Sunday 2 June 2024

Tutorial 3 June 2024


Contact me

Website

 

18

EMQ. Hepatitis C

19

EMQ. Arrive trial

20

SBA.   Coeliac disease & pregnancy

21

EMQ. Mycoplasma Genitalium

22

EMQ. Brexanolone  

23

EMQ. Zuranolone

 

18.      Hepatitis C.

Abbreviations.

HBV:              Hepatitis B virus.

HCV:              Hepatitis C virus.

Scenario 1.         Which, if any, of the following statements are true?

A

Hepatitis kills more people world-wide than HIV

B

Hepatitis kills more people world-wide than TB

C

Hepatitis B kills more people world-wide that Hepatitis C

D

Hepatitis B kills more people world-wide than TB

E

None of the above

Scenario 2.         Which, if any, of the following statements are true in relation to HCV?

A

It is a DNA virus

B

It is a RNA virus

C

It is a member of the Flaviviridae family

D

it is a member of the Hepadnaviridae family

E

it is a member of the Herpesviridae family

F

most infections are due to genotypes 1 & 3

G

most infections are due to genotypes 2 & 4

Scenario 3.         What is the approximate prevalence of HCV infection in the UK?

A

0.1 per 1,000

B

0.3 per 1,000

C

0.5 per 1,000

D

1 per 1,000

E

3 per 1,000

F

5 per 1,000

G

10 per 1,000

H

13 per 1,000

I

15 per 1,000

J

None of the above

Scenario 4.         What are the key aspects of the WHO’s Global Health Sector Strategy in relation to

HCV infection?

A

elimination as a as a major public health threat by 2020

B

elimination as a as a major public health threat by 2030

C

elimination as a as a major public health threat by 2040

D

reduction in incidence by 50% by 2030

E

reduction in incidence by 75% by 2030

F

reduction in incidence by 80% by 2030

G

reduction in mortality by 50% by 2030

H

reduction in mortality by 65% by 2030

I

reduction in mortality by 70% by 2030

Scenario 5.         What is the incubation period of HCV infection?

A

6 weeks

B

2 months

C

up to 3 months

D

up to 4 months

E

up to 6 months

F

up to 12 months

G

none of the above

Scenario 6.         What symptoms are most common in acute HCV infection? There is no option list.

Scenario 7.         How is acute HCV infection diagnosed?

A

clinically

B

presence of HCV antibody

C

presence of HCV RNA

D

none of the above

Scenario 8.         What proportion of those with acute HCV infection are asymptomatic?

A

10%

B

20%

C

50%

D

60%

E

70%

F

> 80%

Scenario 9.         When does continuing infection after initial exposure become defined as chronic

infection?

A

after 6 weeks

B

after 2 months

C

after 3 months

D

after 4 months

E

after 6 months

F

after 12 months

G

none of the above

Answer. E. After 6 months.

Scenario 10.      Approximately how many of those with acute HCV infection will go on to chronic

infection?

A

10%

B

20%

C

40%

D

50%

E

>50%

F

>70%

Scenario 11.      A woman is found to have HCV antibodies. Which, if any, of the following statements

could be true?

A

she could have acute HCV infection

B

she could have chronic infection

C

she could have had HCV infection that has cleared spontaneously

D

she could have had HCV infection that has responded to drug therapy

E

she could have a false +ve test result

F

she could have chronic HBV infection due to cross reaction with HBcAg

G

she is immune to HCV

H

the antibodies could result from HCV vaccine

I

the antibodies could result from yellow fever vaccine

J

none of the above

Scenario 12.      Which, if any, of the following statements reflect current thinking about the

mechanisms of damage in chronic HCV infection?

A

hepatic damage is proportional to the duration of HCV infection

B

hepatic damage is a direct result of HCV replication within hepatocytes

C

hepatic damage is proportional to the level of detectable HCV RNA in maternal blood

D

hepatic damage is immune-mediated

E

hepatic damage is due to progressive biliary tract infection, scarring  and stenosis

F

hepatic damage mostly occurs in women who abuse alcohol

G

hepatic damage is worse in women with co-existing HIV infection

H

hepatitis D is end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating from the original name: ‘deadly-stage’ HCV disease 

Scenario 13.      How common is vertical transmission? There is no option list.

Scenario 14.      Which, if any, of the following statements are true in relation to the hepatitides?.

A

acute hepatitis is notifiable

B

chronic hepatitis is notifiable

C

hepatitis A is notifiable as the main route of spread is faecal contamination of food & water

D

hepatitis D is notifiable as the main source of infection is infected food and water

E

hepatitis E is notifiable as the main source of infection in the UK is raw or undercooked pork

F

none of the above

Scenario 15.      What anti-viral treatment is recommended for pregnancy? There is no option list.

Scenario 16.      Which, if any, of the following are true about Ribavirin?

A

it is the least expensive of the new DAADs for HCV

B

it is the least toxic of the new DAADs for HCV

C

it is the most effective of the new DAADs for HCV

D

it is contraindicated in pregnancy because of fears of teratogenicity

E

can cause sperm abnormalities

F.

can persist in humans for up to 6 months

G.

none of the above

Scenario 17.           A woman with chronic HCV wishes to breastfeed. What advice would you give? There is no option list.

Scenario 18.      How is neonatal infection diagnosed? There is no option list.

Scenario 19.      How is neonatal infection treated? There is no option list.

Scenario 20.           Which, if any, of the following conditions is more common in women with HCV infection?

A

dermatitis herpetiformis

B

HELLP syndrome

C

obstetric cholestasis

D

postnatal depression

E

thrombocytopenia

Scenario 21.      By how much is the risk of the condition in question 20 increased in women with HCV?

A

by a factor of 2

B

by a factor of 5

C

by a factor of 20

D

by a factor of 50

E

none of the above

Scenario 22.      Which, if any, of the following statements is true about HCV and the Nobel Prize?

A

the Nobel Prize was awarded to Alter, Houghton & Rice in 2020

B

the Nobel Prize was awarded to Alter, Hogg & Rice in 2020

C

the Nobel Prize was awarded to Alter, Houghton & Rees in 2020

D

the Nobel Prize was awarded to Change, Houghton & Rice in 2020

E

the Nobel Prize was awarded to Change, Hogg & Rice in 2020

F

the Nobel Prize was awarded to Change, Hogg & Barleycorn in 2020

G

the Nobel Prize has not been awarded for work on HCV

 

19.   Arrive trial.

Abbreviations.

EBL:    estimated blood loss.

IOL:    induction of labour.

Question 1.   What does the acronym ‘ARRIVE’ mean?

Option list.

A

a randomised review of intravenous ergometrine for the prevention of PPH

B

a randomised review of IVF efficacy

C

a retrospective review of IVF efficacy

D

a randomised review of IOL at term versus expectant management of high-risk pregnancy

E

a randomised review of IOL at 39 weeks versus expectant management of high-risk pregnancy

F

a randomised trial of IOL at term versus expectant management of low-risk pregnancy

G

a randomised trial of IOL at 39 weeks versus expectant management of low-risk pregnancy

H

none of the above

Question 2.   What was the primary outcome of the trial?

Option list.

A

C section and instrumental delivery rates versus the spontaneous delivery rate

B

cost-effectiveness of IVF

C

composite outcome of perinatal death or severe neonatal complications

D

estimated blood loss using low-dose ergometrine versus oxytocin for the 3rd. stage

E

frequency and severity of perineal trauma

F

length of labour

G

maternal satisfaction

H

urinary incontinence severity score at 3 months postpartum

I

none of the above

Question 3.   Which, if any, of the following were the important conclusions of the trial?

Option list.

A

C section and instrumental delivery rates were significantly with IOL at 39/52

B

C section rate but not instrumental delivery rate was significantly with IOL at 39/52

C

instrumental delivery rate but not C section rate was significantly with IOL at 39/52

D

C section and instrumental delivery rates were significantly with IOL at 39/52

E

C section rate but not instrumental delivery rate was significantly with IOL at 39/52

F

instrumental delivery rate but not C section rate was significantly with IOL at 39/52

G

C section and instrumental delivery rates were unchanged

H

IVF was cost-effective

I

IVF was not cost-effective

J

composite perinatal outcome was better with IOL

K

composite perinatal outcome was unchanged with IOL

L

composite perinatal outcome was worse with IOL

M

EBL using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓

N

EBL using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓ but with ↑↑ BP

O

frequency and severity of perineal trauma with IOL

P

length of labour was ↑↑ with IOL

Q

maternal satisfaction was higher with IOL

R

urinary incontinence at 3 months was reduced by IOL

S

none of the above

 

20.   Coeliac disease & pregnancy.

Abbreviations.

CD:           coeliac disease.

EMA:       IgG endomysial antibodies. 

IgA:          immunoglobulin A. 

tIgA:         total immunoglobulin A.

tTGA:       IgA tissue transglutaminase antibody.

Question 1. What is coeliac disease?

A.

allergy to gluten

B.

malabsorption due to large bowel inflammation

C.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition

D.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition

E.

an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the small bowel in individuals with a genetic predisposition

Question 2. What is the prevalence of coeliac disease in women of reproductive age?

A.

0.1%

B.

0.5%

C.

1%

D.

2-5%

E.

5-10%

Question 3. Which of the following groups have an increased risk of CD?

A.

1st. degree relatives of those with CD

B.

those with type 1 diabetes

C.

those with iron deficiency anaemia

D.

those with osteoporosis

E.

those with unexplained infertility

Question 4. Which of the following are features of CD in the non-pregnant population?

A.

abdominal bloating and pain

B.

amenorrhoea

C.

anaemia

D.

recurrent miscarriage

E.

unexplained infertility

Question 5. How do pregnant women with CD present most commonly?

A

anaemia

B

failure to gain weight in pregnancy

C

intra-uterine growth retardation

D

low BMI

E

no recognised abnormality

Question 6. Which of the following commonly occur in pregnant women with CD?

A

anaemia

B

failure to gain weight in pregnancy

C

intra-uterine growth retardation

D

low BMI

E

no recognised abnormality

Question 7. How should the woman with suspected CD be investigated initially?

A.

jejunal biopsy

B.

IgA EMA

C.

IgA tTGA

D.

IgA EMA + IgA tTGA

E.

tIgA + tTGA

Question 8. Which, if any, of the following statements are true in relation to the woman due to have testing for suspected CD?

A.

continue with a diet that includes gluten ≥ once daily for at least 1 month

B.

continue with a diet that includes gluten ≥ once daily for at least 6 weeks

C.

continue with a diet with ≥ 10 gm. gluten daily for at least 1 month

D.

continue with a diet with ≥ 10 gm. gluten daily for at least 6 weeks

E.

follow a strict gluten-free diet for at least 3 months

Question 9. What advice should be given to those who have gone on to a gluten-free diet in the month before testing?

A.

the gluten-free diet may render the serological tests –ve, but not intestinal biopsy

B.

the gluten-free diet may render the intestinal biopsy –ve, but not the serological tests

C.

the gluten-free diet may render all the tests -ve

D.

if she is happy with the gluten-free diet, there is no  point in testing

E.

she is not qualified to make medical decisions and should not be so stupid on future occasions

Question 10. Which of the following conditions should make consideration of testing for CD sensible?

A.

amenorrhoea

B.

Down’s syndrome

C.

epilepsy

D.

recurrent miscarriage

E.

Turner’s syndrome

F.

unexplained infertility

Question 11. What recommendation does NICE make about the information to be provided to healthcare professionals with the results of serological tests for CD?

A.

the results alone should be provided

B.

the results with the local reference values for children, adult men and adult women

C.

the results with the local and national reference values for children, adult men and women

D.

the results with interpretation of their meaning

E.

the results with interpretation of their meaning + recommended actions

Question 12. How is the diagnosis of CD confirmed after +ve serological testing?

A.

colonoscopy

B.

enteroscopy

C.

gastroscopy

D.

rectal biopsy

E.

small bowel biopsy

Question 13. Which skin condition is particularly associated with CD?

A.

atopic eczema

B.

dermatitis herpetiformis

C.

dermatitis multiforme

D.

dermatographia

E.

psoriasis

Question 14. Which of the following are likely to be absorbed less well than normally in women with CD?

A.

carbohydrate

B.

fat

C.

folic acid

D.

protein

E.

vitamins B12, D & K

Question 15. What is the appropriate treatment of CD?

A.

antibiotics: long-term in low-dosage

B.

azathioprine

C.

cyclophosphamide

D.

rectal steroids

E.

none of the above

Question 16. Which of the following do not contain gluten?

A.

barley

B.

oats

C.

rapeseed oil

D.

rye

E.

wheat

 

21.   Mycoplasma Genitalium.

Many of the questions are not true EMQs as they have more than one correct answer

Abbreviations.

BASHHMG:        British Association for Sexual Health and HIV’s “National guideline for the management of infection with Mycoplasma genitalium”. 2018

MG:       Mycoplasma genitalium.

MP:       Mycoplasma pneumoniae.

MSSU:   mid-stream specimen of urine.

NAAT:   nucleic acid amplification test.

NCSP:    National Chlamydia Screening Programme.

NHSCS: NHS Cervical Screening Programme

PID:       pelvic inflammatory disease.

STI:        sexually-transmitted infection.

Scenario 1.         Which, if any, of the following statements are true in relation to Mg? This is not a true

EMQ as there may be more than one correct answer.

A

MG was first isolated in 2001

B

MG was first isolated from men with non-gonococcal urethritis (NGU)

C

MG belongs to the Cutemollies class

D

MG is the smallest known yeast with the ability to self-replicate

E

MG is the smallest known bacterium with the ability to self-replicate

F

MG has an unusual, double-layered cell wall

G

MG has an unusual protrusion at one end

H

MG’s protrusion enables it to adhere to epithelial cells

I

MG’s protrusion enables it to invade epithelial cells

J

MG is best seen on a Gram stain

Scenario 2.         Which, if any, of the following statements are true in relation to Mycoplasmas?

A

are the largest known bacteria

B

have no cell wall

C

have no nuclei

D

are resistant to ß-lactam antibiotics

E

are resistant to sulphonamides

F

colonies show a ‘scrambled egg’ appearance on culture on agar

G

particularly affect mucosal surfaces.

Scenario 3.         Which, if any, of the following statements are true in relation to Mg?

A

when the organism was originally found, culture took 50 days

B

Mg is facetious

C

Mg is a facultative aerobe

D

Mg is a facultative anaerobe

E

Mg is a facultative aerobe & anaerobe

F

Mg is fastidious

Scenario 4.         Which, if any, of the following are true in relation to the approximate prevalence of

MG?

A

it is ~ 0.1%

B

it is ~ 1.0%

C

it is ~ 5.0%

D

it is ~ 5-10%

E

it is > 10%

F

none of the above

Scenario 5.         Which, if any, of the following is true in relation to screening for MG? This is a true

EMQ with only one correct answer.

A

screening for MG is now included in the NCSP

B

screening for MG is now offered as part of the NHSCS

C

screening should be offered to all sexually active women < 30 years old

D

screening should only be offered to those with symptoms suggestive of infection

E

screening should be offered to all partners of those with MG infection

F

none of the above

Scenario 6.         Which, if any, of the following are included in BASHHMG as risk factors for infection

with MG?

A

Cigarette smoking

B

Multiple dancing partners

C

Multiple sexual partners

D

Non-white ethnicity

E

Younger age

F

None of the above

Scenario 7.         Which of the following statements is true in relation to MG and co-infection with

other organisms?

A

MG excretes bactericidal toxins and co-infection is rare

B

MG co-infection is most often with chlamydia

C

MG co-infection is most often with E. coli

D

MG co-infection is most often with HIV

E

MG co-infection is most often with TB

F

None of the above

Scenario 8.         Which of the following statements is true in relation to MG and men?

A

It is the most common cause of NGU

B

It is the most common cause of epididymitis

C

It is the most common cause of prostatitis

D

It is a well-recognised cause of male sub-fertility

E

Most men with MG infection are asymptomatic

F

None of the above

Scenario 9.         Which, if any, of the following statements are true in relation to MG and women?

A

MG is linked to an risk of cervicitis

B

MG is linked to an risk of endometritis

C

MG is linked to an risk of female infertility

D

MG is linked to an risk of miscarriage

E

MG is linked to an risk of otitis media

F

MG is linked to an risk of pelvic inflammatory disease

G

MG is linked to an risk of postcoital bleeding

H

MG is linked to an risk of postmenopausal bleeding

I

MG is linked to an risk of preterm birth

J

MG is linked to an risk of damage to Fallopian tube cilia

K

MG is linked to an risk of puerperal psychosis

L

MG is linked to an risk of puerperal sepsis

M

Most infected women are asymptomatic

N

None of the above

Scenario 10.      Which, if any, of the following statements are true in relation to current concerns

about Mg?

A

It could become a ‘superbug’, resistant to most antibiotics, within a decade

B

Infection is often misdiagnosed as chlamydia with risk of antibiotic resistance

C

‘superbug’ status would be likely to lead to an in renal failure

D

‘superbug’ status would be likely to lead to an in female infertility

E

‘superbug’ status would be likely to lead to an in male infertility

Scenario 11.      Which, if any, of the following are used in the recommended test for MG infection in

women?

A

blood testing for MG IgG

B

blood testing for MG IgM

C

cervical smears checked microscopically for the diagnostic intracellular inclusion bodies

D

culture and sensitivity of cervical swab specimens using MG-specific culture medium

E

culture and sensitivity of 1st. void MSSU using MG-specific culture medium

F

culture and sensitivity of vaginal swab specimens using MG-specific culture medium

G

NAATs that detect the MG G-antigen

H

NAATs that detect MG DNA

I

NAATs that detect MG RNA

J

serum testing for MG-specific antigen

K

vaginal swabs taken by the woman

L

none of the above

Scenario 12.      Which, if any, of the following statements are true in relation to testing for antibiotic

resistance after initial tests are +ve for MG?

A

test for resistance to cephalosporins

B

test for resistance to macrolides

C

test for resistance to penicillin

D

test for resistance to quinolones

E

test for resistance to macrolides

F

test for resistance to streptomycin

F

test for resistance to sulphonamides

F

test for resistance to tetracyclines

G

None of the above

Scenario 13.      Which, if any, of the following statements are true in relation to estimates of

antibiotic resistance in current strains of MG in the UK?

A

20% are resistant to cephalosporins

B

40% are resistant to macrolides

C

50% are resistant to penicillin

D

50% are resistant to quinolones

E

10% are resistant to streptomycin

F

90% are resistant to sulphonamides

F

40% are resistant to tetracyclines

F

None of the above

Scenario 14.      Which, if any, of the following is BASHHMG’s recommended 1st. line treatment of

uncomplicated MG?

A

azithromycin 1 gram daily for 7 days

B

doxycycline 100 mg twice daily for 7 days

C

doxycycline 100 mg twice daily for 10 days

D

doxycycline 100 mg twice daily for 7 days

E

doxycycline 100 mg twice daily for 7 days then azithromycin 1 gram daily for 2 days

F

moxifloxacin 400mg orally once daily for 7 days

G

moxifloxacin 400mg orally once daily for 10 days

H

none of the above

Scenario 15.      Which, if any, of the following is BASHHMG’s recommended 1st. line treatment of

complicated MG?

A

doxycycline 100 mg twice daily for 10 days

B

doxycycline 100 mg twice daily for 14 days

C

moxifloxacin 400mg orally once daily for 10 days

D

moxifloxacin 400mg orally once daily for 14 days

E

none of the above

Scenario 16.      This is not an EMQ or SBA! Fill in the gaps in the table below, using option list.

Drug name

Category of drug

azithromycin

 

doxycycline

 

moxifloxacin

 

Option List.

Category of drug

macrolide

tetracycline

quinolone

Scenario 17.      Which, if any, of the following statements is true in relation to test of cure (TOC) after

treatment of MG?

A

TOC should be offered to everyone who has been treated for MG

B

TOC should only be offered to those who had signs of infection before treatment

C

TOC should only be offered to those who had symptoms of infection before treatment

D

TOC should only be offered to those who had signs and symptoms before treatment

E

TOC should only be offered to those who continue to have signs or symptoms two weeks or more after the start of treatment

F

none of the above

Scenario 18.      Which, if any, of the following statements are true in relation to the timing of test of

cure (TOC) after treatment of MG?

A

TOC is best done at 3 weeks after start of treatment

B

TOC is best done at 4 weeks after start of treatment

C

TOC is best done at 5 weeks after start of treatment

D

TOC is best done at 6 weeks after start of treatment

E

TOC should not be done < 2 weeks from the start of treatment

F

TOC should not be done < 3 weeks from the start of treatment

G

TOC should not be done < 4 weeks from the start of treatment

 

22.   Brexanolone.

Abbreviations.

GABAA: γ-aminobutyric acid type A.

Scenario 1.    Which, if any, of the following statements are true?

A

Brexanolone it is a water soluble form of allopregnanolone

B

allopregnanolone is an oestrogen metabolite and levels mirror those of oestrogen

C

allopregnanolone is a potent modulator of GABAA receptors in the brain

D

brexanolone is effective in the treatment of postpartum depression

E

brexanolone is administered orally

F

brexanolone is licensed for use in the UK

 

23.   Zuranolone.

Question. Which, if any, of the following statements are true? There is > 1 correct answer.

Option list.

A

Zuranolone it is a water soluble form of allopregnanolone

B

allopregnanolone is an oestrogen metabolite and levels mirror those of oestrogen

C

allopregnanolone is a potent modulator of GABAA receptors in the brain

D

Zuranolone is effective in the treatment of postpartum depression

E

Zuranolone is administered orally

F

Zuranolone is licensed for use in the UK

 

 

 


No comments:

Post a Comment