MRCOGManchester: Tutorial 17 December 2020

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40	EMQ. Cervical cancer staging
41	EMQ. Anatomy of fetal skull and maternal pelvis
42	EMQ. Haemophilia A
43	SBA. Androgen insensitivity syndrome
44	EMQ. Family origin questionnaire
45	EMQ. Pertussis

40. EMQ. Cervical cancer staging .

Option list.

A	Micro-invasive cervical cancer.
B	Stage IA1
C	Stage IA2
D	Stage IA3
E	Stage IB1
F	Stage IB2
G	Stage IB3
H	Stage IIA
I	Stage IIB
J	Stage IIC
K	Stage IIIa
L	Stage IIIB
M	Stage IIIC
N	Stage IVA
O	Stage IVB
P	Stage IVC
Q	Stage VA
R	Stage VB
S	Stage VC
T	None of the above.

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 4 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 cervix. 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 sidewall. It involves the upper 1/3 of the vagina. There is MRI evidence of para-aortic node involvement.

Scenario 8.

A woman of 55 has carcinoma of the cervix. It extends to the pelvic sidewall. 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 sidewall. 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, which was not visible to the naked eye, 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.

41. EMQ. Anatomy of fetal skull and maternal pelvis.

Scenario 1.

How many bones make up the vault of the skull?

Option list.

A.	3
B.	5
C.	6
D.	7
E.	8

Scenario 2.

What is the origin of the word “bregma”?

Option list.

A.	the Greek word meaning “arrow”
B.	the Greek word meaning “front of the head”
C.	the Greek word meaning “top of the head”
D.	the Greek word meaning “where lines intersect”
E.	none of the above

Scenario 3.

What is the origin of the word “lambdoid”?

Option list.

A.	it is derived from “lambda”, the 11^th. letter of the Greek alphabet, with the symbol “λ”
B.	it is derived from the shape of the rear end of a newborn lamb, with legs apart for balance in the shape of an inverted “V”
C.	it derives from the Norse noun “lam” meaning to hit

Scenario 4.

What is the origin of the word “sagittal”?

Option list.

A.	it derives from the Latin verb “sagire” meaning to be wise
B.	it derives from the Latin noun “sagitta” meaning “arrow”
C.	it derives from the Latin adjective “sagitta” meaning “pointing north”
D.	it derives from the Latin adjective “sagitta” meaning “lacking tension”

Scenario 5.

What is the meaning of the word “coronal”.

Option list.

A.	it is the 11^th. letter of the Greek alphabet
B.	it derives from the Latin “corona” meaning “crown”.
C.	it derives from the sun’s corona, meaning equator

Scenario 6.

What is the definition of “vertex”?

Option list.

A.	the most prominent part of the occiput
B.	the area around the posterior fontanelle
C.	the area bounded by the anterior fontanelle and the posterior fontanelle
D.	the area bounded by the anterior & posterior fontanelles and the parietal bones
E.	the area bounded by the anterior & posterior fontanelles and the parietal eminences
F.	the area bounded by the anterior & posterior fontanelles and the parietal cardinals

Scenario 7.

What is the definition of the anterior fontanelle?

Option list.

A.	the anterior end of the sagittal suture
B.	the area where the sagittal and coronal sutures meet
C.	the area between the frontal and parietal bones
D.	the posterior end of the sagittal suture
E.	the area between the parietal bones and the occiput

Scenario 8.

What is the definition of the posterior fontanelle?

Option list.

A.	the anterior end of the sagittal suture
B.	the area where the sagittal and lambda sutures meet
C.	the area between the frontal and parietal bones
D.	the posterior end of the sagittal suture
E.	the area between the parietal bones and the occiput

Scenario 9.

How many other fontanelles are there?

A.	0
B.	2
C.	3
D.	4
E.	6

Scenario 10.

What is the falx cerebri?

Option list.

A.	an area of dura mater at the back of the skull like a roof over the cerebellum
B.	is an artefact on ultrasound suggesting the presence of cerebral tissue where there is none
C.	is the horizontal fibrous platform on which the cerebellum rests
D.	is a crescent-shaped fold of dura mater separating the cerebral hemispheres

Scenario 11.

What is the importance of the falx cerebri in relation to delivery, particularly breech delivery?

Option list.

A.	the falx cerebri is inserted into the tentorium cerebelli and traction on the base of the skull may lead to tentorial tears and intracranial bleeding
B.	the falx cerebri is inserted into the bone of base of the skull and traction on the base of the skull may lead to tears of the falx and intracranial bleeding
C.	the falx cerebri is inserted into the tentorium cerebelli and traction on the base of the skull may lead to tentorial tears leaving the cerebellum unsupported and liable to trauma

Scenario 12.

What diameter presents to the pelvis with vertex presentation?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 13.

What diameter presents to the pelvis with typical occipito-posterior position?

Option list.

Use the Option List from Scenario 12.

Scenario 14.

What diameter presents to the pelvis with brow presentation?

Scenario 15.

What diameter presents to the pelvis with mento-anterior face presentation?

Option list.

Use the Option List from Scenario 12.

Scenario 16.

What diameter presents to the pelvis with mento-posterior face presentation?

Option list.

Use the Option List from Scenario 12.

Scenario 17.

What is the average length of the suboccipito-bregmatic diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.

Scenario 18.

What is the average length of the suboccipito-frontal diameter in a term baby?

Use the Option List from Scenario 17.

Scenario 19.

What is the average length of the occipito-frontal diameter in a term baby?

Use the Option List from Scenario 17.

Scenario 20.

What is the average length of the mento-vertical diameter in a term baby?

Use the Option List from Scenario 17.

Scenario 21.

What is the average length of the submento-bregmatic diameter in a term baby?

Use the Option List from Scenario 17.

42. EMQ. Haemophilia A.

Abbreviations.

HA: haemophilia A.

HB: haemophilia B.

Question 1.

What other names are used for haemophilia A? There is no option list.

Question 2.

What is haemophilia A due to?

A	lack of factor VII
B	lack of factor VIII
C	lack of factor IX
D	lack of factor X
E	lack of fibrinogen
F	platelet malfunction

Question 3.

What is the pattern of inheritance of haemophilia A?

A	autosomal dominant
B	autosomal recessive
C	X-linked dominant
D	X-linked recessive
E	Y-linked recessive
F	Y-linked dominant
G	none of the above

Question 4.

Which chromosome is involved in haemophilia A?

A	chromosome 8
B	chromosome 10
C	chromosome 12
D	chromosome 13
E	chromosome 15
F	chromosome X
G	chromosome Y
H	none of the above

Question 5.

What is the approximate incidence of haemophilia A in neonates?

A	1 in 1,000
B	1 in 5,000
C	1 in 10,000
D	1 in 15,000
E	1 in 20,000
F	1 in 25,000
G	< 1 in 25,000
H	none of the above

Question 6.

What other names are used for haemophilia B? There is no option list.

Question 7.

What is haemophilia B due to?

A	lack of factor VII
B	lack of factor VIII
C	lack of factor IX
D	lack of factor X
E	lack of fibrinogen
F	platelet malfunction

Question 8.

What is the pattern of inheritance of haemophilia B?

A	autosomal dominant
B	autosomal recessive
C	X-linked dominant
D	X-linked recessive
E	Y-linked recessive
F	Y-linked dominant
G	none of the above

Question 9.

Which chromosome is involved in haemophilia B?

A	chromosome 8
B	chromosome 10
C	chromosome 12
D	chromosome 13
E	chromosome 15
F	chromosome X
G	chromosome Y
H	none of the above

Question 10.

What is the approximate incidence of haemophilia B in neonates?

A	1 in 1,000
B	1 in 5,000
C	1 in 10,000
D	1 in 15,000
E	1 in 20,000
F	1 in 25,000
G	< 1 in 25,000
H	none of the above

Question 11.

A woman attends for pre-pregnancy counselling. Her brother has haemophilia A. What is her risk of being a carrier?

Question 12.

A woman attends for pre-pregnancy counselling. Her father has haemophilia A. What is her risk of being a carrier?

Question 13.

If she is tested and found to be a carrier, what tests will you arrange for her partner?

Question 14.

If she is a carrier, what is the risk to her male offspring?

Question 15.

If she is a carrier, what is the risk to her female offspring?

Question 16.

If she is a carrier and her partner has haemophilia A, what are the risks to their female offspring?

Question 17.

If she is a carrier and her partner has haemophilia A, what are the risks to their male offspring?

Question 18.

A lady doctor has a brother with haemophilia. There is no other FH of haemophilia. The brother has a 20-year-old daughter who is planning pregnancy and phones his sister, the doctor, to ask what the risk is of his daughter being a carrier.

Question 19.

Question 20.

Question 21.

A lady doctor has a brother with haemophilia. There is no other FH of haemophilia. She has a pregnancy with no testing. A son in born. What is the chance that he is affected?

Question 22.

A lady doctor has a brother with haemophilia. There is no other FH of haemophilia. She has a pregnancy with no testing. A son in born. What is the chance that he is not affected?

Question 23.

A lady doctor has a brother with haemophilia. There is no other FH of haemophilia. She has a pregnancy with no testing. A daughter is born. What is the chance she will be a carrier?

Question 24.

A lady doctor has a brother with haemophilia. There is no other FH of haemophilia. She is found to be a carrier. What additional tests, if any, should be done because of her carrier status?

43. SBA. Androgen insensitivity syndrome.

Abbreviations.

AIS: androgen insensitivity syndrome

Question 1.

What is the estimated prevalence of AIS?

Option List

A.	2-5 per 100,000 boys at birth
B.	5-10 per 100,000 girls at birth
C.	2-5 per 100,000 genetic males at birth
D.	5-10 per 100,000 genetic females at birth
E.	none of the above.

Question 2.

Which of the following sub-types of AIS do not exist?

Sub-types

1.	complete AIS
2.	incomplete AIS
3.	mild AIS
4.	partial AIS
5.	total AIS

Option List

A.	1
B.	2
C.	3
D.	4
E.	5
F.	1 + 3
G.	2 + 3
H.	2 + 5
I.	3 + 5
J.	4 + 5

Question 3.

How common is partial AIS?

Option List

A.	at least as common as complete AIS
B.	at least as common as total AIS
C.	less common than mild AIS
D.	as common as incomplete AIS
E.	none of the above.

Question 4.

How common is incomplete AIS?

Option List

A.	at least as common as complete AIS
B.	at least as common as total AIS
C.	less common than mild AIS
D.	as common as partial AIS
E.	none of the above.

Question 5.

How common is mild AIS?

Option List

A.	at least as common as complete AIS
B.	at least as common as total AIS
C.	less common than complete AIS
D.	as common as partial AIS
E.	none of the above.

Question 6.

No more prevalence!! What is the mode of inheritance of AIS?

Option List

A.	autosomal dominant
B.	autosomal recessive
C.	X-linked dominant
D.	X-linked recessive
E.	mitochondrial

Question 7.

What proportion of AIS is due to new mutations?

Option List

A.	0%
B.	1 – 20%
C.	21 – 40%
D.	41-60%
E.	61-80%

Question 8.

Lead-in

Which gene is involved in AIS?

Option List

A.	androgen receptor gene
B.	aromatase receptor gene
C.	androstenedione gene
D.	oestrogen receptor gene
E.	none of the above

Question 9.

How many mutations have been described of the gene which is involved in AIS?

Option List

A.	0-10
B.	11-100
C.	101-200
D.	201-300
E.	>300

Question 10.

Lead-in

Which is the most common clinical presentation in AIS?

Option List

A.	ambiguous genitalia
B.	precocious puberty
C.	premature menopause
D.	primary amenorrhoea
E.	secondary amenorrhoea

Question 11.

Which of the following are more common in AIS?

Option List

A.	anlagen
B.	coarctation of the aorta
C.	“coast of Maine” pigmentation pattern
D.	renal tract anomalies
E.	none of the above.

Question 12.

A woman of 20 is found to have AIS. She has a pre-pubertal sister. What is the chance that the sister also has AIS, assuming that the condition is not due to a new mutation in the elder sister?

Option List

A.	1 in 1
B.	1 in 2
C.	1 in 3
D.	1 in 4
E.	1 in 16

Question 13.

What is the risk of the gonads becoming malignant in AIS?

Option List

A.	10%
B.	20%
C.	30%
D.	> 30%
E.	accurate risk not known

44. EMQ. Family origin questionnaire.

Question 1.

What is the main purpose of the Family Origin Questionnaire?

Option list.

A	to identify illegal immigrants
B	to identify those who are not entitled to free NHS care
C	to monitor the degree to which different ethnic groups use the NHS
D	to screen for sickle cell disease
E	to screen for α-thalassaemia
F	none of the above.

Question 2.

Whose ancestry is asked about in the FOQ? This is not a true EMQ as there may be more than one correct answer.

Option list.

A	the pregnant woman
B	the woman’s partner/husband
C	the biological father of the pregnancy
D	the postman in case he delivered more than the mail
E	the queen
F	the woman’s mother
G	the woman’s father
H	the woman’s siblings
I	none of the above

Question 3.

Which generations should be included? This is an EMQ with only one correct answer.

Option list.

A	the current generation
B	the current generation + the previous generation
C	the current generation + 2 previous generations
D	the current generation + 3 previous generations
E	the current generation + as many previous generations as possible
F	none of the above

Question 4.

Who should complete the FOQ? This is an EMQ with only one correct answer.

Option list.

A	the woman
B	the woman’s husband / partner
C	the biological father of the pregnancy
D	the midwife
E	the obstetrician
F	an interpreter if the woman & partner are not fluent in English
G	none of the above

Question 5.

What other responsibilities does the person completing the FOQ have? There is no option list so as not to make it too easy.

Question 6.

Which tick boxes are highlighted in yellow on the FAQ. This is an EMQ with one correct answer.

Option list.

A	those that must be completed
B	those that suggest a possible ↑ risk of neonatal jaundice
C	those that suggest a possible ↑ risk of HepB
D	those that suggest a possible ↑ risk of SCD. SCT or thalassaemia
E	those showing areas with a ↑ risk of having SCD. SCT or thalassaemia
F	none of the above

Question 7.

What is the significance of the red ‘hash’ mark # that appears alongside some of the boxes. There is only one correct answer.

Option list.

A	the box that must be completed
B	just decoration to make the form more pleasing to the eye
C	denotes area with ↑ risk of bilharzia
D	denotes area with ↑ risk of falciparum malaria
E	denotes area with ↑ risk of α-thalassaemia
F	denotes area with ↑ risk of β-thalassaemia
G	none of the above

Question 8.

A woman books at 10 weeks in her 1^st. pregnancy. Her husband in Turkish and healthy. What screening for sickle cell and thalassaemia should be offered?

Option list.

A	screening depends on whether the area is high or low risk
B	screening depends on whether the FOQ shows high or low risk
C	the husband should first be screened
D	the woman should be screened using Hb and red cell indices
E	the woman should be screened using electrophoresis
F	none of the above

Question 9.

A woman books at 10 weeks in her 1^st. pregnancy. Her husband is English and healthy. What screening for sickle cell and thalassaemia should be offered?

Option list.

A	screening depends on whether the area is high or low risk
B	screening depends on whether the FOQ shows high or low risk
C	the husband should first be screened
D	the woman should be screened using Hb and red cell indices
E	the woman should be screened using electrophoresis
F	none of the above

45. EMQ. Pertussis.

Question 1.

Why is pertussis of current concern in obstetrics?

Option List

A	Research has linked pertussis in the 1^st. trimester with an ↑ risk of congenital heart disease
B	A mini-epidemic since 2011 has caused ↑ deaths of mothers & of babies < 3 months
C	A mini-epidemic since 2011 has caused ↑ deaths of babies < 3 months
D	The infecting organism has become increasingly drug-resistant
E	The infecting organism has become increasingly virulent

Question 2.

Which organism causes whooping cough?

Option List

A	Bordella pertussis
B	Bacteroides pertussis
C	Rotavirus whoopoe
D	Respiratory syncytiovirus pertussis
E	None of the above

Question 3.

Which, if any, of the following statements is true about the organism what causes whooping cough? This is not a true SBA as I have condensed several questions into one to save space, there are more than 5 options and there may be more than one correct answer.

Option List

A	the organism is aerobic
B	the organism is anaerobic
C	the organism is capsulated
D	the organism is flagellate
E	the organism is an obligate intra-cellular parasite
F	the organism is a Gram -ve diplococcus
G	the organism is a Gram +ve diplococcus
H	the organism requires special transport media
I	no one is going to ask me any of this stuff

Question 4.

Which of the following statements is true?

Option List

A	Pertussis is no longer a significant threat to infants
B	Pertussis remains a significant threat to infants
C	The risk of death from pertussis is eliminated by timely antibiotic therapy
D	the risk of death from pertussis is eliminated by timely antiviral therapy
E	None of the above

Question 5.

Which of the following statements is true?

Option List

A	Pertussis is not a notifiable disease
B	Pertussis is a notifiable disease
C	Pertussis is not a notifiable disease, but cases should be reported to the local bacteriologist
D	Pertussis is not a notifiable disease, but cases should be subject to audit

Question 6.

What is the main mode of spread of the organism that causes pertussis?

Option List

A	contact with contaminated surfaces
B	contaminated food
C	contaminated water
D	respiratory droplets
E	none of the above

Question 7.

What is the main reservoir of the organism that causes pertussis?

Option List

A	budgerigars
B	cats
C	dogs
D	humans
E	pigeons
F	pigs
G	none of the above

Question 8.

What is the epidemiology of pertussis?

Option List

A	the condition is endemic
B	the condition is endemic with mini-epidemics every 3-5 years
C	the condition is endemic with mini-epidemics most years in the winter months
D	the condition is epidemic, with outbreaks at roughly three-year intervals
E	the condition is epidemic, with outbreaks at unpredictable intervals

Question 9.

What is the incubation period for pertussis?

Option List

A	3-6 days
B	7-10 days
C	11-14 days
D	15-18 days
E	none of the above.

Question 10.

What is the duration of infectivity of someone with pertussis?

Option List

A	2 days from exposure → 5 days after onset of paroxysms of coughing
B	3 days from exposure → 10 days after onset of paroxysms of coughing
C	4 days from exposure → 14 days after onset of paroxysms of coughing
D	6 days from exposure → 21 days after onset of paroxysms of coughing
E	none of the above

Question 11.

What % of non-immune, close contacts of pertussis will develop the disease?

Option List

A	50%
B	60%
C	70%
D	80%
E	90%

Question 12.

What practical issues are current for obstetrician in relation to pertussis?

Option List

A	The DOH advises that all pregnant women be immunised to ↓maternal death rates.
B	The DOH advises that all pregnant women be immunised to ↓ deaths in babies < 3 months.
C	The DOH advises that all babies be immunised at birth.
D	The DOH advised that “Boostrix- IPV” should replace “Repevax” from July 2014.
E	The DOH advises that immunisation of pregnant women be continued until 2019

Question 13.

Which, if any, of the following statements is true in relation to average annual number of deaths due to pertussis in the years before routing child immunisation was introduced?

Option List

A	the number was 10,000
B	the number was 5,000
C	the number was 4,000
D	the number was 3,500
E	the number was <1,000

Question 14.

Which, if any, of the following statements are true in relation to pertussis vaccine.

Option List

A	“Boostrix- IPV” is a vaccine for pertussis only
B	“Repevax” is a vaccine for pertussis only
C	“Boostrix- IPV” & “Repevax” are live, attenuated vaccines
D	“Boostrix- IPV” & “Repevax” act against diphtheria, tetanus and polio as well as pertussis
E	“Boostrix- IPV” & “Repevax” are acellular

Question 15.

Which, if any, of the following statements are true in relation to the JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?

Option List

A	20 - 24 weeks
B	25- 28 weeks
C	28 - 32 weeks
D	28 - 34 weeks
E	none of the above

Question 16.

A woman has suspected pertussis in early pregnancy. Should she still be offered vaccination?

Option List

A	Yes
B	No
C	I don’t know
D	I don’t know
E	I hate this subject now

Question 17.

A woman has proven pertussis in early pregnancy. Should she still be offered vaccination?

Option List. Use the list from question 16.

Question 18.

A pregnant woman misses out on vaccination as part of the TIPP. Should vaccination still be offered in the puerperium?

Option List. Use the list from question 16.

MRCOGManchester

Thursday 17 December 2020

Tutorial 17 December 2020

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