Contact us.
24 August 2015.
48
|
EMQ.
Endometrial cancer & FIGO
|
49
|
SBA.
Needle-stick & related injuries
|
50
|
EMQ.
Turner’s syndrome.
|
51
|
EMQ.
Drugs in pregnancy. 1
|
52
|
EMQ.
Drugs in pregnancy. 2
|
48. EMQ. Endometrial cancer & FIGO
Lead-in.
The
following scenarios relate to endometrial cancer.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Option list.
Scenario 1.
A histology report on endometrial curetting is of 95% adenocarcinoma
with 5% solid, non-squamous areas. What is the FIGO grade?
Scenario 2.
A histology report on endometrial curetting is of 90% adenocarcinoma
with 10% solid, non-squamous areas. What is the FIGO grade?
Scenario 3.
A histology report on endometrial curetting is of 50% adenocarcinoma
with 50% solid, non-squamous areas. What is the FIGO grade?
Scenario 4.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 5% myometrial invasion. What
is the FIGO staging?
Answer.
Scenario 5.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 25% myometrial invasion. What
is the FIGO staging?
Scenario 6.
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the body of the uterus with 60% myometrial invasion. What
is the FIGO staging?
Scenario 7
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the uterus. There is no myometrial invasion, but there is
extension to the endocervical endothelium. What is the FIGO staging?
Scenario 8
A
woman undergoes surgery for carcinoma of the endometrium. Histology shows the
tumour is confined to the uterus. There is no myometrial invasion, but there is
extension to the stroma of the cervix. What is the FIGO staging?
Scenario 9
A
woman undergoes surgery for carcinoma of the endometrium. Peritoneal washings
are +ve but there is no other evidence of spread outside the uterus. There is
no myometrial invasion. There is extension to the stroma of the cervix. What is
the FIGO staging?
Scenario 10
A
woman undergoes surgery for carcinoma of the endometrium. There is no evidence
of extension outside the uterus. There is myometrial invasion through to and
including the serosa. What is the FIGO staging?
Scenario 11
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. There is no evidence of disease
elsewhere. What is the FIGO staging?
Scenario 12
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. Positive pelvic nodes are found, but
no other lymphatic involvement. There is no distant spread. What is the FIGO staging?
Scenario 13
A
woman undergoes surgery for carcinoma of the endometrium. There is myometrial
invasion. Tumour is noted in the vagina. The tumour involves the mucosa of the
bladder. There is no lymphatic or distant spread. What is the FIGO staging?
49. SBA. Needle-stick & related injuries
Background.
I am told
that there have been MRCOG questions on this topic. I could not find a really
helpful source of information until the excellent article mentioned below
appeared in the BMJ. The authors are Anna Riddell, SpR in infectious diseases
and virology, Ioana Kennedy, Consultant occupational health physician and C Y.
William Tong, Consultant virologist, exactly the kind of mix you would want to
get a good exposition of the topic.
Abbreviations.
CMV: cytomegalovirus
GBCV: GB virus C
HAV: hepatitis A virus
HBV: hepatitis B virus
HCV: hepatitis C virus
HDV: hepatitis
D virus
SOE: significant occupational exposure to
blood-borne infective agent. This includes exposure to potentially infected
body fluids from injuries from “sharps” and splash events and bites, which, I
hope are rare!.
VL: viral load.
Question 1.
Lead-in
Approximately
how many SOEs are reported annually in the UK?
Option List
A.
|
~ 100
|
B.
|
~ 250
|
C.
|
~ 500
|
D.
|
~ 1,000
|
E.
|
~ 5,000
|
Question 2.
Lead-in
Who was Ignac
Phillip Semmelweis?
Option List
A.
|
the
person credited with demonstrating the infective nature of puerperal sepsis
|
B.
|
the horticularist who first grew the white flower
subsequently popularised in the musical, “The sound of music”, naming it
after his first wife, Eidel.
|
C.
|
the person who first used antisepsis in aerosol form to
reduce the risk of infection during C
section.
|
D.
|
the inventor of catgut sutures
|
E.
|
the inventor of the Dalkon shield
|
Question 3.
Lead-in
Why does
the name of Semmelweis’s colleague Kotecha live on in medical history?
Option List
A.
|
he was
the first doctor to perform hysterectomy
|
B.
|
he was the first doctor know to undergo transgender
surgery
|
C.
|
he died of infection akin to puerperal sepsis after a
SOE
|
D.
|
he performed the first successful repair of a 3rd.
degree perineal tear
|
E.
|
none of the above
|
Question 4.
Lead-in
Which of
the following have been described as causing infection after a SOE.
Infective agents
1.
|
hepatitis
A virus
|
2.
|
hepatitis
B virus
|
3.
|
hepatitis C virus
|
4.
|
human T cell leukaemia virus
|
5.
|
malaria parasites
|
Option List
A.
|
1 + 2 + 3 + 4 + 5
|
B.
|
1 + 2 + 3 + 5
|
C.
|
2 + 3 + 4 + 5
|
D.
|
2 + 3 + 4
|
E.
|
2 + 3 + 5
|
Question 5.
Lead-in
Which are
the main causes of infection to cause concern in the UK in relation to SOEs?
Infective agents.
1.
|
hepatitis A virus
|
2.
|
hepatitis B virus
|
3.
|
hepatitis C virus
|
4.
|
HIV
|
5.
|
treponema pallidum
|
Option List
A.
|
1 + 2 + 3 + 4 + 5
|
B.
|
1 + 2 + 3 + 4
|
C.
|
1 + 2 + 3 + 5
|
D.
|
2 + 3 + 4 + 5
|
E.
|
2 + 3 + 4
|
Question 6.
Lead-in
Which
group features most in the list of those reporting SOEs?
Option List
A.
|
doctors
|
B.
|
midwives
|
C.
|
phlebotomists
|
D.
|
nurses
|
E.
|
other healthcare workers.
|
Question 7.
Lead-in
Which
clinical activity generates most SOEs?
Option List
A.
|
acupuncture
|
B.
|
assisting in the operating theatre
|
C.
|
intramuscular drug / vaccine injection
|
D.
|
subcutaneous drug / vaccine injection
|
E.
|
venepuncture
|
Question 8.
Lead-in
Approximately
how many cases of HIV seroconversion after SOE were recorded in the UK between
2004 and 2013?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 9.
Lead-in
Rate the
following body fluids as: high or low risk in relation to infectivity.
Option List
A.
|
amniotic
fluid
|
B.
|
blood
|
C.
|
breast milk
|
D.
|
cerebro-spinal fluid
|
E.
|
faeces
|
F.
|
peritoneal fluid
|
G.
|
saliva
|
H.
|
urine
|
I.
|
urine – blood stained
|
J.
|
vaginal fluid
|
K.
|
vomit
|
Question 10 .
Lead-in
Rate the
following types of contact with body fluids as:
high-risk
low-risk
minimal or zero risk
Option List
A.
|
exposure to faeces: not bloodstained
|
B.
|
exposure to saliva: not bloodstained
|
C.
|
exposure to urine: not bloodstained
|
D.
|
exposure to vomit: not bloodstained
|
E.
|
exposure via broken skin
|
F.
|
exposure via intact skin
|
G.
|
injury deep, percutaneous
|
H.
|
exposure via mucosa
|
I.
|
injury superficial
|
J.
|
needle not used on source’s blood vessels
|
K.
|
needle used on source’s blood vessels
|
L.
|
sharps old
|
M.
|
sharps recently used
|
N.
|
sharps with blood not visible
|
O.
|
sharps with blood visible sharps
|
Question 11.
Lead-in
Rate the
following types of sources of potentially infective body fluids as:
high-risk
low-risk
minimal or
zero risk
Option List
A.
|
infected but VL and treatment details unknown
|
B.
|
recent blood test negative for all relevant viruses
|
C.
|
source has known risk factors but recent tests negative
|
D.
|
viral status not known but source has known risk
factors
|
E.
|
viral status not known but source has no known risk
factors
|
F.
|
VL detectable
|
G.
|
VL not detectable
|
H.
|
VL unknown but on treatment with good adherence
|
Question 12.
Lead-in
Approximately
how many cases of HBV seroconversion after SOE have been recorded in the UK
since 1997?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 13.
Lead-in
Approximately
how many cases of HCV seroconversion after SOE have been recorded in the UK
since 1997?
Option List
A.
|
0
|
B.
|
1
|
C.
|
20
|
D.
|
100
|
E.
|
500
|
Question 14.
Lead-in
What is
the usually quoted figure for the risk of transmission of HAV in cases of SOE.
Option list.
A.
|
1 in 100
|
B.
|
1 in 50
|
C.
|
1 in 33.3
|
D.
|
1 in 10
|
E.
|
1 in 2
|
F.
|
none of the above
|
Question 15.
Lead-in
What is
the usually quoted figure for the risk of transmission of HBV in cases of SOE.
Option list.
A.
|
1 in 100
|
B.
|
1 in 50
|
C.
|
1 in 33.3
|
D.
|
1 in 10
|
E.
|
1 in 2
|
Question 16.
Lead-in
What is
the usually quoted figure for the risk of transmission of HCV in cases of SOE.
Option list.
A.
|
1 in 100
|
B.
|
1 in 50
|
C.
|
1 in 33.3
|
D.
|
1 in 10
|
E.
|
1 in 2
|
Question 17.
Lead-in
What is
the usually quoted figure for the risk of transmission of HIV in cases of SOE.
Option list.
A.
|
1 in 100
|
B.
|
1 in 50
|
C.
|
1 in 33.3
|
D.
|
1 in 10
|
E.
|
1 in 2
|
Question 18.
Lead-in
What is
the estimated risk of transmission of infection of HBV in an SOE involving
sharps in a patient +ve for HBe antigen?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 19.
Lead-in
What is
the estimated risk of transmission of infection of HCV in an SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 20.
Lead-in
What is
the estimated risk of transmission of infection of HIV in an SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 21.
Lead-in
What is
the estimated risk of transmission of infection of HIV in an SOE involving
mucosal splashing?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 22.
Lead-in
Which of
the following carries the highest risk of transmission of an infective agent
after a SOE.
Option List
A.
|
a bite
on the bottom by an HIV-infected patient who finds your buttocks irresistible
|
B.
|
deep injury from a scalpel wielded by a psychopathic
surgeon
|
C.
|
deep
needle-stick after venepuncture
|
D.
|
spitting by a patient with HIV
|
E.
|
splash SOE from beating a disagreeable patient round
the head with a frozen turkey because you are sick to death of their
whingeing and perennial misery
|
Question 23.
Lead-in
List the
steps you would take in relation to immediate first aid, including the things
that might be suggested but you know are contraindicated.
Question 24.
Lead-in
Which
tests should be performed on the source after obtaining consent?
List what
you think should be done.
Option List
A.
|
HBV
surface antigen
|
B.
|
HCV
antibody
|
C.
|
HCV RNA
|
D.
|
HIV
antigen and antibody (fourth generation HIV immunoassay)
|
E.
|
TTV
antibody
|
Question 25.
Lead-in
What consent is required from
the source individual?
Option List
A.
|
consent
to having the tests
|
B.
|
consent
to having the results given to the occupational health department
|
C.
|
consent
to having the results given to the person who sustained the SOE
|
D.
|
consent
to having the results given to the hospital’s legal team
|
E.
|
consent
to notifying the hospital staff if the results are +ve.
|
Question 26.
Lead-in
What tests
should be done on the person who has sustained the SOE and there is a
significant risk of infection?
Option List
A.
|
a
baseline sample should be taken and stored for possible future use
|
B.
|
HBV surface antibody
|
C.
|
HCV antibody
|
D.
|
HIV antigen and antibody
|
Question 27.
Lead-in
If there
is a significant risk of HIV transmission, which of the following statements
are correct in relation to when should PEP be given?
Option List
A.
|
before
the results of the tests done on the source are available
|
B.
|
after the results of the tests done on the source are
available
|
C.
|
as soon as is practical
|
D.
|
within 24 hours
|
E.
|
within 72 hours
|
Question 28.
Lead-in
What are
the recommended drugs for PEP in the UK?
Option List
A.
|
Kaletra (200 mg lopinavir and 50 mg ritonavir)
|
B.
|
Raltegravir
400 mg twice daily
|
C.
|
Rifampicin 450-600mg daily as a single dose
|
D.
|
Tenofovir
+ lamivudine or emtricitabine
|
E.
|
Truvada
(245 mg tenofovir disoproxil fumarate and 200 mg emtricitabine)
|
Question 29.
Lead-in
Which of
the following statements are correct in relation to PEP in early pregnancy
Option List
A.
|
PEP is
contraindicated until after 12 weeks
|
B.
|
PEP should be started as for the non-pregnant
|
C.
|
PEP should be started, but TOP should be offered
|
D.
|
PEP should be started, but not until the puerperium
|
Question 30.
Lead-in
Which of
the following statements is true in relation to reducing the risk of HCV
infection.
Option List
A.
|
HCV
vaccine is safe in pregnancy and should be offered immediately
|
B.
|
HCV vaccine is a live vaccine and contraindicated in
pregnancy
|
C.
|
acyclovir is an effective drug for prophylaxis
|
D.
|
there is no known effective prophylactic drug
|
E.
|
early treatment of HCV infection is effective, so SOE
staff should be closely followed up for evidence of infection.
|
50. EMQ. Turner’s syndrome.
This is supposed to be an EMQ, but some of the questions
are MCQs with “True” and “False” answers. But it includes everything I think
you might be asked about Turner’s.
Abbreviations.
DDH
|
developmental dysplasia of the hip
|
Option list 1.
1.
|
1 in 500
|
2.
|
1 in 1,000
|
3.
|
1 in 1,500
|
4.
|
1 in 2,000
|
5.
|
1 in 2,500
|
6.
|
1 in 3,000
|
7.
|
1 in 10,000
|
8.
|
1 in 50,000
|
Option list 2.
A.
|
0%
|
B.
|
0.1%
|
C.
|
1 %
|
D.
|
2%
|
E.
|
5%
|
F.
|
10%
|
G.
|
15%
|
H.
|
20%
|
I.
|
30%
|
J.
|
40%
|
K.
|
50%
|
L.
|
60%
|
M.
|
70%
|
N.
|
80%
|
O.
|
90%
|
P.
|
> 90%
|
Q.
|
Most common
|
R.
|
2nd. most common
|
S.
|
True
|
T.
|
False
|
U.
|
Answer not on this option list.
|
Questions.
Option list 1 is for question 2,
option list 2 is for all the others that are not True/False.
1. TS is due to 45XO. True
/False
2. What is the
incidence of TS?
3. The incidence
of TS rises with maternal age? . True
/False
4. Most cases of
TS are due to loss of a paternal chromosome. True /False
5. How common is monosomy X in TS?
6. How common is monosomy Y in TS?
7. What % of
miscarriages are due to TS?
8. What % of TS
pregnancies miscarry?
9. ↑ NT is a
feature of TS True
/False
10.↑ NT is more common in foetuses with congenital heart
disease True /False
11. Low birth weight is a
feature of TS. True
/False.
12. If TS is suspected, but the neonate’s karyotype from
blood testing is normal, the diagnosis is Noonan’s syndrome. True /False.
13. Neonates with TS are at normal risk of DDH. True
/False
14. Immune hydrops is more common in TS. True
/False
15. Cystic hygroma is more common in TS. True
/False
16. What is the approximate risk of malignancy if there
is XY mosaicism in TS?
17. How common is webbing of the neck in TS?
18. How common is a low occipital hairline in TS?
19. How common is congenital heart disease in TS?
20. Dissecting aortic aneurysm is more common in TS. True
/False
21. How common is lymphoedema in TS?
22. How common is kidney disease in TS?
23. Short stature in TS has been linked to the TS gene. True
/False
24. What % of adolescents with TS have scoliosis. .
25. Inverted nipples are more common in TS. True
/False
26. 1ry. amenorrhoea occurs in all cases. True
/False
27. Adrenarche occurs at a normal time. True /False
28. Cubitus valgus is more common in TS. True
/False
29. Cleft palate if a feature of TS. True
/False
30. Micrognathia is a feature of TS. True
/False
31. Abnormalities of teeth and nails are more common in
TS. True
/False
32. Otitis media is more common in TS. True
/False
33. Intelligence is usually
lower in TS, especially verbal skills. True /False
34. Women with TS have higher mortality rates than other
women. True
/False
35. Oestrogen should be started on diagnosis to promote
bone growth. True /False
36. Oestrogen-only HRT is
appropriate for bone protection. True /False
37. Women with TS have an ↑
risk of hypertension. True /False
38. Women with TS have an ↑ risk of coeliac disease. True /False
39. Women with TS have an
increased risk of Crohn’s disease and ulcerative colitis. True /False
40. Women with TS have an ↑ risk of diabetes True
/False
41. Women with TS have an ↑ risk of hyperthyroidism. True /False True
/False
42. Women with TS have an ↑
risk of deafness. . True /False
43. Women with TS have an ↑ risk of osteoporosis. True
/False
44. Women with TS have similar rates of red-green colour
blindness to men. True
/False
45. Women with TS have a normal incidence of ptosis. True
/False
46. Women with TS cannot have children. True
/False
47. The “short stature
homeobox” (SHOX) gene has been implicated in TS. True /False
51. EMQ.
Drugs in O&G 1.
Lead-in.
The
following scenarios relate to drugs & hypertension in pregnancy.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
ACE: angiotensin-converting enzyme.
ACEI: angiotensin-converting enzyme inhibitor.
ARA: angiotensin II receptor antagonist.
MAOI: monoaminoxidase inhibitor.
Option list.
A.
|
False.
|
B.
|
True.
|
C.
|
5
|
D.
|
10
|
E.
|
15
|
F.
|
18
|
G.
|
20
|
H.
|
24
|
I.
|
contraindicated in the months before pregnancy
|
J.
|
contraindicated in the 1st. trimester
|
K.
|
contraindicated in the 2nd. trimester
|
L.
|
contraindicated in the 3rd. trimester
|
M.
|
contraindicated in all trimesters
|
N.
|
not contraindicated in pregnancy
|
O.
|
contraindicated in breastfeeding
|
P.
|
not contraindicated in breastfeeding
|
Q.
|
an acute, severe illness like rheumatoid arthritis
|
R.
|
an acute, severe illness with encephalopathy and acute
fatty liver
|
S.
|
an acute, severe illness with gastro-intestinal tract
bleeding.
|
T.
|
Scenario 1.
When are ACE inhibitors contraindicated in pregnancy?
Scenario 2.
When are ARAs contraindicated in pregnancy?
Scenario 3.
Can St. John’s Wort (SJW) be used in pregnancy?
Scenario 4.
Methyl dopa is an acceptable option for the treatment of gestational
hypertension. True / False.
Scenario 5.
Spironolactone is contraindicated in pregnancy. True/False
Scenario 6.
Furosemide is an acceptable option in the management of gestational
hypertension. True / False.
Scenario 7.
When are thiazide diuretics contraindicated in pregnancy?
Scenario 8.
Salbutamol is contraindicated for the management of premature labour.
True / False.
Scenario 9.
Ergometrine is an integral part of active management of the 3rd.
stage. True / False.
Scenario 10.
When is aspirin contraindicated in pregnancy & the puerperium?
Scenario 11.
When are NSAID’s contraindicated in pregnancy and why?
Scenario 12.
Pethidine: adverse neonatal effects are most likely
if the drug is administered in the six hours before birth. True / False.
Scenario 13.
Pethidine: what is the half-life in the mature
neonate?
Scenario 14.
Pethidine: is contraindicated in those taking MOAIs
or who have taken them in the previous 2 months.
Scenario 15.
Pethidine: is relatively contra-indicated when there is significant
blood loss.
Scenario 16.
Pethidine: has greater
analgesic effect in labour than Diamorphine.
Scenario 17.
What is Reye’s syndrome?
52. EMQ. Drugs in Pregnancy. 2
Lead-in.
The
following scenarios relate to some common drugs used in pregnancy.
Pick
one option from the option list. Each option can be used once, more than once
or not at all.
Abbreviations.
NSAID. non-steroidal anti-inflammatory drug.
Option list.
I have not given one to make you think! And, in the exam, you should be
deciding your answer before you check the option list.
Scenario 1.
What is the generic name for Prostin?
Scenario 2.
What kind of drug is Prostin?
Scenario 3.
What is the generic name for Misoprostol?
Scenario 4.
What
kind of drug is Misoprostol?
Scenario 5.
What
is the generic name for Gemeprost?
Scenario 6.
What kind of drug is Gemeprost?
Scenario 7
What is the generic name for Mifepristone?
Scenario 8
What king of drug is Mifepristone?
Scenario 9
What are the constituents of a 1 ml. ampoule of Syntometrine?
Scenario 10
What
is the generic name for Carbetocin?
Scenario 11
What kind of drug is Carbetocin?
Scenario 12
What is the generic name for Hemabate?
Scenario 13
What kind of drug is Hemabate?
Scenario 14
What is the generic name for Atosiban?
Scenario 15
What kind of drug is atosiban?
Scenario 16
What
if the generic name for Cervagem?
Scenario 17
What
kind of drug is Cervagem?
Scenarion 18
What
is the cost of 1mg. of Prostin E2 gel and what are its storage requirements?
Scenarion 19
What
is the cost of a 1mg. Gemeprost pessary and what are its storage requirements?
Scenarion 20
What
is the cost of 200 mcg. of misoprostol and what are its storage requirements?
No comments:
Post a Comment