35.
Role-play. Teach audit
36.
EMQ. Vulval conditions
37.
Role-play. Cs on maternal request
38.
SBA. Bevacizumab
39.
SBA. Fragile X syndrome
35. Role-play.
Teach audit.
Candidate’s
instructions.
You are the SpR on call for the labour ward.
It is a quiet afternoon: all the patients are
healthy and in normal labour.
Dr. Jane Jones has started in the department
as a new FY1. She is keen to specialise in O&G and has already passed the
Part 1 examination.
A measure of her enthusiasm is that she has
asked her consultant if she can be involved in doing an audit, but she is aware
that she knows little about it.
Her consultant happens to be the consultant
on duty for the labour ward and has asked you to ensure that she has enough
knowledge to be a useful member of a team conducting an audit.
36. EMQ. Vulval conditions.
Abbreviations.
LP: lichen planus.
LS: lichen sclerosus.
Option
list.
|
A. |
Acne. |
|
B. |
Behçet’s syndrome. |
|
C. |
Candidiasis. |
|
D. |
CIN 3 |
|
E. |
CIN1 |
|
F. |
Crohn’s disease. |
|
G. |
Dermatitis. |
|
H. |
Eczema. |
|
I. |
Genital warts. |
|
J. |
Hidradenitis suppurativa. |
|
K. |
Leprosy. |
|
L. |
Lichen planus |
|
M. |
Lichen sclerosis |
|
N. |
Lymphogranuloma venereum |
|
O. |
Normal skin. |
|
P. |
Psoriasis. |
|
Q. |
Seborrhoeic dermatitis. |
|
R. |
Type 1 diabetes mellitus |
|
S. |
Type 2 diabetes mellitus |
|
T. |
Ulcerative colitis. |
|
U. |
VIN III. |
Scenario
1.
A 22 year-old woman attends the colposcopy clinic after 2 smears
showing minor atypia. The cervical appearances are of aceto-white with punctation.
Scenario
2.
A 60-year old woman has an erythematous rash of the vulva
extending to the inner thighs with small satellite lesions. A similar rash is
noted under the breasts. She is not known to have diabetes.
Scenario
3.
A woman attends the gynaecology clinic with a vulval rash. It has is
a “lacy” appearance.
Scenario
4.
A 35-year old woman attends is noted to have a vulval fistula. She
has a history of episodic diarrhoea.
Scenario
5.
A 25-year old woman attends the gynaecology clinic with a history
of intense vulval itching and soreness. The appearances are of diffuse erythema
with excoriation. Diabetes, candidiasis and other local infections have been
eliminated by the GP.
Scenario
6.
A 35-year old woman attends the gynaecology clinic with vulvitis.
She also has a scalp rash. Clinical examination shows scaly, pink patches with
signs of excoriation. Skin samples grow Malassezia
ovalis.
Scenario
7.
A 40-year old woman has evidence of chronic vulval ulceration. She
has recently been seen by a dermatologist for mouth ulceration and has been
started on thalidomide.
Scenario
8.
An African woman of 35 years attends the gynaecology clinic. She
has a ten-year history of chronic vulval ulceration. Examination shows
multiple, tender vulval and pubic subcutaneous nodules, some of which have
ulcerated.
Scenario
9.
A Caucasian woman of 29 years attends the gynaecology clinic with
a chronic vulval rash. Examination shows erythematous areas with clearly defined
margins and white scaly patches.
Scenario
10.
A 30-year old woman attends the gynaecology clinic with vulval
itching. Examination shows erythema of the labia minora and perineum. Full-thickness
biopsy shows abnormal cell maturation throughout the epithelium with increased
mitotic activity.
Scenario
11.
Which condition is described in GTG58 as presenting with polygonal
lesions?
Scenario
12.
Which condition is described in GTG58 as presenting with “well-demarcated,
glazed erythema around the introitus?
Scenario
13.
What is the aetiology of lichen planus?
There is no option list – just write what you think.
37. Role-play. Caesarean
section.
Candidate’s
instructions.
You
are a SpR5 in the antenatal clinic. Your consultant is feeling unwell and has
gone to lie down. The midwife has just seen a primigravid woman who has requested
Caesarean section.She is healthy, with no significant medical history and the
pregnancy has been normal. The gestation is 36 weeks, the head is engaged and
the baby seems to be of an average size. The midwife has done all the routine
investigations and has asked you to see her to discuss the request for
Caesarean section. Your task to discuss her request as you would in a normal
clinic.
38. Bevacizumab. SBA Question.
Abbreviations.
VEGF: Vascular Endothelial Growth
Factor.
Question 1.
What type of drug is bevacizumab?
Option
list.
|
A |
antibody to VEGF |
|
B |
anti-mitotic |
|
C |
apoptosis accelerant |
|
D |
platinum derivative |
|
E |
taxane |
Question 2.
How long has it been in clinical use?
Option
list.
|
A |
since 2004 |
|
B |
since 2010 |
|
C |
since 2016 |
|
D |
since 2017 |
|
E |
since 2018 |
Question 3.
Why it is causing excitement in the UK now?
Option
list.
|
A |
it has been approved by NICE as 1st. line treatment
for choriocarcinoma |
|
B |
it has been approved by NICE for all cervical cancer patients
with no contraindications |
|
C |
it has been approved by NICE for all ovarian cancer patients
with no contraindications |
|
D |
it has been approved by NICE under the Cancer Drugs Fund for
advanced cervical cancer in patients with no
contraindications |
|
E |
it has been approved by NICE under the Cancer Drugs Fund for
advanced ovarian cancer in patients with no
contraindications |
Question 4.
What adverse effects do you know of treatment
with bevacizumab? There is no option list.
Question 5.
Are there concerns about teratogenicity in
relation to bevacizumab?
Question 6.
How long should women wait after treatment with
bevacizumab before becoming pregnant?.
39. SBA. Fragile X syndrome
Abbreviations.
FXS: Fragile
X syndrome
FXTAS: Fragile
X tremor ataxia syndrome
HFEA: Human
Fertilisation and Embryology Authority
PIGD: pre-implantation
genetic diagnosis.
POI: premature
ovarian insufficiency
TR: trinucleotide
repeat
Question
1.
Which, if any, of the following are features
of FXS in males?
Option
List
|
A.
|
autism |
|
B.
|
epilepsy |
|
C.
|
hyper-extensible joints |
|
D.
|
learning difficulty |
|
E.
|
post-pubertal macroorchidism |
Question
2.
Which, if any, of the following are features
of FXS in females?
Option
List
|
A.
|
autism |
|
B.
|
epilepsy |
|
C.
|
hyper-extensible joints |
|
D.
|
learning difficulty |
|
E.
|
post-pubertal ovarian enlargement |
Question
3.
Why are women thought to be less affected by
FXS than men?
Option
List
|
A.
|
two X chromosomes dilute the
effect of an affected X chromosome |
|
B.
|
leonisation |
|
C.
|
lionisation |
|
D.
|
lyonisation |
|
E.
|
none of the above |
Question
4.
How common is FXS in males?
Option
List
|
A.
|
1 in 1,000 |
|
B.
|
1 in 4,000 |
|
C.
|
1 in 8,000 |
|
D.
|
1 in 20,000 |
|
E.
|
1 in 100.000 |
Question
5.
How common is FXS in females?
Option
List
|
A.
|
1 in 1,000 |
|
B.
|
1 in 4,000 |
|
C.
|
1 in 8,000 |
|
D.
|
1 in 20,000 |
|
E.
|
1 in 100.000 |
Question
6.
Which gene is implicated in the causation of
FXS?
Option
List
|
A.
|
fragile X mental retardation 1 |
|
B.
|
fragile X mitochondrial recognition 1 |
|
C.
|
fragile X 1 |
|
D.
|
the gene has not yet been identified |
|
E.
|
none of the above |
Question
7.
Which is the leading hereditary cause of
learning difficulty?
Option
List
|
A.
|
Down’s syndrome |
|
B.
|
fragile X syndrome |
|
C.
|
galactosaemia |
|
D.
|
homocystinuria |
|
E.
|
phenylketonuria |
Question
8.
Which is the most common genetic cause of autism?
Option
List
|
A.
|
Down’s syndrome |
|
B.
|
fragile X syndrome |
|
C.
|
galactosaemia |
|
D.
|
homocystinuria |
|
E.
|
phenylketonuria |
Question
9.
Which mode of inheritance occurs with FXS?
|
A. |
autosomal dominant |
|
B. |
autosomal
recessive |
|
C. |
X-linked
dominant |
|
D. |
X-linked
recessive |
|
E. |
none of the
above |
Question
10.
What is the story about trinucleotide repeats
and FXS. What are TRs? Which TRs are involved with FXS? How are TRs categorised
in relation to FXS?
There
is no option list – just write your Answers.
Question
11.
What is the FXS premutation? What are its key
features?
There
is no option list – just write your Answers.
Question
12.
A woman has FXS. What is her approximate risk
of POI?
Option
List
|
A.
|
0.1% |
|
B.
|
1.0% |
|
C.
|
5.0% |
|
D.
|
10% |
|
E.
|
20% |
|
F.
|
none of the above |
Question
13.
A woman is a carrier of the FX pre-mutation.
What is her approximate risk of POI?
Use the option list in the previous question.
Question
14.
A woman develops POI. What is the chance that
she has FXS?
Option
List. There is none to make you think.
Question
15.
A woman develops POI. What is the chance that
she is a carrier of the FXS premutation?
Option
List. There is none to make you think.
Question
16.
A woman develops POI. She has a 1st.
degree relative with POI. What is the chance that she has FXS?
Option
List. There is none to make you think.
Question
17.
A woman develops POI. She has a 1st.
degree relative with POI. What is the chance that she is a carrier of the FXS
premutation?
Option
List. There is none to make you think.
The following are TOG CPD questions. They are open
access, so I have produced them here. There are linked to the following
article, which is also open access.
Fragile X syndrome: an overview Bambang et al. TOG
2011. Volume 13. Issue 2
Fragile
X syndrome (FXS)
1. is the most
common cause of learning difficulty. True
/ False
2. is an
X-linked dominant disorder. True / False
With
regard to women with FXS,
3. the phenotype
is worse than in men. True
/ False
4. if they have
the full mutation, they are more likely to have a normal IQ than autistic
features.
True
/ False
With
regard to the genetics of FXS,
5. women with
100 trinucleotide repeats are at higher risk of POI than those with 60. True
/ False
6. equal
numbers of female & male carriers of the premutation are affected by FXTAS.
True
/ False
With
regard to POI and FXS,
7. up to 25% of
women with the fragile X premutation develop POI. True / False
8. measurement
of levels of anti-Müllerian hormone is a valid test for assessing risk of POI.
True
/ False
9. women with POI
have a 5-10% chance of spontaneous pregnancy. True
/ False
With
regard to testing for FXS,
10. cell-free
fetal DNA testing in maternal blood at 11 weeks is available for identifying
the fragile X premutation. True
/ False
11. cascade
screening involves testing within families of affected individuals. True
/ False
12. the HFEA
allows preimplantation genetic diagnosis of FXS. True
/ False
With
regard to fragile X tremor ataxia syndrome,
13. Parkinson’s
disease is one of the recognised differential diagnoses. True
/ False
With
regard to testing for FXS,
14. PIGD allows
distinction between the pre- and full FMR-1mutations. True
/ False
With
regard to FXS,
15. the mother and
daughters of a normal transmitting father are obligate carriers. True / False
16. women with the
syndrome are at a greater risk of developing depression compared with the general
population. True
/ False
17. where there
are larger numbers of repeat trinucleotides, there is an increased tendency for
these repeats to expansion in the offspring, causing them to have earlier onset
or more severe clinical effects. True
/ False
18. it is a
recognised cause of macro-orchidism before and after puberty. True
/ False
19. men with the
syndrome are known to have spermatozoa containing the FMR-1mutation.
True
/ False
20. in families of
women with FXS, carriers of the premutation are known to have irregular menses and
shorter cycles than non-carriers. True
/ False
