|
1 |
How to prepare. Part 2. What to
read. StratOG. TOG CPD. RCOG sample questions. Revision system. Study
buddies. Intelligent guessing. Statistics. Urogynae. Other specialist
tutorial. |
18 |
Nov |
2021 |
|
2 |
How to prepare. Part 3. StratOG.
Picking a course. Communication skills. Study partner. Importance of polished
introduction to role-plays. Senior doctor thinking: staffing, training,
audit, critical incident reporting and analysis etc. |
18 |
Nov |
2021 |
|
3 |
Part 3. The 5 domains and creating an agenda. |
18 |
Nov |
2021 |
|
4 |
Structured conversation. The Part 3
exam. |
|
|
|
|
5 |
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with
the information in a GP referral letter, general pre-pregnancy counselling,
recessive inheritance, x-linked inheritance, how to ask if the role-player
has questions, dealing with information such as a relative with a serious
problem, etc. Make a list |
18 |
Nov |
2021 |
|
6 |
EMQ. Hepatitis B |
18 |
Nov |
2021 |
|
7 |
EMQ. Hepatitis D |
18 |
Nov |
2021 |
|
8 |
EMQ. Mycoplasma Genitalium |
18 |
Nov |
2021 |
2. How to prepare. Part 3.
3. Part 3. The 5 domains and creating an agenda.
4. Structured conversation. The Part 3 exam.
Candidate’s
instructions.
This is a viva station. The examiner will ask you 6
questions.
5. Basic “blurbs” to write and practise.
6. EMQ. Hepatitis B
Abbreviations.
GDM: gestational diabetes mellitus.
HAV: hepatitis A virus
HBcAg: hepatitis B core antigen
HBeAg: hepatitis B e antigen
HBsAg: hepatitis B surface antigen
HBcAb: antibody to hepatitis B core antigen
HBeAb: antibody to hepatitis B e antigen
HBsAb: antibody to hepatitis B surface antigen
HBIG: hepatitis B immunoglobulin
HBV: hepatitis B virus
HBcAg: hepatitis B core antigen
HBeAg: hepatitis B e antigen
HBsAg: hepatitis B surface antigen
HBcAb: antibody to hepatitis B core antigen
HBeAb: antibody to hepatitis B e antigen
HBsAb: antibody to hepatitis B surface antigen
HBIG: hepatitis B immunoglobulin
HCV: hepatitis C virus
HEV: hepatitis E virus
HSV: herpes simplex virus
VT: vertical transmission
Question 1.
An asymptomatic primigravida
books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What
results on routine blood testing would indicate that she has an acute HBV infection?
Question 2.
An asymptomatic primigravida
books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What
results on routine blood testing would indicate that she is immune to the HBV
as a result of infection?
Question 3.
An asymptomatic primigravida
books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What
results on routine blood testing would indicate that she is immune to the HBV
as a result of HBV vaccine?
Question 4.
An asymptomatic primigravida
books at 10 weeks. Her partner had an acute HBV infection 9 months ago. What
results on routine blood testing would show that she is a chronic carrier of HBV
infection?
Question 5.
Testing shows that he is positive for
HBsAg, positive for HBcAb but negative for IgM HBcAb. What does this mean in
relation to his HBV status?
Question 6.
Testing shows that he is negative for
HBsAg, positive for HBcAb and positive for HBsAb.
What does this mean in relation to his HBV
status?
Question 7.
How common is chronic HBV
carrier status in UK pregnant women?
Question 8.
What is the risk of death from
chronic HBV carrier status?
Question 9.
A primigravid woman at 8 weeks
gestation is found to be non-immune to HBV. She has recently married and her
husband is a chronic carrier. What should be done to protect her from
infection?
Question 10.
A woman is a known carrier of
HBV. What is the risk of vertical transmission in the first trimester?
Question 11.
What is the risk of the
neonate who has been infected by vertical transmission becoming a carrier
without treatment?
Question 12.
Should antiviral maternal
therapy in the 3rd. trimester be considered for women with HBeAg or
high viral load?
Question 13.
How effective is hepatitis B
prophylaxis for the neonate in preventing chronic carrier status as a result of
vertical transmission?
Question 14.
Can a woman who is a chronic
HBV carrier breastfeed safely?
Question 15.
Is Hepatitis B infection the most
dangerous of the viral hepatitis infections in pregnancy?
Question 16.
A pregnant woman who is not
immune to HBV has a partner who is a chronic carrier. Can HBV vaccine be
administered safely in pregnancy?
Question 17.
How long can HBV survive
outside the body?
Question 18.
A pregnant woman who is not
immune has a partner with acute hepatitis due to HBV. He cuts his hand and
bleeds onto the kitchen table. How should she clean the surface to ensure that
she gets rid of the virus?
Is
it true that the presence of HBeAg in maternal blood is a particular risk
factor for vertical transmission? Not really a scenario, but never mind!
Question 20.
What
does 5 log10 copies /mL mean?
|
A |
>
10 copies / mL |
|
B |
>
100 copies / mL |
|
C |
>
1,000 copies / mL |
|
D |
>
10,000 copies / mL |
|
E |
>
100,000 copies / mL |
|
F |
this
has scared me witless and I am going straight home to complain to my Mum |
Question 21.
Which, if any, of the following statements are true about amniocentesis
and CVS and the risk of vertical transmission if the mother is HbsAg+ve?
Option list.
|
A |
they are contraindicated |
|
B |
they should be done with cover with HBIG |
|
C |
they should be done with cover with a drug that is effective for HBV and safe in pregnancy. |
|
D |
none of the above |
Question 22.
Which, if any, of the
following statements are true about treatment in the third trimester to reduce
the risk of vertical transmission?
Option list.
|
A |
women who are HbsAg+ve
should be offered testing for HBV DNA levels in the 3rd. trimester |
|
B |
there is no effective
treatment for HBV in the 3rd. trimester |
|
C |
the risks of treatment for
HBV in the 3rd. trimester outweigh the benefits |
|
D |
drug treatment for HBV in
the 3rd. trimester adds nothing beneficial to the normal use of
HBIG + HB vaccination of the neonate |
|
E |
none of the above. |
Question 23.
Which, if any, of the
following drugs is recommended for use in the third trimester to reduce the
risk of vertical transmission?
Option list.
|
A |
acyclovir |
|
B |
lamivudine |
|
C |
telbivudine |
|
D |
tenofovir |
Question 24.
Does elective Cs before labour
and with the membranes intact reduce the vertical transmission rate?
Question 25.
Which hepatitis virus normally
produces a mild illness, but represents a major risk to pregnant women, with a
mortality rate of up to 5%?
Question 26.
A pregnant woman has a history
of viral hepatitis and informs the midwife at booking that she is a carrier and
that she has a significant risk of cirrhosis and has been advised not to drink
alcohol. Which is the most likely hepatitis virus?
Question 27.
Which hepatitis virus is an
absolute contraindication to breastfeeding after appropriate treatment of the
infected mother and prophylaxis for the baby?
Question 28.
Which hepatitis virus is
linked to an increased risk of obstetric cholestasis?
Question 29.
Which, if any, of the
following statements is true in relation to HepB and the risk of GDM?
Option list.
|
A |
the risk is about the same |
|
B |
the relative risk is about
0.1. |
|
C |
the relative risk is about
0.2. |
|
D |
the relative risk is about
0.5. |
|
E |
the relative risk is about
1.2. |
|
F |
the relative risk is about
1.5. |
|
G |
the relative risk is about
2.0 |
|
H |
the relative risk is about
3.0 |
|
I |
the risk is unknown |
7. Hepatitis D.
Hepatitis Delta. EMQ.
Abbreviations:
HBsAg: hepatitis B surface antigen
HBsAb: antibody to hepatitis B surface antigen
HBV: hepatitis B virus
HCsAg: hepatitis
C surface antigen
HDV: hepatitis D virus; hepatitis delta
virus
HEsAg: hepatitis E surface antigen
Question 1.
Which, if any, of the following statements are true in
relation to HDV? This is not a true EMQ as there may be >1 correct answer.
Option list.
|
A |
HDV is a large
DNA virus |
|
B |
HDV is a
defective virus |
|
C |
HDV gains
entry to human cells via the HDV receptor |
|
D |
HDV gains
entry to human cells by donning a disguise and using the HBV receptor |
|
E |
HDV only
flourishes when HBsAb is present |
|
F |
HDV only
flourishes when HbsAg is present |
|
G |
Coinfection is
when HDV and another viral infection are present at the same time |
|
H |
Superinfection
is when HDV is present in abnormally high numbers |
|
I |
HDV infection
is the least serious of the viral hepatitides in relation to pregnancy |
|
J |
HDV treatment
was revolutionised by analysis of the benefits of drinking bleach as suggested
by Donald Trump |
|
K |
the WHO has
recommended that those who follow medical advice from Donald trump should be
categorised as ‘having the DTs’. |
|
L |
HDV needs the
presence of HBsAg to be a significant pathogen |
|
M |
HDV needs the
presence of HCsAg to be a significant pathogen |
|
N |
HDV needs the
presence of HEsAg to be a significant pathogen |
|
O |
pegylated
interferon alpha is highly effective as treatment |
|
P |
mother-to-child
transmission is mainly via the placenta |
|
Q |
WHO recommends
tenofovir prophylaxis from 28 weeks in pregnancy in HDV infected women |
|
R |
the infected neonate
should be given HDV vaccine |
8. Mycoplasma
Genitalium. EMQ.
BASSH
launched a new, “NICE-accredited” guideline on MG in July 2018 This makes it a
hot topic and it is one that most people will know nothing about. There are
enough “buzz words” to catch the attention of MRCOG examiner sand make its
inclusion in the exam databases irresistible! It would be a killer “structured
discussion” in the Part 3 and would sink most candidates in the Part 2.
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.
BASHHMG: British Association for Sexual Health and HIV’s
“National guideline for the management of
infection with Mycoplasma genitalium”. 2018
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 |
