Contact us.
There was no tutorial. These are the topics we would have covered.
Don't waste time researching. Just write the answers using what you already know.
I'll try to ensure all the necessary facts are in my answers.
21
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EMQ. Cervical smear management
& referral.
|
14
|
August
|
2014
|
22
|
EMQ. Antepartum haemorrhage.
|
14
|
August
|
2014
|
23
|
EMQ. Ca Cx staging.
|
14
|
August
|
2014
|
24
|
EMQ. Drugs in O&G 1.
|
14
|
August
|
2014
|
71
|
With regard to the Human Fertilisation
and Embryology Act:
1. When was the latest update of the Act and what were the key
amendments . 4 marks
2. With regard to the body that oversees the implementation of the
Act:
What is it
called? 1 mark
What kind of body
is it? 1 mark
3. What are the main functions of the body that oversees
implementation of the Act? 14 marks
|
14
|
August
|
2014
|
72
|
There has been a recent spate of requests
for Caesarean section with no medical grounds. The
Clinical Director has asked you to produce a provisional policy document on
the subject for discussion at a Unit meeting with a view to formulating Unit
policy.
|
14
|
August
|
2014
|
73
|
With regard to vulval cancer.
1. critically evaluate screening.
2 marks.
2. outline the FIGO staging system. 6
marks.
3. critically evaluate the modern approach to management.
12 marks
|
14
|
August
|
2014
|
74
|
With regard to UKOSS.
1. What is UKOSS? 2 marks
2. Who is responsible for UKOSS and how does it work?
4 marks
3. Critically evaluate the work of UKOSS. 14 marks
|
14
|
August
|
2014
|
Cervical smear management
& referral.
Lead-in.
There
are too many scenarios and the option list is too long. And some of the
“scenarios” are really MCQs. Don’t tell me – I know! I have tried to think of
all the questions that could arise. At some point I’ll chop it into several
bits to make the option list more sensible. A smaller option list would also
allow me to introduce more “tempters” that sound as though they should be the
correct answer.
The
following scenarios relate to the management of cervical smears.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
ALOs: actinomyces-like organisms
BSCCP British Society for Colposcopy and
Cervical Pathology. http://www.bsccp.org.uk/
CIN: cervical intraepithelial
abnormality
CGIN: cervical glandular intraepithelial
abnormality
FSRH: Faculty of Sexual and Reproductive
Health: http://www.fsrh.org/
GUM
clinic: genito-urinary medicine clinic
LBC: liquid-based cytology
LLETZ: large loop excision of the
transformation zone
NEC: normal endometrial cell
NHSCSP: NHS Cervical Screening Programme: http://www.cancerscreening.nhs.uk/cervical/
POP: progesterone-only Pill
TZ: transformation zone
Option list.
a.
repeat the test
b.
repeat the test after 6 months
c.
repeat the test at 6 and 12 months
d.
repeat the test at 6 and 12 months and then
annually until she has had 10 years’ follow-up followed by repeat tests at the
normal intervals for her age
e.
repeat the test after 3 or 5 years according to
her age as per routine follow-up
f.
repeat the test after HPV testing
g.
repeat the test after giving an appropriate
antibiotic
h.
repeat the test after removing her IUCD.
i.
repeat the test after removing the IUCD and
giving an appropriate antibiotic
j.
repeat the test after treating the TZ with
diathermy
k.
repeat the test after treating the TZ with
cryocautery
l.
discharge from follow-up
m. refer for colposcopy
n.
refer for colposcopy within 2 weeks
o.
refer for colposcopy within 8 weeks
p.
refer for colposcopy within 12 weeks
q.
refer for colposcopy only if she has other
significant signs or symptoms
r.
refer for cone biopsy
s.
refer for fractional curettage
t.
refer for “see and treat” LLETZ
u.
refer to GUM clinic
v.
recommend that she go back to America
w. there is insufficient information to formulate a management plan
x.
false
y.
true
z.
none of the above
Scenario 1.
A woman with no previous abnormal smears has a routine smear
showing an inadequate sample . What management will you suggest?
Scenario 2.
A woman with no previous abnormal smears has had a smear showing
borderline nuclear changes. What
management will you suggest?
Scenario 3.
A woman with no previous abnormal smears has had a smear showing
borderline nuclear changes. Cervical ectopy is noted. What management will you suggest?
Scenario 4.
A woman with no previous abnormal smears has had a smear showing
borderline cells of endocervical origin. What management will you suggest?
Scenario 5.
A woman with no previous abnormal smears has had a smear showing
inflammatory changes. What management
will you suggest?
Scenario 6.
A woman with no previous abnormal smears has had a smear
showing inflammatory changes and ALOs.
What management will you suggest?
Scenario 7.
A woman with no previous abnormal smears has had a smear
showing inflammatory changes. She takes
the COC for contraception. What management will you suggest?
Scenario 8.
A woman with no previous abnormal smears has had a smear
showing inflammatory changes. She has a
copper IUCD. What management will you suggest?
Scenario 9.
A woman with no previous abnormal smears has had a smear
showing inflammatory changes and ALOs.
She has had hysteroscopic sterilisation with ESSURE. What management will you
suggest?
Scenario 10
A woman with no previous abnormal smears has had a smear showing
borderline changes. A repeat smear after 6 months is normal. A repeat smear
after 3 years shows inflammatory changes. A repeat smear after 6 months is
normal. A repeat smear after 3 years shows borderline changes. What management
will you suggest?
Scenario 11
A woman with no previous abnormal smears has had a smear showing
mild dyskaryosis of squamous cells. What management will you suggest?
Scenario 12
A woman with no previous abnormal smears has had a smear showing
moderate dyskaryosis of squamous cells. What management will you suggest?
Scenario 13
A woman with no previous abnormal smears has had a smear showing
severe dyskaryosis of squamous cells. What management will you suggest?
Scenario 14
A woman with no previous abnormal smears has had a smear
suggestive invasive disease. What management will you suggest?
Scenario 15
A woman with no previous abnormal smears has had a smear showing
borderline nuclear changes in glandular cells. What management will you
suggest?
Scenario 16
A woman with no previous abnormal smears has had a smear showing ?
glandular neoplasia. What management will you suggest?
Scenario 17.
A
woman with no previous abnormal smears has had a smear showing normal endometrial cells. What management will you suggest?
Scenario 18.
A
woman with no previous abnormal smears has had a smear showing atypical endometrial cells. What management will you suggest?
Scenario 19
A woman with no previous abnormal smears has had a smear with a
normal result. Clinical examination was normal, but contact bleeding was noted
when the smear was taken. What management will you suggest?
Scenario 20
An American woman with no previous abnormal smears has been used
to having annual smears. She has had a smear with a normal result and requests
a repeat in 12 months. What management will you suggest?
Scenario 21
A woman with no previous abnormal smears is on renal dialysis and
has had a smear with a normal result. What management will you suggest?
Scenario 22
A HIV +ve woman with no previous abnormal smears has had a smear with
a normal result. What management will you suggest?
Scenario 23
A woman with no previous abnormal smears has had a smear with a
normal result. She smokes 20 cigarettes daily and has a long history of
recurrent genital warts. What management will you suggest?
Scenario 24.
A woman of 70 presents with postmenopausal bleeding. She had
smears at the recommended intervals from the age of 22. All were normal. The
last was taken at the age of 64. What is your management in relation to taking
a smear?
Scenario 25.
A woman of 55 presents with hot flushes since her periods stopped
at the age of 54. She wishes to go on HRT and there are no contraindications.
She had smears at the recommended intervals from the age of 25. All were
normal. The last was taken two years ago. What is your management in relation
to taking a smear?
Scenario 26.
Women
who have been treated for CIN are 2 – 5 times more likely to develop cancer
than women who have not been treated. True or false?
Scenario 27.
Scenario 27.
More
than 50% of women who develop cervical cancer have been lost to follow-up. True
or false?
Scenario 28.
Which
of the following statements are true and which false?
a. cone biopsy is linked to ↓risk of recurrence
compared to LLETZ.
b. excision margins that are not CIN-free ↑ the
risk of recurrence, with endocervical margins that are not CIN-free posing a
greater risk that similar ectocervical margins.
c. age > 35 years increases the risk of
recurrent disease.
d. follow-up after treatment for CIN should start
between 3 & 6 months from the time of treatment.
e. the initial examination should be with
colposcopy plus cytology.
f. a failure to achieve negative results in the
year after treatment means colposcopy should be done.
g. a required standard for treatment success is
that ≥ 90% of women should have no evidence of dyskaryosis in the year after
treatment.
h. a required standard for treatment success is
that there should be ≤ 5% of histologically-confirmed treatment failures by 1
year after treatment.
Scenario 29
Women
who have had normal follow-up results for 2 years after treatment of CIN 1 can
revert to the routine recall.
Scenario 30.
Follow-up
should continue with increased frequency for 5 years after treatment of CIN 2
& 3, after which recall at routine intervals is OK if all the follow-up has
been normal. True or false?
Scenario 31.
A woman with LLETZ for CIN3 twelve months ago had a normal smear 6
months later. A smear taken 12 months
after treatment is also normal. What management will you suggest?
Scenario 32.
A woman with LLETZ for CIN3 twelve months ago had a normal smear 6
months later. A smear taken 12 months
after treatment shows mild dyskaryosis. What management will you suggest?
Scenario 33.
A woman on normal recall has hysterectomy for menorrhagia. There
is no evidence of CIN on histology. What follow-up would you recommend?
Scenario 34.
A woman who was not on normal recall has hysterectomy for
menorrhagia. There is no evidence of CIN on histology. What follow-up would you
recommend?
Scenario 35.
Women who have had hysterectomy and require follow-up with vault
smears cannot be managed within the NHSCSP. True or False?
Scenario 36.
A woman who was not on normal recall has hysterectomy for
menorrhagia. There is evidence of completely excised CIN3 on histology. What
follow-up would you recommend?
Scenario 37.
A woman who was not on normal recall has hysterectomy for
menorrhagia. There is evidence of incompletely excised CIN3 on histology. What
follow-up would you recommend?
Scenario 38.
A
woman has conservative treatment for early stage cancer of the cervix. What
follow-up should be recommended?
Scenario 39.
A
woman is referred with severe dyskaryosis, but colposcopy is normal. What
follow-up should be recommended?
Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ART: assisted
reproduction technology
FGR: fetal
growth restriction
PET: pre-eclampsia
Option list.
genital tract bleeding ≥ 500 ml. from 24 weeks until the
delivery of the baby
genital tract bleeding ≥ 500 ml. from 24 weeks until the
delivery of the placenta.
genital tract bleeding ≥ 500 ml. from 24 weeks, or
earlier if the baby is live-born, until the delivery of the baby.
1
2
3
4
5
6
7
8
9
10
15
20
30
50
100
500
1,000
true
false
none of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml.
for minor APH
Scenario 3.
What is the upper limit in ml.
of major haemorrhage
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor
for placental abruption.
Scenario 7
List 10 risk factors for
placental abruption.
Scenario 8
List 6 risk factors for
placenta previa.
Scenario 9
In what % of pregnancies does APH
occur?
Scenario 10
With regards to steps that can be taken to reduce the
incidence of APH, what things would you include in an essay?
EMQ Ca Cx staging.
Lead-in.
The
following scenarios relate to cervical cancer staging.
For
each, select the most appropriate staging.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Scenario 1.
A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 2 mm and 6 mm in width. The
resection margins are tumour-free. There is no evidence of spread outside the
uterus. She is nulliparous and wishes to retain her fertility.
Scenario 2.
A
woman of 25 has a cone biopsy. The histology report shows squamous cell
carcinoma penetrating to a depth of 5 mm and 6 mm in width. The resection
margins are tumour-free. There is no evidence of spread outside the uterus. She
is nulliparous and wishes to retain her fertility.
Scenario 3.
A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The
resection margins are not tumour-free. There is no evidence of spread outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 4.
A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 6 mm and 3 cm in width. The
resection margins are tumour-free. There is no evidence of extension outside
the uterus. She is nulliparous and wishes to retain her fertility.
Scenario 5.
A woman of 25 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 6 mm and 5 cm in width. The
resection margins are tumour-free. She is nulliparous and wishes to retain her
fertility.
Scenario 6.
A woman of 38 has a cone biopsy. The histology report shows
squamous cell carcinoma penetrating to a depth of 4 mm and 6mm in width. The
resection margins are tumour-free. An MR scan shows involvement of the
lymphatic nodes in the left of the pelvis.
Scenario 7.
A woman of 45 has carcinoma of the cervix. It extends into the
parametrium, but not to the pelvic side-wall. It involves the upper 1/3 of the
vagina. There is MR evidence of para-aortic node involvement.
Scenario 8.
A woman of 55 has carcinoma of the cervix. It extends to the
pelvic side-wall. It involves the upper 1/3 of the vagina. She has a secondary
on the end of her nose.
Scenario 9.
A woman of 55 has carcinoma of the cervix. It involves the bladder
mucosa.
Scenario 10.
A woman of 35 has a proven cancer of the cervix with extension
into the right parametrium, but not to the pelvic side-wall. Left hydroureter
and left non-functioning kidney are noted on IVP and there is no other
explanation for the findings. Cystoscopy shows bullous oedema of the bladder
mucosa.
Scenario 11.
A woman of 25 has a cone biopsy. It shows malignant melanoma. The
lesion invades to a depth of 3 mm and is 5 mm in width. The margins of the
biopsy are clear. There is evidence of lymphatic vessel involvement. There is
no evidence of spread outside the uterus.
Option list.
Micro-invasive
cervical cancer.
Stage
Ia1
Stage
Ia2
Stage
Ia3
Stage
Ib1
Stage
Ib2
Stage
Ib3
Stage
IIa
Stage
IIb
Stage
IIc
Stage
IIIa
Stage
IIIb
Stage
IIIc
Stage
IVa
Stage
IVb
Stage
IVc
Stage
Va
Stage
Vb
Stage
Vc
None
of the above.
This
question illustrates the problems surrounding staging. If you are not a cancer
specialist, it is not something that you think about very often, if ever. So
you have to put it into your list of things to revise in the days before the
exam.
Lead-in.
The
following scenarios relate to drugs & hypertension in pregnancy.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Abbreviations.
ACE: angiotensin-converting
enzyme.
ACEI: angiotensin-converting enzyme
inhibitor.
ARA: angiotensin II receptor
antagonist.
CNP: Handbook
of Obstetric Medicine. 4th. Edition. Catherine Nelson-Piercy.
Informa. 2010
Dewhurst: Dewhurst’s Textbook of O&G. Edmonds. 8th. Edition. 2012. Wiley-Blackwell
DDPL: Drugs
during pregnancy and lactation. Schaeffer et al. 2nd. Edition.
2007. Academic Press.
GCE: German Commission E
L&B: Obstetrics and Gynaecology: An Evidence-Based
Text for MRCOG (2nd edition). Luesley & Baker. 2010.
MAOI: monoaminoxidase inhibitor.
SAC16: Vitamin Supplementation in Pregnancy.
Scientific Advisory Committee.
Opinion Paper 16. 2009
Option list.
a)
False.
b)
True.
c)
5
d)
10
e)
15
f)
18
g)
20
h)
24
i)
contraindicated in the months before pregnancy
j)
contraindicated in the 1st. trimester
k)
contraindicated in the 2nd. trimester
l)
contraindicated in the 3rd. trimester
m) contraindicated in all trimesters
n)
not contraindicated in pregnancy
o)
contraindicated in breastfeeding
p)
not contraindicated in breastfeeding
q)
an acute, severe illness like rheumatoid
arthritis
r)
an acute, severe illness with encephalopathy and
acute fatty liver
s)
an acute, severe illness with gastro-intestinal
tract bleeding.
Scenario 1.
When are ACE inhibitors contraindicated in pregnancy?
Scenario 2.
When are ARAs contraindicated in pregnancy?
Scenario 3.
Can St. John’s Wort (SJW) be used in pregnancy?
Scenario 4.
Methyl dopa is an acceptable option for the treatment of
gestational hypertension. True / False.
Scenario 5.
Spironolactone is contraindicated in pregnancy. True/False
Scenario 6.
Furosemide is an acceptable option in the management of
gestational hypertension. True / False.
Scenario 7.
When are thiazide diuretics contraindicated in pregnancy?
Scenario 8.
Salbutamol is contraindicated for the management of premature
labour. True / False.
Scenario 9.
Ergometrine is an integral part of active management of the 3rd.
stage. True / False.
Scenario 10.
When is aspirin contraindicated in pregnancy & the puerperium?
Scenario 11.
When are NSAID’s contraindicated in pregnancy and why?
Scenario 12.
Pethidine: adverse
neonatal effects are most likely if the drug is administered in the six hours
before birth. True / False.
Scenario 13.
Pethidine: what is the
half-life in the mature neonate?
Scenario 14.
Pethidine: is contraindicated in those taking MOAIs
or who have taken them in the previous 2 months.
Scenario 15.
Pethidine: is relatively contra-indicated when there is significant
blood loss.
Scenario 16.
Pethidine:
has
greater analgesic effect in labour than Diamorphine.
Scenario 17.
What is Reye’s syndrome?
