|
48 |
Diabetes & pregnancy. Jenny Myers |
|
49 |
EMQ. Kell antibodies. |
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50 |
EMQ. Anatomy of the fetal skull |
48. Diabetes in pregnancy. Jenny Myers.
Jenny is Professor of Obstetrics and Maternal
Medicine at Manchester University. She will give a PowerPoint presentation on
diabetes and answer questions.
49. Kell
antibodies & pregnancy.
Abbreviations.
∆OD450: spectrophotometric
measurement of deviation in optical density at wavelength 450 nm.
FMM: feto-maternal
medicine
HDFN: haemolytic disease of the fetus and newborn.
MCAPSV: middle cerebral artery peak systolic velocity.
RBC: red
blood cell.
Scenario 1.
Which, if any, of the following
alloantibodies is the most common cause of significant HDFN?
Option list.
|
A |
anti-D |
|
B |
anti-C |
|
C |
anti-c |
|
D |
anti-e |
|
E |
Duffy: Fya |
|
F |
Duffy: Fyb |
|
G |
Kell |
|
H |
Kidd: Jka |
|
I |
Kidd: Jkb |
Scenario 2.
Which, if any, of the following
alloantibodies is the 2nd. most common cause of significant HDFN?
Option list. Use the
option list from Scenario 1.
Scenario 3.
Which, if any, of the following
alloantibodies is the 3rd. most common cause of significant HDFN?
Option list. Use the
option list from Scenario 1.
Scenario 4.
Which of the following
statements is true in relation to the Kell antigen?
Option list.
|
A |
it is named after Mrs. Kelleher who was found to have
antibodies to it in 1946 |
|
B |
it is named after Gene Kelly, the American actor,
dancer and singer as the research group who found the antigen were big fans |
|
C |
there are > 50 significant variants of the Kell
antigen |
|
D |
Kell antibodies are mainly IgA |
|
E |
Kell antibodies are mainly IgM |
|
F |
none of the above |
Scenario 5.
What proportion of the
Caucasian population is K +ve?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
9% |
|
D |
15% |
|
E |
25% |
|
F |
33% |
|
G |
57% |
|
H |
none of the above |
Scenario 6.
The Kell antigen can be
detected using cell-free fetal DNA in maternal serum. True / False.
Scenario 7.
Anti-K is thought to occur
mainly as a result of feto-maternal transfusion of Kell +ve cells during
pregnancy and delivery. True / False.
Scenario 8.
Kell HDFN resulting from
transfusion of Kell +ve blood is thought to produce more severe HDFN than that
resulting from feto-maternal transfusion. True / False.
Scenario 9.
The Kell antigen can be
detected using cell-free fetal DNA in maternal serum. True / False.
Scenario 10.
Which of the following
statements is true in relation to anti-Kell antibodies in a Kell-negative
mother with a Kell +ve pregnancy?
Option list.
|
A |
HDND is mainly due to haemolysis of fetal RBC |
|
B |
HDND is mainly due to haemolysis of fetal &
neonatal RBC |
|
C |
HDND is mainly due to haemolysis of neonatal RBC |
|
D |
HDND is mainly due to sequestration of fetal RBC |
|
E |
HDND is mainly due to sequestration of fetal &
neonatal RBC |
|
F |
HDND is mainly due to sequestration of neonatal RBC |
|
G |
HDND is mainly due to suppression of fetal erythroid
progenitor cells |
|
H |
HDND is mainly due to suppression of neonatal erythroid
progenitor cells |
|
I |
none of the above |
Scenario 11.
Which of the following statements
is true in relation to antenatal detection of HDFN due to anti-K antibodies?
Option list.
|
A |
the threshold for significant HDFN is a titre of 1 in 4 |
|
B |
the threshold for significant HDFN is a titre of 1 in 8 |
|
C |
the threshold for significant HDFN is a titre of 1 in
16 |
|
D |
the threshold for significant HDFN is a titre of 1 in
32 |
|
E |
the threshold for significant HDFN is a titre of 1 in
64 |
|
F |
the threshold for significant HDFN is a titre of 1 in
128 |
|
G |
the threshold for significant HDFN is a titre of 1 in
256 |
|
H |
none of the above |
Scenario 12.
Which of the following
statements is true in relation to antenatal detection of HDFN due to anti-K
antibodies?
Option list.
|
A |
the threshold for significant HDFN is a level > 2
iu/L. |
|
B |
the threshold for significant HDFN is a level > 4
iu/L. |
|
C |
the threshold for significant HDFN is a level > 7.5
iu/L. |
|
D |
the threshold for significant HDFN is a level > 10
iu/L. |
|
E |
the threshold for significant HDFN is a level > 15
iu/L. |
|
F |
the threshold for significant HDFN is a level > 25
iu/L. |
|
G |
the threshold for significant HDFN is any level if
anti-E is also present. |
|
H |
none of the above |
Scenario 13.
Which, if any, of the following
statements are true in relation to referral to a FMM expert when Kell
antibodies are detected?
Option list.
|
A |
the threshold for referral is a level of anti-K > 2
iu/L. |
|
B |
the threshold for referral is a level of anti-K > 4
iu/L. |
|
C |
the threshold for referral is a level of anti-K >
7.5 iu/L. |
|
D |
the threshold for referral is a level of anti-K > 10
iu/L. |
|
E |
the threshold for referral is a level of anti-K > 15
iu/L. |
|
F |
the threshold for referral is a level of anti-K > 25
iu/L. |
|
G |
the threshold for referral is any level of anti-K. |
|
H |
the threshold for referral is any level of anti-K if
anti-E is also present. |
|
I |
none of the above |
Scenario 14.
Which of the following
statements is true in relation to the threshold for antenatal diagnosis of
significant HDFN due to anti-K when using measurement of MCAPSV?
Option list.
|
A |
MoM > 1.25 |
|
B |
MoM > 1.50 |
|
C |
MoM > 1.75 |
|
D |
MoM > 2.00 |
|
E |
MoM > 2.50 |
|
F |
MoM > 3.00 |
|
G |
none of the above |
Scenario 15.
Which of the following
statements is true in relation to the threshold for antenatal diagnosis of
significant HDFN due to anti-K when using measurement of ∆OD450?
Option list.
|
A |
MoM > 1.25 |
|
B |
MoM > 1.50 |
|
C |
MoM > 1.75 |
|
D |
MoM > 2.00 |
|
E |
MoM > 2.50 |
|
F |
MoM > 3.00 |
|
G |
none of the above |
Scenario 16.
Which, if any, of the following
statements are true in relation to the numbers of reticulocytes in cord blood
in moderate to severe HDFN?
Option list.
|
A |
the numbers are decreased |
|
B |
the numbers are increased |
|
C |
the numbers are normal |
|
D |
none of the above |
Scenario 17.
Which, if any, of the following
statements are true in relation to the numbers of erythroblasts in cord blood
in moderate to severe HDFN?
Option list.
|
A |
the numbers are decreased |
|
B |
the numbers are increased |
|
C |
the numbers are normal |
|
D |
none of the above |
Scenario 18.
Which, if any, of the following
statements are true in relation to the level of bilirubin in cord blood in
moderate to severe HDFN?
Option list.
|
A |
it is decreased |
|
B |
it is increased |
|
C |
it is greatly increased |
|
D |
none of the above |
Scenario 19.
Which, if any, of the following
statements are true in relation to King Henry VIII and Kell?
Option list.
|
A |
Kell may have been the cause of his subfertility |
|
B |
He may have had the McLeod syndrome |
|
C |
He may have inherited the Kell antigen from Jacquetta
Woodville |
|
D |
The Kell antigen may have explained his passion for
jousting |
|
E |
The Kell antigen may have explained his passion for
extramarital dalliance |
The TOG questions for the Gajjar article can be found here. These are open access, so
reproduced here. These are obviously MCQs with True or False options.
Regarding Kell
alloimmunisation in pregnancy,
1 the amniotic fluid bilirubin level
correlates well with the degree of fetal anaemia.
2 previous obstetric history does not
reliably predict outcome.
3 the incidence in the obstetric population
is approximately 1–2 per 1000.
4 prophylaxis is available.
5 the relationship between fetal middle
cerebral artery peak systolic velocity (MCA-PSV) and haemoglobin concentration
is poor.
6 anti-Kell antibodies cause fetal anaemia
via the suppression of erythropoesis rather than red cell destruction.
With
regard to maternal anti-Kell antibody screening,
7 if the father of the fetus is Kell antigen
positive, the fetus is likely to be affected with severe HDFN.
8 where the father is heterozygous for Kell,
there is a 50% chance of the fetus carrying the Kell antigen on its fetal red
cells.
9 anti-Kell antibodies stimulated by
transfusion are known to affect the fetus to the same degree as those
stimulated from a previous pregnancy.
10 where the critical titre of anti-Kell
antibodies has been reached in the maternal serum, amniocentesis for spectral
analysis of amniotic fluid is a reliable means of establishing the degree and
severity of fetal anaemia.
50. Anatomy
of fetal skull and maternal pelvis.
Scenario 20.
How many bones make up the
vault of the skull?
Option list.
|
A. |
3 |
|
B. |
5 |
|
C. |
6 |
|
D. |
7 |
|
E. |
8 |
Scenario 21.
What is the origin of the word
“bregma”?
Option list.
|
A. |
the Greek word meaning “arrow” |
|
B. |
the Greek word meaning “front of the head” |
|
C. |
the Greek word meaning “top of the head” |
|
D. |
the Greek word meaning “where lines intersect” |
|
E. |
none of the above |
Scenario 22.
What is the origin of the word
“lambdoid”?
Option list.
|
A. |
it is derived from “lambda”, the 11th.
letter of the Greek alphabet, with the symbol “λ” |
|
B. |
it is derived from the shape of the rear end of a
newborn lamb, with legs apart for balance in the shape of an inverted “V” |
|
C. |
it derives from the Norse noun “lam” meaning to hit |
Scenario 23.
What is the origin of the word
“sagittal”?
Option list.
|
A. |
it derives from the Latin verb “sagire” meaning to be wise |
|
B. |
it derives from the Latin noun “sagitta” meaning
“arrow” |
|
C. |
it derives from the Latin adjective “sagitta” meaning
“pointing north” |
|
D. |
it derives from the Latin adjective “sagitta” meaning
“lacking tension” |
Scenario 24.
What is the meaning of the word
“coronal”.
Option list.
|
A. |
it is the 11th. letter of the Greek alphabet |
|
B. |
it derives from the Latin “corona” meaning “crown”. |
|
C. |
it derives from the sun’s corona, meaning equator |
Scenario 25.
What is the definition of
“vertex”?
Option list.
|
A. |
the most prominent part of the occiput |
|
B. |
the area around the posterior fontanelle |
|
C. |
the area bounded by the anterior fontanelle and the
posterior fontanelle |
|
D. |
the area bounded by the anterior & posterior
fontanelles and the parietal bones |
|
E. |
the area bounded by the anterior & posterior
fontanelles and the parietal eminences |
|
F. |
the area bounded by the anterior & posterior
fontanelles and the parietal cardinals |
Scenario 26.
What is the definition of the
anterior fontanelle?
Option list.
|
A. |
the anterior end of the sagittal suture |
|
B. |
the area where the sagittal and coronal sutures meet |
|
C. |
the area between the frontal and parietal bones |
|
D. |
the posterior end of the sagittal suture |
|
E. |
the area between the parietal bones and the occiput |
Scenario 27.
What is the definition of the
posterior fontanelle?
Option list.
|
A.
|
the anterior end of the
sagittal suture |
|
B.
|
the area where the sagittal
and lambda sutures meet |
|
C.
|
the area between the frontal
and parietal bones |
|
D.
|
the posterior end of the
sagittal suture |
|
E.
|
the area between the parietal
bones and the occiput |
Scenario 28.
How many other fontanelles are
there?
|
A. |
0 |
|
B. |
2 |
|
C. |
3 |
|
D. |
4 |
|
E. |
6 |
Scenario 29.
What is the falx cerebri?
Option list.
|
A. |
an area of dura mater at the back of the skull like a
roof over the cerebellum |
|
B. |
is an artefact on ultrasound suggesting the presence of
cerebral tissue where there is none |
|
C. |
is the horizontal fibrous platform on which the
cerebellum rests |
|
D. |
is a crescent-shaped fold of dura mater separating the
cerebral hemispheres |
Scenario 30.
What is the importance of the
falx cerebri in relation to delivery, particularly breech delivery?
Option list.
|
A. |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears
and intracranial bleeding |
|
B. |
the falx cerebri is inserted into the bone of base of
the skull and traction on the base of the skull may lead to tears of the falx
and intracranial bleeding |
|
C. |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears leaving
the cerebellum unsupported and liable to trauma |
Scenario 31.
What diameter presents to the
pelvis with vertex presentation?
Option list.
|
A. |
suboccipito-bregmatic |
|
B. |
suboccipito-frontal |
|
C. |
occipito-frontal |
|
D. |
mento-vertical |
|
E. |
submento-bregmatic |
Scenario 32.
What diameter presents to the
pelvis with typical occipito-posterior position?
Option list.
Use
the Option List from Scenario 12.
Scenario 33.
What diameter presents to the
pelvis with brow presentation?
Scenario 34.
What diameter presents to the
pelvis with mento-anterior face presentation?
Option list.
Use
the Option List from Scenario 12.
Scenario 35.
What diameter presents to the
pelvis with mento-posterior face presentation?
Option list.
Use
the Option List from Scenario 12.
Scenario 36.
What is the average length of
the suboccipito-bregmatic diameter in a term baby?
Option list.
|
A.
|
9.0 cm. |
|
B.
|
9.5 cm. |
|
C.
|
10.0 cm. |
|
D.
|
10.5 cm. |
|
E.
|
11.0 cm. |
|
F.
|
11.5 cm. |
|
G.
|
12.0 cm. |
|
H.
|
12.5 cm. |
|
I.
|
13.0 cm. |
|
J.
|
13.5 cm. |
|
K.
|
14.0 cm. |
Scenario 37.
What is the average length of
the suboccipito-frontal diameter in a term baby?
Option list.
Use
the Option List from Scenario 17.
Scenario 38.
What is the average length of
the occipito-frontal diameter in a term baby?
Option list.
Use
the Option List from Scenario 17.
Scenario 39.
What is the average length of
the mento-vertical diameter in a term baby?
Option list.
Use
the Option List from Scenario 17.
Scenario 40.
What is the average length of
the submento-bregmatic diameter in a term baby?
Option list.
Use
the Option List from Scenario 17.
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