9 February 2017.
74
|
EMQ.
Gestational trophoblastic
disease
|
75
|
EMQ. Gp B
streptococcus
|
76
|
SBA. Needle-stick and
related injuries
|
77
|
SBA. Sutures and needles
|
Question 74. EMQ. Gestational Trophoblastic Disease (GTD)
Abbreviations.
APSN: atypical placental site nodules
GI: gastro-intestinal
GTD: gestational trophoblastic disease
GTN: Gestational trophoblastic neoplasia.
PSTT: placental site trophoblastic tumour
Option list.
A.
|
100%.
|
B.
|
20%.
|
C.
|
15%.
|
D.
|
10%.
|
E.
|
5%.
|
F.
|
2.5%.
|
G.
|
1.5%.
|
H.
|
0.5%.
|
I.
|
1 in 35.
|
J.
|
1 in 55.
|
K.
|
1 in 65.
|
L.
|
1 in 700.
|
M.
|
1 in 1,000.
|
N.
|
Ö64.
|
O.
|
pr2.
|
P.
|
increased.
|
Q.
|
reduced.
|
R.
|
increased by a factor of 2.
|
S.
|
increased by a factor of 5.
|
T.
|
increased by a factor of 10.
|
U.
|
increased by a factor of 20.
|
V.
|
increased by a factor of 30.
|
W.
|
increased by a factor of > 100.
|
X.
|
hydatidiform mole, both partial and complete.
|
Y.
|
hydatidiform mole, both partial and complete and
placental site tumour.
|
Z.
|
partial mole, complete mole, invasive and metastatic
mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid
trophoblastic tumour.
|
AA.
|
choriocarcinoma invasive and metastatic mole and
epithelioid trophoblastic tumour.
|
BB.
|
true
|
CC.
|
false
|
DD.
|
None of the above.
|
Scenario 1.
List the conditions included in
the term GTD. There is no option list, just make a list.
Scenario 2.
What is the difference between GTD and GTN? Pick one
option from the list below.
Option list.
A
|
GTD comprises the non-malignant conditions, i.e.
complete and partial moles.
GTN comprises the malignant conditions: invasive mole,
choriocarcinoma and PSTT
|
B
|
GTD comprises all the trophoblastic conditions; GTN
comprises the malignant conditions
|
C
|
GTD comprises all the trophoblastic conditions; GTN comprises
persistent GTD
|
D
|
GTD comprises all the trophoblastic conditions; GTN comprises
malignant and potentially malignant conditions, including atypical placental
site nodules
|
E
|
none of the above
|
Scenario 3.
What is the incidence of GTD in
the UK?
Scenario 4.
Which of the following
statements, if any, are true of complete hydatidiform molar pregnancy?
A
|
they are usually diploid and
of androgenic origin
|
B
|
are usually triploid, with 2
sets of paternal haploid genes + 1 set of maternal haploid genes
|
C
|
are usually triploid, with 1
set of paternal haploid genes + 2 sets of maternal haploid genes
|
D
|
are tetraploid or mosaics in
up to 10% of cases
|
E
|
up to 80% are due to
duplication of a single sperm in an egg devoid of maternal chromosomes
|
F
|
up to 80% are due to
duplication of a single sperm in a normal egg
|
G
|
usually result from dispermic
fertilisation of a normal egg
|
H
|
usually result from dispermic
fertilisation of an egg devoid of maternal chromosomes
|
I
|
usually has 46XX makeup
|
J
|
usually has 46XY makeup
|
K
|
the presence of fetal red
blood cells defines a mole as partial
|
L
|
mitochondrial DNA is maternal
|
M
|
mitochondrial DNA is paternal
|
Scenario 5.
Which of the following
statements, if any, are true of partial hydatidiform molar pregnancy?
A
|
they are usually diploid and
of androgenic origin
|
B
|
are usually triploid, with 2
sets of paternal haploid genes + 1 set of maternal haploid genes
|
C
|
are usually triploid, with 1
set of paternal haploid genes + 2 sets of maternal haploid genes
|
D
|
are tetraploid or mosaics in
up to 10% of cases
|
E
|
up to 80% are due to
duplication of a single sperm in an egg devoid of maternal chromosomes
|
F
|
up to 80% are due to
duplication of a single sperm in a normal egg
|
G
|
usually result from dispermic
fertilisation of a normal egg
|
H
|
usually result from dispermic
fertilisation of an egg devoid of maternal chromosomes
|
I
|
usually has 46XX makeup
|
J
|
usually has 46XY makeup
|
K
|
the presence of fetal red
blood cells defines a mole as partial
|
L
|
mitochondrial DNA is maternal
|
M
|
mitochondrial DNA is paternal
|
Scenario 6.
Which, if any, of the following
statements are true in relation to GTN?
A
|
always arises from molar
pregnancy
|
B
|
may occur after normal
pregnancy and livebirth
|
C
|
may arise as primary ovarian
neoplasia
|
D
|
the incidence after complete
molar pregnancy is greater than after partial molar pregnancy
|
E
|
the incidence after livebirth
is estimated at 1 in 50,000
|
Scenario 7
A woman had a complete mole in her first pregnancy. She
is pregnant for the second time. What is the risk that it is another molar
pregnancy?
Scenario 8
A woman has had two molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 9
A woman has had three molar pregnancies. What is the risk
of molar pregnancy if she becomes pregnant again?
Scenario 10
Which, if any, of the following statements are correct in
relation to recurrence of molar pregnancy?
A
|
the histological type is likely to be the same
|
B
|
the histological type in recurrent mole after a
complete mole is likely to be partial mole
|
C
|
the histological type in recurrent mole after a partial
mole is likely to be complete mole
|
D
|
the histological type after PSTT is likely to be
choriocarcinoma
|
E
|
none of the above
|
Scenario 11
Cystic placental spaces in the placenta and a ratio of
transverse to anterioposterior
measurements of the gestation sac <1.5 are strongly
suggestive of a partial mole. True / False.
Scenario 12.
What is the risk of persistent GTD after a complete mole?
Scenario 13
What is the risk
of requiring chemotherapy after a complete mole?
Scenario 14
What is the risk of persistent
GTD after a partial mole?
Scenario 15
What is the risk of requiring
chemotherapy after a partial mole?
Scenario 16
What is the risk of requiring chemotherapy
with hCG level > 20,000 i.u. one month after evacuation?
Scenario 17
What is the overall risk of
requiring chemotherapy after molar pregnancy in the UK?
Scenario 18
What is the risk of requiring
chemotherapy in the USA compared with the UK?
Scenario 19
What is the risk of molar
pregnancy at age < 15 compared to age 30?
Scenario 20
What is the risk of molar
pregnancy at age > 45 compared to age 30?
Scenario 21
Which, if any, of the following statements about hCG are
true?
A
|
is a glycoprotein
|
B
|
shares its α sub-unit with
FSH, LH & TSH
|
C
|
shares its α sub-unit with
FSH & LH but not TSH
|
D
|
shares its β sub-unit with
FSH, LH & TSH
|
E
|
shares its β sub-unit with
FSH & LH but not TSH
|
F
|
β-core exists as a sub-type
of β-hCG
|
G
|
nicked free-β exists as a
sub-type of β-hCG
|
H
|
c-terminal peptide exists as
a sub-type of β-hCG
|
I
|
hCG β core fragment may lead
to false –ve results with urine pregnancy tests
|
J
|
heterophile antibodies may
give false +ve hCG results
|
K
|
heterophile antibodies are
not found in urine
|
Scenario 22
What are the risk factors
included in the FIGO scoring system?
Question 75. EMQ.
Group B Streptococcus.
Abbreviations.
EOGBS: early-onset GBS disease.
GBS: Group B streptococcus.
IAP: intrapartum antibiotic
prophylaxis.
Option list.
1. Streptococcus agaractiae
2. Streptococcus intergalacticae
3. Streptococcus agalactiae
4. Streptococcus ubernastiae
5. Lancelot
6. Lanceforth
7. Lanceford
8. Landscape
9. 0.01%
10. 0.02%
11. 0.023%
12. 0.025%
13. 0.05%
14. 0.1%
15. 0.5%
16. 0.53%
17. 0.54%
18. 0.6%
19. 0.63%
20. 0.75%
21. 0.9%
22. 1%
23. 2%
24. 2.3%
25. 2.4%
26. 2.5%
27. 5%
28. 10%
29. 15%
30. 20%
31. 25%
32. 26.3%
33. 21%
34. 30%
35. 35%
36. 1
37. 2
38. 3
39. 5
40. 6
41. 9
42. 10
43. True
44. False
45. you are driving me mad with all these percentages
Scenario 1.
What is the scientific name for
GBS?
Scenario 2.
Which animal is the main
reservoir of GBS in relation to neonatal GBS?
Scenario 2.
What system is used for
grouping streptococci?
Scenario 3.
Where does GBS disease feature
in the list of serious early-onset neonatal infection?
Scenario 4.
What is the upper limit in days
for time of onset in the definition of “early-onset” disease?
Scenario 5.
GBS is a gram-negative,
capsulated organism.
Scenario 6.
What is the incidence of EOGBS
in the UK in the babies of women who have not been screened for GBS or had IAP?
Scenario 7
What is the incidence of EOGBS
in the babies of American women who have had antenatal GBS screening and IAP if
screen +ve?
Scenario 8
What is the mortality rate of
EOGBS in the UK?
Question 76. SBA. Needle-stick, sharps and related risks.
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.
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 horticulturist 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
Answer
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
Answer
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 estimated risk of transmission of infection of HBV in a 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 15.
Lead-in
What is
the estimated risk of transmission of infection of HCV in a SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 16.
Lead-in
What is
the estimated risk of transmission of infection of HIV in a SOE involving
sharps?
Option List
|
|
1 in 2
|
|
|
1 in 3
|
|
|
1 in 30
|
|
|
1 in 300
|
|
|
1 in 1,000 or less
|
Question 17.
Lead-in
What is
the estimated risk of transmission of infection of HIV in a 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 18.
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 19.
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 20.
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 21.
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 22.
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 23.
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 24.
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 25.
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 26.
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.
|
Question 77. SBA.
Sutures and needles.
Abbreviations
Eas: external anal sphincter
Ias: internal anal sphincter
OASI: obstetric anal sphincter injury
SSI: surgical site infection
Question 1.
Lead-in
What is
the incidence of significant infection of abdominal surgical wounds?
Option List
F.
|
≤ 1%
|
G.
|
≤ 3%
|
H.
|
≤ 5%
|
I.
|
≤ 7%
|
J.
|
≤ 10%
|
Question 2.
Lead-in
Which, if
any, of the following statements are true in relation to SSIs?
Option List
A.
|
pre-operative
showering with antiseptic reduces the rate
|
B.
|
pre-operative chemical depilation of the wound site
halves the rate
|
C.
|
povidone-iodine preparations are superior to those with
chlorhexidine
|
D.
|
alcohol based antiseptic preparations are superior to
aqueous
|
E.
|
antiseptic solutions should be applied using sponge not
swab
|
Question 3.
Lead-in
Why do
alcohol-based solutions carry more risk and how can these risks be minimised?
There is
no option list – write your thoughts and compare them with my answer.
Question 4.
Lead-in
Which of
the following terms are used to categorise suture materials?
Option List
F.
|
natural
|
G.
|
synthetic
|
H.
|
monofilament
|
I.
|
coated
|
J.
|
none of the above
|
Question 5.
Which, if
any, of the following are sources of catgut?
Option List
A.
|
cats
|
B.
|
cows
|
C.
|
kangaroos
|
D.
|
sheep
|
E.
|
whales
|
Question 6.
Lead-in
Which of
the following is closest to being the ideal suture material?
Option list
A.
|
natural
|
B.
|
synthetic
|
C.
|
monofilament
|
D.
|
coated
|
E.
|
none of the above
|
Question 7.
Lead-in
What would
be the key characteristics of the ideal suture?
There is
no option list – write as many as you can dream up.
Question 7.
Lead-in
Which
suture is recommended in GTG 29 for the repair of the anal mucosa in OASIs?
Option List
A.
|
2-0
polyglactin
|
B.
|
3-0 polyglactin
|
C.
|
2-0 PDS
|
D.
|
3-0 PDS
|
E.
|
none of the above
|
Question 8.
Lead-in
Which, if
any, of the following suturing techniques are recommended in GTG 29 for the
repair of the anal mucosa in OASIs?
Option List
A.
|
continuous
suture
|
B.
|
figure of 8 suture
|
C.
|
interrupted sutures with the knot buried beneath the
perineal muscles
|
D.
|
interrupted sutures with the knots in the anal canal
|
E.
|
submucosal suture like a subcuticular suture for skin
|
Question 9.
Lead-in
Which
would be the most suitable suture for repair of the mesosalpinx during tubal
re-anastomosis for reversal of sterilisation after tubal ligation?
Option List
F.
|
Vicryl 0
on a cutting needle
|
G.
|
Vicryl 2-0 on a cutting needle
|
H.
|
Vicryl 2-0 on a round-bodied needle
|
I.
|
Vicryl 3-0 on a cutting needle
|
J.
|
Vicryl 3-0 on a round-bodied needle
|
Question 10.
Lead-in
Which
would be the most suitable suture for the tubal surgery necessary during tubal
re-anastomosis for reversal of sterilisation after tubal ligation?
Option List
A.
|
Vicryl
3-0 on a cutting needle
|
B.
|
Vicryl 3-0 on a round-bodied needle
|
C.
|
Vicryl 5-0 on a cutting needle
|
D.
|
Vicryl 5-0 on a round-bodied needle
|
E.
|
Vicryl 7-0 on a cutting needle
|
F.
|
Vicryl 7-0 on a round-bodied needle
|
Question 11.
Lead-in
You are
performing Caesarean section on a woman who has had 2 previous sections. The
bladder is very adherent. You separate it from the lower segment using sharp
dissection and taking great care. You notice a 1 cm. defect in the dome of the
bladder. The ureteric openings are far from the damage. Which suture would you
use for the repair, assuming that you have the training and expertise to
perform it?
Option List
F.
|
Single-layer
repair using interrupted sutures of 2-0 Vicryl
|
G.
|
Two-layer repair using interrupted sutures of 2-0
Vicryl
|
H.
|
Single-layer
repair using interrupted sutures of 3-0 Vicryl
|
I.
|
Two-layer
repair using interrupted sutures of 3-0 Vicryl
|
J.
|
None of the above
|
Question 12.
Lead-in
You are
performing hysterectomy + bilateral salpingo-oophorectomy for menorrhagia and
extensive endometriosis. After dissecting the right ovary free from
adhesion to the pelvic side-wall, you
detect urine and note that the ureter has been cut. It is suitable for
anastomosis.
Which of
the following would you use for the repair, assuming that you have the training
and expertise to perform it?
Option List
A.
|
Single-layer
repair using interrupted sutures of 2-0 Vicryl
|
B.
|
Two-layer repair using interrupted sutures of 2-0
Vicryl + stent
|
C.
|
Single-layer
repair using interrupted sutures of 3-0 Vicryl
|
D.
|
Two-layer
repair using interrupted sutures of 3-0 Vicryl + stent
|
E.
|
None of the above
|
Question 13.
Lead-in
An obese,
woman of 80 years has a laparotomy for debulking of an ovarian malignancy via a
mid-line incision. Which of the following would be most suitable for closing
the abdomen.
Option List
A.
|
0 Vicryl
to muscle / fascia, 2-0 Vicryl to fat, interrupted 2-0 Vicryl to skin
|
B.
|
0 Vicryl to muscle / fascia, 2-0 Vicryl to fat,
interrupted 2-0 Vicryl to skin + fat drain
|
C.
|
mass closure using 0 Vicryl, interrupted 2-0 Vicryl to
skin
|
D.
|
mass closure using 1 Vicryl, interrupted 2-0 Vicryl to
skin
|
E.
|
mass closure using 0 Prolene, interrupted 2-0 Vicryl to
skin
|
Question 14.
Lead-in
You perform Caesarean section for a woman with a breech
presentation. She had a mid-line lower abdominal scar resulting from a
laparotomy some years before. She has requested that you use this scar and is
aware of the slightly increased risk of dehiscence and hernia formation.
Which of the following best describes your decision re
closing the abdomen.
Option List
A.
|
close
each layer separately using 0 Vicryl, don’t close peritoneum
|
B.
|
mass closure using continuous 0 Prolene, peritoneum not
closed
|
C.
|
mass closure using interrupted 0 Prolene, peritoneum
not closed
|
D.
|
mass closure using continuous 0 Vicryl, peritoneum not
closed
|
E.
|
mass closure using 0 Vicryl, peritoneum closed
|
Question 15.
Lead-in
You perform Caesarean section for a primigravida with a
breech presentation. When you close the uterus, which of the following
statements will govern the technique you use.
Option List
A.
|
the
uterus should be exteriorised to maximise access
|
B.
|
the uterus should be explored digitally to exclude
retained products, e.g. a succenturiate lobe of the placenta
|
C.
|
the uterus should be cleaned out with a swab to remove
any debris
|
D.
|
double-layer closure is recommended
|
E.
|
closure of the pelvic peritoneum is recommended
|
Question 16.
Lead-in
A parous
woman has a normal delivery, then a PPH. All conservative measures fail to
arrest the bleeding and you decide to insert a uterine compression suture.
Which of the following statements would apply to what you do.
Option List
A.
|
place
and inflate an intrauterine balloon before inserting the suture to maximise
the effect.
|
B.
|
exteriorise the uterus to reduce the risk of injury to
bowel when placing sutures
|
C.
|
use 1 Vicryl or 1PDS
|
D.
|
use a curved needle of diameter at least 6 cm.
|
E.
|
none of the above
|
We will discuss the CPD questions from TOG. 16.1
You can find them here: http://onlinelibrary.wiley.com/doi/10.1111/tog.12076/epdf.
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