Contact us.
Website.
|
57
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EMQ. Obesity and endometrial cancer
|
|
58
|
EMQ. Gestational trophoblastic
disease
|
|
59
|
SBA. Coeliac disease & pregnancy
|
|
60
|
EMQ. Mayer-Rokitansky-Küster-Hauser
syndrome
|
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61
|
EMQ. Caldicott guardian
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62
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EMQ. Listeriosis
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57. Obesity
and endometrial cancer.
Abbreviations.
EC: endometrial cancer.
Question
1.
What is the
definition of ‘overweight’?
Option list.
|
A
|
BMI > 25
|
|
B
|
BMI > 30
|
|
C
|
BMI > 35
|
|
D
|
BMI > 40
|
|
E
|
BMI > 45
|
|
F
|
BMI > 50
|
|
G
|
Body shape causing distress or mirth when viewed in a
full-length mirror
|
|
H
|
Body shape causing strangers to stop and gawp
|
|
I
|
None of the above
|
Question
2.
What is the
definition of ‘obesity’?
Option list.
|
A
|
BMI > 25
|
|
B
|
BMI > 30
|
|
C
|
BMI > 35
|
|
D
|
BMI > 40
|
|
E
|
BMI > 45
|
|
F
|
BMI > 50
|
|
G
|
Body shape causing distress or mirth when viewed in a
full-length mirror
|
|
H
|
Body shape causing strangers to stop and gawp
|
|
I
|
None of the above
|
Question
3.
What is the
definition of ‘morbid obesity’?
Option list.
|
A
|
BMI > 25
|
|
B
|
BMI > 30
|
|
C
|
BMI > 35
|
|
D
|
BMI > 40
|
|
E
|
BMI > 45
|
|
F
|
BMI > 50
|
|
G
|
Body shape causing distress when viewed in a
full-length mirror
|
|
H
|
Body shape causing strangers to stop and gawp
|
|
I
|
Obesity as the confirmed cause of death
|
|
J
|
None of the above
|
Question
4.
Approximately what
percentage of UK women are overweight or obese?
Option list. There
is none: just write your answer.
Question
5.
Approximately what
percentage of UK women were obese in 2018?
Option list. There
is none: just write your answer.
Question
6.
Approximately what
percentage of UK women are morbidly obese?
Option list. There
is none: just write your answer.
Question 7.
What is the
life-time risk of endometrial cancer?
Option list.
|
A
|
< 1%
|
|
B
|
3%
|
|
C
|
5%
|
|
D
|
5 - 10%
|
|
E
|
10 - 15%
|
|
F
|
16 - 20%
|
Question 8.
What is the
life-time risk of endometrial cancer in the morbidly obese?
Option list.
Use the list for the previous question
Question
9.
What are the main
risk factors for endometrial cancer?
Option list. There is none. Just write as many as you can think of.
Question 10.
Which, if any, of
the following best describes the ↑ in the life-time risk of EC and
increasing BMI ?
Option list.
|
A
|
the risk ↑
by about 10% with each 5 kg/m2 ↑
in BMI
|
|
B
|
the risk ↑
by about 20% with each 5 kg/m2 ↑
in BMI
|
|
C
|
the risk ↑
by about 30% with each 5 kg/m2 ↑
in BMI
|
|
D
|
the risk ↑
by about 40% with each 5 kg/m2 ↑
in BMI
|
|
E
|
the risk ↑
by about 50% with each 5 kg/m2 ↑
in BMI
|
|
F
|
None of the above.
|
Question
11.
What is the approximate percentage of endometrial cancer
attributable to obesity?
Option list. There
is none: just write your answer.
58. Gestational
trophoblastic disease.
Gestational Trophoblastic Disease (GTD)
Abbreviations.
APSN: atypical
placental site nodule.
BWS: Beckwith-Wiedemann syndrome.
CCGTDS: Charing Cross
Gestational Trophoblast Disease Service.
CHM: complete
hydatidiform mole.
COC: combined
oral contraceptive.
EMA/CO: etoposide,
methotrexate, actinomycin D, cyclophosphamide, vincristine (oncovin).
EPT: epithelioid
tumour.
FIGOSS: FIGO
GTD Scoring System. Included in FIGO Cancer Report 2018: Ngan H et al: “Update
on the diagnosis and management of gestational trophoblastic disease”.
Gynecology
& Obstetrics 2018 Volume143, IssueS2 Special Issue; Pages 79-85.
FSRHCAP: FSRH’s
guideline: “Contraception
after Pregnancy”.
GI: gastro-intestinal.
GTD: gestational
trophoblastic disease.
GTDTC: gestational
trophoblastic disease treatment centre.
GTG38: RCOG’s
Green-top Guideline 38: “Gestational
Trophoblastic Disease”. 2020.
GTN: gestational
trophoblastic neoplasia.
HM: hydatidiform
mole.
IFAP: interval
from antecedent pregnancy in months.
IPI: inter-pregnancy
interval.
LGA: large
for gestational age.
NIUP: negative
intra-uterine pressure.
PHM: partial
hydatidiform mole.
POC: products
of conception.
PSTT: placental
site trophoblastic tumour.
TTC: trophoblastic
tumour centre
UKMEC: UK
Medical Eligibility for Contraceptive Use
UPD: uniparental
disomy.
US: ultrasound.
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 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 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?
Scenario
8.
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 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 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
|
premature labour
|
|
F
|
PPH
|
|
G
|
pulmonary embolism
|
|
G
|
none of the above
|
Scenario 12.
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 13.
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 14. 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.
Scenario
15.
Which, if any, of
the following statements are true about twin pregnancy with a viable pregnancy
and a CHM?
|
A
|
the woman should be referred to a feto-maternal
specialist
|
|
B
|
the woman should be referred to a GTDTC
|
|
C
|
fetal karyotyping should be done
|
|
D
|
the rate of early fetal loss is about 20%
|
|
E
|
the rate of preterm birth is about 40%
|
|
F
|
the rate of preeclampsia is 20%
|
|
G
|
the incidence of GTN in doubled if the pregnancy goes
beyond 24 weeks
|
Scenario
16.
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
|
CHMs have no RhD
|
|
B
|
PHMs 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
|
low risk is
defined as WHO score < 5
|
|
B
|
low risk is
defined as WHO score < 6
|
|
C
|
low risk means
that no treatment is necessary
|
|
D
|
treatment of
low risk GTN is methotrexate
|
|
E
|
treatment of
low risk GTN is folic acid
|
|
F.
|
treatment of
low risk GTN is folinic acid
|
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 use of folic acid / folinic acid in
methotrexate treatment regimens? This is not a true EMQ as there may be > 1
answer.
|
A
|
folic acid must
be converted to tetrahydrofolate to be biologically active
|
|
B
|
folic acid must
be converted to folinic acid to be biologically active
|
|
C
|
dihydrofolate
reductase converts folic acid to folinic acid
|
|
D
|
dihydrofolate
reductase converts folic acid to tetrahydrofolate
|
|
E
|
dihydrofolate
reductase converts folinic acid to tetrahydrofolate
|
|
F
|
folinic acid is
use in preference to folic acid as it reaches higher levels in plasma
|
|
G
|
folate therapy is
used to reduce GI tract damage from methotrexate
|
|
H
|
folate therapy
is used to reduce hepatic damage from methotrexate
|
|
I
|
folate therapy
is used to reduce neurological damage from methotrexate
|
|
J
|
folate therapy
is used to reduce renal damage from methotrexate
|
|
K
|
none of the
above.
|
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.
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 37.
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 38.
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 39.
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 40.
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 41.
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 42.
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 43. 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 44.
A woman has had two molar pregnancies. What
is the risk of molar pregnancy if she becomes pregnant again?
Scenario 45.
A woman has had three molar pregnancies.
What is the risk of molar pregnancy if she becomes pregnant again?
Scenario 46.
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 47. 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 48.
What
proportion of women remain fertile after treatment for GTN?
|
A
|
80%
|
|
B
|
70%
|
|
C
|
60%
|
|
D
|
50%
|
|
E
|
40%
|
Scenario 49.
What
proportion of women will reach the menopause by age 40 after chemotherapy for
GTN?
|
A
|
10%
|
|
B
|
20%
|
|
C
|
30%
|
|
D
|
40%
|
|
E
|
50%
|
FSRHCAP has a SBA. It is open
access, to reproduced here. It is not well written, but highlights some of the
key points.
With gestational trophoblastic disease (GTD), which statement is
false?
A. After complete hydatidiform mole, 15–20%
women develop GTD needing chemotherapy
B. After partial hydatidiform mole, 30–35%
women develop GTD needing chemotherapy
C. Intrauterine contraception is unsuitable
while human chorionic gonadotropin is still detectable
D.
Combined hormonal contraception can be used if gestational trophoblastic
neoplasia develops
59. Coeliac
disease & pregnancy.
Abbreviations.
AGA: anti-gliadin antibodies
CD: coeliac disease.
DGP: IgG deamidated gliadin peptide.
EMA: IgG endomysial antibodies.
FGR: Fetal growth restriction.
HLA: Human leucocyte antigen.
IgA: immunoglobulin A.
tIgA: total
immunoglobulin A.
tTGA: IgA tissue
transglutaminase antibody.
vLBW: very low birth weight.
vPTB: very pre-term birth (<30/52).
Question 1. What is coeliac disease?
Option List
|
A.
|
allergy
to gluten
|
|
B.
|
malabsorption due to large bowel inflammation
|
|
C.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the descending colon in individuals with a genetic
predisposition
|
|
D.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the gastric mucosa in individuals with a genetic
predisposition
|
|
E.
|
an auto-immune disorder triggered by gluten sensitivity
causing villous atrophy of the small bowel in individuals with a genetic
predisposition
|
Question 2. What is the prevalence of coeliac disease in women of reproductive age?
Option List
|
A.
|
0.1%
|
|
B.
|
0.5%
|
|
C.
|
1%
|
|
D.
|
2-5%
|
|
E.
|
5-10%
|
Question 3. Which of the following groups have an
increased risk of CD?
Option List
|
A.
|
1st.
degree relatives of those with CD
|
|
B.
|
those with type 1 diabetes
|
|
C.
|
those
with iron deficiency anaemia
|
|
D.
|
those
with osteoporosis
|
|
E.
|
those
with unexplained infertility
|
Question 4. Which of the following are features of CD in the non-pregnant
population?
Option List
|
A.
|
abdominal
bloating and pain
|
|
B.
|
amenorrhoea
|
|
C.
|
anaemia
|
|
D.
|
recurrent miscarriage
|
|
E.
|
unexplained infertility
|
Question 5. How do pregnant women with CD present most commonly?
Option List
|
A
|
anaemia
|
|
B
|
failure to gain weight in pregnancy
|
|
C
|
intra-uterine growth retardation
|
|
D
|
low BMI
|
|
E
|
no recognised abnormality
|
Question 6. Which of the following commonly occur in pregnant women with CD?
Option List
|
A
|
anaemia
|
|
B
|
failure to gain
weight in pregnancy
|
|
C
|
intra-uterine
growth retardation
|
|
D
|
low BMI
|
|
E
|
no recognised
abnormality
|
Question 7. How should the woman with suspected
CD be investigated initially?
Option List
|
A.
|
jejunal biopsy
|
|
B.
|
IgA EMA
|
|
C.
|
IgA tTGA
|
|
D.
|
IgA EMA + IgA tTGA
|
|
E.
|
tIgA + tTGA
|
Question 8. Which, if any, of the following statements are true in relation to the
woman due to have testing for suspected CD?
Option List
|
A.
|
continue with a diet that includes
gluten ≥ once daily for at least 1 month
|
|
B.
|
continue with a
diet that includes gluten ≥ once daily for at least 6 weeks
|
|
C.
|
continue with a
diet with ≥ 10 gm. gluten daily for at least 1 month
|
|
D.
|
continue with a
diet with ≥ 10 gm. gluten daily for at least 6 weeks
|
|
E.
|
follow a strict
gluten-free diet for at least 3 months
|
Question 9. What advice should be given to those who have gone on to a gluten-free
diet in the month before testing?
Option List
|
A.
|
the gluten-free
diet may render the serological tests –ve, but not intestinal biopsy
|
|
B.
|
the gluten-free
diet may render the intestinal biopsy –ve, but not the serological tests
|
|
C.
|
the gluten-free diet may render all
the tests -ve
|
|
D.
|
if she is happy
with the gluten-free diet, there is no
point in testing
|
|
E.
|
she is not qualified
to make medical decisions and should not be so stupid on future occasions
|
Question 10. Which of the following conditions should make consideration of testing
for CD sensible?
Option List
|
A.
|
amenorrhoea
|
|
B.
|
Down’s syndrome
|
|
C.
|
epilepsy
|
|
D.
|
recurrent miscarriage
|
|
E.
|
Turner’s syndrome
|
|
F.
|
unexplained infertility
|
Question 11. What recommendation does NICE
make about the information to be provided to healthcare professionals with the
results of serological tests for CD?
Option List
|
A.
|
the results
alone should be provided
|
|
B.
|
the results with the local reference
values for children, adult men and adult women
|
|
C.
|
the results with the local and
national reference values for children, adult men and women
|
|
D.
|
the results with interpretation of
their meaning
|
|
E.
|
the results with interpretation of
their meaning + recommended actions
|
Question 12. How is the diagnosis of CD confirmed after +ve serological testing?
Option List
|
A.
|
colonoscopy
|
|
B.
|
enteroscopy
|
|
C.
|
gastroscopy
|
|
D.
|
rectal biopsy
|
|
E.
|
small bowel biopsy
|
Question 13. Which skin condition is particularly associated with CD?
Option List
|
A.
|
atopic eczema
|
|
B.
|
dermatitis herpetiformis
|
|
C.
|
dermatitis
multiforme
|
|
D.
|
dermatographia
|
|
E.
|
psoriasis
|
Question 14. Which of the following are likely to be absorbed less well than normally
in women with CD?
Option List
|
A.
|
carbohydrate
|
|
B.
|
fat
|
|
C.
|
folic acid
|
|
D.
|
protein
|
|
E.
|
vitamins B12,
D & K
|
Question 15. What is the appropriate treatment of CD?
Option List
|
A.
|
antibiotics: long-term in low-dosage
|
|
B.
|
azathioprine
|
|
C.
|
cyclophosphamide
|
|
D.
|
rectal steroids
|
|
E.
|
none of the
above
|
Question 16. Which of the following do not contain gluten?
Option List
|
A.
|
barley
|
|
B.
|
oats
|
|
C.
|
rapeseed oil
|
|
D.
|
rye
|
|
E.
|
wheat
|
60. Mayer-Rokitansky-Küster-Hauser syndrome.
Mayer-Rokitansky-Küster-Hauser syndrome.
Note. Some of the questions are not true EMQs as
there may be more than one correct answer – this is me being lazy and saving
typing.
Mayer–Rokitansky–K
¨
uster–Hauser
syndrome: diagnosis and management
With regard to the MRKH syndrome,
61. there is
failure of development of the
mesonephric
ducts. T F
62. the phenotype and genotype are
female. T F
63. studies have established a link between
the
syndrome and the
use of diethylstilbestrol in
pregnancy. T F
With regard to the anatomical
abnormalities seen in
MRKH syndrome,
64. symmetrical uterovaginal aplasia is
found in
type I disorders. T F
65. renal abnormalities are seen in
more than
half of cases. T F
66. skeletal abnormalities are reported
in up to
one-fifth of cases. T F
67. up to
one-quarter of women have a
malformed ear or auditory canal. T F
68. the close proximity of the m
¨
ullerian and
wolffian duct derivatives to the metanephric
duct in the developing embryo explains
the
higher association of malformations of
the
kidneys with this condition. T F
69. vaginal agenesis is caused by
failure of the
caudal part of the m
¨
ullerian duct
system to
develop. T F
Regarding the diagnosis of MRKH
syndrome,
70. magnetic resonance imaging is the
gold
standard tool. T F
71. two-dimensional ultrasound scanning
is not
useful for associated renal tract
abnormalities. T F
72. complete androgen insensitivity
syndrome is
an important differential diagnosis. T F
73. the presence of cyclical abdominal
pain will
rule out the diagnosis, as it indicates
the
presence of
functioning endometrium. T F
With regard to the
creation of a neovagina,
74. it is recommended that treatment is
initiated
as soon as the diagnosis is made. T F
75. psychological
support to women undergoing
this procedure is of the utmost
importance. T F
76. vaginal dilators are acceptable as
an option
for first-line
therapy. T F
77. Ingram’s modified Frank’s technique
involves
the use of vaginal dilators. T F
With regard to the
surgical creation of a neovagina,
78. in the
Davydov procedure the neovagina is
lined with
peritoneum. T F
With regard to fertility in women with
the MRKH
syndrome,
79. transvaginal
egg retrieval is recognised to be
difficult during in vitro
fertilisation. T F
80. the condition
has been shown to be
transmissible to
the offspring. T F
Abbreviations.
AIS: androgen
insensitivity syndrome
AMH: anti-
Müllerian hormone
MRKH: Mayer-Rokitansky-Küster-Hauser syndrome
MURCS: Müllerian duct aplasia, renal dysplasia and
cervical somite anomaly syndrome.
Question 1.
What are the main
features of MRKH? There is no option list to make life harder.
Question 2.
Which, if any, are the main secondary features associated with
MRKH?
Option list.
|
A
|
anosmia
|
|
B
|
attention-deficit-hyperactivity
syndrome
|
|
C
|
auditory anomalies
|
|
D
|
neural tube defects
|
|
E
|
renal anomalies
|
|
F
|
skeletal anomalies
|
Question 3.
How does MRKH
syndrome usually present?
Option list.
|
A
|
cyclical pain due to haematometra
|
|
B
|
delayed puberty
|
|
C
|
precocious puberty
|
|
D
|
premature menopause
|
|
E
|
primary amenorrhoea
|
|
F
|
recurrent otitis media
|
|
G
|
recurrent urinary tract
infection
|
|
H
|
secondary amenorrhoea
|
Question 4.
Which of the
following chromosome patterns are typical of MRKH?
Option list.
|
A
|
45XO
|
|
B
|
45YO
|
|
C
|
46XX
|
|
D
|
46XY
|
|
E
|
47XXX
|
|
F
|
47XXY
|
Question 5.
What is the
approximate incidence of MRKH in newborn girls?
Option list.
|
A
|
~ 1 in 1,000
|
|
B
|
~ 1 in 2,000
|
|
C
|
~ 1 in 4,000
|
|
D
|
~ 1 in 6.000
|
|
E
|
~ 1 in 8,000
|
|
F
|
~ 1 in 10,000
|
|
G
|
~ 1 in 100,000
|
|
H
|
the figure is unknown
|
|
I
|
it does not occur
|
Question 6.
What is the
approximate incidence of MRKH in newborn boys?
Option list.
|
A
|
~ 1 in 1,000
|
|
B
|
~ 1 in 2,000
|
|
C
|
~ 1 in 4,000
|
|
D
|
~ 1 in 6.000
|
|
E
|
~ 1 in 8,000
|
|
F
|
~ 1 in 10,000
|
|
G
|
~ 1 in 100,000
|
|
H
|
the figure is unknown
|
|
I
|
it does not occur
|
Question 7.
Which of the
following statements are correct in relation to urinary tract anomalies
associated with MRKH?
Option list.
|
A
|
absent bladder
|
|
B
|
absent kidney
|
|
C
|
ectopic ureter
|
|
D
|
horseface kidney
|
|
E
|
hypospadias
|
|
F
|
urinary tract anomalies are
not part of the syndrome
|
Question 8.
Which of the
following statements are correct in relation to skeletal anomalies associated
with MRKH?
Option list.
|
A
|
absent thumb
|
|
B
|
absent big toe
|
|
C
|
developmental dysplasia of
the hip
|
|
D
|
Klippel-Feil anomaly
|
|
E
|
ulnar hypoplasia
|
|
F
|
vertebral fusion
|
|
G
|
skeletal anomalies are not
part of the syndrome
|
Question 9.
Which of the
following statements are correct in relation to auditory anomalies associated
with MRKH?
Option list.
|
A
|
absent ear
|
|
B
|
absent stapes
|
|
C
|
acoustic neuroma
|
|
D
|
conductive deafness
|
|
E
|
inductive deafness
|
|
F
|
stapedial ankylosis
|
|
G
|
auditory anomalies are not
part of the syndrome
|
Question 10.
What is the
recommended first-line management for creation of a neovagina.
Option list.
|
A
|
digital dilatation
|
|
B
|
marriage to a virile
husband
|
|
C
|
vaginal balloons
|
|
D
|
vaginal dilators
|
|
E
|
vaginoplasty
|
|
F
|
there is no recommended 1st.
line management
|
Question 11.
What are the key
features of Davydov vaginoplasty?
Option list.
|
A
|
horseshoe perineal incision
with labial flaps used to create a pouch
|
|
B
|
creation of space between
bladder and rectum and lining it with amnion
|
|
C
|
creation of space between
bladder and rectum and lining it with skin graft
|
|
D
|
creation of space between
bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space between
bladder and rectum and lining it with peritoneum
|
|
F
|
traction via threads
running to the abdomen from a vaginal bead
|
Question 12.
What are the key
features of McIndoe vaginoplasty?
Option list.
|
A
|
horseshoe perineal incision
with labial flaps used to create a pouch
|
|
B
|
creation of space between
bladder and rectum and lining it with amnion
|
|
C
|
creation of space between bladder
and rectum and lining it with skin graft
|
|
D
|
creation of space between
bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space between
bladder and rectum and lining it with peritoneum
|
|
F
|
traction via threads
running to the abdomen from a vaginal bead
|
Question 13.
What are the key
features of Vecchietti vaginoplasty?
Option list.
|
A
|
horseshoe perineal incision
with labial flaps used to create a pouch
|
|
B
|
creation of space between
bladder and rectum and lining it with amnion
|
|
C
|
creation of space between
bladder and rectum and lining it with skin graft
|
|
D
|
creation of space between
bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space between
bladder and rectum and lining it with peritoneum
|
|
F
|
traction via threads running
to the abdomen from a vaginal bead
|
Question 14.
What are the key
features of Williams vaginoplasty?
Option list.
|
A
|
horseshoe perineal incision
with labial flaps used to create a pouch
|
|
B
|
creation of space between
bladder and rectum and lining it with amnion
|
|
C
|
creation of space between
bladder and rectum and lining it with skin graft
|
|
D
|
creation of space between
bladder and rectum and lining it with sigmoid colon
|
|
E
|
creation of space between
bladder and rectum and lining it with peritoneum
|
|
F
|
traction via threads
running to the abdomen from a vaginal bead
|
TOG CPD questions.
With regard to the MRKH syndrome.
1. there is failure of development of the
mesonephric ducts.
2. the phenotype and genotype are female
3. studies have established a link between the
syndrome and the use of diethylstilboestrol in pregnancy.
With regard to the anatomical abnormalities seen in MRKH
syndrome.
4. symmetrical uterovaginal aplasia is found in
type I disorders
5. renal abnormalities are seen in more than
half of cases.
6. skeletal abnormalities are reported in up to
one-fifth of cases.
7. up to one-quarter of women have a malformed
ear or auditory canal.
8. the close proximity of the Müllerian and
Wolffian duct derivatives to the duct in the developing embryo explains the
higher association of malformations of the kidneys with this condition.
9. vaginal
agenesis is caused by failure of the caudal part of the Müllerian duct system
to develop.
Regarding the diagnosis of MRKH syndrome,
10. magnetic resonance imaging is the gold
standard tool.
11. two-dimensional ultrasound scanning is not
useful for associated renal tract abnormalities.
12. complete androgen insensitivity syndrome is an
important differential diagnosis.
13. the presence of cyclical abdominal pain will
rule out the diagnosis, as it indicates the presence of functioning
endometrium.
With regard to the creation of a neovagina,
14. it is recommended that treatment is initiated
as soon as the diagnosis is made.
15. psychological support to women undergoing this
procedure is of the utmost importance.
16. vaginal dilators are acceptable as an option
for first-line therapy.
17. Ingram’s modified Frank’s technique involves
the use of vaginal dilators.
With regard to the surgical creation of a neovagina,
18. in the Davydov procedure the neovagina is
lined with peritoneum.
With regard to fertility in women with the MRKH syndrome,
19. transvaginal egg retrieval is recognised to be
difficult during in vitro fertilisation.
20. the condition has been shown to be
transmissible to the offspring.
61.
Caldicott guardian.
Question 1. Which, if any, of the following statements is true of the
Caldicott Guardian?
Option List
|
A
|
it is a large lizard, unique to the Galapagos
Islands
|
|
B
|
it is the Trust Board member responsible for
child safeguarding procedures
|
|
C
|
it is the Trust Board member responsible for
complaint procedures
|
|
D
|
it is the person within a Trust responsible
for patient confidentiality in relation to information
|
|
E
|
it is the person within a Trust responsible
for dealing with bullying
|
Question 2. The Caldicott Report identified 6
basic principles. What are they?
Option list. There
is none. Imagine that there is information about you stored on the computers of
the local NHS Trust. What conditions would you want to lay down about sharing
of that information within the Trust, with other NHS organisations and with
non-NHS organisations?
Question 3. The Caldicott Report made numerous
recommendations. Which was particularly important for major NHS organisations
such as Trusts?
Option List
|
A.
|
the need to appoint a Caldicott
Guardian
|
|
B.
|
the need to
create a Caldicott Register
|
|
C.
|
the need to
create a Caldicott Police Department
|
|
D.
|
the need to
create a link between the Caldicott Department and the DOH
|
|
E.
|
none of the
above.
|
Question 4. What is the definition of the key role
deriving from the answer to question 3?
Option List. There is none lest it give you the
answer to question 3!
62. Listeriosis.
Abbreviations.
Lm: Listeria
monocytogenes.
TOC: test of cure.
Scenario
1.
Which organism is responsible for human listeriosis?
|
A
|
Listeria diogenys
|
|
B
|
Listeria frigidaire
|
|
C
|
Listeria hominis
|
|
D
|
Listeria monocytogenes
|
|
E
|
Listeria xenophylus
|
Scenario
2.
Which, if any, of the following statements are true about
Lm? This is not a true EMQ as there may be >1 correct answer.
Option list.
|
A
|
it is a small, Gram -ve rod
|
|
B
|
it is a Gram +ve coccus
|
|
C
|
it is flagellated
|
|
D
|
it has no cell wall
|
|
E
|
it is an obligate aerobe
|
|
F
|
it functions within host cells
|
|
G
|
it can easily be mistaken for commensal organisms
|
|
H
|
none of the above
|
Scenario
3.
Which of the following are associated with an increased
risk of contracting listeriosis? This is not a true EMQ as there may be >1
correct answer.
|
A
|
age > 60 years
|
|
B
|
age < 1 year
|
|
C
|
blond hair
|
|
D
|
pregnancy
|
|
E
|
strabismus
|
Scenario
4.
Which of the following is true of the susceptibility of
pregnant women to Lm? This is not a true EMQ as there may be >1 correct
answer.
Option list.
|
A
|
they are not more susceptible
|
|
B
|
they are more susceptible x 2
|
|
C
|
they are more susceptible x 5
|
|
D
|
they are more susceptible x 10
|
|
E
|
they are more susceptible x 20
|
|
F
|
they are > 20 times more susceptible
|
|
G
|
none of the above.
|
Scenario
5.
When does Lm most often occur? This is not a true EMQ as
there may be >1 correct answer.
Option list.
|
A
|
1st. trimester
|
|
B
|
2nd. trimester
|
|
C
|
3rd trimester
|
|
D
|
1st. + 2nd. trimesters
|
|
E
|
2nd. + 3rd trimesters
|
|
F
|
all trimesters equally
|
|
G
|
puerperium
|
|
H
|
none of the above
|
Scenario
6.
What is the incubation period for Lm?.
Option list.
|
A
|
7±3 days
|
|
B
|
7±5 days
|
|
C
|
10±3 days
|
|
D
|
10±5 days
|
|
E
|
14±3 days
|
|
F
|
14±5 days
|
|
G
|
none of the above.
|
Scenario
7.
What is the
significance of Granulomatosis Infantisepticum ?
Option list.
|
A
|
it is a fabrication
by the author and of no significance
|
|
B
|
it is
pathognomonic of Lm infection
|
|
C
|
it is the cause
of vertical transmission of Lm
|
|
D
|
I refuse to
answer Latin questions as they make me think of Boris Johnson
|
|
E
|
none of the above
|
Scenario
8.
Which of the following are accurate about cervico-vaginal
infection? This is not a true EMQ as there may be >1 correct answer.
Option list.
|
A
|
Lm is as often found in the cervix as in the bowel.
|
|
B
|
Lm is as often found in the vagina as in the bowel.
|
|
C
|
Lm is less often
found in the cervix than in the bowel.
|
|
D
|
Lm is less often
found in the vagina than in the bowel.
|
|
E
|
Lm is more often
found in the cervix than in the bowel.
|
|
F
|
Lm is more often
found in the cervix than in the bowel.
|
|
G
|
no one knows and no one cares
|
Scenario
9.
A GP phones about a primigravida at 28 weeks’ gestation.
She has possibly ingested food contaminated by Lm. She is asymptomatic and
afebrile. What advice will you give?
Option list.
|
A
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
|
|
B
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
|
|
C
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
|
|
D
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks
|
|
E
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
F
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
G
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
H
|
admit to hospital for investigation and intensive
treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario
10.
A GP phones about a primigravida at 28 weeks’ gestation.
She has possibly ingested food contaminated by Lm. She has mild symptoms but is
afebrile. What advice will you give?
Option list.
|
A
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
|
|
B
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
|
|
C
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
|
|
D
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks
|
|
E
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
F
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
G
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
H
|
admit to hospital for investigation and intensive
treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario
11.
A GP phones about a primigravida at 28 weeks’ gestation.
She has possibly ingested food contaminated by Lm. She is symptomatic and her
temperature is 38.2oC. What advice will you give?
Option list.
|
A
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
|
|
B
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
|
|
C
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
|
|
D
|
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks
|
|
E
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
F
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
G
|
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
|
|
H
|
admit to hospital for investigation and intensive
treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario
12.
Which, if any, of the following would be appropriate for
consideration as 1st. line treatment of Lm in pregnancy? This is not
a true EMQ as there may be more than 1 correct answer.
Option list.
|
A
|
ampicillin
|
|
B
|
ampicillin + gentamycin
|
|
C
|
ampicillin + streptomycin
|
|
D
|
amoxicillin + clavulanic acid
|
|
E
|
clarithromycin
|
|
F
|
erythromycin
|
|
G
|
erythromycin + metronidazole
|
|
H
|
trimethoprim
|
|
I
|
none of the above
|
Scenario
13.
Is listeriosis a notifiable infection in the UK? Yes/No.
