|
EMQ.
Coroner |
|
|
18 |
EMQ.
Medical Examiner |
|
19 |
EMQ. Peutz-Jeghers syndrome |
|
20 |
EMQ. Mayer-Rokitansky-Küster-Hauser
syndrome |
|
21 |
SBA. Lynch syndrome |
|
22 |
EMQ.
Flu and pregnancy |
17. EMQ. Coroner.
This
topic has featured in the exam and makes for easy marks if you know the basics.
CC: Chief Coroner.
CJA9: Coroners and
Justice Act 2009.
MCCD: medical certificate of the cause of
death.
NOD: notification of deaths.
SB: stillbirth
Option list 1.
A.
an independent judicial officer
B.
a barrister acting for the Local Police Authority
C.
the regional representative of the Home Office
D.
the regional representative of the Queen.
E.
an employee of the High Court.
F.
the Local Authority
G.
the Local Police Authority
H.
the Home Office
I.
the High Court
J.
the Queen
Use option list 1 for scenarios 1 - 3.
Scenario
1.
What is the best description of the status of the Coroner?
Scenario 2.
Who appoints the Coroner?
Scenario 3.
Who pays for the Coroner and the coronial service?
Scenario 4.
Which, if any, are current titles for coroners?
Option list.
|
A |
area coroner |
|
B |
assistant coroner |
|
C |
district coroner |
|
D |
deputy coroner |
|
E |
lead coroner |
|
F |
national coroner |
Scenario 5.
Which, if any, of the following are functions of the Chief
Coroner?
Option list.
|
A |
to appoint coroners |
|
B |
to approve coronial
appointments |
|
C |
to negotiate coroners’
salaries |
|
D |
to negotiate coroners’ terms
and conditions |
|
E |
to oversee the disciplinary
procedures for coroners |
|
F |
to keep an eye on coronial
investigations that have taken too long |
|
G |
to organise advice from
coroners about how deaths may be prevented |
Option list 2. Use for scenarios 6-8.
A.
must have had experience as a detective in the police force with
the rank of Inspector or above
B.
must be a barrister, lawyer or doctor with at least 5 years’
experience
C.
must be a legally qualified individual with at least 5 years’
experience
D.
must be a trained bereavement counsellor
E.
must be able to play the bagpipes
F.
Monday - Friday; 09.00 - 17.00 hours, including bank holidays
G.
Monday - Friday; 09.00 - 17.00 hours excluding bank holiday
H.
All the time
I.
to arrest people suspected of unlawful killing
J.
to manage traffic in the vicinity of the Coroner’s court
K.
to make enquiries on behalf of the Coroner
L.
to make enquiries on behalf of the Coroner and provide
administrative support
Scenario 6.
What qualifications must the Coroner have?
Scenario 7.
What are the hours of availability of the Coroner?
Scenario 8.
What are the roles of the
Coroner’s Officers?
Scenario 9.
Who or what is responsible for appointing medical examiners?
Option list.
|
A |
Local
authorities |
|
B |
the Chief
Coroner |
|
C |
the Chief
Medical Examiner |
|
D |
the local
Senior Coroner |
|
E |
the Lord Chancellor |
|
F |
NHS Trusts |
|
G |
the Queen |
Scenario 10.
Which, if any, of the following are applicable to the role of
medical examiner?
Option list.
|
A |
to decide
if a post-mortem is required |
|
B |
notification
of deaths to the coroner |
|
C |
supervision
of the quality of MCCDs |
|
D |
attendance
at post-mortems |
|
E |
performance
of post-mortems |
Scenario 11.
When was the 1st. Chief Medical Examiner for England
& Wales appointed?
Option list.
|
A |
2005 |
|
B |
2010 |
|
C |
2015 |
|
D |
2017 |
|
E |
2019 |
|
F |
the post
does not exist |
|
G |
none of the
above |
Scenario 12.
What was the specialty of the 1st. appointee to the
post of the lead medical examiner for England & Wales?
Option list.
|
A |
accident
and emergency medicine |
|
B |
forensic
medicine |
|
C |
forensic
pathology |
|
D |
forensic
psychiatry |
|
E |
obstetrics
& gynaecology |
|
F |
pathology |
Scenario 13.
Which, if any, of the following are requirements for those wishing
to become a medical examiner?
Option list.
|
A |
full
registration with the General Medical Council |
|
B |
consultant
status |
|
C |
> 10
years’ experience as a fully-registered doctor |
|
D |
to have the
Diploma of the Faculty of Medical Examiners |
|
E |
to have
membership of the RCP |
|
F |
none of the
above |
Option list 3. Use for the remaining scenarios, unless they have an
option list.
A.
the death must be reported to the Coroner
B.
the death does not need to be reported to the Coroner
C.
the Coroner must order the return of the body for an inquest
D.
the Coroner must order a post-mortem examination
E.
the Coroner must hold an inquest
F.
the Coroner should arrange for the death to be investigated by the
Home Office
G.
the death must be reported to the authorities of the country in
which it took place in order that a certificate of death can be issued
H.
a certificate of live birth
I.
a certificate of stillbirth
J.
a certificate of miscarriage
K.
yes
L.
no
M. none of the above
Scenario 14.
A
resident of Manchester dies suddenly while visiting the town of his birth in
Scotland. His family decides that he will be buried in the town of his birth.
His body is held at the premises of a local funeral director to arrange the
funeral and burial. What actions should be taken with regard to the Manchester
coroner?
Scenario 15.
A
resident of London dies suddenly while visiting Manchester, where he was born.
His family decides that he will be buried in Manchester. His body is held at
the premises of a Manchester funeral director who will arrange the funeral and
burial. What actions should be taken with regard to the Manchester coroner?
Scenario 16.
A resident of Manchester dies on holiday in his native Greece. The
family decide that he will be buried in Greece. What steps must be taken to
obtain a valid death certificate?
Scenario 17.
A man of 65 dies of terminal lung cancer. The GP who had visited
daily up to three weeks before the death has been on holiday for three weeks.
He has now returned and says that he will sign a death certificate, but needs
to visit the funeral director to see the body first. Will this be a valid death certificate?
Scenario 18.
A man of 65 dies of terminal lung cancer. The GP, who has visited
daily up to the day of his death and attended to confirm the death, is on
holiday. However, he says that he will sign a death certificate and put it in
the post, so that it will arrive in the morning. Will this be a valid death
certificate?
Scenario 19.
A man of 65 dies of terminal lung cancer. The GP who has visited
daily up to the day before his death has been on holiday since. However, he
says that he will sign a death certificate and put it in the post, so that it
will arrive in the morning. Will this be a valid death certificate?
Scenario 20.
A 65-year-old man dies suddenly 12 hours after admission to the
local coronary care unit with chest pain, despite apparently satisfactory
insertion of a coronary artery stent after a diagnosis of coronary artery
thrombosis. What action should be taken with regard to the Coroner?
Scenario 21.
A 16-year-old girl is admitted
at 36 weeks’ gestation in her first pregnancy with placental abruption. She is
given the best possible care but develops DIC and hypovolaemic shock and dies
after 48 hours. What action should be taken with regard to the coroner?
Scenario 22.
A 28-year-old woman is admitted with placental abruption at 36
weeks. She has bruising on the abdominal wall and the admitting midwife
suspects that she has been the victim of domestic violence, though the woman
denies it. Despite best possible care she dies as a consequence of bleeding.
What action should be taken with regard to the coroner?
Scenario 23.
A 30-year-old woman delivers normally at home attended by her
husband, but has a PPH. The husband practises herbal medicine. He applies
various potions but her condition deteriorates. She is admitted to hospital by
emergency ambulance. She is given best possible care and is admitted to the
ICU. She dies 7 days later of multi-organ failure and ARDS attributed to
hypovolaemic shock. What action should be taken with regard to the coroner?
Scenario 24.
A woman is admitted at 23 weeks in premature labour. There is
evidence of fetal heart activity throughout the labour, with the last record
being 5 minutes before the baby delivers. The baby shows no evidence of life at
birth. The mother requests a death certificate so that she can register the
birth and arrange a funeral. What form of certificate should be issued?
Scenario 25.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. The presentation is footling
breech. At 8 cm. cervical dilatation the trunk is delivered and the cord
prolapses. There is good evidence of fetal life with fetal movements and
pulsation of the cord. The head is trapped and it takes 5 minutes to deliver
it. The baby is pulseless, apnoeic and without visible movement at birth.
Intubation and CPR are carried out for 20 minutes when the baby is declared
dead. What action should be taken with regard to the coroner?
Scenario 26.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. She says that he did not want
the pregnancy to continue.
Pick the best
option from the option list.
Option list.
A. dial 999
B. get advice from the BMA
C. get advice from the Department of Health
D. get advice from the legal department
E. get advice from the police
F. none of the above.
Option list.
|
A |
provide access to the records by the Coroner in person |
|
B |
provide unrestricted access to the medical records by
the coroner’s officers |
|
C |
provide a copy of the hospital records to the coroner or
her officers |
|
D |
provide a medical report, but no access to the medical
records |
|
E |
provide a copy of the letter to the GP about the recent
admission |
|
F |
none of the above |
Scenario 28.
You have been swimming in the sea at Broad
Beach, Rhosneigr. As you walk back to the
shore your foot hits something in the sand. You explore and find a number of
gold coins that look ancient. What should you do?
Option list.
|
A |
put them
back as they may have been an offering to the Gods |
|
B |
put them in
a safe place with a view to having them valued and sold |
|
C |
take them
to the local museum for identification and advice about informing the coroner |
|
D |
take them
to the nearest police station for advice |
|
E |
take them
to your favourite pub and trade them for a meal and round of drinks |
18. EMQ. Medical Examiner .
Abbreviations.
MCCD: medical certificate of the cause of
death.
ME: medical examiner.
Do I really need to know this stuff? This is ‘hot’: MEs were an
innovation in 2018.
Question 1.
Which, if any, of
the following are included in the role of the ME?
Option list.
|
A |
scrutiny of
all death certificates from the NHS Trust |
|
B |
scrutiny of
all death certificates from the local area |
|
C |
scrutiny of
non-coronial death certificates from the local area |
|
D |
deciding if
postmortem examination is appropriate |
|
E |
supervision of
postmortem examination |
|
F |
deciding on
and arranging further investigations to establish the cause of death |
|
G |
liaison with
the coroner |
|
H |
discussing the
cause of death with the family of the deceased |
|
I |
directing
police investigations in cases of suspicious death |
Question 2.
What
qualifications must a ME have?
Option list.
|
A |
be registered
with the GMC |
|
B |
be licensed to
practise or be < 5 years into retirement |
|
C |
be a member or
fellow of a Royal Medical College |
|
D |
be a member or
fellow of the Royal College of Pathologists |
|
E |
none of the
above. |
Question 3.
Which, if any, of
the following are included in the role of the medical examiner?
Option list.
|
A |
discussing the
case with the doctor who provided care during the final illness |
|
B |
reviewing the
medical records |
|
C |
deciding the
cause of death to be put on the certificate of death |
|
D |
discussing the
cause of death with next of kin |
|
E |
identifying
any concerns the next of kin may have about the care |
|
F |
providing
medical advice to the coroner |
|
G |
identifying
deaths that should trigger a mortality case record review |
Question 4.
Which, if any, of
the following are included in the role of the National ME?
Option list.
|
A |
being a member
of the medical team responsible for the Queen’s health |
|
B |
appointing
Trust MEs |
|
C |
disciplining
errant MEs |
|
D |
producing
reports |
|
E |
arbitrating in
disputes between MEs and coroners about the cause of death |
|
F |
dealing with
appeals by families who are dissatisfied with the MCCD or the care |
19. Peutz-Jeghers
syndrome.
Abbreviations.
PJS: Peutz-Jeghers syndrome.
Scenario
1.
Which, if any, of
the following are characteristics of PJS?
Option list.
|
A |
buccal
pigmentation |
|
B |
gastro-intestinal
hamartomas |
|
C |
perianal
pigmentation |
|
D |
increased risk
of breast cancer |
|
E |
increased risk
of cervical adenoma malignum |
|
F |
increased risk
of colo-rectal cancer |
|
G |
increased risk
of endometrial cancer |
|
H |
increased risk
of ovarian cancer |
|
I |
increased risk
of pancreatic cancer |
|
J |
increased risk
of prostate cancer |
|
K |
increased risk
of stomach cancer |
Scenario
2.
What is the
approximate prevalence of PJS?
Option list.
|
A |
< 1 in
1,000 |
|
B |
1 in 1,000 to
1 in 10,000 |
|
C |
1 in 10,000 to
1 in 100,000 |
|
D |
1 in 25,000 to
1 in 100,000 |
|
E |
1 in 25,000 to
1 in 200,000 |
|
F |
1 in 25,000 to
1 in 300,000 |
|
G |
1 in 300,000
to 1 in 500,000 |
|
H |
< 1 in
500,000 |
Scenario 3.
What is the mode of inheritance in PJS?
Option list.
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
X-linked
dominant |
|
D |
X-linked
recessive |
|
E |
Y-linked
dominant |
|
F |
Y-linked
recessive |
|
G |
triplet repeat |
Scenario 4.
Which, if any, of the following statements are true of PJS?
Option list.
|
A |
PJS only
occurs in families with other affected members |
|
B |
PJS mainly
occurs in families with other affected members |
|
C |
PJS may arise
de-novo in families with no other affected members |
|
D |
PJS may arise
de-novo in families with other affected members |
|
E |
PJS does not
arise de-novo in families with no other affected members |
Scenario
5.
What is the
approximate lifetime risk of developing cancer in PJS?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
30% |
|
D |
40% |
|
E |
50% |
|
F |
60% |
|
G |
70% |
|
H |
80% |
|
I |
90% |
|
J |
>90% |
Scenario
6.
What is the
relevance of STK11 to PJS?
Option list.
|
A |
It is part of
the postcode of the Peutz-Jeghers Society |
|
B |
It is the name
of the gene most commonly associated with PJS |
|
C |
It is the Ornithological
Society’s code for the Orkney Skua |
|
D |
Somatic
mutations have been found in cervical cancer |
|
E |
None of the
above |
20. EMQ.
Mayer-Rokitansky-Küster-Hauser syndrome.
Mayer–Rokitansky–K
¨
uster–Hauser
syndrome: diagnosis and management
With regard to the MRKH syndrome,
61. there is
failure of development of the
mesonephric
ducts. T F
62. the phenotype and genotype are
female. T F
63. studies have established a link
between the
syndrome and the
use of diethylstilbestrol in
pregnancy. T F
With regard to the anatomical
abnormalities seen in
MRKH syndrome,
64. symmetrical uterovaginal aplasia is
found in
type I disorders. T F
65. renal abnormalities are seen in
more than
half of cases. T F
66. skeletal abnormalities are reported
in up to
one-fifth of cases. T F
67. up to
one-quarter of women have a
malformed ear or auditory canal. T F
68. the close proximity of the m
¨
ullerian and
wolffian duct derivatives to the
metanephric
duct in the developing embryo explains
the
higher association of malformations of
the
kidneys with this condition. T F
69. vaginal agenesis is caused by
failure of the
caudal part of the m
¨
ullerian duct
system to
develop. T F
Regarding the diagnosis of MRKH
syndrome,
70. magnetic resonance imaging is the
gold
standard tool. T F
71. two-dimensional ultrasound scanning
is not
useful for associated renal tract
abnormalities. T F
72. complete androgen insensitivity
syndrome is
an important differential diagnosis. T F
73. the presence of cyclical abdominal
pain will
rule out the diagnosis, as it indicates
the
presence of
functioning endometrium. T F
With regard to the
creation of a neovagina,
74. it is recommended that treatment is
initiated
as soon as the diagnosis is made. T F
75. psychological
support to women undergoing
this procedure is of the utmost
importance. T F
76. vaginal dilators are acceptable as
an option
for first-line
therapy. T F
77. Ingram’s modified Frank’s technique
involves
the use of vaginal dilators. T F
With regard to the
surgical creation of a neovagina,
78. in the
Davydov procedure the neovagina is
lined with
peritoneum. T F
With regard to fertility in women with
the MRKH
syndrome,
79. transvaginal
egg retrieval is recognised to be
difficult during in vitro
fertilisation. T F
80. the condition
has been shown to be
transmissible to
the offspring. T F
Abbreviations.
AIS: androgen
insensitivity syndrome
AMH: anti-
Müllerian hormone
MRKH: Mayer-Rokitansky-Küster-Hauser syndrome
MURCS: Müllerian duct aplasia, renal dysplasia and
cervical somite anomaly syndrome.
Question 1.
What are the main
features of MRKH? There is no option list to make life harder.
Question 2.
Which, if any, are the main secondary features associated with
MRKH?
Option list.
|
A |
anosmia |
|
B |
attention-deficit-hyperactivity
syndrome |
|
C |
auditory
anomalies |
|
D |
neural tube
defects |
|
E |
renal
anomalies |
|
F |
skeletal
anomalies |
Question 3.
How does MRKH
syndrome usually present?
Option list.
|
A |
cyclical
pain due to haematometra |
|
B |
delayed
puberty |
|
C |
precocious
puberty |
|
D |
premature
menopause |
|
E |
primary
amenorrhoea |
|
F |
recurrent
otitis media |
|
G |
recurrent
urinary tract infection |
|
H |
secondary
amenorrhoea |
Question 4.
Which of the
following chromosome patterns are typical of MRKH?
Option list.
|
A |
45XO |
|
B |
45YO |
|
C |
46XX |
|
D |
46XY |
|
E |
47XXX |
|
F |
47XXY |
Question 5.
What is the
approximate incidence of MRKH in newborn girls?
Option list.
|
A |
~ 1 in 1,000 |
|
B |
~ 1 in 2,000 |
|
C |
~ 1 in 4,000 |
|
D |
~ 1 in 6.000 |
|
E |
~ 1 in 8,000 |
|
F |
~ 1 in
10,000 |
|
G |
~ 1 in
100,000 |
|
H |
the figure
is unknown |
|
I |
it does not
occur |
Question 6.
What is the
approximate incidence of MRKH in newborn boys?
Option list.
|
A |
~ 1 in 1,000 |
|
B |
~ 1 in 2,000 |
|
C |
~ 1 in 4,000 |
|
D |
~ 1 in 6.000 |
|
E |
~ 1 in 8,000 |
|
F |
~ 1 in
10,000 |
|
G |
~ 1 in
100,000 |
|
H |
the figure
is unknown |
|
I |
it does not
occur |
Question 7.
Which of the
following statements are correct in relation to urinary tract anomalies
associated with MRKH?
Option list.
|
A |
absent
bladder |
|
B |
absent
kidney |
|
C |
ectopic
ureter |
|
D |
horseface
kidney |
|
E |
hypospadias |
|
F |
urinary
tract anomalies are not part of the syndrome |
Question 8.
Which of the
following statements are correct in relation to skeletal anomalies associated
with MRKH?
Option list.
|
A |
absent thumb |
|
B |
absent big
toe |
|
C |
developmental
dysplasia of the hip |
|
D |
Klippel-Feil
anomaly |
|
E |
ulnar
hypoplasia |
|
F |
vertebral
fusion |
|
G |
skeletal
anomalies are not part of the syndrome |
Question 9.
Which of the
following statements are correct in relation to auditory anomalies associated
with MRKH?
Option list.
|
A |
absent ear |
|
B |
absent
stapes |
|
C |
acoustic
neuroma |
|
D |
conductive
deafness |
|
E |
inductive
deafness |
|
F |
stapedial
ankylosis |
|
G |
auditory
anomalies are not part of the syndrome |
Question 10.
What is the
recommended first-line management for creation of a neovagina.
Option list.
|
A |
digital
dilatation |
|
B |
marriage to
a virile husband |
|
C |
vaginal
balloons |
|
D |
vaginal
dilators |
|
E |
vaginoplasty |
|
F |
there is no
recommended 1st. line management |
Question 11.
What are the key features of Davydov vaginoplasty?
Option list.
|
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
|
B |
creation of
space between bladder and rectum and lining it with amnion |
|
C |
creation of
space between bladder and rectum and lining it with skin graft |
|
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
|
E |
creation of
space between bladder and rectum and lining it with peritoneum |
|
F |
traction via
threads running to the abdomen from a vaginal bead |
Question 12.
What are the key
features of McIndoe vaginoplasty?
Option list.
|
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
|
B |
creation of
space between bladder and rectum and lining it with amnion |
|
C |
creation of
space between bladder and rectum and lining it with skin graft |
|
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
|
E |
creation of
space between bladder and rectum and lining it with peritoneum |
|
F |
traction via
threads running to the abdomen from a vaginal bead |
Question 13.
What are the key
features of Vecchietti vaginoplasty?
Option list.
|
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
|
B |
creation of
space between bladder and rectum and lining it with amnion |
|
C |
creation of
space between bladder and rectum and lining it with skin graft |
|
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
|
E |
creation of
space between bladder and rectum and lining it with peritoneum |
|
F |
traction via
threads running to the abdomen from a vaginal bead |
Question 14.
What are the key
features of Williams vaginoplasty?
Option list.
|
A |
horseshoe
perineal incision with labial flaps used to create a pouch |
|
B |
creation of
space between bladder and rectum and lining it with amnion |
|
C |
creation of
space between bladder and rectum and lining it with skin graft |
|
D |
creation of
space between bladder and rectum and lining it with sigmoid colon |
|
E |
creation of
space between bladder and rectum and lining it with peritoneum |
|
F |
traction via
threads running to the abdomen from a vaginal bead |
TOG CPD questions.
With regard to the MRKH syndrome.
1. there is failure of development of the
mesonephric ducts. True / False
2. the phenotype and genotype are female. True / False
3. studies have established a link between the
syndrome and the use of diethylstilboestrol in pregnancy. True / False
With regard to the anatomical abnormalities seen in MRKH
syndrome.
4. symmetrical uterovaginal aplasia is found in
type I disorders. True / False
5. renal abnormalities are seen in more than
half of cases. True / False
6. skeletal abnormalities are reported in up to
one-fifth of cases. True / False
7. up to one-quarter of women have a malformed
ear or auditory canal. True / False
8. the close proximity of the Müllerian and
Wolffian duct derivatives to the duct in the developing embryo explains the
higher association of malformations of the kidneys with this condition.
True / False
9. vaginal
agenesis is caused by failure of the caudal part of the Müllerian duct system
to develop.
True / False
Regarding the diagnosis of MRKH syndrome,
10. magnetic resonance imaging is the gold
standard tool. True / False
11. two-dimensional ultrasound scanning is not
useful for associated renal tract abnormalities.
True / False
12. complete androgen insensitivity syndrome is an
important differential diagnosis. True / False
13. the presence of cyclical abdominal pain will
rule out the diagnosis, as it indicates the presence of functioning
endometrium. True / False
With regard to the creation of a neovagina,
14. it is recommended that treatment is initiated
as soon as the diagnosis is made. True / False
15. psychological support to women undergoing this
procedure is of the utmost importance.
True / False
16. vaginal dilators are acceptable as an option
for first-line therapy. True / False
17. Ingram’s modified Frank’s technique involves
the use of vaginal dilators. True / False
With regard to the surgical creation of a neovagina,
18. in the Davydov procedure the neovagina is
lined with peritoneum. True / False
With regard to fertility in women with the MRKH syndrome,
19. transvaginal egg retrieval is recognised to be
difficult during in vitro fertilisation. True / False
20. the condition has been shown to be
transmissible to the offspring. True / False
21. SBA. 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.
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.
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.
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.
Mutations of which 2 of the following genes cause the majority of cases
of Ls?
Option List
|
A |
MLH1 + MLH2 |
|
B |
MLH1 + MSH1 |
|
C |
MLH1 + MSH2 |
|
D |
MLH2 + MSH1 |
|
E |
MLH2 + MSH2 |
Question
5.
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.
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.
Which, if any, of the following conditions are associated with an ↑ risk of Ls?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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. 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. 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.
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
Question 20.
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 |
With regard to Lynch syndrome,
1. loss
of mismatch repair protein expression on immunohistochemistry of cancer is
diagnostic. True/False
2. most
carriers of the mutation associated with the syndrome know they have the
condition. True/False
3. the
first cancers associated with the syndrome are predominantly endometrial or
ovarian cancers. True/False
4. when
cancers occur, they have in them an unusually high immune infiltrate. True/False
With regard to
testing for Lynch syndrome,
5. consent
must be sought before definitive germline testing for Lynch syndrome by a
trained professional. True/False
6. immunohistochemical
staining of tumours for the mismatch repair proteins or microsatellite
instability analysis are recognised ways of screening cancers for
characteristics suggestive of the syndrome. True/False
7. the
National Institute for Health and Care Excellence endorses universal screening of
colorectal cancer patients for Lynch syndrome. True/False
8. most
gynaecological cancers found to have aberrant mismatch repair
immunohistochemical staining will be in those with the syndrome. True/False
9. the
addition of MLH1 promotor hypermethylation testing in a Lynch syndrome
diagnostic pathway improves specificity. True/False
Regarding
gynaecological surveillance in women with Lynch syndrome,
10. there
is strong evidence to recommend its use. True/False
11. this
should be offered to women around 25 years of age. True/False
12. counselling
should include education on red flag symptoms of cancer and risk-reducing
surgery. True/False
With regard to
risk-reducing strategies for women with Lynch syndrome,
13. hysterectomy
is strongly recommended for all those with the syndrome. True/False
14. the
timing of risk-reducing surgery depends on the syndrome gene. True/False
15. where
possible, a laparoscopic approach is recommended. True/False
16. aspirin
is not recommended as a means of reducing their overall cancer risk. True/False
Regarding Lynch
syndrome-associated gynaecological cancers,
17. endometrial
types that arise as a result of the syndrome have a poorer prognosis than
sporadic types. True/False
18. checkpoint
inhibition of the PD-1/PD-L1 pathway has been shown to be very effective in
mismatch repair-deficient cancers. True/False
19. vaccination
against these cancers is currently the focus of research. True/False
20. the
Manchester International Consensus guideline is a useful reference for
gynaecologists managing women with these cancers. True/False
22. EMQ. Flu and
pregnancy.
Flu and pregnancy
Abbreviations.
JCVI: Joint
Committee on Vaccination and Immunisation
MERS: Middle Eastern Respiratory Syndrome
Question 1. What did MBRRACE say about flu &
pregnancy in its first report in 2014?
Option List
Pick the best option from the
following list.
|
A.
|
1 in 11 women died from flu |
|
B.
|
1 in 11 women
died from flu and flu vaccination could have prevented ½ of the deaths |
|
C.
|
1 in 21 women
died from flu |
|
D.
|
1 in 21 women
died from flu and flu vaccination could have prevented ½ of the deaths |
|
E.
|
1 in 51 women
died from flu |
|
F.
|
1 in 51 women
died from flu and flu vaccination could have prevented ½ of the deaths |
Question 2. How many types of flu virus are
recognised?
Option List
|
F.
|
3 |
|
G.
|
5 |
|
H.
|
10 |
|
I.
|
15 |
|
J.
|
>100 |
Question 3. Why can’t we have a universal flu
vaccine?
List of
statements.
|
A.
|
The main surface antigens are
haemagglutinin and neuraminidase |
|
B.
|
The main
surface antigens are haemolysin and neuroxidase |
|
C.
|
The main
surface antigens frequently |
|
D.
|
The main core
antigens change frequently, rendering existing vaccines impotent |
|
E.
|
The big drug
companies avoid making a universal vaccine for financial reasons. |
Option List
|
1.
|
A + C + D + E |
|
2.
|
A + C |
|
3.
|
A + D + E |
|
4.
|
B + C |
|
5.
|
B + D + E |
Question 4. When is flu’ most often a problem in
the UK?
Option List
|
A.
|
Spring |
|
B.
|
Summer |
|
C.
|
Autumn |
|
D.
|
Winter |
|
E.
|
None of the
above. |
Question 5. How is flu spread?
Option List
|
A.
|
via aerosol or droplets from
respiratory tract of an infected person |
|
B.
|
via aerosol or
droplets from respiratory tract or direct contact with respiratory
secretions of an infected person |
|
C.
|
from getting
drenched in cold winter showers |
|
D.
|
from thinking
lascivious thoughts |
|
E.
|
from toilet
seats |
Question 6. What is the incubation period for flu?
Option List
|
A.
|
1 – 3 days |
|
B.
|
1 – 7 days |
|
C.
|
5 – 10 days |
|
D.
|
up to 2 weeks |
|
E.
|
up to 3 weeks |
Question 7. Who decides which viruses will be used
in the vaccine for seasonal flu?
Option List
|
|
DOH |
|
|
JCVI |
|
|
the Prime Minister |
|
|
the vaccine manufacturers |
|
|
WHO |
Question 8. How long has flu vaccination been
recommended in the UK?
Option List
|
A. |
since the 1950s |
|
B.
|
since the
1960s |
|
C.
|
since the
1970s |
|
D.
|
since the
1980s |
|
E.
|
since the
1990s |
Question 9. What is the recommendation about when
the vaccine should be given?
Option List
|
A.
|
May - July |
|
B.
|
June - August |
|
C.
|
July -
September |
|
D.
|
August -
October |
|
E.
|
September -
November |
Question 10. What advice is given about vaccination
in pregnancy?
Option List
|
A. |
flu vaccine is potentially
teratogenic and should be avoided before 16 weeks |
|
B.
|
the vaccine
contains an attenuated virus with no evidence of risk in pregnancy |
|
C.
|
the vaccine
recommended for pregnancy has no live viral material and all pregnant women
are encouraged to have the seasonal vaccine |
|
D.
|
flu vaccine
contains an attenuated virus with minimal risk, but the anti-viral drug
Tamiflu is given with the vaccine to eliminate any risk of harm |
Question 11. What is the H1N1 virus?
Option List
|
A. |
The avian virus which causes
outbreaks of “bird flu” |
|
B.
|
The virus
associated with “swine” flu, which caused a pandemic in 2009 |
|
C.
|
The virus
associate with MERS, currently causing deaths particularly in Saudi Arabia |
|
D.
|
The virus
associated with simian flu |
|
E.
|
The virus associated
with the pandemic of 1915. |
Question 12. What advice should be given to
pregnant women about protection against H1N1 virus?
Option List
|
F.
|
to have vaccination against H1N1 in
addition to the seasonal vaccine |
|
G.
|
to have
vaccination against H1N1 in preference to the seasonal vaccine |
|
H.
|
to await
evidence of epidemic H1N1 flu and then have vaccination against H1N1 |
|
I.
|
to have the
seasonal vaccine as it gives good protection against H1N1 |
|
J.
|
not to have
any flu vaccination, but to take antiviral drugs if symptoms of flu occur |
Question 13. Which of the following conditions have
been linked to flu in pregnancy?
Conditions.
|
A. |
risk of flu complications for the
mother |
|
B. |
risk of low birthweight |
|
C. |
risk of maternal death |
|
D. |
risk of perinatal death |
|
E. |
risk of prematurity |
Option List
|
1 |
A + C+ D + E |
|
2 |
A + B + C+ D |
|
3 |
A + C + D |
|
4 |
A + C+ D + E |
|
5 |
A + B + C+ D +
E |
Question 14. What is the estimated uptake of flu
vaccination by pregnant women in the UK?
Option List
|
A.
|
20-30% |
|
B.
|
30-40% |
|
C.
|
40-50% |
|
D.
|
50-60% |
|
E.
|
> 60% |
Question 15. How many maternal deaths from flu were
reported by MBRRACE for the years 2012-13?
Option List
|
A.
|
0 |
|
B.
|
5 |
|
C.
|
10 |
|
D.
|
15 |
|
E.
|
20 |
Question 16. With regard to the probable
explanation for the numbers of maternal deaths from ‘flu in 2012 and 2013,
which, if any, of the following statements is true?
Option List
|
A.
|
the numbers reflected increased
prevalence of ‘flu |
|
B.
|
the numbers
reflected reduced prevalence of ‘flu |
|
C.
|
the numbers
reflected improved uptake of ‘flu vaccine in pregnancy |
|
D.
|
the numbers
reflected the introduction of Tamiflu for pregnant women with ‘flu |
|
E.
|
none of the
above |
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