2 September 2024.
Role-players: Anshu
Baser
Sabina Khondoker
|
Role-play. |
|
|
49 |
Viva.
Waiting
list prioritisation |
|
50 |
MCQ.
Folic
acid fortification of flour |
|
51 |
EMQ.
Listeriosis
and pregnancy |
48. Role-play.
Candidate’s instructions will be sent by email a few minutes before the
tutorial.
49. Waiting
list prioritisation.
Candidate’s instructions.
Your consultant is away. The waiting-list
manager comes to see you. The following patients have been listed by junior
staff. The waiting-list manager wants you to:
confirm the
appropriateness of the proposed treatment,
decide the
degree of urgency,
confirm the
appropriateness of the proposed venue,
decide any
special requirement(s) for each patient.
|
Name |
Age |
Clinical Problem |
Proposed operation |
Venue |
Special Needs |
Urgency |
|
JK |
5 |
chronic discharge. ? foreign body |
EUA |
Main theatre |
|
|
|
JM |
32 |
1ry. infertility |
Laparoscopy + tubal patency tests |
Main theatre |
|
|
|
GN |
77 |
Vulval cancer. Coronary thrombosis x 2.
Unstable angina. |
Radical vulvectomy agreed at |
Main theatre |
|
|
|
RU |
55 |
PMB x1. Weight 20 stones. (127 kg.) 1 kg. = 2.2 lb. 1 stone = 14 lb. |
D&C. |
|
|
|
|
LD |
32 |
Menorrhagia. Fibroids. Anaemia. |
Vaginal hysterectomy. |
Main theatre. |
|
|
|
DT |
22 |
Does not want children. |
Lap. Steril. |
|
|
|
|
HB |
14 |
Unwanted pregnancy at 10/52. |
TOP |
|
. |
|
|
JY |
44 |
GSI. |
Anterior colporrhaphy. |
Main theatre. |
|
|
|
JS |
23 |
Vaginal discharge. Cervical ectropion. |
Diathermy to cervix. |
|
|
|
|
DT |
55 |
3 cm. ovarian mass. |
Laparoscopy ? proceed to
Hyst + BSO. |
Main theatre. |
|
|
|
EV |
32 |
|
Cone biopsy. |
|
|
|
|
UW |
34 |
Endometriosis |
Laparoscopic ablation |
|
|
|
|
HT |
88 |
Cystocoele/ rectocoele/ 2nd.
degree uterine prolapse |
Manchester Repair. |
Main theatre. |
|
|
|
KN |
58 |
Haematuria |
Cystoscopy |
|
|
|
|
JW |
18 |
Menorrhagia & copes badly with
menstrual hygiene. Has Down’s syndrome. Sexually active. |
Hysterectomy |
Main theatre |
|
|
|
TB |
30 |
Menorrhagia. 2nd. degree
uterine descent. Been sterilised. Jehovah’s witness. |
Vaginal hysterectomy and
repair. |
Main theatre. |
|
|
|
BM |
55 |
Stage Ib cancer cervix. Been discussed
at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On
warfarin. |
Wertheim’s hysterectomy. |
Main theatre. |
|
|
|
NU |
60 |
Recurrent rectocoele. |
Posterior colporrhaphy. |
Main theatre. |
|
|
50. 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. Which neurological condition
has been thought potentially problematic with folic acid supplementation?
51. Listeriosis.
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?
|
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?
|
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?
|
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?.
|
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 ?
|
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.
|
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?
|
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?
|
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?
|
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.
|
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.
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