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MRCOG tutorial 18th. December 2023

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53

EMQ. Cytomegalovirus and Pregnancy. CMV

54

EMQ. WOMAN trial

55

EMQ. Tranexamic acid

56

EMQ. Uterine inversion

57

EMQ. Kallmann’s syndrome

 

53.         EMQ. Cytomegalovirus and Pregnancy. CMV.

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 1st. pregnancy

B

approximately 20-30% of women are immune before their 1st. pregnancy

C

approximately 30-50% of women are immune before their 1st. pregnancy

D

approximately 40-60% of women are immune before their 1st. 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 1ry. 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 1ry. 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 1st. trimester

B

with 2ry infection during the 1st. trimester

C

with 1ry infection during the 2nd. trimester

D

with 2ry infection during the 2nd. trimester

E

with 1ry infection during the 3rd. trimester

F

with 2ry infection during the 3rd. 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?

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 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 is true in relation to the CMV ‘avidity index’?

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 is true in relation to the CMV ‘avidity index’?

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 statements 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

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 3rd. 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

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

54.         EMQ. WOMAN trial.

Question 1.   What does the acronym “WOMAN” mean? There is no option list.

Question 2.   Which condition and drug were the subjects of the trial?.

Question 3.   What were the main outcomes of the trial?

Question 4.   Which, if any, of the following were in the WHO’s response to the outcomes?

Option list.

D

the drug to be stored at room temperature

A

the drug to be used for all pregnant women

B

the drug to be used prophylactically

C

the drug to be used orally

F

the drug to be used within 6 hours

E

drug manufacturers to be asked to reduce the cost to facilitate use in developing countries

Question 5.   Which, if any, of the following are true about the WOMAN-2 trial?

Option list.

D

the trial does not exist

A

the drug to be used for all pregnant women

B

the drug to be used prophylactically

C

the drug to be used intravenously

F

the drug to be used within 6 hours

E

hysterectomy will be included in the outcomes

Question 6.   Which, if any, of the following are true about the WOMAN-PharmacoTXA trial?

Option list.

A

the trial does not exist

B

the drug to be used for all pregnant women

C

oral v i.m. use will be compared

D

oral v  i.v. use will be compared

E

i.m. v. i.v. use will be compared

F

none of the above

 

55.         EMQ. Tranexamic acid.

This topic featured in the exam in 2019 and 2021, probably prompted by WHOT.

Abbreviations.

EBL:               estimated blood loss.

PPH:              postpartum haemorrhage.

TA:                 tranexamic acid.

WHOT:         WHO’s Updated WHO Recommendation on TA for the Treatment of PPH. 2017.

Scenario 1.               Which, if any, of the following describe the main mode of action of tranexamic acid? This is not a true EMQ as there may be more than one correct answer.

Option list.

A

inhibition of conversion of plasminogen to plasmin

B

inhibition of fibrinolysis

C

inhibition of factor Xa

D

inhibition of heparin activity

E

inhibition of plasmin activity

F

promotion of conversion of fibrinogen to fibrin

G

promotion of conversion of prothrombin to thrombin

H

promotion of platelet activation

I

promotion of platelet production

Scenario 2.               Which, if any, of the following statements are true?

Option list.

A

GOH say that TA should be considered when an apixaban antagonist is required

B

GOH say that TA should be considered when a clopidogrel antagonist is required

C

GOH say that TA should be considered when a factor Xa agonist is required

D

GOH say that TA should be considered when a factor Xa antagonist is required

E

GOH say that TA should be considered when a heparin  antagonist is required

F

GOH say that TA should be considered when Protein C is deficient

G

GOH say that TA should be considered when Protein S is deficient

H

none of the above

Scenario 3.               Which, if any, of the following statements are true in relation to TA? This is not a true EMQ as there may be more than one correct answer.

Option list.

A

TA is teratogenic in rats and should be avoided in the first trimester

B

TA has not been shown to be teratogenic and is safe to use in pregnancy

C

TA is excreted is contraindicated in breastfeeding as the levels equate to maternal levels

D

TA levels in breast milk are one hundredth of maternal levels

E

none of the above.

Scenario 4.               Which, if any, of the following statements are listed by eMC as contraindications?

Option list.

A

asthma

B

barbiturate use

C

consumption coagulopathy

D

convulsions

E

severe renal impairment

Scenario 5.               Which, if any, of the following is included in the definition of PPH in WHOT?

Option list.

A

EBL  500 mL after vaginal birth or C section

B

EBL  1,00 mL after vaginal birth or C section

C

EBL  500 mL after vaginal birth or ≥ 1,00 mL C section

D

EBL  1,000 mL after vaginal birth or ≥ 500 mL C section

E

none of the above

Scenario 6.               What other category of patient is included in the WHOT definition of PPP?

Option list. There is none, to make you think.

Scenario 7.               Which of the following are included in the WHOT recommendations?

Option list.

A

TA to be given to all women with a history of PPH

B

TA to be given to all women in established labour

C

TA to be given to all having C section

D

TA to be given to all women having episiotomy

E

TA to be given to all women having instrumental delivery

F

none of the above

Scenario 8.               Which, if any, of the following are included in WHOT?

Option list.

A

TA should be given within 3 hours of the birth

B

TA should be given within 6 hours of the birth

C

TA should be given IV as a bolus of 10g

D

TA should be given IV at a dose of 1g in 10mL over 5 minutes

E

TA should be given IV at a dose of 1g in 10mL over 10 minutes

F

TA should be given IV at a dose of 5g in 20mL over 5 minutes

G

TA should be given IV at a dose of 5g in 20mL over 10 minutes

Scenario 9.               Which, if any, of the following statements is included WHOT?

Option list.

A

the benefit from TA declines by about 10% for every 5 minutes of delay in starting Rx

B

the benefit from TA declines by about 10% for every 10 minutes of delay in starting Rx

C

the benefit from TA declines by about 10% for every 15 minutes of delay in starting Rx

D

the benefit from TA declines by about 10% for every 20 minutes of delay in starting Rx

E

the benefit from TA declines by about 10% for every 25 minutes of delay in starting Rx

F

the benefit from TA declines by about 10% for every 30 minutes of delay in starting Rx

G

none of the above

Scenario 10.           Which, if any, of the following statements are included in WHOT?

Option list.

A

TA is relatively cheap

B

TA has a shelf life of 5 years

C

TA can be stored safely at room temperature

D

TA is widely available in most countries

E

none of the above.

Scenario 11.           Which, if any, of the following statements are true of the differences between the updated version of WHOT in 2017 and the 2012 version?

A

TA to be used from the start of treatment of PPH

B

TA to be used only for cases with suspected or proven genital tract trauma

C

TA to be used as early as possible

D

TA not to be used > 5 hours after the birth

E

clearer instructions were given about the rate of administration

Scenario 12.           Which, if any, of the following statements are true of GTG52?

Option list.

A

it is being updated

B

it advises use of TA for all cases of PPH with no contraindications

C

it advises prophylactic use of TA for women at risk of bleeding prior to C section

D

in its present form it puts obstetricians at risk of being found negligent

E

none of the above.

Scenario 13.           Which paper in the NEJM in 2023 was a bit of a spanner in the works?

Scenario 14.           What were the key findings in the paper?

 

56.         EMQ. Uterine inversion.

Abbreviations.

MROP:          manual removal of placenta.

UI:                 uterine inversion.

Question 1.             How is uterine inversion categorised and how are the categories defined?

This is not an EMQ and there is no option list.

Question 2.        What is the approximate incidence of UI?

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 10,000

F

1 in 20,000

G

1 in 100,00

Question 3.        Is the incidence of UI higher in less-well developed countries?

Option list.

A

answer unknown

B

no

C

yes

Question 4.        What is the approximate incidence of UI during Caesarean section?

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 10,000

F

1 in 20,000

G

1 in 100,00

Question 5.        Which, if any, of the following are described as risk factors for UI?

Option list.

A

abruptio placenta

B

Caesarean section

C

Credé’s manoeuvre

D

fundal placenta

E

hydramnios

F

lax uterus

G

Marfan syndrome

H

mismanagement of the 2nd. stage of labour

I

mismanagement of the 3rd.  stage of labour

J

oxytocic use

K

postpartum haemorrhage

L

short cord

Question 6.        What are the presenting features of UI? There is no option list.

Question 7.        What is the immediate management of UI? There is no option list.

Question 8.        What procedure should be considered if the inversion is not corrected during initial

management? There is no option list.

Question 9.        What is Huntington’s procedure?.

Question 10.    What is Haultain’s procedure ? There is no option list.

Question 11.    What other procedures have been described? There is no option list.

Question 12.    What should be done to ensure the inversion does not recur? There is no option list.

Question 13.    What is the risk of recurrence in the next pregnancy? There is no option list.

Acute inversion of the uterus. CPD from Bhalla et al: “Acute UI”. TOG. 2009;11:13-18.

With regard to acute uterine inversion,

1      it is spontaneous in up to 50% of cases.                                                                       True / False

2      its incidence is similar in most parts of the world.                                                     True / False

The associated risk factors for acute inversion of the uterus include:

3      injudicious traction on the umbilical cord.                                                                   True / False

4      manual removal of the placenta.                                                                                   True / False

5      uterine atony.                                                                                                                    True / False

6      fundal implantation of a morbidly adherent placenta.                                              True / False

7      placenta praevia.                                                                                                              True / False

Recognised features of acute inversion of the uterus include:

8      haemorrhage.                                                                                                                   True / False

9      neurogenic shock.                                                                                                            True / False

10    severe abdominal pain.                                                                                                   True / False

11    postpartum collapse.                                                                                                       True / False

12    lump per vaginam.                                                                                                            True / False

Regarding management of acute uterine inversion,

13    the best treatment is immediate repositioning of the uterus.                                 True / False

14    the use of tocolysis to promote uterine relaxation will aid uterine reposition.               True / False

15    magnesium sulphate is not used for tocolysis.                                                            True / False

16    in the presence of shock, terbutaline is acceptable as a safe agent  for uterine relaxation.

True / False

17    when halothane is used to encourage uterine relaxation severe hypotension is a recognised complication.                                                                                                             True / False

With regard to future pregnancy,

18    the condition carries a good prognosis if managed correctly.                                  True / False

Regarding treatment of acute inversion,

19    in fewer than 3% of cases, women will need to undergo laparotomy.                     True / False

20    immediate reduction is successful in approximately 50–80% of cases.                     True / False

 

57.         Kallmann’s syndrome.

Scenario 1.               Which of the following might be included in descriptions of Kallmann’s syndrome?

Option list.

A

hypogonadotrophic hypogonadism

B

hypogonadotrophic hypogonadism + anosmia

C

hypogonadotrophic hypogonadism + anosmia + colour-blindness.

D

hypogonadotrophic hypogonadism due to uterine agenesis

Scenario 2.    Which, if any, of the following are features of the Kallmann phenotype?

A

absent or minimal breast development

B

aortic stenosis

C

blue eyes

D

blue hair

E

hot flushes

F

short stature

G

tall stature

H

vaginal agenesis

I

none of the above

Scenario 3.    How common is Kallmann’s syndrome and what is the female: male ratio?

A

1 in 1,000 and F:M ratio 1:1

B

1 in 5,000 and F:M ratio 1:1

C

1 in 10,000 and F:M ratio 1:4

D

1 in 50,000 and F:M ratio 1:4

E

1 in 100,000 and F:M ratio 1:8

F

1 in 250,000 and F:M ration 1:10

Scenario 4.    What is the most common mode of inheritance of Ks?

Option list.

A

hypogonadotrophic hypogonadism

B

hypogonadotrophic hypogonadism + anosmia

C

hypogonadotrophic hypogonadism due to uterine agenesis

D

autosomal dominant

E

autosomal recessive

F

X-linked recessive

G

new mutation of the ANOS1 gene

H

the most common mode of inheritance is not known

Scenario 5.    How is Kallmann’s syndrome diagnosed?

A

abdominal and pelvic ultrasound scan

B

cell-free fetal DNA

C

chromosome analysis

D

CT scan of hypothalamus / pituitary

E

MR scan of hypothalamus / pituitary

F

none of the above.

Scenario 6.    How is Kallmann’s syndrome treated initially?

Which of the following statements are true?

Option list.

A

GnRH analogue depot

B

pulsatile GnRH therapy

C

combined oral contraceptive

D

counselling & education re gender re-assignment

E

depot progestogen

F

none of the above

Scenario 7.    A woman was diagnosed with Kallmann’s syndrome at 16 and had successful initial

treatment. She is now 25, married and wishes to have a pregnancy. She has had pre-pregnancy assessment and counselling. Which of the following should be considered?

A

GnRH analogue depot

B

induction of ovulation with clomiphene

C

gonadotrophin therapy

D

pulsatile GnRH therapy

E

none of the above