25 November 2024.
Specialist talks which can be downloaded from
Dropbox.
|
11 |
EMQ. Hepatitis C |
|
12 |
SBA. Coeliac disease & pregnancy |
|
13 |
EMQ. Mycoplasma
Genitalium |
|
14 |
EMQ.
Brexanolone |
|
15 |
EMQ. Zuranolone |
|
Specialist talk.
Julie Morris. Medical statistics |
7 |
Oct |
|
Specialist talk. Jenny Myers. Diabetes & pregnancy |
10 |
Oct |
|
Specialist talk. Jenny Myers.
Hypertension & pregnancy |
14 |
Oct |
|
Specialist talk. Martino Zacchè. Uro-gynae |
21 |
Oct |
|
TMcF. Maternal &
Perinatal mortality. MBRRACE. UKOSS |
24 |
Oct |
|
Specialist talk.
Janette Mill. Progression and assessment of training. |
28 |
Oct |
|
Specialist talk.
Janette Mill. Abnormal bleeding on HRT. |
28 |
Oct |
11. Hepatitis C.
Abbreviations.
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?
|
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 |
12. Coeliac disease & pregnancy.
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?
|
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?
|
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?
|
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?
|
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?
|
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?
|
colonoscopy |
|
|
B. |
enteroscopy |
|
C. |
gastroscopy |
|
D. |
rectal biopsy |
|
E. |
small bowel biopsy |
Question 13. Which skin condition is particularly
associated with CD?
|
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?
|
carbohydrate |
|
|
B. |
fat |
|
C. |
folic acid |
|
D. |
protein |
|
E. |
vitamins B12, D & K |
Question 15. What is the appropriate treatment of
CD?
|
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?
|
barley |
|
|
B. |
oats |
|
C. |
rapeseed oil |
|
D. |
rye |
|
E. |
wheat |
13. Mycoplasma Genitalium.
Abbreviations.
MG: Mycoplasma genitalium.
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.
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?
|
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 |
14. EMQ. Brexanolone
.
Abbreviations.
GABAA: γ-aminobutyric acid type A.
Scenario 1.
Which, if any, of
the following statements are true?
Option list.
|
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 |
15. EMQ. 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 |
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