27 May 2024.
|
6 |
EMQ. Montgomery & consent |
|
7 |
EMQ. Uterine transplant |
|
8 |
EMQ. WOMAN trial |
|
9 |
EMQ. Tranexamic acid |
|
10 |
EMQ. Clue cells, koilocytes |
|
11 |
SBA.
Lynch syndrome |
6. 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 |
7. Uterine transplant.
Abbreviations.
ET: embryo
transfer.
UT: uterine
transplant
Scenario 1.
When was the 1st.
human uterine transplant performed?
Option list.
|
A |
2000 |
|
B |
2015 |
|
C |
2010 |
|
D |
2011 |
|
E |
2012 |
|
F |
2013 |
|
G |
2014 |
|
H |
2015 |
|
I |
2016 |
|
J |
2017 |
Scenario 2.
When was the 1st.
livebirth after human uterine transplant?
Option list.
|
A |
2000 |
|
B |
2015 |
|
C |
2010 |
|
D |
2011 |
|
E |
2012 |
|
F |
2013 |
|
G |
2014 |
|
H |
2015 |
|
I |
2016 |
|
J |
2017 |
Scenario 3.
How many live
births had occurred worldwide after UT up to the end of 2018?
Option list
|
A |
< 5 |
|
B |
5 - 10 |
|
C |
11 - 20 |
|
D |
21 - 50 |
|
E |
51 - 100 |
|
F |
> 100 |
Scenario 4.
For which of the
following conditions is UT a possible treatment?
Option list.
|
A |
Androgen Insensitivity syndrome. AIS. |
|
B |
Congenital Adrenal hyperplasia. CAH. |
|
C |
Kallmann’s syndrome. KS. |
|
D |
Mayer-Rokitansky-Küster-Hauser syndrome. MRKH. |
|
E |
McCune-Albright syndrome. MCAS. |
|
F |
Swyer’s syndrome. SS. |
|
G |
Turner’s syndrome. TS. |
Scenario 5.
Which, if any, of
the following are commonly used for donor selection?
Option list.
|
A |
absence of adenomyosis |
|
B |
absence of fibroids |
|
C |
age < 65 years |
|
D |
good general health |
|
E |
negative cervical smear and no high-risk HPV |
|
F |
no cancer in past 5 years |
|
G |
parous |
|
H |
vaginal length > 7 cm. |
Scenario 6.
Has successful
transplant occurred using a dead donor?
Option list.
|
A |
No |
|
B |
Yes |
Scenario 7.
What is the rate
of graft survival at 1 year, failure being the need for hysterectomy?
Option list.
|
A |
< 10% |
|
B |
11 – 20% |
|
C |
21 – 30% |
|
D |
31 – 40% |
|
E |
41 – 50% |
|
F |
51 – 60% |
|
G |
> 60% |
|
H |
the figure is unknown |
Scenario 8.
Which of the
following statements is correct?
Option list.
|
A |
donor surgery is more extensive than recipient surgery |
|
B |
donor surgery is less extensive than recipient surgery |
|
C |
donor surgery is as extensive as recipient surgery |
Scenario 9.
What are the main
risks for the recipient?
There is no option list to make you think. Write down the
main things you can think of.
Scenario
10.
What are the risks
to the donor in addition to the usual ones of bleeding, infection, haematoma and thrombosis? There is
no option list.
Scenario
11.
Which condition
has been the reason for recipients needing uterine transplant and which
complication is more likely in addition to the usual ones of bleeding, infection, haematoma and thrombosis? There is
no option list.
Scenario 12.
When is IVF and
cryopreservation of eggs done?
Option list.
|
A |
before uterine transplantation |
|
B |
at the time of uterine transplantation |
|
C |
12 months after uterine transplantation to ensure graft
rejection does not occur |
|
D |
when the recipient chooses |
|
E |
none of the above |
Scenario
13.
Which maintenance
therapy was used immediately before embryo transfer in the first case resulting
in livebirth?
Option list.
|
A |
azathioprine + corticosteroids + tacrolimus |
|
B |
azathioprine + ciclosporin + corticosteroids + mycophenolate
mofetil |
|
C |
azathioprine + corticosteroids + mycophenolate mofetil
+ tacrolimus |
|
D |
azathioprine + corticosteroids + tacrolimus |
|
E |
ciclosporin + corticosteroids + mycophenolate mofetil +
tacrolimus |
|
F |
ciclosporin + mycophenolate mofetil + tacrolimus |
|
G |
corticosteroids + mycophenolate mofetil + tacrolimus |
|
H |
corticosteroids + tacrolimus |
8. 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 |
9. 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?
10.
Clue cells, koilocytes etc.
Abbreviations.
Ct: Chlamydia trachomatis
HSV: Herpes simplex virus
LGV: lymphogranuloma venereum
Ng: Neisseria gonorrhoeae
Tv: Trichomonas vaginalis
Option list.
|
A |
Actinomyces |
|
B |
Bacterial vaginosis |
|
C |
Bacteroides |
|
D |
Chlamydia trachomatis |
|
E |
Chlamydial infection of the genital tract |
|
F |
Herpes Simplex |
|
G |
Human Papilloma Virus |
|
H |
Lymphogranuloma venereum |
|
I |
Monilia |
|
J |
Neisseria gonorrhoeae |
|
K |
Trichomonas vaginalis |
Scenario 1.
Which option or
options best fit with “clue cells”
Scenario 2.
Which option or options best fit with “fishy
odour”?
Scenario 3.
Which option or options best fit with “flagellate
organisms”?
Scenario 4.
Which option or options best fit with “inflammatory
smear”?
Scenario 5.
Which option or options best fit with “koilocytes”?
Scenario 6.
Which option or options best fit with “non-specific
urethritis (NSU) in the male”?
Scenario 7.
Which option or options best fit with “strawberry
cervix”?
Scenario 8.
Which option or options best fit with “thin
grey/ white discharge”?
Scenario 9.
Which option or options best fit with “white,
curdy discharge”?
Scenario 10.
Which option or options best fit with “frothy
yellow discharge”?
Scenario 11.
Which option or options best fit with “protozoan”?
Scenario 12.
Which option or options best fit with “obligate intracellular
organism”?
Scenario 13.
Which option or options best fit with “blindness”?
Scenario 14.
Which option or options best fit with “LGV”?
Scenario 15.
Which option or options best fit with “multinucleated
cells”?
Scenario 16.
Which option or options best fit with “serotypes
D–K”?
Scenario 17.
Which option or options best fit with “serovars
L1-L3”?
Scenario 18.
Which of the following are true in relation
to Amsel’s criteria?
|
A |
used for the diagnosis of
bacterial vaginosis |
|
B |
used for the diagnosis of
trichomonal infection |
|
C |
clue cells present on
microscopy of wet preparation of vaginal fluid |
|
D |
flagellate organism present
on microscopic examination of vaginal fluid |
|
E |
pH ≤ 4.5 |
|
F |
pH > 4.5 |
|
G |
thin, grey-white, homogeneous
discharge present |
|
H |
frothy, yellow-green
discharge present |
|
I |
fishy smell on adding alkali
(10%KOH) |
|
J |
fishy smell on adding acid
(10%HCl) |
|
K |
koilocytes present |
|
L |
absence of vulvo-vaginal
irritation |
Scenario 19.
Which of the following are true in relation
to Nugent’s criteria?
|
A |
used for the diagnosis of
bacterial vaginosis |
|
B |
used for the diagnosis of
trichomonal infection |
|
C |
clue cells present on
microscopy of wet preparation of vaginal fluid |
|
D |
pH ≤ 4.5 |
|
E |
pH > 4.5 |
|
F |
count of lactobacilli |
|
G |
count of Gardnerella and
Bacteroides |
|
H |
count of white cells |
Scenario 20.
Gardnerella
vaginalis can be cultured from the vagina of what % of normal women?
|
A |
< 10% |
|
B |
11 - 20% |
|
C |
21 - 30% |
|
D |
31 - 40% |
|
E |
41 - 50% |
|
F |
> 50% |
11.
SBA. Lynch syndrome.
Lynch syndrome.
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
MLH: mutL-homolog
family of DNA, mismatch repair genes.
MMR: mismatch
repair.
MSH: mutS
homolog family of DNA, mismatch repair genes.
Question 3.
What is Lynch syndrome?
Option List
|
A |
auto-immune
condition leading to reduced factor X levels in blood |
|
B |
hereditary condition which increases the risk of many
cancers, particularly breast |
|
C |
hereditary
condition which increases the risk of many cancers, particularly breast &
colorectal |
|
D |
hereditary
condition which increases the risk of many cancers, particularly colorectal
& endometrial |
|
E |
none of
the above |
Question 4.
How is Lynch syndrome inherited?
Option List
|
A |
it is an
autosomal dominant condition |
|
B |
it is an autosomal recessive condition |
|
C |
it is an X-linked dominant condition |
|
D |
it is an X-linked recessive condition |
|
E |
none of the above |
Question 5.
Which, if any, of the following genes can cause Lynch syndrome?
Option List
|
A |
MLH1 +
MLH2 + MOH1 |
|
B |
MLH1 + MLH2 + MSH1 |
|
C |
MLH1 + MLH2 + MSH6 |
|
D |
MLH1 + MSH2 + MSH6 + PMS2 |
|
E |
None of the above |
Question 6.
Mutations of which 2 of the following genes cause most cases of Lynch
syndrome?
Option List
|
A |
MLH1 +
MLH2 |
|
B |
MLH1 + MSH1 |
|
C |
MLH1 + MSH2 |
|
D |
MLH2 + MSH1 |
|
E |
MLH2 + MSH2 |
Question 7.
What is the approximate prevalence of Ls in the UK population?
Option List
|
A |
1 in 50 |
|
B |
1 in 100 |
|
C |
1 in
1,000 |
|
D |
3 in
1,000 |
|
E |
none of the above |
Question 8.
Approximately what % of individuals with Ls have had the diagnosis
established?
Option List
|
A |
< 5% |
|
B |
5 -10% |
|
C |
10-20% |
|
D |
20-30% |
|
E |
>30% |
Question 9.
Which, if any, of the following conditions are associated with an ↑
risk of Ls?
Option List
|
A |
acromegaly
+ Addison’s disease + coeliac disease + IBD + IDDM |
|
B |
acromegaly
+ disease + anosmia + coeliac disease + IBD |
|
C |
acromegaly
+ IBD + IDDM |
|
D |
acromegaly
+ IBD |
|
E |
Addison’s
disease + anosmia + coeliac disease + IBD + IDDM |
|
F |
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM |
|
G |
none of the above |
Question 10.
Which 2 cancers are most likely in women with Lynch syndrome?
Option List
|
A |
breast +
bowel |
|
B |
breast + pancreas |
|
C |
breast + endometrium |
|
D |
bowel + cervix |
|
E |
bowel + endometrium |
|
F |
bowel + ovary |
|
G |
bowel + pancreas |
|
H |
endometrium + ovary |
Question 11.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of colorectal cancer?
Option List
|
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
|
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
|
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
|
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
|
E |
none of the above |
Question 12.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of colorectal cancer?
Option List
|
A |
offer
screening to everyone, regardless of age and family history |
|
B |
offer screening to those aged < 50 years at
diagnosis |
|
C |
offer screening to those aged < 60 years at
diagnosis |
|
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
|
E |
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative |
Question 13.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of thyroid cancer?
Option List
|
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
|
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
|
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
|
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
|
E |
none of the above |
Question 14.
What does NICE recommend in relation to screening for Lynch syndrome in
those
with a new
diagnosis of thyroid cancer?
Option List
|
A |
offer
screening to everyone, regardless of age and family history |
|
B |
offer screening to those aged < 50 years at diagnosis |
|
C |
offer screening to those aged < 60 years at
diagnosis |
|
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
|
E |
none of the above |
Question 15.
What does NICE recommend about screening for Lynch syndrome for the
population
with no personal history of endometrial
cancer?
Option List
|
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
|
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
|
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
|
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
|
E |
none of the above |
Question 16.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of endometrial cancer?
Option List
|
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
|
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
|
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
|
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
|
E |
none of the above |
Question 17.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of colorectal cancer?
Option List
|
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
|
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
|
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
|
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
|
E |
none of the above |
Question 18.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of colorectal cancer?
Option List
|
A |
offer
screening to everyone, regardless of age and family history |
|
B |
offer screening to those aged < 50 years at
diagnosis |
|
C |
offer screening to those aged < 60 years at
diagnosis |
|
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
|
E |
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative |
Question 19.
What relationship, if any, exists between Ls and acromegaly?
Option List
|
A |
the risk
of Ls is ↓
in those with acromegaly compared with the general population |
|
B |
the risk
of Ls is ↑
in those with acromegaly compared with the general population |
|
C |
the risk
of Ls is unchanged in those with acromegaly compared with the general
population |
|
D |
the risk
of Ls in unknown in those with acromegaly |
|
E |
|
Question 20.
What is the effect of aspirin consumption on the risk of EC and CRC?
Option List
|
A |
aspirin
reduces the risk of EC and CRC |
|
B |
aspirin
reduces the risk of EC but not CRC |
|
C |
aspirin
reduces the risk of CRC but not EC |
|
D |
aspirin
does not reduce the risk of EC or CRC |
|
E |
aspirin reduces the risk of EC and CRC, but the risks
outweigh the benefits |
Question 21.
A healthy woman of 35 years is diagnosed with Ls? What are the key
elements of the
National Screening
Programme for people with Ls?
There is
no option list – just write down everything you know.
Question
22. Which, if any, of the following were
recommendations made by Monahan et al, the 30
experts who wrote to the BMJ in 2017.
Option List
|
A |
creation of a national register of
people with Ls |
|
B |
creation of a
post of Consultant in Ls for each NHS Trust |
|
C |
creation of a
post of Clinical Champion for Ls in each NHS Region. |
|
D |
creation of a
post of Clinical Champion for Ls in the DOH. |
|
E |
none of the
above |
With regard to Lynch
syndrome,
1. loss of mismatch repair protein expression
on immunohistochemistry of cancer is diagnostic.
True/False
2. most carriers of the mutation associated
with the syndrome know they have the condition.
True/False
3. the first cancers associated with the
syndrome are predominantly endometrial or ovarian cancers. True/False
4. when cancers occur, they have in them an unusually
high immune infiltrate. True/False
With regard to testing for Lynch syndrome,
5. consent must be sought before definitive germline
testing for Lynch syndrome by a trained professional. True/False
6. immunohistochemical staining of tumours for
the mismatch repair proteins or microsatellite instability analysis are recognised
ways of screening cancers for characteristics suggestive of the syndrome. True/False
7. the National Institute for Health and Care Excellence
endorses universal screening of colorectal cancer patients for Lynch syndrome. True/False
8. most gynaecological cancers found to have aberrant
mismatch repair immunohistochemical staining will be in those with the
syndrome. True/False
9. the addition of MLH1 promotor hypermethylation
testing in a Lynch syndrome diagnostic pathway improves specificity. True/False
Regarding gynaecological surveillance in women with Lynch
syndrome,
10. there is strong evidence to recommend its use.
True/False
11. this should be offered to women around 25 years
of age. True/False
12. counselling should include education on red flag
symptoms of cancer and risk-reducing surgery.
True/False
With regard to risk-reducing strategies for women with Lynch
syndrome,
13. hysterectomy is strongly recommended for all those
with the syndrome. True/False
14. the timing of risk-reducing surgery depends on
the syndrome gene. True/False
15. where possible, a laparoscopic approach is
recommended. True/False
16. aspirin is not recommended as a means of reducing
their overall cancer risk. True/False
Regarding Lynch syndrome-associated gynaecological
cancers,
17. endometrial types that arise as a result of
the syndrome have a poorer prognosis than sporadic types. True/False
18. checkpoint inhibition of the PD-1/PD-L1 pathway
has been shown to be very effective in mismatch repair-deficient cancers. True/False
19. vaccination against these cancers is currently
the focus of research. True/False
20. the Manchester International Consensus guideline
is a useful reference for gynaecologists managing women with these cancers. True/False
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