11th. July 2022.
|
1 |
How to prepare. Part 2. What to
read. StratOG. TOG CPD. RCOG sample questions. Revision system. Study
buddies. Intelligent guessing. Diabetes. Statistics. Urogynae. Other
specialist tutorials |
11 |
July |
2022 |
|
2 |
EMQ. ARRIVE trial |
11 |
July |
2022 |
|
3 |
EMQ. Cystic fibrosis |
11 |
July |
2022 |
|
4 |
SBA. McCune Albright syndrome |
11 |
July |
2022 |
|
5 |
EMQ. Uterine inversion |
11 |
July |
2022 |
|
6 |
EMQ. Hepatitis B |
11 |
July |
2022 |
|
7 |
EMQ. Vulval conditions |
11 |
July |
2022 |
1. How to prepare for Part 2.
There is a lot to
think about. Being organised is key to success.
2. The ARRIVE trial. EMQ.
Abbreviations.
EBL: estimated blood loss.
IOL: induction of labour.
SGA: small for gestational age.
Question
1.
What does the acronym ‘ARRIVE’ mean?
Option list.
|
A |
a randomised review of intravenous ergometrine for the
prevention of PPH |
|
B |
a randomised review of IVF efficacy |
|
C |
a retrospective review of IVF efficacy |
|
D |
a randomised review of IOL at term versus expectant management
of high-risk pregnancy |
|
E |
a randomised review of IOL at 39 weeks versus expectant
management of high-risk pregnancy |
|
F |
a randomised trial of IOL at term versus expectant
management of low-risk pregnancy |
|
G |
a randomised trial of IOL at 39 weeks versus expectant
management of low-risk pregnancy |
|
H |
none of the above |
Question 2. What was the primary outcome of the trial?
Option list.
|
A |
C section and instrumental delivery rates versus the spontaneous
delivery rate |
|
B |
cost-effectiveness of IVF |
|
C |
composite outcome of perinatal death or severe neonatal
complications |
|
D |
estimated blood loss using low-dose ergometrine versus
oxytocin for the 3rd. stage |
|
E |
frequency and severity of perineal trauma |
|
F |
length of labour |
|
G |
maternal satisfaction |
|
H |
urinary incontinence severity score at 3 months
postpartum |
|
I |
none of the above |
Question 3.
Which, if any, of
the following were the important conclusions of the trial? This is not a true
EMQ as there may be > 1 correct answer.
Option list.
|
A |
C section and instrumental delivery rates were
significantly ↓ with IOL
at 39/52 |
|
B |
C section rate but not instrumental delivery rate was
significantly ↓with IOL
at 39/52 |
|
C |
instrumental delivery rate but not C section rate was
significantly ↓ with IOL
at 39/52 |
|
D |
C section and instrumental delivery rates were
significantly ↑ with IOL
at 39/52 |
|
E |
C section rate but not instrumental delivery rate was
significantly ↑ with IOL
at 39/52 |
|
F |
instrumental delivery rate but not C section rate was
significantly ↑ with IOL
at 39/52 |
|
G |
C section and instrumental delivery rates were
unchanged |
|
H |
IVF was cost-effective |
|
I |
IVF was not cost-effective |
|
J |
composite perinatal outcome was better with IOL |
|
K |
composite perinatal outcome was unchanged with IOL |
|
L |
composite perinatal outcome was worse with IOL |
|
M |
EBL using low-dose ergometrine versus oxytocin for the
3rd. stage was ↓↓ |
|
N |
EBL using low-dose ergometrine versus oxytocin for the
3rd. stage was ↓↓ but
with ↑↑ BP |
|
O |
frequency and severity of perineal trauma ↑ with IOL |
|
P |
length of labour was ↑↑
with IOL |
|
Q |
maternal satisfaction was higher with IOL |
|
R |
urinary incontinence at 3 months was reduced by IOL |
|
S |
none of the above |
3. Cystic fibrosis. EMQ.
There is no option list to
make you behave in a model fashion – best technique is to decide the correct
answer before looking at the option list.
Scenario
1. A woman is 8 weeks pregnant and a carrier of CF. Her husband is
Caucasian. What is the risk of the child having CF?
Scenario
2. A healthy woman attends for pre-pregnancy counselling. Her brother has CF.
Her husband is Caucasian and has a negative CF screen. What is the risk of them
having a child with CF?
Scenario
3. A healthy woman is a carrier of CF. She attends for pre-pregnancy
counselling. Her husband has CF. What is the risk of them having a child with
CF?
Scenario
4. A healthy woman attends for pre-pregnancy counselling. Her sister has
had a child with CF. What is her risk of being a carrier?
Scenario
5. A woman attends for pre-pregnancy counselling. Her mother has CF.
What is the risk that she is a carrier?
Scenario
6 . A woman attends for pre-pregnancy counselling. Her mother has CF.
The partner’s risk of being a carrier is 1 in X. What is the risk that
she will have a child with CF?
Scenario
7. A healthy Caucasian woman is 10 weeks pregnant. Her husband is a carrier
of CF. Which test would you arrange?
Scenario
8. A woman attends for pre-pregnancy counselling. She has read about
diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF
in this way?
Scenario
9. A woman and her husband are carriers of CF. What is the risk of an
affected child?
Scenario
10. A woman and her husband are carriers of CF. What can they do to reduce
the risk of having an affected child?
Scenario
11. A woman and her husband are carriers of CF. Can CVS exclude an affected
pregnancy?
Scenario
12. A woman has CF, her husband is a carrier. What is their risk of an
affected child?
Scenario
13. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will be protein-deficient due to
malabsorption. Is this advice correct?
Scenario
14. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will contain abnormally low levels of
sodium. Is this advice correct?
TOG
CPD. 2009. 11. 1. Cystic fibrosis and pregnancy
These are open access so are produced here.
Regarding cystic fibrosis,
1. there are approximately 8000 people living with
this disease in the UK. True / False
2. the main cause of death is liver disease. True / False
Women with cystic fibrosis
3. have an approximately 50% reduced
fertility. True / False
4. have a life expectancy of approximately 50
years. True / False
With regard to pregnancy in women with cystic fibrosis,
5. their babies usually have an appropriate
birthweight for their gestational age. True / False
6. approximately 70% of babies are born
prematurely. True / False
7. the risk of developing gestational diabetes
is higher than in the general population. True / False
8. the risk of miscarriage is higher than in
the general population. True / False
9. the risk of congenital malformations is
similar to that in women who are carriers. True / False
Women with cystic fibrosis who become pregnant,
10. have a shortened life expectancy compared with
women who do not. True / False
If a woman with cystic fibrosis becomes pregnant, the risk
of the baby being born with cystic fibrosis
11. is 50% if the father carries one of the
common gene mutations for cystic fibrosis. True / False
12. is < 1 in 250 if the father does not carry
any of the common CF mutations. True / False
During pregnancy, a woman with cystic fibrosis
13. should be cared for by a multidisciplinary
team, including a physician and an obstetrician with a special interest in CF
in pregnancy. True / False
14. should have a GTT if she did not have CF-related
diabetes prior to pregnancy. True / False
In pregnant women with cystic fibrosis,
15. the instrumental delivery rate is
approximately 40%. True / False
16. the use of epidural analgesia during delivery
is contraindicated. True / False
17. the risk of poor pregnancy outcome increases
if the FEV1 is < 70%. True / False
Post- delivery in women with cystic fibrosis
18. breastfeeding is contraindicated because of
the high sodium content of breast milk. True / False
Which of the following statements about cystic fibrosis are correct?
19. Menarche in girls with CF occurs at the same
time as in unaffected girls. True / False
20. Fertility in women with CF is affected to the
same extent as it is in men with CF. True / False
4. SBA. McCune Albright syndrome
Abbreviations.
MCA: McCune Albright syndrome.
PFD: polyostotic fibrous dysplasia.
PP: precocious puberty.
Scenario
1.
Which, if
any, of the following are components of the classical triad of MCA?
Option
List
|
A |
albinism |
|
B |
“cafè Cubano” spots |
|
C |
“Coast of California” pigmented areas |
|
D |
lentigo |
|
E |
macroorchidism |
|
F |
osteomalacia |
|
G |
polyostotic fibrous dysplasia |
|
H |
precocious puberty |
|
I |
premature menopause |
|
J |
primary amenorrhoea |
Scenario
2.
Which, if
any, of the following are true in relation to MCA?
Option
List
|
A |
it is an example of central primary amenorrhoea |
|
B |
it is an example of central secondary amenorrhoea |
|
C |
it is an example of central precocious puberty |
|
D |
it is an example of peripheral primary amenorrhoea |
|
E |
it is an example of peripheral secondary amenorrhoea |
|
F |
it is an example of peripheral precocious puberty |
|
G |
none of the above |
Scenario
3.
Which, if
any, of the following are believed to be true in relation to the abnormality of
onset of puberty associated with MCA?
Option
List
|
A |
it is due to abnormal FSH production |
|
B |
it is due to abnormal LH production |
|
C |
it may be due to abnormal androgen production |
|
D |
it may be due to abnormal oestrogen production |
|
E |
it is linked to ovarian cysts with ↑ malignant potential |
|
F |
none of the above |
Scenario
4.
Which, if
any, of the following are true in relation to polyostotic fibrous dysplasia?
Option
List
|
A |
polyostotic means resembling parrot bone |
|
B |
polyostotic means resembling pigeon bone |
|
C |
polyostotic means affecting long bones |
|
D |
fibrous dysplasia refers to replacement of marrow by fibrous
tissue |
|
E |
PFD is a variant of osteomalacia |
|
F |
PFD may be unilateral |
|
G |
PFD is associated with a 1% risk of malignancy |
Scenario
5.
Which, if
any, of the following are true in relation to MCA?
Option
List
|
A |
hyperthyroidism is common |
|
B |
hypothyroidism is common |
|
C |
thyroid function is similar to those without MCA |
Scenario
6.
Which, if
any, of the following are true in relation to MCA?
Option
List
|
A |
excess growth hormone production
is common |
|
B |
inadequate growth hormone production is common |
|
C |
growth hormone production is similar to those without MCA |
Scenario
7.
Which, if
any, of the following is true in relation to MCA?
Option
List
|
A |
inheritance is autosomal dominant |
|
B |
inheritance is autosomal recessive |
|
C |
inheritance is X-linked dominant |
|
D |
inheritance is X-linked recessive |
|
E |
inheritance is multifactorial |
|
F |
it is not a hereditary disorder |
|
G |
it is not genetic |
|
H |
none of the above |
Scenario
8.
Which, if
any, of the following are true in relation to MCA?
Option
List
|
A |
renal artery stenosis is more common |
|
B |
renal cortex wasting is more common |
|
C |
renal phosphate wasting is more common |
|
D |
renal waisting is more common |
|
E |
none of the above. |
Scenario
9.
Approximately
what % of children born to women with MCAS will have MCAS?
Option
List
|
A |
0 |
|
B |
1 in 105 - 106 |
|
C |
1 in 104 |
|
D |
1 in 100 |
|
E |
1 in 50 |
|
F |
1 in 10 |
|
G |
1 in 2 |
|
H |
All |
5. EMQ. Uterine inversion
Abbreviations.
MROP: manual removal of placenta.
UI: uterine inversion.
Question
4.
How is uterine
inversion categorised and how are the categories defined?
This is not an EMQ and there is
no option list.
Question
5.
What is the approximate
incidence of UI?
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 10,000 |
|
F |
1 in 20,000 |
|
G |
1 in 100,00 |
Question
6.
What is the approximate
incidence of UI?
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 10,000 |
|
F |
1 in 20,000 |
|
G |
1 in 100,00 |
Question
7.
Is the incidence
of UI higher in less-well developed countries?
Option list.
|
A |
answer unknown |
|
B |
no |
|
C |
yes |
Question
8.
What is the approximate
incidence of UI during Caesarean section?
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 10,000 |
|
F |
1 in 20,000 |
|
G |
1 in 100,00 |
Question
9.
Which, if any, of the
following are described as risk factors for UI?
Option list.
|
A |
abruptio placenta |
|
B |
Caesarean section |
|
C |
Credé’s manoeuvre |
|
D |
fundal placenta |
|
E |
hydramnios |
|
F |
lax uterus |
|
G |
Marfan syndrome |
|
H |
mismanagement of the 2nd. stage of labour |
|
I |
mismanagement of the 3rd. stage of labour |
|
J |
oxytocic use |
|
K |
postpartum haemorrhage |
|
L |
short cord |
Question
10. What are the presenting features of UI? There is no option list.
Question
11. What is the immediate management of UI? There is no option
list.
Question
12. What procedure should be considered if the inversion is not
corrected during initial
management? There is no option list.
Question
13. What is Huntington’s procedure?.
Question
14. What is Haultain’s procedure ? There is no option list.
Question
15. What other procedures have been described? There is no
option list.
Question
16. What should be done to ensure the inversion does not recur?
There is no option list.
Question
17. What is the risk of recurrence in the next pregnancy? There
is no option list.
TOG questions. These are open
access.
Acute inversion of the uterus
With regard to acute uterine
inversion,
1 it is
spontaneous in up to 50% of cases. True / False
2 its incidence
is similar in most parts of the world. True / False
The associated risk factors for acute inversion of the
uterus include:
3 injudicious
traction on the umbilical cord. True / False
4 manual removal
of the placenta. True / False
5 uterine atony. True / False
6 fundal
implantation of a morbidly adherent placenta. True / False
7 placenta
praevia. True / False
Recognised features of acute inversion of the uterus
include:
8 haemorrhage. True / False
9 neurogenic
shock. True / False
10 severe abdominal
pain. True / False
11 postpartum
collapse. True / False
12 lump per
vaginam. True / False
Regarding management of acute uterine inversion,
13 the best
treatment is immediate repositioning of the uterus. True / False
14 the use of tocolysis
to promote uterine relaxation will aid uterine reposition. True / False
15 magnesium sulphate
is not used for tocolysis. True / False
16 in the presence
of shock, terbutaline is acceptable as a safe agent for uterine relaxation.
True / False
17 when halothane
is used to encourage uterine relaxation severe hypotension is a recognised complication.
True / False
With regard to future pregnancy,
18 the condition
carries a good prognosis if managed correctly. True / False
Regarding treatment of acute inversion,
19 in fewer than
3% of cases, women will need to undergo laparotomy. True / False
20 immediate reduction
is successful in approximately 50–80% of cases. True / False
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. Vulval
conditions. EMQ.
Choose the most
likely vulval condition from the option list. Each option can be used once,
more than once or not at all.
Abbreviations.
LP: lichen
planus.
LS: lichen
sclerosus.
Option list.
|
Acne |
|
|
B. |
Behçet’s
syndrome |
|
C. |
Candidiasis |
|
D. |
CIN 3 |
|
E. |
CIN1 |
|
F. |
Crohn’s
disease |
|
G. |
Dermatitis |
|
H. |
Eczema |
|
I. |
Genital warts |
|
J. |
Hidradenitis suppurativa |
|
K. |
Leprosy |
|
L. |
Lichen planus |
|
M. |
Lichen
sclerosis |
|
N. |
Lymphogranuloma
venereum |
|
O. |
Normal skin |
|
P. |
Psoriasis |
|
Q. |
Seborrhoeic
dermatitis |
|
R. |
Type 1
diabetes mellitus |
|
S. |
Type 2
diabetes mellitus |
|
T. |
Ulcerative
colitis |
|
U. |
VIN III |
|
V |
None of the
above |
Scenario 1. A 22 year-old woman attends the
colposcopy clinic after 2 smears showing minor
atypia. The cervical appearances
are of aceto-white with punctation.
Scenario 2. A 60-year old woman has an
erythematous rash of the vulva extending to the inner
thighs with small satellite lesions. A similar
rash is noted under the breasts. She is not known to have diabetes.
Scenario 3. A woman has a vulval rash with a
“lacy” appearance.
Scenario 4. A 35-year old woman attends is
noted to have a vulval fistula. She has a history of
episodic diarrhoea.
Scenario 5. A 25-year old woman attends the
gynaecology clinic with a history of intense vulval
itching and soreness. The appearances are of
diffuse erythema with excoriation. Diabetes, candidiasis and other local
infections have been eliminated by the GP.
Scenario 6. A 35-year old woman attends the
gynaecology clinic with vulvitis. She also has a scalp
rash. Clinical examination shows scaly, pink
patches with signs of excoriation. Skin samples grow Malassezia ovalis.
Scenario 7. A 40-year old woman has evidence
of chronic vulval ulceration. She has recently been
seen by a dermatologist for
mouth ulceration and has been started on thalidomide.
Scenario 8. An African woman of 35 years
attends the gynaecology clinic. She has a ten-year
history
of chronic vulval ulceration. Examination shows multiple, tender vulval and
pubic subcutaneous nodules, some of which have ulcerated.
Scenario 9. A Caucasian woman of 29 years
attends the gynaecology clinic with a chronic vulval
rash. Examination shows
erythematous areas with clearly defined margins and white scaly patches.
Scenario 10. A 30-year old woman attends the
gynaecology clinic with vulval itching. Examination
shows erythema of the labia minora and
perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium
with increased mitotic activity.
Scenario 11. Which condition is described in
GTG58 as presenting with polygonal lesions?
Scenario 12. Which condition is described in
GTG58 as presenting with “well-demarcated, glazed
erythema around the introitus?
Scenario 13. What is the aetiology of lichen planus?
There is no option list.
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