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16 November 2023.
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18
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EMQ. Hepatitis E
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19
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EMQ.
Gestational trophoblastic disease
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20
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EMQ. Montgomery & consent
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21
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EMQ.
Listeriosis
and pregnancy
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22
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EMQ. Galactosaemia
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18. Hepatitis E.
Hepatitis E. EMQ.
Questions.
Question 1.
What is the most
common cause of acute viral hepatitis in the UK?
Option list.
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A
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hepatitis A virus
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B
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hepatitis B virus
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C
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hepatitis C virus
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D
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hepatitis D virus
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E
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hepatitis E virus
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F
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herpes simplex virus
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G
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HIV
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Question 2.
Which, if any, of
the following are correct about HEV.
Option list.
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A
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it is a DNA virus
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B
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it belongs to the genus Hippieviridae
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C
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it belongs to the genus Hepeviridae
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D
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it belongs to the genus Hoppieviridae
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E
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there are six main genotypes
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F
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genotype 3 is the one of greatest importance
in the UK
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G
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the main reservoir of genotype 3 is intensively-reared
chickens
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H
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the main reservoir of genotype 3 is
domestic cats
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I
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a vaccine exists but is only licensed in Russia
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J
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none of the above
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Question 3.
Which, if any, of
the following statements about HEV and pregnancy are true?
Option list.
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A
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pregnant women are more susceptible to HEV
infection
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B
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pregnant women are more likely to develop
serious disease that the non-pregnant
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C
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the main risk is neonatal death due to
vertical transmission
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D
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the main risk is maternal death
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E
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the risk of maternal death is highest with
infection in the 1st. trimester
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F
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↑
rates
of preterm birth have been reported
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G
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↑
rates of stillbirth have been reported
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19. Gestational trophoblastic disease.
Abbreviations.
CHM: complete hydatidiform mole.
EPT: epithelioid tumour.
GI: gastro-intestinal.
GTD: gestational trophoblastic disease.
GTDTC: gestational trophoblastic disease
treatment centre.
GTN: Gestational trophoblastic
neoplasia.
HM: hydatidiform mole.
PHM: partial hydatidiform mole.
POC: products of conception.
PSTT: placental site trophoblastic tumour.
Option list.
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A
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100%.
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B
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20%.
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C
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15%.
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D
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10%.
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E
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5%.
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F
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2.5%.
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G
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1.5%.
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H
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0.5%.
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I
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1 in 35.
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J
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1 in 55.
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K
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1 in 65.
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L
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1 in 700.
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M
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1 in 1,000.
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N
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Ö64.
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O
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pr2.
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P
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increased.
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Q
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reduced.
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R
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increased by a
factor of 2.
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S
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increased by a
factor of 5.
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T
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increased by a
factor of 10.
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U
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increased by a
factor of 20.
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V
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increased by a
factor of 30.
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W
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increased by a
factor of > 100.
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X
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hydatidiform
mole, both partial and complete.
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Y
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hydatidiform
mole, both partial and complete and placental site tumour.
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Z
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partial mole,
complete mole, invasive and metastatic mole, choriocarcinoma, placental site
trophoblastic tumour and epithelioid trophoblastic tumour.
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AA
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choriocarcinoma
invasive and metastatic mole and epithelioid trophoblastic tumour.
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BB
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true
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false
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none of the
above.
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Scenario
1.
List the
conditions included in the term GTD. There is no option list, just make a list.
Scenario
2.
What is the difference between GTD and GTN?
Pick one option from the list below.
Option list.
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A
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GTD comprises
the non-malignant conditions, i.e. complete and partial moles.
GTN comprises
the malignant conditions: invasive mole, choriocarcinoma and PSTT
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B
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GTD comprises
all the trophoblastic conditions; GTN comprises the malignant conditions
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C
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GTD comprises
all the trophoblastic conditions; GTN comprises persistent GTD
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D
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GTD comprises
all the trophoblastic conditions; GTN comprises malignant and potentially
malignant conditions, including atypical placental site nodules
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E
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none of the
above
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Scenario
3.
GTG38 mentions one
thing as the minimum standard of care. What is it?
There is not option list as that would make it too easy.
Scenario
4.
What is the
incidence of GTD in the UK?
Scenario
5.
Which , if any, of
the following are true of complete moles?
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A
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are usually diploid and with all the chromosomal material
of paternal origin
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B
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are usually triploid, with 2 sets of paternal haploid
genes + 1 set of maternal haploid genes
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C
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are usually triploid, with 1 set of paternal haploid
genes + 2 sets of maternal haploid genes
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D
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are tetraploid or mosaics in up to 10% of cases
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E
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up to 80% are due to duplication of a single sperm in an
egg devoid of maternal chromosomes
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F
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up to 80% are due to duplication of a single sperm in a
normal egg
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G
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usually result from dispermic fertilisation of a normal
egg
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H
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usually result from dispermic fertilisation of an egg
devoid of maternal chromosomes
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I
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usually has 46XX makeup
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J
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usually has 46XY makeup
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K
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the presence of fetal red blood cells defines a mole as
partial
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L
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mitochondrial DNA is maternal
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M
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mitochondrial DNA is paternal
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Scenario
6.
Which, if any, of
the following are true of partial moles?
Option list.
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A
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are usually diploid and with paternal chromosomal
material
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B
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are usually triploid, with 2 sets of paternal haploid
genes + 1 set of maternal haploid genes
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C
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are usually triploid, with 1 set of paternal haploid
genes + 2 sets of maternal haploid genes
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D
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are tetraploid or mosaics in up to 10% of cases
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E
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up to 80% are due to duplication of a single sperm in an
egg devoid of maternal chromosomes
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F
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up to 80% are due to duplication of a single sperm in a
normal egg
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G
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usually result from dispermic fertilisation of a normal
egg
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H
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usually result from dispermic fertilisation of an egg
devoid of maternal chromosomes
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I
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usually has 46XX makeup
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J
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usually has 46XY makeup
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K
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the presence of fetal red blood cells defines a mole as
partial
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L
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mitochondrial DNA is maternal
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M
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mitochondrial DNA is paternal
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Scenario
7.
What is the ratio
of complete: partial moles?
Scenario
8.
What is the risk
of molar pregnancy at age < 15 compared to age 30?
Scenario 9.
What is the risk
of molar pregnancy at age > 45 compared to age 30?
Scenario
10. What is the risk of molar pregnancy in a pregnancy after a complete
mole?
Option list.
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A
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< 1%
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B
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1-2%
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C
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3-5%
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D
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6-10%
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E
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11-20%
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F
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> 20%
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Scenario
11. What is the risk of molar pregnancy in a pregnancy after a
partial mole?
Use the option list from the previous question.
Scenario
12. Which, if any, of the following are more common in
pregnancy after a molar
pregnancy? This is not a true EMQ as there may be > 1
correct answer.
Option list.
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A
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anaemia
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B
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eclampsia / severe PET
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C
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intrauterine growth retardation
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D
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miscarriage
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E
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premature labour
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F
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PPH
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G
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pulmonary embolism
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G
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none of the above
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Scenario
13. Which, if any, of the following statements about hCG are
true?
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A
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is a glycoprotein
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B
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shares its α sub-unit with FSH, LH & TSH
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C
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shares its α sub-unit with FSH & LH but not TSH
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D
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shares its β sub-unit with FSH, LH & TSH
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E
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shares its β sub-unit with FSH & LH but not TSH
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F
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β-core exists as a sub-type of β-hCG
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G
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nicked free-β exists as a sub-type of β-hCG
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H
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c-terminal peptide exists as a sub-type of β-hCG
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I
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hCG β core fragment may lead to false –ve results with
urine pregnancy tests
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J
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heterophile antibodies may give false +ve hCG results
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K
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heterophile antibodies are not found in urine
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Scenario 14.
Which, if any, of
the following statements are true in relation to the diagnosis of molar
pregnancy ?
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A
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definite
diagnosis is usually made by ultrasound
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B
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definitive
diagnosis requires a +ve test for P57KIP2
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C
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definitive
diagnosis requires an hCG level > twice the median value for gestation
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D
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definite
diagnosis requires histological examination
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E
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none of the
above
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Scenario
15. Cystic
placental spaces in the placenta and a ratio of transverse to anterioposterior
measurements of
the gestation sac <1.5 are strongly suggestive of a partial mole. True /
False.
Scenario
16. When
should invasive karyotype testing be considered?
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A
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twin pregnancy with complete mole and a normal twin
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B
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uncertainty whether this is a complete mole with a normal
twin or possible partial mole
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C
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partial molar pregnancy
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D
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suspected mesenchymal hyperplasia of the placenta
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E
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recurrent molar pregnancy
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F
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none of the above
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Scenario 17.
Which, if any, of
the following statements are true about twin pregnancy with a viable
pregnancy and a
CHM?
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A
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the woman should
be referred to a feto-maternal specialist
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B
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the woman should
be referred to a GTDTC
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C
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fetal karyotyping
should be done
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D
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the rate of early
fetal loss is about 20%
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E
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the rate of
preterm birth is about 40%
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F
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the rate of
preeclampsia is 20%
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G
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the incidence of
GTN in doubled if the pregnancy goes beyond 24 weeks
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Scenario 18.
Which, if any, of
the following statements are true about preparation of the cervix
before evacuation
of molar pregnancy?
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A
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medical
preparation is of proven efficacy in making suction evacuation easier
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B
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medical
preparation with prostaglandins ↑ trophoblastic embolisation
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C
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medical preparation with prostaglandins ↑ the risk of needing
chemotherapy
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D
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GTG 38 recommends
the use of laminaria tents
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E
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none of the above
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Scenario 19.
Which, if any, of
the following statements are true about evacuation of molar
pregnancies?
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A
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medical
management is recommended for both CMs and PMs to ↓ the risk of bleeding
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B
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medical
management is recommended for both CMs and PMs to ↓ the risk of dissemination of trophoblastic tissue
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C
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medical
management is recommended for both CMs and PMs to ↓ the risk of uterine perforation
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D
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suction
evacuation is recommended for both CMs and PMs
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E
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suction
evacuation is recommended for CMs
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F
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suction
evacuation is recommended for PMs so long as fetal parts are not too big
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G
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mifepristone +
misoprostol treatment is an acceptable alternative to suction evacuation.
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H
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oxytocin
administration after suction evacuation is recommended to ↓ bleeding
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I
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none of the above
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Scenario
20. What is the management of suspected molar ectopic
pregnancy?
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A
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usual management for ectopic pregnancy
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B
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usual management + any tissue obtained sent to GTDTC
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C
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methotrexate followed by usual surgical management
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D
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referral to GTDTC
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E
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none of the above.
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Scenario
21. What is the management of placental site trophoblastic
tumour?
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A
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referral to GTDTC
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B
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referral to GTDTC, methotrexate and any tissue sent to
GTDTC
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C
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referral to GTDTC, hysterectomy and tissue sent to GTDTC
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D
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referral to and management by GTDTC
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E
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none of the above.
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Scenario
22. What is the management of epitheliod trophoblastic tumour?
Use the option list from
Scenario 21.
Scenario
23. What is the management of placental site nodule?
Use the option list from Scenario
21.
Scenario 24.
What is the
management of atypical placental site nodule?
Use the option list from
Scenario 21.
Scenario
25. Which, if any, of the following statements are true about
urinary hCG testing in
relation to avoiding failure to diagnose molar pregnancy?
|
A
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testing should be done 3 weeks after medical evacuation
of complete moles
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B
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testing should be done 3 weeks after surgical evacuation
of complete moles
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C
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testing should be done 3 weeks after medical evacuation
of partial moles
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D
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testing should be done 3 weeks after surgical evacuation
of complete moles
|
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E
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testing should be done 3 weeks after medical evacuation
of ‘failed’ pregnancy
|
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F
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testing should be done 3 weeks after surgical evacuation
of ‘failed’ pregnancy
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G
|
testing should be done 3 weeks after medical evacuation
of ‘failed’ pregnancy, but only if POC have not been sent for histological
examination
|
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H
|
testing should be done 3 weeks after surgical evacuation
of ‘failed’ pregnancy, but only if POC have not been sent for histological
examination
|
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I
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testing should be done 3 weeks after medical evacuation
of incomplete miscarriage
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J
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testing should be done 3 weeks after surgical evacuation
of incomplete miscarriage
|
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K
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testing should be done 3 weeks after medical evacuation
of incomplete miscarriage, but only if POC have not been sent for
histological examination
|
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L
|
testing should be done 3 weeks after surgical evacuation
of incomplete miscarriage, but only if POC have not been sent for
histological examination
|
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M
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none of the above
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Scenario
26. Which, if any, of the following statements are true in
relation to histological
examination of POC after TOP?
|
A
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it should be done in all cases to exclude GTD
|
|
B
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it should be done in all cases that have not had pre-op
ultrasound examination in case the pregnancy was an unsuspected ectopic.
Absence of trophoblastic tissue on histology will raise suspicion of the
diagnosis
|
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C
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it should be done in all cases where ultrasound has not
shown a viable pregnancy
|
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D
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it should be done in all cases where ultrasound has not
shown fetal parts.
|
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E
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none of the above
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Scenario
27. Which, if any, of the following statements are true in
relation to RhD and GTD?
|
A
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CHMs have no RhD
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B
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PHMs have no RhD
|
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C
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Anti-D should be withheld until histological results are
available
|
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D
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‘C’ is true, but only in relation to CMs
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E
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‘C’ is true, but only in relation to PMs
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F
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none of the above
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Scenario
28. Which, if any, of the following statements are true in
relation to GTN?
|
A
|
always arises from molar pregnancy
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B
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may occur after normal pregnancy and livebirth
|
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C
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may arise as primary ovarian neoplasia
|
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D
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the incidence after complete molar pregnancy is greater
than after partial molar pregnancy
|
|
E
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the incidence after livebirth is estimated at 1 in 50,000
|
Scenario
29. Which, if any, of the following statements are true in
relation to p57KIP2?
|
A
|
it is a tumour suppressor gene, found in complete and
partial moles but not choriocarcinoma
|
|
B
|
takes us to the world of genomic imprinting
|
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C
|
is an example of uniparental disomy
|
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D
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is a gene found in chromosomes of maternal origin, but
not paternal
|
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E
|
is a gene found in chromosomes of paternal origin, but
not maternal
|
|
F
|
can help to distinguish complete and partial moles
|
|
G
|
none of the above
|
Scenario
30. What
is the risk of persistent GTD after a complete mole?
Scenario
31. What
is the risk of requiring chemotherapy after a complete mole?
Scenario
32. What is the risk of persistent GTD after a partial mole?
Scenario
33. What is the risk of requiring chemotherapy after a partial
mole?
Scenario
34. What is the risk of requiring chemotherapy with hCG level
> 20,000 i.u. 4+1 weeks after
evacuation?
Scenario
35. What is the overall risk of requiring chemotherapy after
molar pregnancy in the UK?
Scenario
36. What is the risk of requiring chemotherapy in the USA
compared with the UK?
Scenario
37. Which, if any, of the following are grounds for offering
chemotherapy after
hydatidiform mole?
|
A
|
hCG > 10,000
IU/L > 4 weeks after evacuation
|
|
B
|
hCG > 20,000
IU/L > 4 weeks after evacuation
|
|
C
|
↑ hCG in two consecutive serum
samples
|
|
D
|
hCG the same in
two consecutive samples
|
|
E
|
raised, but
falling, hCG level 3 months after
evacuation
|
|
F
|
persistent
bleeding 3 months after evacuation
|
Scenario
38. What are the risk factors included in the FIGO scoring
system?
Scenario
39. Which, if any, of the following statements is true about
the recommended treatment
of low-risk GTN?
|
A
|
low risk is defined as WHO score ≤ 5
|
|
B
|
low risk is defined as WHO score ≤ 6
|
|
C
|
low risk means that no treatment is necessary
|
|
D
|
treatment of low risk GTN is methotrexate
|
|
E
|
treatment of low risk GTN is folic acid
|
|
F
|
treatment of low risk GTN is folinic acid
|
Scenario
40. Which, if any, of the following is the most common side-effect
of methotrexate?
|
A
|
alopecia
|
|
B
|
anaemia
|
|
C
|
aphasia
|
|
D
|
nausea
|
|
E
|
myelosuppression
|
|
F
|
none of the above.
|
Scenario
41. Which, if any, of the following statements are true about
the use of folic acid / folinic
acid in methotrexate
treatment regimens? There may be > 1 correct answer.
|
A
|
folic acid must be converted to tetrahydrofolate to be
biologically active
|
|
B
|
folic acid must be converted to folinic acid to be
biologically active
|
|
C
|
dihydrofolate reductase converts folic acid to folinic
acid
|
|
D
|
dihydrofolate reductase converts folic acid to
tetrahydrofolate
|
|
E
|
dihydrofolate reductase converts folinic acid to
tetrahydrofolate
|
|
F
|
folinic acid is used in preference to folic acid as it
reaches higher levels in plasma
|
|
G
|
folate therapy is used to reduce GI tract damage from
methotrexate
|
|
H
|
folate therapy is used to reduce hepatic damage from
methotrexate
|
|
I
|
folate therapy is used to reduce neurological damage from
methotrexate
|
|
J
|
folate therapy is used to reduce renal damage from
methotrexate
|
|
K
|
none of the above.
|
Scenario
42. When is repeat surgical evacuation of the
uterus appropriate?
Scenario 43.
Which, if any, of
the following statements are true about the recommended duration
of follow-up after
GTD? This is not a true EMQ as there may be > 1 correct answer.
|
A
|
6 months from the
time the hCG falls to normal
|
|
B
|
6 months from the
date of evacuation of the GTD if the hCG falls to normal within 56 days
|
|
C
|
6 months from the
date of the hCG falling to normal if it does so within 56 days
|
|
D
|
6 months from the
date of evacuation of the GTD if the hCG falls to normal after 56 days
|
|
E
|
6 months from the
date of the hCG falling to normal if it does so after 56 days
|
|
F
|
56 days after the
first full moon after the evacuation of the GTD
|
Scenario
44. What is the approximate cure rate for GTN with a FIGO risk
score ≤ 6?
|
A
|
70%
|
|
B
|
80%
|
|
C
|
90%
|
|
D
|
95%
|
|
E
|
98%
|
|
F
|
100%
|
Scenario
45. What is the approximate cure rate for GTN with a FIGO risk
score >7?
|
A
|
70%
|
|
B
|
80%
|
|
C
|
90%
|
|
D
|
95%
|
|
E
|
98%
|
|
F
|
100%
|
Scenario
46. When should the possibility of persistent GTD be
investigated after non-molar
pregnancy?
|
A
|
if there is abnormal bleeding
|
|
B
|
if there is persistent abnormal bleeding
|
|
C
|
if there is cough
|
|
D
|
if there is new-onset dyspnoea
|
|
E
|
if there is pleurodynia
|
Scenario
47. A woman wishes to become pregnant after a pregnancy with
GTD. Which, if any, of
the following statements are true about the advice she
should be given about an appropriate inter-pregnancy interval?
|
A
|
not before follow-up is complete
|
|
B
|
not for at least 3/12 after completion of follow-up
|
|
C
|
not for at least 6/12 after completion of follow-up
|
|
D
|
not for at least 12/12 after completion of follow-up
|
|
E
|
she should be advised not to become pregnant if
chemotherapy was needed
|
|
F
|
not for at least 6 months after completion of follow-up
if chemotherapy was needed
|
|
G
|
none of the above
|
Scenario
48. Which of the following statements are true about combined hormonal
contraception
use after GTD?
|
A
|
it may increase the risk of GTN if used before hCG levels
have returned to normal
|
|
B
|
is not associated with additional risk
|
|
C
|
intra-uterine contraceptives are preferable
|
Scenario
49. Which, if any, of the following statements are true about
the long-term issues for
women who have needed chemotherapy for GTN?
|
A
|
the menopause is likely to be earlier
|
|
B
|
the risk of other cancers is not increased
|
|
C
|
there is evidence of ↑ risk of breast cancer
|
|
D
|
there is evidence of ↑ risk of colon cancer
|
|
E
|
there is evidence of ↑ risk of myeloid leukaemia
|
|
F
|
there is evidence of ↑ risk of melanoma
|
|
H
|
there is no evidence of addition risk with HRT
|
Scenario
50. A
woman had a complete mole in her first pregnancy. She is pregnant for the
second
time. What is the risk of another molar
pregnancy?
Scenario
51. A
woman has had two molar pregnancies. What is the risk of molar pregnancy if she
becomes pregnant
again?
Scenario
52.
A woman has had three molar pregnancies.
What is the risk of molar pregnancy if
she becomes
pregnant again?
Scenario
53. Which,
if any, of the following statements are correct in relation to recurrence of
molar pregnancy?
|
A
|
the histological
type is likely to be the same
|
|
B
|
the
histological type in recurrent mole after a complete mole is likely to be
partial mole
|
|
C
|
the
histological type in recurrent mole after a partial mole is likely to be
complete mole
|
|
D
|
the
histological type after PSTT is likely to be choriocarcinoma
|
|
E
|
none of the
above
|
Scenario
54. A
woman has a normal pregnancy after treatment for hydatidiform mole. Which, if
any, of the
following statements are true about the need for hCG testing 6 weeks after the
pregnancy?
|
A
|
testing is
optional
|
|
B
|
testing is
only needed for women with persisting GTD
|
|
C
|
testing is
only needed for women with persisting GTN
|
|
D
|
testing is
only needed for women who have needed chemotherapy
|
|
E
|
testing should
be offered to all women who use hair dye
|
Scenario
55. What
proportion of women remain fertile after treatment for GTN?
|
A
|
80%
|
|
B
|
70%
|
|
C
|
60%
|
|
D
|
50%
|
|
E
|
40%
|
Scenario
56. What
proportion of women will reach the menopause by age 40 after chemotherapy
for GTN?
|
A
|
10%
|
|
B
|
20%
|
|
C
|
30%
|
|
D
|
40%
|
|
E
|
50%
|
FSRHCAP has a SBA. It
is open access, so reproduced here. It is badly-worded, mistaking GTD for GTN,
but highlights some of the key points.
With
gestational trophoblastic disease (GTD), which statement is false?
A. After complete
hydatidiform mole, 15–20% women develop GTD needing chemotherapy
B. After partial
hydatidiform mole, 30–35% women develop GTD needing chemotherapy
C. Intrauterine
contraception is unsuitable while human chorionic gonadotropin is still
detectable
D. Combined hormonal
contraception can be used if gestational trophoblastic neoplasia develops
Answer. GTG38 says
the risk of GTN requiring chemotherapy is about 13–16% for CHM and 0.5–1.0% for
PHM, so both A & B are false, but B more so than A.
TOG has some questions from 2008. Volume 10. 1
Molar pregnancy With regard to molar pregnancy,
1. it
arises from a genetic error occurring at or before the time of fertilisation. T
F
2. the
risk is highest in teenage mothers. T F
3. the
risk of malignant change, if partial, is 10 times less than if complete. T F
4. the
longer the interval between diagnosis of molar pregnancy and initiation of
chemotherapy, the poorer the prognosis. T F
5. repeated
uterine evacuation is recommended where serum human chorionic gonadotrophin
(hCG) levels are 5000 iu/l. T F
6. methotrexate/folinic
acid chemotherapy is effective treatment in the majority of cases of persistent
trophoblast disease following molar pregnancy. T F
7. 24-hour
advice on treatment of women overseas is available in specialist treatment
centres in the UK. T F In women with complete molar pregnancy,
8. there
are 69 chromosomes present in the conception. T F
9. the
diagnostic clinical features are bleeding, excessive morning sickness,
abdominal pain and a large-for-dates uterus. T F
10. there
is a 10–20% chance that they will require further treatment with chemotherapy.
T F
With regard to
the treatment of women with persistent trophoblast disease,
11. the
initial investigations carried out should include measurement of hCG levels to
exclude a new pregnancy. T F
12. initial
pretreatment levels of hCG help identify the need for a longer inpatient stay.
T F
13. approximately
30% of women in the low-risk group will require second-line chemotherapy. T F
14. treatment
with single-agent methotrexate increases the lifetime risk of myeloid
leukaemia. T F
15. treatment
of women in the high-risk group with etoposide/methotrexate/dactinomycin,
followed by cyclophosphamide/vincristine, results in a cure rate of 90%. T F
Which of the following statements about chemotherapy for molar pregnancy are
correct?
16. Approximately
5% of women with persistent trophoblast disease following molar pregnancy fall
in the high-risk category for chemotherapy. T F
17. When
women with high-risk persistent trophoblast disease are treated with the
combination of EMA/CO, approximately a third of them will develop resistance. T
F
18. Following
successful chemotherapy, the risk of relapse is approximately 3–5%. T F
19. In
those developing relapse, the cure rate varies between approximately 85–100%,
depending on whether they are high or low risk. T F
20. Chemotherapy
for molar pregnancy is associated with a 2.5-fold increase in the lifetime risk
of developing a second malignancy. T F
20. Montgomery & consent.
Abbreviations.
BMA: British Medical
Association.
GMC: General Medical Council.
Question
1.
Which, if any, of the following statements is most accurate?
Lead-in
|
A
|
The Montgomery ruling largely
replaces the Bolam ruling
|
|
B
|
The Montgomery
ruling largely replaces the Chester ruling
|
|
C
|
The Montgomery
ruling largely replaces the Sidaway ruling
|
|
D
|
The Montgomery
ruling is being contested in the European Court by the GMC as it infringes
the rights of doctors
|
|
E
|
The Montgomery
ruling is being contested in the European Court by the BMA as it infringes
the rights of doctors
|
Question 2.
Which, if any, of the following statements are true? This is not
a true EMQ as > 1 of the answers may be correct.
Lead-in
|
A
|
the level of risk, however small,
must be disclosed if a patient requests it
|
|
B
|
the level of
risk of damage from a procedure need not be disclosed if < 1%
|
|
C
|
the level of
risk of damage from a procedure need not be disclosed if < 10%
|
|
D
|
a material
risk is one that would be reflected in damages > £100,000 if negligence
were proved in court
|
|
E
|
a material
risk is one that would be reflected in damages > £1,000,000 if negligence
were proved in court
|
|
F
|
a material
risk is one that involves anatomical damage, not emotional or psychological
|
|
G
|
a material
risk is one that a reasonable person in the patient’s situation would be
likely to regards as significant
|
21. Listeriosis and pregnancy.
Abbreviations.
Lm: Listeria monocytogenes.
TOC: test of cure.
Scenario 1.
Which organism is
responsible for human listeriosis?
|
A
|
Listeria diogenys
|
|
B
|
Listeria
frigidaire
|
|
C
|
Listeria hominis
|
|
D
|
Listeria
monocytogenes
|
|
E
|
Listeria xenophylus
|
Scenario 2.
Which, if any, of
the following statements are true about Lm?
Option list.
|
A
|
it is a small, Gram
-ve rod
|
|
B
|
it is a Gram +ve
coccus
|
|
C
|
it is flagellated
|
|
D
|
it has no cell
wall
|
|
E
|
it is an obligate
aerobe
|
|
F
|
it functions
within host cells
|
|
G
|
it can easily be
mistaken for commensal organisms
|
|
H
|
none of the above
|
Scenario 3.
Which of the
following are associated with an increased risk of contracting LM?
|
A
|
age > 60 years
|
|
B
|
age < 1 year
|
|
C
|
blond hair
|
|
D
|
pregnancy
|
|
E
|
strabismus
|
Scenario 4.
Which of the following
are true of the susceptibility of pregnant women to Lm?
Option list.
|
A
|
they are not more
susceptible
|
|
B
|
they are more
susceptible x 2
|
|
C
|
they are more
susceptible x 5
|
|
D
|
they are more
susceptible x 10
|
|
E
|
they are more
susceptible x 20
|
|
F
|
they are > 20 times
more susceptible
|
|
G
|
none of the
above.
|
Scenario 5.
When does Lm most
often occur?
Option list.
|
A
|
1st. trimester
|
|
B
|
2nd. trimester
|
|
C
|
3rd trimester
|
|
D
|
1st. +
2nd. trimesters
|
|
E
|
2nd. +
3rd trimesters
|
|
F
|
all trimesters
equally
|
|
G
|
puerperium
|
|
H
|
none of the above
|
Scenario 6.
What is the incubation
period for Lm?.
Option list.
|
A
|
7±3
days
|
|
B
|
7±5
days
|
|
C
|
10±3
days
|
|
D
|
10±5
days
|
|
E
|
14±3
days
|
|
F
|
14±5
days
|
|
G
|
none of the
above.
|
Scenario
7.
What is the
significance of Granulomatosis Infantisepticum ?
Option list.
|
A
|
it is a fabrication by the author and of no significance
|
|
B
|
it is pathognomonic of Lm infection
|
|
C
|
it is the cause of vertical transmission of Lm
|
|
D
|
I refuse to answer Latin questions as they make me think
of Boris Johnson
|
|
E
|
none of the above
|
Scenario 8.
Which of the following
are accurate about cervico-vaginal infection? This is not a true
EMQ as there may be
>1 correct answer.
Option list.
|
A
|
Lm is as often
found in the cervix as in the bowel.
|
|
B
|
Lm is as often
found in the vagina as in the bowel.
|
|
C
|
Lm is less often found in the cervix than in the bowel.
|
|
D
|
Lm is less often found in the vagina than in the bowel.
|
|
E
|
Lm is more often found in the cervix than in the bowel.
|
|
F
|
Lm is more often found in the cervix than in the bowel.
|
|
G
|
no one knows and
no one cares
|
Scenario 9.
A GP phones about
a primigravida at 28 weeks. She has possibly ingested food
contaminated by Lm.
She is asymptomatic and afebrile. What advice will you give?
Option list.
|
A
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 2 weeks
|
|
B
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 4 weeks
|
|
C
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 6 weeks
|
|
D
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 8 weeks
|
|
E
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
F
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
G
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
H
|
admit to hospital
for investigation and intensive treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario 10.
A GP phones about
a primigravida at 28 weeks. She has possibly ingested food
contaminated by Lm.
She has mild symptoms but is afebrile. What advice will you give?
Option list.
|
A
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 2 weeks
|
|
B
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 4 weeks
|
|
C
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 6 weeks
|
|
D
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 8 weeks
|
|
E
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
F
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
G
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
H
|
admit to hospital
for investigation and intensive treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario 11.
A GP phones about
a primigravida at 28 weeks. She has possibly ingested food
contaminated by Lm.
She is symptomatic and her temperature is 38.2oC. What advice will you
give?
Option list.
|
A
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 2 weeks
|
|
B
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 4 weeks
|
|
C
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 6 weeks
|
|
D
|
reassure and advise
her about avoiding exposure and to reattend if she develops signs or symptoms
within 8 weeks
|
|
E
|
prescribe appropriate
antibiotic(s) for 7 days with follow-up for TOC
|
|
F
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
G
|
prescribe
appropriate antibiotic(s) for 7 days with follow-up for TOC
|
|
H
|
admit to hospital
for investigation and intensive treatment if Lm infection found
|
|
I
|
none of the above
|
Scenario 12.
Which, if any, of
the following would be appropriate for consideration as 1st. line
treatment of Lm in
pregnancy? This is not a true EMQ as there may be more than 1 correct answer.
Option list.
|
A
|
ampicillin
|
|
B
|
ampicillin + gentamycin
|
|
C
|
ampicillin +
streptomycin
|
|
D
|
amoxicillin +
clavulanic acid
|
|
E
|
clarithromycin
|
|
F
|
erythromycin
|
|
G
|
erythromycin +
metronidazole
|
|
H
|
trimethoprim
|
|
I
|
none of the above
|
Scenario
13. Is listeriosis a notifiable infection in the UK? Yes/No.
22. Galactosaemia.
Abbreviations.
GA: galactose
GAA: galactosaemia
GALT: galactose-1-phosphate
uridylyltransferase
Scenario
14. What is galactosemia? There is no option list.
Scenario
15. What is the mode of inheritance? There is no option list.
Scenario
16. Which of the following is the most common cause of galactosemia
in Caucasians?
Option list.
|
A
|
mutation of the GALE gene
|
|
B
|
mutation of the GALF gene
|
|
C
|
mutation of the GALK gene
|
|
D
|
mutation of the GALk1 gene
|
|
E
|
mutation of the GALT gene
|
Scenario
17. What is the mutation which causes Classical Galactosaemia?
Option list.
|
A
|
Q188L
|
|
B
|
Q188M
|
|
C
|
Q188R
|
|
D
|
R188L
|
|
E
|
R188M
|
|
F
|
R188R
|
|
G
|
None of the
above
|
Scenario
18. What is the Duarte mutation? There is no option list.
Scenario
19. What are the main sources of galactose? There is no
option list.
Scenario
20. What is the approximate prevalence of galactosemia? There
is no option list.
Answer. GHR says: 1 in
30,000 to 1 in 60,000.
Scenario
21. Which of the following groups has the highest prevalence of
galactosaemia?
Option list.
|
A
|
Armenians
|
|
B
|
Ashkenazi Jews
|
|
C
|
French
absinthe drinkers
|
|
D
|
Irish campers
|
|
E
|
Irish
travellers
|
|
F
|
Masai
|
|
G
|
Scottish
campers
|
|
H
|
None of the
above
|
Scenario 22.
Which is the most
common mutation in the group with the highest incidence of galactosemia? There
is no option list.
Scenario
23. Which, if any, of the following are linked to
untreated GAA in the newborn?
Option list.
|
A
|
risk of coagulation
problems
|
|
B
|
risk of congenital
hypothyroidism
|
|
C
|
risk of diabetes
|
|
D
|
risk of diarrhoea
|
|
E
|
risk of failure to
thrive
|
|
F
|
risk of liver failure
|
|
G
|
risk of renal failure
|
|
H
|
risk of staphylococcal
infection
|
Scenario 24.
What are
the main problems associated with non-treatment of galactosaemia in adults?
There is no option list.
Scenario
25.
Which, if any, of
the following statements are true in relation to the effects of a
galactose-reduced diet (GRD) on long-term complications (LTCs)?
Option list.
|
A
|
a GRD has a major protective effect on LTCs,
but only if started within 2 weeks of birth
|
|
B
|
a GRD has a major protective effect on
LTCs, but only if started within 12 weeks of birth
|
|
C
|
a GRD has a major protective effect on
LTCs, but only if followed meticulously
|
|
D
|
a GRD has a major protective effect on
LTCs, but only if started within 2 weeks of birth and continued for life
|
|
E
|
a GRD has a major protective effect on LTCs,
but only if started within 2 weeks of birth and continued for life
|
|
F
|
none of the above
|
Scenario 26.
Is screening for galactosaemia
included in the UK neonatal screening programme? If not, why not?
