9 March 2023.
|
Role-play. Complaint. Mis-filed combined Ds test report |
|
|
25 |
EMQ. Cystic fibrosis |
|
26 |
EMQ. Hepatitis C |
|
27 |
EMQ. Uterine inversion |
24. Role-play.
Complaint. Mis-filed combined Ds test report
Candidate's Instructions.
You are the SpR in the ante-natal clinic. The consultant
has been called to the labour ward to help with a case of placenta accreta and
you have been put in charge of the clinic.
Mrs Jones had a “combined test” at 11 weeks which gave a
risk of Down’s syndrome of 1: 40. The report was filed in the notes in error by
a clerk without being shown to any of the medical or midwifery staff.
She attended today for the routine 20-week scan. The ultrasonographer
found the report in the notes, realised that no action had been taken, informed
the patient and made arrangements for her to see you urgently.
25. EMQ.
Cystic fibrosis.
Cystic fibrosis.
EMQ. Questions.
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
26. EMQ.
Hepatitis C.
Hepatitis C & pregnancy.
HCV. EMQ. Questions
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 |
27. EMQ.
Uterine inversion.
Abbreviations.
MROP: manual removal of placenta.
UI: uterine inversion.
Question
1.
How is uterine
inversion categorised and how are the categories defined?
This is not an EMQ and there is
no option list.
Question
2.
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
3.
Is the incidence
of UI higher in less-well developed countries?
Option list.
|
A |
answer unknown |
|
B |
no |
|
C |
yes |
Question
4.
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
5.
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
6.
What are the
presenting features of UI? There is no option list.
Question
7.
What is the immediate
management of UI? There is no option list.
Question
8.
What procedure
should be considered if the inversion is not corrected during initial
management? There is no option list.
Question
9.
What is
Huntington’s procedure?.
Question
10. What is Haultain’s procedure ? There is no option list.
Question
11. What other procedures have been described? There is no
option list.
Question
12. What should be done to ensure the inversion does not recur?
There is no option list.
Question
13. What is the risk of recurrence in the next pregnancy? There
is no option list.
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
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