Website
|
30
|
Role-play. Explain,
dyskaryosis, dysplasia, CIN etc.
|
|
31
|
Structured discussion. Obstructive
sleep apnoea
|
|
32
|
EMQ. Mycoplasma genitalium.
|
|
33
|
EMQ. BRCA 1 & 2. Prophylaxis.
|
30. Role-play.
Explain, dyskaryosis, dysplasia, CIN etc.
Candidate's Instructions.
This is a role-play
station. You are a 4th. year SpR.
Jane Smith is a 1st.
year student nurse who has joined the department. She has heard the following
terms used in the gynaecology and colposcopy clinics:
mild, moderate and severe dyskaryosis in relation to
cervical smears,
mild, moderate and severe dysplasia in relation to
cervical smears,
simple, complex and atypical endometrial hyperplasia,
She would like to know
what they mean and their significance as the explanations given by the medical
staff in the clinics were not clear and patients asked her for clarification.
Her knowledge was insufficient for her to provide this, which she found very
unsatisfactory for the patients and her. Your consultant has delegated the
explanation to you.
31. Structured
discussion. Obstructive sleep apnoea.
Candidate's
Instructions.
This
is a viva station, now called a ‘structured discussion’. The examiner will ask
you 11 questions.
When
you have answered a question and moved to the next, you are not allowed to
return as later questions may give answers to earlier ones.
32. EMQ.
Mycoplasma genitalium.
Lead-in.
BASHH launched a new, “NICE-accredited” guideline on
MG in July 2018 This makes it a hot topic and it is one that most people will
know nothing about. There are enough “buzz words” to catch the attention of
MRCOG examiner sand make its inclusion in the exam databases irresistible! It
would be a killer “structured discussion” in the Part 3 and would sink most
candidates in the Part 2.
Many of the questions are not true EMQs as
they have more than one correct answer. I have tried to include all the facts I
think might feature in the exam and packing more than one into a question
reduces the total number of questions and makes the document a bit more
manageable. It also reduces the amount of typing I have to do.
Abbreviations.
BASHHMG: British Association for Sexual Health and
HIV’s “National
guideline for the management of infection with Mycoplasma genitalium”.
2018
BASHHNGU: British Association for Sexual Health and
HIV’s. “ UK National
Guideline on the management of non-gonococcal urethritis”. 2015, updated 2018.
C&S: culture & sensitivity.
MG: Mycoplasma genitalium.
MP: Mycoplasma pneumoniae.
PCB: postcoital bleeding.
PMB: postmenopausal bleeding.
PID: pelvic inflammatory disease.
PTB: preterm birth.
SARA: Sexually-Acquired Reactive
Arthritis.
Which,
if any, of the following statements are true in relation to MG? This is not a
true EMQ as there may be more than one correct answer.
Option list.
|
A
|
MG was first
isolated in 2001
|
|
B
|
MG was first
isolated from men with non-gonococcal urethritis (NGU)
|
|
C
|
MG belongs to
the Cutemollies class
|
|
D
|
MG is the
smallest known yeast with the ability to self-replicate
|
|
E
|
MG is the
smallest known bacterium with the ability to self-replicate
|
|
F
|
MG has an
unusual, double-layered cell wall
|
|
G
|
MG has an
unusual protrusion at one end
|
|
H
|
MG’s
protrusion enables it to adhere to epithelial cells
|
|
I
|
MG’s
protrusion enables it to invade epithelial cells
|
|
J
|
MG is best
seen on a Gram stain
|
Scenario 2.
Which, if any, of the following statements
are true in relation to Mycoplasmas?
Option
list.
|
A
|
are the largest known bacteria
|
|
B
|
have no cell wall
|
|
C
|
have no nuclei
|
|
D
|
are resistant to ß-lactam antibiotics
|
|
E
|
are resistant to sulphonamides
|
|
F
|
colonies show a ‘scrambled egg’ appearance on
culture on agar
|
|
G
|
particularly affect mucosal surfaces
|
Scenario 3.
Which, if any, of the following statements
are true in relation to Mg?
Option
list.
|
A
|
when the organism was originally found, culture took
50 days
|
|
B
|
Mg is facetious
|
|
C
|
Mg is a facultative aerobe
|
|
D
|
Mg is a facultative anaerobe
|
|
E
|
Mg is a facultative aerobe & anaerobe
|
|
F
|
Mg is fastidious
|
Scenario 4.
Which, if any, of the following are true
in relation to the approximate prevalence of MG?
Option
list.
|
A
|
it is ~ 0.1%
|
|
B
|
it is ~ 1.0%
|
|
C
|
it is ~ 5.0%
|
|
D
|
it is ~ 5-10%
|
|
E
|
it is > 10%
|
|
F
|
none of the above
|
Scenario 5.
Which, if any, of the following is true in
relation to screening for MG? This is a true EMQ with only one correct answer.
Option
list.
|
A
|
screening for MG is now included in the NCSP
|
|
B
|
screening for MG is now offered as part of the NHSCS
|
|
C
|
screening should be offered to all sexually active
women < 30 years old
|
|
D
|
screening should only be offered to those with
symptoms suggestive of infection
|
|
E
|
screening should be offered to all partners of those
with MG infection
|
|
F
|
none of the above
|
Scenario 6.
Which, if any, of the following are
included in BASHHMG as risk factors for infection with MG?
Option
list.
|
A
|
cigarette smoking
|
|
B
|
multiple dancing partners
|
|
C
|
multiple sexual partners
|
|
D
|
non-white ethnicity
|
|
E
|
younger age
|
|
F
|
none of the above
|
Scenario 7.
Which of the following statements is true
in relation to MG and co-infection with other organisms?
Option
list.
|
A
|
MG excretes bactericidal toxins and co-infection is
rare
|
|
B
|
MG co-infection is most often with chlamydia
|
|
C
|
MG co-infection is most often with E. coli
|
|
D
|
MG co-infection is most often with HIV
|
|
E
|
MG co-infection is most often with TB
|
|
F
|
None of the above
|
Scenario 8.
Which of the following statements is true
in relation to MG and men?
Option
list.
|
A
|
It is the most common cause of NGU
|
|
B
|
It is the most common cause of epididymitis
|
|
C
|
It is the most common cause of prostatitis
|
|
D
|
It is a well-recognised cause of male sub-fertility
|
|
E
|
Most men with MG infection are asymptomatic
|
|
E
|
None of the above
|
Scenario 9.
Which, if any, of the following statements
are true in relation to MG and women?
Option
list.
|
A
|
MG is linked to an ↑ risk of cervicitis
|
|
B
|
MG is linked to an ↑ risk of endometritis
|
|
C
|
MG is linked to an ↑ risk of female infertility
|
|
D
|
MG is linked to an ↑ risk of miscarriage
|
|
E
|
MG is linked to an ↑ risk of otitis media
|
|
F
|
MG is linked to an ↑ risk of pelvic inflammatory disease
|
|
G
|
MG is linked to an ↑ risk of postcoital bleeding
|
|
H
|
MG is linked to an ↑ risk of postmenopausal bleeding
|
|
I
|
MG is linked to an ↑ risk of preterm birth
|
|
J
|
MG is linked to an ↑ risk of damage to Fallopian tube cilia
|
|
K
|
MG is linked to an ↑ risk of puerperal psychosis
|
|
L
|
MG is linked to an ↑ risk of puerperal sepsis
|
|
M
|
Most infected women are asymptomatic
|
|
N
|
None of the above
|
Scenario 10.
Which, if any, of the following statements
are true in relation to current concerns about Mg?
Option
list.
|
A
|
It could become a ‘superbug’, resistant to most
antibiotics, within a decade
|
|
B
|
Infection is often misdiagnosed as chlamydia with ↑ risk of antibiotic resistance
|
|
C
|
‘superbug’ status would be likely to lead to an ↑ in renal failure
|
|
D
|
‘superbug’ status would be likely to lead to an ↑ in female infertility
|
|
E
|
‘superbug’ status would be likely to lead to an ↑ in male infertility
|
Scenario 11.
Which, if any, of the following are used
in the recommended test for MG infection in women?
Option
list.
|
A
|
blood testing for MG IgG
|
|
B
|
blood testing for MG IgM
|
|
C
|
cervical smears checked microscopically for the
diagnostic intracellular inclusion bodies
|
|
D
|
C&S of cervical swab specimens using MG-specific
culture medium
|
|
E
|
C&S of 1st. void MSSU using MG-specific culture
medium
|
|
F
|
C&S of vaginal swab specimens using MG-specific
culture medium
|
|
G
|
NAATs that detect the MG G-antigen
|
|
H
|
NAATs that detect MG DNA
|
|
I
|
NAATs that detect MG RNA
|
|
J
|
serum testing for MG-specific antigen
|
|
K
|
vaginal swabs taken by the woman
|
|
L
|
none of the above
|
Scenario 12.
Which, if any, of the following statements
are true in relation to testing for antibiotic resistance after initial tests
are +ve for MG?
Option
list.
|
A
|
test for resistance to cephalosporins
|
|
B
|
test for resistance to macrolides
|
|
C
|
test for resistance to penicillin
|
|
D
|
test for resistance to quinolones
|
|
E
|
test for resistance to macrolides
|
|
F
|
test for resistance to streptomycin
|
|
F
|
test for resistance to sulphonamides
|
|
F
|
test for resistance to tetracyclines
|
|
G
|
None of the above
|
Which,
if any, of the following statements are true in relation to estimates of
antibiotic resistance in current strains of MG in the UK?
Option list.
|
A
|
20% are
resistant to cephalosporins
|
|
B
|
40% are
resistant to macrolides
|
|
C
|
50% are
resistant to penicillin
|
|
D
|
50% are
resistant to quinolones
|
|
E
|
10% are
resistant to streptomycin
|
|
F
|
90% are
resistant to sulphonamides
|
|
F
|
40% are
resistant to tetracyclines
|
|
F
|
None of the
above
|
Scenario 14.
Which, if any, of the following is
BASHHMG’s recommended 1st. line treatment of uncomplicated MG?
Option
list.
|
A
|
azithromycin 1 gram daily for 7 days
|
|
B
|
doxycycline 100 mg twice daily for 7 days
|
|
C
|
doxycycline 100 mg twice daily for 10 days
|
|
D
|
doxycycline 100 mg twice daily for 7 days
|
|
E
|
doxycycline 100 mg twice daily for 7 days then
azithromycin 1 gram daily for 2 days
|
|
F
|
moxifloxacin 400mg orally once daily for 7 days
|
|
G
|
moxifloxacin 400mg orally once daily for 10 days
|
|
H
|
none of the above
|
Scenario 15.
Lead-in
Which, if any, of the following is
BASHHMG’s recommended 1st. line treatment of complicated MG?
Option
list.
|
A
|
doxycycline 100 mg twice daily for 10 days
|
|
B
|
doxycycline 100 mg twice daily for 14 days
|
|
C
|
moxifloxacin 400mg orally once daily for 10 days
|
|
D
|
moxifloxacin 400mg orally once daily for 14 days
|
|
E
|
none of the above
|
Scenario 16.
Lead-in
This is not an EMQ or SBA! Fill in the
gaps in the table below, using option list.
Option
list.
|
A
|
aminoglycoside
|
|
B
|
cephalosporin
|
|
C
|
macrolide
|
|
D
|
penicillin
|
|
E
|
quinolone
|
|
F
|
tetracycline
|
Table.
|
Drug
name
|
Category
of drug
|
|
azithromycin
|
|
|
doxycycline
|
|
|
moxifloxacin
|
|
Scenario 17.
Which, if any, of the following statements
is true in relation to test of cure (TOC) after treatment of MG?
Option
list.
|
A
|
TOC should be offered to everyone who has been
treated for MG
|
|
B
|
TOC should only be offered to those who had signs of
infection before treatment
|
|
C
|
TOC should only be offered to those who had symptoms
of infection before treatment
|
|
D
|
TOC should only be offered to those who had signs
and symptoms before treatment
|
|
E
|
TOC should only be offered to those who continue to
have signs or symptoms two weeks or more after the start of treatment
|
|
F
|
none of the above
|
Scenario 18.
Which, if any, of the following statements
are true in relation to the timing of test of cure (TOC) after treatment of MG?
Option
list.
|
A
|
TOC is best done at 3 weeks after start of treatment
|
|
B
|
TOC is best done at 4 weeks after start of treatment
|
|
C
|
TOC is best done at 5 weeks after start of treatment
|
|
D
|
TOC is best done at 6 weeks after start of treatment
|
|
E
|
TOC should not be done < 2 weeks from the start
of treatment
|
|
F
|
TOC should not be done < 3 weeks from the start
of treatment
|
|
G
|
TOC should not be done < 4 weeks from the start
of treatment
|
33. BRCA
1 & 2 and risk of breast and ovarian cancer
Scenario 1.
Which, if any, of the
following statements are true?
|
A
|
EOC is the most common
gynaecological cancer in the developed world
|
|
B
|
EOC is the leading cause
of death from gynaecological cancer in the developed world
|
|
C
|
50% of EOC is mucinoid
|
|
D
|
HGSOG is 20 times more
common than LGSOG
|
|
E
|
HGSOG is the main cause
of death from ovarian cancer
|
|
F
|
overall life time risk
of EOC is 1 in 70
|
|
G
|
the main risk factors
for EOC are cigarette smoking & older age
|
|
H
|
5% of ovarian cancer is
due to identified hereditary genetic factors
|
|
I
|
BRCA1 is linked to an ↑ risk of breast, ovarian, pancreatic and prostate
cancer
|
|
J
|
BRCA2 is linked to an ↑risk of breast, ovarian, pancreatic and prostate
cancer & melanoma
|
|
K
|
The prevalence of BRCA1
& 2 mutations is about 1 in 400 in the general population
|
|
L
|
The prevalence of BRCA1
& 2 mutations is about 1 in 40 in the Ashkenazi Jewish population
|
|
M
|
The risk of developing
ovarian cancer by 75 years is BRCA1: 50% and BRCA2: 25%
|
|
N
|
EOC associated with
BRCA1 &2 is mostly low-grade mucinous in type
|
|
O
|
The risk of male breast
cancer is about 7% with BRCA2, higher than with BRCA1
|
|
P
|
BRCA1 & 2 are DNA
repair genes
|
|
Q
|
male breast, pancreatic
and prostate cancer are more common with BRCA2 than BRCA1
|
Scenario 2.
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA1. She attends the gynaecology clinic requesting information
about her lifetime risk of breast cancer. What is the approximate figure?
Scenario 3.
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA1. She attends the gynaecology clinic requesting information
about her lifetime risk of ovarian cancer. What is the approximate figure?
Scenario 4.
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA2. She attends the gynaecology clinic requesting information
about her lifetime risk of breast cancer. What is the approximate figure?
Scenario 5.
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA2.
She attends the
gynaecology clinic requesting information about her lifetime risk of ovarian
cancer.
What is the approximate
figure?
Scenario 6.
The woman asks for the
overall figure for lifetime risk of breast cancer in UK women for comparison
with her risk. What is the approximate figure?
Scenario 7.
The woman asks for the
overall UK figure for lifetime risk of ovarian cancer for comparison with her
risk. What is the approximate figure?
Scenario 8
Which of the following genes have mutations that increase the risk of
breast cancer?
Scenario 9
A man of 30 has two
sisters who developed breast cancer before the age of 40. They and he have been
proved to be carriers of BRCA2.
His GP phones to ask about
his lifetime risk of breast cancer. What is the approximate figure?
Scenario 10
A man of 30 has two
sisters who developed breast cancer before the age of 40. They and he have been
proved to be carriers of BRCA2.
His GP phones to ask about
his lifetime risk of ovarian cancer. What is the approximate figure?
Scenario 11
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA2.
She attends the
gynaecology clinic requesting information about the value of prophylactic
mastectomy. What advice will you give about efficacy?
Scenario 12
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA2.
She attends the
gynaecology clinic requesting information about the benefits of prophylactic
salpingo-oophorectomy – her family is complete and her husband has had
vasectomy. What is the approximate figure for the efficacy of BSO in relation
to cancer?
Scenario 13.
Which, if any, of the following
statements is true in relation to the findings by Kuchenbaecker in relation to
the incidence of breast cancer in carriers of a BRCA1 mutation?
Pick one option from the
option list.
Option list.
|
A.
|
it rises rapidly until
the age of 30-40, then stays constant until age 80
|
|
B.
|
it rises rapidly from
puberty until the age of 30-40, then stays constant until age 80
|
|
C.
|
it rises rapidly from
young adulthood until the age of 30-40, then stays constant until age 80
|
|
D.
|
it rises rapidly from
puberty until the age of 40-50, then stays constant until age 80
|
|
E.
|
it rises rapidly from
young adulthood until the age of 40-50, then stays constant until age 80
|
|
F.
|
it rises rapidly from
puberty until the menopause, then stays constant until age 80
|
|
G.
|
it rises rapidly from
young adulthood until the menopause, then stays constant until age 80
|
|
H.
|
none of the above
|
Scenario 14.
Which, if any, of the
following statements is true in relation to the findings by Kuchenbaecker in
relation to the incidence of breast cancer in carriers of a BRCA2 mutation?
Pick one option from the
option list.
Option list.
|
A.
|
it rises rapidly until
the age of 30-40, then stays constant until age 80
|
|
B.
|
it rises rapidly from
puberty until the age of 30-40, then stays constant until age 80
|
|
C.
|
it rises rapidly from
young adulthood until the age of 30-40, then stays constant until age 80
|
|
D.
|
it rises rapidly from
puberty until the age of 40-50, then stays constant until age 80
|
|
E.
|
it rises rapidly from
young adulthood until the age of 40-50, then stays constant until age 80
|
|
F.
|
it rises rapidly from
puberty until the menopause, then stays constant until age 80
|
|
G.
|
it rises rapidly from
young adulthood until the menopause, then stays constant until age 80
|
|
H.
|
none of the above
|
Scenario 15.
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA1.
She attends the
gynaecology clinic requesting information about the benefits of prophylactic
salpingo-oophorectomy. What are the disadvantages of BSO?
Scenario 16
A woman of 30 has two
sisters who developed breast cancer before the age of 40. She and they are
carriers of BRCA1.
She attends the
gynaecology clinic requesting information about the benefits of prophylactic
salpingo-oophorectomy. What alternatives
should be discussed?
Scenario 17
A woman of 25 years is a
known carrier of BRCA1. She has no family history of breast cancer. She has a
friend who is similar in age and has similar risk factors for breast cancer,
including being a BRCA1 carrier, apart from having two 1st. degree
relatives with breast cancer. Which, if any of the following statements is true
in relation to the risk of breast cancer for the friend compared with the
woman?
|
A.
|
her risk is the same
|
|
B.
|
her risk is 2 x that of
the woman
|
|
C.
|
her risk is 5x that of
the woman
|
|
D.
|
her risk is ½ of that of
the woman
|
|
E.
|
none of the above
|
Scenario 18
A woman of 25 years is a
known carrier of BRCA2. She has no family history of breast cancer. She has a
friend who is similar in age and has similar risk factors for breast cancer,
including being a BRCA2 carrier, apart from having two 1st. degree
relatives with breast cancer. Which, if any of the following statements is true
in relation to the risk of breast cancer for the friend compared with the
woman?
|
A.
|
her risk is the same
|
|
B.
|
her risk is 2x that of
the woman
|
|
C.
|
her risk is 5x that of
the woman
|
|
D.
|
her risk is ½ of that of
the woman
|
|
E.
|
none of the above
|
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