|
27 |
Role-play. Break bad news. Non-viable
early pregnancy. |
|
28 |
EMQ.
Kallmann’s syndrome |
|
29 |
SBA.
Tamoxifen |
|
30 |
EMQ. Listeriosis and pregnancy |
|
31 |
SBA. Lynch syndrome |
|
32 |
EMQ. Flu and pregnancy |
27. Role-play. Break bad news. Non-viable early
pregnancy.
Candidate’s instructions.
You are the SpR in the ante-natal clinic. The consultant
who was in clinic has been asked to assist her consultant colleague in the
labour ward theatre. She is unlikely to return for some time as the case is one
of massive PPH and hysterectomy may be necessary.
One of the midwives asks you to see Jane Brown, who has
just had a scan in the early pregnancy unit.
She is primigravid and the gestation is 8 weeks. She has had some
bleeding.
An ultrasound scan = IUP.
CRL = 12 mm. No fetal heart
activity. No adnexal masses.
28. Kallmann’s syndrome
Abbreviations.
Ks: Kallmann’s syndrome
Scenario 1.
Which of the following might be
included in descriptions of Kallmann’s syndrome?
Option list.
|
A |
hypogonadotrophic hypogonadism |
|
B |
hypogonadotrophic hypogonadism + anosmia |
|
C |
hypogonadotrophic hypogonadism + anosmia +
colour-blindness. |
|
D |
hypogonadotrophic hypogonadism due to uterine agenesis |
Scenario 2.
Lead in.
Which, if any, of the following are features of the Kallmann
phenotype?
|
A |
absent or minimal breast development |
|
B |
aortic stenosis |
|
C |
blue eyes |
|
D |
blue hair |
|
E |
hot flushes |
|
F |
short stature |
|
G |
tall stature |
|
H |
vaginal agenesis |
|
I |
none of the above |
Scenario 3.
How common is Kallmann’s syndrome and what is the
female: male ratio?
|
A |
1 in 1,000 and F:M ratio 1:1 |
|
B |
1 in 5,000 and F:M ratio 1:1 |
|
C |
1 in 10,000 and F:M ratio 1:4 |
|
D |
1 in 50,000 and F:M ratio 1:4 |
|
E |
1 in 100,000 and F:M ratio 1:8 |
|
F |
1 in 250,000 and F:M ration 1:10 |
Scenario 4.
What is the most common mode of
inheritance of Ks?
Option list.
|
A |
hypogonadotrophic hypogonadism |
|
B |
hypogonadotrophic hypogonadism + anosmia |
|
C |
hypogonadotrophic hypogonadism due to uterine agenesis |
|
D |
autosomal dominant |
|
E |
autosomal recessive |
|
F |
X-linked recessive |
|
G |
new mutation of the ANOS1 gene |
|
H |
the most common mode of inheritance is not known |
Scenario 5.
How is Kallmann’s syndrome
diagnosed?
|
A |
abdominal and pelvic
ultrasound scan |
|
B |
cell-free fetal DNA |
|
C |
chromosome analysis |
|
D |
CT scan of hypothalamus /
pituitary |
|
E |
MR scan of hypothalamus /
pituitary |
|
F |
none of the above. |
Scenario 6.
How is Kallmann’s syndrome
treated initially?
Which of the following
statements are true?
Option list.
|
A |
GnRH analogue depot |
|
B |
pulsatile GnRH therapy |
|
C |
combined oral contraceptive |
|
D |
counselling & education
re gender re-assignment |
|
E |
depot progestogen |
|
F |
none of the above |
Scenario 7.
A woman was diagnosed with
Kallmann’s syndrome at 16 and had successful initial treatment. She is now 25,
married and wishes to have a pregnancy. She has had pre-pregnancy assessment
and counselling. Which of the following should be considered?
|
A |
GnRH analogue depot |
|
B |
induction of ovulation with
clomiphene |
|
C |
gonadotrophin therapy |
|
D |
pulsatile GnRH therapy |
|
E |
none of the above |
29. Tamoxifen
Abbreviations.
HER2: Human epidermal growth factor
receptor 2.
SERM: selective oestrogen receptor
modulator
Question 1. What kind of drug is Taxoxifen?
Option List
|
A |
aromatase inhibitor |
|
B |
GnRH analogue |
|
C |
selective
anti-oestrogen |
|
D |
selective oestrogen-receptor blocker |
|
E |
selective oestrogen receptor modulator. |
Question 2. Which of the following are current indications for using
tamoxifen?
Option List
|
A |
reducing risk of development of breast cancer in women
+ve for BRCA1 & 2 |
|
B |
treatment
of oestrogen receptor –ve breast cancer |
|
C |
treatment of oestrogen receptor +ve breast cancer |
|
D |
treatment of HER2 –ve breast cancer |
|
E |
treatment of HER2 +ve breast cancer |
Question 3. How do aromatase inhibitors work?
Option List
|
A |
negate the olfactory-ovarian feedback loop’s effects |
|
B |
reduce DNA replication and cell division |
|
C |
reduce
FSH production and oestrogen levels in premenopausal women |
|
D |
reduce production of oestrogen from androgen |
|
E |
none of the above |
Question 4. How do SERMS work?
Option List
|
A |
competitive
binding to oestrogen-receptors |
|
B |
competitive binding to oestrogen-receptors in granulosa
cells |
|
C |
competitive binding to oestrogen-receptors in the
anterior pituitary |
|
D |
increased oestrogen receptor apoptosis |
|
E |
none of the above |
Question 5. What have been the main uses of tamoxifen in gynaecology?
Option List
|
A |
peri and
postmenopausal oestrogen replacement therapy |
|
B |
contraception, though no longer used |
|
C |
ovulation induction as an alternative to clomifene |
|
D |
osteoporosis prevention in premature ovarian
insufficiency |
|
E |
none of the above |
Question 6. Which, if any, of
the following are recognised side-effects of tamoxifen?
Option List
|
A |
↑ risk of
cataract and retinopathy |
|
B |
↑ risk of
endometrial pathology, including cancer |
|
C |
↑
risk of thrombocytopenia |
|
D |
↑
risk of thrombosis and VTE by a factor of 2-3 |
|
E |
menopausal
symptoms: hot flushes & sweats |
Question 7. Which, if any, of the following statements are true in
relation to the risk of uterine
cancer in women using Tamoxifen?
Option List
|
A |
the
overall risk of endometrial cancer is
increased by a factor of 2-3 |
|
B |
the overall risk of endometrial cancer is increased by
a factor of 5-10 |
|
C |
the risk
of endometrial cancer is not
increased in postmenopausal women |
|
D |
the risk of endometrial cancer is increased by 50% in
premenopausal women |
|
E |
the risk is endometrial cancer is increased, but the
risk of sarcoma is not |
Question 8. Which, if any, of the following statements are true in
relation to the risk of thrombosis
and VTE in women using Tamoxifen?
Option List
|
A |
the risk
is increased by a factor of 1.5-2 |
|
B |
the risk is increased by a factor of 2-3 |
|
C |
the risk is increased by a factor of 5-10 |
|
D |
the risk increases with age |
|
E |
the risk increases if chemotherapy is given at the same
time |
Question 9. Which, if any, of the following statements are true?
Option List
|
A |
tamoxifen
is metabolised by cytochrome P450 34A |
|
B |
tamoxifen is metabolised by cytochrome P450 34B |
|
C |
inducers of the relevant P450 enzyme reduce tamoxifen
levels |
|
D |
inducers of the relevant P450 enzyme reduce the
efficacy of tamoxifen |
|
E |
fluoxetine is a potent inducer of the relevant P450
enzyme |
Question 10. Which, if any, of the following statements are true?
Option List
|
A |
endoxifen
is a main active metabolite of tamoxifen |
|
B |
cytochrome P450
2D6 reduces endoxifen levels |
|
C |
cytochrome P450
2D6 inducers can reduce tamoxifen’s efficacy |
|
D |
fluoxetine is a potent inducer of cytochrome P450 2DS |
|
E |
paroxetine is a potent inducer of cytochrome P450 2DS |
30. Listeriosis
Lm: Listeria monocytogenes.
TOC: test of cure.
Scenario
1.
Which organism is
responsible for human listeriosis?
|
A |
Listeria diogenys |
|
B |
Listeria frigidaire |
|
C |
Listeria hominis |
|
D |
Listeria monocytogenes |
|
E |
Listeria xenophylus |
Scenario
2.
Which, if any, of
the following statements are true about Lm?
Option list.
|
A |
it is a small, Gram -ve rod |
|
B |
it is a Gram +ve coccus |
|
C |
it is flagellated |
|
D |
it has no cell wall |
|
E |
it is an obligate aerobe |
|
F |
it functions within host cells |
|
G |
it can easily be mistaken for commensal organisms |
|
H |
none of the above |
Scenario
3.
Which of the
following are associated with an increased risk of contracting LM?
|
A |
age > 60 years |
|
B |
age < 1 year |
|
C |
blond hair |
|
D |
pregnancy |
|
E |
strabismus |
Scenario 4.
Which of the
following are true of the susceptibility of pregnant women to Lm?
Option list.
|
A |
they are not more susceptible |
|
B |
they are more susceptible x 2 |
|
C |
they are more susceptible x 5 |
|
D |
they are more susceptible x 10 |
|
E |
they are more susceptible x 20 |
|
F |
they are > 20 times more susceptible |
|
G |
none of the above. |
Scenario
5.
When does Lm most
often occur?
Option list.
|
A |
1st. trimester |
|
B |
2nd. trimester |
|
C |
3rd trimester |
|
D |
1st. + 2nd. trimesters |
|
E |
2nd. + 3rd trimesters |
|
F |
all trimesters equally |
|
G |
puerperium |
|
H |
none of the above |
Scenario
6.
What is the
incubation period for Lm?.
Option list.
|
A |
7±3 days |
|
B |
7±5 days |
|
C |
10±3 days |
|
D |
10±5 days |
|
E |
14±3 days |
|
F |
14±5 days |
|
G |
none of the above. |
Scenario
7.
What is the
significance of Granulomatosis Infantisepticum ?
Option list.
|
A |
it is a
fabrication by the author and of no significance |
|
B |
it is
pathognomonic of Lm infection |
|
C |
it is the cause
of vertical transmission of Lm |
|
D |
I refuse to
answer Latin questions as they make me think of Boris Johnson |
|
E |
none of the above |
Scenario
8.
Which of the
following are accurate about cervico-vaginal infection? This is not a true
EMQ as there may be >1 correct answer.
Option list.
|
A |
Lm is as often found in the cervix as in the bowel. |
|
B |
Lm is as often found in the vagina as in the bowel. |
|
C |
Lm is less often
found in the cervix than in the bowel. |
|
D |
Lm is less often
found in the vagina than in the bowel. |
|
E |
Lm is more often
found in the cervix than in the bowel. |
|
F |
Lm is more often
found in the cervix than in the bowel. |
|
G |
no one knows and no one cares |
Scenario
9.
A GP phones about
a primigravida at 28 weeks. She has possibly ingested food
contaminated by Lm. She is asymptomatic and afebrile. What
advice will you give?
Option list.
|
A |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
H |
admit to hospital for investigation and intensive
treatment if Lm infection found |
|
I |
none of the above |
Scenario
10. A GP phones about a primigravida at 28 weeks. She has
possibly ingested food
contaminated by Lm. She has mild symptoms but is afebrile.
What advice will you give?
Option list.
|
A |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
H |
admit to hospital for investigation and intensive
treatment if Lm infection found |
|
I |
none of the above |
Scenario
11. A GP phones about a primigravida at 28 weeks. She has
possibly ingested food
contaminated by Lm. She is symptomatic and her temperature
is 38.2oC. What advice will you give?
Option list.
|
A |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC |
|
H |
admit to hospital for investigation and intensive
treatment if Lm infection found |
|
I |
none of the above |
Scenario
12. Which, if any, of the following would be appropriate for
consideration as 1st. line
treatment of Lm in pregnancy? This is not a true EMQ as
there may be more than 1 correct answer.
Option list.
|
A |
ampicillin |
|
B |
ampicillin + gentamycin |
|
C |
ampicillin + streptomycin |
|
D |
amoxicillin + clavulanic acid |
|
E |
clarithromycin |
|
F |
erythromycin |
|
G |
erythromycin + metronidazole |
|
H |
trimethoprim |
|
I |
none of the above |
Scenario
13. Is listeriosis a notifiable infection in the UK? Yes/No.
31. SBA.
Lynch syndrome
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
MLH: mutL-homolog
family of DNA, mismatch repair genes.
MMR: mismatch
repair.
MSH: mutS
homolog family of DNA, mismatch repair genes.
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 most 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 Ls?
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 |
none of the above |
Question 8.
Which 2 cancers are most likely in women with Lynch syndrome?
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 |
|
E |
|
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 – just write down everything you know.
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 |
With regard to Lynch
syndrome,
1. loss of mismatch repair protein expression
on immunohistochemistry of cancer is diagnostic.
True/False
2. most carriers of the mutation associated
with the syndrome know they have the condition.
True/False
3. the first cancers associated with the
syndrome are predominantly endometrial or ovarian cancers. True/False
4. when cancers occur, they have in them an unusually
high immune infiltrate. True/False
With regard to testing for Lynch syndrome,
5. consent must be sought before definitive germline
testing for Lynch syndrome by a trained professional. True/False
6. immunohistochemical staining of tumours for
the mismatch repair proteins or microsatellite instability analysis are recognised
ways of screening cancers for characteristics suggestive of the syndrome. True/False
7. the National Institute for Health and Care Excellence
endorses universal screening of colorectal cancer patients for Lynch syndrome. True/False
8. most gynaecological cancers found to have aberrant
mismatch repair immunohistochemical staining will be in those with the
syndrome. True/False
9. the addition of MLH1 promotor hypermethylation
testing in a Lynch syndrome diagnostic pathway improves specificity. True/False
Regarding gynaecological surveillance in women with Lynch
syndrome,
10. there is strong evidence to recommend its use.
True/False
11. this should be offered to women around 25 years
of age. True/False
12. counselling should include education on red flag
symptoms of cancer and risk-reducing surgery.
True/False
With regard to risk-reducing strategies for women with Lynch
syndrome,
13. hysterectomy is strongly recommended for all those
with the syndrome. True/False
14. the timing of risk-reducing surgery depends on
the syndrome gene. True/False
15. where possible, a laparoscopic approach is
recommended. True/False
16. aspirin is not recommended as a means of reducing
their overall cancer risk. True/False
Regarding Lynch syndrome-associated gynaecological
cancers,
17. endometrial types that arise as a result of
the syndrome have a poorer prognosis than sporadic types. True/False
18. checkpoint inhibition of the PD-1/PD-L1 pathway
has been shown to be very effective in mismatch repair-deficient cancers. True/False
19. vaccination against these cancers is currently
the focus of research. True/False
20. the Manchester International Consensus guideline
is a useful reference for gynaecologists managing women with these cancers. True/False
32. EMQ. Flu and pregnancy
Abbreviations.
GB19: The DOH’s book: “Immunisation against infectious disease”,
commonly known as the “Green Book”. Chapter_19_influenza_October_2020.
DOH: Department of Health
JCVI: Joint Committee on Vaccination and Immunisation
PHE: Public Health England.
WHO: World Health Organisation
Question 1. What did MBRRACE say about flu & pregnancy in its first report in
2014?
Option List
|
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?
Option List
|
A |
3 |
|
B |
5 |
|
C |
10 |
|
D |
15 |
|
E |
>100 |
Question 3. Why can’t we have a universal flu vaccine?
List of statements.
|
A |
The main
surface antigens are haemagglutinin and neuraminidase |
|
B |
The main surface antigens are haemolysin and
neuroxidase |
|
C |
The main surface antigens change frequently rendering
existing vaccines impotent |
|
D |
The main core antigens change frequently, rendering
existing vaccines impotent |
|
E |
The big drug companies avoid making a universal vaccine
for financial reasons. |
Question 4. When is flu’ most often a problem in the UK?
Option List
|
A |
Spring |
|
B |
Summer |
|
C |
Autumn |
|
D |
Winter |
|
E |
None of the above. |
Question 5. How is flu spread?
Option List
|
A |
via
aerosol or droplets from respiratory tract of an infected person |
|
B |
via aerosol or droplets from respiratory tract 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
|
A |
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
|
A |
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
|
A |
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
|
A |
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
|
A |
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 recommended for pregnancy has no live viral
material and all pregnant women are encouraged to have the seasonal vaccine |
|
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
|
A |
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 protection against
the H1N1 virus?
Option List
|
A |
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.
|
A |
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 |
Question 14. What is the estimated uptake of flu vaccination by pregnant women in the
UK?
Pick the
best option from the following list.
Option List
|
A |
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 the years
2012 - 2013?
Pick the
best option from the following list.
Option List
|
A |
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, if any, of the following statements
is true?
Option List
|
A |
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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