32
|
Viva. Senior doctor thinking. Baby
with undetected Down’s syndrome
|
33
|
EMQ. Abortion Act.
|
34
|
EMQ. Surrogacy
|
35
|
EMQ. HCV and pregnancy
|
32. Structured conversation. Baby with
Down’s syndrome.
Candidate’s instructions.
You are a year 4 SpR and in charge of the labour ward.
You are preparing for your Part 3 MRCOG exam and the Consultant has offered to
give you a mock viva as the labour ward is quiet.
A patient had a normal delivery about an hour ago of an
apparently healthy baby. When she saw the baby, she said that she thought it
had Down’s syndrome. This was unexpected as antenatal screening had put her in
the low-risk category. The paediatricians have seen the baby and agree with her
and have arranged appropriate tests in addition to those done for all new
babies. The mother says that she believes that everything that happens is part
of God’s plan and that she is happy to welcome the baby and will do everything
to give her the best possible life.
Your consultant has stressed that you will be a
consultant in a few years and that an important part of the transition is the
development of ‘senior doctor thinking’. She would like you to display SDT in
your answer. The consultant is the chair of the labour ward committee and a
member of the antenatal committee. She says you should imagine yourself as a
consultant in 5 years and having these roles when you formulate your answer.
She says that she will ask you 7 questions deriving from
the arrival of this baby. When you have answered a question, you will not be
allowed to return as subsequent questions may suggest answers.
33. EMQ. Abortion Act & TOP.
Scenario 1
Lead in.
How many
abortions were performed on residents of E&W aged 15-44 in 2016?
Option list
A
|
about 50,000
|
B
|
about 100,000
|
C
|
about 150,000
|
D
|
about 200,000
|
E
|
about 250,000
|
F
|
> 250,000
|
Scenario 2
Lead in.
What was the
approximate rate of abortion in E&W residents in 2016?
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 3
Lead in.
The rate of
abortion has declined by >20% in residents of E&W 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 4
Lead in.
What proportion
of TOPs were performed at gestations <10 weeks in E&W in 2016?
Option list
A
|
50%
|
B
|
60%
|
C
|
70%
|
D
|
80%
|
E
|
90%
|
Scenario 5
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 6
Lead in.
What % of
abortions were performed after 24 weeks?
Option list
A
|
< 1%
|
B
|
1 - 3%
|
C
|
4 – 6%
|
D
|
7 – 9%
|
E
|
≥ 10%
|
Scenario 7
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 8
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 9
Lead in.
What happened to
the rate of TOP in 2016 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 10
Lead in.
What happened to
the rate of TOP in 2015 for girls <16 years compared with 2006?
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 11
Lead in.
What happened to
the rate of TOP in 2016 for girls <16 years compared with 2015?
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 12
Lead in
Approximately
what proportion of women having TOP in 2016 had previously had one or more
TOPs?
Option list
A
|
1%
|
B
|
5%
|
C
|
10%
|
D
|
20%
|
E
|
30%
|
F
|
40%
|
G
|
50%
|
Scenario 13
Lead in
What age group of
women 1n 2016 were most likely to have had previous TOP?
Option list
|
|
Age
|
A
|
< 18
|
B
|
18-19
|
C
|
20-24
|
D
|
25-29
|
E
|
30-34
|
F
|
≥ 35
|
Scenario 14
Lead in
There were 185,824
TOPs in 2015. How many deaths occurred?
Option list
A
|
0 - 9
|
B
|
10 – 19
|
C
|
20 – 39
|
D
|
40 - 59
|
E
|
≥ 60
|
Scenario 15
Lead in
There were 185,824
TOPs in 2015. What was the rate of significant complications?
Option list
A
|
<1%
|
B
|
1%
|
C
|
3%
|
D
|
5%
|
E
|
10%
|
Scenario 16
Lead in
The RCOG
recommends that women having TOP should have chlamydia screening. What
proportion of women had this done in 2016?
Option list
A
|
<10%
|
B
|
10- 24%
|
C
|
25- 49%
|
D
|
50- 79%
|
E
|
80- 89%
|
F
|
≥ 90%
|
Scenario 17
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 18
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 19
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 20
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 21
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
|
6
|
none of the
above
|
Scenario 22
Lead in.
With regard to
the wording of the 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 23
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 24
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 25
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 is at serious risk of death
or grave, permanent injury 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 26
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 27
Lead in
TOPs done under ground E are those done at any gestation
because of fetal abnormality. The anomalies are coded using ICD10. The HSA4
notification form relating to each TOP should have details of the ICD10 code
for the fetal anomaly.
Which of the following statements is the most accurate in
relation to the percentage of HSA4 forms that contain the required information?
A
|
0- 24%
|
B
|
25- 49%
|
C
|
50- 59%
|
D
|
60- 69%
|
E
|
≥ 70%
|
Scenario 28
Lead in
TOPs done under ground E are those done at any gestation
because of fetal abnormality. Which, if any, of the following statements are
true of TOPs under ground E in 2015?
A
|
the average of the woman was 34, compared to 21 for the
average for all grounds
|
B
|
congenital malformations were the grounds in > 80% of
cases
|
C
|
Down’s syndrome was the most common reason for ground E
TOP
|
D
|
fetal cardiac anomalies were the most common reason for
ground E TOP
|
E
|
fetal nervous system anomalies were the most common
reason for ground E TOP
|
Scenario 29
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 30
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 31
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 32
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 33
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 34
Lead in.
A woman seeks 1st. 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 35
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?
Use the Option
list for Question 34.
Scenario 36
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?
Use the Option
list for Question 34.
34.
Surrogacy.
Lead-in.
This question is about surrogacy. For each scenario, pick the best choice
from the option list. Each option can be used once, more than once or not at
all.
Abbreviations.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
Option List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman of the HFEA
f)
Senior judge at the Children and Family Court
g)
traditional surrogacy
h)
gestational surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG Surrogacy Sub-Committee
l)
false
m)
true
n)
none of the above
Scenario 1
List the
different types of surrogacy.
Scenario 2.
“Gestational”
surrogacy has better “take-home-baby” rates than “traditional” surrogacy.
Scenario 3.
There are
approximately 1,000 surrogate pregnancies per annum in the UK. True/False
Scenario 4.
Which
national body regulates surrogacy in England?
Scenario 5.
Privately-arranged surrogate pregnancies are illegal and those involved
are liable to up to 2 years in prison. True/False
Scenario 6.
List the risks of surrogacy.
Scenario 7.
Obstetricians are legally obliged to take the CPs’ wishes into
consideration in managing pregnancy complications or problems.
Scenario 8.
The
psychological outcomes of surrogacy are fully understood. True/False.
Scenario 9.
The psychological
outcomes of surrogacy are more severe after traditional surrogacy. True/False
Scenario 10.
Who has the
right to arrange TOP if the fetus is found to have a major congenital abnormality?
Scenario 11.
A SM decides at 10 weeks that she does not wish to be pregnant and
arranges to have a TOP. The CPs. hear about this and object strongly. To whom
should they apply to have the TOP blocked?
Scenario 12.
A woman has hysterectomy and BSO to deal with extensive endometriosis at
the age of 30. She marries two years later and her sister offers to act as
surrogate. She undergoes IVF and 4 embryos are created. One is transferred and
a successful pregnancy ensues. The baby is adopted by the woman and her
husband. The 3 remaining embryos were frozen. Four years later the woman falls
out with her sister, but finds another surrogate and wishes to proceed with
another pregnancy. The sister says she does not want her eggs to be used and
that the frozen embryos should not be transferred. Does the sister have the
legal right to block the use of the embryos? Yes / No.
Scenario 13.
A girl born from donor sperm reaches the age of 16 and wishes to know the
identity of her genetic father. Does she have the right to this
information? Yes / No.
Scenario 14.
A girl born from donor sperm reaches the age of 18 and wins a place at
Oxford University to read medicine. Does she have the legal right to get the
donor to contribute to her fees? Yes / No.
Scenario 15.
A PO is
active from the moment it is completed and signed by the relevant parties. True/False
Scenario 16.
A SM can
change her mind at any time and keep the child, even if the egg was not hers. True/False
Scenario 17.
The CPs can change
their mind, leaving the SM as the legal mother.
True/False
Scenario 18.
A SM’s
husband is the legal father until adoption is completed or a PO comes into
force.
Scenario 19.
A lesbian couple in a stable, co-habiting relationship can be CPs and
become the legal parents of the child of a SM.
Scenario 20.
CPs are likely to get faster legal status as the legal parents through
application for a PO rather than applying for adoption.
35.
Lead-in.
Pick one option from the option list. Each
option can be used once, more than once or not at all.
Some
of the questions are not true EMQs as more than one of the options is true. I
arrange things this way as it makes the answers shorter and reduces the amount
of typing and the amount of paper needed for printing. Some are not EMQs at all
as there is no option list and you have to come up with your own answers.
Abbreviations.
HBcAg: Hepatitis
B core antigen
HCV: Hepatitis C virus.
HCAb: Hepatitis C antibody.
MTCT: mother-to-child transmission.
NICU: neonatal intensive-care unit,
PTB: preterm birth,
STD: sexually-transmitted disease.
Scenario
1.
Which, if any, of the
following statements are true?
Option list.
A
|
Hepatitis kills more people world-wide
than HIV
|
B
|
Hepatitis kills more people world-wide
than TB
|
C
|
Hepatitis B kills more people world-wide
that Hepatitis C
|
D
|
Hepatitis B kills more people world-wide
than TB
|
E
|
None of the above
|
Scenario
2.
Which, if any, of the
following statements are true in relation to HCV?
Option list.
A
|
It is a DNA virus
|
B
|
It is a RNA virua
|
C
|
It is a member of the Flaviviridae
family
|
D
|
it is a member of the Hepadnaviridae
family
|
E
|
it is a member of the Herpesviridae
family
|
F
|
most infections are due to genotypes 1
& 3
|
G
|
most infections are due to genotypes 2
& 4
|
Scenario
3.
What is the approximate
prevalence of HCV infection in the UK?
Option list.
A
|
0.1 per 1,000
|
B
|
0.3 per 1,000
|
C
|
0.5 per 1,000
|
D
|
1 per 1,000
|
E
|
3 per 1,000
|
F
|
5 per 1,000
|
G
|
10 per 1,000
|
H
|
13 per 1,000
|
I
|
15 per 1,000
|
J
|
None of the above
|
Scenario
4.
What are the key aspects of
the WHO’s Global Health Sector Strategy in relation to HCV infection?
Option list.
A
|
elimination as a as a major public
health threat by 2020
|
B
|
elimination as a as a major public
health threat by 2030
|
C
|
elimination as a as a major public
health threat by 2040
|
D
|
reduction in incidence by 50% by 2030
|
E
|
reduction in incidence by 75% by 2030
|
E
|
reduction in incidence by 80% by 2030
|
F
|
reduction in mortality by 50% by 2030
|
G
|
reduction in mortality by 65% by 2030
|
H
|
reduction in mortality by 70% by 2030
|
Scenario
5.
What is the incubation period
of HCV infection?
Option list.
A
|
6 weeks
|
B
|
2 months
|
C
|
up to 3 months
|
D
|
up to 4 months
|
E
|
up to 6 months
|
F
|
up to 12 months
|
G
|
none of the above
|
Scenario
6.
What symptoms are most common
in acute HCV infection? There is no option list.
Scenario
7.
How is acute HCV infection
diagnosed?
Option list.
A
|
clinically
|
B
|
presence of HCV antibody
|
C
|
presence of HCV IgM
|
D
|
presence of HCV IgG
|
E
|
presence of HCV RNA
|
F
|
none of the above
|
Scenario
8.
What proportion of those with
acute HCV infection are asymptomatic?
Option list.
A
|
10%
|
B
|
20%
|
C
|
50%
|
D
|
60%
|
D
|
70%
|
E
|
> 80%
|
Scenario
9.
When does continuing infection
after initial exposure become defined as chronic infection?
Option list.
A
|
after 6 weeks
|
B
|
after 2 months
|
C
|
after 3 months
|
D
|
after 4 months
|
E
|
after 6 months
|
F
|
after 12 months
|
G
|
none of the above
|
Scenario
10.
Approximately how many of
those with acute HCV infection will go on to chronic infection?
Option list.
A
|
10%
|
B
|
20%
|
C
|
40%
|
D
|
50%
|
E
|
>50%
|
F
|
>70%
|
Scenario
11.
A woman is found to have HCV
antibodies. Which, if any, of the following statements could be true?
Option list.
A
|
she could have acute HCV infection
|
B
|
she could have chronic infection
|
C
|
she could have had HCV infection that
has cleared spontaneously
|
D
|
she could have had HCV infection that
has responded to drug therapy
|
E
|
she could have a false +ve test result
|
F
|
she could have chronic HBV infection due
to cross reaction with HBcAg
|
G
|
she is immune to HCV
|
H
|
the antibodies could result from HCV
vaccine
|
I
|
the antibodies could result from yellow
fever vaccine
|
J
|
none of the above
|
Scenario
12.
Which, if any, of the following
statements reflect current thinking about the mechanisms of damage in chronic
HCV infection?
Option list.
A
|
hepatic damage is proportional to the
duration of HCV infection
|
B
|
hepatic damage is a direct result of HCV
replication within hepatocytes
|
C
|
hepatic damage is proportional to the
level of detectable HCV RNA in maternal blood
|
D
|
hepatic damage is immune-mediated
|
E
|
hepatic damage is due to progressive
biliary tract infection, scarring and
stenosis
|
F
|
hepatic damage mostly occurs in women
who abuse alcohol
|
G
|
hepatic damage is worse in women with
co-existing HIV infection
|
H
|
hepatitis D is end-stage hepatitis C,
with cirrhosis and liver failure, ‘D’ originating from the original name:
‘deadly-stage’ HCV disease
|
Scenario
13.
How common is vertical
transmission? There is no option list.
Scenario
14.
Which, if any, of the
following statements are true in relation to the hepatitides?.
A
|
acute hepatitis is
notifiable
|
B
|
chronic hepatitis is
notifiable
|
C
|
hepatitis A is notifiable as
the main route of spread is faecal contamination of food & water
|
D
|
hepatitis D is notifiable as
the main source of infection is infected food and water
|
E
|
hepatitis E is notifiable as
the main source of infection in the UK is raw or undercooked pork
|
F
|
none of the above
|
Scenario
15.
What anti-viral treatment is
recommended for pregnancy? There is no option list.
Scenario
16.
Which, if any, of the
following are true about Ribavirin?
Option list.
A
|
it is the least expensive of the new
DAADs for HCV
|
B
|
it is the least toxic of the new DAADs
for HCV
|
C
|
it is the most effective of the new
DAADs for HCV
|
D
|
it is contraindicated in pregnancy
because of fears of teratogenicity
|
E
|
can cause sperm abnormalities
|
F.
|
can persist in humans for up to 6 months
|
G.
|
none of the above
|
Scenario
17.
A woman with chronic HCV
wishes to breastfeed. What advice would you give? There is no option list.
Scenario
18.
How is neonatal infection
diagnosed? There is no option list.
Scenario
19.
How is neonatal infection treated?
There is no option list.
Scenario 20.
Which,
if any, of the following conditions is more common in women with HCV infection?
A
|
dermatitis herpetiformis
|
B
|
HELLP syndrome
|
C
|
obstetric cholestasis
|
D
|
postnatal depression
|
E
|
thrombocytopenia
|
Scenario 21.
By
how much is the risk of the condition in question 20 increased in women with
HCV?
Option list.
A
|
by
a factor of 2
|
B
|
by
a factor of 5
|
C
|
by
a factor of 20
|
D
|
by
a factor of 50
|
E
|
none
of the above
|
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