|
26 |
Role-play. Teach an FY1 the basics of
audit. |
|
27 |
MCQ. Folic acid fortification of
flour |
|
28 |
EMQ. Renal transplant |
|
29 |
EMQ. Kangaroo care |
|
30 |
SBA. Lynch syndrome |
|
31 |
EMQ. Flu and pregnancy |
26. Role-play. Teach
an FY1 the basics of audit.
Candidate’s instructions.
You are
the SpR on call for the labour ward. It is a quiet afternoon: all the patients
are healthy and in normal labour. Dr. Jane Jones has started in the department
as a new FY1. She is keen to specialise in O&G and has already passed the
Part 1 examination. A measure of her enthusiasm is that she has asked her
consultant if she can be involved in doing an audit, but she is aware that she
knows little about it. Her consultant happens to be the consultant on duty for
the labour ward and has asked you to ensure that she has enough knowledge to be
a useful member of a team conducting an audit.
27. Folic acid supplementation of flour. MCQs.
Abbreviations.
FAFF: folic
acid fortification of flour.
MRC: Medical
Research Council
NTD: neural
tube defect.
SACN: Scientific
Advisory Committee on Nutrition.
With the MCQs you just decide ‘true’ or ‘false’ for each
statement.
MCQ Paper 2. Question 13.
Neural Tube Defect.
a. has uniform geographical spread.
b. occurs in one pregnancy in 200.
c. the risk of recurrence is 10% after an
affected pregnancy.
d. is more common after maternal consumption of
sodium valproate.
e. is more common in the white than the black population.
f. is prevented by pre and early pregnancy folic
acid.
g. is suggested by the pineapple sign.
MCQ Paper 7. Question 23. Folic
acid & pregnancy.
a. the dosage for routine prophylaxis of neural
tube defect is 0.4 mg. daily.
b. the dosage for prophylaxis for patients with
spina bifida or who have had a pregnancy affected by neural tube defect is 5mg.
daily.
c. folic acid reduces the risk of neural tube
defect by more than 70%.
d. folic acid and anti-epilepsy drugs may
interact adversely.
e. folic acid reduces the risk of placental
abruption.
f. folic acid can provoke sub-acute combined
degeneration of the cord.
g. fortification of flour with folic acid was
introduced in the USA in 1998.
h. fortification of flour with folic acid in the
USA has been linked to a 50% reduction in the incidence of neural tube defects.
i. fortification of flour with folic acid was
introduced in the UK in 2005.
28. Renal transplant & pregnancy.
Abbreviations.
AST: American Society for Transplantation
Question 1
Approximately how many women who have had renal transplant
have pregnancies annually in the UK?
Option list.
|
A |
10-20 |
|
B |
30-40 |
|
C |
50-100 |
|
D |
100-200 |
|
E |
200-300 |
|
F |
300-400 |
|
G |
400-500 |
|
H |
>500 |
Question 2
Which, if any, of the following statements are true about
the findings of the UKOSS survey of renal transplant in pregnancy?
Option list.
|
A |
the incidence
of PET was ~ 25%, roughly six times higher than the general population |
|
B |
the incidence
of PET was ~ 25%, roughly ten times higher than the general population |
|
C |
the incidence
of PET was ~ 50%, roughly ten times higher than the general population |
|
D |
the incidence
of PET was ~ 50%, roughly twenty times higher than the general population |
|
E |
none of the
above |
Question 3
Various sources, such as AST, give factors linked to
reduced risks associated with pregnancy after RT. A lot of this is common
sense. Write down all the factors that would be in your list.
Question 4
What is the risk of graft rejection in the year after RT?
Option list.
|
A |
< 5% |
|
B |
10-15% |
|
C |
15-20% |
|
D |
20-25% |
|
E |
unknown |
Question 5
Which of the following factors are the 3 main ones
affecting pregnancy outcome?
Factors
|
1 |
anaemia |
|
2 |
diabetes |
|
3 |
hypertension |
|
4 |
number of
immunosuppressive drugs being used |
|
5 |
obesity |
|
6 |
pre-pregnancy
graft function |
|
7 |
proteinuria |
|
8 |
urinary tract
infection |
Option list.
|
A |
1 + 2 + 3 |
|
B |
1 + 2 + 6 |
|
C |
2 + 3 + 4 |
|
D |
2 + 4 + 6 |
|
E |
3 + 6 +7 |
|
F |
3 + 6 + 8 |
|
G |
4 + 5 + 6 |
|
H |
4 + 6 + 8 |
Question 6
Which of the following statements is true in relation to the
prevalence of hypertension in women after RT?
Option list.
|
A |
> 20% have
hypertension |
|
B |
> 30% have
hypertension |
|
C |
> 40% have
hypertension |
|
D |
> 50 % have
hypertension |
|
E |
none of the
above |
Question 7
State whether these drugs are regarded as safe or unsafe in
pregnancy.
|
|
Drug |
Safe / unsafe |
|
A |
ACE inhibitor |
Safe / unsafe |
|
B |
angiotensin receptor antagonist |
Safe / unsafe |
|
C |
azathioprine |
Safe / unsafe |
|
D |
ciclosporin |
Safe / unsafe |
|
E |
clopidogrel |
Safe / unsafe |
|
F |
erythropoietin |
Safe / unsafe |
|
G |
hydroxychloroquine |
Safe / unsafe |
|
H |
mycophenolate |
Safe / unsafe |
|
I |
prednisolone |
Safe / unsafe |
|
J |
tacrolimus |
Safe / unsafe |
|
K |
warfarin |
Safe / unsafe |
TOG CPD. These are now open access.
With regard to
renal transplant,
1. most recipients have a successful pregnancy
outcome. T F
2. pregnancy is associated with a 10% reduction
in GFR in recipients with prepregnancy eGFR >90 ml/ min/1.73m2 .
T F
3. hypertension complicates pregnancy in over
50% of recipients who did not require antihypertensive treatment prior to
pregnancy. T F
4. proteinuria is a predictor of poor pregnancy
outcome in recipients. T F
5. the risk of damage to the allograft at
caesarean delivery is about 1%. T F
6. a positive serological screening test for
aneuploidy in recipients is a recognised consequence of impaired renal
function. T F
7. superimposed pre-eclampsia in recipients has
defined diagnostic criteria. T F
8. erythropoietin requirements in recipients
fall in pregnancy. T F
9. breastfeeding is safe in recipients on
angiotensin converting enzyme inhibitors. T F
10. conception is not advised in recipients within
the first year following transplantation. T F
11. continuous electronic fetal monitoring is
recommended during labour in recipients. T F
12. the progesterone implant is a safe form of
postpartum contraception in recipients. T F
Women who have
donated a kidney,
13. are at increased risk of gestational
hypertension. T F
Combined
kidney-pancreas transplant recipients,
14. have a higher risk of gestational diabetes
than kidney transplant recipients. T F
Liver transplant
recipients,
15. have a lower risk of pregnancy complications
than renal transplant recipients. T F
With regard to
pregnancy in cardiothoracic transplant recipients,
16. lung transplant recipients have the highest
risk of adverse outcome of all solid organ transplants. T F
17. due to denervation, the transplanted heart
responds poorly to the physiological changes of pregnancy. T F
18. cardiothoracic transplant recipients should be
delivered by caesarean section. T F
Regarding
medications prescribed in patients with solid organ transplants,
19. tacrolimus levels require monitoring during
pregnancy. T F
20. warfarin is safe for breastfeeding mothers. T
F
These are not true EMQs as there may be more than one
answer. I do this to compress several questions into one to reduce the amount of
typing and the paper and ink needed for printing. The wording will indicate whether
there is one or more than one answer.
Question 1.
Which, if any, of the following are true in relation to
kangaroo care?
Option list.
|
A. |
skin-to-skin contact between
mother and baby is a key component |
|
B. |
rooming-in is a key component |
|
C. |
exclusive breastfeeding is a key
component |
|
D. |
carrying the baby in a sling
anterior to the maternal chest is a key component |
|
E. |
carrying the baby in a sling on
the mother’s back is a key component |
|
F. |
carrying the baby in a sling on
the mother’s chest or back is a key component |
|
G. |
carrying the baby in a sling with
skin-to-skin contact with the mother is a key component |
Question 2.
Which, if any, of
the following are proven benefits of Kc?
Option list.
|
A. |
↓ neonatal mortality |
|
B. |
↓
neonatal morbidity |
|
C. |
↑
breastfeeding rates |
|
D. |
↑ head circumference growth |
|
E. |
↓
hypothermia |
|
F. |
↑
mother-baby bonding |
|
G. |
↓
necrotising enterocolitis |
|
H. |
↓ neonatal intra-ventricular
haemorrhage |
|
I. |
↓ neonatal sepsis |
|
J. |
↑
neonatal weight gain |
|
K. |
↓
postnatal depression |
|
L. |
↑ psychomotor development at 12
months |
30. Lynch
syndrome.
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.
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 |
Question 1. What did MBRRACE say about flu &
pregnancy in its first report in 2014?
|
A |
1 in 11 women died from flu |
|
B |
1 in 11 women died from flu and flu
vaccination could have prevented ½ of the deaths |
|
C |
1 in 21 women died from flu |
|
D |
1 in 21 women died from flu and flu
vaccination could have prevented ½ of the deaths |
|
E |
1 in 51 women died from flu |
|
F |
1 in 51 women died from flu and flu
vaccination could have prevented ½ of the deaths |
Question 2. How many types of flu virus are
recognised?
|
A |
3 |
|
B |
5 |
|
C |
10 |
|
D |
15 |
|
E |
>100 |
Question 3. Why can’t we have a universal flu
vaccine?
|
A |
The main surface antigens are haemagglutinin and neuraminidase |
|
B |
The main surface antigens are haemolysin
and neuroxidase |
|
C |
The main surface antigens frequently |
|
D |
The main core antigens change frequently,
rendering existing vaccines impotent |
|
E |
The big drug companies avoid making a
universal vaccine for financial reasons. |
Option List
|
1 |
A + C + D + E |
|
2 |
A + C |
|
3 |
A + D + E |
|
4 |
B + C |
|
5 |
B + D + E |
Question 4. When is flu’ most often a problem in
the UK?
Option List
|
Spring |
|
|
B |
Summer |
|
C |
Autumn |
|
D |
Winter |
|
E |
None of the above. |
Question 5. How is flu spread?
Option List
|
via aerosol or droplets from respiratory tract of an infected person |
|
|
B |
via aerosol from or direct contact with
respiratory secretions of an infected
person |
|
C |
from getting drenched in cold winter
showers |
|
D |
from thinking lascivious thoughts |
|
E |
from toilet seats |
Question 6. What is the incubation period for flu?
Option List
|
1 – 3 days |
|
|
B |
1 – 7 days |
|
C |
5 – 10 days |
|
D |
up to 2 weeks |
|
E |
up to 3 weeks |
Question 7. Who decides which viruses will be used
in the vaccine for seasonal flu?
Option List
|
DOH |
|
|
B |
JCVI |
|
C |
the Prime Minister |
|
D |
the vaccine manufacturers |
|
E |
WHO |
Question 8. How long has flu vaccination been
recommended in the UK?
Option List
|
since the 1950s |
|
|
B |
since the 1960s |
|
C |
since the 1970s |
|
D |
since the 1980s |
|
E |
since the 1990s |
Question 9. What is the recommendation about when
the vaccine should be given?
Option List
|
May - July |
|
|
B |
June - August |
|
C |
July - September |
|
D |
August - October |
|
E |
September - November |
Question 10. What advice is given about vaccination
in pregnancy?
Option List
|
flu vaccine is potentially teratogenic and should be avoided before 16
weeks |
|
|
B |
the vaccine contains an attenuated virus
with no evidence of risk in pregnancy |
|
C |
the vaccine has no live viral material and
all pregnant women are encouraged to have it |
|
D |
flu vaccine contains an attenuated virus
with minimal risk, but the anti-viral drug Tamiflu is given with the vaccine
to eliminate any risk of harm |
Question 11. What is the H1N1 virus?
Option List
|
The avian virus which causes outbreaks of “bird flu” |
|
|
B |
The virus associated with “swine” flu,
which caused a pandemic in 2009 |
|
C |
The virus associate with MERS, currently
causing deaths particularly in Saudi Arabia |
|
D |
The virus associated with simian flu |
|
E |
The virus associated with the pandemic of
1915. |
Question 12. What advice should be given to
pregnant women about the H1N1 virus?
Option List
|
to have vaccination against H1N1 in addition to the seasonal vaccine |
|
|
B |
to have vaccination against H1N1 in preference
to the seasonal vaccine |
|
C |
to await evidence of epidemic H1N1 flu and
then have vaccination against H1N1 |
|
D |
to have the seasonal vaccine as it gives
good protection against H1N1 |
|
E |
not to have any flu vaccination, but to
take antiviral drugs if symptoms of flu occur |
Question 13. Which of the
following conditions have been linked to flu in pregnancy?
Conditions.
|
risk of flu complications for the mother |
|
|
B |
risk of low birthweight |
|
C |
risk of maternal death |
|
D |
risk of perinatal death |
|
E |
risk of
prematurity |
Option List
|
A + C+ D + E |
|
|
2 |
A + B + C+ D |
|
3 |
A + C + D |
|
4 |
A + C+ D + E |
|
5 |
A + B + C+ D + E |
Question 14. What is the estimated uptake of flu
vaccination by pregnant women in the UK?
Option List
|
20-30% |
|
|
B |
30-40% |
|
C |
40-50% |
|
D |
50-60% |
|
E |
> 60% |
Question 15. How many maternal deaths from flu were
reported by MBRRACE for 2012 - 13?
Option List
|
0 |
|
|
B |
5 |
|
C |
10 |
|
D |
15 |
|
E |
20 |
Question 16. With regard to the probable
explanation for the numbers of maternal deaths from ‘flu in 2012 and 2013, which
of the following statements is true?
Option List
|
the numbers reflected increased prevalence of ‘flu |
|
|
B |
the numbers reflected reduced prevalence of
‘flu |
|
C |
the numbers reflected improved uptake of
‘flu vaccine in pregnancy |
|
D |
the numbers reflected the introduction of
Tamiflu for pregnant women with ‘flu |
|
E |
none of the above |
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