not been sent for histological examination |
|
H |
testing
should be done 3 weeks after surgical evacuation of ‘failed’ pregnancy, but
only if POC have not been sent for histological examination |
|
I |
testing
should be done 3 weeks after medical evacuation of incomplete miscarriage |
|
J |
testing
should be done 3 weeks after surgical evacuation of incomplete miscarriage |
|
K |
testing
should be done 3 weeks after medical evacuation of incomplete miscarriage,
but only if POC have not been sent for histological examination |
|
L |
testing
should be done 3 weeks after surgical evacuation of incomplete miscarriage, but
only if POC have not been sent for histological examination |
|
M |
none of the
above |
Scenario 19.
Which, if any,
of the following statements are true in relation to histological examination of
POC after TOP?
|
A |
it should be
done in all cases to exclude GTD |
|
B |
it should be
done in all cases that have not had pre-op ultrasound examination in case the
pregnancy was an unsuspected ectopic. Absence of trophoblastic tissue on histology
will raise suspicion of the diagnosis |
|
C |
it should be
done in all cases where ultrasound has not shown a viable pregnancy |
|
D |
it should be
done in all cases where ultrasound has not shown fetal parts. |
|
E |
none of the
above |
Scenario 20.
Which, if any,
of the following statements are true in relation to RhD and TOP?
|
A |
CMs have no
RhD |
|
B |
PMs have no RhD |
|
C |
Anti-D
should be withheld until histological results are available |
|
D |
‘C’ is true,
but only in relation to CMs |
|
E |
‘C’ is true,
but only in relation to PMs |
|
F |
none of the
above |
Scenario 21.
Which, if any,
of the following statements are true in relation to GTN?
|
A |
always
arises from molar pregnancy |
|
B |
may occur
after normal pregnancy and livebirth |
|
C |
may arise as
primary ovarian neoplasia |
|
D |
the incidence
after complete molar pregnancy is greater than after partial molar pregnancy |
|
E |
the incidence
after livebirth is estimated at 1 in 50,000 |
Scenario 22.
Which, if any,
of the following statements are true in relation to p57KIP2?
|
A |
it is a tumour
suppressor gene, found in complete and partial moles but not choriocarcinoma |
|
B |
takes us to
the world of genomic imprinting |
|
C |
is an
example of uniparental disomy |
|
D |
is a gene
found in chromosomes of maternal origin, but not paternal |
|
E |
is a gene
found in chromosomes of paternal origin, but not maternal |
|
F. |
can help to
distinguish complete and partial moles |
|
G. |
none of the
above |
Scenario 23.
What is the risk of
persistent GTD after a complete mole?
Scenario 24.
What is the risk of
requiring chemotherapy after a complete mole?
Scenario 25.
What is the
risk of persistent GTD after a partial mole?
Scenario 26.
What is the
risk of requiring chemotherapy after a partial mole?
Scenario 27.
What is the
risk of requiring chemotherapy with hCG level > 20,000 i.u. 4+1 weeks
after evacuation?
Scenario 28.
What is the
overall risk of requiring chemotherapy after molar pregnancy in the UK?
Scenario 29.
What is the
risk of requiring chemotherapy in the USA compared with the UK?
Scenario 30.
Which, if any,
of the following are grounds for offering chemotherapy after hydatidiform mole?
Scenario 31.
What are the
risk factors included in the FIGO scoring system?
Scenario 32.
Which, if any,
of the following statements is true about the recommended treatment of low-risk
GTN?
|
A |
risk should be
assessed using the FIGO scoring system |
|
B |
risk should be
assessed using the RCOG scoring system |
|
C |
methotrexate
alone is recommended |
|
D |
methotrexate
combined with folinic acid is recommended |
|
E |
methotrexate alternating
with folinic acid is recommended |
|
F. |
methotrexate
combined with etoposide acid is recommended |
|
G |
methotrexate
combined with dactinomycin is recommended |
Scenario 33.
Which, if any,
of the following is the most common side-effect of methotrexate?
|
A |
alopecia |
|
B |
anaemia |
|
C |
aphasia |
|
D |
nausea |
|
E |
myelosuppression |
|
F. |
none of the
above. |
Scenario 34.
Which, if any,
of the following statements are true about the recommended duration of
follow-up after GTD? This is not a true EMQ as there may be > 1 correct
answer.
|
A |
6 months from
the time the hCG falls to normal |
|
B |
6 months from
the date of evacuation of the GTD if the hCG falls to normal within 56 days |
|
C |
6 months from
the date of the hCG falling to normal if it does so within 56 days |
|
D |
6 months from
the date of evacuation of the GTD if the hCG falls to normal after 56 days |
|
E |
6 months from
the date of the hCG falling to normal if it does so after 56 days |
|
F. |
56 days after
the first full moon after the evacuation of the GTD |
Scenario 35.
Which, if any,
of the following statements are true about the recommended duration of
follow-up after GTD? This is not a true EMQ as there may be > 1 correct
answer.
|
A |
6 months from
the time the hCG falls to normal |
|
B |
6 months from
the date of evacuation of the GTD if the hCG falls to normal within 56 days |
|
C |
6 months from
the date of the hCG falling to normal if it does so within 56 days |
|
D |
6 months from
the date of evacuation of the GTD if the hCG falls to normal after 56 days |
|
E |
6 months from
the date of the hCG falling to normal if it does so after 56 days |
|
F. |
56 days after
the first full moon after the evacuation of the GTD |
Scenario 36.
What is the approximate
cure rate for GTN with a FIGO risk score <6?
|
A |
70% |
|
B |
80% |
|
C |
90% |
|
D |
95% |
|
E |
98% |
|
F. |
100% |
Scenario 37.
What is the approximate
cure rate for GTN with a FIGO risk score >7?
|
A |
70% |
|
B |
80% |
|
C |
90% |
|
D |
95% |
|
E |
98% |
|
F. |
100% |
Scenario 38.
When should
the possibility of persistent GTD be investigated after non-molar pregnancy?
|
A |
if there is
abnormal bleeding |
|
B |
if there is
persistent abnormal bleeding |
|
C |
if there is cough |
|
D |
if there is new-onset
dyspnoea |
|
E |
if there is
pleurodynia |
Scenario 39.
A woman wishes
to become pregnant after a pregnancy with GTD. Which, if any, of the following statements
are true about the advice she should be given about an appropriate inter-pregnancy
interval?
|
A |
not before follow-up
is complete |
|
B |
not for at
least 3/12 after completion of follow-up |
|
C |
not for at
least 6/12 after completion of follow-up |
|
D |
not for at
least 12/12 after completion of follow-up |
|
E |
she should be
advised not to become pregnant if chemotherapy was needed |
|
F |
not for at
least 6 months after completion of follow-up if chemotherapy was needed |
|
G |
none of the above |
Scenario 40.
Which of the
following statements are true about combined hormonal contraception use after
GTD?
|
A |
it may increase
the risk of GTN if used before hCG levels have returned to normal |
|
B |
is not
associated with additional risk |
|
C |
intra-uterine
contraceptives are preferable |
Scenario 41.
Which, if any,
of the following statements are true about the long-term issues for women who
have needed chemotherapy for GTN?
|
A |
the menopause
is likely to be earlier |
|
B |
the risk of other
cancers is not increased |
|
C |
there is
evidence of ↑ risk of
breast cancer |
|
D |
there is
evidence of ↑ risk of colon
cancer |
|
E |
there is
evidence of ↑ risk of myeloid
leukaemia |
|
F |
there is
evidence of ↑ risk of melanoma |
|
G |
there is
evidence of ↑ risk of
breast cancer |
|
H |
there is no evidence
of addition risk with HRT |
Scenario 42.
A woman had a complete
mole in her first pregnancy. She is pregnant for the second time. What is the
risk that it is another molar pregnancy?
Scenario 43.
A woman has had two molar
pregnancies. What is the risk of molar pregnancy if she becomes pregnant again?
Scenario 44.
A woman has had three
molar pregnancies. What is the risk of molar pregnancy if she becomes pregnant
again?
Scenario 45.
Which, if any, of the following
statements are correct in relation to recurrence of molar pregnancy?
|
A |
the histological type is
likely to be the same |
|
B |
the histological type in
recurrent mole after a complete mole is likely to be partial mole |
|
C |
the histological type in
recurrent mole after a partial mole is likely to be complete mole |
|
D |
the histological type
after PSTT is likely to be choriocarcinoma |
|
E |
none of the above |
Scenario 46.
A woman has a normal
pregnancy after treatment for hydatidiform mole. Which, if any, of the following
statements are true about the need for hCG testing 6 weeks after the pregnancy?
|
A |
testing is optional |
|
B |
testing is only needed
for women with persisting GTD |
|
C |
testing is only needed
for women with persisting GTN |
|
D |
testing is only needed for
women who have needed chemotherapy |
|
E |
testing should be
offered to all women who use hair dye |
Scenario 47.
A woman has asked about
support after a diagnosis of hydatidiform mole. What support is available from regional
trophoblastic tumour centres?
|
A |
continuing support is
not available from TTCs and she should be put in touch with the local gynae
cancer support nurse |
|
B |
support is available
from TTCs but only in leaflet form |
|
C |
support is available
from TTCs in the form of support groups |
|
D |
telephone support is
available from TTCs |
|
E |
support is only available
from the National GTD Support Society |
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