Thursday, 28 July 2016

Tutorial 28th. July 2016

28 July 2016.

44
SBA. ART, infertility treatment and cancer
45
SBA. Endometrial cancer & obesity
46
SBA. Coeliac disease & pregnancy
47
EMQ. Cancer incidence and mortality
48
EMQ. Drugs in O&G 1

44.   EMQ. ART, infertility treatment and cancer
Question 1.
Lead-in
Which, if any, of the following statements are true?
Statements
A.       
infertile, nulliparous women are at increased risk of breast cancer
B.       
infertile, nulliparous women are at increased risk of cervical cancer
C.       
infertile, nulliparous women are at increased risk of ovarian cancer
D.       
infertile, nulliparous women are at increased risk of uterine cancer
E.        
infertile, nulliparous women are at increased risk of vaginal cancer
Option List
        I.             
A + B + C + D + E
      II.             
A + B + C + D
    III.             
A + B + D + E
    IV.             
A + C + D
      V.             
B + C + D
Question 2.
Lead-in
Which, if any, of the following statements are true of breast cancer?
Statements
A.       
early age at menarche is a recognised risk factor for breast cancer
B.       
increasing parity is a recognised risk factor for breast cancer
C.       
consumption of alcohol and use of tobacco increase the risk of breast cancer
D.       
the combined oral contraceptive increases the risk of breast cancer
E.        
HRT with oestrogen + progestogen increases the risk of breast cancer
Option List
        I.             
A + B + C + D + E
      II.             
A + C + D
    III.             
A + B + D + E
    IV.             
A + C + D
      V.             
A + C + D + E
Question 3.
Lead-in
Which, if any, of the following statements are true of ovarian cancer?
Statements
A.       
early age at menarche is a recognised risk factor for ovarian cancer
B.       
increasing parity is a recognised risk factor for ovarian cancer
C.       
nulligravidas who fail to conceive after ART are at increased risk of ovarian cancer compared with nulligravidas who conceive after ART
D.       
tubal ligation increases the risk of ovarian cancer
E.        
use of the LNGIUS for > 5 years is a recognised risk factor for ovarian cancer
Option List
        I.             
A + B + C + D + E
      II.             
A + B + C + D
    III.             
A + C
    IV.             
A + C + D
      V.             
B + C + D + E
Question 4.
Lead-in
Which, if any, of the following statements are true of uterine cancer?
Option List
A.       
early age at menarche is a recognised risk factor for uterine cancer
B.       
increasing parity is a recognised risk factor for uterine cancer
C.       
nulligravidas who fail to conceive after ART are at increased risk of uterine cancer compared with nulligravidas who conceive after ART
D.       
tubal ligation increases the risk of uterine cancer
E.        
use of the LNGIUS for > 5 years is a recognised risk factor for uterine cancer
Option List
        I.             
A
      II.             
A + B
    III.             
A + C
    IV.             
A + C + D
      V.             
A + C + D + E
Question 5.
Which, if any, of the following statements are true in relation to cancer in the offspring of women who have had ART?
Option List
A.       
ART doubles the risk of breast cancer when the female offspring reach adulthood
B.       
ART doubles the risk of clear cell adenocarcinoma of the vagina, though the condition remains very rare
C.       
ART doubles the risk of melanoma both in childhood and adulthood
D.       
ART doubles the risk of retinoblastoma, though the condition remains very rare
E.        
ART doubles the risk of thyroid cancer when the offspring reach adulthood
F.        
none of the above
Option List
        I.             
A + B + C + D + E
      II.             
A + C + D
    III.             
A + B + D + E
    IV.             
A + C + D
      V.             
none of the above

45.   SBA. Endometrial cancer & obesity
Question 1.
Lead-in
What % of endometrial cancer is attributable to obesity?
Option List
F.        
 5%
G.       
15%
H.       
20%
I.         
30%
J.         
50%
Question. 2
Lead-in
What is the incidence of endometrial cancer compared with other female cancers?
Option List
F.        
It is the most common.
G.       
It is the second most common.
H.       
It is the fourth most common.
I.         
It is the tenth most common.
J.         
It is the fifteenth most common.
Question 3.
Lead-in
Where does endometrial cancer appear in the list of cancers causing female deaths in the UK?
Option List
A.       
It is the most common.
B.       
It is the second most common.
C.       
It is the fourth most common.
D.       
It is the ninth most common.
E.        
It is the fifteenth most common.
Question 4.
Lead-in
What proportion of the female population of the UK is obese?
Option List

A.       
10%
B.       
15%
C.       
25%
D.       
30%
E.        
40%
Question 5.
Lead-in
Which option is correct in relation to the type of endometrial cancer associated with obesity?
         i.            type 1.
       ii.            type 2.
     iii.            type 3.
     iv.            adeno-squamous
Option List
A.       
i
B.       
ii
C.       
iii
D.       
iv
E.        
i + iv
Question 6.
Lead-in
Pick the correct option from the option list in relation to the following statements.
Statements
         i.            the risk of EC increases significantly with BMI > 25
       ii.            the risk of EC increases significantly with BMI > 30
     iii.            the risk of EC increases significantly with BMI > 35
     iv.            the risk of EC increases significantly with BMI > 40
       v.            the risk of EC increases significantly with BMI > 45
Option List
A.       
i
B.       
ii
C.       
iii
D.       
iv
E.        
v
Question 7.
Lead-in
Which of the following statements is correct?
Statements
         i.            the risk of EC rises linearly in relation to increasing BMI
       ii.            the risk of EC rises exponentially in relation to increasing BMI.
     iii.            the risk of EC rises according to the following formula:
R = 0.7 x BMI x Y. Where R = lifetime risk, Y = duration of significant BMI in years.
     iv.            the risk of EC doubles with BMI> 30 and trebles with BMI > 40
       v.            the risk of EC in relation of obesity has not been defined
Option List
A.       
i
B.       
ii
C.       
iii
D.       
iv
E.        
v
Question 8.
Lead-in
Which, if any, of the following statements are true?
Statements
         i.            the incidence of endometrial cancer increased by 20% between 1975 and 1993
       ii.            the incidence of endometrial cancer increased by 20% between 1993 and 2007
     iii.            the incidence of endometrial cancer increased by 40% between 1993 and 2007
     iv.            the greatest increase in EC has been in the 50 - ≥60 years age band
       v.            the greatest increase in EC has been in the 60 - 79 years age band
Option List
A.       
i + ii
B.       
i + iii
C.       
i + iv
D.       
ii + iv
E.        
iii + v
Question 9.
Lead-in
Which of the following best indicates current overall 5-year survival rates for women treated for EC.
Option List
A.       
55%
B.       
60%
C.       
65%
D.       
70%
E.        
75%
Question 10.
Lead-in
The surgical technique of choice for EC is:
Option List
A.       
Abdominal hysterectomy + BSO
B.       
Abdominal hysterectomy + BSO + lymphadenectomy
C.       
Laparoscopic hysterectomy + BSO
D.       
Laparoscopic hysterectomy + BSO + lymphadenectomy
E.        
Vaginal hysterectomy + BSO
Question 11.
Lead-in
Which, if any, of the following statements are true in relation to laparoscopic hysterectomy + BSO by experienced laparoscopic surgeons compared to open hysterectomy + BSO in obese women with EC?
Statements.
         i.             
Rates of conversion to laparotomy are likely to exceed 50%
       ii.             
Intra-operative complication rates are roughly doubled
     iii.             
Duration of hospital stay and early complications are reduced
     iv.             
Patient-reported outcomes at 6 months are superior.
       v.             
5-year survival rates are superior
Option List
A.       
i + ii
B.       
i + iii
C.       
iii
D.       
iii + iv
E.        
iv + v
Question 12.
Lead-in
Which, if any, of the following statements are true in relation to radiotherapy?
Option List
A.       
radiotherapy should be recommended if there are significant co-morbidities
B.       
external beam radiotherapy is the recommended modality
C.       
brachytherapy is the recommended modality
D.       
recurrence rates of up to 18% have been reported
E.        
none of the above
Question 13.
Lead-in
Which, if any, of the following statements are true in relation to progestogen therapy?
Option List
A.       
high-dose progestogen therapy from the time of the initial endometrial biopsy to definitive surgery improves 5-year survival
B.       
the 52 mg IUS is of proven efficacy and safety for women with endometrial hyperplasia with cytological atypia who wish to retain their fertility
C.       
the 52 mg IUS is of proven efficacy and safety for women with endometrial hyperplasia with early endometrial cancer
D.       
high-dose progestogen therapy is effective in palliative care in 50%  of cases in reducing tumour size and bleeding
E.        
none of the above

46.   EMQ. SBA. Coeliac disease & pregnancy
Question 1.
Lead-in
What is coeliac disease?
Option List
K.        
allergy to gluten
L.        
malabsorption due to large bowel inflammation
M.     
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition
N.       
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition
O.      
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the small bowel in individuals with a genetic predisposition
Question 2.
Lead-in
What is the prevalence of coeliac disease in women of reproductive age?
Option List
K.        
0.1%
L.        
0.5%
M.     
1-2 %
N.       
2-5%
O.      
5-10%
Question 3.
Lead-in
Which of the following groups have an increased risk of CD?
Option List
A.       
1st. degree relatives of those with CD
B.       
those with type 1 diabetes
C.       
those with iron deficiency anaemia
D.       
those with osteoporosis
E.        
those with unexplained infertility
Question 4.
Lead-in
Which of the following are features of CD in the non-pregnant population?
Option List
A.       
abdominal bloating and pain
B.       
amenorrhoea
C.       
anaemia
D.       
recurrent miscarriage
E.        
unexplained infertility
Question 5.
Lead-in
How do pregnant women with CD present most commonly?
Option List
A
anaemia
B
failure to gain weight in pregnancy
C
intra-uterine growth retardation
D
low BMI
E
no recognised abnormality
Question 6.
Lead-in
Which of the following commonly occur in pregnant women with CD?
Option List
A
anaemia
B
failure to gain weight in pregnancy
C
intra-uterine growth retardation
D
low BMI
E
no recognised abnormality
Question 7.
How should the woman with suspected CD be investigated initially?
Option List
F.        
jejunal biopsy
G.       
IgA EMA
H.       
IgA tTGA
I.         
IgA EMA + IgA tTGA
J.         
rectal biopsy
Question 8.
Lead-in
Which, if any, of the following statements are true in relation to the woman due to have testing for suspected CD?
Option List
F.        
continue with a normal diet.
G.       
continue with a normal diet that includes a minimum of 5 gm. gluten daily
H.       
continue with a normal diet that includes a minimum of 10 gm. gluten daily
I.         
follow a strict gluten-free diet for at least 1 month
J.         
follow a strict gluten-free diet for at least 3 months
Question 9.
Lead-in
Which of the following conditions should make consideration of testing for CD sensible?
Option List
F.        
amenorrhoea
G.       
Down’s syndrome
H.       
epilepsy
I.         
recurrent miscarriage
J.         
Turner’s syndrome
K.        
unexplained infertility
Question 10.
Lead-in
How is the diagnosis of CD confirmed after +ve serological testing?
Option List
A.       
colonoscopy
B.       
enteroscopy
C.       
gastroscopy
D.       
rectal biopsy
E.        
small bowel  biopsy
Question 11.
Lead-in
Which skin condition is particularly associated with CD?
Option List
F.        
atopic eczema
G.       
dermatitis herpetiformis
H.       
dermatitis multiforme
I.         
dermatographia
J.         
psoriasis
Question 12.
Lead-in
Which of the following are likely to be absorbed less well than normally in women with CD?
Option List
A.       
carbohydrate
B.       
fat
C.       
folic acid
D.       
protein
E.        
vitamins B12, D & K
Question 13.
Lead-in
What is the appropriate treatment of CD?
Option List
A.       
antibiotics: long-term in low-dosage
B.       
azathioprine
C.       
cyclophosphamide
D.       
rectal steroids
E.        
none of the above
Question 14.
Lead-in
Which of the following do not contain gluten?
Option List
A.       
barley
B.       
oats
C.       
rapeseed oil
D.       
rye
E.        
wheat

47.   EMQ. Cancer incidence and mortality.
We did this question in an earlier tutorial, but are doing it again to reflect the latest data.
Abbreviations.
NHL:      non-Hodgkin Lymphoma
Question 1.
Lead-in
Which is the most common female cancer?
Option List
P.        
Bowel
Q.      
Breast
R.       
Cervix
S.        
Endometrium
T.        
Lung
Question 2.
Lead-in
Which is the 2nd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 3.
Lead-in
Which is the 3rd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 4.
Lead-in
Which is the 4th. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 5.
Lead-in
Which is the 5th. most common female cancer?
Option List
A.       
Cervix
B.       
Malignant melanoma
C.       
Non-Hodgkin’s lymphoma
D.       
Ovary
E.        
Vulva
Question 6.
Lead-in
Which is the 6th. most common female cancer?
Option List
A.       
Cervix
B.       
Non-Hodgkin’s lymphoma
C.       
Ovary
D.       
Skin
E.        
Vulva
Question 7.
Lead-in
Where does cervical cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
11th.
C.       
15th.
D.       
20th.
E.        
24th.
Question 8.
Lead-in
Where does vulval cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
12th.
C.       
16th.
D.       
20th.
E.        
none of the above
Question 9.
Lead-in
Which is the most common cancer causing female death in the UK?
Option List
K.        
Breast
L.        
Bowel
M.     
Lung
N.       
Ovary
O.      
Pancreas
Question 10.
Lead-in
Which is the 2nd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas
Question 11.
Lead-in
Which is the 3rd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas
Question 12.
Lead-in
Which is the 4th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 13.
Lead-in
Which is the 5th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 14.
Which is the 6th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 15.
Lead-in
The incidence of cervical cancer has fallen from the late 1970s until now. What is the approximate figure for the fall?
Option List
A.       
10%
B.       
25%
C.       
50%
D.       
60%
E.        
75%
Question 16.
Lead-in
The incidence of cervical cancer fell in the past decade. What is the approximate figure for the fall?
Option List
A.       
5%
B.       
10%
C.       
15%
D.       
20%
E.        
25%
Question 17.
Lead-in
What proportion of cervical cancer is diagnosed in women < 45 years?
Option List
A.       
20%
B.       
30%
C.       
40%
D.       
50%
E.        
60%
Question 18.
Lead-in
When was routine HPV vaccination of girls introduced in the UK?
Option List
A.       
2000
B.       
2002
C.       
2004
D.       
2006
E.        
2008
Question 19.
Lead-in
From what year might we expect to see a reduction in cervical cancer incidence as a result of the HPV vaccination programme?
Option List
A.       
2020
B.       
2025
C.       
2030
D.       
2040
E.        
2050
Question 20.
Lead-in
When was routine HPV vaccination of boys introduced in the UK?
Option List
A.       
2010
B.       
2011
C.       
2012
D.       
2014
E.        
None of the above

48.         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
HG:               hyperemesis gravidarum
IUGR:            intra-uterine growth retardation
LDA:              low-dose aspirin
MAOI:          monoamine oxidase 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)      there is insufficient information to be able to provide advice

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.
Methyldopa 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.  True / False.
Scenario 16.
Pethidine has greater analgesic effect in labour than Diamorphine.                  True / False.
Scenario 17.
What is Reye’s syndrome and which family of drugs is particularly linked?
Scenario 18.
What is “torsades de pointes” and when is it of importance in the management of HG?



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