MRCOGManchester: MRCOG tutorial 13th. November 2023

13 November 2023.

12	EMQ. Hepatitis C
13	SBA. Chickenpox in pregnancy
14	MCQ. The Coombs test
15	EMQ. Mayer-Rokitansky-Küster-Hauser syndrome
16	EMQ. Brexanolone
17	EMQ. The MAGPIE trial

12. Hepatitis C.

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?

Option list.

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

13. Chickenpox in pregnancy.

Introduction.

This is a regular topic in the exam. The “Green Book” updated its advice on post-exposure prophylaxis in 2022 which probably brought it to the minds of examiners.

Abbreviations.

FVS: fetal varicella syndrome

VZV: varicella-zoster virus

VZIg: varicella-zoster immunoglobulin

Question 1. What type of virus causes chickenpox?

Option List

A	avian virus
B	herpes virus
C	retrovirus
D	picovirus
E	pox virus

Question 2. Which of the following best describes the chickenpox virus

Option List

A	DNA virus
B	RNA virus
C	Prion
D	All of the above
E	None of the above

Question 3. What is the main reservoir of the chickenpox virus?

Option List

A	domestic chickens
B	chickens in battery farms
C	sparrows
D	humans
E	earthworms

Question 4. Which, if any of the following are true about how chickenpox is spread?

Option List.

A	via respiratory droplets
B	direct contact with the fluid from the vesicles
C	contact with fomites
D	contact with stalactites
E	from lavatory seats

Question 5. Fomites - which of the following statements are true?

A	fomites are bedclothes infested with bed bugs which can carry the chickenpox virus
B	“fomites” in Latin is the plural of “fomes”, the noun meaning “tinder” in English
C	fomites are inanimate objects that can effect the transfer of communicable diseases from the infected person to someone who is not infected
D	fomites are horizontal stalagmites, particularly found in the Dolomite mountains and capable of fostering the growth of viruses, including the chickenpox virus
E	fomites are the viral particles in vomit that form the aerosols particularly associated with the respiratory spread of viruses such as the chickenpox virus.

Question 6. Which, if any, of the following are listed in GTG13 as examples of fomites?

A	bathtubs used by person with chickenpox at the infectious stage
B	bedding
C	blood, fresh or dried, from person with chickenpox at the infectious stage
D	clothing
E	hair
F	paper money
G	skin cells
H	viral remnants in vomit from person with chickenpox at the infectious stage

Question 7. With regard to the epidemiology of chickenpox in the UK, which of the following statements are true?

A	Chickenpox is endemic
B	Chickenpox is endemic with mini-epidemics every 3-4 years in the early part of the year
C	The main reservoir is chickens, particularly those that are reared intensively
D	The main reservoir is human sensory nerve root ganglia after primary infection
E	The main reservoir is fomites

Question 8. What proportion of the ante-natal population of the UK is immune to chickenpox?

Option List

A	50%
B	60%
C	70%
D	80%
E	90%
F	≥ 90%

Question 9. Which population of immigrant women is least likely to have immunity to chickenpox?

Option List

A	Middle-Eastern
B	Those from Antarctica
C	Those from the EEC
D	Those from tropical and sub-tropical Africa
E	One-eyed Mongolians with the bad habit of spitting in public

Question 10. What is the incidence of chickenpox in pregnancy in the UK?

Option List

A	1 in 1,000
B	3 in 1,000
C	5 in 1,000
D	8 in 1,000
E	14 in 1,000
	20 in 1,000

Question 11. What is the usual presentation of chickenpox in a child?

Option List

A	Mild fever with malaise then vesicles which appear after 2 days and disappear after 4 – 5 days
B	Mild fever with malaise then vesicles which appear after 2 days and disappear after about 7 days
C	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 5 days
D	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 7 days
E	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 10 days

Question 12. What is the duration of infectivity after primary infection?

Option List

A	From the onset of fever until 48 hours after the vesicles form
B	From the onset of fever until 5 days after the vesicles form
C	From 48 hours before the development of the vesicles until 5 days later.
D	From 48 hours before the development of the vesicles until they crust over
E	From the development of the vesicles until 5 days later.
F	From the development of the vesicles until they crust over

Question 13. A woman books at 8 weeks. Her 6-year-old son lives with her and has recently

developed chickenpox? She is tested and found to be non-immune. What is her risk of infection from the domestic contact with her son?

Option List

A	50%
B	60%
C	70%
D	80%
E	90%

Question 14. Which of the following contacts with a case of chickenpox would be significant?

A	contact with the mother of a child who has just developed the typical chickenpox rash
B	contact with the mother of a child who has not developed the typical chickenpox rash
C	a four-hour journey on a school bus with 20 children, one of whom develops the typical chickenpox rash the next day
D	having a coffee with a neighbour who is having chemotherapy and has just developed shingles
E	visiting a neighbour who has developed ophthalmic shingles and has been admitted to an old-fashioned 20-bed ward
F	having a coffee with an 80-year-old neighbour who is in good health but has just had recurrence of thoracic shingles.

Question 15. In relation to shingles, which, if any, of the following statements are true?

A	Shingles is due to reactivation of the virus which has lain dormant in the sensory nerve root ganglia
B	Shingles is due to reactivation of the virus which has lain dormant in the motor nerve root ganglia
C	Shingles is due to reactivation of the virus which has lain dormant in the autonomic nerve root ganglia
D	Shingles should always be regarded as infectious.
E	Shingles in the immuno-compromised should always be regarded as infectious.
F	Ophthalmic shingles should always be regarded as infectious

Question 16. This is about prophylaxis with chickenpox vaccine.

Which of the following statements are true? Pick the best option from the option list.

Statements.

A	Chickenpox vaccine does not exist.
B	Chickenpox vaccine uses a killed virus of the Okra strain.
C	Chickenpox vaccine uses an attenuated virus of the Oka strain.
D	All children who have not had chickenpox should be offered the vaccine after 1 year of age.
E	Women should be screened for immune status as part of pre-pregnancy counselling or fertility treatment with ART

Question 17. This relates to vaccination in early pregnancy

A 25-year-old woman is given varicella vaccine. Her period is due the next day, but does not occur. A pregnancy test a few days later is +ve. What should be the management?

Option List

A	She should be advised that there is a 5% risk of congenital varicella syndrome and be offered TOP.
B	She should be advised that there is a 10% risk of congenital varicella syndrome and be offered TOP.
C	She should be advised that the level of risk of congenital varicella syndrome after vaccination in early pregnancy is unknown and be offered TOP.
D	She should be advised that the level of risk of congenital varicella syndrome after vaccination in early pregnancy is unknown and be offered referral to a feto-maternal medicine expert.
E	She should be advised that inadvertent vaccination has been studied for > 20 years no evidence has been found to harm to the mother or child.
F	She should be advised that the vaccine contains no live virus and cannot cause fetal infection.

Question 18. A woman has been referred to the booking clinic by her GP. Screening for immunity to chickenpox showed her to be seronegative. What advice would you give her?

Option List

A	Advise her that there is no risk unless she comes into contact with a case of chickenpox or shingles and to speak to GP or midwife if possible contact occurs.
B	Advise her to have the chickenpox vaccine because of the 10% risk and high mortality associated with varicella in pregnancy.
C	Advise her to have VZIG to reduce her risk of infection.
D	Advise her to take oral acyclovir until two weeks post-delivery.
E	None of the above.

Question 19. A woman is referred to the booking clinic by her GP for urgent assessment as she was in contact with a case of chickenpox two days before. What action should be taken?

Possible actions.

A	take a detailed history to determine the significance of the contact and her history of and likely immunity to chickenpox.
B	check for VZV immunity if there is a history of a significant contact and possibility that she is not immune.
C	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer oral acyclovir
D	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer VZIg
E	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer oral acyclovir + VZIg
F	if the contact was significant and the tests for VZV show her to be seronegative, discuss TOP.
	none of the above

Question 20. Which, if any, of the following statements about VZIg are correct?

A	VZIg is manufactured using recombinant technology
B	VZIg is effective in pregnancy when given within 10 days of the contact
C	If VZIg is given, the woman is potentially infectious for up to 28 days
D	Repeat doses of VZIg should not be given in the event of repeated significant contact
E	There are reliable supplies of VZIg and no problems regarding availability

Question 21. How does the administration of VZIG affect the duration of infectivity for the woman?

Option List

A	With no VZIG she is potentially infectious from day 8 to 28.
B	VZIG destroys virus and the woman is potentially infections from day 8 to 21.
C	VZIG does not alter the period in which the woman is potentially infections.
D	VZIG reduces the risk of shingles in later life
E	None of the above

Question 22. With regard to established varicella in pregnancy, which, if any, of the following statements are true? Choose the best option from the option list.

A	the main risk to the mother comes from pneumonia, with an incidence of about 10%
B	the main risk to the mother comes from pneumonia, with an incidence of about 40%
C	hepatitis and encephalitis are more common compared to the non-pregnant state
D	mortality from varicella pneumonia have fallen to < 15%
E	the death rate from varicella pneumonia is estimated to be 5 times greater than in the non-pregnant

Question 23. A GP phones to say that a patient of his at 10 weeks’ gestation has developed the typical rash of chickenpox. Her son had proven chickenpox a couple of weeks previously. She had been tested and found to be non-immune, but declined VZIG. Which, if any of the following statements would you include in your advice to the GP.

A	admit the woman for assessment, VZIG and acyclovir after counselling re risks and benefits.
B	arrange for her to be seen in the next antenatal clinic.
C	advise re prevention of secondary bacterial infection of the lesions
D	advise about her avoiding contact with susceptible individuals until at least 7 days after the lesions crust over
E	advise the GP of the criteria for hospital admission and the need for the woman to be informed of them.
F	advise the GP to discuss the risks and benefits of acyclovir 800mg five times daily for seven days and to prescribe it if the woman agrees.
G	advise that acyclovir is contraindicated once the rash appears
H	advise that VZIG is ineffectual once the rash has appeared
I	advise that acyclovir is not licensed for use in pregnancy and any use would be ‘off-label’.
J	advise that acyclovir is potentially teratogenic and not to be used in the 1^st. trimester.

Question 24.What kind of drug is aciclovir?

Question 25. How effective is aciclovir?

Question 26. Which, if any, of the following statements are true in relation to the diagnosis of fetal varicella syndrome?

Option List

A	detailed ultrasound examination by a fetal medicine expert should be offered
B	fetal MRI is superior to US examination and should be the 1ry test if available
C	amniocentesis should be offered as detection of varicella DNA makes FVS probable
D	amniocentesis should be done as early as possible, avoiding any varicella lesions
E	PCR which is –ve for varicella DNA in amniotic fluid has a strong NPV for FVS
	PCR which is +ve for varicella DNA in amniotic fluid has a strong PPV for FVS

Question 27. Which, if any, of the following statements are true in relation to fetal varicella syndrome?

Option List

A	FVS occurs in relation to 1ry. infection in-utero
B	FVS occurs in relation to 2ry. infection in-utero
C	the risk of FVS is ~ 5% when 1ry. infection in-utero occurs < 13 weeks
D	the risk of FVS is ~ 10% when 1ry. infection in-utero occurs between 13 and 20 weeks
E	the risk of FVS is greatest when 1ry. infection in-utero occurs within 4 weeks of birth

Question 28. Which, if any, of the following statements are true in relation to administration of varicella vaccine in pregnancy.

Option List

A	varicella vaccine is a recombinant vaccine and licensed for use in pregnancy
B	varicella vaccine contains a live, attenuated vaccine and is contraindicated in pregnancy
C	varicella vaccine contains a live, attenuated vaccine and is safe to use after 12 weeks
D	TOP should be advised if varicella vaccine is given in the 1^st. trimester
E	VZV immunoglobulin should be given if varicella vaccine is given in the 1^st. trimester
F	varicella vaccine should not be given to women who are breastfeeding

Question 29. Which, if any, of the following are true in relation to neonatal varicella (NV)

Option List

A	the risk of NV is 90% with fetal infection in the 1^st. trimester
B	the risk of NV is 50% with fetal infection in the 2^nd. trimester
C	the risk of NV is 10% with fetal infection in the 4 weeks before delivery
D	planned delivery should be delayed, if safe, until 7 days after start of the maternal rash
E	women with active chickenpox should not breastfeed until 10 days after the lesions crust

Question 30. Is chickenpox notifiable?

14. The Coombs test.

This is an old-fashioned MCQ with True / False answers.

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.

15. Mayer-Rokitansky-Küster-Hauser syndrome.

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.

MRKH: Mayer-Rokitansky-Küster-Hauser syndrome

Question 1. cooWhat 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 1^st. 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

16. Brexanolone.

Abbreviations.

GABA_A: 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 GABA_Areceptors in the brain
D	brexanolone is effective in the treatment of postpartum depression
E	brexanolone is administered orally
F	brexanolone is licensed for use in the UK

17. The MAGPIE trial .

Question 1. Which 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 2. 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 3. 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 4. 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

MRCOGManchester

Monday, 13 November 2023

MRCOG tutorial 13th. November 2023

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