Thursday, 11 February 2016

Tutorial 11th. February 2016


11 February 2016.

57
SBA. Androgen insensitivity syndrome
58
SBA. Coeliac disease in pregnancy
59
SBA. Fetal origins of adult disease
60
SBA. Influenza & pregnancy
61
SBA. Instrumental delivery

57.   SBA. Androgen insensitivity syndrome.
Abbreviations.
AIS:             androgen insensitivity syndrome

Question 1.
Lead-in
What is the estimated prevalence of AIS?
Option List
A.       
2-5 per 100,000 boys at birth
B.       
5-10 per 100,000 girls at birth
C.       
2-5 per 100,000 genetic males at birth
D.       
5-10 per 100,000 genetic females at birth
E.        
none of the above.

Question 2.
Lead-in
Which of the following sub-types of AIS do not exist?
Sub-types
1.        
complete AIS
2.        
incomplete AIS
3.        
mild AIS
4.        
partial AIS
5.        
total AIS
Option List
A.       
1
B.       
2
C.       
3
D.       
4
E.        
5
F.        
1 + 3
G.       
2 + 3
H.       
2 + 5
I.         
3 + 5
J.         
4 + 5

Question 3.
Lead-in
How common is partial AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than mild AIS
D.       
as common as incomplete AIS
E.        
none of the above.

Question 4.
Lead-in
How common is incomplete AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than mild AIS
D.       
as common as partial AIS
E.        
none of the above.

Question 5.
Lead-in
How common is mild AIS?
Option List
A.       
at least as common as complete AIS
B.       
at least as common as total AIS
C.       
less common than complete AIS
D.       
as common as partial AIS
E.        
none of the above.

Question 6.
Lead-in
No more prevalence!!
What is the mode of inheritance of AIS?
Option List
A.       
autosomal dominant
B.       
autosomal recessive
C.       
X-linked dominant
D.       
X-linked recessive
E.        
mitochondrial

Question 7.
Lead-in
What proportion of AIS is due to new mutations?
Option List
A.       
0%
B.       
1 – 20%
C.       
21 – 40%
D.       
41-60%
E.        
61-80%

Question 8.
Lead-in
Which gene is involved in AIS?
Option List
A.       
androgen receptor gene
B.       
aromatase receptor gene
C.       
androstenedione gene
D.       
oestrogen receptor gene
E.        
none of the above

Question 9.
Lead-in
How many mutations have been described of the gene which is involved in AIS?
Option List
A.       
0-10
B.       
11-100
C.       
101-200
D.       
201-300
E.        
>300

Question 10.
Lead-in
Which is the most common clinical presentation in AIS?
Option List
A.       
ambiguous genitalia
B.       
precocious puberty
C.       
premature menopause
D.       
primary amenorrhoea
E.        
secondary amenorrhoea

Question 11.
Lead-in
Which of the following are more common in AIS?
Option List
A.       
anlagen
B.       
coarctation of the aorta
C.       
“coast of Maine” pigmentation pattern
D.       
renal tract anomalies
E.        
none of the above.

Question 12.
Lead-in
A woman of 20 is found to have AIS. She has a pre-pubertal sister. What is the chance that the sister also has AIS, assuming that the condition is not due to a new mutation in the elder sister?
Option List
A.       
1 in 1
B.       
1 in 2
C.       
1 in 4
D.       
1 in 8
E.        
1 in 16

Question 13.
Lead-in
What is the risk of the gonads becoming malignant in AIS?
Option List
A.       
10%
B.       
20%
C.       
30%
D.       
> 30%
E.        
accurate risk not known


58    SBA. Coeliac disease in pregnancy.
Abbreviations.
AGA:        anti-gliadin antibodies 
CD:           coeliac disease.
EMA:       anti-endomysial antibodies. 
FGR:         Fetal growth restriction.
IgA:          immunoglobulin A IgG. 
tTGA:       anti-tissue transglutaminase antibody.

Question 1.
Lead-in
What is coeliac disease?
Option List
F.        
allergy to gluten
G.       
malabsorption due to large bowel inflammation
H.       
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition
I.         
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition
J.         
an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the small bowel in individuals with a genetic predisposition

Question 2.
Lead-in
What is the prevalence of coeliac disease in women of reproductive age?
Option List
A.       
0.1%
B.       
0.5%
C.       
1-2 %
D.       
2-5%
E.        
5-10%

Question 3.
Lead-in
Which of the following groups have an increased risk of CD?
Option List
F.        
1st. degree relatives of those with CD
G.       
those with type 1 diabetes
H.       
those with iron deficiency anaemia
I.         
those with osteoporosis
J.         
those with unexplained infertility

Question 4.
Lead-in
Which of the following are features of CD in the non-pregnant population?
Option List
A.       
abdominal bloating and pain
B.       
amenorrhoea
C.       
anaemia
D.       
recurrent miscarriage
E.        
unexplained infertility

Question 5.
Lead-in
How do pregnant women with CD present most commonly?
Option List
A
anaemia
B
failure to gain weight in pregnancy
C
intra-uterine growth retardation
D
low BMI
E
no recognised abnormality

Question 6.
Lead-in
Which of the following commonly occur in pregnant women with CD?
Option List
A
anaemia
B
failure to gain weight in pregnancy
C
intra-uterine growth retardation
D
low BMI
E
no recognised abnormality

Question 7.
How should the woman with suspected CD be investigated initially?
Option List
A.       
jejunal biopsy
B.       
IgA EMA
C.       
IgA tTGA
D.       
IgA EMA + IgA tTGA
E.        
rectal biopsy

Question 8.
Lead-in
Which, if any, of the following statements are true in relation to the woman due to have testing for suspected CD?
Option List
A.       
continue with a normal diet.
B.       
continue with a normal diet that includes a minimum of 5 gm. gluten daily
C.       
continue with a normal diet that includes a minimum of 10 gm. gluten daily
D.       
follow a strict gluten-free diet for at least 1 month
E.        
follow a strict gluten-free diet for at least 3 months

Question 9.
Lead-in
Which of the following conditions should make consideration of testing for CD sensible?
Option List
A.       
amenorrhoea
B.       
Down’s syndrome
C.       
epilepsy
D.       
recurrent miscarriage
E.        
Turner’s syndrome
F.        
unexplained infertility

Question 10.
Lead-in
How is the diagnosis of CD confirmed after +ve serological testing?
Option List
A.       
colonoscopy
B.       
enteroscopy
C.       
gastroscopy
D.       
rectal biopsy
E.        
small bowel  biopsy

Question 11.
Lead-in
Which skin condition is particularly associated with CD?
Option List
A.       
atopic eczema
B.       
dermatitis herpetiformis
C.       
dermatitis multiforme
D.       
dermatographia
E.        
psoriasis

Question 12.
Lead-in
Which of the following are likely to be absorbed less well than normally in women with CD?
Option List
A.       
carbohydrate
B.       
fat
C.       
folic acid
D.       
protein
E.        
vitamins B12, D & K

Question 13.
Lead-in
What is the appropriate treatment of CD?
Option List
A.       
antibiotics: long-term in low-dosage
B.       
azathioprine
C.       
cyclophosphamide
D.       
rectal steroids
E.        
none of the above

Question 14.
Lead-in
Which of the following do not contain gluten?
Option List
A.       
barley
B.       
oats
C.       
rapeseed oil
D.       
rye
E.        
wheat

59.   SBA. Fetal origins of adult disease.

Abbreviations.
ADHD:  attention-deficit, hyperactivity disorder
Lead in.
These questions relate to disease in adults resulting from events during fetal, infant and child development.

Scenario 1.
What eponymous title is given to the concept that adverse intra-uterine conditions predispose to the development of disease in adulthood?
Option List                               
K.        
the Barker hypothesis
L.        
the Baker’s dozen
M.     
the Broadbank theory
N.       
PIPAD: Placental Insufficiency Programmes Adult Disease
O.      
SIMCARD: Stop In-utero Malnutrition to Conquer Adult-resulting Disease

Scenario 2.
Which other term is used for the concept that adverse intra-uterine conditions predispose to the development of disease in adulthood?
Option List                               
A.       
FDAD: fetal determination of adult disease
B.       
FIAD:   fetal influences on adult disease
C.       
FIDAD: fetal and infancy determinants of adult disease
D.       
FIGO:   fetal influences on genomic outcomes
E.        
FP:       fetal programming

Scenario 3.
Which of the following is thought to increase the risk of adult disease?
Option List                               
A.       
low birthweight
B.       
low birthweight followed by poor weight gain in infancy and childhood
C.       
low birthweight followed by poor weight gain in infancy but above-average weight gain in childhood
D.       
above-average birthweight
E.        
above-average birthweight followed by poor weight gain in infancy but above-average weight gain in childhood
F.        
above-average birthweight followed by above-average weight gain in infancy and childhood

Scenario 4.
Which adult diseases are generally believed to be more likely in relation to adverse influences on the fetus, infant and child.
Diseases.
A.       
asthma
B.       
chronic bronchitis
C.       
coronary heart disease
D.       
diabetes type I
E.        
diabetes type 2
F.        
hypertension
G.       
Mendelson’s syndrome
Option List                               
A.       
A + B + C + D
B.       
A + B + C + E
C.       
A + B + C + E + F + G
D.       
B + C + E + F + G
E.        
C + E + F

Scenario 5.
What adult condition has been linked to raised maternal c-reactive protein levels?
Option List                               
A.       
asthma
B.       
ADHD
C.       
autism
D.       
inflammatory bowel disease
E.        
schizophrenia

60.   SBA. Influenza & pregnancy.

Question 1.
Lead-in
What did MBRRACE say about flu & pregnancy in its first report in 2014?
Option List
Pick the best option from the following list.
P.        
1 in 11 women died from flu
Q.      
1 in 11 women died from flu and flu vaccination could have prevented ½ of the deaths
R.       
1 in 21 women died from flu
S.        
1 in 21 women died from flu and flu vaccination could have prevented ½ of the deaths
T.        
1 in 51 women died from flu
U.       
1 in 51 women died from flu and flu vaccination could have prevented ½ of the deaths

Question 2.
Lead-in
How many types of flu virus are recognised?
Pick the best option from the following list.
Option List
F.        
3
G.       
5
H.       
10
I.         
15
J.         
>100

Question 3.
Lead-in
Why can’t we have a universal flu vaccine?
Pick the statements from the following list that are true.
List of statements.
A.       
The main surface antigens are haemagglutinin and neuraminidase
B.       
The main surface antigens are haemolysin and neuroxidase
C.       
The main surface antigens frequently
D.       
The main core antigens change frequently, rendering existing vaccines impotent
E.        
The big drug companies avoid making a universal vaccine for financial reasons.
Option List
1.        
A + C + D + E
2.        
A + C
3.        
A + D + E
4.        
B + C
5.        
 B + D + E

Question 4.
Lead-in
When is flu’ most often a problem in the UK?
Pick the best option from the following list.
Option List
A.       
Spring
B.       
Summer
C.       
Autumn
D.       
Winter
E.        
None of the above.

Question 5.
Lead-in
How is flu spread?
Pick the best option from the following list.
Option List
A.       
via aerosol or droplets from respiratory tract of an infected person
B.       
via aerosol or droplets from respiratory tract or direct contact with respiratory secretions  of an infected person
C.       
from getting drenched in cold winter showers
D.       
from thinking lascivious thoughts
E.        
from toilet seats

Question 6.
Lead-in
What is the incubation period for flu?
Pick the best option from the following list.
Option List

A.       
1 – 3 days
B.       
1 – 7 days
C.       
5 – 10 days
D.       
up to 2 weeks
E.        
up to 3 weeks

Question 7.
Lead-in
Who decides which viruses will be used in the vaccine for seasonal flu?
Pick the best option from the following list.
Option List

  1.  
DOH

  1.  
JCVI

  1.  
the Prime Minister

  1.  
the vaccine manufacturers

  1.  
WHO

Question 8.
Lead-in
How long has flu vaccination been recommended in the UK?
Pick the best option from the following list.
Option List
A.       
since the 1950s
B.       
since the 1960s
C.       
since the 1970s
D.       
since the 1980s
E.        
since the 1990s

Question 9.
Lead-in
What is the recommendation about when the vaccine should be given?
Pick the best option from the following list.
Option List
A.       
May - July
B.       
June - August
C.       
July - September
D.       
August - October
E.        
September - November

Question 10.
Lead-in
What advice is given about vaccination in pregnancy?
Pick the best option from the following list.
Option List
A.       
flu vaccine is potentially teratogenic and should be avoided before 16 weeks
B.       
the vaccine contains an attenuated virus with no evidence of risk in pregnancy
C.       
the vaccine recommended for pregnancy has no live viral material and all pregnant women are encouraged to have the seasonal vaccine
D.       
flu vaccine contains an attenuated virus with minimal risk, but the anti-viral drug Tamiflu is given with the vaccine to eliminate any risk of harm

Question 11.
Lead-in
What is the H1N1 virus?
Pick the best option from the following list.
Option List

A.       
The avian virus which causes outbreaks of “bird flu”
B.       
The virus associated with “swine” flu, which caused a pandemic in 2009
C.       
The virus associate with MERS, currently causing deaths particularly in Saudi Arabia
D.       
The virus associated with simian flu
E.        
The virus associated with the pandemic of 1915.

Question 12.
Lead-in
What advice should be given to pregnant women about protection against the H1N1 virus?
Pick the best option from the following list.
Option List
K.        
to have vaccination against H1N1 in addition to the seasonal vaccine
L.        
to have vaccination against H1N1 in preference to the seasonal vaccine
M.     
to await evidence of epidemic H1N1 flu and then have vaccination against H1N1
N.       
to have the seasonal vaccine as it gives good protection against H1N1
O.      
not to have any flu vaccination, but to take antiviral drugs if symptoms of flu occur

Question 13.
Lead-in
Pick the best option from the following list.
Which of the following conditions have been linked to flu in pregnancy?
Conditions.
A.       
­ risk of flu complications for the mother
B.       
­ risk of low birthweight
C.       
­ risk of maternal death
D.       
­ risk of perinatal death
E.        
­ risk of  prematurity
Option List
1
A + C+ D + E
2
A + B + C+ D
3
A + C + D
4
A + C+ D + E
5
A + B + C+ D + E

Question 14.
Lead-in
What is the estimated uptake of flu vaccination by pregnant women in the UK?
Pick the best option from the following list.
Option List
G.       
20-30%
H.       
30-40%
I.         
40-50%
J.         
50-60%
K.        
> 60%

Question 15.
Lead-in
How many maternal deaths were reported by MBRRACE for the years 2012 - 2013?
Pick the best option from the following list.
Option List
A.       
0
B.       
5
C.       
10
D.       
15
E.        
20

Question 16.
Lead-in
With regard to the probable explanation for the numbers of maternal deaths from ‘flu in 2012 and 2013,
              which, if any, of the following statements is true?
Option List
A.       
the numbers reflected increased prevalence of ‘flu
B.       
the numbers reflected reduced prevalence of ‘flu
C.       
the numbers reflected improved uptake of ‘flu vaccine in pregnancy
D.       
the numbers reflected the introduction of Tamiflu for pregnant women with ‘flu
E.        
none of the above

61.   SBA. Instrumental delivery
Operative vaginal delivery.  Based on work done by Aqeela Ayaz.
Abbreviations.
CPD:           cephalo-pelvic disproportion
Cs:              Caesarean section.
MCID:        mid-cavity instrumental delivery
OVD:          operative vaginal delivery
SS:               sagittal suture
                   
Question 1.
Lead-in. Which of the following are categorised as instrumental delivery?
V.       
forceps delivery
W.     
vacuum delivery
X.        
manual rotation
Y.        
delivery with the Odent device
Z.        
delivery with Credé’s manoeuvre
Option List
1.        
A + B
2.        
A + B + D
3.        
A + B + C + D
4.        
A + B + D + E
5.        
A + B + C + D + E

Question 2.
Lead-in. The following are included in the recommended classification of instrumental delivery in GTG26 with which exception?
Option List
K.        
outlet
L.        
low
M.     
mid with sagittal suture ≤ 450 from the OA position
N.       
mid with sagittal suture > 450 from the OA position
O.      
high

Question 3.
Lead-in
What is the incidence of OVD in the UK?
Option List
F.        
≤ 5%
G.       
>5 % but <10%
H.       
≥10 % but <15%
I.         
≥15 % but <20%
J.         
≥20%

Question 4.
Lead-in. What has been the trend in the incidence of OVD in the UK in recent years?
Option List
L.        
the incidence has not changed significantly
M.     
the incidence has increased by 25%
N.       
the incidence has increased by 50%
O.      
the incidence has decreased by 25%
P.        
the incidence has decreased by 50%

Question 5.
Lead-in. Which, if any, of the following features would be grounds for considering OVD?
Option List
F.        
suspected fetal compromise
G.       
meconium staining of the liquor
H.       
maternal pyrexia
I.         
maternal myotonic dystrophy
J.         
paternal myotonic dystrophy
K.        
nullipara who has been “pushing” for 2 hours without evidence of continuing progress
L.        
multipara who has been “pushing” for 2 hours without evidence of continuing progress

Question 6.
Lead-in. In relation to consent for OVD with the woman remaining in the delivery room, which, if any of the following statements are true.
Option List
A.       
It can safely be assumed that all women capable of giving consent will have heard of OVD and no information on the subject needs to be given during antenatal care.
B.       
It cannot safely be assumed that all women capable of giving consent will have heard of OVD.
C.       
All women should be informed during antenatal care about the possibility of OVD being required.
D.       
All women should be given enough information orally and in written form during antenatal care to ensure that they can give informed consent for OVD if required.
E.        
All women should be given enough information orally and in written form during antenatal care to ensure that they can give informed consent for OVD and be asked to sign a consent form for OVD to ensure that there is valid consent if OVD is required.

Question 7.
Lead-in. In relation to consent for OVD with the woman transferred to theatre, which, if any of the following statements are true.
Option List
A.
It can safely be assumed that all women capable of giving consent will have heard of OVD and no information on the subject needs to be given during antenatal care.
B.
It cannot safely be assumed that all women capable of giving consent will have heard of OVD.
C.
Verbal consent suffices.
D.
Written consent should be obtained.
E.
Written consent should be obtained before attempting OVD for both OVD and Caesarean section in case OVD fails.

Question 8.
Lead-in. Which, if any, of the following measures can reduce the need for OVD?
A.       
continuous support in labour, particularly by a supporter who is not a member of the labour ward team
B.       
consumption of raspberry tea in labour
C.       
use of erect or lateral position in labour
D.       
delaying pushing in primiparae
E.        
use of a personalised partogram taking account of height, BMI, ethnicity
Option List
1.        
A + B
2.        
A + B + D
3.        
A + C + D
4.        
A + C + D + E
5.        
A + B + C + D + E

Question 9.
Lead-in. Which, if any, of the following are not contra-indications to the use of the vacuum extractor?
Option List
A.       
blood-borne viral infection of mother
B.       
gestational age less than 34 weeks
C.       
asynclitism
D.       
mento-anterior face presentation
E.        
mento-posterior face presentation
F.        
breech presentation

Question 10.
Lead-in. What are the pre-requisites for OVD?
There is no option list – just jot down as many as you can think of.

Question 11.
Lead-in. Which, if any, of the following statements are true when vacuum extraction (VE) is compared with forceps delivery?
Option List
A.       
VE has a higher risk of failed delivery
B.       
VE has an increased risk of cephalo-haematoma
C.       
VE has an increased risk of risk of maternal retinal haemorrhage
D.       
VE has an increased risk of neonatal retinal haemorrhage
E.        
VE has an increased risk of maternal worry about the baby
F.        
VE has an increased risk of perineal trauma
G.       
VE has an increased risk of vaginal trauma
H.       
VE has an increased risk of Caesarean section
I.         
VE has a decreased risk of low Apgar score at 5 minutes
J.         
VE has a decreased risk of the baby needing phototherapy

Question 12.
Lead-in. How do forceps and the different types of vacuum extractor rank in the likelihood of achieving vaginal delivery?
Option List
F.        
forceps, hand-held vacuum extractor, metal cup vacuum extractor, soft cup vacuum extractor
G.       
forceps, hand-held vacuum extractor, soft cup vacuum extractor, metal cup vacuum extractor
H.       
forceps, metal cup vacuum extractor, hand-held vacuum extractor, soft cup vacuum extractor
I.         
forceps,  metal cup vacuum extractor,  soft cup vacuum extractor hand-held vacuum extractor
J.         
forceps, soft cup vacuum extractor, metal cup vacuum extractor, hand-held vacuum extractor

Question 13.
Lead-in. What is the role of episiotomy in OVD? Which, if any, of the following statements are true?
Option List
A.       
episiotomy should be done in all primiparous women and all multiparous women who have had episiotomy before
B.       
episiotomy should not be done unless 3rd. of 4th. degree tears are anticipated
C.       
a policy of liberal use dependent on the operator’s judgement is advocated in GTG26
D.       
a policy of restrictive use dependent on the operator’s judgement is advocated in GTG26
E.        
GTG26 does not advise

Question 14.
Lead-in. When should attempted OVD be abandoned?
Option List
A.       
after 3 pulls
B.       
when there is no progressive descent
C.       
when, using moderate traction,  there is no progressive descent or delivery is not imminent after 3 pulls
D.       
when there is no progressive descent or delivery is not imminent after 3 pulls
E.        
when the operator needs a rest

Question 15.
Lead-in
When should a clinical incident form be submitted after OVD?
Option List
A.       
all OVDs
B.       
all OVDs that fail to deliver the baby
C.       
all OVDs with an adverse outcome
D.       
all OVDs with an adverse outcome excluding failure to deliver the baby
E.        
all OVDs with injury to the baby or low 5-minute Apgar scores

Question 16.
Lead-in.
What is the main reason for medical litigation in relation to OVD
Option List
A.       
sneezing during traction
B.       
not abandoning the procedure at the appropriate time
C.       
pulling too hard, too long or too many times
D.       
using more than one instrument
E.        
failure to push the head up when C section is needed to deliver the baby

Question 17.
Lead-in
What advice is given in GTG26 in relations to sequential use of instruments for OVD.
Option List
A.       
sequential use should be avoided if possible
B.       
sequential use increased the risk of trauma to the baby
C.       
sequential use increases the risk of the neonate needing mechanical ventilation
D.       
sequential use may particularly indicated with outlet deliveries
E.        
all of the above
F.        
some of the above, but I don’t know which.

Question18.
Lead-in. With regard to prophylactic antibiotics for OVD, which, if any, of the following statements is true?
Option List
A.       
a broad spectrum antibiotic + metronidazole should be prescribed and continued for 5 days
B.       
erythromycin + metronidazole or clindamycin should be prescribed and continued for 5 days
C.       
a broad spectrum antibiotic + metronidazole should be prescribed initially and the drugs reviewed with the results of rectal and vaginal swabs taken at delivery. The final drug regime should be continued for 5 days
D.       
prophylactic antibiotics should be decided with advice from the bacteriologist to reflect local trends in infecting organism and antibiotic sensitivity for genital and urinary tract infections.
E.        
prophylactic antibiotics are not required.

Question 19.
Lead-in. What prophylaxis should be provided after OVD to reduce the risk of DVT & VTE
Option List
A.       
early mobilisation and good hydration unless the woman has thrombophilia
B.       
early mobilisation, good hydration, graded compression stockings + warfarin
C.       
early mobilisation, good hydration, graded compression stockings + LMWH
D.       
early mobilisation, good hydration, graded compression stockings + warfarin
E.        
none of the above

Question 20.
Lead-in. What pain relief should be prescribed after OVD?
Option List
A.       
aspirin
B.       
aspirin + codeine
C.       
aspirin + codeine + paracetamol
D.       
paracetamol and diclofenac
E.        
paracetamol and ibuprofen

Question 21.
Lead-in. Which, if any, of the following would represent minimum bladder care after OVD in women not having regional anaesthetic blocks?
Option List
A.       
documentation of the timing and volume of the first void
B.       
24 hour input / output chart
C.       
self-reporting of voiding difficulty
D.       
physiotherapy-directed strategies to reduce risk of UI
E.        
bladder training

Question 22.
Lead-in. Which, if any, of the following would represent minimum bladder care after OVD in women who have had regional anaesthetic blocks topped up for trial of OVD?
Option List
A.       
indwelling catheter for ≥ 12 hours
B.       
input / output charting to ensure good voiding volumes
C.       
self-reporting of voiding difficulty
D.       
physiotherapy-directed strategies to reduce risk of UI
E.        
bladder training

Question 23.
Lead-in. How effective is physiotherapist-provided intervention in reducing UI after OVD?
Option List

  1.  
it reduces UI from about 50% to about 40%

  1.  
it reduces UI from about 50% to about 30%

  1.  
it reduces UI from about 40% to about 30%

  1.  
it reduces UI from about 40% to about 20%

  1.  
it doesn’t work at all – it is just a measure to keep women happy that something is being done

Question 24.
Lead-in. After OVD, the pre-discharge review is best done by whom?
Option List
A.       
a midwife with de-briefing skills
B.       
the senior midwife on the postnatal ward
C.       
the doctor who performed the delivery
D.       
the consultant under whose care the woman booked
E.        
the SpR on-call for the postnatal wards

Question 25.
Lead-in. GTG26 mentions that OVD can be linked to women developing a PTST syndrome with severe fear of childbirth. What is this called?
Option List
A.       
androphobia
B.       
iatrophobia
C.       
parturophobia
D.       
spermatophobia
E.        
tocophobia

Question 26.
Lead-in. What advice does GTG give about strategies to reduce the risk of tocophobia.
Option List
A.       
midwife de-briefing is effective but to only a small extent
B.       
operator de-briefing is more effective than midwife de-briefing
C.       
combined midwife & operatory de-briefing is the most effective intervention
D.       
fortnightly visits to the same hospital antenatal team are of proven value
E.        
there are no interventions of proven value

Question 27.
Lead-in. What proportion of women at 3 years after OVD indicate that they plan not to have further children?
Option List
P.        
5%
Q.      
10%
R.       
25%
S.        
50%
T.        
100%

Question 28.
Lead-in. What advice should women be given about future deliveries after OVD?
Option List
A.       
aim for normal delivery
B.       
best with planned Caesarean section
C.       
anticipate likely need for OVD
D.       
best not to get pregnant