|
59 |
SBA. Neonatal pulse oximetry screening |
|
60 |
SBA. McCune Albright syndrome |
|
61 |
MCQ. The Kleihauer test |
|
62 |
EMQ. Listeriosis and pregnancy |
|
MCQ.
Folic acid fortification of flour |
|
|
64 |
EMQ. Mental Capacity Act |
|
65 |
EMQ. Cri du chat syndrome |
|
66 |
EMQ. Anatomy of the fetal skull |
|
67 |
EMQ. Flu and pregnancy |
59. Neonatal
pulse oximetry screening.
Abbreviations.
cCHD: critical
congenital heart disease.
CHD: congenital
heart disease.
NPOS: neonatal
pulse oximetry screening.
NSC: National
Screening Committee.
RDS: respiratory
distress syndrome, AKA SDLDN.
Question
1. Which of the following best describes the purpose of NPOS?
|
A |
detection
of congenital heart disease |
|
B |
detection
of critical congenital heart disease |
|
C |
detection
of uncritical congenital heart disease |
|
F |
detection
of hypoplastic left heart |
|
E |
detection
of patent ductus arteriosus |
|
D |
differentiating
between transient tachypnoea of the newborn and RDS |
|
G |
none of
the above |
Question
2. What is the approximate incidence of CHD in neonates?
|
A |
1 in 50 |
|
B |
1 in 100 |
|
C |
1 in 150 |
|
D |
1 in 200 |
|
E |
1 in 250 |
|
F |
1 in 300 |
|
G |
none of
the above |
Question
3. What is the approximate % of CHD that is critical CHD in neonates?
|
A |
10% |
|
B |
15% |
|
C |
20% |
|
D |
25% |
|
E |
30% |
|
F |
35% |
|
G |
40% |
Question
4. What is the National Screening Committee’s advice on NPOS?
|
A |
all NHS
units to have it established by March 2026 |
|
B |
all NHS
units to have it established by March 2030 |
|
C |
further
research needed into cost-benefit ratio |
|
D |
further
research needed into adverse outcomes after false +ve results |
|
E |
further
research needed into risks of “overdiagnosis” |
|
F |
further
research needed into risk/benefit for non-cardiac conditions |
|
G |
none of
the above |
Question
5. What is the sensitivity of NPOS for detecting cCHD before discharge from
hospital?
|
A |
~ 50% |
|
B |
~60 % |
|
C |
~ 70% |
|
D |
~ 80% |
|
E |
~ 90% |
|
F |
~100 % |
Question 6.
What % of NHS Trusts
have introduced NPOS despite the NSC’s reservations?
|
A |
~ 50% |
|
B |
~60 % |
|
C |
~ 70% |
|
D |
~ 80% |
|
E |
~ 90% |
|
F |
~100 % |
60.
McCune Albright syndrome.
Abbreviations.
CPP: central precocious puberty.
MCA: McCune Albright syndrome.
PFD: polyostotic fibrous dysplasia.
PP: precocious puberty.
Scenario 1.
Which, if
any, of the following are components of the classical triad of MCA?
|
A |
albinism |
|
B |
“cafè Cubano” spots |
|
C |
“Coast of California” pigmented areas |
|
D |
lentigo |
|
E |
macroorchidism |
|
F |
osteomalacia |
|
G |
polyostotic fibrous dysplasia |
|
H |
precocious puberty |
|
I |
premature menopause |
|
J |
primary amenorrhoea |
Scenario 2.
Which, if
any, of the following are true in relation to MCA?
|
A |
it is an example of central primary amenorrhoea |
|
B |
it is an example of central secondary amenorrhoea |
|
C |
it is an example of central precocious puberty |
|
D |
it is an example of peripheral primary amenorrhoea |
|
E |
it is an example of peripheral secondary amenorrhoea |
|
F |
it is an example of peripheral precocious puberty |
|
G |
none of the above |
Scenario 3.
Which, if
any, of the following are believed to be true in relation to the abnormality of
onset of puberty associated with
MCA?
|
A |
it is due to abnormal FSH production |
|
B |
it is due to abnormal LH production |
|
C |
it may be due to abnormal androgen production |
|
D |
it may be due to abnormal oestrogen production |
|
E |
it is linked to ovarian cysts with ↑ malignant potential |
|
F |
none of the above |
Scenario 4.
Which, if
any, of the following are true in relation to polyostotic fibrous dysplasia?
|
A |
polyostotic means resembling parrot bone |
|
B |
polyostotic means resembling pigeon bone |
|
C |
polyostotic means affecting long bones |
|
D |
fibrous dysplasia refers to replacement of marrow by fibrous
tissue |
|
E |
PFD is a variant of osteomalacia |
|
F |
PFD may be unilateral |
|
G |
PFD is associated with a 1% risk of malignancy |
Scenario 5.
Which, if
any, of the following are true in relation to MCA?
|
A |
hyperthyroidism is common |
|
B |
hypothyroidism is common |
|
C |
thyroid function is similar to those without MCA |
Scenario 6.
Which, if
any, of the following are true in relation to MCA?
|
A |
excess growth hormone production
is common |
|
B |
inadequate growth hormone production is common |
|
C |
growth hormone production is similar to those without MCA |
Scenario 7.
Which, if
any, of the following is true in relation to MCA?
|
A |
inheritance is autosomal dominant |
|
B |
inheritance is autosomal recessive |
|
C |
inheritance is X-linked dominant |
|
D |
inheritance is X-linked recessive |
|
E |
inheritance is multifactorial |
|
F |
it is not a hereditary disorder |
|
G |
it is not genetic |
|
H |
none of the above |
Scenario 8.
Which, if
any, of the following are true in relation to MCA?
|
A |
renal artery stenosis is more common |
|
B |
renal cortex wasting is more common |
|
C |
renal phosphate wasting is more common |
|
D |
renal waisting is more common |
|
E |
none of the above. |
Scenario 9.
Approximately
what % of children born to women with MCAS will have MCAS?
|
A |
0 |
|
B |
1 in 105 - 106 |
|
C |
1 in 104 |
|
D |
1 in 100 |
|
E |
1 in 50 |
|
F |
1 in 10 |
|
G |
1 in 2 |
|
H |
All |
TOG includes MCAS in CPD
Questions for volume 14, number 2, 2012, which are open access, so
reproduced here. There are only two questions on MCAS. Note that the second
includes CPP.
McCune–Albright syndrome
1. is caused by activating mutations of the GNAS1 gene. True / False
2. is characterised by polyostotic fibrous dysplasia, café-au-lait
spots and CPP. True / False
61.
The Kleihauer test.
Answer True / False
a. may be used to confirm the presence of Rhesus
antibodies.
b. should be performed routinely at 28 and 36
weeks in the woman who is Rhesus negative.
c. 'ghost' cells may be seen, indicating that
the patient is a follower of Dracula and "undead".
d. is no longer required after delivery in the
Rhesus negative woman.
e. is based on the relative resistance of fetal
haemoglobin to denaturation using ultra-violet light.
f. only gives +ve results in women who are
Rhesus +ve.
g. should be done as part of the investigation of
fetal death in utero for all women, regardless of their blood group and that of
their babies.
62.
Listeriosis and pregnancy.
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.
63.
Folic acid fortification of flour.
Abbreviations.
FFF: fortification of flour with
folic acid.
NTD: neural tube defect.
Scenario 1.
What is the incidence of NTD in the UK?
Scenario 2.
What is the risk of an affected sibling for the woman who becomes pregnant
after
having
a baby with NTD?
Scenario
3.
Which foods contain significant amounts of folic acid?
Scenario 4.
What percentage of folic acid is destroyed by cooking / food
storage?
Scenario 5.
How many people in the UK are estimated to have a folate-deficient
diet?
Scenario 6.
What is the significance of the MTHFR (Methylenetetrahydrofolate reductase gene)?
Scenario 7.
What is the significance of the Meckel-Gruber syndrome to this
issue?
Scenario 8.
By what gestation has the neural tube closed?
Scenario 9.
What proportion of pregnant women have taken folic acid
preconceptually?
Scenario 10.
What dose and duration of folic acid is advised for routine periconceptual
use?
Scenario 11.
List the women to whom a higher dose should be offered.
Scenario
12.
How effective is periconceptual folic acid consumption in reducing
NTD risk in the low-risk population?
Scenario
13.
How effective is periconceptual folic acid consumption in reducing
NTD risk in women who have had an affected baby?
Scenario 14.
What is the risk of NTD recurrence for a woman who has had two
affected babies?
Scenario 15.
What is the risk of NTD in Ireland?
Scenario 16. What is
the significance of the name “Bukowski” in relation to folic acid?
Scenario 17.
What effect does periconceptual folic acid have on the risk of
stillbirth?
Scenario
18.
What effect does periconceptual folic acid have on the risk of
autistic spectrum disorder?
Scenario 19.
What effect does periconceptual folic acid have on maternal
haemoglobin levels?
Scenario
20.
What recommendations have been made by the RCOG to improve folic
acid levels in pregnancy?
Scenario 21.
Which names are of importance in the history of folic acid and
NTD?
Scenario
22.
What neurological condition has been thought potentially
problematic with folic acid supplementation?
64.
Mental
Capacity Act
The following scenarios relate to the Mental Capacity Act
2005. Many of the questions are not true EMQs as there is more than 1 correct
answer.
Abbreviations.
COP: Court of Protection.
FGR: fetal growth restriction.
IMCA: Independent Mental Capacity Advocate.
LOC: lack of capacity.
LPA: lasting power of attorney.
MCA: Mental
Capacity Act 2005.
PoA: power of attorney.
Option list. Use this list unless the question has its own.
|
A |
Yes |
|
B |
No |
|
C |
True |
|
D |
False |
|
E |
Does not exist |
|
F |
The husband |
|
G |
A parent |
|
H |
The child |
|
I |
the General Practitioner |
|
J |
the Consultant |
|
K |
the Registrar |
|
L |
The Consultant treating the
patient |
|
M |
A Consultant not involved in
treating the patient |
|
N |
The Medical Director |
|
O |
A person with Lasting Power
of Attorney |
|
P |
The sheriff or sheriff’s
deputy |
|
Q |
Balance of probabilities |
|
R |
Beyond reasonable doubt |
|
S |
None of the above. |
Question 1.
Which, if any, of
the following statements about the MCA are true?
|
A |
it applies to England only |
|
B |
it applies to England &
Wales only |
|
C |
it applies to England, N.
Ireland, Scotland & Wales |
|
D |
it applies to adults > 18
years only |
|
E |
it applies to children 16 –
18 years |
|
F |
it applies to children <
15 years |
|
G |
it applies to men, but not to
women |
|
H |
None of the above |
Question 2.
Which, if any, of
the following statements about the MCA are true?
|
A |
about ½ million people fall
within its remit |
|
B |
about 1 million people fall
within its remit |
|
C |
about 2 million people fall
within its remit |
|
D |
about 5% of acute
gynaecological admissions are of people
lacking capacity at the time |
|
E |
about 10% of acute
gynaecological admissions are of people
lacking capacity at the time |
|
F |
about 10% of acute medical
admissions are of people lacking capacity at the time |
|
G |
about 30% of acute medical
admissions are of people lacking capacity at the time |
|
H |
about 25% of psychiatric
admissions are of people lacking capacity at the time |
|
I |
about 45% of psychiatric
admissions are of people lacking capacity at the time |
|
J |
None of the above. |
Question 3.
Which, if any, of
the following terms are used in relation to the MCA Act?
|
A |
advance decision |
|
B |
advance declaration |
|
C |
advance directive |
|
D |
advance statement |
|
E |
independent mental capacity
adviser |
|
F |
lasting power of attorney |
|
G |
lingering power of attorney |
|
H |
living will |
|
I |
one-stage test of capability |
|
J |
two-stage test of capability |
|
K |
public guardian |
|
L |
temporary power of attorney |
|
M |
none of the above |
Question 4.
Which of the
following are legally obliged to ‘have regard’ to the MCA’s Code of
Practice in their dealings with
those who lack capacity?
|
A |
anyone involved
professionally in the person’s care |
|
B |
any attorney with lasting
power of attorney |
|
C |
any court-appointed deputy |
|
D |
any independent mental
capacity advocate |
|
E |
anyone engaged in research
involving the person lacking capacity |
|
F |
anyone paid for acts relating
to the person lacking capacity |
|
G |
any care assistant involved
with the person lacking capacity |
Question 5.
When must the COP
be involved about the implementation of
advance decisions?
Question 6.
What are the main
roles of the Court of Protection?
|
A |
to oversee implementation of
MCA |
|
B |
to deal with emergency
applications in relation to individuals who lack capacity |
|
C |
to appoint deputies to make
decision on behalf of individuals who lack capacity |
|
D |
to appoint individuals with
LPA |
|
E |
to provide legal advice to
family members of someone lacking capacity |
|
F |
none of the above |
Question 7.
What are the key
capabilities a person must have in relation to information provided
to them to have capacity under
the MCA?
|
A |
the person must be able to
read the information provided |
|
B |
the person must be able to
give a clear account of the information provided |
|
C |
the person must be about to
understand the information provided |
|
D |
the person must be able to
retain the information provided for at least 12 hours |
|
E |
the person must be able to
reach a conclusion that is logical to the doctor |
|
F |
the person must be able to communicate
their decision |
Question 8.
Which, if any, of the following are necessary for the appointment of
someone as an
IMCA?
|
IMCA training |
|
|
B |
approval by the local authority |
|
C |
membership of an approved organisation |
|
D |
been cleared by the Criminal Records Bureau |
|
E |
none of the above |
Question 9.
What does an IMCA
do?.
Question 10.
A person with LPA
is normally not a family member. True?
Question 11.
A Sheriff’s Deputy
is normally not a family member. True?
Question 12.
A person with
Power of Attorney can consent to treatment for the patient who lacks
capacity. True?
Question 13.
A Court-appointed Deputy can consent to
treatment for the patient who lacks
capacity, but must go back to the CoP if further consent
is required for additional treatment.
Question 14.
A person with PoA
can authorise withdrawal of all care in cases of individuals with
persistent vegetative states.
Question 15.
An advance
decision can authorise withdrawal of all but basic care in cases of
persistent vegetative states.
Question 16.
A person with PoA
cannot overrule an advance direction about withdrawal or
withholding of life-sustaining
care.
Question 17.
A woman is seen in
the antenatal clinic at 39 weeks’ gestation. Her blood pressure is
180/110 and she has +++ of
proteinuria on dipstick testing. She has mild epigastric pain. A scan shows
evidence of FGR with the baby on the 2nd. centile. Doppler studies
of the umbilical artery are abnormal and a non-stress CTG shows loss of
variability and variable decelerations. She is advised that she appears to have
severe pre-eclampsia and is at risk of eclampsia and of intracranial haemorrhage.
She is told of the associated risk of mortality and morbidity. She is also
advised that the baby is showing evidence of severe FGR and has abnormal
Doppler studies and CTG which could lead to death or hypoxic damage. She
declines admission or treatment. She says she trusts in God and wishes to leave
her fate and that of her baby in His hands. She is seen by a psychiatrist who
assesses her as competent under the MCA and with no evidence of mental
disorder. The obstetrician wants to apply to the COP for an order for
compulsory treatment. Can he do this?
Question 18.
A woman is
admitted at 36 weeks’ gestation with evidence of placental abruption. She
is semi-comatose and shocked.
There is active bleeding and the cervical os is closed. Fetal heart activity is
present but with bradycardia and decelerations. The consultant decides that
Caesarean section is the best option to save her live and that of the baby.
When reading the notes, the registrar comes across an advance notice drawn up
by the woman and her solicitor. It states that she does not wish Caesarean
section, regardless of the risk to her and the baby. The consultant tells the
registrar that they can ignore it now that she is no longer competent and get
on with the Caesarean section for which she will be thankful afterwards. The
registrar says that the advance notice is binding. Who is correct?
Question 19.
An 8-year-old girl
is admitted with abdominal pain. Appendicitis is diagnosed with
peritonitis and surgery is
advised. The parents decline treatment on religious grounds. Can the consultant
in charge overrule the parents and give consent?
The TOG CPD questions for Volume
12.1 from 2010 are open access and available
here.
Answer True or False.
Understanding the Mental
Capacity Act 2005: a guide for clinicians
Under the Mental Capacity Act
2005:
1. competent
adults have a legal right to refuse life-threatening treatment. True / False
2. unwise
decisions do not need to be adhered to if made by competent adults. True / False
Advance directives:
3. can be made by
anyone aged >16 years. True / False
4. need only be
drawn up in general terms as to a person’s wishes. True / False
5. must be in
writing if life-sustaining treatment is being refused. True / False
The following statements about advance directives are true:
6. Refusal of
basic nursing care such as oral hydration and feeding cannot be made. True / False
7. Oral advance
decisions are never binding. True / False
8. Failure to
recognise an advance decision may give rise to a civil wrong of trespass. True / False
Capacity:
9. is age related,
but never task orientated. True / False
10. cannot be
established by reference to a person’s previous behaviour or appearance.
True / False
The following statements about ‘best interests’ are true:
11. The decision
maker (doctor) is not legally obliged to consult with family members when
dealing with incapacitated adults. True / False
12. Where there are
disputes between the doctor and the family members regarding a patient’s best interests,
getting a court appointed deputy is considered good practice. True / False
13. Restraint of a
patient by the decision maker is allowed, as long as it is proportionate and
there is a reasonable belief of harm in failing to do so. True / False
The following statements about Lasting Powers of Attorney
(LPAs) are true:
14. There are two
types of LPA: one for property and affairs, the other for personal welfare.
True / False
15. Anyone aged >16
years and with the requisite capacity is able to appoint an LPA. True / False
16. Where there is
contradiction between a LPA and an advance directive, the latter will be the effective
one. True / False
Under the Mental Capacity Act 2005:
17. patients who are
only able to retain information for a short period are regarded as lacking capacity.
True / False
Which of the following statements are true?
18. Capacity is not
fixed in time and can therefore change depending on the circumstances.
True / False
19. Parents can
overrule their 16 to 17-year-old’s refusal to be admitted into a mental
institution.
True / False
20 The person
making an advance directive does not have to draw the attention of healthcare professionals
to their decision. True / False
The TOG CPD questions for Volume
20.1 are open access and available
here.
Decision-making framework in gynaecology
for patients who lack mental capacity
The Mental Capacity Act of 2005:
1. is applicable
to individuals aged ≥18 years. True / False
2. is applicable
to individuals residing in England and Scotland. True / False
3. is not
applicable to individuals who are under the influence of drugs or substance
abuse.
True / False
4. ensures that
affected individuals do not make any unwise decision with regard to their
treatment. True / False
With regard to the decision-making model:
5. substituted
judgement is made to overturn an advanced decision by an individual. True / False
6. substituted
judgement is based on the values of the concerned individual. True / False
7. a decision made
by the method of substituted judgement is an objective means of arriving at a
decision. True / False
8. the Court of Protection
is able to appoint a deputy to make a decision on behalf of a mentally
incapacitated individual. True / False
9. someone with
advance directive is able to demand specific life-sustaining treatment in the
event of mental incapacitation. True / False
10. advance
statements are not valid unless they are made in writing. True / False
Regarding lasting power of attorney (LPA):
11. only a person
aged 18 years or more can be appointed as a donee. True / False
12. a donor can
appoint only one attorney with authority to make decisions. True / False
13. an advance
directive is still valid even when the affected person later appoints a donee
with the relevant authority. True / False
14. an individual
with an LPA can decide at his or her own discretion about withdrawal of life
sustaining treatment. True / False
Regarding the best interests model of care:
15. decisions made
in the ‘best interests’ meeting have legal authority. True / False
16. decisions taken
on this basis should be based upon personal opinion and preferences of the decision
maker. True / False
17. decisions taken
on this basis should be based upon the current condition of the incapacitated person.
True / False
For assessment of mental capacity:
18. the opinion of a
psychiatrist should always be sought before a decision of mental incapacity is
confirmed. True / False
19. a mini-mental
state examination score of below 20 increases the likelihood of mental
incapacity. True / False
Regarding the provision under the Mental Capacity Act of
2005,
20. it allows for a
decision to be taken to place a child for adoption on behalf of a mentally incapacitated
person. True / False
65.
Cri du chat syndrome.
Abbreviations.
CDC: cri du chat.
CDCs: cri du chat syndrome.
Question
1. Which of the following are recognised alternative names for
cri-du-chat syndrome?
|
A |
5p minus syndrome |
|
B |
5p- syndrome |
|
C |
6p minus syndrome |
|
D |
6p- syndrome |
|
E |
trisomy 5 |
|
F |
trisomy 6 |
Question
2. Which, if any, of
the following are associated?
|
A |
gene mutation |
|
B |
partial deletion of short arm of a chromosome |
|
C |
partial deletion of long arm of a chromosome |
|
D |
partial deletion of both arms of a chromosome |
|
E |
genetic mutation |
|
F |
translocation |
|
G |
trisomy |
|
H |
none of the above |
Question
3. Which, if any, of the following is the main cause of CDC?
|
A |
autosomal dominant inheritance |
|
B |
autosomal recessive inheritance |
|
C |
new mutation |
|
D |
X-linked dominant inheritance |
|
E |
X-linked recessive inheritance |
|
F |
translocation |
|
G |
trisomy |
|
H |
triploidy |
|
I |
none of the above |
Question
4. What is the approximate prevalence of CDC in neonates?
|
A |
1 in 1,000 - 5,000 |
|
B |
1 in 5,000 - 10,000 |
|
C |
1 in 10,000 - 20,000 |
|
D |
1 in 20,000 - 50,000 |
|
E |
1 in 50,000 - 100,000 |
|
F |
< 1 in 1,000,000 |
Question
5.
Which, if any, of
the following are common features of CDCs?
|
A |
distinctive cry |
|
B |
behavioural difficulty |
|
C |
developmental delay |
|
D |
epicanthic folds |
|
E |
hypertelorism |
|
F |
hypotonia |
|
G |
leaning difficulty |
|
H |
low birthweight |
|
I |
low-set, anteriorly-rotated ears |
|
J |
microcephaly |
|
K |
small jaw |
66.
Anatomy of the fetal skull.
Question 1. How many bones make
up the vault of the skull?
|
A |
3 |
|
B |
5 |
|
C |
6 |
|
D |
7 |
|
E |
8 |
Question 2. What is
the origin of the word “bregma”?
|
A |
the Greek word meaning “arrow” |
|
B |
the Greek word meaning “front of the head” |
|
C |
the Greek word meaning “top of the head” |
|
D |
the Greek word meaning “where lines intersect” |
|
E |
none of the above |
Question 3. What is the origin
of the word “lambdoid”?
|
A |
it is derived from “lambda”, the 11th.
letter of the Greek alphabet, with the symbol “λ” |
|
B |
it is derived from the shape of the rear end of a
newborn lamb, with legs apart for balance in the shape of an inverted “V” |
|
C |
it derives from the Norse noun “lam” meaning to hit |
Question 4. What is the origin of the word “sagittal”?
|
A |
it derives from the Latin verb “sagire” meaning to be
wise |
|
B |
it derives from the Latin noun “sagitta” meaning
“arrow” |
|
C |
it derives from the Latin adjective “sagitta” meaning
“pointing north” |
|
D |
it derives from the Latin adjective “sagitta” meaning
“lacking tension” |
Question 5. What is the meaning of the word “coronal”?
|
A |
it is the 11th. letter of the Greek alphabet |
|
B |
it derives from the Latin “corona” meaning “crown”. |
|
C |
it derives from the sun’s corona, meaning equator |
Question 6. What is
the definition of “vertex”?
|
A |
the most prominent part of the occiput |
|
B |
the area around the posterior fontanelle |
|
C |
the area bounded by the anterior fontanelle and the
posterior fontanelle |
|
D |
the area bounded by the anterior & posterior
fontanelles and the parietal bones |
|
E |
the area bounded by the anterior & posterior
fontanelles and the parietal eminences |
|
F |
the area bounded by the anterior & posterior
fontanelles and the parietal cardinals |
Question 7. What is the
definition of the anterior fontanelle?
|
A |
the anterior end of the sagittal suture |
|
B |
the area where the sagittal and coronal sutures meet |
|
C |
the area between the frontal and parietal bones |
|
D |
the posterior end of the sagittal suture |
|
E |
the area between the parietal bones and the occiput |
Question 8. What is the definition of the posterior fontanelle?
Option list. Use the option list for Question 7
Question 9. How many other fontanelles are there?
|
A |
0 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
6 |
Question 10. What is
the falx cerebri?
Option list.
|
A |
an area of dura mater at the back of the skull like a
roof over the cerebellum |
|
B |
is an artefact on ultrasound suggesting the presence of
cerebral tissue where there is none |
|
C |
is the horizontal fibrous platform on which the
cerebellum rests |
|
D |
is a crescent-shaped fold of dura mater separating the
cerebral hemispheres |
Question 11. What is the importance of the falx cerebri in relation to
delivery, particularly breech delivery?
|
A |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears
and intracranial bleeding |
|
B |
the falx cerebri is inserted into the bone of base of
the skull and traction on the base of the skull may lead to tears of the falx
and intracranial bleeding |
|
C |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears leaving
the cerebellum unsupported and liable to trauma |
Question 12. What
diameter presents to the pelvis with vertex presentation?
|
A |
suboccipito-bregmatic |
|
B |
suboccipito-frontal |
|
C |
occipito-frontal |
|
D |
mento-vertical |
|
E |
submento-bregmatic |
|
F |
none of the above |
Question 13. What
diameter presents to the pelvis with typical occipito-posterior position?
Option list. Use the list for
Question 12.
Question14. What
diameter presents to the pelvis with brow presentation?
Option list. Use the list for Question 12.
Question 15. What diameter presents to the pelvis with mento-anterior
face presentation?
Option list. Use the list for Question 12.
Question 16. What
diameter presents to the pelvis with mento-posterior face presentation?
Option list. Use the list for Question 12.
Question 17. What is the average length of the suboccipito-bregmatic
diameter in a term baby?
Option list.
|
A |
9.0 cm. |
|
B |
9.5 cm. |
|
C |
10.0 cm. |
|
D |
10.5 cm. |
|
E |
11.0 cm. |
|
F |
11.5 cm. |
|
G |
12.0 cm. |
|
H |
12.5 cm. |
|
I |
13.0 cm. |
|
J |
13.5 cm. |
|
K |
14.0 cm. |
Question 18. What is the average length of the suboccipito-frontal
diameter in a term baby?
Option list. Use the option list for Question 17.
Question 19 What is
the average length of the occipito-frontal diameter in a term baby?
Option list. Use the option list for Question 17
Question 20. What is the average
length of the mento-vertical diameter in a term baby?
Option list. Use the option list for Question 17
Question 21. What is the average length of the submento-bregmatic
diameter in a term baby?
Option list. Use the option list for Question 17
67.
Flu and pregnancy.
Abbreviations.
JCVI: Joint Committee on Vaccination and Immunisation
Question 1. What did MBRRACE say about flu & pregnancy in its first report in
2014?
|
A |
1 in 11
women died from flu |
|
B |
1 in 11 women died from flu and flu vaccination could
have prevented ½ of the deaths |
|
C |
1 in 21 women died from flu |
|
D |
1 in 21 women died from flu and flu vaccination could
have prevented ½ of the deaths |
|
E |
1 in 51 women died from flu |
|
F |
1 in 51 women died from flu and flu vaccination could
have prevented ½ of the deaths |
Question 2. How many types of flu virus are recognised?
|
A |
3 |
|
B |
5 |
|
C |
10 |
|
D |
15 |
|
E |
>100 |
Question 3. Why can’t we have a universal flu vaccine?
|
A |
The main
surface antigens are haemagglutinin and neuraminidase |
|
B |
The main surface antigens are haemolysin and
neuroxidase |
|
C |
The main surface antigens change frequently rendering
existing vaccines impotent |
|
D |
The main core antigens change frequently, rendering
existing vaccines impotent |
|
E |
The big drug companies avoid making a universal vaccine
for financial reasons. |
Question 4. When is flu’ most often a problem in the UK?
|
A |
Spring |
|
B |
Summer |
|
C |
Autumn |
|
D |
Winter |
|
E |
None of the above. |
Question 5. How is flu spread?
|
A |
via
aerosol or droplets from respiratory tract of an infected person |
|
B |
via aerosol or droplets from respiratory tract or
direct contact with respiratory secretions of an infected person |
|
C |
from getting drenched in cold winter showers |
|
D |
from thinking lascivious thoughts |
|
E |
from toilet seats |
Question 6. What is the incubation period for flu?
|
A |
1 – 3
days |
|
B |
1 – 7 days |
|
C |
5 – 10 days |
|
D |
up to 2 weeks |
|
E |
up to 3 weeks |
Question 7. Who decides which viruses will be used in the vaccine for seasonal flu?
|
A |
Department
of Health |
|
B |
JCVI |
|
C |
the Prime Minister |
|
D |
the vaccine manufacturers |
|
E |
World Health Organisation |
Question 8. How long has flu vaccination been recommended in the UK?
|
A |
since
the 1950s |
|
B |
since the 1960s |
|
C |
since the 1970s |
|
D |
since the 1980s |
|
E |
since the 1990s |
Question 9. What is the recommendation about when the vaccine should be given?
|
A |
May -
July |
|
B |
June - August |
|
C |
July - September |
|
D |
August - October |
|
E |
September - November |
Question 10. What advice is given about vaccination in pregnancy?
|
A |
flu vaccine
is potentially teratogenic and should be avoided before 16 weeks |
|
B |
the vaccine contains an attenuated virus with no
evidence of risk in pregnancy |
|
C |
the vaccine recommended for pregnancy has no live viral
material and all pregnant women are encouraged to have the seasonal vaccine |
|
D |
flu vaccine contains an attenuated virus with minimal
risk, but the anti-viral drug Tamiflu is given with the vaccine to eliminate
any risk of harm |
Question 11. What is the H1N1 virus?
|
A |
The
avian virus which causes outbreaks of “bird flu” |
|
B |
The virus associated with “swine” flu, which caused a
pandemic in 2009 |
|
C |
The virus associate with MERS, currently causing deaths
particularly in Saudi Arabia |
|
D |
The virus associated with simian flu |
|
E |
The virus associated with the pandemic of 1915. |
Question 12. What advice should be given to pregnant women about protection against
the H1N1 virus?
|
A |
to have
vaccination against H1N1 in addition to the seasonal vaccine |
|
B |
to have vaccination against H1N1 in preference to the
seasonal vaccine |
|
C |
to await evidence of epidemic H1N1 flu and then have
vaccination against H1N1 |
|
D |
to have the seasonal vaccine as it gives good
protection against H1N1 |
|
E |
not to have any flu vaccination, but to take antiviral
drugs if symptoms of flu occur |
Question 13. Which of the following conditions have been linked to flu in pregnancy?
|
A |
risk of flu complications for the mother |
|
B |
risk of low birthweight |
|
C |
risk of maternal death |
|
D |
risk of perinatal death |
|
E |
risk of
prematurity |
Question 14. What is the estimated uptake of flu vaccination by pregnant women in the
UK?
|
A |
20-30% |
|
B |
30-40% |
|
C |
40-50% |
|
D |
50-60% |
|
E |
> 60% |
Question 15. How many maternal deaths from flu were reported by MBRRACE for the years
2012 - 2013?
|
A |
0 |
|
B |
5 |
|
C |
10 |
|
D |
15 |
|
E |
20 |
Question 16. With regard to the probable explanation for the numbers of maternal
deaths from ‘flu in 2012 and 2013, which, if any, of the following statements
is true?
|
A |
the
numbers reflected increased prevalence of ‘flu |
|
B |
the numbers reflected reduced prevalence of ‘flu |
|
C |
the numbers reflected improved uptake of ‘flu vaccine
in pregnancy |
|
D |
the numbers reflected the introduction of Tamiflu for
pregnant women with ‘flu |
|
E |
none of the above |
