|
17
|
EMQ. Cervical cancer staging
|
|
18
|
EMQ. Parvovirus
|
|
19
|
EMQ. Mental Capacity Act
|
|
20
|
EMQ. Confidentiality
& consent
|
|
21
|
EMQ. Hepatitis B
|
|
22
|
EMQ. Clue cells,
koilocytes etc.
|
17. Cervical
cancer staging
Lead-in.
The following scenarios relate to cervical cancer
staging.
For each, select the most appropriate staging.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Scenario 1.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 2 mm and 6 mm in width. The resection margins are tumour-free. There
is no evidence of spread outside the uterus. She is nulliparous and wishes to
retain her fertility.
Scenario 2.
A woman of 25 has a cone biopsy. The histology report
shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width.
The resection margins are tumour-free. There is no evidence of spread outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 3.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 5 mm and 6 mm in width. The resection margins are not tumour-free. There
is no evidence of spread outside the uterus. She is nulliparous and wishes to retain
her fertility.
Scenario 4.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 3 cm in width. The resection margins are tumour-free. There
is no evidence of extension outside the uterus. She is nulliparous and wishes to
retain her fertility.
Scenario 5.
A woman of 25 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 6 mm and 5 cm in width. The resection margins are tumour-free. She is
nulliparous and wishes to retain her fertility.
Scenario 6.
A woman of 38 has a cone
biopsy. The histology report shows squamous cell carcinoma penetrating to a
depth of 4 mm and 6mm in width. The resection margins are tumour-free. An MR
scan shows involvement of the lymphatic nodes in the left of the pelvis.
Scenario 7.
A woman of 45 has carcinoma of
the cervix. It extends into the parametrium, but not to the pelvic side-wall.
It involves the upper 1/3 of the vagina. There is MR evidence of para-aortic
node involvement.
Scenario 8.
A woman of 55 has carcinoma of
the cervix. It extends to the pelvic side-wall. It involves the upper 1/3 of
the vagina. She has a secondary on the end of her nose.
Scenario 9.
A woman of 55 has carcinoma of
the cervix. It involves the bladder mucosa.
Scenario 10.
A woman of 35 has a proven
cancer of the cervix with extension into the right parametrium, but not to the
pelvic side-wall. Left hydroureter and left non-functioning kidney are noted on
IVP and there is no other explanation for the findings. Cystoscopy shows
bullous oedema of the bladder mucosa.
Scenario 11.
A woman of 25 has a cone
biopsy. It shows malignant melanoma. The lesion invades to a depth of 3 mm and
is 5 mm in width. The margins of the biopsy are clear. There is evidence of
lymphatic vessel involvement. There is no evidence of spread outside the
uterus.
Option list.
Micro-invasive cervical cancer.
Stage Ia1
Stage Ia2
Stage Ia3
Stage Ib1
Stage Ib2
Stage Ib3
Stage IIa
Stage IIb
Stage IIc
Stage IIIa
Stage IIIb
Stage IIIc
Stage IVa
Stage IVb
Stage IVc
Stage Va
Stage Vb
Stage Vc
None of the above.
This question illustrates the problems surrounding
staging. If you are not a cancer specialist, it is not something that you think
about very often, if ever. So you have to put it into your list of things to revise
in the days before the exam. If you haven’t started this list, do so now.
18. EMQ.
Parvovirus
Lead-in.
The following scenarios relate to parvovirus infection
Abbreviations.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There is none: make up your own
answers!
Scenario 1.
What type of virus is
parvovirus?
Scenario 2.
Is the title B19 something to do with the American B19
bomber, its potentially devastating bomb load and the comparably devastating
consequences of the parvovirus on human erythroid cell precursors?
Scenario 3.
PVB19 in the UK occurs in mini-epidemics at 3 – 4 year
intervals, usually during the summer months.
Scenario 4.
Which animal acts as the main
reservoir for infection?
Scenario 5.
What percentage of UK adults are immune to parvovirus
infection?
Scenario 6.
What names are given to acute
infection in the human?
Scenario 7.
What is the incubation period for parvovirus infection?
Scenario 8
What is the duration of infectivity for parvovirus
infection?
Scenario 9.
What are the usual symptoms of parvovirus infection in
the adult?
Scenario 10.
What is the incidence of parvovirus infection in
pregnancy?
Scenario 11.
How is recent infection diagnosed?
Scenario 12.
How long does PvIgM persist and why is this important?
Scenario 13.
What is the rate of vertical transmission of parvovirus
infection?
Scenario 14.
Are women with parvovirus infection who are asymptomatic
less likely to pass the virus to their fetuses?
Scenario 15.
To what degree is parvovirus infection teratogenic?
Scenario 16.
What proportion of pregnancies infected with parvovirus
are lost?
Scenario 17.
What is the timescale for the onset of hydrops?
Scenario 18.
Laboratories are advised to retain bloods obtained at booking
for at least 2 years for possible future reference. True or false?
Scenario 19.
What ultrasound features would trigger consideration of
cordocentesis?
Scenario 20.
Must suspected parvovirus infection be notified to the
authorities? Yes or No.
Scenario 21.
Possible parvovirus infection
does not need to be investigated after 20 week’s gestation. True or false?
Scenario 22
If serum is sent to the
laboratory from a woman with a rash in pregnancy for screening for rubella, the
laboratory should automatically test for parvovirus infection too. True or false?
19. EMQ. Mental
Capacity Act
Lead-in.
The following scenarios relate to the Mental Capacity Act
2005.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
CAD: Court-appointed Deputy.
COP: Court of Protection.
FGR: fetal growth restriction.
LPA: Lasting Power of Attorney.
MCA: Mental
Capacity Act 2005.
PoA: Power of Attorney.
Option list.
A.
Yes
B.
No
C.
True
D.
False
E.
Does not exist
F.
The husband
G.
A parent
H.
The child
I.
the General
Practitioner
J.
the Consultant
K.
the Registrar
L.
The Consultant
treating the patient
M. A Consultant not involved in treating the patient
N.
The Medical Director
O.
A person with Powers
of Attorney
P.
The sheriff or
sheriff’s deputy
Q.
Balance of
probabilities
R.
Beyond reasonable
doubt
S.
None of the above.
Scenario 1.
A person with LPA is normally
not a family member.
Scenario 2.
A Sheriff’s Deputy is normally
not a family member.
Scenario 3.
A person with PoA can consent
to treatment for the patient who lacks capacity.
Scenario 4.
A Court-appointed Deputy can consent to treatment for the
patient who lacks capacity, but must go back to the Court of Protection if
further consent is required for additional treatment.
Scenario 5.
A person with PoA can authorise
withdrawal of all care except basic care in cases of individuals with
persistent vegetative states.
Scenario 6.
An advance decision can
authorise withdrawal of all but basic care in cases of persistent vegetative
states.
Scenario 7
A person with PoA cannot
overrule an advance direction about withdrawal or withholding of
life-sustaining care.
Scenario 8
A woman is seen in the
antenatal clinic at 39 weeks’ gestation. Her blood pressure is 180/110 and she
has +++ of proteinuria on dipstick testing. She has mild epigastric pain. A
scan shows evidence of FGR with the baby on the 2nd. centile.
Doppler studies of the umbilical artery are abnormal and a non-stress CTG shows
loss of variability and variable decelerations. She is advised that she appears
to have severe pre-eclampsia and is at risk of eclampsia and of intracranial
haemorrhage. She is told of the associated risk of mortality and morbidity. She
is also advised that the baby is showing evidence of severe FGR and has
abnormal Doppler studies and CTG which could lead to death or hypoxic damage.
She declines admission or treatment. She says she trusts in God and wishes to
leave her fate and that of her baby in His hands. She is seen by a psychiatrist
who assesses her as competent under the MCA and with no evidence of mental
disorder. The obstetrician wants to apply to the COP for an order for
compulsory treatment. Can he do this?
Scenario 9
A woman is admitted at 36
weeks’ gestation with evidence of placental abruption. She is semi-comatose and
shocked. There is active bleeding and the cervical os is closed. Fetal heart
activity is present but with bradycardia and decelerations. The consultant
decides that Caesarean section is the best option to save her live and that of
the baby. When reading the notes, the registrar comes across an advance notice
drawn up by the woman and her solicitor. It states that she does not wish
Caesarean section, regardless of the risk to her and the baby. The consultant
tells the registrar that they can ignore it now that she is no longer competent
and get on with the Caesarean section for which she will be thankful
afterwards. The registrar says that the advance notice is binding. Who is
correct?
Scenario 10
An 8 year old girl is admitted
with abdominal pain. Appendicitis is diagnosed with peritonitis and surgery is
advised. The parents decline treatment on religious grounds. Can the consultant
in charge overrule the parents and give consent?
20. Confidentiality
& consent.
Lead-in.
The following scenarios relate to confidentiality.
For each, select the number that best fits the scenario.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
This EMQ has not option list. This is to make you decide
your answers. Send them to me and I’ll send my version including what I think
an option list might have looked like.
Scenario 1.
A 15-year-old girl attends the
TOP clinic requesting TOP. She is assessed as Fraser competent. After full
discussion arrangements are made for her admission for TOP. She does not wish
her parents to be informed. Her mother attends clinic 1 hour after the child
has left. She demands full information about her daughter. The consultant has
delegated you to deal with her. Which option best fits the action you
will take?
Scenario 2.
A 17-year-old A-level student
attends the gynaecology clinic requesting TOP. She is accompanied by her
30-year-old mathematics teacher, who is her lover and wishes to give consent. Which
option best fits the action you will take?
Scenario 3.
A 12-year-old girl attends the
gynaecology clinic with her mother seeking contraceptive advice. She has an
18-year-old boyfriend whom the parents like and she wishes to start having sex.
Which option best fits the action you will take?
Scenario 4.
A 15-year-old girl who is Fraser competent is referred to
the gynaecology clinic with a complaint of vaginal discharge. She reveals that
she has been having consensual sexual intercourse for six months with her
18-year-old boyfriend. She asks for advice about suitable contraception as she
is happy in the relationship and wants to continue to have sex. Which option
best fits the action you will take?
Scenario 5.
You are the new oncology consultant and have just
operated on the wife of a local General Practitioner for suspected ovarian
cancer. The diagnosis is confirmed and you proceed with appropriate surgery. On
completion of the operation you go to the surgeon’s room for a coffee. The
senior consultant anaesthetist who was not involved in theatre but is the
Medical Director and tells you he is a close friend of the woman, asks what the
diagnosis and prognosis are. Which option best fits the action you will take?
Scenario 6.
You are phoned by a doctor
looking for information about his wife’s results from the booking clinic she
attended two weeks ago. He says that she has given consent for disclosure. She
has given a history of 2 terminations but no other pregnancies. She is Rhesus
negative, but has Rhesus antibodies. Which option best fits the action
you will take?
Scenario 7
You are phoned by a doctor
looking for information about his wife’s results from the booking clinic she
attended two weeks ago. He says that she has given consent for disclosure. Her
serology tests have proved +ve for syphilis. You have spoken to the consultant
bacteriologist who says that they have run confirmatory tests and they are +ve
too. He is sure the woman has active syphilis. Which option best fits
the action(s) you will take?
Scenario 8
A 15-year-old girl attends the
TOP clinic requesting TOP. She is assessed as Fraser competent. After full
discussion arrangements are made for her admission for TOP. She does not wish
her parents to be informed despite your best efforts to persuade her. Who will
give consent for the procedure?
Scenario 9
An immature 15-year-old girl
attends the gynaecology clinic requesting TOP. She is accompanied by her
25-year-old sister who is a lawyer with whom she has been staying since she
knew she was pregnant. She does not want her parents to be informed. The girl
is assessed as not Fraser competent. The sister says that she is happy to act
in loco parentis and to give consent. Which option best fits the
action(s) you will take?
Scenario 10
A 25-year-old woman with Down’s syndrome attends the
clinic accompanied by her mother. She has menorrhagia and copes badly with the
hygiene aspects. The menorrhagia is bad enough for her now to be on treatment
for iron-deficiency anaemia. She has tried all the standard medical methods. To
complicate the problem, she has become close friends with a young man she has
met at College, to which she travels independently each weekday. Her mother
fears that she may already be involved in sexual activity and cannot get an
accurate answer from her about it. The mother is keen for her to have
hysterectomy to deal with both problems. If you agree that the surgery is
appropriate, who can give consent?
Scenario 11
A 25-year-old woman with Down’s syndrome is admitted from
College after collapsing. The clinical features are of ectopic pregnancy and
she states that she has UPSI with her boyfriend of six months. She has
tachycardia and hypotension and it is felt that she should have urgent surgery.
You reckon that she is not competent to consent for surgery. Who can give
consent?
Scenario 12
A 25-year-old woman with Down’s syndrome is admitted from
College after collapsing. The clinical features are of ectopic pregnancy and
she states that she has UPSI with her boyfriend of six months. She has
tachycardia and hypotension and it is felt that she should have urgent surgery.
You reckon that she is not competent to consent for surgery. What limits are
there on the surgery?
Scenario 13.
You are the SpR on call and are asked to see a
10-year-old child in the A&E department. She has been brought because of
vaginal bleeding. She is accompanied by her parents who give a story of her
injuring herself falling of her bike. Examination shows vaginal bleeding and you
think the hymen looks torn. You suspect sexual abuse and don’t believe the
parents’ story. When this is discussed with the parents they say it is
impossible and that they do not want involvement of police or social workers. What
action will you take?
Scenario 14.
You are the SpR in theatre with your consultant. Mrs Mary
White, age 45, has been listed for abdominal hysterectomy and bilateral
salpingo-oophorectomy – she has a long history of menorrhagia that has not
responded to conservative measures. Her mother had ovarian cancer diagnosed at
55 and died from the disease 3 years later. A 10 cm., solid tumour of the left
ovary is found on opening the abdomen. Which of the following options is the
correct course of action?
|
A
|
close the abdomen, see her to explain the findings and
book a follow-up appointment in the gynaecological clinic to discuss further
management
|
|
B
|
close the abdomen, arrange to see her to explain the
findings and refer to the gynaecological oncologist to discuss further
management
|
|
C
|
continue with the operation, but don’t remove the left
ovary
|
|
D
|
continue with the operation, removing the uterus and
both ovaries and tubes
|
|
E
|
continue with the operation, removing the uterus and
both ovaries and tubes and obtaining peritoneal washings
|
|
F
|
ask the gynaecological oncologist to attend to perform
definitive surgery on the basis that the cyst is likely to be malignant
|
|
G
|
phone the legal department for advice
|
|
H
|
phone the Court of Protection for advice
|
Scenario 15.
You are an SpR in theatre with
your consultant.
Mrs Mary White, age 45, has
been listed for abdominal hysterectomy and bilateral salpingo-oophorectomy –
she has a long history of menorrhagia that has not responded to conservative
measures. Her mother had ovarian cancer diagnosed at 55 and died from the
disease 3 years later.
You perform examination under
anaesthesia prior to the abdomen being opened. You find a 10 cm., mass to the
left of the uterus. It feels solid. There is no evidence of ascites or other
pathology.
Which of the following options is the correct
course of action?
|
A
|
Cancel the operation and
arrange review in the gynaecology department in 6 weeks
|
|
B
|
Cancel the operation and
arrange review by the oncology team
|
|
C
|
Cancel the operation and arrange
an urgent scan
|
|
D
|
Continue with the planned
procedure
|
|
E
|
Ask the gynaecological
oncologist to attend theatre to examine the patient and advise
|
|
F
|
Perform laparoscopy to
identify the nature of the mass
|
|
G
|
Phone the legal department
|
21. EMQ.
Hepatitis B
Topic. Hepatitis B and pregnancy.
Lead-in.
These
scenarios relate to hepatitis 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?
22. EMQ. 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%
|
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