2 February 2017.
|
67
|
EMQ. Puerperal
mental illness
|
|
68
|
SBA. WHO criteria for a
screening programme
|
|
69
|
EMQ. Kallmann’s syndrome
|
|
70
|
SBA. Recurrent
miscarriage.
|
Question 67. EMQ.
Puerperal mental illness.
Puerperal mental illness.
Lead-in.
The following scenarios relate to puerperal mental
illness.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
If I had put all the answers into the option list it
would have been enormous. So there are quite a few where you need to decide
what your answer would be. Opting for “none of the above” is not exercising
your brain – make sure you come up with an answer.
Option list.
a.
arrange admission to hospital
under Section 5 of the Mental Health Act
b.
send a referral letter
to the perinatal psychiatrist requesting an urgent appointment.
c.
send an e-mail to the
perinatal psychiatrist requesting an urgent appointment.
d.
phone the community
psychiatric team.
e.
phone the on-call
psychiatrist.
f.
arrange to see the
patient in the next ante-natal clinic.
g.
arrange to see the
patient urgently.
h.
send a referral letter
to the social services department.
i.
phone the fire
brigade.
j.
phone the police.
k.
there is no such
thing.
l.
4 weeks
m. 6 weeks
n.
12 weeks
o.
26 weeks
p.
1 year
q.
<1%
r.
1-5%
s.
5-10%
t.
10-20%
u.
25%
v.
50%
w. 60%
x.
70%
y.
80%
z.
True
aa. False
bb. none of the above.
Scenario 1
What is the internationally
agreed classification for postpartum psychiatric disease?
Scenario 2
What time limits does DSM-IV
use for postpartum psychiatric disorders?
Scenario 3
What time limits does ICD-10
use for postpartum psychiatric disorders?
Scenario 4
What clinical classification
would you use in a viva?
Scenario 5
What is the incidence of
suicide in relation to pregnancy and the puerperium?
Scenario 6
What are the main conditions
associated with suicide in pregnancy and the postnatal period?
Scenario 7
Most suicides occur in single
women of low social class who have poor education. True / False
Scenario 8
The preferred method of suicide
reported in recent MMRs was drug overdose. True / False.
Scenario 9
When are women with Social
Services involvement particularly at risk of suicide.
Scenario 10
Which women have the highest
risk for puerperal psychosis and what is the risk?
Scenario 11.
What is the risk of puerperal
psychosis for a primigravida with BPD?
Scenario 12
What is the risk of PP in a
woman with no history of psychiatric illness but who has a FH of PP?
Scenario 13
Should screening include the
identification of women with no history of psychiatric illness but who has a FH
of PP?
Scenario 14
What do the Confidential Enquiries into Maternal Deaths
say about the use of the term “postnatal depression”?
Scenario 15
Women with schizophrenia have a
≥ 25% risk of puerperal recurrence. True / False
Scenario 16
If lithium therapy for BPD is
stopped in pregnancy, there is an increased risk of severe puerperal illness.
True / False.
Scenario 17
You are the on-call SpR for obstetrics. A woman has just
had a normal delivery of a 30 week baby that requires resuscitation. The mother
says that the baby must be left alone and not resuscitated. The paediatric SpR
and midwives are uncertain about what to do. What action will you take?
Scenario 18
You are the on-call SpR for obstetrics. The midwife on
the postnatal ward phones for advice. A primigravida who delivered yesterday
has stated that the baby is not hers and is refusing to care for it. What
action will you take?
Scenario 19
You are the on-call Consultant in O&G. The community
midwife has phoned for advice. She was asked to visit a primiparous woman who
had a normal delivery seven days before. The husband reports that she has
struck him several times. The woman tells her that voices have informed her
that this man is not her husband and that she should drive him away in case he
rapes her. What action will you take?
Scenario 20
You are the on-call Consultant in O&G. The community
midwife has phoned. She has just been phoned by a woman who had a Caesarean
section for breech presentation four weeks ago. She has been told by God that
breech babies are the spawn of the Devil and she is going to the local
multi-storey car park to jump off with the baby so that the baby cannot grow up
and harm people and so that she cannot have more Devil babies. What action will
you advise?
Question 68. 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
|
A.
|
the test should acceptable to the population to be
screened
|
|
B.
|
the natural history of the condition should be fully
understood, particularly the factors causing progression from latent to
established disease
|
|
C.
|
there should be agreement on whom to treat
|
|
D.
|
the financial cost of the screening programme and any
consequent treatments should be reasonable in relation to the available
budget for medical care
|
|
E.
|
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
|
Question 69. Kallmann’s syndrome.
Abbreviations.
Ks: Kallmann’s syndrome
Scenario 1.
Which of the following might be
included in descriptions of Kallmann’s syndrome?
Option list.
|
A
|
hypogonadotrophic hypogonadism
|
|
B
|
hypogonadotrophic hypogonadism + anosmia
|
|
C
|
hypogonadotrophic hypogonadism + anosmia +
colour-blindness.
|
|
D
|
hypogonadotrophic hypogonadism due to uterine agenesis
|
Scenario 2.
Lead in.
Which, if any, of the following are features of the Kallmann
phenotype?
|
A
|
absent or minimal breast development
|
|
B
|
aortic stenosis
|
|
C
|
blue eyes
|
|
D
|
blue hair
|
|
E
|
hot flushes
|
|
F
|
short stature
|
|
G
|
tall stature
|
|
H
|
vaginal agenesis
|
|
I
|
none of the above
|
Scenario 3.
How common is Kallmann’s syndrome and what is the
female: male ratio?
|
A
|
1 in 1,000 and F:M ratio 1:1
|
|
B
|
1 in 5,000 and F:M ratio 1:1
|
|
C
|
1 in 10,000 and F:M ratio 1:4
|
|
D
|
1 in 50,000 and F:M ratio 1:4
|
|
E
|
1 in 100,000 and F:M ratio 1:8
|
|
F
|
1 in 250,000 and F:M ration 1:10
|
Scenario 4.
What is the most common mode of
inheritance of Ks?
Option list.
|
A
|
hypogonadotrophic hypogonadism
|
|
B
|
hypogonadotrophic hypogonadism + anosmia
|
|
C
|
hypogonadotrophic hypogonadism due to uterine agenesis
|
|
D
|
autosomal dominant
|
|
E
|
autosomal recessive
|
|
F
|
X-linked recessive
|
|
G
|
new mutation of the ANOS1 gene
|
|
H
|
the most common mode of inheritance is not known
|
Scenario 5.
How is Kallmann’s syndrome
diagnosed?
|
A
|
abdominal and pelvic
ultrasound scan
|
|
B
|
cell-free fetal DNA
|
|
C
|
chromosome analysis
|
|
D
|
CT scan of hypothalamus /
pituitary
|
|
E
|
MR scan of hypothalamus /
pituitary
|
|
F
|
none of the above.
|
Scenario 6.
How is Kallmann’s syndrome
treated initially?
Which of the following
statements are true?
Option list.
|
A
|
GnRH analogue depot
|
|
B
|
pulsatile GnRH therapy
|
|
C
|
combined oral contraceptive
|
|
D
|
counselling & education
re gender re-assignment
|
|
E
|
depot progestogen
|
|
F
|
none of the above
|
Scenario 7.
A woman was diagnosed with
Kallmann’s syndrome at 16 and had successful initial treatment. She is now 25,
married and wishes to have a pregnancy. She has had pre-pregnancy assessment
and counselling. Which of the following can be considered?
|
A
|
GnRH analogue depot
|
|
B
|
induction of ovulation with
clomiphene
|
|
C
|
gonadotrophin therapy
|
|
D
|
pulsatile GnRH therapy
|
|
E
|
none of the above
|
Question 70. Recurrent
Miscarriage.
This question and answer are
derived from a question written by Selvambigai Raman.
Abbreviations.
EPAS: early pregnancy assessment service.
EPU: dedicated early pregnancy assessment
unit.
GDG: guideline development group.
GGT: Gamma-glutamyl transferase.
GTD: gestational trophoblastic disease.
NK: natural killer.
PCOS: polycystic ovary syndrome.
PIGD: pre-implantation genetic diagnosis.
PIGS: pre-implantation genetic screening.
RM: recurrent miscarriage.
TORCH: Toxoplasmosis, rubella, cytomegalovirus
& herpes. (Other definitions include HIV, syphilis and other infections.)
Fortunately, TORCH screening is out-of-date, exact definitions are not
important, though I’d stick with the first if asked.
UA: uterine anomaly.
Question 1.
Lead-in
In relation
to miscarriage, which, if any, of the following statements are correct?
- the
term “spontaneous miscarriage” is really stupid
- most
miscarriages are genetic in causation.
- most
women who miscarry do not get a diagnosis of causation
- the
majority of women have significant levels of psychological distress after
miscarriage.
- counselling
is of significant benefit in reducing levels of psychological distress
after miscarriage.
Option List
|
A.
|
i + ii
|
|
B.
|
i + ii + iii
|
|
C.
|
i + ii + iii + iv
|
|
D.
|
i + ii + iii + v
|
|
E.
|
i + ii + iii + iv + v
|
Question 2.
Lead-in
Which of the
following statements are true.
- miscarriage
occurs in 11% of women with age 20-24 years
- miscarriage
occurs in 25% of women with age 35-39 years
- miscarriage
occurs in > 90% of mothers with age ≥ 45 years
- recurrent
miscarriage affects about 1% of couples
- recurrent
miscarriage affects about 5% of couples
Option List
|
A.
|
i + ii
|
|
B.
|
i + iii
|
|
C.
|
i + ii + iv
|
|
D.
|
i + iii + v
|
|
E.
|
i + ii + iii + iv
|
Question 3.
Lead-in
What figure
is usually given for the overall incidence of miscarriage?
Option List
|
A.
|
< 10
%
|
|
B.
|
10 - 20%
|
|
C.
|
20 - 25%
|
|
D.
|
25 – 30
%
|
|
E.
|
>30%
|
Question 4.
Lead-in
A healthy, 26-year-old, woman attends the booking clinic at
6 weeks in her first pregnancy. A pregnancy test is +ve. Her best friend
recently had an early miscarriage and she is concerned about her risk. What
risk will you quote?
Option List
|
A.
|
≤ 5%
|
|
B.
|
5 – 10%
|
|
C.
|
10 – 15%
|
|
D.
|
15 – 20%
|
|
E.
|
≥ 20%
|
Question 5.
Lead-in
The same healthy woman attends the ANC at 8 weeks for a
dating scan. Before she has the scan she asks you what her risk is now. She has
had no abnormal symptoms. What risk will you quote?
Option List
|
A.
|
≤ 5%
|
|
B.
|
5 – 10%
|
|
C.
|
10 – 15%
|
|
D.
|
15 – 20%
|
|
E.
|
≥ 20%
|
Question 6.
Lead-in
The same healthy, nulliparous woman comes back to see you
after the scan. The scan is normal and shows a viable fetus. She asks what her
risk is now. What risk will you quote?
Option List
|
|
≤ 5%
|
|
|
5 – 10%
|
|
|
10 – 15%
|
|
|
15 – 20%
|
|
|
≥ 20%
|
Question 7.
Lead-in
Pick the best
option from the list below for the definition of RM.
Option List
|
|
two or more miscarriages
|
|
B.
|
two or more miscarriages in healthy women
|
|
C.
|
three or
more miscarriages
|
|
D.
|
three or
more miscarriages in women with no children
|
|
E.
|
none of the above.
|
Question 8.
Lead-in
The following
are possible causes of RM except for one. Pick the best option for the
exception.
Option List
|
|
increased
maternal age
|
|
|
maternal cigarette smoking
|
|
|
maternal alcohol consumption
|
|
|
exposure to anaesthetic gases
|
|
|
exposure to emissions from video display terminals
|
Question 9.
Lead-in
A woman presents to
antenatal clinic for booking at 6 weeks. She has a history of 3 RMs with no
explanation found after full investigation. What is her risk of miscarriage in
this pregnancy?
Option List
|
A.
|
≤ 10%
|
|
B.
|
20%
|
|
C.
|
25%
|
|
D.
|
50%
|
|
E.
|
75%
|
Question 10.
Lead-in
A 35-year-old woman with a
history of 3 RMs presents to you for advice regarding the risk of miscarriage
if she conceives. Pick the best option to describe her risk from
the list below.
Option List
|
F.
|
20%
|
|
G.
|
30%
|
|
H.
|
40%
|
|
I.
|
50%
|
|
J.
|
55%
|
Question 11.
Lead-in
The following statement
relates to women with arcuate uteri.
There is evidence to suggest
that women with arcuate uteri:
i. tend
to miscarry more in first trimester
ii. tend
to miscarry more in second trimester
iii. have
no increased risk of miscarriage
iv. are
at increased risk of cephalo-pelvic disproportion
v. are
at increased risk of Caesarean section
Pick the
best option from the list below.
Option List
|
A.
|
i
|
|
B.
|
i + v
|
|
C.
|
ii + iv
|
|
D.
|
ii + v
|
|
E.
|
iii + v
|
Question 12.
Lead-in
With
regards to EPUs, which of the following statements, if any, are true.
i.
all
women with pain + bleeding in early pregnancy can self-refer to an EPU
ii.
all
women with pain + bleeding in early pregnancy should be seen by a health
professional before referral to an EPU
iii.
women
with a history of ectopic pregnancy, molar pregnancy or recurrent miscarriage
should be able to self-refer to an EPU
iv.
women
with a history of puerperal psychosis should be able to self-refer to an EPU
Option List
|
A.
|
i
|
|
B.
|
ii
|
|
C.
|
iii
|
|
D.
|
iv
|
|
E.
|
iii + iv
|
Question 13.
Lead-in
Which, if
any, of the following investigations should be done for a couple with 1st
trimester RM?
i.
APS
screen
ii.
Fragile
X syndrome screen
iii.
HbA1c
iv.
hysterosalpingogram
v.
inherited
thrombophilia screen
vi.
karyotyping
vii.
NK
cells in peripheral blood
viii.
thyroid
function tests
ix.
TORCH
screen
Option List
|
A.
|
i
|
|
B.
|
i + v
|
|
C.
|
i + ii + v + vi + viii + ix
|
|
D.
|
i + iii
+ iv + v + vi + vii + viii + ix
|
|
E.
|
all of the above except vii
|
Question 14.
Lead-in
Which, if
any of the following treatments should be offered to women with RM and evidence
of APS?
Option List
|
i.
|
low-dose
aspirin + clopidogrel
|
|
ii.
|
low-dose aspirin + LMWH
|
|
iii.
|
low-dose aspirin + LMWH + low-dose corticosteroids
|
|
iv.
|
low-dose aspirin + unfractionated heparin
|
|
v.
|
low-dose aspirin
+ unfractionated heparin + low-dose corticosteroids
|
Question 15.
Lead-in
Which, if
any, of the following treatments are of proven benefit in improving outcomes in
unexplained RM?
i.
cervical
cerclage
ii.
hCG
iii.
leptin
iv.
LH
v.
metformin
vi.
rectal
or vaginal progesterone
vii.
supportive
therapy in a dedicated EPU
viii.
PIGS
Option List
|
A.
|
i + ii
|
|
B.
|
i + vi +
vii
|
|
C.
|
ii + vi + vii + vii
|
|
D.
|
vii
|
|
E.
|
none of the above
|
Question 16 .
Lead-in
With
regard to the role of PIGS in the management of women with unexplained RM,
which, if any, of the following statements are true.
i.
PIGS
is of proven benefit in unexplained RM
ii.
PIGS is regulated by the HFEA
iii.
PIGD and PIGS are different names for the same
process
Option List
|
A.
|
i
|
|
B.
|
ii
|
|
C.
|
i + ii
|
|
D.
|
i + ii +
iii
|
|
E.
|
none of the above
|
Question 17.
Lead-in
Pick the
most appropriate option from the list below about the risk of miscarriage in
women with PCOS and a history of RM who conceive spontaneously.
Option List
|
F.
|
increased
serum LH levels predict an increased risk of miscarriage
|
|
G.
|
Increased testosterone levels predict an increased risk of
miscarriage
|
|
H.
|
Decreased androgen levels predict an increased risk of miscarriage
|
|
I.
|
Typical PCOS ovarian morphology predicts an increased risk of miscarriage
|
|
J.
|
Hyperinsulinaemia predicts an increased risk of miscarriage
|
No comments:
Post a Comment