21 November 2022.
|
13 |
Role-play. Break bad news. Non-viable
early pregnancy. |
|
14 |
EMQ. Hepatitis E and pregnancy. HEV |
|
15 |
EMQ. The CLASP trial. |
|
16 |
EMQ. Mycoplasma genitalium |
|
17 |
EMQ. Montgomery & consent |
13. Role-play. 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.
14. Hepatitis E. EMQ.
Questions.
Question
1.
What is the most
common cause of acute viral hepatitis in the UK?
Option list.
|
A |
hepatitis A virus |
|
B |
hepatitis B virus |
|
C |
hepatitis C virus |
|
D |
hepatitis D virus |
|
E |
hepatitis E virus |
|
F |
herpes simplex virus |
|
G |
HIV |
Question
2.
Which, if any, of
the following are correct about HEV.
Option list.
|
A |
it is a DNA virus |
|
B |
it belongs to the genus Hippieviridae |
|
C |
it belongs to the genus Hepeviridae |
|
D |
it belongs to the genus Hoppieviridae |
|
E |
there are six main genotypes |
|
F |
genotype 3 is the one of greatest importance in the UK |
|
G |
the main reservoir of genotype 3 is intensively-reared
chickens |
|
H |
the main reservoir of genotype 3 is domestic cats |
|
I |
a vaccine exists but is only licensed in Russia |
|
J |
none of the above |
Question
3.
Which, if any, of
the following statements about HEV and pregnancy are true?
Option list.
|
A |
pregnant women are more susceptible to HEV infection |
|
B |
pregnant women are more likely to develop serious
disease that the non-pregnant |
|
C |
the main risk is neonatal death due to vertical
transmission |
|
D |
the main risk is maternal death |
|
E |
the risk of maternal death is highest with infection in
the 1st. trimester |
|
F |
↑ rates of preterm birth have been
reported |
|
G |
↑
rates of stillbirth have been reported |
15. CLASP trial.
Question
4. Which, if
any, of the following is accurate in relation to ‘CLASP’.
Option list.
|
A |
Clap
loudly and Santa will Provide Lavishly |
|
B |
Clinical
liaison for Antenatal Service Personnel |
|
C |
Clinical
Log for Anticoagulant Specialists in Pregnancy |
|
D |
Collaborative
Low-dose Aspirin Study in Pregnancy |
|
E |
Conditional
Licence for Antenatal Service Providers |
|
F |
None of
the above |
Question
5. What were the main conclusions of the CLASP trial?
Question
6. What have been the main effects of the CLASP trial on
clinical practice?
16. Mycoplasma genitalium.
Many of the questions are not true EMQs as they have more
than one correct answer. I have tried to include all the facts I think might
feature in the exam and packing more than one into a question reduces the total
number of questions and makes the document a bit more manageable. It also
reduces the amount of typing I have to do.
Abbreviations.
BASHHMG: British Association for Sexual Health and HIV’s “National
guideline for the management of infection with Mycoplasma genitalium”. 2018
CT: Chlamydia trachomatis.
MG: Mycoplasma genitalium.
MP: Mycoplasma pneumoniae.
MSSU: mid-stream specimen of urine.
NAAT: nucleic acid amplification test.
NCSP: National
Chlamydia Screening Programme.
NHSCS: NHS
Cervical Screening Programme
PID: pelvic inflammatory disease.
STI: sexually-transmitted infection.
EMQ as there may be more than one correct answer.
Option list.
|
A |
MG was first
isolated in 2001 |
|
B |
MG was first
isolated from men with non-gonococcal urethritis (NGU) |
|
C |
MG belongs to
the Cutemollies class |
|
D |
MG is the
smallest known yeast with the ability to self-replicate |
|
E |
MG is the
smallest known bacterium with the ability to self-replicate |
|
F |
MG has an
unusual, double-layered cell wall |
|
G |
MG has an
unusual protrusion at one end |
|
H |
MG’s protrusion
enables it to adhere to epithelial cells |
|
I |
MG’s protrusion
enables it to invade epithelial cells |
|
J |
MG is best seen
on a Gram stain |
Scenario
2.
Which, if any, of the
following statements are true in relation to Mycoplasmas?
Option list.
|
A |
are the largest known bacteria |
|
B |
have no cell wall |
|
C |
have no nuclei |
|
D |
are resistant to ß-lactam antibiotics |
|
E |
are resistant to sulphonamides |
|
F |
colonies show a ‘scrambled egg’ appearance on culture
on agar |
|
G |
particularly affect mucosal surfaces. |
Scenario
3.
Which, if any, of
the following statements are true in relation to Mg?
Option list.
|
A |
when the organism was originally found, culture took 50
days |
|
B |
Mg is facetious |
|
C |
Mg is a facultative aerobe |
|
D |
Mg is a facultative anaerobe |
|
E |
Mg is a facultative aerobe & anaerobe |
|
F |
Mg is fastidious |
Scenario
4.
Which, if any, of
the following are true in relation to the approximate prevalence of
MG?
Option list.
|
A |
it is ~ 0.1% |
|
B |
it is ~ 1.0% |
|
C |
it is ~ 5.0% |
|
D |
it is ~ 5-10% |
|
E |
it is > 10% |
|
F |
none of the above |
Scenario
5.
Which, if any, of
the following is true in relation to screening for MG? This is a true
EMQ with only one correct
answer.
Option list.
|
A |
screening for MG is now included in the NCSP |
|
B |
screening for MG is now offered as part of the NHSCS |
|
C |
screening should be offered to all sexually active
women < 30 years old |
|
D |
screening should only be offered to those with symptoms
suggestive of infection |
|
E |
screening should be offered to all partners of those
with MG infection |
|
F |
none of the above |
Scenario
6.
Which, if any, of
the following are included in BASHHMG as risk factors for infection
with MG?
Option list.
|
A |
Cigarette smoking |
|
B |
Multiple dancing partners |
|
C |
Multiple sexual partners |
|
D |
Non-white ethnicity |
|
E |
Younger age |
|
F |
None of the above |
Scenario
7.
Which of the
following statements is true in relation to MG and co-infection with
other organisms?
Option list.
|
A |
MG excretes bactericidal toxins and co-infection is
rare |
|
B |
MG co-infection is most often with chlamydia |
|
C |
MG co-infection is most often with E. coli |
|
D |
MG co-infection is most often with HIV |
|
E |
MG co-infection is most often with TB |
|
F |
None of the above |
Scenario
8.
Which of the
following statements is true in relation to MG and men?
Option list.
|
A |
It is the most common cause of NGU |
|
B |
It is the most common cause of epididymitis |
|
C |
It is the most common cause of prostatitis |
|
D |
It is a well-recognised cause of male sub-fertility |
|
E |
Most men with MG infection are asymptomatic |
|
F |
None of the above |
Scenario
9.
Which, if any, of
the following statements are true in relation to MG and women?
Option list.
|
A |
MG is linked to an ↑
risk of cervicitis |
|
B |
MG is linked to an ↑
risk of endometritis |
|
C |
MG is linked to an ↑
risk of female infertility |
|
D |
MG is linked to an ↑
risk of miscarriage |
|
E |
MG is linked to an ↑
risk of otitis media |
|
F |
MG is linked to an ↑
risk of pelvic inflammatory disease |
|
G |
MG is linked to an ↑
risk of postcoital bleeding |
|
H |
MG is linked to an ↑
risk of postmenopausal bleeding |
|
I |
MG is linked to an ↑
risk of preterm birth |
|
J |
MG is linked to an ↑
risk of damage to Fallopian tube cilia |
|
K |
MG is linked to an ↑
risk of puerperal psychosis |
|
L |
MG is linked to an ↑
risk of puerperal sepsis |
|
M |
Most infected women are asymptomatic |
|
N |
None of the above |
Scenario
10. Which, if any, of the following statements are true in
relation to current concerns
about Mg?
Option list.
|
A |
It could become a ‘superbug’, resistant to most
antibiotics, within a decade |
|
B |
Infection is often misdiagnosed as chlamydia with ↑ risk of antibiotic resistance |
|
C |
‘superbug’ status would be likely to lead to an ↑ in renal failure |
|
D |
‘superbug’ status would be likely to lead to an ↑ in female infertility |
|
E |
‘superbug’ status would be likely to lead to an ↑ in male infertility |
Scenario
11. Which, if any, of the following are used in the recommended
test for MG infection in
women?
Option list.
|
A |
blood testing for MG IgG |
|
B |
blood testing for MG IgM |
|
C |
cervical smears checked microscopically for the
diagnostic intracellular inclusion bodies |
|
D |
culture and sensitivity of cervical swab specimens
using MG-specific culture medium |
|
E |
culture and sensitivity of 1st. void MSSU using MG-specific
culture medium |
|
F |
culture and sensitivity of vaginal swab specimens using
MG-specific culture medium |
|
G |
NAATs that detect the MG G-antigen |
|
H |
NAATs that detect MG DNA |
|
I |
NAATs that detect MG RNA |
|
J |
serum testing for MG-specific antigen |
|
K |
vaginal swabs taken by the woman |
|
L |
none of the above |
Scenario
12. Which, if any, of the following statements are true in
relation to testing for antibiotic
resistance after initial tests
are +ve for MG?
Option list.
|
test for
resistance to cephalosporins |
|
|
B |
test for
resistance to macrolides |
|
C |
test for
resistance to penicillin |
|
D |
test for
resistance to quinolones |
|
E |
test for
resistance to macrolides |
|
F |
test for
resistance to streptomycin |
|
F |
test for
resistance to sulphonamides |
|
F |
test for
resistance to tetracyclines |
|
G |
None of the
above |
Scenario 13.
Which, if any, of
the following statements are true in relation to estimates of
antibiotic resistance in current strains of MG in the UK?
Option list.
|
A |
20% are
resistant to cephalosporins |
|
B |
40% are
resistant to macrolides |
|
C |
50% are
resistant to penicillin |
|
D |
50% are
resistant to quinolones |
|
E |
10% are
resistant to streptomycin |
|
F |
90% are
resistant to sulphonamides |
|
F |
40% are
resistant to tetracyclines |
|
F |
None of the
above |
Scenario
14. Which, if any, of the following is BASHHMG’s recommended 1st.
line treatment of
uncomplicated MG?
Option list.
|
A |
azithromycin 1 gram daily for 7 days |
|
B |
doxycycline 100 mg twice daily for 7 days |
|
C |
doxycycline 100 mg twice daily for 10 days |
|
D |
doxycycline 100 mg twice daily for 7 days |
|
E |
doxycycline 100 mg twice daily for 7 days then
azithromycin 1 gram daily for 2 days |
|
F |
moxifloxacin 400mg orally once daily for 7 days |
|
G |
moxifloxacin 400mg orally once daily for 10 days |
|
H |
none of the above |
Scenario
15. Which, if any, of the following is BASHHMG’s recommended 1st.
line treatment of
complicated MG?
Option list.
|
A |
doxycycline 100 mg twice daily for 10 days |
|
B |
doxycycline 100 mg twice daily for 14 days |
|
C |
moxifloxacin 400mg orally once daily for 10 days |
|
D |
moxifloxacin 400mg orally once daily for 14 days |
|
E |
none of the above |
Scenario
16. This is not an EMQ or SBA! Fill in the gaps in the table
below, using option list.
|
Drug name |
Category of drug |
|
azithromycin |
|
|
doxycycline |
|
|
moxifloxacin |
|
Option List.
|
Category of drug |
|
macrolide |
|
tetracycline |
|
quinolone |
Scenario
17. Which, if any, of the following statements is true in
relation to test of cure (TOC) after
treatment of MG?
Option list.
|
A |
TOC should be offered to everyone who has been treated
for MG |
|
B |
TOC should only be offered to those who had signs of infection
before treatment |
|
C |
TOC should only be offered to those who had symptoms of
infection before treatment |
|
D |
TOC should only be offered to those who had signs and
symptoms before treatment |
|
E |
TOC should only be offered to those who continue to have
signs or symptoms two weeks or more after the start of treatment |
|
F |
none of the above |
Scenario
18. Which, if any, of the following statements are true in
relation to the timing of test of
cure (TOC) after treatment of
MG?
Option list.
|
A |
TOC is best done at 3 weeks after start of treatment |
|
B |
TOC is best done at 4 weeks after start of treatment |
|
C |
TOC is best done at 5 weeks after start of treatment |
|
D |
TOC is best done at 6 weeks after start of treatment |
|
E |
TOC should not be done < 2 weeks from the start of
treatment |
|
F |
TOC should not be done < 3 weeks from the start of
treatment |
|
G |
TOC should not be done < 4 weeks from the start of
treatment |
17. Montgomery Ruling.
Abbreviations.
BMA: British
Medical Association.
GMC: General
Medical Council.
Question 1.
Which, if any, of the following statements is most accurate?
Lead-in
|
A |
The
Montgomery ruling largely replaces the Bolam ruling |
|
B |
The Montgomery ruling largely replaces the Chester
ruling |
|
C |
The Montgomery ruling largely replaces the Sidaway
ruling |
|
D |
The Montgomery ruling is being contested in the
European Court by the GMC as it infringes the rights of doctors |
|
E |
The Montgomery ruling is being contested in the
European Court by the BMA as it infringes the rights of doctors |
Question
2.
Which, if any, of the following statements are true? This is not
a true EMQ as > 1 of the answers may be correct.
Lead-in
|
A |
the
level of risk, however small, must be disclosed if a patient requests it |
|
B |
the level of risk of damage from a procedure need not
be disclosed if < 1% |
|
C |
the level of risk of damage from a procedure need not
be disclosed if < 10% |
|
D |
a material risk is one that would be reflected in
damages > £100,000 if negligence were proved in court |
|
E |
a material risk is one that would be reflected in
damages > £1,000,000 if negligence were proved in court |
|
F |
a material risk is one that involves anatomical damage,
not emotional or psychological |
|
G |
a material risk is one that a reasonable person in the
patient’s situation would be likely to regards as significant |
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