Monday 8 February 2016

Tutorial 8th. February 2016


53
Tutorial. Neonatal screening
54
SBA. Myocardial infarction.
55
EMQ. APH.
56
EMQ. Folic acid & pregnancy

53.   Neonatal screening.
         The slides that will be used are on Dropbox.

54.   SBA. Myocardial infarction.
Topic. Myocardial infarction.
Abbreviations.
CG167:             NICE’s Clinical Guideline 167: Myocardial infarction with ST-segment elevation. 2013.
MI:                   myocardial infarction
MMRpt:           Maternal Mortality Report 2006-8: Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer: 2006-2008
UKOSS:            UK Obstetric Surveillance System

Question 1.
Lead-in
Where did cardiac disease rank in the direct and indirect causes of maternal death for the years 2011-13 in MBRRACE15?
Option List
A.       
1
B.       
2
C.       
3
D.       
4
E.        
5
Question 2.
Lead-in
What has happened to the incidence of maternal death due to cardiac disease in the UK since 1985?
Option List
A.       
it has roughly increased by a factor of 1.5
B.       
it has roughly increased by a factor of 2.0
C.       
it has roughly increased by a factor of 3.0
D.       
it has roughly reduced by a quarter
E.        
it has roughly reduced by a half
Question 3.
Lead-in
What was the estimated prevalence of MI in the UKOSS survey?
There is no option list – what is your figure?
Question 4.
Lead-in
What risk factors for MI were identified in the UKOSS survey?
Question 5.
Lead-in
What underlying pathological conditions were noted in the UKOSS survey?
Question 6.
Lead-in
What risk factors for MI have been mentioned in recent Maternal Mortality Reports?
There is no option list.
Write your list and you can compare it with the list in the answers.
Question 7.
Lead in
What risk factors for MI have been reported in other publications?
A big question!! Write your list and compare it with mine.
Question 8.
Lead-in
How are the causes of MI normally categorised and what are the sub-headings in the main categories.
You know this or could work it out, certainly the main headings and most of the sub-headings.
Write your list and you can compare it with the answer.
Question 9.
Lead-in
What ECG criteria are used to categorise acute myocardial infarction?
Option List
A.       
presence of arrhythmia
B.       
presence of QT interval prolongation
C.       
presence of ST segment depression
D.       
presence of ST segment elevation
E.        
presence of T wave inversion
 Question 10.
Lead-in
What ECHO criteria are used to categorise acute myocardial infarction?
Option List

A.       
presence of arrhythmia
B.       
presence of atrial dilatation
C.       
presence of ventricular dilatation
D.       
presence of mitral valve reflux
E.        
none of the above
Question 11.
Lead-in
With regard to coronary artery dissection, which of the following statements are false?
Statements.
A.       
only occurs in women with coronary artery disease
B.       
mainly occurs in the right anterior descending branch of the coronary artery
C.       
is most common in the puerperium
D.       
is particularly associated with the use of ergometrine for management of the 3rd. stage and its complications
E.        
is associated with mortality rates ≥ 50%, mainly due to late diagnosis or mis-diagnosis
Option List
1.        
A + B + C
2.        
A + C + D
3.        
B + D
4.        
B + D + E
5.        
A + B + C + D + E
Question 12.
Lead-in
Which ECG feature is particularly used to diagnose MI?
Option List
A.       
presence of arrhythmia
B.       
presence of QT interval prolongation
C.       
presence of ST segment depression
D.       
presence of ST segment elevation
E.        
presence of T wave inversion
Question 13.
Lead-in
Which blood markers are best for the diagnosis of MI?
Markers
1.        
Treponemin A
2.        
Treponemin B
3.        
Troponin A
4.        
Troponin I
5.        
Troponin T
Option List
A
1 + 2
B
3
C
3 + 4
D
3 + 5
E
4 + 5
F
none of the above
Question 14.
Lead-in
Which of the following statements are true about the blood markers that are best for the diagnosis of MI?
Statements
1.        
Their levels are normal in normal pregnancy
2.        
Their levels are increased from about 28 weeks, making pregnancy-specific ranges mandatory
3.        
Their levels rise with prolonged labour
4.        
Their levels rise with Caesarean section
5.        
Their levels can be elevated in pregnancy-induced hypertension and PET
6.        
Their levels can be elevated in pulmonary embolism
Option List
A
1 + 3
B
1 + 3 + 4
C
2 + 3 + 4
D
1 + 3 + 5
E
1 + 5 + 6
F
none of the above
Question 15
Lead-in
How many maternal deaths due to cardiac disease were reported for the years 2010-12 in MBRRACE14?
Option List
A.       
10
B.       
26
C.       
38
D.       
47
E.        
54
Question 16.
What were the main causes of maternal death from cardiac disease in 2010-12?
List of possible causes.
A.       
aortic dissection
B.       
atherosclerosis
C.       
atrial fibrillation
D.       
coronary thrombosis
E.        
myocardial infarction
F.        
peripartum cardiomyopathy
G.       
sudden adult death syndrome
H.       
ventricular fibrillation
Option List
There is no option list.
Question 17.
How many maternal deaths were attributed to myocardial infarction in MBRRACE15?
Option List
A.       
  0
B.       
  5
C.       
  8
D.       
12
E.        
36
Question 18.
Lead-in
What are the latest figures for the split between congenital and acquired disease in deaths due to cardiac disease and what years do they derive from?
Option Lists
    List 1                                               List 2
A
  3: 100

F
2006-08
B
  6: 100

G
2007-09
C
13: 100

H
2008-10
D
31: 100

I
2009-11
E
50: 100

J
2010-12
Question 19.
Lead-in
Which causes of death have occupied the number 1 spot in the ranking order of the causes of direct and indirect maternal deaths in the past 30 years?
List of causes.
1.        
AFE
2.        
anaesthesia
3.        
early pregnancy: ectopic, miscarriage & TOP
4.        
cardiac disease
5.        
haemorrhage
6.        
PET, eclampsia, pregnancy-induced hypertension
7.        
psychiatric disease including suicide
8.        
sepsis
9.        
thromboembolism/ thrombosis

55.   EMQ. APH.
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.
A.        genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the baby
B.         genital tract bleeding ≥ 500 ml. from 24 weeks until the delivery of the placenta.
C.         genital tract bleeding ≥ 500 ml. from 24 weeks, or earlier if the baby is live-born, until the delivery of the baby.
D.        1
E.         2
F.         3
G.        4
H.        5
I.           6
J.          7
K.         8
L.          9
M.      10
N.        15
O.        20
P.         30
Q.        50
R.         100
S.         500
T.         1,000
U.        true
V.        false
W.      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 a viva in the OSCE?

56.   EMQ. Folic acid & pregnancy.
Lead-in.
The following scenarios relate to folic acid and pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Option list.
No option list to make your life harder!
Scenario 1.                
What is the incidence of NTD in the UK?
Scenario 2.                
What is the risk of an affected sibling for the woman who becomes pregnant after having a baby with NTD?
Scenario 3.                
Which foods contain significant amounts of folic acid?
Scenario 4.                
What percentage of folic acid is destroyed by cooking / food storage?
How many people in the UK are estimated to have a folate-deficient diet?
Scenario 5.                
What is the significance of the MTHFR (Methylenetetrahydrofolate reductase gene)?
Scenario 6.                
What is the significance of the Meckel-Gruber syndrome to this issue?
Scenario 7.                
By what gestation has the neural tube closed?
Scenario 8.                
What proportion of pregnant women have taken folic acid preconceptually?
Scenario 9.                
What dose and duration of folic acid is advised for routine periconceptual use?
Scenario 10.            
List the women to whom a higher dose should be offered.
Scenario 11.            
How effective is periconceptual folic acid consumption in reducing NTD risk in the low-risk population?
Scenario 12.            
How effective is periconceptual folic acid consumption in reducing NTD risk in women who have had an affected baby?
Scenario 13.            
What is the risk of NTD recurrence for a woman who has had two affected babies?
Scenario 14.            
What is the risk of NTD in Ireland?
Scenario 15.            
What is the significance of the name “Bukowski” in relation to folic acid?
Scenario 16.            
What effect does periconceptual folic acid have on the risk of stillbirth?
Scenario 17.            
What effect does periconceptual folic acid have on the risk of autistic spectrum disorder?
Scenario 18.            
What effect does periconceptual folic acid have on maternal haemoglobin levels?
Scenario 19.            
What recommendations have been made by the RCOG to improve folic acid levels in pregnancy?
Scenario 20.            
Which names are of particular importance in the history of folic acid and NTD?
Scenario 21.            
What neurological condition has been thought potentially problematic with folic acid supplementation?



2 comments:

  1. sir i m starting to solve this blog from jan2016.....but not geting answers .....I M OBGY consultant in India....n preparing for part II MRCOG for Sep 2016. I need your valuable guidance from how to study to what to study?

    I have emailed you previously for dropbox.....pls let me know the answers from jan 2016...

    ReplyDelete
    Replies
    1. You need to send me your answers. Then I link you to the answers, which are on Dropbox. I want to know that you have tackled the questions as you don't get much benefit from just reading the answers.
      In the exam you will not be able to answer everything. This leaves you with "intelligent guessing" as the best way to maximise marks and the only way to get good at this is to practise.
      It is also important to answer the questions without preparation. This is what you have to do in the exam, so it is what you should do now. Tom.

      Delete