|
50 |
EMQ. Kell antibodies |
|
51 |
Role-play. Topic revealed at the tutorial. |
|
52 |
SBA. Fetal origins of adult disease |
|
53 |
EMQ. G6PDD & G6PD |
Kell antibodies & pregnancy.
Abbreviations.
∆OD450: spectrophotometric
measurement of deviation in optical density at wavelength 450 nm.
FMM: feto-maternal medicine.
HDFN: haemolytic disease of the fetus and newborn.
MCAPSV: middle cerebral artery peak systolic velocity.
RBC: red
blood cell.
Scenario 1.
Which of the
following alloantibodies is the most common cause of significant HDFN?
Option list.
|
A |
anti-D |
|
B |
anti-C |
|
C |
anti-c |
|
D |
anti-e |
|
E |
Duffy: Fya |
|
F |
Duffy: Fyb |
|
G |
Kell |
|
H |
Kidd: Jka |
|
I |
Kidd: Jkb |
Scenario 2.
What is the 2nd.
most common cause of significant HDFN?
Scenario 3.
What is the 3rd.
most common cause of significant HDFN?
Scenario 4.
Which of the
following is true in relation to the Kell antigen?
Option list.
|
A |
it is named after Mrs. Kelleher who was found to have
antibodies to it in 1946 |
|
B |
it is named after Gene Kelly, the American actor,
dancer and singer as the research group who found the antigen were big fans |
|
C |
there are > 50 significant variants of the Kell
antigen |
|
D |
Kell antibodies are mainly IgA |
|
E |
Kell antibodies are mainly IgM |
|
F |
none of the above |
Scenario 5.
What proportion of
the Caucasian population is K +ve?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
9% |
|
D |
15% |
|
E |
25% |
|
F |
33% |
|
G |
57% |
|
H |
none of the above |
Scenario 6.
Can the Kell
antigen be detected using cffDNA in maternal serum. True / False.
Scenario 7.
Anti-K is thought
to occur mainly as a result of feto-maternal transfusion of Kell +ve
cells during pregnancy and
delivery. True / False.
Scenario 8.
Kell HDFN
resulting from transfusion of Kell +ve blood is thought to produce more
severe HDFN than that resulting
from feto-maternal transfusion. True / False.
Scenario 9.
Which of the
following statements is true in relation to anti-Kell antibodies in a Kell-
negative mother with a Kell +ve
pregnancy?
Option list.
|
A |
HDND is mainly due to haemolysis of fetal RBC |
|
B |
HDND is mainly due to haemolysis of fetal &
neonatal RBC |
|
C |
HDND is mainly due to haemolysis of neonatal RBC |
|
D |
HDND is mainly due to sequestration of fetal RBC |
|
E |
HDND is mainly due to sequestration of fetal &
neonatal RBC |
|
F |
HDND is mainly due to sequestration of neonatal RBC |
|
G |
HDND is mainly due to suppression of fetal erythroid
progenitor cells |
|
H |
HDND is mainly due to suppression of neonatal erythroid
progenitor cells |
|
I |
none of the above |
Scenario 10.
Which of the
following statements is true in relation to antenatal detection of HDFN
due to anti-K antibodies?
Option list.
|
A |
the threshold for significant HDFN is a titre of 1 in 4 |
|
B |
the threshold for significant HDFN is a titre of 1 in 8 |
|
C |
the threshold for significant HDFN is a titre of 1 in
16 |
|
D |
the threshold for significant HDFN is a titre of 1 in
32 |
|
E |
the threshold for significant HDFN is a titre of 1 in
64 |
|
F |
the threshold for significant HDFN is a titre of 1 in
128 |
|
G |
the threshold for significant HDFN is a titre of 1 in
256 |
|
H |
none of the above |
Scenario 11.
Which of the
following statements is true in relation to antenatal detection of HDFN
due to anti-K antibodies?
Option list.
|
A |
the threshold for significant HDFN is a level > 2
iu/L. |
|
B |
the threshold for significant HDFN is a level > 4
iu/L. |
|
C |
the threshold for significant HDFN is a level > 7.5
iu/L. |
|
D |
the threshold for significant HDFN is a level > 10
iu/L. |
|
E |
the threshold for significant HDFN is a level > 15
iu/L. |
|
F |
the threshold for significant HDFN is a level > 25
iu/L. |
|
G |
the threshold for significant HDFN is any level if
anti-E is also present. |
|
H |
none of the above |
Scenario 12.
Which, if any, of
the following statements are true in relation to referral to a FMM
expert when Kell antibodies are
detected?
Option list.
|
A |
the threshold for referral is a level of anti-K > 2
iu/L. |
|
B |
the threshold for referral is a level of anti-K > 4
iu/L. |
|
C |
the threshold for referral is a level of anti-K >
7.5 iu/L. |
|
D |
the threshold for referral is a level of anti-K > 10
iu/L. |
|
E |
the threshold for referral is a level of anti-K > 15
iu/L. |
|
F |
the threshold for referral is a level of anti-K > 25
iu/L. |
|
G |
the threshold for referral is any level of anti-K. |
|
H |
the threshold for referral is any level of anti-K if
anti-E is also present. |
|
I |
none of the above |
Scenario 13.
Which of the
following statements is true in relation to the threshold for antenatal
diagnosis of significant HDFN
due to anti-K when using measurement of MCAPSV?
Option list.
|
A |
MoM > 1.25 |
|
B |
MoM > 1.50 |
|
C |
MoM > 1.75 |
|
D |
MoM > 2.00 |
|
E |
MoM > 2.50 |
|
F |
MoM > 3.00 |
|
G |
none of the above |
Scenario 14.
Which of the
following statements is true in relation to the threshold for antenatal
diagnosis of significant HDFN
due to anti-K when using measurement of ∆OD450?
Option list.
|
A |
MoM > 1.25 |
|
B |
MoM > 1.50 |
|
C |
MoM > 1.75 |
|
D |
MoM > 2.00 |
|
E |
MoM > 2.50 |
|
F |
MoM > 3.00 |
|
G |
none of the above |
Scenario 15.
Which, if any, of
the following statements are true in relation to the numbers of
reticulocytes in cord blood in
moderate to severe HDFN due to anti-K antibodies?
Option list.
|
A |
the numbers are decreased |
|
B |
the numbers are increased |
|
C |
the numbers are normal |
|
D |
none of the above |
Scenario 16.
Which, if any, of
the following statements are true in relation to the numbers of
erythroblasts in cord blood in
moderate to severe HDFN due to anti-K antibodies?
Option list.
|
A |
the numbers are decreased |
|
B |
the numbers are increased |
|
C |
the numbers are normal |
|
D |
none of the above |
Scenario 17.
Which, if any, of
the following statements are true in relation to the level of bilirubin
in cord blood in moderate to
severe HDFN due to anti-K antibodies?
Option list.
|
A |
it is decreased |
|
B |
it is increased |
|
C |
it is greatly increased |
|
D |
none of the above |
Scenario 18.
Which, if any, of
the following are true in relation to King Henry VIII and Kell?
Option list.
|
A |
Kell may have been the cause of his subfertility |
|
B |
He may have had the McLeod syndrome |
|
C |
He may have inherited the Kell antigen from Jacquetta
Woodville |
|
D |
The Kell antigen may have explained his passion for
jousting |
|
E |
The Kell antigen may have explained his passion for
extramarital dalliance |
The TOG questions for the Gajjar article can be found here.
They are open access, which allows me to reproduce them.
Regarding Kell alloimmunisation in pregnancy,
1 the amniotic
fluid bilirubin level correlates well with the degree of fetal anaemia. True / False
2 previous
obstetric history does not reliably predict outcome. True / False
3 the incidence
in the obstetric population is approximately 1–2 per 1000. True / False
4 prophylaxis is
available. True / False
5 the
relationship between fetal middle cerebral artery peak systolic velocity
(MCA-PSV) and haemoglobin concentration is poor. True / False
6 anti-Kell
antibodies cause fetal anaemia via the suppression of erythropoiesis rather
than red cell destruction. True / False
With regard to maternal anti-Kell antibody screening,
7 if the father of the fetus is Kell antigen
positive, the fetus is likely to be affected with severe HDFN. True / False
8 where the father is heterozygous for Kell,
there is a 50% chance of the fetus carrying the Kell antigen on its fetal red
cells. True / False
9 anti-Kell antibodies stimulated by
transfusion are known to affect the fetus to the same degree as those
stimulated from a previous pregnancy. True / False
Transfusion seems to produce less severe disease.
10 where the critical titre of anti-Kell
antibodies has been reached in the maternal serum, amniocentesis for spectral
analysis of amniotic fluid is a reliable means of establishing the degree and
severity of fetal anaemia. True / False
51. Role-play.
Topic revealed at the tutorial.
You do
not get forewarning of topics in the exam, so I have done the same here.
52. Fetal origins
of adult disease.
Abbreviations.
ADHD: attention-deficit,
hyperactivity disorder
Lead in. These questions relate to disease in adults resulting from events during
fetal, infant and child development.
Scenario 1. What eponymous title is given to the concept that adverse
intra-uterine conditions
predispose to the development of
disease in adulthood?
Option List
|
A |
the Barker hypothesis |
|
B |
the Baker’s dozen |
|
C |
the Broadbank theory |
|
D |
PIPAD: Placental Insufficiency Programmes Adult Disease |
|
E |
SIMCARD: Stop In-utero Malnutrition to Conquer Adult-resulting
Disease |
Scenario 2. Which other term is used for the concept that adverse
intra-uterine conditions
predispose to the development of disease in
adulthood?
Option List
|
A |
FDAD: fetal determination of adult disease |
|
B |
FIAD: fetal
influences on adult disease |
|
C |
FIDAD: fetal and infancy determinants of adult disease |
|
D |
FIGO: fetal
influences on genomic outcomes |
|
E |
FP: fetal
programming |
Scenario 3. Which of the following is thought to increase the risk of
adult disease?
Option List
|
A |
low birthweight (LBW) |
|
B |
LBW followed by poor weight gain in infancy and
childhood |
|
C |
LBW followed by poor weight gain in infancy but above-average
weight gain in childhood |
|
D |
above-average birthweight (AABW) |
|
E |
AABW followed by poor weight gain in infancy but
above-average weight gain in childhood |
|
F |
AABW followed by above-average weight gain in infancy
and childhood |
Scenario 4. Which adult diseases are generally believed to be more
likely in relation to adverse
influences on the fetus, infant and
child.
Diseases.
|
A |
asthma |
|
B |
chronic
bronchitis |
|
C |
coronary
heart disease |
|
D |
diabetes
type I |
|
E |
diabetes
type 2 |
|
F |
hypertension |
|
G |
Mendelson’s
syndrome |
|
H |
Stroke |
Scenario 5. What adult condition has been linked to raised maternal
c-reactive protein levels?
Option List
|
A |
asthma |
|
B |
ADHD |
|
C |
autism |
|
D |
inflammatory bowel disease |
|
E |
schizophrenia |
53. EMQ.
G6PDD & G6PD.
Glucose-6-phosphate dehydrogenase deficiency.
Abbreviations.
G6PD: glucose-6-phosphatase
deficiency
G6PDD: glucose-6-phosphate
dehydrogenase deficiency
Scenario 1.
What is G6PDD?
There is no option list.
Scenario 2.
What categories
are applied to G6PDD by the WHO? There is no option list.
Scenario 3.
What other names
are commonly used for G6PDD? There is no option list.
Scenario 4.
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 5.
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 6.
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
7.
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
8.
Approximately how
many mutations of the G6PDD gene have been identified?
Scenario
9.
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 10.
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 11.
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 |
No comments:
Post a Comment