|
1 |
Jenny Myers. Tutorial. Diabetes. |
|
2 |
How to prepare. Part 2. What to read. StratOG. TOG CPD.
RCOG sample questions. Revision system. Study buddies. Intelligent guessing. Statistics.
Urogynae. Other specialist tutorials. |
|
3 |
EMQ. Cystic fibrosis |
|
4 |
EMQ. Hepatitis B |
|
5 |
EMQ.
ARRIVE trial |
|
6 |
SBA. McCune Albright syndrome |
1. Jenny Myers. Tutorial. Diabetes.
We will give this a quick run-through and I’ll attempt to
answer any questions.
There is no option list to
make you behave in a model fashion – best technique is to decide the correct
answer before looking at the option list.
Scenario
1. A woman is 8 weeks pregnant and a carrier of CF. Her husband is
Caucasian. What is the risk of the child having CF?
Scenario
2. A healthy woman attends for pre-pregnancy counselling. Her brother has CF.
Her husband is Caucasian and has a negative CF screen. What is the risk of them
having a child with CF?
Scenario
3. A healthy woman is a carrier of CF. She attends for pre-pregnancy
counselling. Her husband has CF. What is the risk of them having a child with
CF?
Scenario
4. A healthy woman attends for pre-pregnancy counselling. Her sister has
had a child with CF. What is her risk of being a carrier?
Scenario
5. A woman attends for pre-pregnancy counselling. Her mother has CF.
What is the risk that she is a carrier?
Scenario
6 . A woman attends for pre-pregnancy counselling. Her mother has CF.
The partner’s risk of being a carrier is 1 in X. What is the risk that
she will have a child with CF?
Scenario
7. A healthy Caucasian woman is 10 weeks pregnant. Her husband is a carrier
of CF. Which test would you arrange?
Scenario
8. A woman attends for pre-pregnancy counselling. She has read about
diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF
in this way?
Scenario
9. A woman and her husband are carriers of CF. What is the risk of an
affected child?
Scenario
10. A woman and her husband are carriers of CF. What can they do to reduce
the risk of having an affected child?
Scenario
11. A woman and her husband are carriers of CF. Can CVS exclude an affected
pregnancy?
Scenario
12. A woman has CF, her husband is a carrier. What is their risk of an
affected child?
Scenario
13. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will be protein-deficient due to
malabsorption. Is this advice correct?
Scenario
14. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will contain abnormally low levels of
sodium. Is this advice correct?
TOG
CPD. 2009. 11. 1. Cystic fibrosis and pregnancy
These are open access so are produced here.
Regarding cystic fibrosis,
1. there are approximately 8000 people living with
this disease in the UK. True / False
2. the main cause of death is liver disease. True / False
Women with cystic fibrosis
3. have an approximately 50% reduced
fertility. True / False
4. have a life expectancy of approximately 50
years. True / False
With regard to pregnancy in women with cystic fibrosis,
5. their babies usually have an appropriate
birthweight for their gestational age. True / False
6. approximately 70% of babies are born
prematurely. True / False
7. the risk of developing gestational diabetes
is higher than in the general population. True / False
8. the risk of miscarriage is higher than in
the general population. True / False
9. the risk of congenital malformations is
similar to that in women who are carriers. True / False
Women with cystic fibrosis who become pregnant,
10. have a shortened life expectancy compared with
women who do not. True / False
If a woman with cystic fibrosis becomes pregnant, the risk
of the baby being born with cystic fibrosis
11. is 50% if the father carries one of the
common gene mutations for cystic fibrosis. True / False
12. is < 1 in 250 if the father does not carry
any of the common CF mutations. True / False
During pregnancy, a woman with cystic fibrosis
13. should be cared for by a multidisciplinary
team, including a physician and an obstetrician with a special interest in CF
in pregnancy. True / False
14. should have a GTT if she did not have CF-related
diabetes prior to pregnancy. True / False
In pregnant women with cystic fibrosis,
15. the instrumental delivery rate is
approximately 40%. True / False
16. the use of epidural analgesia during delivery
is contraindicated. True / False
17. the risk of poor pregnancy outcome increases
if the FEV1 is < 70%. True / False
Post- delivery in women with cystic fibrosis
18. breastfeeding is contraindicated because of
the high sodium content of breast milk. True / False
Which of the following statements about cystic fibrosis are correct?
19. Menarche in girls with CF occurs at the same
time as in unaffected girls. True / False
20. Fertility in women with CF is affected to the
same extent as it is in men with CF. True / False
4. Hepatitis B.
Abbreviations.
GDM: gestational
diabetes mellitus.
HAV: hepatitis A
virus
HBcAg: hepatitis B
core antigen
HBeAg: hepatitis B e
antigen
HBsAg: hepatitis B
surface antigen
HBcAb: antibody to hepatitis
B core antigen
HBeAb: antibody to
hepatitis B e antigen
HBsAb: antibody to
hepatitis B surface antigen
HBIG: hepatitis B
immunoglobulin
HBV: hepatitis B
virus
HCV: hepatitis C
virus
HEV: hepatitis
E virus
HSV: herpes
simplex virus
Question
1.
An asymptomatic
primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What
results on routine blood testing would indicate that she has an acute HBV infection?
Question
2.
An asymptomatic
primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What
results on routine blood testing would indicate that she is immune to the HBV
as a result of infection?
Question
3.
An asymptomatic
primigravida books at 10 weeks. Her partner had an acute HBV
infection 4 months ago. What
results on routine blood testing would indicate that she is immune to the HBV
as a result of HBV vaccine?
Question
4.
An asymptomatic
primigravida books at 10 weeks. Her partner had an acute HBV
infection 9 months ago. What
results on routine blood testing would show that she is a chronic carrier of HBV
infection, assuming that she became infected early in the partner’s illness?
Question
5.
Testing shows that he is positive for HBsAg,
positive for HBcAb but negative for IgM
HBcAb. What does
this mean in relation to his HBV status?
Question
6.
Testing shows that he is negative for HBsAg,
positive for HBcAb and positive for
HBsAb. What does this mean in relation to his HBV status?
Question
7.
How common is
chronic HBV carrier status in UK pregnant women?
Question
8.
What is the risk
of death from chronic HBV carrier status?
Question
9.
A primigravid
woman at 8 weeks gestation is found to be non-immune to HBV. She has
recently married and her
husband is a chronic carrier. What should be done to protect her from
infection?
Question
10. A woman is a known carrier of HBV. What is the risk of
vertical transmission in the first
trimester?
Question
11. What is the risk of the neonate who has been infected by
vertical transmission
becoming a carrier without
treatment?
Question
12. Should antiviral maternal therapy in the 3rd.
trimester be considered for women with
HBeAg or high viral load?
Question
13. How effective is hepatitis B prophylaxis for the neonate in
preventing chronic carrier
status as a result of vertical
transmission?
Question
14. Can a woman who is a chronic HBV carrier breastfeed safely?
Question
15. Hepatitis
B infection is the most dangerous of the viral hepatitis infections in
pregnancy.
Question
16. A pregnant woman who is not immune to HBV has a partner who
is a chronic carrier.
Can HBV vaccine be administered
safely in pregnancy?
Question
17. How long can HBV survive outside the body?
Question
18. A pregnant woman who is not immune has a partner with acute
hepatitis due to HBV.
He cuts his hand and bleeds
onto the kitchen table. How should she clean the surface to ensure that she
gets rid of the virus?
Question 19.
Is it true that the presence of HBeAg in
maternal blood is a particular risk factor for
vertical
transmission? Not really a scenario, but never mind!
Question 20.
What does 5 log10 copies /mL mean?
|
A |
> 10 copies
/ mL |
|
B |
> 100 copies
/ mL |
|
C |
> 1,000
copies / mL |
|
D |
> 10,000
copies / mL |
|
E |
> 100,000
copies / mL |
|
F |
this has scared
me witless and I am going straight home to complain to my Mum |
Question 21.
Which, if any, of
the following statements are true about amniocentesis and CVS and
the risk of vertical transmission if the mother is HbsAg+ve?
|
A |
they are contraindicated |
|
B |
they should be done with cover with HBIG |
|
C |
they should be done with cover with a drug that is effective for HBV and safe in pregnancy. |
|
D |
none of the above |
Question
22. Which, if any, of the following statements are true about
treatment in the third
trimester to reduce the risk of
vertical transmission?
|
A |
women who are HbsAg+ve should
be offered testing for HBV DNA levels in the 3rd. trimester |
|
B |
there is no effective
treatment for HBV in the 3rd. trimester |
|
C |
the risks of treatment for
HBV in the 3rd. trimester outweigh the benefits |
|
D |
drug treatment for HBV in the
3rd. trimester adds nothing beneficial to the normal use of HBIG +
HB vaccination of the neonate |
|
E |
none of the above. |
Question
23. Which, if any, of the following drugs is recommended for
use in the third trimester to
reduce the risk of vertical transmission?
|
A |
acyclovir |
|
B |
lamivudine |
|
C |
telbivudine |
|
D |
tenofovir |
Question
24. Does elective Cs before labour and with the membranes
intact reduce the vertical
transmission rate?
Question
25. Which hepatitis virus normally produces a mild illness, but
represents a major risk to
pregnant women, with a
mortality rate of up to 5%?
Question
26. A pregnant woman has a history of viral hepatitis and
informs the midwife at booking
that she is a carrier and that
she has a significant risk of cirrhosis and has been advised not to drink
alcohol. Which is the most likely hepatitis virus?
Question
27. Which hepatitis virus is an absolute contraindication to
breastfeeding after
appropriate treatment of the
infected mother and prophylaxis for the baby?
Question
28. Which hepatitis virus is linked to an increased risk of
obstetric cholestasis?
Question
29. Which, if any, of the following statements is true in
relation to HepB and the risk of
GDM?
|
A |
the risk is about the same |
|
B |
the relative risk is about
0.1. |
|
C |
the relative risk is about
0.2. |
|
D |
the relative risk is about
0.5. |
|
E |
the relative risk is about
1.2. |
|
F |
the relative risk is about
1.5. |
|
G |
the relative risk is about
2.0 |
|
H |
the relative risk is about
3.0 |
|
I |
the risk is unknown |
5. ARRIVE trial.
Abbreviations.
EBL: estimated
blood loss.
IOL: induction
of labour.
SGA: small for
gestational age.
Question 1.
What does the
acronym ‘ARRIVE’ mean?
Option list.
|
A |
a randomised review of intravenous ergometrine for
the prevention of PPH |
|
B |
a randomised review of IVF efficacy |
|
C |
a retrospective review of IVF efficacy |
|
D |
a randomised review of IOL at term versus expectant
management of high-risk pregnancy |
|
E |
a randomised review of IOL at 39 weeks versus
expectant management of high-risk pregnancy |
|
F |
a randomised trial of IOL at term versus expectant
management of low-risk pregnancy |
|
G |
a randomised trial of IOL at 39 weeks versus
expectant management of low-risk pregnancy |
|
H |
none of the above |
Question 2.
What was the
primary outcome of the trial?
Option list.
|
A |
C section and instrumental delivery rates versus the
spontaneous delivery rate |
|
B |
cost-effectiveness of IVF |
|
C |
composite outcome of perinatal death or severe
neonatal complications |
|
D |
estimated blood loss using low-dose ergometrine
versus oxytocin for the 3rd. stage |
|
E |
frequency and severity of perineal trauma |
|
F |
length of labour |
|
G |
maternal satisfaction |
|
H |
urinary incontinence severity score at 3 months
postpartum |
|
I |
none of the above |
Question 3.
Which, if
any, of the following were the important conclusions of the trial?
Option list.
|
A |
C section and instrumental delivery rates were
significantly ↓ with IOL at 39/52 |
|
B |
C section rate but not instrumental delivery rate
was significantly ↓with IOL at 39/52 |
|
C |
instrumental delivery rate but not C section rate
was significantly ↓ with IOL at 39/52 |
|
D |
C section and instrumental delivery rates were
significantly ↑ with IOL at 39/52 |
|
E |
C section rate but not instrumental delivery rate
was significantly ↑
with IOL at 39/52 |
|
F |
instrumental delivery rate but not C section rate
was significantly ↑ with IOL at 39/52 |
|
G |
C section and instrumental delivery rates were
unchanged |
|
H |
IVF was cost-effective |
|
I |
IVF was not cost-effective |
|
J |
composite perinatal outcome
was better with IOL |
|
K |
composite perinatal outcome
was unchanged with IOL |
|
L |
composite perinatal outcome
was worse with IOL |
|
M |
EBL using low-dose
ergometrine versus oxytocin for the 3rd. stage was ↓↓ |
|
N |
EBL using low-dose
ergometrine versus oxytocin for the 3rd. stage was ↓↓ but with ↑↑ BP |
|
O |
frequency and severity of
perineal trauma ↑ with IOL |
|
P |
length of labour was ↑↑ with IOL |
|
Q |
maternal satisfaction was higher
with IOL |
|
R |
urinary incontinence at 3
months was reduced by IOL |
|
S |
none of the above |
6. McCune Albright syndrome.
McCune-Albright syndrome.
Abbreviations.
CPP: central precocious puberty.
MCA: McCune Albright syndrome.
PFD: polyostotic fibrous
dysplasia.
PP: precocious puberty.
Scenario 1.
Which, if any, of the following are components of the classical triad of
MCA?
Option List
|
A |
albinism |
|
B |
“cafè Cubano” spots |
|
C |
“Coast of California” pigmented areas |
|
D |
lentigo |
|
E |
macroorchidism |
|
F |
osteomalacia |
|
G |
polyostotic fibrous dysplasia |
|
H |
precocious puberty |
|
I |
premature menopause |
|
J |
primary amenorrhoea |
Scenario 2.
Which, if any, of the following are true in relation to MCA?
Option List
|
A |
it is an example of central primary amenorrhoea |
|
B |
it is an example of central secondary amenorrhoea |
|
C |
it is an example of central precocious puberty |
|
D |
it is an example of peripheral primary amenorrhoea |
|
E |
it is an example of peripheral secondary amenorrhoea |
|
F |
it is an example of peripheral precocious puberty |
|
G |
none of the above |
Scenario 3.
Which, if any, of the following are believed to be true in relation to
the abnormality of
onset of
puberty associated with MCA?
Option List
|
A |
it is due to abnormal FSH production |
|
B |
it is due to abnormal LH production |
|
C |
it may be due to abnormal androgen production |
|
D |
it may be due to abnormal oestrogen production |
|
E |
it is linked to ovarian cysts with ↑ malignant potential |
|
F |
none of the above |
Scenario 4.
Which, if any, of the following are true in relation to polyostotic fibrous dysplasia?
Option List
|
A |
polyostotic means resembling parrot bone |
|
B |
polyostotic means resembling pigeon bone |
|
C |
polyostotic means affecting long bones |
|
D |
fibrous dysplasia refers to replacement of marrow by
fibrous tissue |
|
E |
PFD is a variant of osteomalacia |
|
F |
PFD may be unilateral |
|
G |
PFD is associated with a 1% risk of malignancy |
Scenario 5.
Which, if any, of the following are true in relation to MCA?
Option List
|
A |
hyperthyroidism is common |
|
B |
hypothyroidism is common |
|
C |
thyroid function is similar to those without MCA |
Scenario 6.
Which, if any, of the following are true in relation to MCA?
Option List
|
A |
excess growth hormone production is common |
|
B |
inadequate growth hormone production is common |
|
C |
growth hormone production is similar to those without
MCA |
Scenario 7.
Which, if any, of the following is true in relation to MCA?
Option List
|
A |
inheritance is autosomal dominant |
|
B |
inheritance is autosomal recessive |
|
C |
inheritance is X-linked dominant |
|
D |
inheritance is X-linked recessive |
|
E |
inheritance is multifactorial |
|
F |
it is not a hereditary disorder |
|
G |
it is not genetic |
|
H |
none of the above |
Scenario 8.
Which, if any, of the following are true in relation to MCA?
Option List
|
A |
renal artery stenosis is more common |
|
B |
renal cortex wasting is more common |
|
C |
renal phosphate wasting is more common |
|
D |
renal waisting is more common |
|
E |
none of the above. |
Scenario 9.
Approximately what % of children born to women with MCAS will have MCAS?
Option List
|
A |
0 |
|
B |
1 in 105 - 106 |
|
C |
1 in 104 |
|
D |
1 in 100 |
|
E |
1 in 50 |
|
F |
1 in 10 |
|
G |
1 in 2 |
|
H |
All |
TOG includes MCAS in CPD
Questions for volume 14, number 2, 2012, which are open access, so reproduced
here. There are only two questions on MCAS. Note that the second includes CPP.
McCune–Albright syndrome
1. is caused by activating mutations of the GNAS1 gene. True / False
2. is characterised by polyostotic fibrous dysplasia, café-au-lait
spots and CPP. True / False
No comments:
Post a Comment