34
|
EMQ. COC. Starting and missed pills
|
35
|
EMQ. Headache
|
36
|
EMQ. MgSO4
use in O&G. List all the points you
think might get a mark in the exam. Think main headings for uses then key
points for each. Think EMQ, SBA and viva.
|
37
|
EMQ. Hepatitis B
|
38
|
EMQ; Clue cells,
koilocytes etc.
|
Question 34. COC Missed pills. Starting the Pill.
Lead-in.
The following scenarios relate to the combined oral
contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at
all.
Abbreviations.
UPSI: unprotected
sexual intercourse.
Option list.
A.
pill that is ≥ 12
hours late.
B.
pill that is > 12
hours late.
C.
pill that is ≥ 24
hours late.
D.
pill that is > 24
hours late.
E.
two missed pills at
any time in a single cycle.
F.
the first pill taken
in one’s first love affair, now recalled with fond nostalgia for its
effectiveness in preventing pregnancy, the Prince having been truly a loathsome
toad.
G.
no additional
contraception required.
H.
additional contraception
required for 7 days.
I.
emergency contraception
should be considered.
J.
emergency
contraception should be recommended.
K.
take the missed pill
immediately, but not if it means 2 pills in one day; no additional
contraception needed; pill-free interval as normal.
L.
take the missed pill
immediately, even if it means 2 pills in one day; no additional contraception
needed; pill-free interval as normal.
M. take the missed pill immediately, even if it means 2 pills
in one day; additional contraception for 7 days; pill-free interval as usual.
N.
take one of the missed
pills immediately, discard the other missed pills, use extra contraception for
7 days and discuss emergency contraception with your doctor.
O.
take the missed pills
immediately, use extra contraception for 7 days and discuss emergency
contraception with your doctor.
P.
continuous combined
preparation.
Q.
bi-phasic preparation.
R.
quadriphasic
preparation.
S.
cannot be answered
from the data given.
T.
none of the above.
Scenario 1.
What is the definition of a
missed pill?
Scenario 2.
What is the definition of two
missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice
should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What
advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation.
The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a
21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a
21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the
first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the
second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack.
What advice should be given?
Scenario 11
What kind of preparation is
Qlaira?
Scenario 12
What advice does the FSRH give
in relation to CHC use by women who are breastfeeding?
Option list.
A.
|
UKMEC 1
|
B.
|
UKMEC 1 until 6 weeks then
UKMEC 2
|
C.
|
UKMEC 2 until 6 weeks then
UKMEC 1
|
D.
|
UKMEC 3
|
E.
|
UKMEC 4
|
Scenario 13
At what age does the FSRH
advise that women should stop using CHC?
Pick the statement from the
option list that best reflects the FSRH’s advice
Option list.
F.
|
there is no age limit if the
woman has no risk factors for VTE or medical contraindications
|
G.
|
the age limit is 50 if the
woman has no risk factors for VTE or medical contraindications
|
H.
|
the age limit is 55 if the
woman has no risk factors for VTE or medical contraindications
|
I.
|
contraception is not needed
for women ≥ 55 years.
|
J.
|
none of the above
|
Scenario 14
Add the risk of VTE per 10,000
women years to the right column for each category.
Category
|
Risk per 10,000 women per year
|
Reproductive age not using
CHC
|
|
Pregnancy
|
|
Puerperium
|
|
CHC progestogens 1
|
|
CHC progestogens 2
|
|
“Evra” transdermal patch (
|
|
“NuvaRing” vaginal ring
|
Progestogens 1 are: levonorgestrel,
norethisterone & norgestimate
Progestogens 1 are: desogestrel,
Dienogest, drospirenone, gestodene & nomegestrol
List of possible risks.
Risk per 10,000 women per year
|
2
|
15
|
29
|
300-400
|
500-600
|
5 - 7
|
6 - 12
|
9 - 12
|
9 - 15
|
Scenario 15
What is the risk of death for a
woman having a VTE on CHC?
Option list
A.
|
0.1%
|
B.
|
1%
|
C.
|
2%
|
D.
|
5%
|
E.
|
10%
|
The
document has 10 MCQs at the end. As these are picked out as important facts, it
is likely that the exam committee will have woven them into EMQs or SBAs, so
you should know the answers.
1 The bleed
experienced during the pill-free week is a natural menstrual bleed. T
F
2 Contraceptive
efficacy of the combined transdermal patch (CTP) may be decreased in women
weighing >90 kg. T
F
3 CHC can be
started at any time in the cycle if the clinician is reasonably certain the woman
is not pregnant. T F
4 If switching
from the POP to CHC, additional contraceptive protection is not required. T
F
5 The CTP can be
detached for 48 hours before contraceptive efficacy is decreased. T F
6 Lamotrigine
affects contraceptive efficacy of CHC. T F
7 The risk of
venous thromboembolism (VTE) when using CHC is highest in the first few months
of use. T F
8 UK Medical
Eligibility Criteria for Contraceptive Use states that having a 1st.-degree
relative with a history of VTE under the age of 45 years is UKMEC 3. T F
9 CHC can be used
if there is a family history of breast cancer without genetic mutation. T F
10 CHC is not
thought to cause weight gain. T F
Question 35. Headache.
Lead-in.
The following scenarios relate to headache in pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
1. abdominal migraine
2. analgesia overuse headache aka medication overuse headache
3. bacterial meningitis
4. benign intracranial hypertension
5. BP check
6. cerebral venous sinus thrombosis
7. chest X-ray
8. cluster headache
9. severe PET / impending eclampsia
10. malaria
11. meningococcal meningitis
12. methyldopa
13. methysergide
14. migraine
15. MRI brain scan
16. nifedipine
17. nitrofurantoin
18. pancreatitis
19. sinusitis
20. subdural haematoma
21. subarachnoid haemorrhage
22. tension headache
23. ultrasound scan of the abdomen
Scenario 1.
A 40-year-old para 3 is
admitted at 38 weeks by ambulance with severe headache of sudden onset. She
describes it as “the worst I’ve ever had”. Which diagnosis needs to be excluded
urgently?
Scenario 2.
A 32-year-old para 1 has
recently experienced headaches. They are worse on exercise, even mild exercise
such as walking up stairs. She experiences photophobia with the headaches.
Which is the most likely diagnosis?
Scenario 3.
A woman returns from a
sub-Saharan area of Africa. She develops severe headache, fever and rigors.
What diagnosis should particularly be in the minds of the attending doctors?
Scenario 4.
A woman at 37 weeks has headaches. They particularly
occur at night without obvious triggers. They occur every few days.
Scenario 5.
A primigravida has had headaches on a regular basis for
many years. They occur most days, are bilateral and are worse when she is
stressed. What is the most likely diagnosis?
Scenario 6.
A woman complains of recent
headaches at 36 weeks. The history reveals that the headaches started soon
after she began treatment with a drug prescribed by her GP. Which is the most
likely of the following drugs to be the culprit: 7. methyldopa, methysergide, nifedipine and Nitrofurantoin?
Scenario 7
A woman is booked for Caesarean
section and wishes regional anaesthesia. She had severe headache due to dural
tap after a previous Caesarean section. She wants to take all possible steps to
reduce the risk of having this again. Which of epidural and spinal anaesthesia has the lower risk of causing
dural tap headache?
Scenario 8
A 25-year-old primigravida
complains of headaches which started two weeks before when she attends for her
20 week scan. There is no significant history of previous headache. The pain
occurs behind her right eye and she describes it as severe and “stabbing” in
nature. The pain is so severe that she cannot sit still and has to walk about.
She has noticed that her right eye becomes reddened and “watery” during the
attack and her nose is “runny”. The attacks have no obvious trigger and mostly
occur a few hours after she has gone to sleep. The usually last about 20
minutes. She has no other symptoms. She smokes 20 cigarettes a day but does not
take any other drugs, legal or otherwise. What is the most likely diagnosis?
Scenario 9
A woman has a 5-year history of
unilateral, throbbing headache often preceded by nausea, visual disturbances,
photophobia and sensitivity to loud noise. What is the most likely diagnosis?
Scenario 10
A primigravida is admitted at 38 weeks complaining of
headache, abdominal pain and a sensation of flashing lights. What would be the
appropriate initial investigation?
Scenario 11
A woman with BMI of 35 attends for her combined Downs
syndrome screening test. She complains of pain behind her eyes. The pain is
worst last thing at night before she goes to sleep or if she has to get up in
the night. She has noticed she has noticed horizontal diplopia on several occasions. She has no other symptoms.
Examination shows papilloedema.
Scenario 12
A grande multip of 40 years experienced sudden-onset,
severe headache, vomited several times and then collapsed, all within the space
of 30 minutes. She is admitted urgently in a semi-comatose state. Examination
shows neck-stiffness and left hemi-paresis.
Scenario 13.
What did the MMR include as
“red flags” for headache in pregnancy? These are not on the option list – you
need to dig them out of your head.
Question 36. Magnesium sulphate use in O&G.
MgSO4 use in O&G.
List all the points you think might get a mark
in the exam. Think of main headings for uses then key points for each. Think
EMQ, SBA and viva.
Question 37. Hepatitis B and pregnancy.
Instructions.
For each
scenario, select the most appropriate option from the option list.
Each option
can be used once, more than once or not at all.
Abbreviations.
CNP: Handbook
of Obstetric Medicine. 5th. Edition. Catherine Nelson-Piercy. CRC
Press. 2015.
HAV: hepatitis
A virus
HBcAg: hepatitis
B core antigen
HBeAg: hepatitis
B e antigen
HBsAg: hepatitis
B surface antigen
HBcAb: antibody
to hepatitis B core antigen
HBeAb: antibody
to hepatitis B e antigen
HBsAb: antibody
to hepatitis B surface antigen
HBIG: hepatitis
B immunoglobulin
HBV: hepatitis
B virus
HBcAg: hepatitis
B core antigen
HBeAg: hepatitis
B e antigen
HBsAg: hepatitis
B surface antigen
HBcAb: antibody
to hepatitis B core antigen
HBeAb: antibody
to hepatitis B e antigen
HBsAb: antibody
to hepatitis B surface antigen
HBIG: hepatitis
B immunoglobulin
HCV: hepatitis
C virus
HEV: hepatitis
E virus
HSV: herpes
simplex virus
VT: vertical
transmission
Option list.
A.
|
acyclovir
|
B.
|
divorce
|
C.
|
HBcAg
+ve
|
D.
|
HBeAg
+ve
|
E.
|
HbsAg
+ve
|
F.
|
HBsAg
+ve; HBsAb –ve; HBcAb –ve; HBeAg +ve
|
G.
|
HBsAg
+ve; HBsAb –ve on two tests six months apart
|
H.
|
HBsAg
-ve; HBsAb -ve on two tests six months apart
|
I.
|
HBsAg
-ve; HBsAb +ve; HBcAb –ve
|
J.
|
HBsAg
-ve; HBsAb +ve; HBcAb +ve
|
K.
|
HBsAg
-ve; HBsAb +ve
|
L.
|
HBsAg
+ve; HBcAg +ve
|
M.
|
HBV
vaccine
|
N.
|
HBIG
|
O.
|
HBV
vaccine + HBIG
|
P.
|
immune
as a result of infection
|
Q.
|
immune
as a result of vaccination
|
R.
|
not
immune
|
S.
|
chronic
carrier of HBV infection
|
T.
|
10%
|
U.
|
30%
|
V.
|
50%
|
W.
|
60%
|
X.
|
70-90%
|
Y.
|
soap
and boiling water
|
Z.
|
10%
dilution of bleach in water
|
AA.
|
10%
dilution of formaldehyde in alcohol
|
BB.
|
ultraviolet
irradiation
|
CC.
|
yes
|
DD.
|
no
|
EE.
|
HAV
|
FF.
|
HBV
|
GG.
|
HCV
|
HH.
|
HEV
|
II.
|
HSV
|
JJ.
|
none
of the above
|
Scenario 1.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she has an acute HBV infection?
Scenario 2.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she is immune to the HBV as a result of infection?
Scenario 3.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What results on routine blood testing would indicate
that she is immune to the HBV as a result of HBV vaccine?
Scenario 4.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 9 months ago. What results on routine blood testing would show that
she is a chronic carrier of HBV infection?
Scenario 5.
Testing shows
that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb.
What does this mean in relation to his HBV status?
Scenario 6.
Testing shows
that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.
What does this
mean in relation to his HBV status?
Scenario 7.
How
common is chronic HBV carrier status in UK pregnant women?
Scenario 8.
What
is the risk of death from chronic HBV carrier status?
Scenario 9.
A
primigravid woman at 8 weeks gestation is found to be non-immune to HBV. She
has recently married and her husband is a chronic carrier. What should be done
to protect her from infection?
Scenario 10.
A
woman is a known carrier of HBV. What is the risk of vertical transmission in
the first trimester?
Scenario 11.
What
is the risk of the neonate who has been infected by vertical transmission becoming
a carrier without treatment?
Scenario 12.
Should
antiviral maternal therapy in the 3rd. trimester be considered for
women with HBeAg or high viral load?
Scenario 13.
How
effective is hepatitis B prophylaxis for the neonate in preventing chronic carrier
status as a result of vertical transmission?
Scenario 14.
Can
a woman who is a chronic HBV carrier breastfeed safely?
Scenario 15.
Hepatitis B
infection is the most dangerous of the viral hepatitis infections in pregnancy.
Scenario 16.
A
pregnant woman who is not immune to HBV has a partner who is a chronic carrier.
Can HBV vaccine be administered safely in pregnancy?
Scenario 17.
A
pregnant woman who is not immune has a partner with acute hepatitis due to HBV.
He cuts his hand and bleeds onto the kitchen table. How should she clean the
surface to ensure that she gets rid of the virus?
Scenario 18.
Is it true
that the presence of HBeAg in maternal blood is a particular risk factor for
vertical transmission? Not really a scenario, but never mind!
Scenario 19.
Does
elective Cs before labour and with the membranes intact reduce the vertical
transmission rate?
Scenario 20.
Which
hepatitis virus normally produces a mild illness, but represents a major risk
to pregnant women, with a mortality rate of up to 5%?
Scenario 21.
A
pregnant woman has a history of viral hepatitis and informs the midwife at
booking that she is a carrier and that she has a significant risk of cirrhosis
and has been advised not to drink alcohol. Which is the most likely hepatitis
virus?
Scenario 22.
Which
hepatitis virus is an absolute contraindication to breastfeeding after
appropriate treatment of the infected mother and prophylaxis for the baby?
Scenario 23.
Which
hepatitis virus is linked to an increased risk of obstetric cholestasis?
Question 38. Clue cells, koilocytes etc.
Lead-in.
The following scenarios relate to genital infection.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
Ct: Chlamydia trachomatis
HSV: Herpes simplex virus
LGV: lymphogranuloma venereum
Ng: Neisseria gonorrhoeae
Tv: Trichomonas vaginalis
Option list.
A
|
Actinomyces
|
B
|
Bacterial vaginosis
|
C
|
Bacteroides
|
D
|
Chlamydia trachomatis
|
E
|
Chlamydial infection of the genital tract
|
F
|
Herpes Simplex
|
G
|
Human Papilloma Virus
|
H
|
Lymphogranuloma venereum
|
I
|
Monilia
|
J
|
Neisseria gonorrhoeae
|
K
|
Trichomonas vaginalis
|
Scenario 1.
Which option or options from
the option list best fit with “clue cells”
Scenario 2.
Which
option or options from the option list best fit with “fishy odour”?
Scenario 3.
Which
option or options from the option list best fit with “flagellate organisms”?
Scenario 4.
Which
option or options from the option list best fit with “inflammatory smear”?
Scenario 5.
Which
option or options from the option list best fit with “koilocytes”?
Scenario 6.
Which
option or options from the option list best fit with “non-specific urethritis
in the male”?
Scenario 7.
Which
option or options from the option list best fit with “strawberry cervix”?
Scenario 8.
Which
option or options from the option list best fit with “thin grey/ white
discharge”?
Scenario 9.
Which
option or options from the option list best fit with “white, curdy discharge”?
Scenario 10.
Which
option or options from the option list best fit with “frothy yellow discharge”?
Scenario 11.
Which option or options from the option list best fit
with “protozoan”?
Scenario 12.
Which option or options from the option list best fit
with “obligate intracellular organism”?
Scenario 13.
Which option or options from the option list best fit
with “blindness”?
Scenario 14.
Which option or options from the option list best fit
with “LGV”?
Scenario 15.
Which option or options from the option list best fit
with “multinucleated cells”?
Scenario 16.
Which option or options from the option list best fit
with “serotypes D–K”?
Scenario 17.
Which option or options from the option list best fit
with “serovars L1-L3”?
Scenario 18.
Which of the following are true in relation to Amsel’s
criteria?
A
|
used for the diagnosis of
bacterial vaginosis
|
B
|
used for the diagnosis of
trichomonal infection
|
C
|
clue cells present on
microscopy of wet preparation of vaginal fluid
|
D
|
flagellate organism present
on microscopic examination of vaginal fluid
|
E
|
pH ≤ 4.5
|
F
|
pH > 4.5
|
G
|
thin, grey-white, homogeneous
discharge present
|
H
|
frothy, yellow-green
discharge present
|
I
|
fishy smell on adding alkali
(10%KOH)
|
J
|
fishy smell on adding acid
(10%HCl)
|
K
|
koilocytes present
|
L
|
absence of vulvo-vaginal
irritation
|
Scenario 19.
Which of the following are true in relation to Nugent’s
Amsel’s criteria?
A
|
used for the diagnosis of
bacterial vaginosis
|
B
|
used for the diagnosis of
trichomonal infection
|
C
|
clue cells present on
microscopy of wet preparation of vaginal fluid
|
D
|
pH ≤ 4.5
|
E
|
pH > 4.5
|
F
|
count of lactobacilli
|
G
|
count of Gardnerella and
Bacteroides
|
H
|
count of white cells
|
Scenario 20.
Garnerella vaginallis can be cultured from the vagina of
what proportion of normal women?
A
|
< 10%
|
B
|
11 - 20%
|
C
|
21 - 30%
|
D
|
31 - 40%
|
E
|
41 - 50%
|
F
|
> 50%
|
how can i find keys to these questions to correct myself.
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