MRCOGManchester: Tutorial 10 December 2020

10 December 2020

30	EMQ. Clue cells, koilocytes etc.
31	EMQ. Cytomegalovirus.
32	EMQ. Surrogacy
33	EMQ. Renal transplant
34	EMQ. Edward syndrome

30. EMQ. Clue cells, koilocytes etc.

Abbreviations.

Ct: Chlamydia trachomatis

FPA: Family Planning Association

HSV: Herpes simplex virus

LGV: lymphogranuloma venereum

Ng: Neisseria gonorrhoeae

SNHL: sensorineural hearing loss

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%

31. EMQ. Cytomegalovirus.

Abbreviations.

AI: avidity index.

CMV: cytomegalovirus.

CNS: central nervous system.

FGR: fetal growth restriction.

HIG: hyperimmunoglobulin.

IUFD: intrauterine fetal death.

Scenario 1.

What does the term “cytomegalovirus” mean?

Option list.

A	it is an unusually large virus
B	it is the largest known virus
C	the viral cytoplasm is increased in volume
D	infected cells are enlarged and have enlarged nuclei
E	none of the above

Scenario 2.

Which of the following terms is used in relation to CMV infected cells?

Option list.

A	almond-eyed
B	apple of my eye
C	cross-eyed
D	doe-eyed
E	owl-eyed

Scenario 3.

Which family of viruses does CMV belong to?

Option list.

A	Adenoviridae
B	Arachnoviridae
C	Enteroviridae
D	Herpesviridae
E	Poxviridae

Scenario 4.

What kind of virus is CMV?

Option list.

A	bacteriophage
B	DNA virus
C	RNA virus
D	none of the above

Scenario 5.

What is the structure of the herpes virus?

Option list.

A	double-stranded DNA core, surrounded by three layers: capsid, tegument and envelope
B	single-stranded DNA core, surrounded by two layers: capsid and envelope
C	double-stranded RNA core, surrounded by three layers: capsid, tegument and envelope
D	single-stranded RNA core, surrounded by two layers: capsid and envelope
E	none of the above

Scenario 6.

How many herpes viruses have been described?

Option list.

A	>1,000
B	> 500
C	> 250
D	> 100
E	none of the above.

Scenario 7.

How many herpes viruses are of relevance to human infection?

Option list.

A	8
B	10
C	12
D	14
E	20

Scenario 8.

Write the list of herpes viruses which affect humans and the conditions they cause?

Option list.

There is none. You have to write your own list.

Scenario 9.

Where does CMV rank in the list of the most common causes of congenital viral infection?

Option list.

A	1
B	2
C	3
D	4
E	5

Scenario 10.

Which of the following statements is the most accurate in relation to CMV?

Option list.

A	CMV can lie dormant after 1ry. infection, usually in bone marrow
B	CMV can lie dormant after 1ry. infection, usually in dorsal root ganglia
C	CMV can lie dormant after 1ry. infection, usually in the lungs
D	CMV can lie dormant after 1ry. infection, usually in the salivary glands
E	CMV does not lie dormant after 1ry. infection

Scenario 11.

Which, if any, of the following statements is true of CMV & pregnancy in the UK?

Option list.

A	approximately 10-20% of women are immune before their 1^st. pregnancy
B	approximately 20-30% of women are immune before their 1^st. pregnancy
C	approximately 30-50% of women are immune before their 1^st. pregnancy
D	approximately 40-60% of women are immune before their 1^st. pregnancy
E	none of the above

Scenario 12.

Which of the following statements is true in relation to vertical transmission?

Option list.

A	it is mainly transplacental
B	it is mainly due to feto-maternal haemorrhage
C	it mainly occurs during labour and delivery
D	it mainly occurs during lactation
E	none of the above

Scenario 13.

What is the approximate incidence of 1^ry. CMV infection in pregnancy?

Option list.

A	< 1%
B	< 5%
C	< 7.5%
D	< 10%
E	≥ 10%

Scenario 14.

What is the biggest source of CMV infection for women of reproductive age?

Option list.

A	contaminated food or water
B	blood transfusion
C	infected sexual partner
D	infected small children
E	undercooked meat, particularly pork

Scenario 15.

What proportion of 1^ry. maternal CMV infection in pregnancy is asymptomatic?

Option list.

A	up to 10%
B	11 – 29%
C	30 – 49%
D	50 – 79%
E	80 – 89%
F	≥ 90%

Scenario 16.

What is the approximate prevalence of CMV infection in UK neonates?

Option list.

A	0.10- 0.25%
B	0.10- 0.50%
C	0.20- 0.50%
D	0.20- 1.00%
E	0.20- 2.25%

Scenario 17.

Where does CMV rank in the non-genetic causes of SNHL in children?

Option list.

A	1
B	2
C	3
D	4
E	none of the above

Scenario 18.

When does vertical transmission carry the greatest risk of inflicting neurological damage on the fetus?

Option list.

A	with 1ry infection during the 1^st. trimester
B	with 2ry infection during the 1^st. trimester
C	with 1ry infection during the 2^nd. trimester
D	with 2ry infection during the 2^nd. trimester
E	with 1ry infection during the 3^rd. trimester
F	with 2ry infection during the 3^rd. trimester
G	with 1ry infection during labour / delivery
H	with 2ry infection during labour / delivery
I	none of the above

Scenario 19.

What is the risk of vertical transmission after CMV infection in the immediate preconception period?

Option list.

A	< 1%
B	1-5%
C	6-10%
D	11-15%
E	16-20%
F	21-30%

Scenario 20.

A fetus is infected with CMV at the time of highest risk for neurological damage. What is the approximate upper limit for the risk that the child will have neurological damage?

Option list.

A	up to 1%
B	up to 5%
C	up to 7.5%
D	up to 10%
E	up to 12.5%
F	up to 15%
G	up to 20%
H	none of the above

Scenario 21.

Approximately what % of cerebral palsy is thought attributable to fetal CMV infection?

Option list.

A	1%
B	5%
C	7.5%
D	10%
E	12.5%
F	15%
G	20%
H	25%

Scenario 22.

Approximately what % of SNHL is thought attributable to fetal CMV infection?

Option list.

A	1%
B	5%
C	7.5%
D	10%
E	12.5%
F	15%
G	20%
H	25%

Scenario 23.

Which, if any, of the following statements is true of CMV?

Option list.

A	1ry. infection is followed by life-long latent infection
B	1ry. infection is followed by life-long latent infection in a minority of cases
C	life-long latent infection is characteristic of CMV but not other herpes viruses
D	life-long latent infection only occurs after 2ry. infection
E	none of the above.

Scenario 24.

How is 1ry. maternal CMV infection best diagnosed?

Option list.

A	by the regional laboratory
B	IgM to IgG conversion
C	presence of IgM with low avidity IgG
D	religious conversion
E	sero-conversion from IgG -ve to IgG +ve

Scenario 25.

Which, if any, of the following statements is true in relation to ‘avidity’ in CMV infection?

Option list.

A	avidity declines directly with the interval from 1ry infection to the test
B	avidity is an indirect measure of viral load
C	avidity measures the determination of the obstetrician to make a diagnosis
D	avidity measures the enthusiasm of the laboratory for maximising the cost of testing
E	avidity measures the strength of binding of CMV antibody to the virus

Scenario 26.

Which, if any, of the following statements is true in relation to the ‘avidity index’ in CMV infection?

Option list.

A	the AI is the ratio of free: albumin-bound CMV IgG in maternal serum
B	the AI is the IgG antibody titre in maternal serum
C	the AI is the percentage of IgG that is bound to the antigen
D	the AI is the amount of IgG bound to the antigen expressed as micrograms / gram
E	none of the above

Scenario 27.

Which, if any, of the following statements is true in relation to the ‘avidity index’ in CMV infection?

Option list.

A	an AI < 30 is indicative of old infection
B	an AI < 30 is indicative of recent 1ry infection
C	an AI < 30 suggests a faulty assay
D	the AI assay used in the NHS is standard across all laboratories
E	none of the above

Scenario 28.

Which, if any, of the following statements is true in relation to identifying women at greatest risk of having a baby with severe congenital infection?

Option list.

A	a low AI < 18 weeks indicates high risk
B	a high AI < 18 weeks indicates high risk
C	a high IgM titre indicates low risk
D	a high IgG titre indicates high risk
E	none of the above

Scenario 29.

What is UK policy in relation to routine screening for CMV in pregnancy?

Option list.

A	routine screening was introduced in 2018
B	routine screening is not advocated because of cost
C	routine screening is not advocated because of the lack of an accurate test
D	routine screening is not advocated because of cross-reaction with EBV
E	none of the above

Scenario 30.

What is UK policy in relation to routine screening of the neonate for CMV?

Option list.

A	routine screening was introduced in 2015
B	routine screening is not advocated because of cost
C	routine screening is not advocated because of the lack of an accurate test
D	routine screening is not advocated because of cross-reaction with EBV
E	none of the above

Scenario 31.

Pick the true statement from the list below?

Option list.

A	avidity testing is not done on CMV IgM antibodies
B	CMV IgG is a maverick and does not play by the usual rules
C	CMV IgM is a maverick and does not play by the usual rules
D	CMV IgG persists for many years
E	CMV IgM persists for 1 year or more
F	none of the above

Scenario 32.

A woman has been shown to have had CMV infection in pregnancy. It is decided to check for evidence of fetal infection. What does SIP56 say is the mainstay of diagnosing fetal CMV infection.?

Option list.

A	amniocentesis and PCR for evidence of CMV
B	amniocentesis and electron microscopy for evidence of CMV
C	amniocentesis and light microscopy for evidence of CMV
D	amniocentesis and viral culture
E	MRI
F	ultrasound – abdominal
G	ultrasound - transvaginal

Scenario 33.

A woman has been shown to have had CMV infection in pregnancy. Which, if any of the following statements best describe the role of MRI scanning in assessing the fetus? This is not a true EMQ as more than one statement may be true.

Option list.

A	it should be offered in conjunction with ultrasound
B	it should be offered if ultrasound examination suggests fetal infection
C	it should be offered if ultrasound examination does not suggest fetal infection
D	it should be offered if there is sufficient funding to pay for it
E	the role of MRI scanning is not yet clear
F	none of the above

Scenario 34.

A pregnant woman is HIV+ve? Which of the following statements is true?

Option list.

A	the risk of vertical transmission in pregnancy is ↑
B	the risk of vertical transmission in pregnancy is ↓
C	the risk of vertical transmission in pregnancy is the same as in HIV-ve women

Scenario 35.

A pregnant woman is HIV+ve? Which of the following statements is true?

Option list.

A	her neonate is at ↑ risk of acquiring CMV perinatally
B	her neonate is at ↓ risk of acquiring CMV perinatally
C	her neonate is at normal risk of acquiring CMV perinatally
D	none of the above

Scenario 36.

A pregnant woman is HIV+ve? Her neonate is +ve for both CMV and HIV. Which of the following statements is true?

Option list.

A	the child has a ↓ risk of HIV progression and ↓ risk of CNS damage from CMV
B	the child has a ↓ risk of HIV progression and ↑ risk of CNS damage from CMV
C	the child has a ↓ risk of HIV progression and normal risk of CNS damage from CMV
D	the child has an ↑ risk of HIV progression and ↓ risk CNS damage from CMV
E	the child has an ↑ risk of HIV progression and ↑ risk CNS damage from CMV
F	the child has an ↑ risk of HIV progression and normal risk of CNS damage from CMV
G	the child has a normal risk of HIV progression and ↓ risk of CNS damage from CMV
H	the child has a normal risk of HIV progression ↑ risk of CNS damage from CMV
I	the child has a normal risk of both HIV progression and CNS damage from CMV

Scenario 37.

Which of the following treatments in pregnancy is of proven efficacy and safety in reducing the risk of vertical transmission to the fetus?

Option list.

A	acyclovir
B	CMV vaccine
C	ganciclovir
D	HIG
E	valaciclovir
F	none of the above

TOG CPD

Comprehensive review and update of

cytomegalovirus infection in pregnancy

Regarding cytomegalovirus (CMV),

1. it is a double-stranded RNA herpes virus. True False

2. it is the commonest congenital viral infection in

the developed world. True False

3. prevalence is most common in social class V. True False

Regarding CMV morbidity,

4. it is the leading genetic cause of

sensorineural deafness. True False

5. maternal infection occurring in the third

trimester carries the highest risk to the

fetus. True False

6. previous infection confers complete future

immunity to the mother. True False

Regarding feto-maternal transmission of CMV,

7. there is good evidence to suggest that

gestational age has no apparent inﬂuence on

risk of transmission. True False

8. breastfeeding is a route of transmission. True False

9. for healthy mature babies, an infection with

the CMV through breastmilk does not pose

signiﬁcant danger. True False

10. transmission can be reduced by appropriate

hand washing after nappy changes and

exposure to bodily ﬂuids, avoiding kissing

young children on mouth and cheeks and by

avoiding sharing food, drinks or utensils with

young children. True False

11. primary infection, reactivation and reinfection

with different CMV strains during pregnancy

has been shown to lead to congenital CMV. True False

Regarding maternal CMV in pregnancy,

12. diagnosis of maternal CMV based on

symptoms is reliable with over 70% of women

presenting with classic symptoms. True False

13. viral reactivation is more common in HIV

positive pregnant women. True False

Regarding diagnosis of CMV infection in pregnancy,

14. seroconversion of CMV speciﬁc

immunoglobulin G (IgG) in paired acute and

convalescent sera is diagnostic of a new

acute infection. True False

15. When prepregnancy status is unknown,

detection of immunoglobulin M (IgM)-

speciﬁc antibody is diagnostic of

primary infection. True False

16. IgM serology is imprecise for determining

primary infection as it has been shown to

remain positive for up to a year following

acute infection. True False

17. The presence of IgG and IgM CMV antibodies

with low CMV antibody avidity is diagnostic

of primary infection. True False

Concerning congenital CMV infection,

18. 85% are asymptomatic at birth. True False

19. 30% of affected infants will develop

neurological sequelae. True False

20. 15% of infants born to mothers with recurrent

CMV infection are overtly symptomatic. True False

Comprehensive review and update of cytomegalovirus infection in pregnancy.

These derive from the TOG article by Navti et al. The article is from 2016 and is open-access.

TOG. Volume 18, Issue 4 October 2016 Pages 301–7.

Some of the questions are badly written – I would expect exam questions to be better.

Regarding cytomegalovirus (CMV),

1. it is a double-stranded RNA herpes virus. True False

2. it is the commonest congenital viral infection in the developed world. True False.

3. prevalence is most common in social class V. True False

Regarding CMV morbidity,

4. it is the leading genetic cause of sensorineural deafness. True False

5. maternal infection occurring in the 3^rd. trimester carries the highest risk to the fetus. True False

6. previous infection confers complete future immunity to the mother. True False

Regarding feto-maternal transmission of CMV,

7. there is good evidence to suggest that gestational age has no apparent influence on risk of transmission. True False

8. breastfeeding is a route of transmission. True False

9. for healthy mature babies, an infection with the CMV through breastmilk does not pose significant danger. True False

10. transmission can be reduced by appropriate hand washing after nappy changes and exposure to bodily fluids, avoiding kissing young children on mouth and cheeks and by avoiding sharing food, drinks or utensils with young children. True False

11. primary infection, reactivation and reinfection with different CMV strains during pregnancy has been shown to lead to congenital CMV. True False

Regarding maternal CMV in pregnancy,

12. diagnosis of maternal CMV based on symptoms is reliable with over 70% of women presenting with classic symptoms. True False

13. viral reactivation is more common in HIV positive pregnant women. True False

Regarding diagnosis of CMV infection in pregnancy,

14. seroconversion of CMV specific immunoglobulin G (IgG) in paired acute and convalescent sera is diagnostic of a new acute infection. True False

15. When prepregnancy status is unknown, detection of immunoglobulin M (IgM)- specific antibody is diagnostic of primary infection. True False

16. IgM serology is imprecise for determining primary infection as it has been shown to remain positive for up to a year following acute infection. True False

17. The presence of IgG and IgM CMV antibodies with low CMV antibody avidity is diagnostic of primary infection. True False

Concerning congenital CMV infection,

18. 85% are asymptomatic at birth. True False

19. 30% of affected infants will develop neurological sequelae. True False

20. 15% of infants born to mothers with recurrent CMV infection are overtly symptomatic.

True False

32. EMQ. Surrogacy.

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

Most of the following are ‘true/ false’ or ‘yes / no’.

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.

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.

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.

Scenario 9.

The psychological outcomes of surrogacy are more severe after traditional surrogacy.

Scenario 10.

Who has the right to arrange TOP if the fetus is found to have a major 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?

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?

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?

Scenario 15.

A PO is active from the moment it is completed and signed by the relevant parties.

Scenario 16.

A SM can change her mind at any time and keep the child, even if the egg was not hers.

Scenario 17.

The CPs can change their mind, leaving the SM as the legal mother.

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.

33. EMQ. Renal transplant.

Abbreviations.

AST: American Society for Transplantation

Question 1

Approximately how many women who have had renal transplant have pregnancies annually in the UK?

Option list.

A	10-20
B	30-40
C	50-100
D	100-200
E	200-300
F	300-400
G	400-500
H	>500

Question 2

Which, if any, of the following statements are true about the findings of the UKOSS survey of renal transplant in pregnancy?

Option list.

A	the incidence of PET was ~ 25%, roughly 6 X higher than the general population
B	the incidence of PET was ~ 25%, roughly ten X higher than the general population
C	the incidence of PET was ~ 50%, roughly ten X higher than the general population
D	the incidence of PET was ~ 50%, roughly 20 X higher than the general population
E	none of the above

Question 3

Various sources, such as AST, give factors linked to reduced risks associated with pregnancy after RT. A lot of this is common sense. Write down all the factors that would be in your list.

Question 4

What is the risk of graft rejection in the year after RT?

Option list.

A	< 5%
B	10-15%
C	15-20%
D	20-25%
E	unknown

Question 5

Which of the following factors are the 3 main ones affecting pregnancy outcome?

Factors

1	anaemia
2	diabetes
3	hypertension
4	number of immunosuppressive drugs being used
5	obesity
6	pre-pregnancy graft function
7	proteinuria
8	urinary tract infection

Option list.

A	1 + 2 + 3
B	1 + 2 + 6
C	2 + 3 + 4
D	2 + 4 + 6
E	3 + 6 +7
F	3 + 6 + 8
G	4 + 5 + 6
H	4 + 6 + 8

Question 6

Which of the following statements is true in relation to the prevalence of hypertension in women after RT?

Option list.

A	> 20% have hypertension
B	> 30% have hypertension
C	> 40% have hypertension
D	> 50 % have hypertension
E	none of the above

Question 7

State whether these drugs are regarded as safe or unsafe in pregnancy.

	Drug	Safe / unsafe
A	ACE inhibitor	Safe / unsafe
B	angiotensin receptor antagonist	Safe / unsafe
C	azathioprine	Safe / unsafe
D	ciclosporin	Safe / unsafe
E	clopidogrel	Safe / unsafe
F	erythropoietin	Safe / unsafe
G	hydroxychloroquine	Safe / unsafe
H	mycophenolate	Safe / unsafe
I	prednisolone	Safe / unsafe
J	tacrolimus	Safe / unsafe
K	warfarin	Safe / unsafe

TOG CPD. These are open access. They are ‘True/False’.

With regard to renal transplant,

1. most recipients have a successful pregnancy outcome.

2. pregnancy is associated with a 10% reduction in GFR in recipients with prepregnancy eGFR >90 ml/ min/1.73m² .

3. hypertension complicates pregnancy in over 50% of recipients who did not require antihypertensive treatment prior to pregnancy.

4. proteinuria is a predictor of poor pregnancy outcome in recipients.

5. the risk of damage to the allograft at caesarean delivery is about 1%.

6. a positive serological screening test for aneuploidy in recipients is a recognised consequence of impaired renal function.

7. superimposed pre-eclampsia in recipients has defined diagnostic criteria.

8. erythropoietin requirements in recipients fall in pregnancy.

9. breastfeeding is safe in recipients on angiotensin converting enzyme inhibitors.

10. conception is not advised in recipients within the first year following transplantation.

11. continuous electronic fetal monitoring is recommended during labour in recipients.

12. the progesterone implant is a safe form of postpartum contraception in recipients.

Women who have donated a kidney,

13. are at increased risk of gestational hypertension.

Combined kidney-pancreas transplant recipients,

14. have a higher risk of gestational diabetes than kidney transplant recipients.

Liver transplant recipients,

15. have a lower risk of pregnancy complications than renal transplant recipients.

With regard to pregnancy in cardiothoracic transplant recipients,

16. lung transplant recipients have the highest risk of adverse outcome of all solid organ transplants.

17. due to denervation, the transplanted heart responds poorly to the physiological changes of pregnancy.

18. cardiothoracic transplant recipients should be delivered by caesarean section.

Regarding medications prescribed in patients with solid organ transplants,

19. tacrolimus levels require monitoring during pregnancy.

20. warfarin is safe for breastfeeding mothers.

34. EMQ. Edward syndrome.

Abbreviations.

ES: Edward syndrome. T₁₈.

DS: Down syndrome. T₂₁.

PS: Patau syndrome. T₁₃.

Lead-in.

Some of the questions are not true EMQs as there may be > 1 correct answer. The use of ‘is’ or ‘are’ usually indicates which are or are not true EMQs.

Question 1.

Which, if any, of the following are features of ED.

Option list.

A	abnormal head shape
B	atrial septal defect
C	camptodactyly
D	cleft lip
E	clenched fingers
F	corpus callosum hypoplasia
G	cryptorchidism
H	exomphalos
I	gastroschisis
J	IUGR
K	large ears
L	low birthweight
M	macroorchidism
N	micrognathia
O	myelomeningocoele
P	omphalocoele
Q	overlapping fingers
R	rocker bottom
S	none of the above

Question 2.

Which of the following statements is true?

Option list.

A	ES is the most common autosomal trisomy
B	ES is the 2^nd. most common autosomal trisomy
C	ES is the 3^rd. most common autosomal trisomy
D	ES is the 4^th. most common autosomal trisomy
E	none of the above

Question 3.

What is the approximate incidence of ED in neonates?

Option list.

A	1 in 1,000
B	1 in 2,000
C	1 in 5,000
D	1 in 10,000
E	1 in 100,000
F	none of the above

Question 4.

Which, if any, of the following are true in relation to ES and choroid plexus cysts?

Option list.

A	CPC are not more common in ES
B	CPCs are the most frequent reason for suspecting ES
C	CPCs are seen in ≥ 50% of fetuses with ES
D	CPC + another anomaly give a high risk of ES
E	CPCs persist longer in ES
F	none of the above

Question 5.

What % of neonates with T18 survive to 1 year of age.

Option list.

A	< 1 %
B	1-5%
C	6-10%
D	10-15%
E	> 15%

MRCOGManchester

Thursday 10 December 2020

Tutorial 10 December 2020

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