DOI: 10.1111/tog.

12925 2024;26:102–4
The Obstetrician & Gynaecologist
CPD
http://onlinetog.org

CPD and SBA questions for volume 26 issue 2

CPD credits can be claimed for the following questions Sarcoidosis in pregnancy increases the risk of,
online via the TOG CPD submission system in the RCOG
11. miscarriage. ThFh
CPD ePortfolio. You must be a registered CPD participant of
12. pre-eclampsia. ThFh
the RCOG CPD programme (available in the UK and
13. venous thromboembolism. ThFh
worldwide) in order to submit your answers.
14. fetal growth restriction. ThFh
Completion of TOG T/F and SBA questions can be
15. pregnancy-induced hypertension. ThFh
claimed as a Specific Learning Event. Participants can claim
two credits per set of questions if at least 70% of questions In managing pregnancies complicated by sarcoidosis,
have been answered correctly. CPD participants are advised
to consider whether the articles are still relevant for their 16. pulmonary function tests provide a
CPD, in particular if there are more recent articles on the measure of disease activity. ThFh
same topic available and if clinical guidelines have been 17. 24-hour Holter monitor is indicated in
updated since publication. those with symptomatic palpitations. ThFh
Please direct all questions or problems to the CPD Office. 18. azathioprine is associated with increased
Tel: +44 (0)20 7772 6307 or email: cpd@rcog.org.uk. risk of fetal structural differences. ThFh
The blue symbol denotes which source the questions refer to 19. caesarean section is advisable. ThFh
including the RCOG journals, TOG and BJOG, and RCOG 20. intrapartum oxygen has been shown to benefit
guidance, such as Green-top Guidelines (GTGs) and Scientific those with pulmonary disease. ThFh
Impact Papers (SIPs). All of the above sources are available to
RCOG Members and Fellows via the RCOG website. Single best answer (SBA) questions:

1. A 34 year old with sarcoidosis and on methotrexate

TOG Sarcoidosis in pregnancy attends having missed a period. A urine pregnancy
With regard to sarcoidosis, test is positive.
1. the peak age of incidence is between What would be the advice to give this woman?
20-40 years old. ThFh
A. Stop methotrexate and commence
2. up to one in five of those with pulmonary
on folic acid 400 mcg/day until 12 weeks ThFh
disease have progressive parenchyma fibrosis. ThFh
B. Stop methotrexate and commence on
3. cardiac involvement is the most common
folic acid 5 mg/day until 12 weeks ThFh
presentation. ThFh
C. Stop methotrexate and commence on
4. most case are symptomatic. ThFh
folic acid 400 mcg/day until 12 weeks
The diagnosis of sarcoidosis, and aspirin from 12 weeks ThFh
5. is predominantly one of exclusion. ThFh D. Stop methotrexate and commence on
6. in pregnancy, requires the measurement folic acid 5 mg/day until 12 weeks
of serum angiotensin converting enzyme and aspirin from 12 weeks ThFh
(ACE) levels. ThFh E. Stop methotrexate and commence on folic
acid, vitamin D and calcium now and aspirin
In pregnancy, sarcoidosis, from 12 weeks ThFh
7. with severe interstitial lung disease is
2. What would be the indication for offering a patient with
associated with increased maternal mortality. ThFh
sarcoidosis an elective caesarean section?
8. affects the heart in up to 40% of patients. ThFh
9. increases the risk of implantable A. Associated raised intracranial pressure ThFh
cardiac defibrillator discharges. ThFh B. interstitial lung disease (ILD) ThFh
10. is commonly associated with a postnatal flare. ThFh C. Cardiac disease ThFh

102 ª 2024 Royal College of Obstetricians and Gynaecologists.

 17444667, 2024, 2, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12925, Wiley Online Library on [17/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
CPD

D. Cardiac disease with an implantable cardia 19. higher rates of anaemia have been reported. ThFh
defibrillator ThFh 20. admission to the post anaesthesia care unit
E. Pulmonary hypertension ThFh (PACU) or intensive care unit (ICU) is
usually required. ThFh
TOG Hyperthermic intraperitoneal
Single best answer (SBA) questions:
chemotherapy (HIPEC) in the management
of ovarian cancer 1. When is it best to administer hyperthermic
intraperitoneal chemotherapy in women with ovarian
Regarding hyperthermic intraperitoneal
cancer undergoing interval cytoreductive surgery?
chemotherapy (HIPEC),
A. Prior to the commencement of neoadjuvant
1. following the therapy, the drug concentration therapy ThFh
at the peritoneal surface is lower than that B. After completing the 6th cycle of neoadjuvant
in plasma. ThFh therapy ThFh
2. an advantage is that chemotherapy is C. Before the start of cytoreductive surgery ThFh
delivered intraperitoneally before the D. After 3/4 cycles of neoadjuvant
formation of adhesions. ThFh chemotherapy ThFh
3. heating reduces the cytotoxic effect of E. 6 weeks after cytoreductive surgery ThFh
chemotherapy. ThFh
4. most of the evidence for this comes from 2. Approximately how long will HIPEC add to
its use in primary surgery. ThFh theatre time?
5. an age limit of up to 70-75 years has been A. 30 minutes ThFh
recommended. ThFh B. 60 minutes ThFh
C. 90 minutes ThFh
Heating at the time of HIPEC,
D. 120 minutes ThFh
6. enhances penetration of chemotherapy at E. 150 minutes ThFh
the peritoneal surface. ThFh
3. Sodium thiosulphate is administered during HIPEC to
7. induces activation of the systemic immune
prevent which complication?
response. ThFh
8. increases sensitivity of cancer to A. Bone marrow suppression ThFh
chemotherapy. ThFh B. Bowel injury ThFh
9. decreases the formation of adhesions. ThFh C. Hepatotoxicity ThFh
D. Nephrotoxicity ThFh
In the pre-operative assessment of patients for HIPEC, E. Neurotoxicity ThFh
contraindications to consider include,
10. WCC of <3.5 x 109/l. ThFh TOG Heavy menstrual bleeding in adolescence:
11. creatinine clearance of >60 ml/min. ThFh who to investigate and how to manage it
12. stage II ovarian cancer. ThFh
13. platelets of >100x109/L. ThFh Regarding adolescent menstrual cycles,
1. the mean age at menarche in the UK is 14 years. T h F h
HIPEC administration,
2. the average length is 21–45 days. ThFh
14. increases the theatre time for cytoreductive
3. HPO axis immaturity is one of the most
surgery by about 2 hours. ThFh
common causes of heavy menstrual bleeding
15. requires that urine output is maintained at
(HMB) in adolescents. ThFh
>2 ml/kg/hr from the start to 6 hours
Regarding the clinical assessment and investigations for
post-operatively. ThFh
HMB in adolescents,
16. associated liver toxicity can be reduced by
the administration of sodium thiosulphate. ThFh 4. first-line investigations include full blood
count, ferritin and a coagulation screen. ThFh
During the post-operative period after cytoreductive 5. a timed hormone profile is required to
surgery combined with HIPEC, diagnose HMB secondary to HPO axis
17. enhanced recovery is advocated. ThFh immaturity. ThFh
18. fluid balance should be assessed carefully 6. low vaginal swabs are routinely indicated
for the first 3 days. ThFh in those presenting with HMB. ThFh

ª 2024 Royal College of Obstetricians and Gynaecologists. 103


CPD
Regarding pathological causes of HMB,
7. von Willebrand disease is prevalent in
approximately one-third of cases. ThFh
8. thrombocytopenia is the predominant
cause in child-onset SLE. ThFh
9. antipsychotic medications may improve
symptoms through reducing
hyperandrogenism. ThFh
10. carbamazepine reduces the efficacy of CHC. ThFh
Regarding treatment of HMB in adolescents,
11. tranexamic acid 500–1000 mg TDS is
first-line therapy for the idiopathic type. ThFh
12. breakthrough bleeding can be addressed
by switching CHC to a higher
progesterone containing preparation. ThFh
13. there is sufficient evident to support the use of
the combined hormonal ring over CHC pill. T h F h
14. desogestrel 75 mcg is associated with high
rates of amenorrhoea by 12 months’ use. ThFh
15. long-term norethisterone use is contraindicated
in those at increased risk of venous
thromboembolism. ThFh
16. the LNG-IUS significantly reduces HMB
compared with COCP. ThFh
17. those who are 16 years old who are deemed
to have capacity are able to consent to surgical
treatment on an adult consent form 1. ThFh
Regarding acute heavy menstrual bleeding,
18. oral progestogens, e.g. medroxyprogesterone
acetate, are typically first line. ThFh
104
17444667, 2024, 2, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12925, Wiley Online Library on [17/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
19. high-dose CHC is superior to standard dosing
CHC in acute HMB. ThFh
20. admission is indicated if Hb is <85g/dl. ThFh
Single best answer (SBA) questions:
1. What is considered heavy menstrual bleeding (HMB) by
the National Institute for Health and Care Excellence?
A. Menstrual loss where sanitary products are
changed 3–4 hours ThFh
B. Menstrual loss where sanitary products are
changed more than four times per day ThFh
C. Menstrual loss that is associated with
symptoms of excessive blood loss ThFh
D. Menstrual loss that lasts more than 5 days ThFh
E. Menstrual loss that last more than 7 days ThFh
2. A 14-year-old presents with heavy menstrual bleeding,
which she has had since attaining menarche at the age of
13 years. Her periods, which are irregular, last for 7–
8 days. What would be the treatment of first choice for
this patient?
A. A combined hormonal contraceptive pill ThFh
B. Cyclical progestogen e.g.
desogestrel 75 mcg ThFh
C. Non-steroidal anti-inflammatory
agent (e.g. ibuprofen) ThFh
D. The levonorgestrel intrauterine system
(Mirena) ThFh
E. Tranexamic acid ThFh
ª 2024 Royal College of Obstetricians and Gynaecologists.