Tutorial 11th. August 2016

Website.

Contact us.

11 August 2016.

64	SBA. Myocardial infarction & pregnancy
65	EMQ. Hyperandrogenism
66	EMQ. Abortion Act
67	EMQ. Fetal anomaly scan

64.   SBA. Myocardial infarction and pregnancy.

Question 1.

Lead-in

Where did cardiac disease rank in the direct and indirect causes of maternal death for the years 2011-13 in MBRRACE15?

Option List

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

Question 2.

Lead-in

What has happened to the incidence of maternal death due to cardiac disease in the UK since 1985?

Option List

A.	it has roughly increased by a factor of 1.5
B.	it has roughly increased by a factor of 2.0
C.	it has roughly increased by a factor of 3.0
D.	it has roughly reduced by a quarter
E.	it has roughly reduced by a half

Question 3.

Lead-in

What was the estimated prevalence of MI in the UKOSS survey?

There is no option list – what is your figure?

Question 4.

Lead-in

What risk factors for MI were identified in the UKOSS survey?

Question 5.

Lead-in

What underlying pathological conditions were noted in the UKOSS survey?

Question 6.

Lead-in

What risk factors for MI have been mentioned in recent Maternal Mortality Reports?

There is no option list.

Write your list and you can compare it with the list in the answers.

Question 7.

Lead in

What risk factors for MI have been reported in other publications?

A big question!! Write your list and compare it with mine.

Question 8.

Lead-in

How are the causes of MI normally categorised and what are the sub-headings in the main categories.

You know this or could work it out, certainly the main headings and most of the sub-headings.

Write your list and you can compare it with the answer.

Question 9.

Lead-in

What ECG criteria are used to categorise acute myocardial infarction?

Option List

A.	presence of arrhythmia
B.	presence of QT interval prolongation
C.	presence of ST segment depression
D.	presence of ST segment elevation
E.	presence of T wave inversion

Question 10.

Lead-in

What ECHO criteria are used to categorise acute myocardial infarction?

Option List

A.	presence of arrhythmia
B.	presence of atrial dilatation
C.	presence of ventricular dilatation
D.	presence of mitral valve reflux
E.	none of the above

Question 11.

Lead-in

With regard to coronary artery dissection, which of the following statements are false?

Statements.

A.	only occurs in women with coronary artery disease
B.	mainly occurs in the right anterior descending branch of the coronary artery
C.	is most common in the puerperium
D.	is particularly associated with the use of ergometrine for management of the 3rd. stage and its complications
E.	is associated with mortality rates ≥ 50%, mainly due to late diagnosis or mis-diagnosis

Option List

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

Question 12.

Lead-in

Which ECG feature is particularly used to diagnose MI?

Option List

A.	presence of arrhythmia
B.	presence of QT interval prolongation
C.	presence of ST segment depression
D.	presence of ST segment elevation
E.	presence of T wave inversion

Question 13.

Lead-in

Which blood markers are best for the diagnosis of MI?

Markers

1.	Treponemin A
2.	Treponemin B
3.	Troponin A
4.	Troponin I
5.	Troponin T

Option List

A	1 + 2
B	3
C	3 + 4
D	3 + 5
E	4 + 5
F	none of the above

Question 14.

Lead-in

Which of the following statements are true about the blood markers that are best for the diagnosis of MI?

Statements

1.	Their levels are normal in normal pregnancy
2.	Their levels are increased from about 28 weeks, making pregnancy-specific ranges mandatory
3.	Their levels rise with prolonged labour
4.	Their levels rise with Caesarean section
5.	Their levels can be elevated in pregnancy-induced hypertension and PET
6.	Their levels can be elevated in pulmonary embolism

Option List

A	1 + 3
B	1 + 3 + 4
C	2 + 3 + 4
D	1 + 3 + 5
E	1 + 5 + 6
F	none of the above

Question 15

Lead-in

How many maternal deaths due to cardiac disease were reported for the years 2010-12 in MBRRACE14?

Option List

A.	10
B.	26
C.	38
D.	47
E.	54

Question 16.

What were the two main causes of maternal death from cardiac disease in 2010-12?

List of possible causes.

A.	aortic dissection
B.	atherosclerosis
C.	atrial fibrillation
D.	coronary thrombosis
E.	myocardial infarction
F.	peripartum cardiomyopathy
G.	sudden adult death syndrome
H.	ventricular fibrillation

Option List

There is no option list. Just choose the top two.

Question 17.

How many maternal deaths were attributed to myocardial infarction in MBRRACE15?

Option List

A.	0
B.	5
C.	8
D.	12
E.	36

Question 18.

Lead-in

What are the latest figures for the split between congenital and acquired disease in deaths due to cardiac disease and what years do they derive from?

Option Lists

    List 1                                               List 2

A	3: 100		F	2006-08
B	6: 100		G	2007-09
C	13: 100		H	2008-10
D	31: 100		I	2009-11
E	50: 100		J	2010-12

Question 19.

Lead-in

Which causes of death have occupied the number 1 spot in the ranking order of the causes of direct plus indirect maternal deaths in the past 30 years?

List of causes.

1	AFE
2	anaesthesia
3	early pregnancy: ectopic, miscarriage & TOP
4	cardiac disease
5	haemorrhage
6	PET, eclampsia, pregnancy-induced hypertension
7	psychiatric disease including suicide
8	sepsis
9	thromboembolism/ thrombosis

Option List

A	1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 + 9
B	3 + 4 + 5 + 6 + 7 + 8 + 9
C	4 + 5 + 6 + 7 + 8 + 9
D	4 + 5 + 6 + 8 + 9
E	4 + 9

65.   EMQ. Hyperandrogenism, ovarian hyperthecosis and PCOS.

Abbreviations.

ACTH:      adreno-corticotrophic hormone released by the anterior pituitary to stimulate release of glucocorticoids from the adrenal cortex

CRH:        corticotrophin-releasing hormone released by the hypothalamus to stimulate ACTH release from the anterior pituitary

DHEA:     dehydroepiandrosterone

DHEAS:   dehydroepiandrosterone sulphate

DHT:        dihydrotestosterone

FT:            free testosterone

PCO:        polycystic ovaries

PCOS:      polycystic ovary syndrome

SHBG:      sex-hormone binding globulin

T:              testosterone

Question 1.

Lead-in

The following statements relate to androgen production by the adrenal gland. Which, if any, are true?

Statements

F.	adrenal androgens are mainly produced in the adrenal medulla
G.	adrenal androgens are produced from pregnenolone derived from cholesterol
H.	testosterone is the main adrenal androgen
I.	DHEA is the most potent activator of the androgen receptor
J.	DHEAS is a useful measure of adrenal androgen production as it is almost entirely produced in the adrenal
K.	DHEA is the main ovarian androgen
L.	androstenedione is the main ovarian androgen

Option List

1.	A + B
2.	A + C
3.	A + B + D + E
4.	B + C
5.	B + E
6.	B + E + G
7.	C + D + E

Question 2.

Lead-in

Which, if any, of the following statements are true in relation to blood testosterone in healthy women?

Statements

A.	50% is bound to SHBG
B.	80% is bound to SHBG
C.	49% is bound to albumin
D.	19% is bound to albumin
E.	1% is free

Option List

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

Question 3.

Lead-in

The following statements relate to androgen receptors. Which, if any, are true?

Statements

A	androgen receptors are located on cell membranes
B	androgens diffuse across cell membranes and attach to mitochondrial androgen receptors
C	androgens diffuse across cell membranes and attach to nuclear androgen receptors
D	androgen receptors in the brain are located in the pre-optic area of the hypothalamus
E	androgen receptors are not present in breast tissue
F	androgen receptors in bone are important for bone mineralisation

Option List

i	A + D + E + F
ii	B + D + E + F
iii	C + D + E + F
iv	A + E + F
v	C + D + F

Question 4.

Lead-in

Which, if any, of the following substances are significant activators of the androgen receptor?

Option List

A.	androstenedione
B.	DHEA
C.	DHEAS
D.	DHT
E.	T

Option List

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

Question 5.

Lead-in

Approximately what proportion of circulating testosterone in healthy women is ovarian in origin?

Option List

A.	< 5%
B.	5 - ≤10%
C.	10 - ≤15%
D.	15 - ≤20%
E.	25%

Question 6.

Lead-in

What is the major pathway for metabolism / excretion of testosterone in healthy women

Option List

A.	aromatisation in peripheral tissues
B.	hepatic metabolism
C.	hepatic metabolism and conjugation with urinary excretion as 17-ketosteroids
D.	hepatic metabolism and conjugation with urinary excretion as 17-OH progesterone
E.	urinary excretion as esters of testosterone

Question 7.

Lead-in

Which of the following statements is true about testosterone assay in most hospitals?

Option List

A.	assays are accurate in both male and female ranges
B.	assays are accurate in the male range, but not the female
C.	assays consistently give results that are greater than they should be for women
D.	assays consistently give results that are less than they should be for women
E.	assays may give results that are half of what they should be

Question 8.

Lead-in

What testosterone level is usually taken as indicating a need to exclude serious pathology in women?

Option List

A.	≥ 1 nmol/l
B.	≥ 2 nmol/l
C.	≥ 3 nmol/l
D.	≥  5nmol/l
E.	≥  10nmol/l

Lead-in.

What criteria are now used to define PCOS? What are they called? Where do they come from?

Question 9.

Lead-in

Which, if any, of the following statements are true in relation to PCOS and Stein-Leventhal syndrome (SLs).

Option List

A.	PCOS used to be known as SLs
B.	PCOS and SLs are synonyms
C.	the definition of PCOS includes less severe cases than those included in SLs
D.	Stein-Leventhal was one person
E.	the original paper was presented at a meeting in New Orleans – nice work, if you can get it!

Question 10.

Lead-in

Which, if any, of the following statements are true in relations to hyperandrogenism in pregnancy?

Statements

A.	maternal hyperandrogenism has been postulated as a cause of PCOS in the offspring
B.	maternal hyperandrogenism is usually due to conditions that pre-dated the pregnancy
C.	total T levels are higher and SHBG levels are higher in pregnancy
D.	total T levels are lower and SHBG levels are higher in pregnancy
E.	unilateral, solid ovarian masses + hyperandrogenism carry an ↑ risk of malignancy

Option List

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

Question 11.

Lead-in

Which, if any, of the following statements are true in relations to hyperandrogenism in pregnancy?

Option List

A.	is most often due to persisting corpus luteum
B.	is most often due to adrenal adenoma
C.	is most often due to consumption of androgenic drugs
D.	is most often due to ovarian luteomas & theca lutein cysts
E.	is most often due to ovarian hyperthecosis

Question 12.

Lead-in

Which, if any, of the following statements are true in relation to ovarian hyperthecosis (OH).

Statements

A	OH is the most common cause of hyperandrogenism in postmenopausal women
B	approximately 10% of premenopausal women with hyperandrogenism have OH
C	is associated with the presence of luteinised theca cell nests in the adrenal stroma
D	is associated with higher testosterone levels than are typical of PCOS
E	is associated with more severe clinical features than occur in women with PCOS

Option List

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

 Question 13.

Lead-in

Lead-in

Which, if any, of the following statements are true in relation to ovarian hyperthecosis.

Statements

A	acanthosis nigricans may be a consequence
B	clinical features reduce with a trial of dexamethasone
C	endometrial hyperplasia and cancer are more common
D	onset of clinical features is usually sudden and progression is rapid
E	significant insulin resistance is common
F	testosterone levels exceed those in PCOS and may be > 5nmol/l.

Option List

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

Question 14.

Lead-in

Lead-in

Which, if any, of the following statements are true in relation to acanthosis nigricans.

Statements

A	acanthosis nigricans only occurs in those of Afro-Caribbean descent
B	obesity is a common cause
C	acanthosis nigricans is a good marker for insulin resistance
D	acanthosis progresses to malignant melanoma in 5% of cases
E	acanthosis nigricans of sudden onset may indicate malignancy
F	acanthosis nigricans responds well to local steroid ointments

Option List

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

Question 15.

Lead-in

List all the causes of hyperandrogenism that you can think of.

There is no option list – the list will come with the answers.

Question 16.

Lead-in

Which, if any, of the following statements are true?

Statements

A	ovarian androgen-secreting tumours are mostly Brenner tumours
B	ovarian androgen-secreting tumours produce significant ↑ of testosterone levels
C	ovarian androgen-secreting tumours produce significant ↑ of serum DHEAS & urinary 17-ketosteroids
D	ovarian androgen-secreting tumours usually result in early virilisation
E	ovarian androgen-secreting tumours are less common than adrenal androgen-secreting tumours

Option List

i	A + B + C + D + E
ii	A + B + D
iii	B + C + D
iv	B + D
v	B + E

Question 17.

Lead-in

Which, if any, of the following statements are true?

Statements

A	adrenal androgen-secreting tumours are mostly Brenner tumours
B	adrenal adenomas produce significant ↑ of cortisol and aldosterone levels
C	adrenal carcinomas significant ↑ of androgens and cortisol
D	adrenal androgen-secreting tumours usually result in early virilisation
E	adrenal androgen-secreting tumours are associated with ↑↑ in levels of testosterone, DHEAS and urinary 17-ketosteroids that do not ↓ with dexamethasone

Option List

i	A + B + C + D + E
ii	A + C + D + E
iii	B + C + D + E
iv	B + C + D
v	C + D + E

CPD questions from TOG 15.3

Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism

Androgen excess in women is associated with,

1.     menstrual irregularity.

With regard to normal androgen physiology in women,

2.     the adrenal medulla makes dehydroepiandrosterone sulfate.

3.     less than 10% of testosterone is bound to sex hormone binding globulin.

With regard to androgen action and metabolism,

4.     androgens are excreted unchanged in the urine.

5.     testosterone binds to a nuclear receptor.

With regard to the clinical presentation of hyperandrogenism,

6.     the Ferriman-Gallwey score is useful in objectively assessing the severity of hirsutism.

7.     deepening voice and breast atrophy are features suggestive of an adrenal tumour.

Regarding the biochemical assessment of hyperandrogenic patients,

8.     serum testosterone >5 nmol/l should prompt further investigation.

Regarding the pathophysiology of polycystic ovary syndrome,

9.     a combination of genetic and lifestyle factors are likely to be causative.

10.   arrest of follicular development is characteristic

Regarding the differential diagnoses of hyperandrogenism,

11.   ovarian hyperthecosis is a disease of childhood.

12.   congenital adrenal hyperplasia is often diagnosed in infancy.

13.   the most common virilising adrenal tumours are the Sertoli-Leydig cell type.

With regard to the pathophysiology of hyperandrogenism,

14.   approximately 50% of circulating androgens are conjugated with either glucuronic or sulfuric acid.

15. In hyperandrogenaemic women with PCOS, it has been shown that there is an increased risk of breast cancer.

With regard to the quantification of androgens in secondary care institutions in the UK,

16.   automated immunoassays on whole serum are known to consistently overestimate serum testosterone concentrations.

In cases of hyperandrogenism,

17.   ovarian hyperthecosis accounts for less than 50% of cases in postmenopausal women.

18.   the non-classic 21-hydroxylase deficiency tends to typically present in childhood.

19.   luteomas of the ovary are one of the most common causes of gestational hyperandrogenism.

20.   unilateral solid ovarian lesions as a cause have an increased risk of malignancy when presenting in pregnancy.

66.   EMQ. Abortion Act.

Scenario 1

Lead in.

What was the approximate rate of abortion in the UK in 2014?

Option list

A	1 per 1,000 resident women aged 15-44
B	10 per 1,000 resident women aged 15-44
C	15 per 1,000 resident women aged 15-44
D	20 per 1,000 resident women aged 15-44
E	50 per 1,000 resident women aged 15-44
F	100 per 1,000 resident women aged 15-44

Scenario 2

Lead in.

The rate of abortion has declined by > 20% in the UK in the past ten years.

Pick the answer from the option list that best matches the above statement.

Option list

A	False
B	Haven’t a clue
C	Maybe
D	No data exist
E	True

Scenario 3

Lead in.

What proportion of TOPs were performed at gestations < 10 weeks in 2014?

Option list

A	50%
B	60%
C	70%
D	80%
E	90%

Scenario 4

Lead in.

There has been a significant improvement in the proportion of TOPs performed early in the past decade.

Option list

A	False
B	Haven’t a clue
C	Maybe
D	No data exist
E	True

Scenario 5

Lead in.

What proportion of TOPs were performed using medical, not surgical techniques?

Option list

A	20%
B	30%
C	40%
D	50%
E	60%
F	70%
G	80%

Scenario 6

Lead in.

Which age had the highest rate of TOP?

Option list

A	18
B	19
C	20
D	21
E	22
F	23
G	24
H	25

Scenario 7

Lead in.

What happened to the rate of TOP in 2014 for girls < 18 years compared with 2013?

Option list

A	the rate was much lower
B	the rate was slightly lower
C	the rate was much higher
D	the rate was slightly higher
E	the rate was unchanged

Scenario 8

Lead in.

What happened to the rate of TOP in 2014 for girls < 16 years compared with 2013?

Option list

A	the rate was much lower
B	the rate was slightly lower
C	the rate was much higher
D	the rate was slightly higher
E	the rate was unchanged

Scenario 9

Lead in.

What happened to the rate of TOP in 2014 for girls < 16 years compared with 2004?

Option list

A	the rate was much lower
B	the rate was slightly lower
C	the rate was much higher
D	the rate was slightly higher
E	the rate was unchanged

Scenario 10

Lead in

Approximately what proportion of women having TOP in 2014 had previously had one or more TOPs?

Option list

A	1%
B	5%
C	10%
D	20%
E	30%
F	40%
G	50%

Scenario 11

Lead in

There were 190,092 TOPs in 2014. How many deaths occurred?

Option list

A	0
B	10
C	22
D	40
E	56

Scenario 12

Lead in

There were 190,092 TOPs in 2014. What was the rate of significant complications?

Option list

A	<1%
B	1%
C	3%
D	5%
E	10%

Scenario 13

Lead in.

The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) a”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Scenario 14

Lead in.

The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) b”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 15

Lead in.

The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) c.

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 16

Lead in.

The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) d”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 17

Lead in.

The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) e”?

Option list

1	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
2	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Scenario 18

Lead in.

With regard to the he Abortion Act and grounds “F” and “G”. Which of the following statements are true?

1	“F” & “G” are grounds for TOP in an emergency with only one doctor needing to sign the legal form necessary for the TOP to take place
2	“F” & “G” are grounds for TOP after 24 weeks.
3	“F” relates to TOP to save the woman’s life
4	“F” relates to TOP to prevent grave permanent injury her physical or mental health
5	“F” & “G” do not exist.

Option list

A	1  + 3
B	1  + 4
C	2 + 3
D	2 + 4
E	5

Scenario 19

Lead in

In relation to terms such as “substantial risk”, “grave permanent injury” and “seriously handicapped”, which of the following is true?

Option list

A	The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (b) to the Act.
B	The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (c) to the Act.
C	The terms were defined by the General Medical Council, examples were given and the information can be downloaded from the GMC website.
D	The terms were defined by the RCOG, examples were given and the information can be downloaded from the RCOG website.
E	The terms have not been defined.

Scenario 20

Lead in

Which of the following statement is true about the most common grounds for TOP?

Option list

1	TOP is most commonly done on ground A from Certificate A.
2	TOP is most commonly done on ground B from Certificate A.
3	TOP is most commonly done on ground C from Certificate A.
4	TOP is most commonly done on ground D from Certificate A.
5	TOP is most commonly done on ground E from Certificate A.
6	TOP is most commonly done on ground F from Certificate A.
7	TOP is most commonly done on ground G from Certificate A.
8	TOP is most commonly done on ground H from Certificate A..

Scenario 21

Lead in

Which of the following statements is true in relation to the upper gestational limit for TOP to be legal in the UK.

1	Termination of pregnancy is legal to 24 weeks
2	Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly.
3	Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly, but only if approved by the Department of Health’s “Late Termination of Pregnancy Assessment Panel”.
4	Termination of pregnancy is illegal after 24 weeks, but is still done if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly and there is a long-standing agreement that the police and legal authorities will “turn a blind eye”.

Option list

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

Scenario 22

Lead in

Which of the following statement are true in relation to TOP after 24 weeks?

Statements

1	TOP is illegal after 24 weeks
2	The mother must agree to feticide pre-TOP
3	Feticide must be offered
4	There must be very serious grounds for the TOP
5	Gender-selection TOP is unacceptable

Option list

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

Scenario 23

Lead in

Which form relates to certifying that a woman requesting a TOP can have it done legally?

Option list

A	HSA1
B	HSA2
C	HSA3
D	HSA4
E	HSA5

Scenario 24

Lead in

Which form must the practitioner performing the TOP complete to notify the Department of Health that a TOP has been done?

Option list

A	HSA1
B	HSA2
C	HSA3
D	HSA4
E	HSA5

Scenario 25

Lead in

A doctor signing the form giving the grounds for a TOP must have seen the woman.

Option list

A	True
B	False
C	Sometimes
D	Don’t know & don’t care

Scenario 26

Lead in

A doctor performing a TOP must be one of the doctors who signed the initial form giving the grounds for the TOP.

Option list

A	True
B	False
C	Sometimes
D	Don’t know & don’t care

Scenario 27

Lead in

What is the time scale for the return of the form notifying that a TOP has taken place?

Option list

A	3 working days
B	5 working days
C	1 week
D	2 weeks
E	1 month

Scenario 28

Lead in.

A woman seeks 1^st. trimester TOP on social grounds which she declines to discuss in detail.

Which of the following statements apply?

Option List

A	TOP can be done under clause A of Certificate A
B	TOP can be done under clause B of Certificate A
C	TOP can be done under clause C of Certificate A
D	TOP can be done under clause D of Certificate A
E	TOP can be done under clause E of Certificate A
F	TOP can be done under clause F of Certificate A
G	TOP can be done under clause G of Certificate A
F	there is no clause authorising TOP on social grounds

Scenario 29

A woman seeks 1st. trimester TOP. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.

Which of the following statements apply?

A	TOP can be done under clause A of Certificate A
B	TOP can be done under clause B of Certificate A
C	TOP can be done under clause C of Certificate A
D	TOP can be done under clause D of Certificate A
E	TOP can be done under clause E of Certificate A
F	TOP can be done under clause F of Certificate A
G	TOP can be done under clause G of Certificate A
F	there is no clause authorising TOP on these grounds

Scenario 30

A woman books at 26 weeks. She has an unplanned pregnancy. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.

Which of the following statements apply?

A            TOP should be offered under clause A of Certificate A

B            TOP should be offered under clause B of Certificate A

C            TOP should be offered under clause C of Certificate A

D            TOP should be offered under clause D of Certificate A

E            TOP should be offered under clause E of Certificate A

F            TOP should be offered under clause F of Certificate A

G            TOP should be offered under clause G of Certificate A

F            there is no clause authorising TOP on these grounds

67.   EMQ. 2^nd. trimester fetal anomaly scan.

Lead-in.

The following questions relate to the routine 2^nd. trimester fetal anomaly scan.

Abbreviations.

FAS:      fetal anomaly scan.

Option list.

There is none. You must provide the answers.

Question 1.  When should women be informed about the FAS?

Question 2.  When should women be offered the FAS?

Question 3.  What information should women be given about the FAS?

Question 4.  What documentation is essential?

Question 5.  At what gestation should the FAS be done?

Question 6.  The FASP details a number of major conditions to be looked for during the  18⁺⁰ to 20⁺⁶ week scan. How many are there and what are they?

Just write what you know.

Question 7. 

A woman has a vaginal bleed at 18 weeks gestation. An ultrasound scan confirms viability but raises the suspicion of a significant anomaly. She is referred to the local obstetric ultrasound specialist. Within what timescale must she be seen?

Question 8. 

A woman has a vaginal bleed at 18 weeks gestation. An ultrasound scan confirms viability but raises the suspicion of a significant anomaly. She is referred to the fetal medicine unit at the teaching hospital some 10 miles distant as it has a particular interest in the anomaly. Within what timescale must she be seen?