9 December 2024.
|
36 |
SBA. Appendicitis
in pregnancy |
|
37 |
SBA. Pertussis and pregnancy |
|
38 |
|
|
39 |
EMQ. Cervical
cancer staging |
|
40 |
EMQ. Headache |
36. Appendicitis in pregnancy.
AIP: appendicitis
in pregnancy
CRP : C
reactive protein
EFHRM: electronic
fetal heart rate monitoring
RLQP: right
lower quadrant pain
RUQP: right
upper quadrant pain
Question 1.
What is the
approximate incidence of appendicitis in pregnancy?
|
A |
1 in 500 |
|
B |
1 in
1,000 |
|
C |
1 in
2,000 |
|
D |
1 in
5,000 |
|
E |
1 in 10,000 |
Question 2.
Is
appendicitis more or less common in pregnancy?
|
A |
just as common |
|
B |
less common |
|
C |
maybe |
|
D |
more
common |
|
E |
no one
knows |
|
F |
no one
cares |
Question 3.
How is
maternal death from appendicitis classified?
|
A |
coincidental death |
|
B |
direct death |
|
C |
incidental
death |
|
D |
indirect
death |
|
E |
none of
the above |
Question 4.
When is
appendicitis in pregnancy most common?
|
A |
first trimester |
|
B |
second
trimester |
|
C |
trimester |
|
D |
1st.
and 2nd. stages of labour |
|
E |
in the
hours after the 3rd. stage of labour |
|
|
during
the puerperium |
Question 5.
What eponymous
title is given to the surface marker for the appendix?
|
A |
McBarney’s point |
|
B |
MacBurney’s
point |
|
C |
McBurney’s
point |
|
D |
MacBorney’s
point |
|
E |
McBorney’s
point |
Question 6.
Where is the
point referred to in the above question?
|
A |
1/3 of the way along the line joining the
anterior superior iliac spine and umbilicus |
|
B |
1/2 of
the way along the line joining the anterior superior iliac spine and
umbilicus |
|
C |
2/3 of
the way along the line joining the anterior superior iliac spine and
umbilicus |
|
D |
1/3 of
the way along the line joining the left and right anterior superior iliac
spines |
|
E |
1/2 of
the way along the line joining the left and right anterior superior iliac
spines |
Question 7.
Which, if
any, of the following statements are true about the person after whom the
point in the
above questions is named?
|
A |
he spent 2 years as a postgraduate working
in Berlin, London, Paris and Vienna |
|
B |
he was Professor of surgery at the
Roosevelt hospital, New York from 1889 to 1894 |
|
C |
he
presented his classical paper on appendicitis to the NY Surgical Society in
1889 |
|
D |
he was a
transvestite |
|
E |
he died
of a heart attack while on a hunting trip |
Question 8.
Pick the best
option from the list below in relation to right lower quadrant pain in
AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
RLQP is as common in the pregnant as in the
non-pregnant |
|
C |
RLQP is less common in the pregnant |
|
D |
RLQP is
more common in the pregnant |
|
E |
RLQP is
rare in pregnancy |
Question 9.
Pick the best
option from the list below in relation to right upper quadrant pain in
AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
RUQP is ½ as common in the pregnant as in the
non-pregnant |
|
C |
RUQP is as common in the pregnant as in the
non-pregnant |
|
D |
RUQP is twice as common in the pregnant as in
the non-pregnant |
|
E |
RUQP is four times as common in the pregnant
as in the non-pregnant |
Question 10.
Pick the best
option from the list below in relation to nausea in AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
nausea is as common in the pregnant as in
the non-pregnant |
|
C |
nausea is less common in the pregnant |
|
D |
nausea
is more common in the pregnant |
|
E |
nausea
is rare in pregnancy |
Question 11.
Which
condition did CMACE say should be excluded in women presenting acutely
with gastrointestinal symptoms?
|
A |
aortic
dissection |
|
B |
appendicitis |
|
C |
Caesarean section scar pregnancy |
|
D |
ectopic
pregnancy |
|
E |
pancreatitis |
|
F |
ovarian
torsion |
Question 12.
Pick the best
option from the list below in relation to abdominal guarding in AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
abdominal guarding is as common in the
pregnant as in the non-pregnant |
|
C |
abdominal guarding is less common in the
pregnant |
|
D |
abdominal guarding is more common in the pregnant |
|
E |
abdominal guarding is rare in pregnancy |
Question 13.
Pick the best
option from the list below in relation to rebound tenderness in AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
rebound
tenderness is as common in the pregnant as in the non-pregnant |
|
C |
rebound
tenderness is less common in the pregnant |
|
D |
rebound
tenderness is more common in the pregnant |
|
E |
rebound
tenderness is rare in pregnancy |
Question 14.
Pick the best
option from the list below in relation to fever in AIP.
|
A |
comparative
figures for the pregnant and non-pregnant are unknown |
|
B |
fever is as common in the pregnant as in
the non-pregnant |
|
C |
fever is less common in the pregnant |
|
D |
fever is more common in the pregnant |
|
E |
fever is rare in pregnancy |
Question 15.
How useful is
the finding of leucocytosis in making the diagnosis of AIP?
|
A |
sine qua non |
|
B |
very
useful |
|
C |
not very
useful |
|
D |
I don’t
know |
|
E |
none of
the above |
Question 16.
How useful is
the finding of a raised CRP level in the diagnosis of AIP?
|
A |
sine qua non |
|
B |
very
useful |
|
C |
not very
useful |
|
D |
I don’t
know |
|
E |
none of
the above |
Question 17.
What are the
ultrasound features of appendicitis?
|
A |
appendix with diameter > 6 mm. |
|
B |
appendix
with diameter > 1 cm. |
|
C |
blind-ending
tubular structure |
|
D |
non-compressible tubular structure |
|
E |
none of
the above |
Question 18.
What do
W&M give for sensitivity & specificity for US diagnosis of
appendicitis?
|
|
Sensitivity |
Specificity |
|
A |
≥65% |
≥80% |
|
B |
≥75% |
≥85% |
|
C |
≥86% |
≥97% |
|
D |
≥91% |
≥98% |
|
E |
≥95% |
≥95% |
Question 19.
Which, if
any, of the following are true about CT scanning for the diagnosis of AIP?
|
A |
CT scanning has sensitivity > 85% and
specificity >95% |
|
B |
CT
scanning exposes mother and fetus to radiation doses of little concern |
|
C |
CT
scanning has replaced ultrasound scanning for AIP |
|
D |
CT
scanning is not of proven value after inconclusive ultrasound scanning |
|
E |
CT
scanning is of proven value and most useful after inconclusive ultrasound
scanning |
Question 20.
Which, if
any, of the following statements are true about MRI scanning for the
diagnosis of AIP?
|
A |
MRI scanning has sensitivity > 90% and
specificity >97% |
|
B |
MRI
scanning exposes mother and fetus to radiation doses of little concern |
|
C |
MRI
scanning has replaced ultrasound scanning for AIP |
|
D |
MRI
scanning is not of proven value after inconclusive ultrasound scanning |
|
E |
MRI
scanning is of proven value and most useful after inconclusive ultrasound
scanning |
Question 21.
Which, if
any, of the following statements are true about the complications of AIP?
|
A |
bowel obstruction |
|
B |
longer inpatient stay |
|
C |
pneumonia sepsis and septic shock |
|
D |
postoperative infection |
|
E |
ureteric
damage |
|
F |
none of
the above |
Question 22.
Which, if
any, of the following statements are true about the complications of AIP?
|
A |
fetal loss rate in uncomplicated AIP is
about 1.5% |
|
B |
fetal
loss rate in AIP complicated by peritonitis is about 6% |
|
C |
fetal loss rate in AIP complicated by
perforation of the appendix is up to 36% |
|
D |
pre-term
delivery rates increase in AIP complicated by perforation of the appendix |
|
E |
none of
the above |
Question 23.
Which, if
any, of the following statements are true about surgery for AIP?
|
A |
conservative management is linked to a
greater incidence of complications |
|
B |
laparotomy should be done through a
grid-iron incision with the mid-point the surface marker for the appendix in
the right iliac fossa |
|
C |
laparotomy
should be done through a right paramedian incision starting at the level of
the umbilicus |
|
D |
about 35% of laparotomies show no evidence
of appendicitis |
|
E |
the
appendix should be removed even if it looks normal |
|
F |
antibiotic
therapy is an alternative to surgery in early cases of acute AIP |
Question 24.
Which, if
any, of the following statements are true about surgery for AIP?
|
A |
laparoscopic appendicectomy is an
acceptable alternative to laparotomy, but only in the 1st.
trimester |
|
B |
laparoscopic
appendicectomy is an acceptable alternative to laparotomy, but only in the 1st.
& 2nd. trimesters |
|
C |
laparoscopic
appendicectomy is an acceptable alternative to laparotomy, at all gestations |
|
D |
there is
evidence that laparoscopic appendicectomy is associated with doubling of the
rate of fetal loss |
|
E |
none of
the above |
Question 25.
Which, if
any, of the following statements are true about C section in relation to AIP?
|
A |
C section is rarely necessary |
|
B |
C section increases the risk of uterine
infection if peritonitis is present |
|
C |
C section should be offered if elective C
section is planned |
|
D |
C section should be considered if the woman
is critically ill |
Question 26.
Which, if
any, of the following statements are true about the fetal heart rate?
|
A |
EFHRM should be done pre and
post-operatively in surgery for AIP |
|
B |
EFHRM should
always be done intra-operatively in surgery for AIP |
|
C |
the
drugs used for GA tend to cause fetal tachycardia |
|
D |
the
drugs used for GA commonly cause a sinusoidal pattern |
|
E |
C
section should be done if abnormal EFHRM patterns occur |
|
F |
fetal
scalp pH sampling should be done if abnormal EFHRM patterns occur |
|
G |
fetal
blood sampling should be done if abnormal EFHRM patterns occur |
TOG questions. These are open access, so reproduced here.
Appendicitis is
a likely diagnosis in pregnancy when,
1. ultrasound shows a
non-compressible blind-ending tube in the right iliac fossa measuring 10 mm in
diameter. False / True
2. a patient presents with
right-sided abdominal pain, constipation and malaise. False / True
In the diagnosis
of appendicitis in pregnancy,
3. ultrasound is the best
method for imaging in a morbidly obese patient. False / True
4. MRI has the greatest
specificity of all imaging modalities. False / True
With regard to
the management of a pregnant patient with appendicitis,
5. it should be operative if
the diagnosis is certain. False
/ True
6. it should primarily aim to
reduce any delay in surgical intervention. False
/ True
7. it should not involve
appendicectomy if the appendix appears normal at the time of surgery.
False
/ True
8. it should include delivery
of the fetus regardless of gestation if the patient is critically ill.
False / True
9. some cases may be treated
with antibiotics alone. False / True
General
anaesthesia for pregnant women undergoing appendicetomy,
10. carries ~ a 25-fold increased
risk of complications than regional anaesthesia. False / True
11. has temporary effects on the
fetus as all induction and maintenance agents cross the placenta.
False / True
12. has a uterotonic effect. False
/ True
Surgery for
appendicetomy in pregnancy,
13. increases the rate of
miscarriage. False
/ True
14. has the lowest risk to the
fetus when performed in the second trimester. False / True
15. should be delayed until
antenatal corticosteroids are given (in the absence of severe maternal sepsis)
if the gestation is critical. False / True
Concerning acute
appendicitis in pregnancy,
16. it is the most common cause
of acute surgical abdomen. False
/ True
17. it most commonly occurs in
the first trimester. False
/ True
18. it has a fetal loss rate
exceeding 50% if the appendix perforates. False
/ True
With regard to
imaging as an investigation for appendicitis in pregnancy,
19. the primary goal is to rule
out differential diagnoses. False
/ True
20. the secondary goal is to
reduce the negative appendicectomy rate. False
/ True
37. Pertussis and pregnancy.
JCVI: Joint
Committee on Vaccination and Immunisation .
PIPP: pertussis immunisation programme for
pregnancy.
Question 1.
Why is
pertussis of current concern in obstetrics?
|
A |
Research
has linked pertussis in the 1st. trimester to ↑ risk of congenital heart disease |
|
B |
A mini-epidemic since 2011 has caused ↑ deaths
of mothers & of babies < 3 months |
|
C |
A mini-epidemic since 2011 has caused ↑ deaths
of babies < 3 months |
|
D |
The infecting organism has become
increasingly drug-resistant |
|
E |
The infecting organism has become
increasingly virulent |
Question 2.
Which
organism causes whooping cough?
|
A |
Bordella pertussis |
|
B |
Bacteroides
pertussis |
|
C |
Rotavirus
whoopoe |
|
D |
Respiratory
syncytiovirus pertussis |
|
E |
None of
the above |
Question 3.
Which, if
any, of the following statements are true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space and there may be more than one correct answer.
|
A |
the organism is aerobic |
|
B |
the organism is anaerobic |
|
C |
the organism is capsulated |
|
D |
the organism is flagellate |
|
E |
the
organism is an obligate intra-cellular parasite |
|
F |
the organism is a Gram -ve diplococcus |
|
G |
the organism is a Gram +ve diplococcus |
|
H |
the organism requires special transport
media |
|
I |
no one is going to ask me any of this stuff |
Question 4.
Which of the
following statements is true?
|
A |
Pertussis is no longer a significant threat
to infants |
|
B |
Pertussis
remains a significant threat to infants |
|
C |
The risk
of death from pertussis is eliminated by timely antibiotic therapy |
|
D |
the risk
of death from pertussis is eliminated by timely antiviral therapy |
|
E |
None of
the above |
Question 5.
Which of the following
statements is true?
|
A |
Pertussis is not a notifiable disease |
|
B |
Pertussis
is a notifiable disease |
|
C |
Pertussis
is not a notifiable disease, but cases should be reported to the local
bacteriologist |
|
D |
Pertussis
is not a notifiable disease, but cases should be subject to audit |
Question 6.
What is the
main mode of spread of the organism that causes pertussis?
|
A |
contact
with contaminated surfaces |
|
B |
contaminated food |
|
C |
contaminated water |
|
D |
respiratory droplets |
|
E |
none of the above |
Question 7.
What is the
main reservoir of the organism that causes pertussis?
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of the above |
Question 8.
What is the
epidemiology of pertussis?
|
A |
the condition is endemic |
|
B |
the
condition is endemic with mini-epidemics every 3-5 years |
|
C |
the
condition is endemic with mini-epidemics most years in the winter months |
|
D |
the
condition is epidemic, with outbreaks at roughly three-year intervals |
|
E |
the
condition is epidemic, with outbreaks at unpredictable intervals |
Question 9.
What is the
incubation period for pertussis?
|
A |
3-6 days |
|
B |
7-10 days |
|
C |
11-14 days |
|
D |
15-18 days |
|
E |
none of the
above. |
Question 10.
What is the
duration of infectivity of someone with pertussis?
|
A |
2 days from
exposure → 5 days after onset of paroxysms of coughing |
|
B |
3 days from
exposure → 10 days after onset of paroxysms of coughing |
|
C |
4 days from
exposure → 14 days after onset of paroxysms of coughing |
|
D |
6 days from
exposure → 21 days after onset of paroxysms of coughing |
|
E |
none of the
above |
Question 11.
What % of
non-immune, close contacts of pertussis will develop the disease?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Which of the
following best describe the DOH’s advice about pertussis? This is not a true
SBA as there may be > 1 connect answer.
|
A |
The DOH advises that all pregnant women be
immunised to ↓ maternal death rates. |
|
B |
The DOH advises
that all pregnant women be immunised to ↓ deaths
in babies < 3 months. |
|
C |
The DOH advises
that all babies be immunised at birth. |
|
D |
The DOH advised
that “Boostrix- IPV” should
replace “Repevax” from July 2014. |
|
E |
The DOH advises
that immunisation of pregnant women be continued permanently |
Question 13.
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routine child immunisation was
introduced?
|
A |
the number
was 10,000 |
|
B |
the number
was 5,000 |
|
C |
the number
was 4,000 |
|
D |
the number
was 3,500 |
|
E |
the number was
1,000 |
Question 14.
Which, if
any, of the following statements are true in relation to pertussis vaccine.
|
A |
“Boostrix- IPV” is a vaccine for pertussis
only |
|
B |
“Repevax” is a
vaccine for pertussis only |
|
C |
“Boostrix-
IPV” & “Repevax” are live, attenuated vaccines |
|
D |
“Boostrix-
IPV” & “Repevax” act against diphtheria, tetanus and polio as well as
pertussis |
|
E |
“Boostrix-
IPV” & “Repevax” are acellular |
Question 15.
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the above |
Question 16.
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I hate this subject now |
Question 17.
A pregnant woman misses out on vaccination as part of the PIPP. Should
vaccination still be offered in the puerperium?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I hate this subject now |
38. Placenta accreta, increta & percreta.
Abbreviations.
Creta: term to describe accreta, increta or
percreta.
GTG27a: RCOG’s Green-top Guideline27a: “Placenta Praevia and Placenta Accreta:
Diagnosis and Management”.
MROP: manual removal of placenta.
PAS: placenta accreta spectrum.
PET: pre-eclampsia.
PIH: pregnancy-induced hypertension.
TAS: trans-abdominal ultrasound scan.
TVS: trans-vaginal ultrasound scan.
Question 1.
Which of the
following terms are commonly used for abnormal placental adherence/
invasion?
|
A.
|
a bugger
to remove |
|
B.
|
abnormally
adherent and invasive |
|
C.
|
bled
like Hell |
|
D.
|
morbidly
adherent placenta |
|
E.
|
morbidly
invasive placenta |
|
F.
|
placenta
accreta spectrum |
|
G.
|
none of the above. |
Question 2.
Which of the
following terms is favoured in GTG27a for abnormal placental
adherence/ invasion?
|
A. |
a bugger to remove |
|
B. |
abnormally adherent and invasive |
|
C. |
bled like Hell |
|
D. |
morbidly adherent placenta |
|
E. |
morbidly invasive placenta |
|
F. |
placenta accreta spectrum |
|
G. |
none of the above. |
Question 3.
Who is
accredited in GTG27a for being the historical source of the definition relating
to PAS? And what observations did they make that echo
relevantly today? There is no option list for the second question, which you
won’t be asked, but is interesting and may help you to remember stuff.
|
A.
|
Irvine
and Berlin |
|
B.
|
Irving and
Harthog |
|
C.
|
Irvine
and St. Michael |
|
D.
|
Irvine
and Beyond |
|
E.
|
Irving
and Berlin |
|
F.
|
Irving
Berlin |
|
G.
|
Irving
& Hertig |
Question 4. Which, if any, of the following are true about the definition
of ‘low-lying’ placenta?
|
A.
|
a placenta associated with the birth of a
child destined to be an actor specialising in roles as a ‘baddie’ in cowboy
films. |
|
B.
|
a placenta within 50 mm of the internal os. |
|
C.
|
a placenta within 20 mm of the internal os. |
|
D.
|
a placenta within 10 mm of the internal os. |
|
E.
|
a placenta within 10 miles of the South
Pole. |
|
F.
|
a placenta that reaches, but does not cover
the internal os. |
|
G.
|
a placenta that covers the internal os, but
not when it is fully dilated. |
|
H.
|
none of
the above |
Question 5.
Which, if
any, of the following are true about the definition of placenta previa?
|
A.
|
a placenta within 50 mm of the internal os. |
|
B.
|
a placenta within 20 mm of the internal os. |
|
C.
|
a placenta within 10 mm of the internal os. |
|
D.
|
a placenta that reaches, but does not cover
the internal os. |
|
E.
|
a placenta that covers the internal os. |
|
F.
|
a
placenta that covers the internal os, but not when it is fully dilated. |
|
G.
|
none of
the above |
Question 6.
What is the approximate
incidence of placenta previa at term?
|
A.
|
1 in
50 |
|
B.
|
1 in 150 |
|
C.
|
1 in 200 |
|
D.
|
1 in 250 |
|
E.
|
1 in 500 |
|
F.
|
1 in 750 |
|
G.
|
1 in
1,000 |
Question 7.
Which of the
following is true about abnormal placental adherence / invasion?
|
A.
|
the diagnosis is dependent on the amount of cursing
done by the obstetrician |
|
B.
|
the diagnosis is clinical |
|
C.
|
the diagnosis is conditional |
|
D.
|
the diagnosis is empirical |
|
E.
|
the diagnosis is hearsay |
|
F.
|
the diagnosis is histological |
|
G.
|
none of
the above |
Question 8. Choose the best option from the option list for the
definition of placenta accreta.
|
A.
|
Placenta which is difficult to remove, but
can be separated digitally |
|
B.
|
Placental villi invade the decidua, but not
the myometrium |
|
C.
|
Placental villi attach to the superficial
myometrium but do not invade deeper |
|
D.
|
Placental villi attach to the superficial
myometrium, do not invade deeper and there is no decidua between the villi
and myometrium |
|
E.
|
Placental villi invade the decidua,
myometrium and serosa |
|
F.
|
Placental villi invade adjacent organs, e.g.
the bladder |
Question 9.
Choose the
best option from the option list for the definition of placenta increta.
|
A.
|
Placenta is difficult to remove, but can be
separated digitally |
|
B.
|
Placental villi invade the decidua, but not
the myometrium |
|
C.
|
Placental villi invade the myometrium but
not the serosa |
|
D.
|
Placental villi invade the decidua,
myometrium and serosa |
|
E.
|
Placental villi invade adjacent organs, e.g.
the bladder |
Question 10.
Choose the
best option from the option list for the definition of placenta percreta.
|
A.
|
Placenta which is difficult to remove, but
can be separated digitally |
|
B.
|
Placental villi invade the myometrium and
reach the serosa |
|
C.
|
Placental villi invade the myometrium and
serosa |
|
D.
|
Placental villi invade the myometrium the
serosa and may invade adjacent organs, e.g. the bladder |
|
E.
|
Placental villi invade adjacent organs, e.g.
the bladder |
Question 11.
What is the
approximate incidence of placenta creta in the UK?
|
A.
|
1-2 per
1,000 deliveries |
|
B.
|
1-2 per
1,000 maternities |
|
C.
|
1-2 per
5,000 deliveries |
|
D.
|
1-2 per
5,000 maternities |
|
E.
|
1-2 per 10,000 deliveries |
|
F.
|
1-2 per 10,000 maternities |
Question 12.
You need to
be able to define “maternity”. What is a “maternity”?
|
A.
|
Any pregnancy, including ectopic pregnancy
and miscarriage |
|
B.
|
Any pregnancy, excluding termination of pregnancy |
|
C.
|
Any pregnancy resulting in a live birth |
|
D.
|
Any pregnancy resulting in live birth or stillbirth |
|
E.
|
Any pregnancy ending from 24 completed weeks
plus any resulting in a live birth. |
Question 13.
Why is the
term “maternity” important?
|
A.
|
We should take best possible care of our
pregnant patients |
|
B.
|
It is used as the denominator in
calculations of the maternal mortality rate |
|
C.
|
It is used as the numerator in calculations
of the maternal mortality rate |
|
D.
|
It is used as the denominator in
calculations of the maternal mortality ratio |
|
E.
|
It is used as the numerator in calculations
of the maternal mortality ratio |
Question 14.
This question relates to risk factors for placenta accreta.
Match each of the risk
factors listed
below with an adjusted odds ratio from the Option List. Each option can be used
once, more than once or not at all. Note that some of the adjusted odds ratios
show a reduced risk.
Risk factors and adjusted odds
ratio.
|
Risk factor |
Adjusted odds ratio |
|
BMI > 30 |
|
|
Cigarette smoking in pregnancy |
|
|
Ethnic group non-white |
|
|
IVF pregnancy |
|
|
Maternal age > 35 |
|
|
Parity ≥ 2 |
|
|
PIH or PET |
|
|
Placenta previa diagnosed pre-delivery |
|
|
Previous Caesarean section > 1 |
|
|
Previous Caesarean section x 1 |
|
|
Previous uterine surgery – not C. section |
|
Option
List
|
Adjusted odds ratio |
|
0.53 |
|
0.57 |
|
0.66 |
|
0.9 |
|
1.0 |
|
2.0 |
|
3.06 |
|
3.4 |
|
3.48 |
|
10 |
|
14 |
|
16.31 |
|
32.13 |
|
65.02 |
|
102 |
Question 15.
Placental
‘migration’ is known to occur in a proportion of cases where the placenta is
low-lying, resulting in a normally-sited placenta. Which,
if any, of the following statements are true?
Question 16.
What is the
explanation for the apparent placental ‘migration’ that leads to the
resolution of
low-lying placenta in some cases?
|
A.
|
development
of the lower segment |
|
B.
|
development
of the upper segment |
|
C.
|
gravity |
|
D. |
↑ liquor
volume |
|
E. |
↑ ratio
of placental: uterine volume |
|
F. |
↑ ratio
of placental: decidual surface area |
|
G. |
↑ ultrasound
sensitivity in the 3rd. trimester |
|
H. |
none of
the above |
Question 17.
Which, if
any, of the following ultrasound features are markers for risk of PAS?
Question 18.
Why on earth
was the lower segment C section developed when section through the
body of the
uterus gives better access and keeps away from the ureters and bladder? You
might ask why I have included this in an answer or placenta creta and you would
have good justification as it has nothing to do with the subject.
Question 19.
Which, if any
of the following statements about MRI is true in relation to PAS?
|
A. |
MRI is superior to US in the diagnosis of PAS |
|
B. |
gadolinium increases the sensitivity and specificity of MRI and
is particularly recommended when increta and percreta are suspected |
|
C. |
MRI may be particularly helpful if the placenta is anterior |
|
D. |
MRI may be particularly helpful if the placenta is posterior |
|
E. |
dark intra-placental bands on T2-weighted scanning suggest PAS |
|
F. |
disruption of the utero-placental zone suggests PAS |
39. Cervical cancer staging.
Option list.
|
A |
Micro-invasive
cervical cancer. |
|
B |
Stage IA1 |
|
C |
Stage IA2 |
|
D |
Stage IA3 |
|
E |
Stage IB1 |
|
F |
Stage IB2 |
|
G |
Stage IB3 |
|
H |
Stage IIA |
|
I |
Stage IIB |
|
J |
Stage IIC |
|
K |
Stage IIIa |
|
L |
Stage IIIB |
|
M |
Stage IIIC |
|
N |
Stage IVA |
|
O |
Stage IVB |
|
P |
Stage IVC |
|
Q |
Stage VA |
|
R |
Stage VB |
|
S |
Stage VC |
|
T |
None of the
above. |
Scenario 1. A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 2 mm and 6 mm in width. The resection
margins are tumour-free. There is no evidence of spread outside the uterus. She
is nulliparous and wishes to retain her fertility.
Scenario 2. A
woman of 25 has a cone biopsy. The histology report shows squamous cell
carcinoma penetrating to a depth of 4 mm and 6 mm in width. The resection
margins are tumour-free. There is no evidence of spread outside the uterus. She
is nulliparous and wishes to retain her fertility.
Scenario 3. A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The
resection margins are not tumour-free. There is no evidence of spread outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 4. A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 6 mm and 3 cm in width. The
resection margins are tumour-free. There is no evidence of extension outside
the cervix. She is nulliparous and wishes to retain her fertility.
Scenario 5. A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 6 mm and 5 cm in width. The
resection margins are tumour-free. She is nulliparous and wishes to retain her
fertility.
Scenario 6. A woman of 38 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 4 mm and 6mm in width. The
resection margins are tumour-free. An MR scan shows involvement of the
lymphatic nodes in the left of the pelvis.
Scenario 7. A woman of 45 has carcinoma of the cervix. It extends into
the parametrium, but not to the pelvic sidewall. It involves the upper 1/3 of
the vagina. There is MRI evidence of para-aortic node involvement.
Scenario 8. A woman of 55 has carcinoma of the cervix. It extends to
the pelvic sidewall. It involves the upper 1/3 of the vagina. She has a
secondary on the end of her nose.
Scenario 9. A woman of 55 has carcinoma of the cervix. It involves the
bladder mucosa.
Scenario 10. A woman of 35 has a proven cancer of the cervix with
extension into the right parametrium, but not to the pelvic sidewall. Left
hydroureter and left non-functioning kidney are noted on IVP and there is no
other explanation for the findings. Cystoscopy shows bullous oedema of the
bladder mucosa.
Scenario 11. A woman of 25 has a cone biopsy. It shows malignant
melanoma. The lesion, which was not visible to the naked eye, invades to a
depth of 3 mm and is 5 mm in width. The margins of the biopsy are clear. There
is evidence of lymphatic vessel involvement. There is no evidence of spread
outside the uterus.
40. Headache .
|
1 |
abdominal migraine |
|
2 |
analgesia overuse, aka medication overuse |
|
3 |
bacterial meningitis |
|
4 |
benign intracranial hypertension |
|
5 |
BP check |
|
6 |
cerebral venous sinus thrombosis |
|
7 |
chest X-ray |
|
8 |
cluster |
|
9 |
severe PET / impending eclampsia |
|
10 |
malaria |
|
11 |
meningococcal meningitis |
|
12 |
methyldopa |
|
13 |
methysergide |
|
14 |
migraine |
|
15 |
MRI brain scan |
|
16 |
nifedipine |
|
17 |
nitrofurantoin |
|
18 |
pancreatitis |
|
19 |
sinusitis |
|
20 |
subdural haematoma |
|
21 |
subarachnoid haemorrhage |
|
22 |
tension |
|
23 |
ultrasound scan of the abdomen |
Scenario 1. A 405-year-old
para 3 is admitted at 38 weeks by ambulance with severe headache of sudden onset. She d6escribes it as “the worst I’ve ever
had”. Which diagnosis needs to be excluded urgently?
Scenario 2. A
32-year-old para 1 has recently experienced headaches. They are worse on exercise, even mild exercise such as walking
up stairs. She experiences photophobia with the headaches. Which is the most likely diagnosis?
Scenario 3. A woman
returns from a sub-Saharan area of Africa. She develops severe headache, fever and rigors. What diagnosis should particularly be
in the minds of the attending doctors?
Scenario 4. A woman at 37 weeks has s. They
particularly occur at night without obvious triggers. They occur every few days.
Scenario 5. A primigravida has had s on a regular
basis for many years. They occur most days, are bilateral and are worse when she
is stressed. What is the most likely diagnosis?
Scenario 6. A woman
complains of recent headaches at 36 weeks. The
history reveals that they started soon after she began treatment with a drug
prescribed by her GP. Which is the most likely of the following drugs to be the
culprit: methyldopa, methysergide, nifedipine or nitrofurantoin?
Scenario 7. A woman is
booked for Caesarean section and wishes regional anaesthesia. She had severe
headache due to dural tap after a previous Caesarean section. She wants to take
all possible steps to reduce the risk of having this again. Which of epidural /
spinal anaesthesia has the lower risk of causing dural tap?
Scenario 8. A
25-year-old primigravida attends for her 20-week scan and complains of headache
which started two weeks before. There is no significant history. The pain
occurs behind her right eye and she describes it as severe and “stabbing” in
nature. The pain is so severe that she cannot sit still and has to walk about. She
has noticed that her right eye becomes reddened and “watery” during the attack
and her nose is “runny”. The attacks have no obvious trigger and mostly occur a
few hours after she has gone to sleep. The usually last about 20 minutes. She
has no other symptoms. She smokes 20 cigarettes a day but does not take any
other drugs, legal or otherwise. What is the most likely diagnosis?
Scenario 9. A woman has
a 5-year history of unilateral, throbbing headache often preceded by nausea,
visual disturbances, photophobia and sensitivity to loud noise. What is the
most likely diagnosis?
Scenario 10. A primigravida is admitted at 38
weeks complaining of headache, abdominal pain and a sensation of flashing
lights. What would be the appropriate initial investigation?
Scenario 11. A woman with BMI of 35 attends for
her combined Downs syndrome screening test. She complains of pain behind her
eyes. The pain is worst last thing at night before she goes to sleep or if she
has to get up in the night. She has noticed she has noticed horizontal diplopia
on several occasions. She has no other symptoms. Examination shows
papilloedema.
Scenario 12. A grande multip of 40 years
experienced sudden-onset, severe headache, vomited several times and then
collapsed, all within the space of 30 minutes. She is admitted urgently in a
semi-comatose state. Examination shows neck-stiffness and left hemi-paresis.
Scenario 13. What did
the MMR include as “red flags” for headache in
pregnancy? These are not on the option list – you need to dig them out of your
head.
|
A |
asthma |
↔ |
↑ |
↓ |
|
B |
developmental
dysplasia of the hip in child |
↔ |
↑ |
↓ |
|
C |
diabetes |
↔ |
↑ |
↓ |
|
D |
Down’s
syndrome in child |
↔ |
↑ |
↓ |
|
E |
hypertension |
↔ |
↑ |
↓ |
|
F |
ischaemic
heart disease |
↔ |
↑ |
↓ |
|
G |
PET |
↔ |
↑ |
↓ |
|
H |
stroke |
↔ |
↑ |
↓ |
Scenario 15. Which
of the following drugs is contraindicated in the prophylaxis of migraine in pregnancy?
|
A |
amitriptyline |
|
B |
ß-blockers |
|
C |
ergotamine |
|
D |
low-dose
aspirin |
|
E |
pizotifen |
|
F |
pregabalin |
|
G |
tricyclic
antidepressants |
|
H |
verapamil |
Scenario 16. Which, if any, of the following
statements is true about posterior reversible
encephalopathy syndrome. This is not a true
EMQ as there may be > 1 true answer.
Option list.
|
A |
‘thunderclap’
headache is typical |
|
B |
‘handclap’
headache is typical |
|
C |
classically
occurs in the early puerperium and is recurrent |
|
D |
classically
occurs in the early puerperium and is not recurrent |
|
E |
arterial
beading is typically seen on MRI |
|
F |
arterial
beating is typically seen on MRI |
|
G |
arterial
bleeding is typically seen on MRI |
|
H |
venous
beading is typically seen on MRI |
|
I |
venous
beating is typically seen on MRI |
|
J |
venous
bleeding is typically seen on MRI |
|
K |
diagnosis
requires lumbar puncture and evidence of ↑
CSF pressure |
|
L |
treatment
is with nimodipine |
Scenario 17. Which, if any, of the following
statements is true about reversible cerebral
vasoconstriction syndrome. This is not a true
EMQ as there may be > 1 true answer.
|
A |
‘thunderclap’
headache is typical |
|
B |
‘handclap’
headache is typical |
|
C |
classically
occurs in the early puerperium and is recurrent |
|
D |
classically
occurs in the early puerperium and is not recurrent |
|
E |
arterial
beading is typically seen on MRI |
|
F |
arterial
beating is typically seen on MRI |
|
G |
arterial
bleeding is typically seen on MRI |
|
H |
venous
beading is typically seen on MRI |
|
I |
venous
beating is typically seen on MRI |
|
J |
venous
bleeding is typically seen on MRI |
|
K |
diagnosis
requires lumbar puncture and evidence of ↑
CSF pressure |
|
L |
treatment
is with nimodipine |
Questions from
TOG article by Revell & Moorish. 2014. They are open
access.
Red flag features for headaches include:
1. headache that changes with posture True / False
2. associated vomiting True / False
3. occipital location True / False
4. associated visual disturbance. True / False
Migraine is classically,
5. bilateral. True / False
6. pulsating. True / False
7. aggravated by physical exercise. True / False
With regard to migraine headaches in pregnancy,
8. there is an increase in the frequency of
attacks without aura. True / False
9. women who suffer from this have not been
shown to have an increase in the risk of pre-eclampsia. True / False
10. the 5HT1-receptor sumatriptan has been shown
to be teratogenic. True / False
11. women presenting with an aura for the first
time are not at an increased risk of intracranial disease. True / False
Posterior reversible encephalopathy syndrome,
12. is associated with an impairment of the
autoregulatory mechanism which maintains constant cerebral blood flow where
there are blood pressure fluctuations. True / False
13. when it is associated with pre-eclampsia,
management should follow the pathway for managing severe pre-eclampsia. True / False
With regard to cerebral venous thrombosis,
14. the incidence in western countries in
pregnancy ranges from 1 in 2500 deliveries to 1 in 10 000 deliveries. True / False
15. the greatest risk in pregnancy is mainly in
the last four weeks. True / False
16. the most common site is the sagittal sinus. True / False
17. a plain computed tomography is a highly
sensitive investigation. True / False
18. T2-weighted magnetic resonance imaging has
been shown to have limited value in diagnosis.
True / False
19. the outcome is better when it is associated
with pregnancy and the puerperium compared to that occurring outside pregnancy.
True / False
20. when it occurs in pregnancy, it is a
contraindication for future pregnancies. True / False
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