15th. August 2022.
|
52 |
Structured conversation. Labour ward
scenario |
|
53 |
EMQ. Toxoplasmosis |
|
54 |
EMQ. Caldicott guardian |
|
55 |
SBA. Blob and Bagel signs |
|
56 |
SBA. Cardiac arrest and laparoscopy |
|
57 |
SBA. Preterm birth and maternal risk
of cardiovascular disease |
Toxoplasmosis.
EMQ. Questions.
Abbreviations.
cTg: congenital toxoplasmosis.
TgIgG: Toxoplasmosis
immunoglobulin G.
TgIgM: Toxoplasmosis immunoglobulin M.
Question
1.
Which, if any, of
the following are true in relation to the organism causing
toxoplasmosis.
Option list.
|
A |
it is Toxoplasma giardia |
|
B |
it is Toxoplasma gondi |
|
C |
it is Toxoplasma gondii |
|
D |
it is Toxoplasma gondola |
|
E |
it is Toxoplasma gung-ho |
|
F |
none of the above |
Question
2.
Approximately what
proportion of the UK pregnant population shows evidence of
previous Tg infection?
Option list.
|
A |
< 10% |
|
B |
10% |
|
C |
20% |
|
D |
30% |
|
E |
40% |
|
F |
50% |
|
G |
> 50% |
Question
3.
When is maternal
infection believed to be of greatest risk to the fetus?
Option list.
|
A |
peri-conceptually |
|
B |
1st. trimester |
|
C |
2nd. trimester |
|
D |
3rd. trimester |
|
E |
during vaginal birth |
|
F |
in the puerperium |
|
G |
in the puerperium if breastfeeding |
|
H |
none of the above |
Question
4.
Which, if any, of the following are true with regard to when
tgIgG is detectable after
1ry maternal infection?
Option list.
|
A |
2 weeks |
|
B |
4 weeks |
|
C |
2 months |
|
D |
3 months |
|
E |
6 months |
|
F |
none of the above |
Question
5.
Which, if any, of the following are true with regard to when TgIgM
is detectable after
1ry maternal infection?
Option list.
|
A |
2 weeks |
|
B |
4 weeks |
|
C |
2 months |
|
D |
3 months |
|
E |
6 months |
|
F |
none of the above |
Question
6.
Which, if any, of the following are true with regard to
avidity testing for Tg?
Option list.
|
A |
avidity testing is of little use |
|
B |
avidity testing requires expert advice |
|
C |
avidity < 30% indicates infection in the previous 3
months |
|
D |
avidity < 30% indicates infection in the previous 6
months |
|
E |
avidity < 30% indicates infection in the previous 9 months |
|
F |
avidity > 40% indicates infection more than 3 months
previously |
|
G |
avidity > 40% indicates infection more than 6 months
previously |
|
H |
avidity > 40% indicates infection more than 9 months
previously |
|
I |
none of the above |
Question
7.
Which, if any, of the following are true with regard to confirmation
of fetal infection?
Option list.
|
A |
avidity testing is of little use |
|
B |
avidity testing requires expert advice |
|
C |
avidity < 30% indicates infection in the previous 3
months |
|
D |
avidity < 30% indicates infection in the previous 6
months |
|
E |
avidity < 30% indicates infection in the previous 9 months |
|
F |
avidity > 40% indicates infection more than 3 months
previously |
|
G |
avidity > 40% indicates infection more than 6 months
previously |
|
H |
avidity > 40% indicates infection more than 9 months
previously |
|
I |
none of the above |
Question
8.
Which, if any, of
the following are true in relation to the NSC’s decision on routine
toxoplasmosis screening in
pregnancy in 2016?
Option list.
|
A |
screening should be introduced as soon as practicable |
|
B |
testing would produce a falsely-high prevalence of Tg
in pregnancy |
|
C |
the prevalence of Tg is too low for screening to be
cost-effective |
|
D |
the prevalence of Tg is high enough for screening to be cost-effective |
|
E |
the prevalence of Tg is unknown |
|
F |
there is no treatment in pregnancy of proven benefit to
mother or baby |
|
G |
they would leave the decision until after lunch, but
drank too much wine and did not return |
|
H |
maybe some of the above, please tick the boxes for me |
|
I |
none of the above |
Question 9.
Which, if any, of
the following are complications of intrauterine Tg infection for the fetus and newborn.
Option list.
|
A |
miscarriage |
|
B |
IUGR |
|
C |
stillbirth |
|
D |
chorioretinitis |
|
E |
hepato-splenomegaly |
|
F |
holoprosencephaly |
|
G |
hydrocephalus |
|
H |
intracranial calcification |
|
I |
microcephaly |
|
J |
neural tube defect |
Question
10. Approximately how common in vertical transmission of Tg in
the 1st. trimester?
Option list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question
11. Approximately how common in vertical transmission of Tg in
the 2nd. trimester? Use
the option list for question 4.
Option list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question 12.
Approximately how
common in vertical transmission of Tg in the 3rd. trimester? Use the
option list for question 4.
Option list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question 13.
Which of the
following are true in relation to reducing the risk of vertical transmission of
Tg?
Option list.
|
A |
the SYROCOT trial showed strong evidence of the
efficacy of spiramycin |
|
B |
a Cochrane trial has suggested that pyrimethamine +
sulfadiazine give better results than spiromycin |
|
C |
there is evidence that metronidazole is the most
effective drug |
|
D |
there is a lack of clear evidence about effective
therapies |
|
E |
spiromycin crosses the placenta, so is effective in
reducing MTBT and treating the infected fetus |
|
E |
this is too esoteric for my poor pummelled brain |
Question 14.
Which, if any, of
the following are features of the classical triad associated with congenital
Tg?
Option list.
|
A |
chorioretinitis |
|
B |
deafness |
|
C |
hepatosplenomegaly |
|
D |
hydrocephalus |
|
E |
intracranial calcifications |
|
F |
low birthweight |
|
G |
jaundice |
|
H |
leukopenia |
Question
15. Which of the following are used in the treatment of cTg?
Option list.
|
A |
metronidazole |
|
B |
pyrimethamine |
|
C |
steroids |
|
D |
sulfadiazine |
|
E |
none of the above. |
53. EMQ. Caldicott guardian.
Question 1. Which, if any, of the following statements is true
of the Caldicott Guardian?
Option List
|
A |
it is a large lizard, unique to the Galapagos Islands |
|
B |
it is the Trust Board member responsible for child safeguarding
procedures |
|
C |
it is the Trust Board member responsible for complaint
procedures |
|
D |
it is the person within a Trust responsible for patient
confidentiality in relation to information |
|
E |
it is the person within a Trust responsible for dealing
with bullying |
Question 2. The Caldicott Report identified 6 basic
principles. What are they?
Option list. There
is none. Imagine that there is information about you stored on the computers of
the local NHS Trust. What conditions would you want to lay down about sharing
of that information within the Trust, with other NHS organisations and with
non-NHS organisations?
Question 3. The Caldicott Report made numerous
recommendations. Which was particularly important for major NHS organisations
such as Trusts?
Option List
|
A.
|
the need to appoint a Caldicott
Guardian |
|
B.
|
the need to
create a Caldicott Register |
|
C.
|
the need to
create a Caldicott Police Department |
|
D.
|
the need to
create a link between the Caldicott Department and the DOH |
|
E.
|
none of the
above. |
Question 4. What is the definition of the key role
deriving from the answer to question 3?
Option List. There is none lest it give you the
answer to question 3!
54. SBA. Blob and Bagel signs.
Question 1.
What do the ‘blob and bagel’ signs relate to?
Option List
|
A |
C.
section scar pregnancy |
|
B |
corpus luteum |
|
C |
interstitial pregnancy |
|
D |
ovarian ectopic pregnancy |
|
E |
tubal ectopic pregnancy |
Question 2.
Which of the following best fits the term ‘blob sign’?
Option List
|
A |
an obese
patient |
|
B |
a homogeneous mass |
|
C |
an amorphous mass |
|
D |
an empty gestational sac |
|
E |
an inhomogeneous mass |
Question 3.
Which of the following best fits the term ‘bagel sign’?
Option List
|
A |
an obese
patient |
|
B |
a homogeneous mass |
|
C |
an amorphous mass |
|
D |
an empty gestational sac |
|
E |
an inhomogeneous mass |
Question 4.
Which of the following best applies to the usefulness of the signs?
Option List
|
A |
advocates say they should be taken as definitive in diagnosis |
|
B |
they denote obesity precluding effective transabdominal
scanning |
|
C |
they
reflect habitus, which is already obvious |
|
D |
they should not be used as they are pejorative |
|
E |
never heard of them, so I don’t give a damn |
|
Sign |
Sensitivity |
Specificity |
PPV |
NPV |
|
Blob |
89.8% |
99.5% |
96.7% |
98.3% |
|
Bagel |
83.3% |
99.6% |
95.2% |
98.6 |
55. SBA. Cardiac arrest and laparoscopy.
This topic has featured in the Part 2 and could be part
of a structured conversation on the complications of laparoscopy. Some are not
true EMQs with > 5 options / > 1 correct answer.
Abbreviations.
AIMD: Australian Incident Monitoring database.
CA2: RCOG’s Consent Advice 2: “Diagnostic
Laparoscopy”.
Question 1. How does the
RCOG categorise and describe risk? There is no option list.
Question 2. Which, if
any, of the following are listed in CA2 list as the serious complications of
laparoscopy?
Option list.
|
A |
being aware
during the procedure |
|
B |
cardiac arrest |
|
C |
death |
|
D |
damage to
bowel, bladder, major vessels, ureters or uterus, |
|
E |
gas embolism |
|
F |
incisional
hernia |
|
G |
pneumothorax |
|
H |
thromboembolism |
Question 3.
What does CA2 give as the risk of a serious
complication during laparoscopy?
Option list.
|
A |
1 in 250 |
|
B |
1 in 500 |
|
C |
1 in 1,000 |
|
D |
1 in 2,500 |
|
E |
1 in 5,000 |
|
F |
none of the above |
Question 4.
What does CA2 give as the risk of death during
laparoscopy?
Option list. Use the list from the previous question.
Question 5.
What does CA2 include as frequent
complications of laparoscopy?
Option list.
|
A |
bleeding |
|
B |
depression |
|
C |
infection |
|
D |
keloid scar |
|
E |
none of the above |
Question 6.
What does CA2 say about cardiac arrest in
relation to laparoscopy?
Option list. There is none.
Question 7.
What is the estimated incidence of cardiac
arrest during laparoscopy?
Option list. Use the list from question 3.
Question 8.
When is cardiac arrest most likely during
laparoscopy?
Option list.
|
A |
during induction of anaesthesia |
|
B |
during creation of the pneumoperitoneum |
|
C |
during manipulation of the uterine appendages |
|
D |
during manipulation of the uterus |
|
E |
none of the above. |
Question 9.
What is the
main warning sign of impending cardiac arrest?
Option list.
|
A |
atrial fibrillation |
|
B |
bradycardia |
|
C |
ectopic beats |
|
D |
tachycardia |
|
E |
ventricular fibrillation |
|
F |
none of the above |
Question 10. What step
should the gynaecologist first take on being informed of impending cardiac
arrest?
Option list.
|
A |
call for help |
|
B |
deflate the abdomen |
|
C |
perform external cardiac massage |
|
D |
rapid one towards the exit |
|
E |
slap the anaesthetist to promote action |
Question 11.
What steps should the anaesthetist take on being
aware of possible impending cardiac
arrest?
Option list. There is none to make you think.
Question 12.
What steps should the anaesthetist take if
cardiac arrest occurs?
Option list. There is none.
Question 13.
What should be done about completing the
surgical procedure in the event of cardiac
arrest during laparoscopy?
Option list.
|
A |
abandon the procedure |
|
B |
continue the procedure once normal cardiac function has
been restored |
|
C |
continue the procedure once normal cardiac function has
been restored but with slow creation of the peritoneum |
|
D |
continue the procedure once normal cardiac function has
been restored, so long as the ECG is normal |
|
E |
none of the above |
Question 14.
What follow-up should be arranged for the
patient after cardiac arrest during
laparoscopy?
Option list. There is none to make you think, as you
would have to do in a viva.
Question 15.
What else should be done after cardiac arrest
during laparoscopy?
Option list. There is none.
56. SBA. Preterm birth and maternal risk of
cardiovascular disease.
Question 1.
What is the definition of preterm birth?
Option list.
|
A |
birth at < 39 weeks |
|
B |
birth at < 38 weeks |
|
C |
birth at < 37 weeks |
|
D |
birth at < 36 weeks |
|
E |
birth at < 34 weeks |
Question 2.
What does the WHO estimate the range of
incidence of preterm birth to be?
Option list.
|
A |
5% to 10% |
|
B |
5% to 18% |
|
C |
10% to 15% |
|
D |
15% to 25% |
|
E |
none of the above |
Question 3.
What is the current rate of premature birth in
the UK?
Option list.
|
A |
5% |
|
B |
6% |
|
C |
8% |
|
D |
10 |
|
E |
none of the above |
Question 4.
Which, if any, of the following statements is
true about the approximate proportions of perinatal mortality and morbidity
attribute to preterm birth?
Option list.
|
A |
55% of mortality and 55% of morbidity |
|
B |
65% of mortality and 65% of morbidity |
|
C |
75% of mortality and 75% of morbidity |
|
D |
85% of mortality and 85% of morbidity |
|
E |
none of the above |
Question 5.
Which, if any, of the following statements are
true about the maternal risk of
hypertension in the decade after PTB?
Option list.
|
A |
the risk of hypertension is decreased |
|
B |
the risk of hypertension is increased |
|
C |
the risk of hypertension is not altered |
|
D |
the risk of hypertension is increased by a factor of
about 3 |
|
E |
the risk of hypertension increases with the degree of
prematurity |
|
F |
the risk of hypertension further increases repeated
preterm birth |
Question 6.
Which, if any, of the following statements are
true about the possible association of
maternal hypertension in the 2nd. 3rd. and 4th.
decades after PTB?
Option list.
|
A |
the risk of hypertension is decreased |
|
B |
the risk of hypertension is increased |
|
C |
the risk of hypertension is not altered |
|
D |
the risk of hypertension is increased by an aHR of
about 1.2 – 1.4 |
Question 7.
Which, if any, of the following statements are
true about the risk of stroke for those
born prematurely compared with those born at term?
Option list.
|
A |
the risk of stroke is decreased |
|
B |
the risk decreases with the degree of prematurity |
|
C |
the risk of stroke is increased |
|
D |
the risk increases with the degree of prematurity |
|
E |
the risk mainly relates to haemorrhagic stroke |
|
F |
the absolute risk is ~ 1% |
Question 8. Which, if
any, of the following statements is true about the maternal risk of ischaemic
heart
disease after PTB?
Option list.
|
A |
the risk of
ischaemic heart disease is decreased |
|
B |
the risk of
ischaemic heart disease is increased |
|
C |
the risk of ischaemic
heart disease is not altered |
|
D |
the risk of
ischaemic heart disease is increased by an aHR of about 1.2 – 1.4 |
|
E |
the risk of
ischaemic heart disease is unknown |
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