29 May 2023.
|
17 |
EMQ. Hepatitis D |
|
18 |
EMQ. Pertussis |
|
19 |
EMQ. Brexanolone |
|
20 |
EMQ. Turner syndrome |
|
21 |
EMQ. The MAGPIE trial |
17. Hepatitis
D.
Abbreviations:
HBsAg: hepatitis
B surface antigen
HBsAb: antibody
to hepatitis B surface antigen
HBV: hepatitis
B virus
HCsAg: hepatitis C surface antigen
HDV: hepatitis
D virus; hepatitis delta virus
HEsAg: hepatitis
E surface antigen
Question 1.
Which, if any, of
the following statements are true in relation to HDV? This is not a true EMQ as
there may be >1 correct answer.
Option list.
|
A |
HDV is a large DNA virus |
|
B |
HDV is a defective virus |
|
C |
HDV gains entry to human
cells via the HDV receptor |
|
D |
HDV gains entry to human
cells by donning a disguise and using the HBV receptor |
|
E |
HDV only flourishes when
HBsAb is present |
|
F |
HDV only flourishes when HBsAg
is present |
|
G |
Coi coinfection
is when HDV and another viral infection are present at the same time |
|
H |
Susu superinfection is when
HDV is present in abnormally high numbers |
|
I |
HDV infection is the least
serious of the viral hepatitides in relation to pregnancy |
|
J |
HDV treatment was revolutionised
by analysis of the benefits of drinking bleach as suggested by Donald Trump |
|
K |
the WHO
has recommended that those who follow medical advice from Donald trump should
be categorised as ‘having the DTs’. |
|
L |
HDV needs the presence of HBsAg
to be a significant pathogen |
|
M |
HDV needs the presence of HCsAg
to be a significant pathogen |
|
N |
HDV needs the presence of HEsAg
to be a significant pathogen |
|
O |
ppe pegylated interferon alpha is highly
effective as treatment |
|
P |
m mother-to-child transmission is mainly
via the placenta |
|
Q |
WHO recommends tenofovir prophylaxis
from 28 weeks in pregnancy in HDV infected women |
|
R |
the infected neonate should be given HDV
vaccine |
18. Pertussis.
JCVI: Joint Committee on Vaccination and
Immunisation .
PIPP: pertussis immunisation programme for pregnancy.
Question 1.
Why is
pertussis of current concern in obstetrics?
|
A |
Research has linked pertussis in the 1st.
trimester to ↑ risk of
congenital heart disease |
|
B |
A
mini-epidemic since 2011 has caused ↑ deaths
of mothers & of babies < 3 months |
|
C |
A
mini-epidemic since 2011 has caused ↑ deaths
of babies < 3 months |
|
D |
The
infecting organism has become increasingly drug-resistant |
|
E |
The
infecting organism has become increasingly virulent |
Question 2.
Which
organism causes whooping cough?
|
A |
Bordella pertussis |
|
B |
Bacteroides pertussis |
|
C |
Rotavirus whoopoe |
|
D |
Respiratory syncytiovirus pertussis |
|
E |
None of the above |
Question 3.
Which, if
any, of the following statements are true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space and there may be more than one correct answer.
|
A |
the
organism is aerobic |
|
B |
the
organism is anaerobic |
|
C |
the
organism is capsulated |
|
D |
the
organism is flagellate |
|
E |
the organism is an obligate intra-cellular
parasite |
|
F |
the
organism is a Gram -ve diplococcus |
|
G |
the
organism is a Gram +ve diplococcus |
|
H |
the
organism requires special transport media |
|
I |
no one
is going to ask me any of this stuff |
Question 4.
Which of the
following statements is true?
|
A |
Pertussis
is no longer a significant threat to infants |
|
B |
Pertussis remains a significant threat to
infants |
|
C |
The risk of death from pertussis is
eliminated by timely antibiotic therapy |
|
D |
the risk of death from pertussis is
eliminated by timely antiviral therapy |
|
E |
None of the above |
Question 5.
Which of the following
statements is true?
|
A |
Pertussis is not a notifiable
disease |
|
B |
Pertussis is a notifiable disease |
|
C |
Pertussis is not a notifiable disease, but cases should be
reported to the local bacteriologist |
|
D |
Pertussis is not a notifiable disease, but cases should be
subject to audit |
Question 6.
What is the
main mode of spread of the organism that causes pertussis?
|
A |
contact with contaminated surfaces |
|
B |
contaminated
food |
|
C |
contaminated
water |
|
D |
respiratory
droplets |
|
E |
none of
the above |
Question 7.
What is the
main reservoir of the organism that causes pertussis?
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of
the above |
Question 8.
What is the
epidemiology of pertussis?
|
A |
the condition is endemic |
|
B |
the condition is endemic with mini-epidemics every 3-5 years |
|
C |
the condition is endemic with mini-epidemics most years in the
winter months |
|
D |
the condition is epidemic, with outbreaks at roughly three-year
intervals |
|
E |
the condition is epidemic, with outbreaks at unpredictable
intervals |
Question 9.
What is the
incubation period for pertussis?
|
A |
3-6
days |
|
B |
7-10
days |
|
C |
11-14 days |
|
D |
15-18 days |
|
E |
none of the above. |
Question 10.
What is the
duration of infectivity of someone with pertussis?
|
A |
2 days from exposure → 5 days after onset
of paroxysms of coughing |
|
B |
3 days from exposure → 10 days after onset
of paroxysms of coughing |
|
C |
4 days from exposure → 14 days after onset
of paroxysms of coughing |
|
D |
6 days from exposure → 21 days after onset
of paroxysms of coughing |
|
E |
none of the above |
Question 11.
What % of
non-immune, close contacts of pertussis will develop the disease?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Which of the
following best describe the DOH’s advice about pertussis? This is not a true
SBA as there may be > 1 connect answer.
|
A |
The DOH advises that all
pregnant women be immunised to ↓ maternal
death rates. |
|
B |
The DOH advises that all pregnant women be immunised to ↓ deaths in babies < 3 months. |
|
C |
The DOH advises that all babies be immunised at birth. |
|
D |
The DOH advised that “Boostrix-
IPV” should replace “Repevax” from July 2014. |
|
E |
The DOH advises that immunisation of pregnant women be continued
permanently |
Question 13.
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routine child immunisation was
introduced?
|
A |
the number was 10,000 |
|
B |
the number was 5,000 |
|
C |
the number was 4,000 |
|
D |
the number was 3,500 |
|
E |
the number was 1,000 |
Question 14.
Which, if
any, of the following statements are true in relation to pertussis vaccine.
|
A |
“Boostrix-
IPV” is a vaccine for pertussis only |
|
B |
“Repevax” is a vaccine for pertussis only |
|
C |
“Boostrix- IPV” & “Repevax” are live, attenuated
vaccines |
|
D |
“Boostrix- IPV” & “Repevax” act against
diphtheria, tetanus and polio as well as pertussis |
|
E |
“Boostrix- IPV” & “Repevax” are
acellular |
Question 15.
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the
above |
Question 16.
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this
subject now |
Question 17.
A pregnant woman misses out on vaccination as part of the PIPP. Should
vaccination still be offered in the puerperium?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this
subject now |
19. Brexanolone.
GABAA: γ-aminobutyric acid type A.
Scenario
1. Which, if any, of the following statements are true?
Option list.
|
A |
Brexanolone it
is a water soluble form of allopregnanolone |
|
B |
allopregnanolone
is an oestrogen metabolite and levels mirror those of oestrogen |
|
C |
allopregnanolone
is a potent modulator of GABAA receptors
in the brain |
|
D |
brexanolone is
effective in the treatment of postpartum depression |
|
E |
brexanolone is
effective in stimulating FSH release |
|
F |
brexanolone is
effective in suppressing FSH release |
|
G |
brexanolone is
administered orally |
|
H |
brexanolone is
licensed for use in the UK |
20. Turner
syndrome.
This is supposed
to be an EMQ, but some of the questions are MCQs with “True” and “False”
answers. But it includes everything I think you might be asked about Turner’s.
Abbreviations.
|
DDH |
developmental dysplasia of
the hip |
Option list 1 is for question 2, option list 2 is for all the
others.
Option list 1.
|
|
1 in 500 |
|
|
1 in 1,000 |
|
|
1 in 1,500 |
|
|
1 in 2,000 |
|
|
1 in 2,500 |
|
|
1 in 3,000 |
|
|
1 in 10,000 |
|
|
1 in 50,000 |
Option list 2.
|
|
0% |
|
|
0.1% |
|
|
1 % |
|
|
2% |
|
|
5% |
|
|
10% |
|
|
15% |
|
|
20% |
|
|
30% |
|
|
40% |
|
|
50% |
|
|
60% |
|
|
70% |
|
|
80% |
|
|
90% |
|
|
> 90% |
|
|
Most common |
|
|
2nd. most common |
|
|
True |
|
|
False |
|
|
Answer not on this option
list. |
Questions.
1.
TS is due
to 45XO. True /False
2.
What is the incidence
of TS?
3.
The incidence of TS
rises with maternal age? . True /False
4.
Most cases of TS are
due to loss of a paternal chromosome. True /False
5.
How
common is monosomy X in TS?
6.
How
common is monosomy Y in TS?
7.
What % of
miscarriages are due to TS?
8.
What % of TS
pregnancies miscarry?
9.
↑ NT is a feature of
TS True
/False
10.
↑ NT is more common
in foetuses with congenital heart disease True
/False
11.
Low birth
weight is a feature of TS. True /False.
12.
If TS is suspected,
but the neonate’s karyotype from blood testing is normal, the diagnosis is
Noonan’s syndrome. True /False.
13.
Neonates with TS are
at normal risk of DDH.
True /False
14.
Immune hydrops is
more common in TS. True
/False
15.
Cystic hygroma is
more common in TS. True
/False
16.
What is the
approximate risk of gonadal malignancy if there is XY mosaicism in TS?
17.
How common is webbing
of the neck in TS?
18.
How common is a low
occipital hairline in TS?
19.
How common is
congenital heart disease in TS?
20. Dissecting aortic aneurysm is more common in TS. True /False
21.
How common is
lymphoedema in TS?
22.
How common is kidney
disease in TS?
23.
Short stature in TS
has been linked to the TS gene. True
/False
24.
What % of adolescents
with TS have scoliosis. .
25.
Inverted nipples are
more common in TS. True /False
26.
1ry. amenorrhoea occurs in all
cases. True /False
27.
Adrenarche occurs at
a normal time. True /False
28.
Cubitus valgus is
more common in TS. True /False
29.
Cleft palate if a
feature of TS. True /False
30.
Micrognathia is a
feature of TS. True /False
31.
Abnormalities of
teeth and nails are more common in TS. True /False
32.
Otitis media is more
common in TS. True /False
33.
Intelligence
is usually lower in TS, especially verbal skills. True /False
34.
Women with TS have
higher mortality rates than other women. True /False
35.
Oestrogen should be
started on diagnosis to promote bone growth. True /False
36.
Oestrogen-only
HRT is appropriate for bone protection. True /False
37.
Women
with TS have an ↑ risk of
hypertension. True
/False
38.
Women
with TS have an ↑ risk of coeliac
disease. True
/False
39.
Women
with TS have an increased risk of Crohn’s disease and ulcerative colitis. True
/False
40.
Women with TS have an
↑ risk of diabetes True
/False
41.
Women with TS have an
↑ risk of hyperthyroidism. True /False True /False
42.
Women
with TS have an ↑ risk of deafness. . True /False
43.
Women with TS have an
↑ risk of osteoporosis. True
/False
44.
Women with TS have
similar rates of red-green colour blindness to men. True /False
45.
Women with TS have a
normal incidence of ptosis. True
/False
46.
Women with TS cannot
have children. True
/False
47.
The
“short stature homeobox” (SHOX) gene has been implicated in TS. True /False
TOG
questions from Mascarenhas et al: “Routes
to parenthood for women with Ts”.
TOG. 2019.
Volume 21, Issue 1; P 43-50.
Mark as
True or False.
With regard to the epidemiology of Turner syndrome (TS)
1. it
is the second most common chromosomal aneuploidy in humans.
2. its incidence increases
with increasing maternal age
3. approximately 1 in 100
affected fetuses are born alive
With regard to the clinical features of TS
4. most affected women have spontaneous
menarche
5. those presenting with 1ry.
amenorrhea are likely to have suboptimal uterine development
Concerning the pathogenesis of TS
6. there is accelerated
atresia of primordial follicles in the ovary
7. those who have spontaneous
menarche are likely to be mosaic
8. serum AMH levels do not correlate
with karyotype.
9. estrogen replacement
should be started at 15 years of age
10. estrogen needs to be started
at half the normal adult dose
11. when childbearing is complete,
it is advisable to stop HRT.
Regarding pregnancy in women with TS,
12. the most dramatic risk during
pregnancy is aortic dissection
13. the risk of maternal
mortality is around 2%
14. a history of aortic
dissection is a definite contraindication to pregnancy
Concerning fertility in women with TS
15. approximately 8% conceive
naturally
16. there is an increased risk
of miscarriage
With regard to assisted reproductive technology in women
with TS
17. in gestational surrogacy,
the surrogate is genetically unrelated to the baby.
18. there are reliable data on
outcomes after oocyte freezing and embryo freezing
19. ovarian tissue freezing is
an option for fertility preservation, even before the onset of puberty
20. preserved embryos are
allowed to be used for treatment even if there is a relationship breakdown and
the male partner withdraws consent for the use of embryos created using his
sperm
21. The
MAGPIE trial .
Question 2.
Which, if any, of the following is true of
the Magpie trial?
Option list.
|
A |
it compared
MgSO4 with placebo in the management of eclampsia / severe PET |
|
B |
it compared
MgSO4 with lytic cocktail in the management of eclampsia / severe
PET |
|
C |
it compared
MgSO4 with phenytoin in the management of eclampsia / severe PET |
|
D |
it compared
MgSO4 with alcohol in the management of threatened premature
labour |
|
E |
it compared
MgSO4 with atosiban in the management of threatened premature
labour |
|
F |
it compared
MgSO4 with ritodrine in the management of threatened premature
labour |
|
G |
it compared
MgSO4 with dexamethasone in the prevention of cerebral palsy due
to extreme prematurity |
|
H |
it compared
MgSO4 with placebo in the prevention of cerebral palsy due to
extreme prematurity |
|
I |
none of the
above |
Question
3. Which
if any of the following are true of the Magpie trial?
Option list.
|
A |
it involved ~ 1,000 women |
|
B |
it involved ~ 10,000 women |
|
C |
it involved ~ 20,000 women |
|
C |
it involved > 20,000 women |
|
D |
it involved ~ 30 hospitals |
|
E |
it involved ~ 50 hospitals |
|
F |
it involved ~ 80 hospitals |
|
G |
it involved > 150 hospitals |
|
H |
it involved 5 countries |
|
I |
it involved 10 countries |
|
J |
it involved 20 countries |
|
K |
it involved 30 countries |
|
L |
it involved 50 countries |
|
M |
it involved >50 countries |
Question
4. Which
if any of the following are true?
Option list.
|
A |
almost 50% of the women were in Africa |
|
B |
almost 50% of the women were in America |
|
C |
almost 50% of the women were in Asia |
|
D |
almost 50% of the women were in Australia / New Zealand |
|
E |
almost 50% of the women were in Europe |
Question
5. Which,
if any, of the following is true of the Magpie trial?
Option list.
|
A |
cerebral palsy rates at 2 years were ↓ by the use of MgSO4
in babies born < 34 weeks |
|
B |
cerebral palsy rates at 2 years were unchanged by the use of MgSO4 in babies
born < 34 week |
|
C |
eclampsia rates were reduced by about half by the use
of MgSO4 |
|
D |
eclampsia rates were reduced by about half by the use
of MgSO4 but only in underdeveloped countries |
|
E |
maternal mortality was significantly ↓ by the use of
MgSO4 |
|
F |
maternal mortality was significantly ↓ by the use of
MgSO4, but only in underdeveloped countries |
|
G |
premature delivery was significantly ↓ by the use of
MgSO4 |
|
H |
perinatal mortality from prematurity was significantly
↓ by the use of MgSO4 |
No comments:
Post a Comment