2 December 2024.
Specialist talks which can be downloaded from
Dropbox.
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 |
Programme 5 December 2024.
29 |
EMQ.
Gestational trophoblastic disease |
30 |
SBA. Lynch syndrome |
31 |
MCQ5.6&46. Ergot
and ergometrine |
32 |
MCQ7.23. Folic acid fortification of flour |
33 |
EMQ. Folic acid fortification of flour |
34 |
EMQ. The MAGPIE trial |
35 |
29. Gestational Trophoblastic Disease
(GTD).
CHM: complete hydatidiform mole.
GI: gastro-intestinal.
GTD: gestational trophoblastic disease.
GTDTC: gestational trophoblastic disease
treatment centre.
GTN: Gestational trophoblastic
neoplasia.
HM: hydatidiform mole.
PHM: partial hydatidiform mole.
POC: products of conception.
PSTT: placental site trophoblastic tumour.
Option list.
A |
100%. |
B |
20%. |
C |
15%. |
D |
10%. |
E |
5%. |
F |
2.5%. |
G |
1.5%. |
H |
0.5%. |
I |
1 in 35. |
J |
1 in 55. |
K |
1 in 65. |
L |
1 in 700. |
M |
1 in 1,000. |
N |
Ö64. |
O |
pr2. |
P |
increased. |
Q |
reduced. |
R |
increased by a
factor of 2. |
S |
increased by a
factor of 5. |
T |
increased by a
factor of 10. |
U |
increased by a
factor of 20. |
V |
increased by a
factor of 30. |
W |
increased by a
factor of > 100. |
X |
hydatidiform
mole, both partial and complete. |
Y |
hydatidiform
mole, both partial and complete and placental site tumour. |
Z |
partial mole,
complete mole, invasive and metastatic mole, choriocarcinoma, placental site
trophoblastic tumour and epithelioid trophoblastic tumour. |
AA |
choriocarcinoma
invasive and metastatic mole and epithelioid trophoblastic tumour. |
BB |
true |
CC |
false |
DD |
none of the
above. |
Scenario
1.
List the
conditions included in the term GTD. There is no option list, just make a list.
Scenario
2.
What is the difference between GTD and GTN?
Pick one option from the list below.
A |
GTD comprises
the non-malignant conditions, i.e. complete and partial moles. GTN comprises
the malignant conditions: invasive mole, choriocarcinoma and PSTT |
B |
GTD comprises
all the trophoblastic conditions; GTN comprises the malignant conditions |
C |
GTD comprises
all the trophoblastic conditions; GTN comprises persistent GTD |
D |
GTD comprises
all the trophoblastic conditions; GTN comprises malignant and potentially
malignant conditions, including atypical placental site nodules |
E |
none of the
above |
Scenario
3.
GTG38 mentions one
thing as the minimum standard of care. What is it?
There is not option list as that would make it too easy.
Scenario
4.
What is the
incidence of GTD in the UK?
Scenario
5.
Which , if any, of
the following are true of complete moles?
A |
are usually diploid and with all the chromosomal material
of paternal origin |
B |
are usually triploid, with 2 sets of paternal haploid
genes + 1 set of maternal haploid genes |
C |
are usually triploid, with 1 set of paternal haploid
genes + 2 sets of maternal haploid genes |
D |
are tetraploid or mosaics in up to 10% of cases |
E |
up to 80% are due to duplication of a single sperm in an
egg devoid of maternal chromosomes |
F |
up to 80% are due to duplication of a single sperm in a
normal egg |
G |
usually result from dispermic fertilisation of a normal
egg |
H |
usually result from dispermic fertilisation of an egg
devoid of maternal chromosomes |
I |
usually has 46XX makeup |
J |
usually has 46XY makeup |
K |
the presence of fetal red blood cells defines a mole as
partial |
L |
mitochondrial DNA is maternal |
M |
mitochondrial DNA is paternal |
Scenario
6.
Which, if any, of
the following are true of partial moles?
A |
are usually diploid and with paternal chromosomal
material |
B |
are usually triploid, with 2 sets of paternal haploid
genes + 1 set of maternal haploid genes |
C |
are usually triploid, with 1 set of paternal haploid
genes + 2 sets of maternal haploid genes |
D |
are tetraploid or mosaics in up to 10% of cases |
E |
up to 80% are due to duplication of a single sperm in an
egg devoid of maternal chromosomes |
F |
up to 80% are due to duplication of a single sperm in a
normal egg |
G |
usually result from dispermic fertilisation of a normal
egg |
H |
usually result from dispermic fertilisation of an egg
devoid of maternal chromosomes |
I |
usually has 46XX makeup |
J |
usually has 46XY makeup |
K |
the presence of fetal red blood cells defines a mole as
partial |
L |
mitochondrial DNA is maternal |
M |
mitochondrial DNA is paternal |
Scenario
7.
What is the ratio
of complete: partial moles?
Scenario
8.
What is the risk
of molar pregnancy at age < 15 compared to age 30?
Scenario 9.
What is the risk
of molar pregnancy at age > 45 compared to age 30?
Scenario
10. What is the risk of molar pregnancy in a pregnancy after a
complete mole?
A |
< 1% |
B |
1-2% |
C |
3-5% |
D |
6-10% |
E |
11-20% |
F |
> 20% |
Scenario
11. What is the risk of molar pregnancy in a pregnancy after a
partial mole?
Use the option list from the previous question.
Scenario
12. Which, if any, of the following are more common in
pregnancy after a molar
pregnancy? This is not a true EMQ as there may be > 1
correct answer.
A |
anaemia |
B |
eclampsia / severe PET |
C |
intrauterine growth retardation |
D |
miscarriage |
E |
premature labour |
F |
PPH |
G |
pulmonary embolism |
G |
none of the above |
Scenario
13. Which, if any, of the following statements about hCG are
true?
A |
is a glycoprotein |
B |
shares its α sub-unit with FSH, LH & TSH |
C |
shares its α sub-unit with FSH & LH but not TSH |
D |
shares its β sub-unit with FSH, LH & TSH |
E |
shares its β sub-unit with FSH & LH but not TSH |
F |
β-core exists as a sub-type of β-hCG |
G |
nicked free-β exists as a sub-type of β-hCG |
H |
c-terminal peptide exists as a sub-type of β-hCG |
I |
hCG β core fragment may lead to false –ve results with
urine pregnancy tests |
J |
heterophile antibodies may give false +ve hCG results |
K |
heterophile antibodies are not found in urine |
pregnancy ?
A |
definite
diagnosis is usually made by ultrasound |
B |
definitive
diagnosis requires a +ve test for P57KIP2 |
C |
definitive
diagnosis requires an hCG level > twice the median value for gestation |
D |
definite
diagnosis requires histological examination |
E |
none of the
above |
Scenario
15. Cystic
placental spaces in the placenta and a ratio of transverse to anterioposterior
measurements of
the gestation sac <1.5 are strongly suggestive of a partial mole. True /
False.
Scenario
16. When
should invasive karyotype testing be considered?
A |
twin pregnancy with complete mole and a normal twin |
B |
uncertainty whether this is a complete mole with a normal
twin or possible partial mole |
C |
partial molar pregnancy |
D |
suspected mesenchymal hyperplasia of the placenta |
E |
recurrent molar pregnancy |
F |
none of the above |
Scenario 17.
Which, if any, of
the following statements are true about twin pregnancy with a viable
pregnancy and a
CHM?
A |
the woman should
be referred to a feto-maternal specialist |
B |
the woman should
be referred to a GTDTC |
C |
fetal karyotyping
should be done |
D |
the rate of early
fetal loss is about 20% |
E |
the rate of
preterm birth is about 40% |
F |
the rate of
preeclampsia is 20% |
G |
the incidence of
GTN in doubled if the pregnancy goes beyond 24 weeks |
Scenario 18.
Which, if any, of
the following statements are true about preparation of the cervix
before evacuation
of molar pregnancy?
A |
medical
preparation is of proven efficacy in making suction evacuation easier |
B |
medical
preparation with prostaglandins ↑ trophoblastic embolisation |
C |
medical preparation with prostaglandins ↑ the risk of needing
chemotherapy |
D |
GTG 38 recommends
the use of laminaria tents |
E |
none of the above |
Scenario 19.
Which, if any, of
the following statements are true about evacuation of molar
pregnancies?
A |
medical
management is recommended for both CMs and PMs to ↓ the risk of bleeding |
B |
medical
management is recommended for both CMs and PMs to ↓ the risk of dissemination of trophoblastic tissue |
C |
medical
management is recommended for both CMs and PMs to ↓ the risk of uterine perforation |
D |
suction
evacuation is recommended for both CMs and PMs |
E |
suction
evacuation is recommended for CMs |
F |
suction
evacuation is recommended for PMs so long as fetal parts are not too big |
G |
mifepristone +
misoprostol treatment is an acceptable alternative to suction evacuation. |
H |
oxytocin
administration after suction evacuation is recommended to ↓ bleeding |
I |
none of the above |
Scenario
20. What is the management of suspected molar ectopic
pregnancy?
A |
usual management for ectopic pregnancy |
B |
usual management + any tissue obtained sent to GTDTC |
C |
methotrexate followed by usual surgical management |
D |
referral to GTDTC |
E |
none of the above. |
Scenario
21. What is the management of placental site trophoblastic
tumour?
A |
referral to GTDTC |
B |
referral to GTDTC, methotrexate and any tissue sent to
GTDTC |
C |
referral to GTDTC, hysterectomy and tissue sent to GTDTC |
D |
referral to and management by GTDTC |
E |
none of the above. |
Scenario
22. What is the management of epitheliod trophoblastic tumour?
Use the option list from
Scenario 21.
Scenario
23. What is the management of typical placental site nodule?
Use the option list from Scenario
21.
Scenario 24.
What is the
management of atypical placental site nodule?
Use the option list from
Scenario 21.
Scenario
25. Which, if any, of the following statements are true about
urinary hCG testing in
relation to avoiding failure to diagnose molar pregnancy?
A |
testing should be done 3 weeks after medical evacuation
of complete moles |
B |
testing should be done 3 weeks after surgical evacuation
of complete moles |
C |
testing should be done 3 weeks after medical evacuation
of partial moles |
D |
testing should be done 3 weeks after surgical evacuation
of complete moles |
E |
testing should be done 3 weeks after medical evacuation
of ‘failed’ pregnancy |
F |
testing should be done 3 weeks after surgical evacuation
of ‘failed’ pregnancy |
G |
testing should be done 3 weeks after medical evacuation
of ‘failed’ pregnancy, but only if POC have not been sent for histological
examination |
H |
testing should be done 3 weeks after surgical evacuation
of ‘failed’ pregnancy, but only if POC have not been sent for histological
examination |
I |
testing should be done 3 weeks after medical evacuation
of incomplete miscarriage |
J |
testing should be done 3 weeks after surgical evacuation
of incomplete miscarriage |
K |
testing should be done 3 weeks after medical evacuation
of incomplete miscarriage, but only if POC have not been sent for
histological examination |
L |
testing should be done 3 weeks after surgical evacuation
of incomplete miscarriage, but only if POC have not been sent for
histological examination |
M |
none of the above |
Scenario
26. Which, if any, of the following statements are true in
relation to histological
examination of POC after TOP?
A |
it should be done in all cases to exclude GTD |
B |
it should be done in all cases that have not had pre-op
ultrasound examination in case the pregnancy was an unsuspected ectopic.
Absence of trophoblastic tissue on histology will raise suspicion of the
diagnosis |
C |
it should be done in all cases where ultrasound has not
shown a viable pregnancy |
D |
it should be done in all cases where ultrasound has not
shown fetal parts. |
E |
none of the above |
Scenario
27. Which, if any, of the following statements are true in
relation to RhD and GTD?
A |
CHMs have no RhD |
B |
PHMs have no RhD |
C |
Anti-D should be withheld until histological results are
available |
D |
‘C’ is true, but only in relation to CMs |
E |
‘C’ is true, but only in relation to PMs |
F |
none of the above |
Scenario
28. Which, if any, of the following statements are true in
relation to GTN?
A |
always arises from molar pregnancy |
B |
may occur after normal pregnancy and livebirth |
C |
may arise as primary ovarian neoplasia |
D |
the incidence after complete molar pregnancy is greater
than after partial molar pregnancy |
E |
the incidence after livebirth is estimated at 1 in 50,000 |
Scenario
29. Which, if any, of the following statements are true in
relation to p57KIP2?
A |
it is a tumour suppressor gene, found in complete and
partial moles but not choriocarcinoma |
B |
takes us to the world of genomic imprinting |
C |
is an example of uniparental disomy |
D |
is a gene found in chromosomes of maternal origin, but
not paternal |
E |
is a gene found in chromosomes of paternal origin, but
not maternal |
F |
can help to distinguish complete and partial moles |
G |
none of the above |
Scenario
30. What
is the risk of persistent GTD after a complete mole?
Scenario
31. What
is the risk of requiring chemotherapy after a complete mole?
Scenario
32. What is the risk of persistent GTD after a partial mole?
Scenario
33. What is the risk of requiring chemotherapy after a partial
mole?
Scenario
34. What is the risk of requiring chemotherapy with hCG level
> 20,000 i.u. 4+1 weeks after
evacuation?
Scenario
35. What is the overall risk of requiring chemotherapy after
molar pregnancy in the UK?
Scenario
36. What is the risk of requiring chemotherapy in the USA
compared with the UK?
Scenario
37. Which, if any, of the following are grounds for offering
chemotherapy after
hydatidiform mole?
A |
hCG > 10,000
IU/L > 4 weeks after evacuation |
B |
hCG > 20,000
IU/L > 4 weeks after evacuation |
C |
↑ hCG in two consecutive serum
samples |
D |
hCG the same in
two consecutive samples |
E |
raised, but
falling, hCG level 3 months after
evacuation |
F |
persistent
bleeding 3 months after evacuation |
Scenario
38. What are the risk factors included in the FIGO scoring
system?
Scenario
39. Which, if any, of the following statements is true about
the recommended treatment
of low-risk GTN?
A |
low risk is defined as WHO score ≤ 5 |
B |
low risk is defined as WHO score ≤ 6 |
C |
low risk means that no treatment is necessary |
D |
treatment of low risk GTN is methotrexate |
E |
treatment of low risk GTN is folic acid |
F |
treatment of low risk GTN is folinic acid |
Scenario
40. Which, if any, of the following is the most common
side-effect of methotrexate?
A |
alopecia |
B |
anaemia |
C |
aphasia |
D |
nausea |
E |
myelosuppression |
F |
none of the above. |
Scenario
41. Which, if any, of the following statements are true about
the use of folic acid / folinic
acid in methotrexate
treatment regimens? There may be > 1 correct answer.
A |
folic acid must be converted to tetrahydrofolate to be
biologically active |
B |
folic acid must be converted to folinic acid to be
biologically active |
C |
dihydrofolate reductase converts folic acid to folinic
acid |
D |
dihydrofolate reductase converts folic acid to
tetrahydrofolate |
E |
dihydrofolate reductase converts folinic acid to
tetrahydrofolate |
F |
folinic acid is used in preference to folic acid as it
reaches higher levels in plasma |
G |
folate therapy is used to reduce GI tract damage from
methotrexate |
H |
folate therapy is used to reduce hepatic damage from
methotrexate |
I |
folate therapy is used to reduce neurological damage from
methotrexate |
J |
folate therapy is used to reduce renal damage from
methotrexate |
K |
none of the above. |
Scenario
42. When is repeat surgical evacuation of the
uterus appropriate?
Scenario 43.
Which, if any, of
the following statements are true about the recommended duration
of follow-up after
GTD? This is not a true EMQ as there may be > 1 correct answer.
A |
6 months from the
time the hCG falls to normal |
B |
6 months from the
date of evacuation of the GTD if the hCG falls to normal within 56 days |
C |
6 months from the
date of the hCG falling to normal if it does so within 56 days |
D |
6 months from the
date of evacuation of the GTD if the hCG falls to normal after 56 days |
E |
6 months from the
date of the hCG falling to normal if it does so after 56 days |
F |
56 days after the
first full moon after the evacuation of the GTD |
Scenario
44. What is the approximate cure rate for GTN with a FIGO risk
score ≤ 6?
A |
70% |
B |
80% |
C |
90% |
D |
95% |
E |
98% |
F |
100% |
Scenario
45. What is the approximate cure rate for GTN with a FIGO risk
score >7?
A |
70% |
B |
80% |
C |
90% |
D |
95% |
E |
98% |
F |
100% |
Scenario
46. When should the possibility of persistent GTD be
investigated after non-molar
pregnancy?
A |
if there is abnormal bleeding |
B |
if there is persistent abnormal bleeding |
C |
if there is cough |
D |
if there is new-onset dyspnoea |
E |
if there is pleurodynia |
Scenario
47. A woman wishes to become pregnant after a pregnancy with
GTD. Which, if any, of
the following statements are true about the advice she
should be given about an appropriate inter-pregnancy interval?
A |
not before follow-up is complete |
B |
not for at least 3/12 after completion of follow-up |
C |
not for at least 6/12 after completion of follow-up |
D |
not for at least 12/12 after completion of follow-up |
E |
she should be advised not to become pregnant if
chemotherapy was needed |
F |
not for at least 6 months after completion of follow-up
if chemotherapy was needed |
G |
none of the above |
Scenario
48. Which of the following statements are true about combined
hormonal contraception
use after GTD?
A |
it may increase the risk of GTN if used before hCG levels
have returned to normal |
B |
is not associated with additional risk |
C |
intra-uterine contraceptives are preferable |
Scenario
49. Which, if any, of the following statements are true about
the long-term issues for
women who have needed chemotherapy for GTN?
A |
the menopause is likely to be earlier |
B |
the risk of other cancers is not increased |
C |
there is evidence of ↑ risk of breast cancer |
D |
there is evidence of ↑ risk of colon cancer |
E |
there is evidence of ↑ risk of myeloid leukaemia |
F |
there is evidence of ↑ risk of melanoma |
H |
there is no evidence of addition risk with HRT |
Scenario
50. A
woman had a complete mole in her first pregnancy. She is pregnant for the
second
time. What is the risk of another molar
pregnancy?
Scenario
51. A
woman has had two molar pregnancies. What is the risk of molar pregnancy if she
becomes pregnant
again?
Scenario
52.
A woman has had three molar pregnancies.
What is the risk of molar pregnancy if
she becomes
pregnant again?
Scenario
53. Which,
if any, of the following statements are correct in relation to recurrence of
molar pregnancy?
A |
the
histological type is likely to be the same |
B |
the
histological type in recurrent mole after a complete mole is likely to be
partial mole |
C |
the
histological type in recurrent mole after a partial mole is likely to be
complete mole |
D |
the histological
type after PSTT is likely to be choriocarcinoma |
E |
none of the
above |
Scenario
54. A
woman has a normal pregnancy after treatment for hydatidiform mole. Which, if
any, of the
following statements are true about the need for hCG testing 6 weeks after the
pregnancy?
A |
testing is
optional |
B |
testing is
only needed for women with persisting GTD |
C |
testing is
only needed for women with persisting GTN |
D |
testing is
only needed for women who have needed chemotherapy |
E |
testing should
be offered to all women who use hair dye |
Scenario
55. What
proportion of women remain fertile after treatment for GTN?
A |
80% |
B |
70% |
C |
60% |
D |
50% |
E |
40% |
Scenario
56. What
proportion of women will reach the menopause by age 40 after chemotherapy
for GTN?
A |
10% |
B |
20% |
C |
30% |
D |
40% |
E |
50% |
FSRHCAP has a SBA. It
is open access, so reproduced here. It is badly-worded, mistaking GTD for GTN,
but highlights some of the key points.
With
gestational trophoblastic disease (GTD), which statement is false?
A. After complete
hydatidiform mole, 15–20% women develop GTD needing chemotherapy
B. After partial
hydatidiform mole, 30–35% women develop GTD needing chemotherapy
C. Intrauterine
contraception is unsuitable while human chorionic gonadotropin is still
detectable
D. Combined hormonal
contraception can be used if gestational trophoblastic neoplasia develops
Answer. GTG38 says
the risk of GTN requiring chemotherapy is about 13–16% for CHM and 0.5–1.0% for
PHM, so both A & B are false, but B more so than A.
TOG has some questions from Savage and 2008. Volume 10. 1.
Molar pregnancy With regard to molar pregnancy,
1. it arises from a genetic
error occurring at or before the time of fertilisation. T F
2. the risk is highest in
teenage mothers. T F
3. the risk of malignant
change, if partial, is 10 times less than if complete. T F
4. the longer the interval
between diagnosis of molar pregnancy and initiation of chemotherapy, the poorer
the prognosis. T F
5. repeated uterine evacuation
is recommended where serum human chorionic gonadotrophin (hCG) levels are 5000
iu/l. T F
6. methotrexate/folinic acid
chemotherapy is effective treatment in the majority of cases of persistent
trophoblast disease following molar pregnancy. T F
7. 24-hour advice on treatment
of women overseas is available in specialist treatment centres in the UK. T F
In women with
complete molar pregnancy,
8. there are 69 chromosomes
present in the conception. T F
9. the diagnostic clinical
features are bleeding, excessive morning sickness, abdominal pain and a
large-for-dates uterus. T F
10. there is a 10–20% chance that
they will require further treatment with chemotherapy. T F
With regard to
the treatment of women with persistent trophoblast disease,
11. the initial investigations
carried out should include measurement of hCG levels to exclude a new
pregnancy. T F
12. initial pretreatment levels
of hCG help identify the need for a longer inpatient stay. T F
13. approximately 30% of women in
the low-risk group will require second-line chemotherapy. T F
14. treatment with single-agent
methotrexate increases the lifetime risk of myeloid leukaemia. T F
15. treatment of women in the
high-risk group with etoposide/methotrexate/dactinomycin, followed by
cyclophosphamide/vincristine, results in a cure rate of 90%. T F Which of the
following statements about chemotherapy for molar pregnancy are correct?
16. Approximately 5% of women
with persistent trophoblast disease following molar pregnancy fall in the
high-risk category for chemotherapy. T F
17. When women with high-risk
persistent trophoblast disease are treated with the combination of EMA/CO,
approximately a third of them will develop resistance. T F
18. Following successful
chemotherapy, the risk of relapse is approximately 3–5%. T F
19. In those developing relapse,
the cure rate varies between approximately 85–100%, depending on whether they
are high or low risk. T F
20. Chemotherapy for molar
pregnancy is associated with a 2.5-fold increase in the lifetime risk of
developing a second malignancy. T F
30. Lynch syndrome.
Abbreviations
CRC: colorectal
cancer.
EC: endometrial
cancer.
IBD: inflammatory
bowel disease: Crohn’s & ulcerative colitis.
IDDM: insulin-dependent
diabetes mellitus.
Ls: Lynch
syndrome.
MLH: mutL-homolog
family of DNA, mismatch repair genes.
MMR: mismatch
repair.
MSH: mutS
homolog family of DNA, mismatch repair genes.
Question 1.
What is Lynch syndrome?
Option List
A |
auto-immune
condition leading to reduced factor X levels in blood |
B |
hereditary condition which increases the risk of many
cancers, particularly breast |
C |
hereditary
condition which increases the risk of many cancers, particularly breast &
colorectal |
D |
hereditary
condition which increases the risk of many cancers, particularly colorectal
& endometrial |
E |
none of
the above |
Question 2.
How is Lynch syndrome inherited?
Option List
A |
it is an
autosomal dominant condition |
B |
it is an autosomal recessive condition |
C |
it is an X-linked dominant condition |
D |
it is an X-linked recessive condition |
E |
none of the above |
Question 3.
Which, if any, of the following genes can cause Lynch syndrome?
Option List
A |
MLH1 +
MLH2 + MOH1 |
B |
MLH1 + MLH2 + MSH1 |
C |
MLH1 + MLH2 + MSH6 |
D |
MLH1 + MSH2 + MSH6 + PMS2 |
E |
None of the above |
Question 4.
Mutations of which 2 of the following genes cause most cases of Lynch
syndrome?
Option List
A |
MLH1 +
MLH2 |
B |
MLH1 + MSH1 |
C |
MLH1 + MSH2 |
D |
MLH2 + MSH1 |
E |
MLH2 + MSH2 |
Question 5.
What is the approximate prevalence of Ls in the UK population?
Option List
A |
1 in 50 |
B |
1 in 100 |
C |
1 in
1,000 |
D |
3 in
1,000 |
E |
none of the above |
Question 6.
Approximately what % of individuals with Ls have had the diagnosis
established?
Option List
A |
< 5% |
B |
5 -10% |
C |
10-20% |
D |
20-30% |
E |
>30% |
Question 7.
Which, if any, of the following conditions are associated with an ↑
risk of Ls?
Option List
A |
acromegaly
+ Addison’s disease + coeliac disease + IBD + IDDM |
B |
acromegaly
+ disease + anosmia + coeliac disease + IBD |
C |
acromegaly
+ IBD + IDDM |
D |
acromegaly
+ IBD |
E |
Addison’s
disease + anosmia + coeliac disease + IBD + IDDM |
F |
acromegaly
+ Addison’s disease + anosmia + coeliac disease + IBD + IDDM |
G |
none of the above |
Question 8.
Which 2 cancers are most likely in women with Lynch syndrome?
Option List
A |
breast +
bowel |
B |
breast + pancreas |
C |
breast + endometrium |
D |
bowel + cervix |
E |
bowel + endometrium |
F |
bowel + ovary |
G |
bowel + pancreas |
H |
endometrium + ovary |
Question 9.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of colorectal cancer?
Option List
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
E |
none of the above |
Question 10.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of colorectal cancer?
Option List
A |
offer
screening to everyone, regardless of age and family history |
B |
offer screening to those aged < 50 years at diagnosis |
C |
offer screening to those aged < 60 years at
diagnosis |
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
E |
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative |
Question 11.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of thyroid cancer?
Option List
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
E |
none of the above |
Question 12.
What does NICE recommend in relation to screening for Lynch syndrome in
those
with a new
diagnosis of thyroid cancer?
Option List
A |
offer
screening to everyone, regardless of age and family history |
B |
offer screening to those aged < 50 years at
diagnosis |
C |
offer screening to those aged < 60 years at
diagnosis |
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
E |
none of the above |
Question 13.
What does NICE recommend about screening for Lynch syndrome for the
population
with no personal history of endometrial
cancer?
Option List
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
B |
offer screening to those aged < 60 years with ≥ 1 affected
1st.O relative |
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
E |
none of the above |
Question 14.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of endometrial cancer?
Option List
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
E |
none of the above |
Question 15.
What does NICE recommend about screening for Lynch syndrome for the
population
with no
personal history of colorectal cancer?
Option List
A |
offer screening to those aged < 50 years with ≥ 1 affected 1st.O
relative |
B |
offer screening to those aged < 60 years with ≥ 1
affected 1st.O relative |
C |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 50 years at diagnosis |
D |
offer screening to those with ≥ 1 affected 1st.O
relative aged < 60 years at diagnosis |
E |
none of the above |
Question 16.
What does NICE recommend in relation to screening for Lynch syndrome in
those with
a new
diagnosis of colorectal cancer?
Option List
A |
offer
screening to everyone, regardless of age and family history |
B |
offer screening to those aged < 50 years at
diagnosis |
C |
offer screening to those aged < 60 years at
diagnosis |
D |
offer screening to those aged < 50 years at
diagnosis with + ≥ 1 affected 1st.O relative |
E |
offer screening to those aged < 60 years at
diagnosis with + ≥ 1 affected 1st.O relative |
Question 17.
What relationship, if any, exists between Ls and acromegaly?
Option List
A |
the risk
of Ls is ↓
in those with acromegaly compared with the general population |
B |
the risk
of Ls is ↑
in those with acromegaly compared with the general population |
C |
the risk
of Ls is unchanged in those with acromegaly compared with the general
population |
D |
the risk
of Ls in unknown in those with acromegaly |
E |
|
Question 18.
What is the effect of aspirin consumption on the risk of EC and CRC?
Option List
A |
aspirin
reduces the risk of EC and CRC |
B |
aspirin
reduces the risk of EC but not CRC |
C |
aspirin
reduces the risk of CRC but not EC |
D |
aspirin
does not reduce the risk of EC or CRC |
E |
aspirin reduces the risk of EC and CRC, but the risks
outweigh the benefits |
Question 19.
A healthy woman of 35 years is diagnosed with Ls? What are the key
elements of the
National
Screening Programme for people with Ls?
There is
no option list – just write down everything you know.
Question
20. Which, if any, of the following were
recommendations made by Monahan et al, the 30
experts who wrote to the BMJ in 2017.
Option List
A |
creation of a national register of
people with Ls |
B |
creation of a
post of Consultant in Ls for each NHS Trust |
C |
creation of a
post of Clinical Champion for Ls in each NHS Region. |
D |
creation of a
post of Clinical Champion for Ls in the DOH. |
E |
none of the
above |
Question
21.
What research programme was established in 2024 in the hope of reducing
cancer incidence in those with L?
A |
LynchAspirin |
B |
LynchEndo |
C |
LynchGene |
D |
LynchMicrobiome |
E |
LynchVax |
F |
none of the above |
Question 22.
When was the UK Lynch syndrome national registry established?
A |
2000 |
B |
2006 |
C |
2012 |
D |
2028 |
E |
2022 |
F |
2024 |
CPD questions for TOG. 2021.Volume 23, Issue 1 has
the CPD questions linked to the Ryan article, but they are not yet open access,
so you will need to download them. I have prepared answers – try to answer them
before the tutorial.
31. Ergot and Ergometrine. MCQ paper 5 – available on Dropbox.
Q6. Ergometrine.
a. is given in a dosage of 5 mg.
in the active management of the third stage of labour.
b. is contra-indicated in cases
of significant hypertension.
c. may cause significant fluid
retention.
d. may cause nausea and
vomiting.
e. is contra-indicated in
patients with epilepsy.
f. causes strong rhythmic
uterine contractions.
Q46. Ergot & its alkaloids:
a. ergot is due to infection
with Claviceps purpurea.
b. ergot poisoning was
associated with rye bread.
c. Lonitzer wrote in 1582 of
the use of ergot to expedite childbirth.
d. ergotism may cause
hallucinations.
e. LSD is an ergot alkaloid.
f. bromocriptine is an ergot
alkaloid.
32. MCQ7.23. Folic
acid fortification of flour.
Abbreviations.
FFF: fortification of flour with folic acid.
NTD: neural tube defect.
23. Folic
acid & pregnancy.
a. the dosage for routine prophylaxis of
neural tube defect is 0.4 mg. daily.
b. the dosage for prophylaxis for patients
with spina bifida or who have had a pregnancy affected by neural tube defect is
5mg. daily.
c. folic acid reduces the risk of neural tube
defect by more than 70%.
d. folic acid and anti-epilepsy drugs may
interact adversely.
e. folic acid reduces the risk of placental
abruption.
f. folic acid can provoke sub-acute combined
degeneration of the cord.
g. fortification of flour with folic acid was
introduced in the USA in 1998.
h. fortification of flour with folic acid in
the USA has been linked to a 50% reduction in the incidence of neural tube
defects.
i. fortification of flour with folic acid was
introduced in the UK in 2005.
33. Folic
acid fortification of flour.
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?
34. MAGPIE Trial.
Question 1.
Which of the following is true of the Magpie
trial?
A |
it compared MgSO4 with placebo in
the management of eclampsia / severe PET |
B |
it compared MgSO4 with lytic
cocktail in the management of eclampsia / severe PET |
C |
it compared MgSO4 with phenytoin
in the management of eclampsia / severe PET |
D |
it compared MgSO4 with alcohol in
the management of threatened premature labour |
E |
it compared MgSO4 with atosiban
in the management of threatened premature labour |
F |
it compared MgSO4 with ritodrine
in the management of threatened premature labour |
G |
it compared MgSO4 with
dexamethasone in the prevention of cerebral palsy due to extreme prematurity |
H |
it compared MgSO4 with placebo in
the prevention of cerebral palsy due to extreme prematurity |
I |
none of the above |
Question 2.
Which if any of the following are true of the
Magpie trial?
A |
it
involved ~ 1,000 women |
B |
it
involved ~ 10,000 women |
C |
it
involved ~ 20,000 women |
C |
it involved
> 20,000 women |
D |
it
involved ~ 30 hospitals |
E |
it
involved ~ 50 hospitals |
F |
it
involved ~ 80 hospitals |
G |
it
involved > 150 hospitals |
H |
it
involved 5 countries |
I |
it
involved 10 countries |
J |
it
involved 20 countries |
K |
it
involved 30 countries |
L |
it
involved 50 countries |
M |
it
involved >50 countries |
Question 3.
Which if any of the following are true?
A |
almost
50% of the women were in Africa |
B |
almost
50% of the women were in America |
C |
almost
50% of the women were in Asia |
D |
almost
50% of the women were in Australia / New Zealand |
E |
almost
50% of the women were in Europe |
Question 4.
Which, if any, of the following is true of the
Magpie trial?
A |
cerebral
palsy rates at 2 years were ↓ by the use of MgSO4 in babies born
< 34 weeks |
B |
cerebral
palsy rates at 2 years were unchanged
by the use of MgSO4 in babies born < 34 week |
C |
eclampsia
rates were reduced by about half by the use of MgSO4 |
D |
eclampsia
rates were reduced by about half by the use of MgSO4 but only in
underdeveloped countries |
E |
maternal
mortality was significantly ↓ by the use of MgSO4 |
F |
maternal
mortality was significantly ↓ by the use of MgSO4, but only in
underdeveloped countries |
G |
premature
delivery was significantly ↓ by the use of MgSO4 |
H |
perinatal
mortality from prematurity was significantly ↓ by the use of MgSO4 |
35. Clue cells, koilocytes.
Abbreviations.
Ct: Chlamydia trachomatis
HSV: Herpes simplex virus
LGV: lymphogranuloma venereum
Ng: Neisseria gonorrhoeae
Tv: Trichomonas vaginalis
Option
list.
A |
Actinomyces |
B |
Bacterial vaginosis |
C |
Bacteroides |
D |
Chlamydia trachomatis |
E |
Chlamydial infection of the genital tract |
F |
Herpes Simplex |
G |
Human Papilloma Virus |
H |
Lymphogranuloma venereum |
I |
Monilia |
J |
Neisseria gonorrhoeae |
K |
Trichomonas vaginalis |
Scenario 1.
Which option or options best fit with “clue cells”
Scenario 2.
Which option or options best fit with “fishy
odour”?
Scenario 3.
Which option or options best fit with
“flagellate organisms”?
Scenario 4.
Which option or options best fit with
“inflammatory smear”?
Scenario 5.
Which option or options best fit with
“koilocytes”?
Scenario 6.
Which option or options best fit with
“non-specific urethritis (NSU) in the male”?
Scenario 7.
Which option or options best fit with
“strawberry cervix”?
Scenario 8.
Which option or options best fit with “thin
grey/ white discharge”?
Scenario 9.
Which option or options best fit with “white,
curdy discharge”?
Scenario 10.
Which option or options best fit with “frothy
yellow discharge”?
Scenario 11.
Which option or options best fit with
“protozoan”?
Scenario 12.
Which option or options best fit with “obligate intracellular
organism”?
Scenario 13.
Which option or options best fit with
“blindness”?
Scenario 14.
Which option or options best fit with “LGV”?
Scenario 15.
Which option or options best fit with
“multinucleated cells”?
Scenario 16.
Which option or options best fit with
“serotypes D–K”?
Scenario 17.
Which option or options best fit with
“serovars L1-L3”?
Scenario 18.
Which of the following are true in relation to
Amsel’s criteria?
A |
used for the diagnosis of bacterial vaginosis |
B |
used for the diagnosis of trichomonal infection |
C |
clue cells present on microscopy of wet preparation
of vaginal fluid |
D |
flagellate organism present on microscopic
examination of vaginal fluid |
E |
pH ≤ 4.5 |
F |
pH > 4.5 |
G |
thin, grey-white, homogeneous discharge present |
H |
frothy, yellow-green discharge present |
I |
fishy smell on adding alkali (10%KOH) |
J |
fishy smell on adding acid (10%HCl) |
K |
koilocytes present |
L |
absence of vulvo-vaginal irritation |
Scenario 19.
Which of the following are true in relation to
Nugent’s criteria?
A |
used for the diagnosis of bacterial vaginosis |
B |
used for the diagnosis of trichomonal infection |
C |
clue cells present on microscopy of wet preparation
of vaginal fluid |
D |
pH ≤ 4.5 |
E |
pH > 4.5 |
F |
count of lactobacilli |
G |
count of Gardnerella and Bacteroides |
H |
count of white cells |
Scenario 20.
Gardnerella vaginalis can be
cultured from the vagina of what % of normal women?
A |
< 10% |
B |
11 - 20% |
C |
21 - 30% |
D |
31 - 40% |
E |
41 - 50% |
F |
> 50% |