Thursday 11 February 2021

Tutorial 11 February 2021

 


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22

Role-play. Postnatal depression.

23

SBA. Lynch syndrome

24

Template. Gynae history

25

Template. Obstetric history

26

EMQ. Hepatitis E and pregnancy

 

22.         Postnatal depression.

Candidate’s instructions.

You are an SpR5 in the antenatal clinic. A midwife has booked Mary Merridew. She found that she had had postnatal depression and was not confident about advising her. She has asked you to deal with this. Your tasks are to take an appropriate history, discuss the situation with Mary and agree a management plan.

 

23.         Lynch syndrome.

Abbreviations

CRC:              colorectal cancer.

EC:                endometrial cancer.

HNPCC:         hereditary non-polyposis colo-rectal cancer.

IBD:               inflammatory bowel disease: Crohn’s & ulcerative colitis.

IDDM:           insulin-dependent diabetes mellitus.

Ls:                 Lynch syndrome.

Question 1.             

Lead-in

What is Lynch syndrome?

Option List

A

auto-immune condition leading to reduced factor X levels in blood

B

hereditary condition which increases the risk of many cancers, particularly breast

C

hereditary condition which increases the risk of many cancers, particularly breast & colorectal

D

hereditary condition which increases the risk of many cancers, particularly colorectal & endometrial

E

none of the above

Question 2.             

Lead-in

How is Lynch syndrome inherited?

Option List

A

it is an autosomal dominant condition

B

it is an autosomal recessive condition

C

it is an X-linked dominant condition

D

it is an X-linked recessive condition

E

none of the above

Question 3.             

Lead-in

Which, if any, of the following genes can cause Lynch syndrome?

Option List

A

MLH1 + MLH2 + MOH1

B

MLH1 + MLH2 + MSH1

C

MLH1 + MLH2 + MSH6

D

MLH1 + MSH2 + MSH6

E

None of the above

Question 4.             

Lead-in

Mutations of which 2 of the following genes cause the majority of cases of Lynch syndrome?

Option List

A

MLH1 + MLH2

B

MLH1 + MSH1

C

MLH1 + MSH2

D

MLH2 + MSH1

E

MLH2 + MSH2

Question 5.             

Lead-in

What is the approximate prevalence of Ls in the UK population?

Option List

A.       

1 in 50

B.       

1 in 100

C.       

1 in 1,000

D.      

3 in 1,000

E.       

none of the above

Question 6.             

Lead-in

Approximately what % of individuals with Ls have had the diagnosis established?

Option List

A.       

< 5%

B.       

5 -10%

C.       

10-20%

D.      

20-30%

E.       

>30%

Question 7.             

Lead-in

Which, if any, of the following conditions are associated with an risk of Lynch syndrome?

Conditions

acromegaly

Addison’s disease

anosmia

coeliac disease

IBD

IDDM

Option List

A

acromegaly + Addison’s disease + coeliac disease + IBD + IDDM

B

acromegaly + disease + anosmia + coeliac disease + IBD

C

acromegaly + IBD + IDDM

D

acromegaly + IBD

E

Addison’s disease + anosmia + coeliac disease + IBD + IDDM

F

acromegaly + Addison’s disease + anosmia + coeliac disease + IBD + IDDM

G

acromegaly + Addison’s disease + anosmia + coeliac disease + IBD + IDDM

H

none

Question 8.             

Lead-in

Which 2 cancers are most likely in women with Lynch syndrome?

Cancers.

A

breast

B

bowel

C

cervix

D

endometrium

E

ovary

F

pancreas

Option List

A

breast + bowel

B

breast + pancreas

C

breast + endometrium

D

bowel + cervix

E

bowel + endometrium

F

bowel + ovary

G

bowel + pancreas

H

endometrium + ovary

Question 9.             

Lead-in

What does NICE recommend about screening for Lynch syndrome for the population with no personal history of colorectal cancer?

Option List

A

offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative

B

offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative

C

offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis

D

offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis

E

none of the above

Question 10.         

Lead-in

What does NICE recommend in relation to screening for Lynch syndrome in those with a new diagnosis of colorectal cancer?

Option List

A

offer screening to everyone, regardless of age and family history

B

offer screening to those aged < 50 years at diagnosis

C

offer screening to those aged < 60 years at diagnosis

D

offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative

E

offer screening to those aged < 60 years at diagnosis with + ≥ 1 affected 1st.O relative

Question 11.         

Lead-in

What does NICE recommend about screening for Lynch syndrome for the population with no personal history of thyroid cancer?

Option List

A

offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative

B

offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative

C

offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis

D

offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis

E

none of the above

Question 12.         

Lead-in

What does NICE recommend in relation to screening for Lynch syndrome in those with a new diagnosis of thyroid cancer?

Option List

A

offer screening to everyone, regardless of age and family history

B

offer screening to those aged < 50 years at diagnosis

C

offer screening to those aged < 60 years at diagnosis

D

offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative

E

none of the above

Question 13.         

Lead-in

What does NICE recommend about screening for Lynch syndrome for the population with no personal history of endometrial cancer?

Option List

A

offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative

B

offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative

C

offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis

D

offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis

E

none of the above

Question 14.         

Lead-in

What does NICE recommend in relation to screening for Lynch syndrome in those with a new diagnosis of endometrial cancer?

Option List

A

offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative

B

offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative

C

offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis

D

offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis

E

none of the above

Question 15.         

Lead-in

What does NICE recommend about screening for Lynch syndrome for the population with no personal history of colorectal cancer?

Option List

A

offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative

B

offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative

C

offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis

D

offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis

E

none of the above

Question 16.         

Lead-in

What does NICE recommend in relation to screening for Lynch syndrome in those with a new diagnosis of colorectal cancer?

Option List

A

offer screening to everyone, regardless of age and family history

B

offer screening to those aged < 50 years at diagnosis

C

offer screening to those aged < 60 years at diagnosis

D

offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative

E

offer screening to those aged < 60 years at diagnosis with + ≥ 1 affected 1st.O relative

Question 17.         

Lead-in

What relationship, if any, exists between Ls and acromegaly?

Option List

A

the risk of Ls is in those with acromegaly compared with the general population

B

the risk of Ls is in those with acromegaly compared with the general population

C

the risk of Ls is unchanged in those with acromegaly compared with the general population

D

the risk of Ls in unknown in those with acromegaly

Question 18.         

Lead-in

What is the effect of aspirin consumption on the risk of EC and CRC?

Option List

A

aspirin reduces the risk of EC and  CRC

B

aspirin reduces the risk of EC but not CRC

C

aspirin reduces the risk of CRC but not EC

D

aspirin does not reduce the risk of EC or CRC

E

aspirin reduces the risk of EC and CRC, but the risks outweigh the benefits

Question 19.         

Lead-in

A healthy woman of 35 years is diagnosed with Ls? What are the key elements of the National Screening Programme for people with Ls?

There is no option list – just write down everything you know.

Question 20.         

Lead-in

Which, if any, of the following were recommendations made by Monahan et al, the 30 experts who wrote to the BMJ in 2017?

Option List

A

creation of a national register of people with Ls

B

creation of a post of Consultant in Ls for each NHS Trust

C

creation of a post of Clinical Champion for Ls in each NHS Region.

D

creation of a post of Clinical Champion for Ls in the DOH.

E

none of the above

 

24.         Gynaecology history.

Candidate’s instructions.

Sketch the headlines you would use when taking a gynaecological history and present them to the examiner.

 

25.         Obstetric history.

Candidate’s instructions.

You are to conduct a tutorial with hospital’s junior obstetricians and midwives about how to take an obstetric history. Prepare the headlines you use for a model obstetric history and consider how you would conduct the tutorial.

Then you will have a viva with the examiner.

The examiner will ask 4 questions.

1. What are your headings?

2. What clinical situations do you envisage covering?

3. What teaching methods would you consider for use in the tutorial?

4. Which methods would be most suitable and why?

 

26.         Hepatitis E.

Abbreviations.

Gt:              genotype

PPROM:     preterm, prelabour rupture of membranes.

Question 1.             

Which, if any, of the following is the most common cause of acute viral hepatitis in the UK?

Option list.

A

hepatitis A virus

B

hepatitis B virus

C

hepatitis C virus

D

hepatitis D virus

E

hepatitis E virus

F

herpes simplex virus

G

HIV

Question 2.             

Which, if any, of the following are correct about HEV.

Option list.

A

it is a DNA virus

B

it belongs to the genus Hippieviridae

C

it belongs to the genus Hepeviridae

D

it belongs to the genus Hoppieviridae

E

there are six main genotypes

F

genotype 3 is the one of greatest importance in the UK

G

the main reservoir of genotype 3 is intensively-reared chickens

H

the main reservoir of genotype 3 is domestic cats

I

a vaccine exists but is only licensed in Russia

J

none of the above

Question 3.             

Which, if any, of the following statements about HEV and pregnancy are true?

Option list.

A

pregnant women are more susceptible to HEV infection

B

pregnant women are more likely to develop serious disease that the non-pregnant

C

the main risk is neonatal death due to vertical transmission

D

the main risk is maternal death

E

the risk of maternal death is highest with infection in the 1st. trimester

F

rates of preterm birth have been reported

G

rates of stillbirth have been reported

 


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