Role-play.
Teach
an FY1 the basics of audit.
|
|
50
|
Structured
conversation. Care Quality Commission Report.
|
51
|
SBA.
Quinolone
antibiotics.
|
52
|
EMQ.
Galactosaemia.
|
53
|
EMQ.
HCV
and pregnancy
|
49.
Role-play. Teach an FY1 the basics of audit.
Candidate’s instructions.
You are the SpR on call for the labour ward.
It is a quiet afternoon: all the patients are healthy and in normal
labour.
Dr. Jane Jones has started in the department as a new FY1. She is keen
to specialise in O&G and has already passed the Part 1 examination. A
measure of her enthusiasm is that she has asked her consultant if she can be
involved in doing an audit, but she is aware that she knows little about it.
Her consultant happens to be on duty for the labour ward and has asked
you to ensure that she has enough knowledge to be a useful member of a team
conducting an audit.
50.
Structured conversation. Care Quality Commission Report.
Candidate’s instructions.
This is a structured
conversation.
The Care Quality
Commission recently inspected the maternity department and concluded that
improvements were required, particularly in relation to the labour ward. You
have been a consultant for 5 years and were appointed lead consultant for the
labour ward a week before the visit of the Care Quality Commission. The
Clinical Director has asked you to produce a plan for rectifying the problems
identified by the CQC and delivering the requisite improvements.
The examiner will ask a
series of questions about how you will go about these tasks and the key issues
you will consider.
51. Quinolone & fluoroquinolone antibacterial drugs.
Not all of the questions are true SBAs as some have more than one answer
– this reduces the amount of typing I have to do and the size of the document.
Abbreviations.
FQ: fluoroquinolone.
QUI: quinolone.
Question 1.
Lead-in
Which, if
any, of the following drugs are QUIs or FQs?
Drugs
A.
|
cimetidine
|
B.
|
ciprofloxacin
|
C.
|
nalidixic acid
|
D.
|
neomycin
|
E.
|
nitrofurantoin
|
Question 2.
Lead-in
Which, if
any, of the following statements are true in relation to QUIs & FQs? This
is not a true SBA as there may be more than one answer.
Statements
A.
|
nalidixic
acid is an older quinolone and is mainly excreted in the urine
|
B.
|
ciprofloxacin is effective against most Gram +ve and
–ve bacteria and 1st- line treatment for pneumococcal pneumonia.
|
C.
|
ciprofloxacin is contraindicated in pregnancy due to
the ↑ risk of neonatal haemolysis
|
D.
|
many staphylococci are resistant to quinolones
|
E.
|
quinolones are particularly useful in the treatment of
MRSA
|
Question 3.
Lead-in
Which was
the first QUI antibiotic?
Option List
A
|
acetylsalicylic
acid
|
B
|
nalidixic
acid
|
C
|
oxalic
acid
|
D
|
pipemidic
acid
|
E
|
none of
the above
|
Question 4.
Lead-in
How do QUI
and FQ antibiotics work? There is only one correct answer.
Option List
A
|
impair
bacterial DNA coiling
|
B
|
impair
bacterial DNA binding
|
C
|
impair
bacterial RNA action
|
D
|
impair
bacterial mitochondrial action
|
E
|
none of
the above.
|
Question 5.
Lead-in
Which, if
any, of the following QUIs & FQs is not available for prescription in the
UK. There is only one correct answer.
Option List
A
|
ciprofloxacin
|
B
|
levofloxacin
|
C
|
nalidixic
acid
|
D
|
moxifloxacin
|
E
|
ofloxacin
|
Question 6.
Lead-in
Which, if
any, of the following statements are true in relation to the quinolones and
fluoroquinolones and pregnancy? This is not a true SBA as there may be more
than one answer.
Option list.
A.
|
FQs are
newer than QUIs with better systemic spread and efficacy
|
B.
|
QUIs concentrate in urine but have a special affinity
for cartilage
|
C.
|
consumption of a FQ in the 1st. trimester is
grounds for TOP
|
D.
|
if an FQ is used, norfloxacin and ciprofloxacin should
be considered 1st.
|
E.
|
FQs are linked to a risk of discolouration of the teeth
of offspring
|
Question 7.
Lead-in
Which of
the following is true about the warning issued by the FDA in 2008 in relation
to QUIs & FQs?
Option List
A
|
they may
cause congenital cartilage defects
|
B
|
they may
cause congenital deafness
|
C
|
they may
cause tendonitis and tendon rupture
|
D
|
they may
cause prolongation of the Q-T interval
|
E
|
none of
the above
|
Question 8.
Lead-in
Which of
the following is true about the warning issued by the FDA in 2011 in relation
to QUIs & FQs?
Option List
A
|
they may
cause exacerbation of eczema
|
B
|
they may
cause exacerbation of hypertension
|
C
|
they may
cause exacerbation of multiple sclerosis
|
D
|
they may
cause exacerbation of myasthenia gravis
|
E
|
they may
cause exacerbation of SLE
|
Question 9.
Lead-in
Which of
the following is true about the warning emphasised by the FDA in 2013 in
relation to QUIs & FQs?
Option List
A
|
they may
cause aortic dissection
|
B
|
they may
cause mitral stenosis
|
C
|
they may
cause pancreatitis
|
D
|
they may
cause peripheral neuropathy
|
E
|
they may
cause flare of SLE
|
Question 10.
Lead-in
FDA issued
a warning in July 2016. Which, if any, of the following were included? This is
not a true SBA as there may be more than one answer.
Option List
A
|
the
risks generally outweigh the benefits
|
B
|
QUIs
& FQs should not be used for acute
sinusitis,
|
C
|
QUIs
& FQs should not be used for exacerbation
of chronic bronchitis
|
D
|
QUIs
& FQs should not be used for uncomplicated
UTI
|
E
|
QUIs
& FQs may be useful for anthrax and plague
|
Question 11.
Lead-in
FDA issued
a warning in July 2018 about the use of FQs in pregnancy. Which, if any, of the
following were included in the reasons for its publication?
Option List
A
|
to
strengthen previous warnings about hyperglycaemia and mental health risks
|
B
|
to
strengthen previous warnings about hypoglycaemia and mental health risks
|
C
|
to
strengthen previous warnings about the risk of ASD in the offspring
|
D
|
to
strengthen previous warnings about the risk of acute pancreatitis
|
E
|
to
strengthen previous warnings about the risk of PET
|
Question 12.
Lead-in
The FDA
issued a warning in December 2018 about the use of FQs in pregnancy. Which, if
any, of the following was included? This is an SBA with only one correct
answer.
Option List
A
|
↑ risk of atrial
fibrillation
|
B
|
↑ risk of aortic
aneurysm and rupture
|
C
|
↑ risk of
mitral stenosis
|
D
|
↑ risk of
pulmonary hypertension
|
E
|
↑ risk of
ulcerative colitis
|
52. Galactosaemia.
Some of the questions have no option list. The technique for the exam is
to decide your answer before you read the option list. The absence of an option
list forces this behaviour!
Abbreviations.
GA: galactose
GAA: galactosaemia
Scenario
1.
What is galactosemia? There is
no option list.
Scenario
2.
What is the mode of inheritance?
There is no option list.
Scenario
3.
Which of the following is the
most common cause of galactosemia in Caucasians?
Option list.
A
|
mutation of the GALE gene
|
B
|
mutation of the GALF gene
|
C
|
mutation of the GALK gene
|
D
|
mutation of the GALk1 gene
|
E
|
mutation of the GALT gene
|
Scenario
4.
What is the mutation which
causes Classical Galactosaemia?
Option list.
A
|
Q188L
|
B
|
Q188M
|
C
|
Q188R
|
D
|
R188L
|
E
|
R188M
|
F
|
R188R
|
G
|
None of the above
|
Scenario
5.
What is the Duarte mutation?
There is no option list.
Scenario
6.
What are the main sources of
galactose? There is no option list.
Scenario
7.
What is the approximate prevalence
of galactosemia? There is no option list.
Scenario
8.
Which of the following groups
has the highest prevalence of galactosaemia?
Option list.
A
|
Armenians
|
B
|
Ashkenazi Jews
|
C
|
French absinthe drinkers
|
D
|
Irish campers
|
E
|
Irish travellers
|
F
|
Masai
|
G
|
Scottish campers
|
H
|
None of the above
|
Scenario
9.
Which is the most common
mutation in the group with the highest incidence of galactosemia? There is no
option list.
Scenario
10.
Which, if any, of the following
are linked to untreated GAA in the newborn?
Option list.
A
|
risk of coagulation problems
|
B
|
risk of congenital hypothyroidism
|
C
|
risk of diabetes
|
D
|
risk of diarrhoea
|
E
|
risk of failure to thrive
|
F
|
risk of liver failure
|
G
|
risk of renal failure
|
H
|
risk of staphylococcal infection
|
Scenario
11.
What are the main problems
associated with non-treatment of galactosaemia in adults? There is no option
list.
Scenario
12.
Which, if any, of the following
statements are true in relation to the effects of a galactose-reduced diet
(GRD) on long-term complications (LTCs)?
Option list.
A
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth
|
B
|
a GRD has a major protective effect on LTCs, but only
if started within 12 weeks of birth
|
C
|
a GRD has a major protective effect on LTCs, but only
if followed meticulously
|
D
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth and continued for life
|
E
|
a GRD has a major protective effect on LTCs, but only
if started within 2 weeks of birth and continued for life
|
F
|
none of the above
|
Scenario
13.
Is screening for galactosaemia
included in the UK neonatal screening programme? If not, why not?
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 virus
|
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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