|
SBA. Lynch syndrome |
|
|
13 |
EMQ. Peutz-Jeghers syndrome |
|
14 |
EMQ. Uterine transplant |
|
15 |
EMQ. Tranexamic acid |
|
16 |
EMQ. Parvovirus |
|
17 |
SBA. Quinolone antibiotics |
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 |
13. EMQ.
Peutz-Jeghers syndrome.
Abbreviations.
PJS: Peutz-Jeghers
syndrome.
Scenario 1.
Which, if any,
of the following are characteristics of PJS?
Option list.
|
A. |
buccal pigmentation |
|
B. |
gastro-intestinal
hamartomas |
|
C. |
perianal pigmentation |
|
D. |
increased risk of breast
cancer |
|
E. |
increased risk of
cervical adenoma malignum |
|
F. |
increased risk of colo-rectal
cancer |
|
G. |
increased risk of
endometrial cancer |
|
H. |
increased risk of ovarian
cancer |
|
I.
|
increased risk of
pancreatic cancer |
|
J. |
increased risk of
prostate cancer |
|
K. |
increased risk of stomach
cancer |
Scenario 2.
What is the
approximate prevalence of PJS?
Option list.
|
A. |
< 1 in 1,000 |
|
B. |
1 in 1,000 to 1 in
10,000 |
|
C. |
1 in 10,000 to 1 in
100,000 |
|
D. |
1 in 25,000 to 1 in
100,000 |
|
E. |
1 in 25,000 to 1 in
200,000 |
|
F. |
1 in 25,000 to 1 in
300,000 |
|
G. |
1 in 300,000 to 1 in
500,000 |
|
H. |
< 1 in 500,000 |
Scenario 3.
What is the
mode of inheritance in PJS?
Option list.
|
A |
autosomal dominant |
|
B |
autosomal recessive |
|
C |
X-linked dominant |
|
D |
X-linked recessive |
|
E |
Y-linked dominant |
|
F |
Y-linked recessive |
|
G |
triplet repeat |
Scenario 4.
Which, if any,
of the following statements are true of PJS?
Option list.
|
A |
PJS only occurs in
families with other affected members |
|
B |
PJS mainly occurs in
families with other affected members |
|
C |
PJS may arise de-novo in
families with no other affected members |
|
D |
PJS may arise de-novo in
families with other affected members |
|
E |
PJS does not arise
de-novo in families with no other affected members |
Scenario 5.
What is the
approximate lifetime risk of developing cancer in PJS?
Option list.
|
A. |
10% |
|
B. |
20% |
|
C. |
30% |
|
D. |
40% |
|
E. |
50% |
|
F. |
60% |
|
G. |
70% |
|
H. |
80% |
|
I.
|
90% |
|
J. |
>90% |
Scenario 6.
What is the
relevance of STK11 to PJS?
Option list.
|
A. |
It is part of the
postcode of the Peutz-Jeghers Society |
|
B. |
It is the name of the
gene most commonly associated with PJS |
|
C. |
It is the Ornithological
Society’s code for the Orkney Skua |
|
D. |
Somatic mutations have
been found in cervical cancer |
|
E. |
None of the above |
14. EMQ.
Uterine transplant.
Abbreviations.
ET: embryo
transfer.
UT: uterine
transplant
Scenario 1.
When was the 1st.
human uterine transplant performed?
Option list.
|
A |
2000 |
|
B |
2015 |
|
C |
2010 |
|
D |
2011 |
|
E |
2012 |
|
F |
2013 |
|
G |
2014 |
|
H |
2015 |
|
I |
2016 |
|
J |
2017 |
Scenario 2.
When was the 1st.
livebirth after human uterine transplant?
Option list.
|
A |
2000 |
|
B |
2015 |
|
C |
2010 |
|
D |
2011 |
|
E |
2012 |
|
F |
2013 |
|
G |
2014 |
|
H |
2015 |
|
I |
2016 |
|
J |
2017 |
Scenario 3.
How many live
births had occurred worldwide after UT up to the end of 2018?
Option list
|
A |
< 5 |
|
B |
5 - 10 |
|
C |
11 - 20 |
|
D |
21 - 50 |
|
E |
51 - 100 |
|
F |
> 100 |
Scenario 4.
For which of the
following conditions is UT a possible treatment?
Option list.
|
A |
Androgen Insensitivity
syndrome. AIS. |
|
B |
Congenital Adrenal
hyperplasia. CAH. |
|
C |
Kallmann’s syndrome. KS. |
|
D |
Mayer-Rokitansky-Küster-Hauser
syndrome. MRKH. |
|
E |
McCune-Albright syndrome.
MCAS. |
|
F |
Swyer’s syndrome. SS. |
|
G |
Turner’s syndrome. TS. |
Scenario 5.
Which, if any,
of the following are commonly used for donor selection?
Option list.
|
A |
absence of adenomyosis |
|
B |
absence of fibroids |
|
C |
age < 65 years |
|
D |
good general health |
|
E |
negative cervical smear
and no high-risk HPV |
|
F |
no cancer in past 5
years |
|
G |
parous |
|
H |
vaginal length > 7
cm. |
Scenario 6.
Has successful
transplant occurred using a dead donor?
Option list.
|
A |
No |
|
B |
Yes |
Scenario 7.
What is the
rate of graft survival at 1 year, failure being the need for hysterectomy?
Option list.
|
A |
< 10% |
|
B |
11 – 20% |
|
C |
21 – 30% |
|
D |
31 – 40% |
|
E |
41 – 50% |
|
F |
51 – 60% |
|
G |
> 60% |
|
H |
the figure is unknown |
Scenario 8.
Which of the
following statements is correct?
Option list.
|
A |
donor surgery is more
extensive than recipient surgery |
|
B |
donor surgery is less
extensive than recipient surgery |
|
C |
donor surgery is as extensive
as recipient surgery |
Scenario 9.
What are the main risks for the recipient?
There is no option list to make you think.
Write down the main things you can think of.
Scenario 10.
What are the
risks to the donor in addition to the usual ones of bleeding, infection, haematoma and thrombosis? There is
no option list.
Scenario 11.
Which
condition has been the reason for recipients needing uterine transplant and
which complication is more likely in addition to the usual ones of
bleeding, infection, haematoma and
thrombosis? There is no option list.
Scenario 12.
When is IVF
and cryopreservation of eggs done?
Option list.
|
A |
before uterine
transplantation |
|
B |
at the time of uterine
transplantation |
|
C |
12 months after uterine
transplantation to ensure graft rejection does not occur |
|
D |
when the recipient
chooses |
|
E |
none of the above |
Scenario 13.
Which maintenance
therapy was used immediately before embryo transfer in the first case resulting
in livebirth?
Option list.
|
A |
azathioprine +
corticosteroids + tacrolimus |
|
B |
azathioprine +
ciclosporin + corticosteroids + mycophenolate mofetil |
|
C |
azathioprine + corticosteroids
+ mycophenolate mofetil + tacrolimus |
|
D |
azathioprine +
corticosteroids + tacrolimus |
|
E |
ciclosporin +
corticosteroids + mycophenolate mofetil + tacrolimus |
|
F |
ciclosporin +
mycophenolate mofetil + tacrolimus |
|
G |
corticosteroids +
mycophenolate mofetil + tacrolimus |
|
H |
corticosteroids +
tacrolimus |
15. EMQ.
Tranexamic acid.
This topic featured in the exam in 2019. probably prompted by WHOT.
Abbreviations.
APA: anti-platelet
agent.
DOAC: Direct
oral anticoagulants.
EBL: estimated
blood loss.
PPH: postpartum haemorrhage.
TA: tranexamic acid.
WHOT: WHO’s “Updated
WHO Recommendation on TA for the Treatment of PPH”. 2017.
Scenario 1.
Which, if any,
of the following describe the main mode of action of tranexamic acid? This is
not a true EMQ as there may be more than one correct answer.
Option list.
|
A |
inhibition of conversion
of plasminogen to plasmin |
|
B |
inhibition of fibrinolysis
|
|
C |
inhibition of factor Xa |
|
D |
inhibition of heparin
activity |
|
E |
inhibition of plasmin
activity |
|
F |
promotion of conversion
of fibrinogen to fibrin |
|
G |
promotion of conversion
of prothrombin to thrombin |
|
H |
promotion of platelet
activation |
|
I |
promotion of platelet production
|
Scenario 2.
Which, if any,
of the following statements are true?
Option list.
|
A |
GOH say that TA should
be considered when an apixaban antagonist is required |
|
B |
GOH say that TA should
be considered when a clopidogrel antagonist is required |
|
C |
GOH say that TA should
be considered when a factor Xa agonist is required |
|
D |
GOH say that TA should
be considered when a factor Xa antagonist is required |
|
E |
GOH say that TA should
be considered when a heparin antagonist is required |
|
F |
GOH say that TA should
be considered when Protein C is deficient |
|
G |
GOH say that TA should be
considered when Protein S is deficient |
|
H |
none of the above |
Scenario 3.
Which, if any,
of the following statements are true in relation to TA? This is not a true EMQ
as there may be more than one correct answer.
Option list.
|
A |
TA is teratogenic in
rats and should be avoided in the first trimester |
|
B |
TA has not been shown to
be teratogenic and is safe to use in pregnancy |
|
C |
TA is excreted is
contraindicated in breastfeeding as the levels equate to maternal levels |
|
D |
TA levels in breast milk
are one hundredth of maternal levels |
|
E |
none of the above. |
Scenario 4.
Which, if any,
of the following statements are listed by eMC as contraindications?
Option list.
|
A |
asthma |
|
B |
barbiturate use |
|
C |
consumption coagulopathy
|
|
D |
convulsions |
|
E |
severe renal impairment |
Scenario 5.
Which, if any,
of the following is included in the definition of PPH in WHOT?
Option list.
|
A |
EBL ≥ 500 mL
after vaginal birth or C section |
|
B |
EBL ≥ 1,00 mL
after vaginal birth or C section |
|
C |
EBL ≥ 500 mL
after vaginal birth or ≥ 1,00 mL C section |
|
D |
EBL ≥ 1,000
mL after vaginal birth or ≥ 500 mL C section |
|
E |
none of the above |
Scenario 6.
What other
category of patient is included in the WHOT definition of PPP?
Option list. There is none, to
make you think.
Scenario 7.
Which of the
following are included in the WHOT recommendations?
Option list.
|
A |
TA to be given to all
women with a history of PPH |
|
B |
TA to be given to all
women in established labour |
|
C |
TA to be given to all
having C section |
|
D |
TA to be given to all
women having episiotomy |
|
E |
TA to be given to all
women having instrumental delivery |
|
F |
none of the above |
Scenario 8.
Which, if any,
of the following are included in WHOT?
Option list.
|
A |
TA should be given
within 3 hours of the birth |
|
B |
TA should be given
within 6 hours of the birth |
|
C |
TA should be given IV as
a bolus of 10g |
|
D |
TA should be given IV at
a dose of 1g in 10mL over 5 minutes |
|
E |
TA should be given IV at
a dose of 1g in 10mL over 10 minutes |
|
F |
TA should be given IV at
a dose of 5g in 20mL over 5 minutes |
|
G |
TA should be given IV at
a dose of 5g in 20mL over 10 minutes |
Scenario 9.
Which, if any,
of the following statements is included WHOT?
Option list.
|
A |
the benefit from TA declines
by about 10% for every 5 minutes of delay in starting Rx |
|
B |
the benefit from TA declines
by about 10% for every 10 minutes of delay in starting Rx |
|
C |
the benefit from TA declines
by about 10% for every 15 minutes of delay in starting Rx |
|
D |
the benefit from TA declines
by about 10% for every 20 minutes of delay in starting Rx |
|
E |
the benefit from TA declines
by about 10% for every 25 minutes of delay in starting Rx |
|
F |
the benefit from TA declines
by about 10% for every 30 minutes of delay in starting Rx |
|
G |
none of the above |
Which, if any, of the following statements
are included in WHOT?
Option
list.
|
A |
TA is relatively cheap |
|
B |
TA has a shelf life of 5 years |
|
C |
TA can be stored safely at room temperature |
|
D |
TA is widely available in most countries |
|
E |
none of the above. |
Scenario 11.
Which, if any,
of the following statements are true of the differences between the updated version
of WHOT in 2017 and the 2012 version?
Option list.
|
A |
TA to be used from the
start of treatment of PPH |
|
B |
TA to be used only for
cases with suspected or proven genital tract trauma |
|
C |
TA to be used as early as
possible |
|
D |
TA not to be used > 5
hours after the birth |
|
E |
clearer instructions were
given about the rate of administration |
16. EMQ.
Parvovirus.
Abbreviations.
PvB19: parvovirus B19
PvIgG: parvovirus
B19 IgG
PvIgM: parvovirus
B19 IgM
Option list.
There are no
option lists apart from the last few questions. Make up your own answers! In
the exam it is best if you decide the answer without reference to the option
list and then identify it on the list.
Scenario 1.
What type of
virus is parvovirus?
Scenario 2.
Is the title B19 something
to do with the American B19 bomber, its potentially devastating bomb load and
the comparably devastating consequences of the parvovirus on human erythroid
cell precursors?
Scenario 3.
PVB19 in the UK occurs in
mini-epidemics at 3 to 4-year intervals, usually during the summer.
Scenario 4.
Which animal
acts as the main reservoir for infection?
What is the approximate incidence of maternal parvovirus
infection in the UK?
Scenario 6.
What percentage of UK
adults are immune to parvovirus infection?
Scenario 7.
What names are
given to acute infection in the human?
Scenario 8.
What is the incubation
period for parvovirus infection?
Answer: 14-21
days according to GOVRIP.
Scenario 9.
What is the duration of
infectivity for parvovirus infection?
Scenario 10.
What are the usual
symptoms of parvovirus infection in the adult?
Scenario 11.
What is the incidence of
parvovirus infection in pregnancy?
Scenario 12.
How is recent infection
diagnosed?
Scenario 13.
How long does PvIgM
persist and why is this important?
Scenario 14.
What is the rate of
vertical transmission of parvovirus infection?
Scenario 15.
Are women with parvovirus
infection who are asymptomatic less likely to pass the virus to their fetuses?
Scenario 16.
To what degree is
parvovirus infection teratogenic?
Scenario 17.
What proportion of
pregnancies infected with parvovirus are lost?
Scenario 18.
What is the timescale for
the onset of hydrops?
Scenario 19.
Laboratories are advised
to retain bloods obtained at booking for at least 2 years for possible future
reference. True or false?
Scenario 20.
What ultrasound features
would trigger consideration of cordocentesis?
Scenario 21.
Must suspected parvovirus
infection be notified to the authorities?
Scenario 22.
Possible
parvovirus infection does not need to be investigated after 20 week’s
gestation. True or false?
Scenario 23.
If serum is
sent to the laboratory from a woman with a rash in pregnancy for screening for
rubella, the laboratory should automatically test for parvovirus infection too?
Scenario 24.
A woman attends the
pre-pregnancy counselling clinic as she is planning her first pregnancy.
She wants to know what screening
for parvovirus is recommended.
Scenario 25.
A pregnant
woman has had a significant contact with a child with PARV infection. She has
had urgent tests for PvIgG and PvIgM. Both results were -ve. Which of the
options best fits the advice she should be given?
Option list.
|
1. |
the tests
show acute parvovirus infection |
|
2. |
the tests
show chronic parvovirus infection |
|
3. |
the tests
show that she has not had PARV infection and is susceptible to it |
|
4. |
the tests
show no evidence of PARV infection but she should have repeat tests in 1 month |
|
5. |
the tests
show old PARV infection and immunity |
|
6. |
the tests
show recent PARV infection |
|
7. |
none of the
above |
Scenario 26.
A pregnant
woman has had a significant contact with a child with PARV infection. She has
had urgent tests for PvIgG and PvIgM. Both results were +ve. Which of the
options best fits the advice she should be given?
Option list.
|
1. |
the tests
show acute parvovirus infection |
|
2. |
the tests
show chronic parvovirus infection |
|
3. |
the tests
show that she has not had PARV infection and is susceptible to it |
|
4. |
the tests
show no evidence of PARV infection but she should have repeat tests in 1 month |
|
5. |
the tests
show old PARV infection and immunity |
|
6. |
the tests
show recent PARV infection |
|
7. |
none of the
above |
Scenario 27.
A pregnant
woman has had a significant contact with a child with PARV infection. She has
had urgent tests for PvIgG and PvIgM. The results were PvIgG +ve and PvIgM -ve.
Which of the options best fits the advice she should be given?
Option list.
|
1. |
the tests
show acute parvovirus infection |
|
2. |
the tests
show chronic parvovirus infection |
|
3. |
the tests
show that she has not had PARV infection and is susceptible to it |
|
4. |
the tests
show no evidence of PARV infection but she should have repeat tests in 1 month |
|
5. |
the tests
show old PARV infection and immunity |
|
6. |
the tests
show recent PARV infection |
|
7. |
none of the
above |
Scenario 28.
A pregnant
woman has had a significant contact with a child with PARV infection. She has had
urgent tests for PvIgG and PvIgM. The results were PvIgG -ve and PvIgM +ve.
Which of the options best fits the advice she should be given?
Option list.
|
1. |
the tests
show acute parvovirus infection |
|
2. |
the tests
show chronic parvovirus infection |
|
3. |
the tests
show that she has not had PARV infection and is susceptible to it |
|
4. |
the tests
show no evidence of PARV infection but she should have repeat tests in 1 month |
|
5. |
the tests
show old PARV infection and immunity |
|
6. |
the tests
show recent PARV infection |
|
7. |
none of the above |
Scenario 29.
A pregnant
woman has had a significant contact with a child with PARV infection. What
prophylaxis should be offered?
Option list.
|
1. |
acyclovir orally |
|
1. |
acyclovir i.m. |
|
2. |
acyclovir i.v. |
|
3. |
hand-washing
and avoiding small children |
|
4. |
i.v. hyperimmune
globulin |
|
5. |
PVV vaccine |
|
6. |
there is no
proven prophylaxis |
17. SBA. Quinolone antibiotics.
Abbreviations.
FQ: fluoroquinolone.
QUI: quinolone.
Question 1.
Which, if any, of the following drugs are QUIs or FQs?
Drugs
|
A. |
cimetidine |
|
B. |
ciprofloxacin |
|
C. |
nalidixic acid |
|
D. |
neomycin |
|
E. |
nitrofurantoin |
Option List
|
1 |
A + B |
|
2 |
A + B + C |
|
3 |
B + C |
|
4 |
B + C + D + E |
|
5 |
A + B + C + D + E |
Question 2.
Which, if any, of the following statements are true in relation to QUIs
& FQs? This is not a true SBA as there may be more than one answer.
Statements
|
F. |
nalidixic acid is an older quinolone and is mainly excreted in the
urine |
|
G. |
ciprofloxacin is
effective against most Gram +ve and –ve bacteria and 1st- line
treatment for pneumococcal pneumonia. |
|
H. |
ciprofloxacin is contraindicated
in pregnancy due to the ↑ risk of neonatal haemolysis |
|
I.
|
many staphylococci are
resistant to quinolones |
|
J. |
quinolones are
particularly useful in the treatment of MRSA |
Question 3.
Which was the first QUI antibiotic?
Option List
|
A |
acetylsalicylic acid |
|
B |
nalidixic acid |
|
C |
oxalic acid |
|
D |
pipemidic acid |
|
E |
none of the above |
Question 4.
How do QUI and FQ antibiotics work? There is only one correct answer.
Option List
|
A |
impair bacterial DNA coiling |
|
B |
impair bacterial DNA binding |
|
C |
impair bacterial RNA action |
|
D |
impair bacterial mitochondrial action |
|
E |
none of the above. |
Question 5.
Which, if any, of the following QUIs & FQs is not available for
prescription in the UK. There is only one correct answer.
Option List
|
A |
ciprofloxacin |
|
B |
levofloxacin |
|
C |
nalidixic acid |
|
D |
moxifloxacin |
|
E |
ofloxacin |
Question 6.
Which, if any, of the following statements are true in relation to the
quinolones and fluoroquinolones and pregnancy? This is not a true SBA as there
may be more than one answer.
Option list.
|
F. |
FQs are newer than QUIs with better systemic spread and efficacy |
|
G. |
QUIs concentrate in
urine but have a special affinity for cartilage |
|
H. |
consumption of a FQ in
the 1st. trimester is grounds for TOP |
|
I.
|
if an FQ is used, norfloxacin
and ciprofloxacin should be considered 1st. |
|
J. |
FQs are linked to a risk
of discolouration of the teeth of offspring |
Question 7.
Which of the following is true about the warning issued by the FDA in
2008 in relation to QUIs & FQs?
Option List
|
A |
they may cause congenital cartilage defects |
|
B |
they may cause congenital deafness |
|
C |
they may cause tendonitis and tendon rupture |
|
D |
they may cause prolongation of the Q-T interval |
|
E |
none of the above |
Question 8.
Which of the following is true about the warning issued by the FDA in 2011
in relation to QUIs & FQs?
Option List
|
A |
they may cause exacerbation of eczema |
|
B |
they may cause exacerbation of hypertension |
|
C |
they may cause exacerbation of multiple sclerosis |
|
D |
they may cause exacerbation of myasthenia gravis |
|
E |
they may cause exacerbation of SLE |
Question 9.
Which of the following is true about the warning emphasised by the FDA
in 2013 in relation to QUIs & FQs?
Option List
|
A |
they may cause aortic dissection |
|
B |
they may cause mitral stenosis |
|
C |
they may cause pancreatitis |
|
D |
they may cause peripheral neuropathy |
|
E |
they may cause flare of SLE |
Question 10.
FDA issued a warning in July 2016. Which, if any, of the following were
included? This is not a true SBA as there may be more than one answer.
Option List
|
A |
the risks generally outweigh the benefits |
|
B |
QUIs & FQs should not be used for acute sinusitis, |
|
C |
QUIs & FQs should not be used for exacerbation of chronic bronchitis |
|
D |
QUIs & FQs should not be used for uncomplicated UTI |
|
E |
QUIs & FQs may be useful for anthrax and plague |
Question 11.
FDA issued a warning in July 2018 about the use of FQs in pregnancy.
Which, if any, of the following were included in the reasons for its
publication?
Option List
|
A |
to strengthen previous warnings about hyperglycaemia and mental health
risks |
|
B |
to strengthen previous warnings about hypoglycaemia and mental health
risks |
|
C |
to strengthen previous warnings about the risk of ASD in the offspring |
|
D |
to strengthen previous warnings about the risk of acute pancreatitis |
|
E |
to strengthen previous warnings about the risk of PET |
Question 12.
The FDA issued a warning in December 2018 about the use of FQs in
pregnancy. Which, if any, of the following was included? This is an SBA with
only one correct answer.
Option List
|
A |
↑ risk of atrial fibrillation |
|
B |
↑ risk of aortic aneurysm and rupture |
|
C |
↑ risk of mitral stenosis |
|
D |
↑ risk of pulmonary hypertension |
|
E |
↑ risk of ulcerative colitis |
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