2 June 2025.
|
24 |
EMQ. Hepatitis D |
|
25 |
Viva. Topic revealed during the
tutorial |
|
26 |
EMQ. G6PDD & G6PD |
|
27 |
|
|
28 |
SBA. Yellow card reporting system |
|
29 |
SBA. Treacher-Collins syndrome |
|
30 |
EMQ. Tranexamic acid |
Abbreviations:
HBsAg: hepatitis
B surface antigen
HBsAb: antibody
to hepatitis B surface antigen
HBV: hepatitis
B virus
HCsAg: hepatitis C surface antigen
HDV: hepatitis
D virus; hepatitis delta virus
HEsAg: hepatitis
E surface antigen
Question 1.
Which, if any, of
the following statements are true in relation to HDV? This is not a true EMQ as
there may be >1 correct answer.
Option list.
|
A |
HDV is a large DNA virus |
|
B |
HDV is a defective
virus |
|
C |
HDV gains entry to
human cells via the HDV receptor |
|
D |
HDV gains entry to
human cells by donning a disguise and using the HBV receptor |
|
E |
HDV only flourishes
when HBsAb is present |
|
F |
HDV only flourishes
when HBsAg is present |
|
G |
Coi coinfection
is when HDV and another viral infection are present at the same time |
|
H |
Susu superinfection
is when HDV is present in abnormally high numbers |
|
I |
HDV infection is the
least serious of the viral hepatitides in relation to pregnancy |
|
J |
HDV treatment was revolutionised
by analysis of the benefits of drinking bleach as suggested by Donald Trump |
|
K |
the WHO
has recommended that those who follow medical advice from Donald trump should
be categorised as ‘having the DTs’. |
|
L |
HDV needs the
presence of HBsAg to be a significant pathogen |
|
M |
HDV needs the
presence of HCsAg to be a significant pathogen |
|
N |
HDV needs the
presence of HEsAg to be a significant pathogen |
|
O |
ppe pegylated interferon alpha is highly
effective as treatment |
|
P |
m mother-to-child transmission is mainly
via the placenta |
|
Q |
WHO recommends tenofovir prophylaxis
from 28 weeks in pregnancy in HDV infected women |
|
R |
the infected neonate should be given HDV
vaccine |
Scenario 25.
Viva. Topic to be announced during the tutorial; relevant for
Part 2!
Scenario 26.
G6PDD & G6PD.
Glucose-6-phosphate dehydrogenase deficiency.
Abbreviations.
G6PD: glucose-6-phosphatase
deficiency
G6PDD: glucose-6-phosphate
dehydrogenase deficiency
Question 1.
What is G6PDD?
There is no option list.
Question 2.
What categories
are applied to G6PDD by the WHO? There is no option list.
Question 3.
What other names
are commonly used for G6PDD? There is no option list.
Question 4.
Which, if any, of
the following statements are true in relation to G6PDD?
Option list.
|
A |
it is the most common enzyme defect in
humans |
|
B |
it is the most common RBC enzyme defect in
humans |
|
C |
it is the most common cause of neonatal
jaundice |
|
D |
it is the most common cause of sickling
crises |
|
E |
is a glycogen storage disorder |
|
F |
most of those with G6PDD have chronic
anaemia |
Question 5.
Approximately how
many people are affected by G6PDD worldwide?
|
A |
1,000 million |
|
B |
800 million |
|
C |
600 million |
|
D |
400 million |
|
E |
100 million |
|
F |
50 million |
|
G |
20 million |
|
H |
10 million |
|
I |
none of the above |
Question 6.
Which population
has the highest prevalence of G6PDD?
|
A |
American Amish |
|
B |
Asians |
|
C |
Ashkenazi Jews |
|
D |
Eskimos |
|
E |
Irish Travellers |
|
F |
Kurdistan Jews |
|
G |
Sub-Saharan Africans |
|
H |
Turks |
|
I |
Uzbekistan albinos |
|
J |
None of the above |
Question
7.
Which, if any, of
the following is the mode of inheritance of G6PDD?
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Question
8.
Which, if any, of
the following is the mode of inheritance of G6PD?
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
mitochondrial
pattern |
|
D |
X-linked
dominant |
|
E |
X-linked
recessive |
|
F |
Y-linked |
Question
9.
Approximately how
many mutations of the G6PDD gene have been identified?
Question 10. Which foodstuff can trigger haemolysis in G6PDD and gives
us one of the alternative
names for the
condition? What is the common name for the foodstuff? Which pest particularly
attacks it? There is no option list.
Question 11. Which, if any, of the following drugs may cause haemolysis
in those with G6PDD?
|
A |
aspirin |
|
B |
diphenhydramine |
|
C |
nalidixic acid |
|
D |
nitrofurantoin |
|
E |
paracetamol |
|
F |
phenytoin |
|
G |
sulphamethoxazole |
|
H |
trimethoprim |
Scenario 27.
Quinolone antibiotics.
Abbreviations.
FQ: fluoroquinolone.
SLE: systemic lupus
erythematosus.
QUI: quinolone.
Question 1. Which,
if any, of the following drugs are QUIs or FQs?
|
A |
cimetidine |
|
B |
ciprofloxacin |
|
C |
nalidixic acid |
|
D |
neomycin |
|
E |
nitrofurantoin |
Question 2. Which,
if any, of the following statements are true in relation to QUIs & FQs?
|
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?
|
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?
|
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.
|
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.
|
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?
|
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?
|
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?
|
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?
|
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?
|
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.
|
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 |
Question 13. What
appeared on the 3rd. page of the BMJ of the 24th.
February 2024 about fluoroquinolone drugs? This is an SBA with only one correct answer.
|
A |
a summary
of MHRA’s advice of January 2024 |
|
B |
a summary
of the CDC’s advice of January 2024 |
|
C |
warning
that FQS and QUIS are now banned |
|
D |
news flash
re BIA President requesting better advice |
|
E |
news flash
re King Charles receiving treatment with a FQ |
Scenario 28.
Yellow card reporting system.
Abbreviations.
BNF: British National Formulary.
MHRA: Medicines
& Healthcare products Regulatory Agency.
YCRS: Yellow Card Reporting System.
Scenario 1. What is the purpose of the YCRS?
|
A |
to report suspected side-effects of air
pollution |
|
B |
to report suspected side-effects of alcohol |
|
C |
to report suspected side-effects of
e-cigarettes |
|
D |
to report suspected side-effects of
medical device use |
|
E |
to report defective or fake medical
products |
|
F |
to report sellers of defective or fake
medical products |
|
G |
none of the above. |
Scenario 2. Which organisation runs the YCRS?
|
A |
British National Formulary |
|
B |
Metropolitan Police |
|
C |
MHRA |
|
D |
NHS |
|
E |
NICE |
|
F |
Royal College of Medicine |
|
G |
none of the above |
Scenario 3. How does one report an issue using the YCRS?
|
A |
completing a form from the BNF and posting
it to ‘FREEPOST YELLOW CARD’ |
|
B |
completing a form from the BNF and posting
it to ‘Metropolitan Police’ |
|
C |
completing a form from the BNF and posting
it to ‘FREEPOST MHRA’ |
|
D |
completing a form from the BNF and posting
it to ‘FREEPOST NHS’ |
|
E |
completing a form from the BNF and posting
it to ‘FREEPOST ’NICE’ |
|
F |
completing a form from the BNF and posting
it to ‘FREEPOST ’Royal College of Medicine’ |
|
G |
on-line at https://yellowcard.mhra.gov.uk/ |
|
H |
none of the above |
Scenario 29.
Treacher-Collins syndrome.
MCQ Paper 13.
Question 18. Answer “False” or “True”. This
was written in the previous millenium!
18. Treacher
Collins Syndrome
a. is an X-linked recessive disorder
b. is an autosomal recessive disorder
c. is associated with severe mental
retardation
d. has a characteristic facial appearance
e. is associated with deafness.
Question 1. The correct spelling of the name of the syndrome
should be?
|
A |
Teacher Collins |
|
B |
Treacher Collins |
|
C |
Treacher-CollinsFranceschetti |
|
D |
Teacher Collins |
|
E |
Treacher-Collins |
|
F |
Treacher-Collins-Franceschetti |
|
G |
none of the above |
Question 2. What is the prevalence?
|
A |
1 in 1,000 |
|
B |
1 in 10,000 |
|
C |
1 in 25,000 |
|
D |
1 in 50,000 |
|
E |
1 in 100,000 |
|
F |
none of the above |
Question 3. Which, if any, of the following is correct re
the gene most commonly involved?
|
A |
it is TCF1 |
|
B |
it is TCOF1 |
|
C |
it is TCF2 |
|
D |
it is TCOF2 |
|
E |
it is TREACLE 1 |
|
F |
it is TREACLE 2 |
|
G |
the condition is not genetic |
Question 4. What is the main mode of inheritance?
|
A |
autosomal dominant |
|
B |
autosomal recessive |
|
C |
X-linked dominant |
|
D |
X-linked recessive |
|
E |
none of the above: it is not a hereditary
condition |
Question 5. Which, if any, of the following are common
features?
|
A |
anomalies of the inner ears |
|
B |
anomalies of the outer ears |
|
C |
autism |
|
D |
downward-slanting palpebral fissures |
|
E |
eyelid coloboma |
|
F |
hypoplasia of the mandible |
|
G |
hypoplasia of the zygoma |
|
H |
learning difficulty |
|
I |
microcephaly |
|
J |
micrognathia |
|
K |
neural tube defect |
|
L |
retinal detachment |
Scenario 30.
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.
Question
12.
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.
|
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 |
Question
13.
Which, if any, of
the following statements are true?
|
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 |
Question
14.
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.
|
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. |
Question
15.
Which, if any, of
the following statements are listed by eMC as contraindications?
|
A |
asthma |
|
B |
barbiturate use |
|
C |
consumption coagulopathy |
|
D |
convulsions |
|
E |
severe renal impairment |
Question
16.
Which, if any, of
the following is included in the definition of PPH in WHOT?
|
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 |
Question
17.
What other
category of patient is included in the WHOT definition of PPP?
Option list. There is none, to make you think.
Question
18.
Which of the
following are included in the WHOT recommendations?
|
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 |
Question
19.
Which, if any, of
the following are included in WHOT?
|
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 |
Question
20.
Which, if any, of
the following statements is included WHOT?
|
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 |
Question 21.
Which, if any, of
the following statements are included in WHOT?
|
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. |
Question
22.
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 |
Question 23.
Which, if any, of
the following statements are true of GTG52?
|
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. |
Question 24.
Which paper in the
NEJM in 2023 was a bit of a spanner in the works?
Question 25.
What were the key
findings in the paper?
