|
8 |
EMQ. Hepatitis C and pregnancy. HCV |
|
9 |
EMQ. Gestational trophoblastic
disease |
|
10 |
SBA. Quinolone antibiotics. |
|
11 |
EMQ. Family origin questionnaire |
|
12 |
EMQ. G6PDD & G6PD |
Abbreviations.
DAAD: Direct-acting, antiviral drug.
HBV: Hepatitis B
virus.
HCV: Hepatitis C
virus.
HCAb: Hepatitis C
antibody.
ROM: Rupture of
membranes.
Scenario 1.
Which, if any, of the following statements are true?
Option list.
|
A |
Hepatitis
kills more people world-wide than HIV |
|
B |
Hepatitis
kills more people world-wide than TB |
|
C |
Hepatitis B
kills more people world-wide that Hepatitis C |
|
D |
Hepatitis B
kills more people world-wide than TB |
|
E |
None of the
above |
Scenario 2.
Which, if any, of the following statements are true in
relation to HCV?
Option list.
|
A |
It is a DNA
virus |
|
B |
It is a RNA
virus |
|
C |
It is a
member of the Flaviviridae family |
|
D |
it is a
member of the Hepadnaviridae family |
|
E |
it is a
member of the Herpesviridae family |
|
F |
most infections
are due to genotypes 1 & 3 |
|
G |
most
infections are due to genotypes 2 & 4 |
Scenario 3.
What is the approximate prevalence of HCV infection in the UK?
Option list.
|
A |
0.1 per
1,000 |
|
B |
0.3 per
1,000 |
|
C |
0.5 per
1,000 |
|
D |
1 per 1,000 |
|
E |
3 per 1,000 |
|
F |
5 per 1,000 |
|
G |
10 per 1,000 |
|
H |
13 per 1,000 |
|
I |
15 per 1,000 |
|
J |
None of the
above |
Scenario 4.
What are the key aspects of the WHO’s Global Health Sector
Strategy in relation to
HCV
infection?
Option list.
|
A |
elimination
as a as a major public health threat by 2020 |
|
B |
elimination
as a as a major public health threat by 2030 |
|
C |
elimination as
a as a major public health threat by 2040 |
|
D |
reduction in
incidence by 50% by 2030 |
|
E |
reduction in
incidence by 75% by 2030 |
|
F |
reduction in
incidence by 80% by 2030 |
|
G |
reduction in
mortality by 50% by 2030 |
|
H |
reduction in
mortality by 65% by 2030 |
|
I |
reduction in
mortality by 70% by 2030 |
Scenario 5.
What is the incubation period of HCV infection?
Option list.
|
A |
6 weeks |
|
B |
2 months |
|
C |
up to 3
months |
|
D |
up to 4
months |
|
E |
up to 6
months |
|
F |
up to 12
months |
|
G |
none of the
above |
Scenario 6.
What symptoms are most common in acute HCV infection? There is no
option list.
Scenario 7.
How is acute HCV infection diagnosed?
Option list.
|
A |
clinically |
|
B |
presence of HCV
antibody |
|
C |
presence of HCV
RNA |
|
D |
none of the
above |
Scenario 8.
What proportion of those with acute HCV infection are asymptomatic?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
50% |
|
D |
60% |
|
D |
70% |
|
E |
> 80% |
Scenario 9.
When does continuing infection after initial exposure become defined
as chronic
infection?
Option list.
|
A |
after 6 weeks |
|
B |
after 2
months |
|
C |
after 3
months |
|
D |
after 4
months |
|
E |
after 6
months |
|
F |
after 12
months |
|
G |
none of the
above |
Answer. E. After 6 months.
Scenario 10.
Approximately how many of those with acute HCV infection will go on
to chronic
infection?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
40% |
|
D |
50% |
|
E |
>50% |
|
F |
>70% |
Scenario 11.
A woman is found to have HCV antibodies. Which, if any, of the
following statements
could
be true?
Option list.
|
A |
she could
have acute HCV infection |
|
B |
she could
have chronic infection |
|
C |
she could
have had HCV infection that has cleared spontaneously |
|
D |
she could
have had HCV infection that has responded to drug therapy |
|
E |
she could
have a false +ve test result |
|
F |
she could have
chronic HBV infection due to cross reaction with HBcAg |
|
G |
she is
immune to HCV |
|
H |
the
antibodies could result from HCV vaccine |
|
I |
the
antibodies could result from yellow fever vaccine |
|
J |
none of the
above |
Scenario 12.
Which, if any, of the following statements reflect current
thinking about the
mechanisms
of damage in chronic HCV infection?
Option list.
|
A |
hepatic
damage is proportional to the duration of HCV infection |
|
B |
hepatic
damage is a direct result of HCV replication within hepatocytes |
|
C |
hepatic
damage is proportional to the level of detectable HCV RNA in maternal blood |
|
D |
hepatic
damage is immune-mediated |
|
E |
hepatic
damage is due to progressive biliary tract infection, scarring and stenosis |
|
F |
hepatic damage
mostly occurs in women who abuse alcohol |
|
G |
hepatic
damage is worse in women with co-existing HIV infection |
|
H |
hepatitis D
is end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating
from the original name: ‘deadly-stage’ HCV disease |
Scenario 13.
How common is vertical transmission? There is no option list.
Scenario 14.
Which, if any, of the following statements are true in
relation to the hepatitides?.
|
A |
acute
hepatitis is notifiable |
|
B |
chronic
hepatitis is notifiable |
|
C |
hepatitis
A is notifiable as the main route of spread is faecal contamination of food
& water |
|
D |
hepatitis
D is notifiable as the main source of infection is infected food and water |
|
E |
hepatitis
E is notifiable as the main source of infection in the UK is raw or undercooked
pork |
|
F |
none
of the above |
Scenario 15.
What anti-viral treatment is recommended for pregnancy? There is
no option list.
Scenario 16.
Which, if any, of the following are true about Ribavirin?
Option list.
|
A |
it is the least
expensive of the new DAADs for HCV |
|
B |
it is the
least toxic of the new DAADs for HCV |
|
C |
it is the most
effective of the new DAADs for HCV |
|
D |
it is contraindicated
in pregnancy because of fears of teratogenicity |
|
E |
can
cause sperm abnormalities |
|
F. |
can persist
in humans for up to 6 months |
|
G. |
none of the
above |
Scenario 17.
A woman with chronic HCV wishes to breastfeed. What advice would
you give? There is no option list.
Scenario 18.
How is neonatal infection diagnosed? There is no option list.
Scenario 19.
How is neonatal infection treated? There is no option list.
Scenario 20.
Which, if any, of the following conditions is more common in women
with HCV infection?
|
A |
dermatitis herpetiformis |
|
B |
HELLP syndrome |
|
C |
obstetric cholestasis |
|
D |
postnatal depression |
|
E |
thrombocytopenia |
Scenario 21.
By how much is the risk of the condition in question 20 increased
in women with HCV?
Option list.
|
A |
by
a factor of 2 |
|
B |
by
a factor of 5 |
|
C |
by
a factor of 20 |
|
D |
by
a factor of 50 |
|
E |
none
of the above |
Scenario 22.
Which, if any, of the following statements is true about HCV and the Nobel Prize?
Option list.
|
A |
the
Nobel Prize was awarded to Alter, Houghton & Rice in 2020 |
|
B |
the
Nobel Prize was awarded to Alter, Hogg & Rice in 2020 |
|
C |
the
Nobel Prize was awarded to Alter, Houghton & Rees in 2020 |
|
D |
the
Nobel Prize was awarded to Change, Houghton & Rice in 2020 |
|
E |
the
Nobel Prize was awarded to Change, Hogg & Rice in 2020 |
|
F |
the
Nobel Prize was awarded to Change, Hogg & Barleycorn in 2020 |
|
G |
the
Nobel Prize has not been awarded for work on HCV |
9. EMQ. Gestational trophoblastic disease.
Abbreviations.
APSN: atypical
placental site nodule.
CCGTDS: Charing Cross
Gestational Trophoblast Disease Service.
CHC: combined
hormonal contraception.
CHM: complete
hydatidiform mole.
COC: combined
oral contraceptive.
EMA/CO: etoposide, methotrexate,
actinomycin D, cyclophosphamide, vincristine (oncovin).
EPT: epithelioid
tumour.
GI: gastro-intestinal.
GTD: gestational
trophoblastic disease.
GTDTC: gestational
trophoblastic disease treatment centre.
GTN: Gestational
trophoblastic neoplasia.
HM: hydatidiform
mole.
IFAP: interval
from antecedent pregnancy in months.
IPI: inter-pregnancy
interval.
LGA: large
for gestational age.
PHM: partial
hydatidiform mole.
POC: products
of conception.
PSTT: placental
site trophoblastic tumour.
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 |
|
|
false |
|
|
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.
GTG38 mentions one
thing as a standard of care. What is it?
There is not option list as
that would make it too easy.
Scenario 4.
What is the
incidence of GTD in the UK?
Scenario 5.
Which , if any, of
the following are true of complete moles?
|
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 6.
Which, if any, of
the following are true of partial moles?
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 7.
What is the ratio
of complete: partial moles?
Scenario 8.
What is the risk
of molar pregnancy at age < 15 compared to age 30?
Scenario
9.
What is the risk
of molar pregnancy at age > 45 compared to age 30?
Scenario 10.
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 11.
What is the risk
of molar pregnancy in a pregnancy after a partial mole?
Use the option list from the
previous question.
Scenario 12.
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 13.
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 |
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 15.
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 16.
When should invasive karyotype testing be
considered?
|
A |
twin pregnancy with complete
mole and a normal twin |
|
B |
uncertainty whether this is a
complete mole with a normal twin or possible partial mole |
|
C |
partial molar pregnancy |
|
D |
suspected mesenchymal hyperplasia
of the placenta |
|
E |
recurrent molar pregnancy |
|
F |
none of the above |
Scenario
17. 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
18. 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
19. 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 20.
What is the
management of suspected molar ectopic pregnancy?
|
A |
usual management for ectopic
pregnancy |
|
B |
usual management + any tissue
obtained sent to GTDTC |
|
C |
methotrexate followed by
usual surgical management |
|
D |
referral to GTDTC |
|
E |
none of the above. |
Scenario 21.
What is the
management of placental site trophoblastic tumour?
|
A |
referral to GTDTC |
|
B |
referral to GTDTC, methotrexate
and any tissue sent to GTDTC |
|
C |
referral to GTDTC,
hysterectomy and tissue sent to GTDTC |
|
D |
referral to and management by
GTDTC |
|
E |
none of the above. |
Scenario 22.
What is the
management of epitheliod trophoblastic tumour?
Use
the option list from Scenario 21.
Scenario 23.
What is the
management of placental site nodule?
Use the
option list from Scenario 21.
Scenario
24. What is the management of atypical placental site
nodule?
Use
the option list from Scenario 21.
Scenario 25.
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 26.
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 27.
Which, if any, of
the following statements are true in relation to RhD and GTD?
|
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 28.
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 29.
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 30.
What is the risk of persistent GTD after a complete
mole?
Scenario 31.
What is the risk of requiring chemotherapy
after a complete mole?
Scenario 32.
What is the risk of
persistent GTD after a partial mole?
Scenario 33.
What is the risk
of requiring chemotherapy after a partial mole?
Scenario 34.
What is the risk
of requiring chemotherapy with hCG level > 20,000 i.u. 4+1 weeks after
evacuation?
Scenario 35.
What is the overall
risk of requiring chemotherapy after molar pregnancy in the UK?
Scenario 36.
What is the risk
of requiring chemotherapy in the USA compared with the UK?
Scenario 37.
Which, if any, of the
following are grounds for offering chemotherapy after
hydatidiform mole?
|
A |
hCG > 10,000 IU/L > 4 weeks after evacuation |
|
B |
hCG > 20,000 IU/L > 4 weeks after evacuation |
|
C |
↑
hCG in two consecutive serum samples |
|
D |
hCG the same in two consecutive samples |
|
E |
raised, but falling, hCG level 3 months after evacuation |
|
F |
persistent bleeding 3 months after evacuation |
Scenario 38.
What are the risk
factors included in the FIGO scoring system?
Scenario 39.
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 40.
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 41.
Which, if any, of
the following statements are true about the use of folic acid / folinic
acid in methotrexate treatment regimens? There
may be > 1 correct 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 used 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 42.
When
is repeat surgical evacuation of the uterus appropriate?
Scenario
43. 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 44.
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 45.
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 46.
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 47.
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 48.
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 49.
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 50.
A woman had a complete mole in her first
pregnancy. She is pregnant for the second
time. What is the
risk of another molar pregnancy?
Scenario 51.
A woman has had two molar pregnancies. What
is the risk of molar pregnancy if she
becomes pregnant again?
Scenario 52.
A woman has had three molar pregnancies.
What is the risk of molar pregnancy if
she becomes pregnant again?
Scenario 53.
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 54.
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 55.
What proportion of women remain fertile after
treatment for GTN?
|
A |
80% |
|
B |
70% |
|
C |
60% |
|
D |
50% |
|
E |
40% |
Scenario 56.
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, so reproduced here. It is badly-worded,
mistaking GTD for GTN, 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
Answer. GTG38 says the risk of GTN requiring chemotherapy is about
13–16% for CHM and 0.5–1.0% for PHM, so both A & B are false, but B more so
than A.
10. Quinolone & fluoroquinolone antibacterial drugs
Abbreviations.
FQ: fluoroquinolone.
MHRA: UK’s Medicines and Healthcare products Regulatory
Agency.
SLE: systemic lupus erythematosus.
QUI: quinolone.
Question 1. Which, if any, of the following drugs
are QUIs or FQs?
Drugs
|
A |
cimetidine
|
|
B |
ciprofloxacin |
|
C |
nalidixic acid |
|
D |
neomycin |
|
E |
nitrofurantoin |
Option List
|
1 |
A + B |
|
2 |
A + B + C |
|
3 |
B + C |
|
4 |
B + C + D + E |
|
5 |
A + B + C + D + E |
Question 2. Which, if any, of the following
statements are true in relation to QUIs & FQs? This is
not a true
SBA as there may be more than one answer.
Statements
|
A |
nalidixic
acid is an older quinolone and is mainly excreted in the urine |
|
B |
ciprofloxacin is effective against most Gram +ve and
–ve bacteria and 1st- line treatment for pneumococcal pneumonia. |
|
C |
ciprofloxacin is contraindicated in pregnancy due to
the ↑ risk of neonatal haemolysis |
|
D |
many staphylococci are resistant to quinolones |
|
E |
quinolones are particularly useful in the treatment of
MRSA |
Question 3. Which was the first QUI antibiotic?
Option List
|
A |
acetylsalicylic
acid |
|
B |
nalidixic
acid |
|
C |
oxalic
acid |
|
D |
pipemidic
acid |
|
E |
none of
the above |
Question 4. How do QUI and FQ antibiotics work?
There is only one correct answer.
Option List
|
A |
impair
bacterial DNA coiling |
|
B |
impair
bacterial DNA binding |
|
C |
impair
bacterial RNA action |
|
D |
impair
bacterial mitochondrial action |
|
E |
none of
the above. |
Question 5. Which, if any, of the following QUIs
& FQs is not available for prescription in the UK.
There is
only one correct answer.
Option List
|
A |
ciprofloxacin |
|
B |
levofloxacin |
|
C |
nalidixic
acid |
|
D |
moxifloxacin |
|
E |
ofloxacin |
Question 6. Which, if any, of the following
statements are true in relation to the quinolones and
fluoroquinolones
and pregnancy? This is not a true SBA as there may be more than one answer.
Option list.
|
A |
FQs are
newer than QUIs with better systemic spread and efficacy |
|
B |
QUIs concentrate in urine but have a special affinity
for cartilage |
|
C |
consumption of a FQ in the 1st. trimester is
grounds for TOP |
|
D |
if an FQ is used, norfloxacin and ciprofloxacin should
be considered 1st. |
|
E |
FQs are linked to a risk of discolouration of the teeth
of offspring |
Question 7. Which of the following is true about
the warning issued by the FDA in 2008 in relation
to QUIs
& FQs?
Option List
|
A |
they may
cause congenital cartilage defects |
|
B |
they may
cause congenital deafness |
|
C |
they may
cause tendonitis and tendon rupture |
|
D |
they may
cause prolongation of the Q-T interval |
|
E |
none of
the above |
Question 8. Which of the following is true about
the warning issued by the FDA in 2011 in relation
to QUIs
& FQs?
Option List
|
A |
they may
cause exacerbation of eczema |
|
B |
they may
cause exacerbation of hypertension |
|
C |
they may
cause exacerbation of multiple sclerosis |
|
D |
they may
cause exacerbation of myasthenia gravis |
|
E |
they may
cause exacerbation of SLE |
Question 9. Which of the following is true about
the warning emphasised by the FDA in 2013 in
relation
to QUIs & FQs?
Option List
|
A |
they may
cause aortic dissection |
|
B |
they may
cause mitral stenosis |
|
C |
they may
cause pancreatitis |
|
D |
they may
cause peripheral neuropathy |
|
E |
they may
cause flare of SLE |
Question 10. FDA issued a warning in July 2016.
Which, if any, of the following were included? This
is not a
true SBA as there may be more than one answer.
Option List
|
A |
the
risks generally outweigh the benefits |
|
B |
QUIs
& FQs should not be used for acute
sinusitis, |
|
C |
QUIs
& FQs should not be used for exacerbation
of chronic bronchitis |
|
D |
QUIs
& FQs should not be used for uncomplicated
UTI |
|
E |
QUIs
& FQs may be useful for anthrax and plague |
Question 11. FDA issued a warning in July 2018
about the use of FQs in pregnancy. Which, if any, of
the
following were included in the reasons for its publication?
Option List
|
A |
to
strengthen previous warnings about hyperglycaemia and mental health risks |
|
B |
to
strengthen previous warnings about hypoglycaemia and mental health risks |
|
C |
to
strengthen previous warnings about the risk of ASD in the offspring |
|
D |
to
strengthen previous warnings about the risk of acute pancreatitis |
|
E |
to
strengthen previous warnings about the risk of PET |
Question 12. The FDA issued a warning in December 2018
about the use of FQs in pregnancy.
Which, if
any, of the following was included? This is an SBA with only one correct
answer.
Option List
|
A |
↑ risk of atrial
fibrillation |
|
B |
↑ risk of aortic
aneurysm and rupture |
|
C |
↑ risk of
mitral stenosis |
|
D |
↑ risk of
pulmonary hypertension |
|
E |
↑ risk of
ulcerative colitis |
11. Family origin questionnaire.
Abbreviations.
FBC: full blood count.
FOQ: UK Government’s Family Origin Questionnaire.
Hb: haemoglobin.
SCD: sickle cell disease.
SCT: sickle cell trait.
Question 1.
What is the main purpose of the Family
Origin Questionnaire?
Option list.
|
A |
to
identify illegal immigrants |
|
B |
to
identify those who are not entitled to free NHS care |
|
C |
to monitor
the degree to which different ethnic groups use the NHS |
|
D |
to screen for sickle
cell disease |
|
E |
to screen
for α-thalassaemia |
|
F |
none of
the above. |
Question 2.
What is a low-risk area?
Option list. An area in which the prevalence
of booking bloods +ve for sickle cell or thalassaemia is less than:
|
A |
1% |
|
B |
2% |
|
C |
5% |
|
D |
7.5% |
|
E |
10% |
Question 3.
What is a high-risk area?
Question 4.
What screening is offered in low-risk
areas?.
Option list.
|
A |
none |
|
B |
FOQ |
|
C |
maternal testing |
|
D |
maternal + paternal testing |
|
E |
none of the above |
Question 5.
What screening is offered in high-risk
areas?.
Option list.
|
A |
none |
|
B |
FOQ |
|
C |
maternal testing |
|
D |
maternal + paternal testing |
|
E |
none of the above |
Question 6.
What are listed by the NHS as ‘essential
elements’ of the FOQ?
Option list. There
is none to challenge your brain. But you should be able to work out what they
are if you go back to basics.
Question 7.
Whose ancestry is asked about in
the FOQ? There may be > one correct answer.
Option list.
|
A |
the
pregnant woman |
|
B |
the
woman’s partner/husband |
|
C |
the
biological father of the pregnancy |
|
D |
the postman
in case he delivered more than the mail |
|
E |
the queen |
|
F |
the woman’s
mother |
|
G |
the
woman’s father |
|
H |
the
woman’s siblings |
|
I |
none of
the above |
Question 8.
Which generations should be included?
Option list.
|
A |
the current
generation |
|
B |
the
current generation + the previous generation |
|
C |
the
current generation + 2 previous generations |
|
D |
the
current generation + 3 previous generations |
|
E |
the
current generation + as many previous generations as possible |
|
F |
none of
the above |
Question 9.
Who should complete the FOQ?
Option list.
|
A |
the woman |
|
B |
the
woman’s husband / partner |
|
C |
the
biological father of the pregnancy |
|
D |
the
midwife |
|
E |
the
obstetrician |
|
F |
an interpreter
if the woman & partner are not fluent in English |
|
G |
none of
the above |
Question 10.
What other responsibilities does the
person completing the FOQ have? There is no
option list so as not to make it too easy.
Question 11.
Which tick boxes are highlighted in
yellow on the FAQ.
Option list.
|
A |
those that
must be completed |
|
B |
those that
suggest a possible ↑ risk of neonatal jaundice |
|
C |
those
that suggest a possible ↑ risk of HepB |
|
D |
those that
suggest a possible ↑ risk of SCD. SCT or
thalassaemia |
|
E |
those
showing areas with a ↑ risk of having SCD. SCT or
thalassaemia |
|
F |
none of the
above |
Question 12.
What is the significance of the red
‘hash’ mark # that appears alongside some of
the
boxes?
Option list.
|
A |
the box
that must be completed |
|
B |
just
decoration to make the form more pleasing to the eye |
|
C |
denotes area
with ↑ risk of bilharzia |
|
D |
denotes area
with ↑ risk of falciparum malaria |
|
E |
denotes area
with ↑ risk of α-thalassaemia |
|
F |
denotes area
with ↑ risk of β-thalassaemia |
|
G |
none of
the above |
Question 13.
A woman books at 10 weeks in her 1st. pregnancy. Her husband in Turkish and
healthy.
What screening for sickle cell and thalassaemia
should be offered?
Option list.
|
A |
screening
depends on whether the area is high or low risk |
|
B |
screening
depends on whether the FOQ shows high or low risk |
|
C |
the
husband should first be screened |
|
D |
the woman
should be screened using Hb and red cell indices |
|
E |
the woman
should be screened using electrophoresis |
|
F |
none of
the above |
Question 14.
A woman books at 10 weeks in her 1st. pregnancy. Her husband is English and
healthy.
What screening for sickle cell and thalassaemia
should be offered?
Option list.
|
A |
screening
depends on whether the area is high or low risk |
|
B |
screening
depends on whether the FOQ shows high or low risk |
|
C |
the
husband should first be screened |
|
D |
the woman
should be screened using Hb and red cell indices |
|
E |
the woman
should be screened using electrophoresis |
|
F |
none of the
above |
Question 15.
A woman books at 10 weeks gestation in
a low-risk area. She does not wish to
complete the FOQ. Which, if any, of the following
are recommended.
Option list.
|
A |
accept her wishes if you feel
she is fully informed |
|
B |
give her a good slapping for
being stupid |
|
C |
offer blood tests to screen for
sickle and haemoglobinopathy |
|
D |
refer her to a psychiatrist |
|
E |
tell her to have a serious
think about the potential benefits |
|
F |
none of the above. |
12. Glucose-6-phosphate dehydrogenase
deficiency.
Abbreviations.
G6PD: glucose-6-phosphatase
deficiency
G6PDD: glucose-6-phosphate
dehydrogenase deficiency
Scenario 23.
What is G6PDD?
There is no option list.
Scenario 24.
What categories
are applied to G6PDD by the WHO? There is no option list.
Scenario 25.
What other names
are commonly used for G6PDD? There is no option list.
Scenario 26.
Which, if any, of
the following statements are true in relation to G6PDD?
Option list.
|
A |
it is the most common enzyme defect in humans |
|
B |
it is the most common RBC enzyme defect in humans |
|
C |
it is the most common cause of neonatal jaundice |
|
D |
it is the most common cause of sickling crises |
|
E |
is a glycogen storage disorder |
|
F |
most of those with G6PDD have chronic anaemia |
Scenario 27.
Approximately how
many people are affected by G6PDD worldwide?
Option list.
|
A |
1,000 million |
|
B |
800 million |
|
C |
600 million |
|
D |
400 million |
|
E |
100 million |
|
F |
50 million |
|
G |
20 million |
|
H |
10 million |
|
I |
none of the above |
Scenario 28.
Which population
has the highest prevalence of G6PDD?
Option list.
|
A |
American Amish |
|
B |
Asians |
|
C |
Ashkenazi Jews |
|
D |
Eskimos |
|
E |
Irish Travellers |
|
F |
Kurdistan Jews |
|
G |
Sub-Saharan Africans |
|
H |
Turks |
|
I |
Uzbekistan albinos |
|
J |
None of the above |
Scenario
29. Which, if any, of the following is the mode of inheritance
of G6PDD?
Option list.
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Scenario
30. Approximately how many mutations of the G6PDD gene have
been identified?
Scenario
31. Which, if any, of the following is the mode of inheritance
of G6PD?
Option list.
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Scenario 32.
Which foodstuff
can trigger haemolysis in G6PDD and gives us one of the alternative
names for the condition? What
is the common name for the foodstuff? Which pest particularly attacks it? There
is no option list.
Scenario 33.
Which, if any, of
the following drugs may cause haemolysis in those with G6PDD?
Option list.
|
A |
aspirin |
|
B |
diphenhydramine |
|
C |
nalidixic acid |
|
D |
nitrofurantoin |
|
E |
paracetamol |
|
F |
phenytoin |
|
G |
sulphamethoxazole |
|
H |
trimethoprim |
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