Tutorial 23rd. March 2023

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23  March 2023.

 

39	SBA. Meigs syndrome
40	Role-play. Caesarean section on maternal request
41	Viva von Willebrand disease
42	SBA. Quinolone antibiotics

 

38.         Meigs syndrome.

Scenario1.    Which, if any, of the following are features of Meigs syndrome?

Option List

A	ascites
B	bilateral ovarian tumours
C	Gorlin syndrome
D	most common in women < 25 years
E	ovarian fibroma
F	ovarian metastatic malignancy
G	primary gastro-intestinal tumour
H	precocious puberty
I	primary amenorrhoea
J	postmenopausal bleeding
K	resolution of symptoms after oophorectomy
L	right-sided hydrothorax
M	signet ring cells

 

39.         Role-play. Caesarean section on maternal request.

Candidate’s instructions.

You are a SpR5 in the antenatal clinic. Your consultant is feeling unwell and has gone to lie down.

The midwife has just seen a primigravid woman who has requested Caesarean section. She is healthy, with no significant medical history and the pregnancy has been normal. The gestation is 36 weeks, the head is engaged and the baby seems to be of an average size. The midwife has done all the routine investigations and has asked you to see her to discuss the request for Caesarean section.

Your task to discuss her request as you would in a normal clinic.

 

40.         Viva von Willebrand disease.

The examiner will ask a series of questions about von Willebrand disease.

 

41.         Quinolone & fluoroquinolone antibacterial drugs

Abbreviations.

FQ:              fluoroquinolone.

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