12 |
EMQ. The Term Breech Trial |
Part
3. Create ‘blurb’. General pre-pregnancy counselling |
|
14 |
EMQ. Hepatitis C |
15 |
MCQ. The Coombs test |
16 |
EMQ. Mayer-Rokitansky-Küster-Hauser
syndrome |
12. The
Term Breech Trial.
Abbreviations.
Cs: Caesarean section.
ECV: external cephalic version.
VB: vaginal birth.
VBD: vaginal breech delivery.
Question 1.
What is the approximate incidence
of breech presentation at 28 weeks?
3% |
|
B |
5% |
C |
7% |
D |
10% |
E |
12% |
F |
15% |
G |
20% |
Question
2.
What is the approximate incidence
of breech presentation at 32 weeks?
Option
list. Use that from Q1.
Question
3.
What is the approximate incidence
of breech presentation at 36 weeks?
Question
4.
What is the approximate incidence
of breech presentation at 40 weeks?
Question
5.
What is the approximate incidence
of breech presentation at 40 weeks after
successful ECV at 36 weeks? Don’t get bogged down
looking for trick questions. You could argue that to be successful, ECV would
need to ensure that all babies were cephalic at T, but the simplest meaning is
that the baby was successfully turned at 36 weeks.
A |
1% |
B |
2% |
C |
3% |
D |
4% |
E |
5% |
Question
6.
What is the approximate incidence
of cord prolapse with breech presentation in term
labour?
1% |
|
B |
3% |
C |
5% |
D |
7% |
E |
10% |
F |
12% |
G |
15% |
H |
20% |
I |
none of
the above |
Question
7.
Which, if any, of the following
are included in the RCOG’s PIF about the risks
associated with Cs?
damage
to bowel |
|
B |
damage
to bladder |
C |
damage
to ureter |
D |
damage
to partner from fainting / falling |
E |
endometriosis |
F |
gestational
trophoblastic disease |
G |
hysterectomy |
H |
miscarriage |
I |
placental
accreta |
J |
placenta
previa |
K |
postnatal
depression |
L |
PPH |
M |
scar
dehiscence |
N |
scar
herniation |
O |
scar
pregnancy |
P |
stillbirth |
Q |
thromboembolism |
Question 8.
What are the 3 key questions in
the RCOG’s PIF that patients are advised to ask?
Question
9.
Which, if any, of the following
were in the main conclusions of the Term Breech Trial?
stillbirths
were significantly fewer with planned C section |
|
B |
neonatal
mortality was reduced significantly by planned C section |
C |
neonatal
morbidity was reduced significantly by planned C section |
D |
serious
neonatal morbidity was reduced significantly by planned C section |
E |
perinatal
mortality was reduced significantly by planned C section |
F |
perinatal
morbidity was reduced significantly by planned C section |
G |
serious
perinatal morbidity was reduced significantly by planned C section |
H |
none of
the above |
Question
10. Which,
if any, of the following were in the main conclusions of the follow up at 2
years
of the children in the Term Breech Trial?
neonatal
mortality was reduced significantly by planned C section |
|
B |
neonatal
morbidity was reduced significantly by planned C section |
C |
planned
C section reduced the risk of child death up to 2 years |
D |
planned
C section reduced the risk of child morbidity up to 2 years |
E |
planned
C section improved child neurodevelopment at 2 years of age |
F |
none of
the above |
Question
11. Which,
if any, of the following were included in the conclusions of the Premoda Trial?
A |
fetal mortality was reduced by planned cs |
B |
neonatal mortality was reduced by planned cs |
C |
neonatal morbidity was reduced by planned cs |
D |
surgeons’ sleep patterns were improved planned cs |
E |
Cs should be offered as superior to planned vaginal delivery
even in expert centres |
F |
VBD is a safe option in centres where it is commonly practised
and strict criteria are met |
Question
12. Which,
if any, of the following are listed as contraindications to VBD in GTG20a.
A |
maternal height < 1.6 metres |
B |
maternal BMI > 30 |
C |
gestation < 36 weeks |
D |
failed ECV at 36 weeks |
E |
reversion to breech presentation after successful ECV at 36
weeks |
F |
estimated fetal weight > 3.5 kg. |
G |
estimated fetal weight <25th. centile. |
H |
hyperextended fetal neck |
I |
footling presentation |
13. Part
3. Create ‘blurb’. General pre-pregnancy counselling.
14. 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 |
15. The
Coombs test. MCQ.
This
is an MCQ, so the answers are just ‘true’ or ‘false’.
a. the direct test detects maternal IgM on fetal
cells.
b. is used in the investigation of
thrombocytopenia.
c. is positive in the baby with jaundice due to
spherocytosis.
d. who wrote: “A flea
hath smaller fleas that on him prey…..”
e. what was
the rest of the verse?
f. what
connection has this verse with the Coomb’s test?
g. the indirect
Coomb’s test is used to detect antibodies in maternal serum.
h. the direct test uses anti IgG serum.
16. Mayer-Rokitansky-Küster-Hauser
syndrome.
Note. Some of
the questions are not true EMQs as there may be more than one correct answer –
this is me being lazy and saving typing.
Mayer–Rokitansky–K
¨
uster–Hauser
syndrome: diagnosis and management
With
regard to the MRKH syndrome,
61. there is failure of development of the
mesonephric ducts. T
F
62.
the phenotype and genotype are female. T F
63.
studies have established a link between the
syndrome and the use of diethylstilbestrol in
pregnancy.
T F
With
regard to the anatomical abnormalities seen in
MRKH
syndrome,
64.
symmetrical uterovaginal aplasia is found in
type I disorders. T
F
65.
renal abnormalities are seen in more than
half
of cases. T F
66.
skeletal abnormalities are reported in up to
one-fifth
of cases. T F
67. up to one-quarter of women have a
malformed
ear or auditory canal. T F
68.
the close proximity of the m
¨
ullerian
and
wolffian
duct derivatives to the metanephric
duct
in the developing embryo explains the
higher
association of malformations of the
kidneys
with this condition. T F
69.
vaginal agenesis is caused by failure of the
caudal
part of the m
¨
ullerian duct system to
develop. T
F
Regarding
the diagnosis of MRKH syndrome,
70.
magnetic resonance imaging is the gold
standard
tool. T F
71.
two-dimensional ultrasound scanning is not
useful
for associated renal tract
abnormalities.
T F
72.
complete androgen insensitivity syndrome is
an
important differential diagnosis. T F
73.
the presence of cyclical abdominal pain will
rule
out the diagnosis, as it indicates the
presence of functioning endometrium. T
F
With regard to the creation of a neovagina,
74.
it is recommended that treatment is initiated
as
soon as the diagnosis is made. T F
75. psychological support to women undergoing
this
procedure is of the utmost importance. T F
76.
vaginal dilators are acceptable as an option
for first-line therapy. T
F
77.
Ingram’s modified Frank’s technique involves
the
use of vaginal dilators. T F
With regard to the surgical creation of a
neovagina,
78. in the Davydov procedure the neovagina is
lined with peritoneum. T
F
With
regard to fertility in women with the MRKH
syndrome,
79. transvaginal egg retrieval is recognised to be
difficult
during in vitro fertilisation. T F
80. the condition has been shown to be
transmissible to the offspring. T
F
Abbreviations.
AIS: androgen
insensitivity syndrome
AMH: anti- Müllerian
hormone
MRKH: Mayer-Rokitansky-Küster-Hauser
syndrome
MURCS: Müllerian
duct aplasia, renal dysplasia and cervical somite anomaly syndrome.
Question
1.
What are the main features of
MRKH? There is no option list to make life harder.
Question
2.
Which, if any, are the main
secondary features associated with MRKH?
Option list.
A |
anosmia |
B |
attention-deficit-hyperactivity
syndrome |
C |
auditory
anomalies |
D |
neural tube defects |
E |
renal anomalies |
F |
skeletal
anomalies |
Question
3.
How does MRKH syndrome usually
present?
Option list.
A |
cyclical pain
due to haematometra |
B |
delayed puberty |
C |
precocious
puberty |
D |
premature
menopause |
E |
primary
amenorrhoea |
F |
recurrent
otitis media |
G |
recurrent
urinary tract infection |
H |
secondary
amenorrhoea |
Question
4.
Which of the following chromosome
patterns are typical of MRKH?
Option list.
A |
45XO |
B |
45YO |
C |
46XX |
D |
46XY |
E |
47XXX |
F |
47XXY |
Question
5.
What is the approximate incidence
of MRKH in newborn girls?
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 8,000 |
F |
~ 1 in 10,000 |
G |
~ 1 in 100,000 |
H |
the figure is
unknown |
I |
it does not
occur |
Question
6.
What is the approximate incidence
of MRKH in newborn boys?
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 8,000 |
F |
~ 1 in 10,000 |
G |
~ 1 in 100,000 |
H |
the figure is
unknown |
I |
it does not
occur |
Question 7.
Which of the following statements
are correct in relation to urinary tract anomalies associated with MRKH?
Option list.
A |
absent bladder |
B |
absent kidney |
C |
ectopic ureter |
D |
horseface
kidney |
E |
hypospadias |
F |
urinary tract
anomalies are not part of the syndrome |
Question 8.
Which of the following statements
are correct in relation to skeletal anomalies associated with MRKH?
Option list.
A |
absent thumb |
B |
absent big toe |
C |
developmental
dysplasia of the hip |
D |
Klippel-Feil
anomaly |
E |
ulnar
hypoplasia |
F |
vertebral
fusion |
G |
skeletal
anomalies are not part of the syndrome |
Question 9.
Which of the following statements
are correct in relation to auditory anomalies associated with MRKH?
Option list.
A |
absent ear |
B |
absent stapes |
C |
acoustic
neuroma |
D |
conductive
deafness |
E |
inductive
deafness |
F |
stapedial
ankylosis |
G |
auditory
anomalies are not part of the syndrome |
Question
10. What
is the recommended first-line management for creation of a neovagina.
Option list.
A |
digital
dilatation |
B |
marriage to a
virile husband |
C |
vaginal
balloons |
D |
vaginal
dilators |
E |
vaginoplasty |
F |
there is no
recommended 1st. line management |
Question
11. What are the key features of Davydov vaginoplasty?
Option list.
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
B |
creation of
space between bladder and rectum and lining it with amnion |
C |
creation of
space between bladder and rectum and lining it with skin graft |
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
E |
creation of
space between bladder and rectum and lining it with peritoneum |
F |
traction via
threads running to the abdomen from a vaginal bead |
Question
12. What
are the key features of McIndoe vaginoplasty?
Option list.
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
B |
creation of
space between bladder and rectum and lining it with amnion |
C |
creation of space
between bladder and rectum and lining it with skin graft |
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
E |
creation of
space between bladder and rectum and lining it with peritoneum |
F |
traction via
threads running to the abdomen from a vaginal bead |
Question
13. What
are the key features of Vecchietti vaginoplasty?
Option list.
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
B |
creation of
space between bladder and rectum and lining it with amnion |
C |
creation of
space between bladder and rectum and lining it with skin graft |
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
E |
creation of
space between bladder and rectum and lining it with peritoneum |
F |
traction via threads
running to the abdomen from a vaginal bead |
Question
14. What
are the key features of Williams vaginoplasty?
Option list.
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
B |
creation of
space between bladder and rectum and lining it with amnion |
C |
creation of
space between bladder and rectum and lining it with skin graft |
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
E |
creation of
space between bladder and rectum and lining it with peritoneum |
F |
traction via
threads running to the abdomen from a vaginal bead |
TOG
CPD questions.
With regard to the MRKH syndrome.
1. there
is failure of development of the mesonephric ducts. True / False
2. the
phenotype and genotype are female. True / False
3. studies
have established a link between the syndrome and the use of diethylstilboestrol
in pregnancy. True / False
With regard to the anatomical
abnormalities seen in MRKH syndrome.
4. symmetrical
uterovaginal aplasia is found in type I disorders. True / False
5. renal
abnormalities are seen in more than half of cases. True / False
6. skeletal
abnormalities are reported in up to one-fifth of cases. True / False
7. up
to one-quarter of women have a malformed ear or auditory canal. True / False
8. the
close proximity of the Müllerian and Wolffian duct derivatives to the duct in
the developing embryo explains the higher association of malformations of the
kidneys with this condition.
True
/ False
9. vaginal agenesis is caused by failure of the
caudal part of the Müllerian duct system to develop.
True
/ False
Regarding the diagnosis of MRKH
syndrome,
10. magnetic
resonance imaging is the gold standard tool. True / False
11. two-dimensional
ultrasound scanning is not useful for associated renal tract abnormalities.
True
/ False
12. complete
androgen insensitivity syndrome is an important differential diagnosis. True / False
13. the
presence of cyclical abdominal pain will rule out the diagnosis, as it
indicates the presence of functioning endometrium. True / False
With regard to the creation of a
neovagina,
14. it
is recommended that treatment is initiated as soon as the diagnosis is made. True / False
15. psychological
support to women undergoing this procedure is of the utmost importance.
True
/ False
16. vaginal
dilators are acceptable as an option for first-line therapy. True / False
17. Ingram’s
modified Frank’s technique involves the use of vaginal dilators. True / False
With regard to the surgical
creation of a neovagina,
18. in
the Davydov procedure the neovagina is lined with peritoneum. True / False
With regard to fertility in women
with the MRKH syndrome,
19. transvaginal
egg retrieval is recognised to be difficult during in vitro fertilisation. True / False
20. the
condition has been shown to be transmissible to the offspring. True / False