|
EMQ. Cytomegalovirus and Pregnancy. CMV |
|
|
54 |
EMQ. WOMAN trial |
|
55 |
EMQ. Tranexamic acid |
|
56 |
EMQ. Uterine inversion |
|
57 |
EMQ. Kallmann’s syndrome |
53. EMQ.
Cytomegalovirus and Pregnancy. CMV.
Abbreviations.
AI: avidity
index.
CMV: cytomegalovirus.
CNS: central
nervous system.
FGR: fetal
growth restriction.
HIG: hyperimmunoglobulin.
IUFD: intrauterine fetal death.
Scenario 1.
What does the term
“cytomegalovirus” mean?
Option list.
|
A |
it is an unusually large virus |
|
B |
it is the largest known virus |
|
C |
the viral cytoplasm is increased in volume |
|
D |
infected cells are enlarged and have enlarged nuclei |
|
E |
none of the above |
Scenario 2.
Which of the
following terms is used in relation to CMV infected cells?
Option list.
|
A |
almond-eyed |
|
B |
apple of my eye |
|
C |
cross-eyed |
|
D |
doe-eyed |
|
E |
owl-eyed |
Scenario 3.
Which family of
viruses does CMV belong to?
Option list.
|
A |
Adenoviridae |
|
B |
Arachnoviridae |
|
C |
Enteroviridae |
|
D |
Herpesviridae |
|
E |
Poxviridae |
Scenario 4.
What kind of virus
is CMV?
Option list.
|
A |
bacteriophage |
|
B |
DNA virus |
|
C |
RNA virus |
|
D |
none of the above |
Scenario 5.
What is the
structure of the herpes virus?
Option list.
|
A |
double-stranded DNA core, surrounded by three layers:
capsid, tegument and envelope |
|
B |
single-stranded DNA core, surrounded by two layers:
capsid and envelope |
|
C |
double-stranded RNA core, surrounded by three layers:
capsid, tegument and envelope |
|
D |
single-stranded RNA core, surrounded by two layers:
capsid and envelope |
|
E |
none of the above |
Scenario 6.
How many herpes
viruses have been described?
Option list.
|
A |
>1,000 |
|
B |
> 500 |
|
C |
> 250 |
|
D |
> 100 |
|
E |
none of the above. |
Scenario 7.
How many herpes
viruses are of relevance to human infection?
Option list.
|
A |
8 |
|
B |
10 |
|
C |
12 |
|
D |
14 |
|
E |
20 |
Scenario 8.
Write the list of
herpes viruses which affect humans and the conditions they cause?
Option list. There is
none. You have to write your own list.
Scenario 9.
Where does CMV
rank in the list of the most common causes of congenital viral
infection?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
5 |
Scenario 10.
Which of the
following statements is the most accurate in relation to CMV?
Option list.
|
A |
CMV can lie dormant after 1ry. infection, usually in
bone marrow |
|
B |
CMV can lie dormant after 1ry. infection, usually in
dorsal root ganglia |
|
C |
CMV can lie dormant after 1ry. infection, usually in
the lungs |
|
D |
CMV can lie dormant after 1ry. infection, usually in
the salivary glands |
|
E |
CMV does not lie dormant after 1ry. infection |
Scenario 11.
Which, if any, of
the following statements is true of CMV & pregnancy in the UK?
Option list.
|
A |
approximately 10-20% of women are immune before their 1st.
pregnancy |
|
B |
approximately 20-30% of women are immune before their 1st.
pregnancy |
|
C |
approximately 30-50% of women are immune before their 1st.
pregnancy |
|
D |
approximately 40-60% of women are immune before their 1st.
pregnancy |
|
E |
none of the above |
Scenario 12.
Which of the
following statements is true in relation to vertical transmission?
Option list.
|
A |
it is mainly transplacental |
|
B |
it is mainly due to feto-maternal haemorrhage |
|
C |
it mainly occurs during labour and delivery |
|
D |
it mainly occurs during lactation |
|
E |
none of the above |
Scenario 13.
What is the
approximate incidence of 1ry. CMV infection in pregnancy?
Option list.
|
A |
< 1% |
|
B |
< 5% |
|
C |
< 7.5% |
|
D |
< 10% |
|
E |
≥ 10% |
Scenario 14.
What is the
biggest source of CMV infection for women of reproductive age?
Option list.
|
A |
contaminated food or water |
|
B |
blood transfusion |
|
C |
infected sexual partner |
|
D |
infected small children |
|
E |
undercooked meat, particularly pork |
Scenario 15.
What proportion of
1ry. maternal CMV infection in pregnancy is asymptomatic?
Option list.
|
A |
up to 10% |
|
B |
11 – 29% |
|
C |
30 – 49% |
|
D |
50 – 79% |
|
E |
80 – 89% |
|
F |
≥ 90% |
Scenario 16.
What is the
approximate prevalence of CMV infection in UK neonates?
Option list.
|
A |
0.10- 0.25% |
|
B |
0.10- 0.50% |
|
C |
0.20- 0.50% |
|
D |
0.20- 1.00% |
|
E |
0.20- 2.25% |
Scenario 17.
Where does CMV
rank in the non-genetic causes of SNHL in children?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
none of the above |
Scenario 18.
When does vertical
transmission carry the greatest risk of inflicting neurological
damage on the fetus?
Option list.
|
A |
with 1ry infection during the 1st. trimester |
|
B |
with 2ry infection during the 1st. trimester |
|
C |
with 1ry infection during the 2nd. trimester |
|
D |
with 2ry infection during the 2nd. trimester |
|
E |
with 1ry infection during the 3rd. trimester |
|
F |
with 2ry infection during the 3rd. trimester |
|
G |
with 1ry infection during labour / delivery |
|
H |
with 2ry infection during labour / delivery |
|
I |
none of the above |
Scenario 19.
What is the risk
of vertical transmission after CMV infection in the immediate
preconception period?
Option list.
|
A |
< 1% |
|
B |
1-5% |
|
C |
6-10% |
|
D |
11-15% |
|
E |
16-20% |
|
F |
21-30% |
Scenario 20.
A fetus is
infected with CMV at the time of highest risk for neurological damage. What
is the approximate upper limit
for the risk that the child will have neurological damage?
Option list.
|
A |
up to 1% |
|
B |
up to 5% |
|
C |
up to 7.5% |
|
D |
up to 10% |
|
E |
up to 12.5% |
|
F |
up to 15% |
|
G |
up to 20% |
|
H |
none of the above |
Scenario
21. Approximately what % of cerebral palsy is thought
attributable to fetal CMV?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario 22.
Approximately what
% of SNHL is thought attributable to fetal CMV infection?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario 23.
Which, if any, of
the following statements is true of CMV?
Option list.
|
A |
1ry. infection is followed by life-long latent
infection |
|
B |
1ry. infection is followed by life-long latent infection
in a minority of cases |
|
C |
life-long latent infection is characteristic of CMV but
not other herpes viruses |
|
D |
life-long latent infection only occurs after 2ry.
infection |
|
E |
none of the above. |
Scenario 24.
How is 1ry.
maternal CMV infection best diagnosed?
Option list.
|
A |
by the regional laboratory |
|
B |
IgM to IgG conversion |
|
C |
presence of IgM with low avidity IgG |
|
D |
religious conversion |
|
E |
sero-conversion from IgG -ve to IgG +ve |
Scenario 25.
Which, if any, of
the following is true in relation to ‘avidity’ in CMV infection?
Option list.
|
A |
avidity declines directly with the interval from 1ry
infection to the test |
|
B |
avidity is an indirect measure of viral load |
|
C |
avidity measures the determination of the obstetrician
to make a diagnosis |
|
D |
avidity measures the enthusiasm of the laboratory for
maximising the cost of testing |
|
E |
avidity measures the strength of binding of CMV
antibody to the virus |
Scenario 26.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
the AI is the ratio of free: albumin-bound CMV IgG in
maternal serum |
|
B |
the AI is the IgG antibody titre in maternal serum |
|
C |
the AI is the percentage of IgG that is bound to the
antigen |
|
D |
the AI is the amount of IgG bound to the antigen
expressed as micrograms / gram |
|
E |
none of the above |
Scenario 27.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
an AI < 30 is indicative of old infection |
|
B |
an AI < 30 is indicative of recent 1ry infection |
|
C |
an AI < 30 suggests a faulty assay |
|
D |
the AI assay used in the NHS is standard across all
laboratories |
|
E |
none of the above |
Scenario 28.
Which, if any, of the following
statements is true in relation to identifying women at greatest risk of having
a baby with severe congenital infection?
Option list.
|
A |
a low AI < 18 weeks indicates high risk |
|
B |
a high AI < 18 weeks indicates high risk |
|
C |
a high IgM titre indicates low risk |
|
D |
a high IgG titre indicates high risk |
|
E |
none of the above |
Scenario 29.
What is UK policy
in relation to routine screening for CMV in pregnancy?
Option list.
|
A |
routine screening was introduced in 2018 |
|
B |
routine screening is not advocated because of cost |
|
C |
routine screening is not advocated because of the lack
of an accurate test |
|
D |
routine screening is not advocated because of cross-reaction
with EBV |
|
E |
none of the above |
Scenario 30.
What is UK policy
in relation to routine screening of the neonate for CMV?
Option list.
|
A |
routine screening was introduced in 2015 |
|
B |
routine screening is not advocated because of cost |
|
C |
routine screening is not advocated because of the lack
of an accurate test |
|
D |
routine screening is not advocated because of cross-reaction
with EBV |
|
E |
none of the above |
Scenario
31. Pick the true statements from the list below.
Option list.
|
A |
avidity testing
is not done on CMV IgM antibodies |
|
B |
CMV IgG is a
maverick and does not play by the usual rules |
|
C |
CMV IgM is a
maverick and does not play by the usual rules |
|
D |
CMV IgG
persists for many years |
|
E |
CMV IgM
persists for 1 year or more |
|
F |
none of the
above |
Scenario 32.
A woman has been
shown to have had CMV infection in pregnancy. It is decided to
check for evidence of fetal
infection. What does SIP56 say is the mainstay of diagnosing fetal CMV
infection.?
Option list.
|
A |
amniocentesis and PCR for evidence of CMV |
|
B |
amniocentesis and electron microscopy for evidence of
CMV |
|
C |
amniocentesis and light microscopy for evidence of CMV |
|
D |
amniocentesis and viral culture |
|
E |
MRI |
|
F |
ultrasound – abdominal |
|
G |
ultrasound - transvaginal |
Scenario 33.
A woman has been
shown to have had CMV infection in pregnancy. Which, if any of
the following statements best
describe the role of MRI scanning in assessing the fetus? This is not a true
EMQ as more than one statement may be true.
Option list.
|
A |
it should be offered in conjunction with ultrasound |
|
B |
it should be offered if ultrasound examination suggests
fetal infection |
|
C |
it should be offered if ultrasound examination does not
suggest fetal infection |
|
D |
it should be offered if there is sufficient funding to
pay for it |
|
E |
the role of MRI scanning is not yet clear |
|
F |
none of the above |
Scenario 34.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
the risk of vertical transmission in pregnancy is ↑ |
|
B |
the risk of vertical transmission in pregnancy is ↓ |
|
C |
the risk of vertical transmission in pregnancy is the
same as in HIV-ve women |
Scenario 35.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
her neonate is at ↑
risk of acquiring CMV perinatally |
|
B |
her neonate is at ↓
risk of acquiring CMV perinatally |
|
C |
her neonate is at normal risk of acquiring CMV
perinatally |
|
D |
none of the above |
Scenario 36.
A pregnant woman
is HIV+ve? Her neonate is +ve for both CMV and HIV. Which of the
following statements is true?
Option list.
|
A |
the child has a ↓
risk of HIV progression and ↓
risk of CNS damage from CMV |
|
B |
the child has a ↓
risk of HIV progression and ↑
risk of CNS damage from CMV |
|
C |
the child has a ↓
risk of HIV progression and normal risk of CNS damage from CMV |
|
D |
the child has an ↑
risk of HIV progression and ↓
risk CNS damage from CMV |
|
E |
the child has an ↑
risk of HIV progression and ↑
risk CNS damage from CMV |
|
F |
the child has an ↑
risk of HIV progression and normal risk of CNS damage from CMV |
|
G |
the child has a normal risk of HIV progression and ↓ risk of CNS damage from CMV |
|
H |
the child has a normal risk of HIV progression ↑ risk of CNS damage from CMV |
|
I |
the child has a normal risk of both HIV progression and
CNS damage from CMV |
Scenario 37.
Which of the
following treatments in pregnancy is of proven efficacy and safety in
reducing the risk of vertical
transmission to the fetus?
Option list.
|
A |
acyclovir |
|
B |
CMV vaccine |
|
C |
ganciclovir |
|
D |
HIG |
|
E |
valaciclovir |
|
F |
none of the above |
TOG CPD
TOG article by Navti et al. The article is from 2016 and is open-access.
TOG. Volume
18, Issue 4 October 2016 Pages 301–7.
Some of the questions are badly
written – I would expect exam questions to be better.
Regarding cytomegalovirus
(CMV),
1. it is a double-stranded RNA herpes virus. True False
2. it is the commonest congenital viral
infection in the developed world. True False.
3. prevalence is most common in social class
V. True False
Regarding CMV morbidity,
4. it is the leading genetic cause of
sensorineural deafness. True False
5. maternal infection occurring in the 3rd.
trimester carries the highest risk to the fetus. True False
6. previous infection confers complete future
immunity to the mother. True False
Regarding feto-maternal transmission of CMV,
7. there is good evidence to suggest that
gestational age has no apparent influence on risk of transmission. True False
8. breastfeeding is a route of transmission. True False
9. for healthy mature babies, an infection
with the CMV through breastmilk does not pose significant danger. True False
10. transmission can be reduced by appropriate
hand washing after nappy changes and exposure to bodily fluids, avoiding
kissing young children on mouth and cheeks and by avoiding sharing food, drinks
or utensils with young children. True False
11. primary infection, reactivation and
reinfection with different CMV strains during pregnancy has been shown to lead
to congenital CMV. True False
Regarding maternal CMV in pregnancy,
12. diagnosis of maternal CMV based on symptoms
is reliable with over 70% of women presenting with classic symptoms. True False
13. viral reactivation is more common in HIV
positive pregnant women. True False
Regarding diagnosis of CMV infection in pregnancy,
14. seroconversion of CMV specific immunoglobulin
G (IgG) in paired acute and convalescent sera is diagnostic of a new acute
infection. True False
15. When prepregnancy status is unknown,
detection of immunoglobulin M (IgM)- specific antibody is diagnostic of primary
infection. True False
16. IgM serology is imprecise for determining
primary infection as it has been shown to remain positive for up to a year
following acute infection. True
17. The presence of IgG and IgM CMV antibodies
with low CMV antibody avidity is diagnostic of primary infection. True False
Concerning congenital CMV infection,
18. 85% are asymptomatic at birth. True False
19. 30% of affected infants will develop
neurological sequelae. True False
20. 15% of infants born to mothers with recurrent
CMV infection are overtly symptomatic.
True False
54. EMQ.
WOMAN trial.
Question
1. What does the acronym “WOMAN” mean? There is no option
list.
Question
2. Which condition and drug were the subjects of the trial?.
Question
3. What were the main outcomes of the trial?
Question
4. Which, if any, of the following were in the WHO’s response
to the outcomes?
Option list.
|
D |
the drug to be stored at room temperature |
|
A |
the drug to be used for all pregnant women |
|
B |
the drug to be used prophylactically |
|
C |
the drug to be used orally |
|
F |
the drug to be used within 6 hours |
|
E |
drug manufacturers to be asked to reduce the cost to
facilitate use in developing countries |
Question
5. Which, if any, of the following are true about the WOMAN-2
trial?
Option list.
|
D |
the trial does not exist |
|
A |
the drug to be used for all pregnant women |
|
B |
the drug to be used prophylactically |
|
C |
the drug to be used intravenously |
|
F |
the drug to be used within 6 hours |
|
E |
hysterectomy will be included in the outcomes |
Question
6. Which, if any, of the following are true about the WOMAN-PharmacoTXA
trial?
Option list.
|
A |
the trial does not exist |
|
B |
the drug to be used for all pregnant women |
|
C |
oral v i.m. use will be compared |
|
D |
oral v i.v. use
will be compared |
|
E |
i.m. v. i.v. use will be compared |
|
F |
none of the above |
55. EMQ.
Tranexamic acid.
This
topic featured in the exam in 2019 and 2021, probably prompted by WHOT.
Abbreviations.
EBL: estimated
blood loss.
PPH: postpartum
haemorrhage.
TA: tranexamic
acid.
WHOT: WHO’s
“Updated WHO Recommendation on TA for the
Treatment of PPH”. 2017.
Scenario
1.
Which, if any, of
the following describe the main mode of action of tranexamic acid? This is not
a true EMQ as there may be more than one correct answer.
Option list.
|
A |
inhibition of conversion of plasminogen to plasmin |
|
B |
inhibition of fibrinolysis |
|
C |
inhibition of factor Xa |
|
D |
inhibition of heparin activity |
|
E |
inhibition of plasmin activity |
|
F |
promotion of conversion of fibrinogen to fibrin |
|
G |
promotion of conversion of prothrombin to thrombin |
|
H |
promotion of platelet activation |
|
I |
promotion of platelet production |
Scenario
2.
Which, if any, of
the following statements are true?
Option list.
|
A |
GOH say that TA should be considered when an apixaban
antagonist is required |
|
B |
GOH say that TA should be considered when a clopidogrel
antagonist is required |
|
C |
GOH say that TA should be considered when a factor Xa
agonist is required |
|
D |
GOH say that TA should be considered when a factor Xa
antagonist is required |
|
E |
GOH say that TA should be considered when a heparin antagonist is required |
|
F |
GOH say that TA should be considered when Protein C is
deficient |
|
G |
GOH say that TA should be considered when Protein S is
deficient |
|
H |
none of the above |
Scenario
3.
Which, if any, of
the following statements are true in relation to TA? This is not a true EMQ as
there may be more than one correct answer.
Option list.
|
A |
TA is teratogenic in rats and should be avoided in the
first trimester |
|
B |
TA has not been shown to be teratogenic and is safe to
use in pregnancy |
|
C |
TA is excreted is contraindicated in breastfeeding as
the levels equate to maternal levels |
|
D |
TA levels in breast milk are one hundredth of maternal
levels |
|
E |
none of the above. |
Scenario
4.
Which, if any, of
the following statements are listed by eMC as contraindications?
Option list.
|
A |
asthma |
|
B |
barbiturate use |
|
C |
consumption coagulopathy |
|
D |
convulsions |
|
E |
severe renal impairment |
Scenario
5.
Which, if any, of
the following is included in the definition of PPH in WHOT?
Option list.
|
A |
EBL ≥ 500 mL after vaginal birth or
C section |
|
B |
EBL ≥ 1,00 mL after vaginal birth
or C section |
|
C |
EBL ≥ 500 mL after vaginal birth or
≥ 1,00 mL C section |
|
D |
EBL ≥ 1,000 mL after vaginal birth
or ≥ 500 mL C section |
|
E |
none of the above |
Scenario
6.
What other
category of patient is included in the WHOT definition of PPP?
Option list. There is none, to make you think.
Scenario
7.
Which of the
following are included in the WHOT recommendations?
Option list.
|
A |
TA to be given to all women with a history of PPH |
|
B |
TA to be given to all women in established labour |
|
C |
TA to be given to all having C section |
|
D |
TA to be given to all women having episiotomy |
|
E |
TA to be given to all women having instrumental
delivery |
|
F |
none of the above |
Scenario
8.
Which, if any, of
the following are included in WHOT?
Option list.
|
A |
TA should be given within 3 hours of the birth |
|
B |
TA should be given within 6 hours of the birth |
|
C |
TA should be given IV as a bolus of 10g |
|
D |
TA should be given IV at a dose of 1g in 10mL over 5
minutes |
|
E |
TA should be given IV at a dose of 1g in 10mL over 10
minutes |
|
F |
TA should be given IV at a dose of 5g in 20mL over 5
minutes |
|
G |
TA should be given IV at a dose of 5g in 20mL over 10
minutes |
Scenario
9.
Which, if any, of
the following statements is included WHOT?
Option list.
|
A |
the benefit from TA declines by about 10% for every 5
minutes of delay in starting Rx |
|
B |
the benefit from TA declines by about 10% for every 10
minutes of delay in starting Rx |
|
C |
the benefit from TA declines by about 10% for every 15
minutes of delay in starting Rx |
|
D |
the benefit from TA declines by about 10% for every 20 minutes
of delay in starting Rx |
|
E |
the benefit from TA declines by about 10% for every 25
minutes of delay in starting Rx |
|
F |
the benefit from TA declines by about 10% for every 30
minutes of delay in starting Rx |
|
G |
none of the above |
Scenario 10.
Which, if any, of the
following statements are included in WHOT?
Option list.
|
A |
TA is
relatively cheap |
|
B |
TA has a shelf
life of 5 years |
|
C |
TA can be
stored safely at room temperature |
|
D |
TA is widely
available in most countries |
|
E |
none of the
above. |
Scenario
11.
Which, if any, of the
following statements are true of the differences between the updated version of
WHOT in 2017 and the 2012 version?
|
A |
TA to be used from the start of treatment of PPH |
|
B |
TA to be used only for cases with suspected or proven
genital tract trauma |
|
C |
TA to be used as early as possible |
|
D |
TA not to be used > 5 hours after the birth |
|
E |
clearer instructions were given about the rate of
administration |
Scenario 12.
Which, if any, of
the following statements are true of GTG52?
Option list.
|
A |
it is being updated |
|
B |
it advises use of TA for all cases of PPH with no
contraindications |
|
C |
it advises prophylactic use of TA for women at ↑ risk of bleeding prior to C
section |
|
D |
in its present form it puts obstetricians at risk of
being found negligent |
|
E |
none of the above. |
Scenario 13.
Which paper in the
NEJM in 2023 was a bit of a spanner in the works?
Scenario 14.
What were the key
findings in the paper?
56. 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.
CPD from Bhalla et al: “Acute UI”. TOG.
2009;11:13-18.
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
57. Kallmann’s
syndrome.
Scenario 1.
Which of the
following might be included in descriptions of Kallmann’s syndrome?
Option list.
|
A |
hypogonadotrophic hypogonadism |
|
B |
hypogonadotrophic hypogonadism + anosmia |
|
C |
hypogonadotrophic hypogonadism + anosmia +
colour-blindness. |
|
D |
hypogonadotrophic hypogonadism due to uterine agenesis |
Scenario 2.
Which, if any, of
the following are features of the Kallmann phenotype?
|
A |
absent or minimal breast development |
|
B |
aortic stenosis |
|
C |
blue eyes |
|
D |
blue hair |
|
E |
hot flushes |
|
F |
short stature |
|
G |
tall stature |
|
H |
vaginal agenesis |
|
I |
none of the above |
Scenario
3. How
common is Kallmann’s syndrome and what is the female: male ratio?
|
A |
1 in 1,000 and F:M ratio 1:1 |
|
B |
1 in 5,000 and F:M ratio 1:1 |
|
C |
1 in 10,000 and F:M ratio 1:4 |
|
D |
1 in 50,000 and F:M ratio 1:4 |
|
E |
1 in 100,000 and F:M ratio 1:8 |
|
F |
1 in 250,000 and F:M ration 1:10 |
Scenario 4.
What is the most
common mode of inheritance of Ks?
Option list.
|
A |
hypogonadotrophic hypogonadism |
|
B |
hypogonadotrophic hypogonadism + anosmia |
|
C |
hypogonadotrophic hypogonadism due to uterine agenesis |
|
D |
autosomal dominant |
|
E |
autosomal recessive |
|
F |
X-linked recessive |
|
G |
new mutation of the ANOS1 gene |
|
H |
the most common mode of inheritance is not known |
Scenario 5.
How is Kallmann’s
syndrome diagnosed?
|
A |
abdominal and pelvic
ultrasound scan |
|
B |
cell-free fetal DNA |
|
C |
chromosome analysis |
|
D |
CT scan of hypothalamus /
pituitary |
|
E |
MR scan of hypothalamus /
pituitary |
|
F |
none of the above. |
Scenario 6.
How is Kallmann’s
syndrome treated initially?
Which of the following
statements are true?
Option list.
|
A |
GnRH analogue depot |
|
B |
pulsatile GnRH therapy |
|
C |
combined oral contraceptive |
|
D |
counselling & education
re gender re-assignment |
|
E |
depot progestogen |
|
F |
none of the above |
Scenario 7.
A woman was
diagnosed with Kallmann’s syndrome at 16 and had successful initial
treatment. She is now 25,
married and wishes to have a pregnancy. She has had pre-pregnancy assessment
and counselling. Which of the following should be considered?
|
A |
GnRH analogue depot |
|
B |
induction of ovulation with
clomiphene |
|
C |
gonadotrophin therapy |
|
D |
pulsatile GnRH therapy |
|
E |
none of the above |
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