|
Role-play. Premature ovarian insufficiency |
|
|
43 |
Structured discussion. |
|
44 |
EMQ. Hepatitis C |
|
45 |
EMQ. Uterine inversion |
|
46 |
SBA. Kisspeptin |
42. Role-play. Premature ovarian insufficiency.
Candidate’s
instructions.
You
are a SpR5 in the gynae clinic and about to see Caroline Faulkner. Your tasks
are to take an appropriate history and advise about investigation and
management.
GP referral letter.
The Health
Centre,
Middle
Brook.
Dear Doctor,
Please
see Caroline who appears to have an early menopause. Her periods were
infrequent for six months or so and she last had one three months ago. She is
having some hot flushes. I checked her FSH level and it was reported to be in
the menopausal range. I have not dealt with this condition previously and look
forward to reading your expert advice.
43. Structured
discussion.
The examiner will ask a series of questions. Topic
announced on the night.
44. 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% |
|
E |
70% |
|
F |
> 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 |
45. 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
46. SBA.
Kisspeptin.
Pick the best statement.
Option list.
|
A |
is a pheromone released by the salivary glands during
passionate embraces |
|
B |
is a digestive enzyme released by the salivary glands
during passionate embraces |
|
C |
is a digestive enzyme found in human carnivores but not
vegetarians |
|
D |
is thought necessary for trophoblastic invasion and low
levels have been linked to miscarriage, recurrent miscarriage and ↑ risk of PET |
|
E |
is named after “Kiss me quick” chocolate |
|
F |
does not exist and this question is a very poor joke by
someone who should know better |
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