Tutorial 18th. February 2016

18 February 2016.

62	SBA. Caldicott
63	SBA. WHO criteria for screening programmes
64	SBA. Late fetal death reporting
65	SBA. Germ cell & sex cord tumours & substances secreted
66	SBA. TB & pregnancy
67	SBA. Vulval conditions.
68	SBA. Kisspeptin

62.         Caldicott Guardian.

Question 1.

Lead-in

Which, if any, of the following statements is true of the Caldicott Guardian?

Option List

A	it is a large lizard, unique to the Galapagos Islands
B	it is the local newspaper for the village of Caldicott
C	it is the Trust Board member responsible for complaint procedures
D	it is the person within a Trust responsible for patient confidentiality in relation to information
E	it is the person within a Trust responsible for dealing with bullying

Question 2.

Lead-in

The Caldicott Report identified 6 basic principles. What are they?

Option list.

There is none. Imagine that there is information about you stored on the computers of the local NHS Trust. What conditions would you want to lay down about sharing of that information within the Trust, with other NHS organisations and with non-NHS organisations?

Question 3.

Lead-in

The Caldicott Report made numerous recommendations. Which was particularly important for major NHS organisations such as Trusts?

Option List

A.	the need to appoint a Caldicott Guardian
B.	the need to create a Caldicott Register
C.	the need to create a Caldicott Police Department
D.	the need to create a link between the Caldicott Department and the DOH
E.	none of the above.

Question 4.

Lead-in

What is the definition of the key role deriving from the answer to question 3?

Option List

There is none lest it give you the answer to question 3!

63    SBA. WHO criteria for a screening programme.

Question 1.

Lead-in

List as many as you can of the WHO criteria.

Option List

There is none. But there are 10 criteria – just trying to be helpful!

Question 2.

Lead-in

Which, if any, of the following statements are true in relation to the WHO criteria for a screening test?

Option List

A	screening should be for an important health problem
B	there should be an accepted treatment
C	facilities for diagnosis and treatment should exist
D	there should be an identifiable latent or early stage of the condition
E	there should be a suitable screening test

Question 3.

Lead-in

Which, if any, of the following statements are true in relation to the WHO criteria for a screening test?

Option List

F.	the test should acceptable to the population to be screened
G.	the natural history of the condition should be fully understood, particularly the factors causing progression from latent to established disease
H.	there should be agreement on whom to treat
I.	the financial cost of the screening programme and any consequent treatments should be reasonable in relation to the available budget for medical care
J.	case-finding should be continuous and not a “one-off” exercise

Question 4.

Lead-in

Who wrote the original paper on which the WHO criteria are based?

Option List

A.	Felix & Juggler
B.	Harriman & Jones
C.	Stevenson & Jugular
D.	Waterston & Juggernaut
E.	Wilson & Jugner

64.   SBA. Late fetal deaths and reporting

Question 1.

Lead-in

A woman goes into labour at 20 weeks’ gestation and delivers a baby with no sign of life.

Which of the options below best applies.

Option List

A.	register as a miscarriage
B.	register as an early fetal death
C.	register as a live-birth
D.	register as a stillbirth
E.	none of the above.

Question 2.

Lead-in

A woman goes into labour at 20 weeks’ gestation. When the head is delivering it is thought that the baby gasped, but once the baby is fully delivered and the cord is cut there is no sign of life. Resuscitation is not attempted.

Which of the options below best applies.

Option List

A.	register as a miscarriage
B.	register as an early fetal death
C.	register as a live-birth
D.	register as a stillbirth
E.	none of the above.

Question 3.

Lead-in

A woman goes into labour at 20 weeks’ gestation. The baby gasps just after it is fully delivered and the cord has been cut. A midwife thinks she detects a faint heartbeat, but the baby then shows no sign life. Attempted resuscitation fails.

Which of the options below best applies.

Option List

A.	register as a miscarriage
B.	register as an early fetal death
C.	register as a live-birth
D.	register as a stillbirth
E.	none of the above.

Question 4.

Lead-in

A woman goes into labour at 23 weeks’ gestation and delivers a baby with no sign of life.

Which of the options below best applies.

Option List

A.	register as a miscarriage
B.	register as an early fetal death
C.	register as a live-birth
D.	register as a stillbirth
E.	none of the above.

Question 5.

Lead-in

A woman goes into labour at 23 weeks’ gestation and delivers a baby with no sign of life.

Which of the options below best applies in relation to MBRRACE’s enquiry into late fetal deaths?

Option List

A	this would be eligible for inclusion
B	this would be ineligible because of the gestation
C	this would be ineligible because the cause of death must be known
D	this would be ineligible because I say so
E	none of the above

Question 6.

Lead-in

A woman goes into labour at 24 weeks’ gestation and delivers a baby with no sign of life.

Which of the options below best applies.

Option List

A	register as a miscarriage
B	register as an early fetal death
C	register as a live-birth
D	register as a stillbirth
E	none of the above.

Question 7.

Lead-in

A woman goes into labour at 24 weeks’ gestation and delivers a baby with no sign of life.

Which of the options below best applies in relation to MBRRACE’s enquiry into late fetal deaths?

Option List

A	this would be eligible for inclusion
B	this would be ineligible because of the gestation
C	this would be ineligible because the cause of death must be known
D	this would be ineligible because I say so
E	none of the above.

65.   SBA. Germ cell and sex cord tumours and substances secreted.

Lead-in.

The following scenarios relate to the substances that ovarian cell tumours usually secrete.

For each, select the most appropriate substance from the option list.

Each option can be used once, more than once or not at all.

Option List.

A.        None.

B.         a-fetoprotein.

C.         a-fetoprotein + hCG.

D.        a1-antitrypsin

E.         Androgen.

F.         Ascites.

G.        Walthard

H.        Ca125

I.           hCG.

J.          β-hCG

K.         Follicle stimulating hormone.

L.          Luteinising hormone.

M.      Oestrogen.

N.        Prolactin.

O.        Thyroxine sufficient to produce hyperthyroidism.

P.         Pleuritic fluid.

Q.        None of the above.

Scenario 1.

Mature cystic teratoma.

Scenario 2.

Granulosa cell tumour.

Scenario 3.

Sertoli-Leydig tumours.

Scenario 4 .

Brenner tumour.

Scenario 5.

Struma ovarii.

Scenario 6.

Embryonal carcinoma.

Scenario 7.

Polyembryoma.

Scenario 8.

Endodermal sinus tumour (Yolk sac tumour).

Scenario 9.

Dysgerminoma.

Scenario 10.

Primary ovarian choriocarcinomas.

66. SBA. Tuberculosis and pregnancy.

Question 1.

Lead-in

Approximately how many cases of TB were identified in the UKOSS survey of 2005-6?

Option List

A.	30
B.	60
C.	100
D.	500
E.	1,000

Question 2.

Lead-in

Which of the following is the best approximation to UKOSS’s estimated incidence of TB from 2005-6 in the UK?

Option List

F.	1 per   10,000 maternities
G.	1 per   25,000 maternities
H.	1 per   50,000 maternities
I.	1 per 100,000 maternities
J.	1 per 500,000 maternities

Question 3.

Lead-in

UKOSS only deals with “rare” conditions. What cut-off does it use for the definition of “rare”?

Option List

K.	1 in      500
L.	1 in   1,000
M.	1 in   2,000
N.	1 in   5,000
O.	1 in 10,000

Question 4.

Lead-in

Which of the following statements are false?

Statements.

F.	All of the affected women were from ethnic minorities
G.	All of the affected women were born outside the UK
H.	All of the affected women had arrived in the UK in the past year
I.	All of the affected women were based in London or Birmingham
J.	All of the women had had previous inadequate treatment for TB

Option List

1	A + B
2	A + B + C
3	A + B + C + D + E
4	B + C + D
5	B + C + D + E

Question 5.

Lead-in

Which was the most common country of birth?

Option List

A.	Ethiopia
B.	India
C.	Pakistan
D.	Somalia
E.	Sudan

Question 6.

Lead-in

What proportion of the women were HIV+ve?

Option List

A.	5%
B.	10%
C.	15%
D.	20%
E.	50%

Question 7.

Lead-in

What proportion of the women had multi-drug-resistant TB?

Option List

A.	0%
B.	5%
C.	10%
D.	15%
E.	50%

Question 8.

Lead-in

What proportion of the women had extra-pulmonary disease?

Option List

A.	0%
B.	5%
C.	10%
D.	15%
E.	50%

Question 9.

Lead-in

What was the most common location of extra-pulmonary disease?

Option List

A.	abdominal lymphatics
B.	bone
C.	cervical lymphatics
D.	CNS
E.	the eyes

Question 10.

Lead-in

What was the most common clinical presentation?

Option List

A.	cough
B.	erythema nodosum
C.	haemoptysis
D.	meningeal irritation
E.	non-specific symptoms

Question 11.

Lead-in

Tuberculin testing is recommended for the investigation of suspected TB. What proportion of the women had it done?

Option List

A.	5%
B.	10%
C.	12.5%
D.	15%
E.	25%

Question 12.

Lead-in

Chest X-ray is recommended for the investigation of suspected TB. What proportion of the women with pulmonary TB had it done?

Option List

A.	10%
B.	20%
C.	50%
D.	75%
E.	100%

Question 13.

Lead-in

What was the median time from symptoms being reported to diagnosis?

Option List

A.	one week
B.	two weeks
C.	three weeks
D.	1 month
E.	3 months

Question 14.

Lead-in

How many women died?

Option List

A.	1
B.	3
C.	5
D.	7
E.	10

Question 15.

Lead-in

What was the main cause of death?

Option List

A.	CNS disease
B.	complications of HIV
C.	CVS disease
D.	pulmonary disease
E.	septicaemia

Question 16.

Lead-in

What was noteworthy about the perinatal outcomes?

Option List

A.	high risk of NEC
B.	high risk of neonatal TB
C.	high risk of perinatal mortality
D.	high risk of SIDS
E.	high risk of stillbirth

Question 17.

Lead-in

Which initial treatments were most commonly used?

Treatments

A.	ethambutol
B.	isoniazid
C.	pyrazinamide
D.	rifampicin or rifabutin
E.	streptomycin

Option List

1	A + B + C + D + E
2	A + B + C + D
3	A + B + C + E
4	B + C + D + E
5	B + C + D

67.   Vulval conditions.

Lead-in.

The following scenarios relate to vulval conditions.

Choose the most likely vulval condition from the option list.

Each option can be used once, more than once or not at all.

Option list.

A.	Acne.
B.	Behçet’s syndrome.
C.	Candidiasis.
D.	CIN 3
E.	CIN1
F.	Crohn’s disease.
G.	Dermatitis.
H.	Eczema.
I.	Genital warts.
J.	Hidradenitis suppurativa.
K.	Leprosy.
L.	Lichen planus
M.	Lichen sclerosis
N.	Lymphogranuloma venereum
O.	Normal skin.
P.	Psoriasis.
Q.	Seborrhoeic dermatitis.
R.	Type 1 diabetes mellitus
S.	Type 2 diabetes mellitus
T.	Ulcerative colitis.
U.	VIN III.

Scenario 1.

A 22 year-old woman attends the colposcopy clinic after 2 smears showing minor atypia. The cervical appearances are of aceto-white with punctation. 

Scenario 2.

A 60-year old woman has an erythematous rash of the vulva extending to the inner thighs. A similar rash is noted under the breasts. She is not known to have diabetes.

Scenario 3.

A woman attends the gynaecology clinic with a vulval rash. It has a “lacy” appearance. 

Scenario 4.

A 35-year old woman attends is noted to have a vulval fistula. She has a history of episodic diarrhoea. 

Scenario 5.

A 25-year old woman attends the gynaecology clinic with a history of intense vulval itching and soreness. The appearances are of diffuse erythema with excoriation. Diabetes, candidiasis and other local infections have been eliminated by the GP. 

Scenario 6.

A 35-year old woman attends the gynaecology clinic with vulvitis. She also has a scalp rash. Clinical examination shows scaly, pink patches with signs of excoriation. Skin samples grow Malassezia ovalis.

Scenario 7.

A 40-year old woman has evidence of chronic vulval ulceration. She has recently been seen by a dermatologist for mouth ulceration and has been started on thalidomide.

Scenario 8.

An African woman of 35 years attends the gynaecology clinic. She has a ten-year history of chronic vulval ulceration. Examination shows multiple, tender vulval and pubic subcutaneous nodules, some of which have ulcerated.

Scenario 9.

A Caucasian woman of 29 years attends the gynaecology clinic with a chronic vulval rash. Examination shows erythematous areas with clearly defined margins and white scaly patches. 

Scenario 10.

A 30-year old woman attends the gynaecology clinic with vulval itching. Examination shows erythema of the labia minora and perineum. Full-thickness biopsy shows abnormal cell maturation throughout the epithelium with increased mitotic activity.

Scenario 11.

Which condition is described in GTG58 as presenting with polygonal lesions?

Scenario 12.

Which condition is described in GTG58 as presenting with “well-demarcated, glazed erythema around the introitus?

Scenario 13.

What is the aetiology of lichen planus?

There is no option list – just write what you think.

Option list.

A.	Acne.
B.	Behçet’s syndrome.
C.	Candidiasis.
D.	CIN 3
E.	CIN1
F.	Crohn’s disease.
G.	Dermatitis.
H.	Eczema.
I.	Genital warts.
J.	Hidradenitis suppurativa.
K.	Leprosy.
L.	Lichen planus
M.	Lichen sclerosis
N.	Lymphogranuloma venereum
O.	Normal skin.
P.	Psoriasis.
Q.	Seborrhoeic dermatitis.
R.	Type 1 diabetes mellitus
S.	Type 2 diabetes mellitus
T.	Ulcerative colitis.
U.	VIN III.

68.         SBA. Kisspeptin

Lead in

Read the question below and then pick the best answer.

In relation to kisspeptin, pick the best answer from the list below.

Option list.

A	is a pheromone released by the salivary glands during passionate embraces
B	is a digestive enzyme released by the salivary glands during passionate embraces
C	is a digestive enzyme found in human carnivores but not vegetarians
D	is thought necessary for trophoblastic invasion and low levels have been linked to miscarriage and recurrent miscarriage
E	does not exist and this question is a very poor joke by someone who should know better