MRCOG tutorial 25th. September 2023

Contact me

Website

25 September 2023.

 

56	Teresa Kelly. COVID
57	Structured conversation. Waiting list prioritisation
58	SBA. Quinolone antibiotics
59	SBA. Yellow card reporting system

 

56. Teresa Kelly. COVID .

Teresa is a Consultant at St. Mary’s hospital, the main teaching hospital in Manchester. She ran the COVID service from the desperate earliest days when little was known about how best to manage the disease. She gives an insight into the difficulties and how knowledge and management improved rapidly, particularly in relation to treatment and vaccines. She also displays her great commitment to individual patients; almost a ‘my girls’ attachment.

Her Scottish accent is even more pronounced than mine and, like most Glaswegians, she speaks very quickly, so you will need to listen carefully, but I hope your ears will soon tune in.

 

57. Structured conversation. Waiting list prioritisation.

Candidate’s instructions.

Your consultant is away. The waiting-list manager comes to see you. The following patients have been listed by junior staff. The waiting-list manager wants you to:

confirm the appropriateness of the proposed treatment,

decide the degree of urgency,

confirm the appropriateness of the proposed venue,

decide any special requirement(s) for each patient.

 

Name	Age	Clinical Problem	Proposed operation	Venue	Special Needs	Urgency
JK	5	chronic discharge. ? foreign body	EUA	Main theatre
JM	32	1ry. infertility	Laparoscopy + tubal patency tests	Main theatre
GN	77	Vulval cancer. Coronary thrombosis x 2. Unstable angina.	Radical vulvectomy agreed at MDT.	Main theatre
RU	55	PMB x1. Weight 20 stones. (127 kg.) 1 kg. = 2.2 lb. 1 stone = 14 lb.	D&C.	DCU.
LD	32	Menorrhagia. Fibroids. Anaemia.	Vaginal hysterectomy.	Main theatre.
DT	22	Does not want children.	Lap. Steril.	DCU
HB	14	Unwanted pregnancy at 10/52.	TOP	DCU. TOP list.	.
JY	44	GSI.	Anterior colporrhaphy.	Main theatre.
JS	23	Vaginal discharge. Cervical ectropion.	Diathermy to cervix.	DCU
DT	55	3 cm. ovarian mass.	Laparoscopy ? proceed to Hyst + BSO.	Main theatre.
EV	32	CIN3.	Cone biopsy.	DCU
UW	34	Endometriosis	Laparoscopic ablation	DCU
HT	88	Cystocoele/ rectocoele/ 2nd. degree uterine prolapse	Manchester Repair.	Main theatre.
KN	58	Haematuria	Cystoscopy	DCU
JW	18	Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.	Hysterectomy	Main theatre
TB	30	Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.	Vaginal hysterectomy and repair.	Main theatre.
BM	55	Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin.	Wertheim’s hysterectomy.	Main theatre.
NU	60	Recurrent rectocoele.	Posterior colporrhaphy.	Main theatre.

 

58.         SBA. Quinolone & fluoroquinolone antibiotics.

Abbreviations.

FQ:        fluoroquinolone.

SLE:       systemic lupus erythematosus.

QUI:      quinolone.

Question 1. Which, if any, of the following drugs are QUIs or FQs? 

Drugs

A	cimetidine
B	ciprofloxacin
C	nalidixic acid
D	neomycin
E	nitrofurantoin

Option List

1	A + B
2	A + B + C
3	B + C
4	B + C + D + E
5	A + B + C + D + E

Question 2. Which, if any, of the following statements are true in relation to QUIs & FQs? This is

not a true SBA as there may be more than one answer.

Statements

A	nalidixic acid is an older quinolone and is mainly excreted in the urine
B	ciprofloxacin is effective against most Gram +ve and –ve bacteria and 1st- line treatment for pneumococcal pneumonia.
C	ciprofloxacin is contraindicated in pregnancy due to the ↑ risk of neonatal haemolysis
D	many staphylococci are resistant to quinolones
E	quinolones are particularly useful in the treatment of MRSA

Question 3. Which was the first QUI antibiotic?

Option List

A	acetylsalicylic acid
B	nalidixic acid
C	oxalic acid
D	pipemidic acid
E	none of the above

Question 4. How do QUI and FQ antibiotics work? There is only one correct answer.

Option List

A	impair bacterial DNA coiling
B	impair bacterial DNA binding
C	impair bacterial RNA action
D	impair bacterial mitochondrial action
E	none of the above.

Question 5. Which, if any, of the following QUIs & FQs is not available for prescription in the UK.

There is only one correct answer.

Option List

A	ciprofloxacin
B	levofloxacin
C	nalidixic acid
D	moxifloxacin
E	ofloxacin

Question 6. Which, if any, of the following statements are true in relation to the quinolones and

fluoroquinolones and pregnancy? This is not a true SBA as there may be more than one answer.

Option list.

A	FQs are newer than QUIs with better systemic spread and efficacy
B	QUIs concentrate in urine but have a special affinity for cartilage
C	consumption of a FQ in the 1st. trimester is grounds for TOP
D	if an FQ is used, norfloxacin and ciprofloxacin should be considered 1st.
E	FQs are linked to a risk of discolouration of the teeth of offspring

Question 7. Which of the following is true about the warning issued by the FDA in 2008 in relation

to QUIs & FQs?

Option List

A	they may cause congenital cartilage defects
B	they may cause congenital deafness
C	they may cause tendonitis and tendon rupture
D	they may cause prolongation of the Q-T interval
E	none of the above

Question 8. Which of the following is true about the warning issued by the FDA in 2011 in relation

to QUIs & FQs?

Option List

A	they may cause exacerbation of eczema
B	they may cause exacerbation of hypertension
C	they may cause exacerbation of multiple sclerosis
D	they may cause exacerbation of myasthenia gravis
E	they may cause exacerbation of SLE

Question 9. Which of the following is true about the warning emphasised by the FDA in 2013 in

relation to QUIs & FQs?

Option List

A	they may cause aortic dissection
B	they may cause mitral stenosis
C	they may cause pancreatitis
D	they may cause peripheral neuropathy
E	they may cause flare of SLE

Question 10. FDA issued a warning in July 2016. Which, if any, of the following were included? This

is not a true SBA as there may be more than one answer.

Option List

A	the risks generally outweigh the benefits
B	QUIs & FQs should not be used for acute sinusitis,
C	QUIs & FQs should not be used for exacerbation of chronic bronchitis
D	QUIs & FQs should not be used for uncomplicated UTI
E	QUIs & FQs may be useful for anthrax and plague

Question 11. FDA issued a warning in July 2018 about the use of FQs in pregnancy. Which, if any, of

the following were included in the reasons for its publication?

Option List

A	to strengthen previous warnings about hyperglycaemia and mental health risks
B	to strengthen previous warnings about hypoglycaemia and mental health risks
C	to strengthen previous warnings about the risk of ASD in the offspring
D	to strengthen previous warnings about the risk of acute pancreatitis
E	to strengthen previous warnings about the risk of PET

Question 12. The FDA issued a warning in December 2018 about the use of FQs in pregnancy.

Which, if any, of the following was included? This is an SBA with only one correct answer.

Option List

A	↑ risk of atrial fibrillation
B	↑ risk of aortic aneurysm and rupture
C	↑ risk of mitral stenosis
D	↑ risk of pulmonary hypertension
E	↑ risk of ulcerative colitis