72
|
EMQ. MBRRACE
and maternal mortality.
|
73
|
EMQ. Vulval
conditions.
|
74
|
EMQ. ‘CAESAR’
trial.
|
75
|
SBA. Fetal
origins of adult disease
|
76
|
SBA. ‘Flu’
and pregnancy.
|
72.
MBRRACE and maternal mortality.
Abbreviations.
WWE: women with
epilepsy
Question 1. What is the meaning of the acronym MBRRACE-UK”?
Question 2.
Which organisation does it
replace?
Question 3.
How does it differ
structurally from its predecessor?
Question 4. How will the format of its reports differ from those
of its predecessor?
Question 5. When was MBRRACE’s first Report published?
Question 6. What was unusual about MBRRACE’s first Report?
A
|
it covered three years,
not two
|
B
|
it covered four years,
not three
|
C
|
it was very amusing
|
D
|
it made serious
criticisms of the funding of the NHS
|
E
|
it made serious
criticisms of the hours worked by junior doctors
|
F
|
none of the above
|
Question 7.
What is ICD-MM?
A
|
ICD-10 as applied to
maternal death
|
B
|
ICD-11 as applied to
maternal death
|
C
|
International
classification of maternal madness
|
D
|
International chocolate
delice- Mmmmm!
|
E
|
none of the above
|
Question 8. When was ICD-MM adopted by MBRRACE?
A
|
2014
|
B
|
2015
|
C
|
2016
|
D
|
ICD-MM does not exist
|
E
|
ICD-MM will be introduced
in 2017
|
F
|
none of the above
|
Question 9. What changes were made to the classification of
maternal suicide by MBRRACE?
A
|
maternal suicide was
reclassified as direct death
|
B
|
maternal suicide was
reclassified as indirect death
|
C
|
maternal suicide was
reclassified as late death as most occur > 6/52 post-delivery
|
D
|
maternal suicide was
reclassified as coincidental, as most women were already very ill
|
E
|
maternal suicide was
reclassified as irrelevant as these women were suicide-likely
|
F
|
none of the above
|
Question 10. When were the changes to the classification of
maternal suicide made by MBRRACE?
A
|
2014
|
B
|
2015
|
C
|
2016
|
D
|
the changes are planned
for 2017
|
E
|
no changes have been made
and none are planned
|
F
|
none of the above
|
Question 11. What geographical
innovation was included in MBRRACE’s first Report?
Question 12.
What alterations did
MBRRACE make to the timings of death to be considered in its Reports?
Question 13. What was the latest MMR
reported by MBRRACE?
Question 14. How did this compare with figure for the triennium
2011-2013?
A
|
MMR was lower, but the
difference was not statistically significant
|
B
|
MMR was lower and the
difference was statistically
significant
|
C
|
MMR was higher, but the
difference was not statistically significant
|
D
|
MMR was higher and the
difference was statistically significant
|
E
|
MMR was similar
|
Question 14.
Which,
if any, of the following topics were included in the confidential enquiries in
the first MBRRACE Report in December 2014?
A
|
amniotic fluid embolism
|
B
|
epilepsy
|
C
|
haemorrhage
|
D
|
placenta accreta, increta
& percreta
|
E
|
psychiatric causes
|
Question 15.
Which topics were reviewed
in detail in the second Report in 2015?
Question 16. Which topics were reviewed in detail in the third
Report in 2016?
Question 17.
Which topics were reviewed
in detail in the fourth Report in 2017?
Question 18.
Which topics were reviewed
in detail in the fifth Report in 2018?
Question 19.
What is the definition of a
direct maternal death?
Question 20.
What is the definition of a
maternal death?
Question 21.
What is the definition of
indirect maternal death?
Question 22. What was the leading direct
cause of death in the first MBRRACE Report?
Question 23.
What was the leading
indirect cause of death in the first Report?
Question 25. What were the top causes of indirect death in the
triennia 2013-15 and 2014-16?
Question 26. What observation was made in the 1st.
Report about hypertensive diseases?
Question 27.
Which condition was linked
to 1 in 11 maternal deaths in the first Report in 2014?
Question 28. What key messages were singled out in the first
MBRRACE Report in 2014?
Question 29. What key messages were singled out in the second
MBRRACE Report in 2015?
Question 30. What key messages were singled out in the third
MBRRACE Report in 2016?
Question 31. What critical care messages were included in the 3rd.
MBRRACE Report in 2016?
Question 32. What is the definition of the maternal mortality rate?
Question 33. What is the definition of a
“maternity”?
Question 34. What is the definition of a live birth?
Question 35. What is the definition of a
stillbirth?
Question 36. What is the definition of the maternal mortality
ratio?
Question 37. How many deaths in
pregnancy or the 6 weeks after were due to epilepsy in 2013-15?
Option list.
A
|
5
|
B
|
8
|
C
|
23
|
D
|
34
|
E
|
41
|
Question 38. Which, if any, of the following was true of epilepsy
in pregnancy in 2013-15?
Option list.
A
|
the main cause was asphyxia
|
B
|
the main cause was drowning in the bath
|
C
|
the main cause was falling
|
D
|
the main cause was intracranial bleeding
|
E
|
the main cause was status epilepticus
|
F
|
the main cause was SUDEP
|
Question 39. Which, if any, of the following is true of the women
who died due to epilepsy in pregnancy in 2013-15?
Option list.
A
|
90% had good pre-pregnancy control of the
epilepsy
|
B
|
80% had good pre-pregnancy control of the
epilepsy
|
C
|
70% had good pre-pregnancy control of the
epilepsy
|
D
|
60% had good pre-pregnancy control of the
epilepsy
|
E
|
50% had good pre-pregnancy control of the
epilepsy
|
F
|
40% had good pre-pregnancy control of the
epilepsy
|
G
|
30% had good pre-pregnancy control of the
epilepsy
|
H
|
20% had good pre-pregnancy control of the
epilepsy
|
J
|
10% had good pre-pregnancy control of the
epilepsy
|
I
|
8 of the 9 did not have good control and the
quality of control was unknown for the 9th.
|
K
|
None of the above
|
Question 40. Which, if any, of the following statements is true of
non-epileptic attack disorder (NEAD) as
discussed in MBRRACE17?
Option list.
A
|
is less common than epilepsy in pregnancy
|
B
|
is more common than epilepsy in pregnancy
|
C
|
is as common as epilepsy in pregnancy
|
D
|
NEAD is a diagnosis that should not be made in
pregnancy
|
E
|
NEAD is most common in male adolescents
|
F
|
Most women with NEAD also have epilepsy
|
Question 41.
Which, if any, of the
following statements is most appropriate to describe notification of the women
who died in 2013-15 to the UK Epilepsy and Pregnancy Register?
Option list.
A
|
>90% were notified
|
B
|
80-90% were notified
|
C
|
70-79% were notified
|
D
|
60-69% were notified
|
E
|
50-59% were notified
|
F
|
40-49% were notified
|
G
|
<30% were notified
|
H
|
<25% were notified
|
J
|
<20% were notified
|
I
|
<10% were notified
|
K
|
<5% were notified
|
Question 42. How many maternal deaths were due to cardiac causes in
2012-14?
Option list.
A
|
47
|
B
|
51
|
C
|
56
|
D
|
63
|
E
|
78
|
F
|
82
|
G
|
90
|
Question 43. How many maternal deaths were due to cardiac causes in
2013-15?
Option list.
A
|
47
|
B
|
51
|
C
|
54
|
D
|
56
|
E
|
78
|
F
|
82
|
G
|
90
|
Question 44. What is the definition of a stillbirth?
Question 45. What is the definition of
the maternal mortality ratio?
Question 46. How many maternal deaths were due to cardiac causes in
2012-14?
Option list.
A
|
47
|
B
|
51
|
C
|
56
|
D
|
63
|
E
|
78
|
F
|
82
|
G
|
90
|
Question 47. How many deaths were considered in detail in the
Confidential Enquiry to cardiac deaths in the 2012-14 Report?
Option list.
A
|
35
|
B
|
48
|
C
|
51
|
D
|
78
|
E
|
108
|
F
|
135
|
G
|
153
|
H
|
178
|
I
|
201
|
Question 48. Which day was singled out as the most dangerous for
cardiac death?
Option list.
A
|
the day of onset of labour
|
B
|
the 24 hours after the administration of a
general anaesthetic in labour
|
C
|
the 24 hours after the delivery of a baby by
Caesarean section
|
D
|
the 24 hours after instrumental delivery of a
baby
|
E
|
the day of delivery
|
F
|
the day of delivery after the birth of the
baby
|
G
|
the first day at home
|
Question 49. What % of cardiac deaths took place on the day highlighted
as the most dangerous?
Option list.
A
|
5%
|
B
|
10%
|
C
|
15%
|
D
|
20%
|
E
|
25%
|
F
|
30%
|
Question 50. What were the 3 most common causes of cardiac death
recorded in MBRRACE16?
Option list.
A
|
Aortic dissection
|
B
|
Congenital heart disease (CDH)
|
C
|
Hypertension
|
D
|
Ischaemic heart disease
|
E
|
Myocardial disease / cardiomyopathy
|
F
|
Other
|
G
|
Rheumatic heart disease.
|
H
|
SADS/MNH
|
I
|
Valvular heart disease
|
Question 51. How many deaths due to congenital heart disease were
recorded in MBRRACE16?
Option list.
A
|
0
|
B
|
3
|
C
|
5
|
D
|
11
|
E
|
15
|
F
|
24
|
G
|
35
|
Question 52. What were the main causes of congenital heart disease
deaths in MBRRACE16?
Option list.
A
|
Aortic dissection
|
B
|
Aortic rupture
|
C
|
Left heart failure
|
D
|
Right heart failure
|
E
|
Pulmonary artery hypertension
|
F
|
Pulmonary vein hypertension
|
G
|
Valvular heart disease
|
Question 53. Approximately what % of the women who died of cardiac disease in
MBRRACE16 were known to have cardiac disease before the pregnancy?
Option list.
A
|
10%
|
B
|
20%
|
C
|
30%
|
D
|
40%
|
E
|
50%
|
F
|
60%
|
G
|
70%
|
H
|
80%
|
I
|
90%
|
Question 54. What other risk factors were in MBRRACE16 in relation
to the women who died of cardiac causes?
Option list. There is no option list to make your life
harder. But you know the risk factors!
Question 55. What proportion of the cardiac deaths in MBRRACE16
occurred in ambulances or emergency departments?
Option list.
A
|
5%
|
B
|
10%
|
C
|
20%
|
D
|
30%
|
E
|
40%
|
F
|
50%
|
Question 56. What “overall messages for
future care” in relation to cardiac disease were included in MBRRACE16?
Option list. There
is none.
Question 57. How many deaths occurred
due to aortic dissection in 2009-14?
Option list.
A
|
0
|
B
|
3
|
C
|
6
|
D
|
9
|
E
|
15
|
F
|
18
|
G
|
21
|
H
|
24
|
I
|
30
|
Question 58. Which, if any of the
following statements are true in relation to the deaths from aortic dissection
in MBRRACE16?
Option list.
A
|
most occur in late pregnancy / puerperium, the
risk being 25 times greater than at other times
|
B
|
the most common cause of death is tamponade
|
C
|
20 of the deaths involved the descending aorta
|
D
|
the classical symptom is severe chest pain
radiating to the back
|
E
|
the classical symptom is severe chest pain
radiating to the left arm
|
F
|
the classical symptom is severe chest pain
radiating to the neck
|
G
|
most cases occurred in women with known
aortopathy, especially Marfan’s syndrome
|
H
|
surgical repair of congenital, complex
coarctation was identified as a risk factor.
|
I
|
8 of the 21 women had presented in the days
before death but aortic dissection had not been considered
|
J
|
42% of the women died at home or before
reaching the emergency department.
|
K
|
better care might have made a difference to
the outcome in almost 60% of cases.
|
Question 59. What were the “Key
messages” about cardiovascular disease in MBRRACE16?
Option list. There is none. Write as many as you know.
Question 60. Acute coronary syndrome. I
have written an EMQ about myocardial infarction. It has data from the UKOSS
survey. https://www.ncbi.nlm.nih.gov/pubmed/22127355 and https://www.npeu.ox.ac.uk/research/ukoss-myocardial-infarction-136. I’ll add the data from
MBRRACE 16 and put it in one of the tutorials..
Question 61. Approximately
how many women died of myocardial disease / cardiomyopathy?
Option list.
A
|
5
|
B
|
10
|
C
|
15
|
D
|
20
|
E
|
25
|
Question 62. Approximately how many
women died of peripartum cardiomyopathy?
Option list.
A
|
5
|
B
|
10
|
C
|
15
|
D
|
20
|
E
|
25
|
Question 63. What type of cardiomyopathy
is peripartum cardiomyopathy?
Option list.
A
|
congenital cardiomyopathy
|
B
|
dilated cardiomyopathy
|
C
|
hypertrophic cardiomyopathy
|
D
|
obesity-related cardiomyopathy
|
E
|
restrictive cardiomyopathy
|
Question 64. With regard to
cardiomyopathy, which symptom is singled out in MBRRACE 16 as particularly
needing full investigation?
Option list.
A
|
angina
|
B
|
“drop” attacks
|
C
|
dyspnoea
|
D
|
nocturnal sweats
|
E
|
palpitations
|
Question 65. Which of the following are
especially problematic for women with hypertrophic cardiomyopathy?
Option list.
A
|
bradycardia
|
B
|
epilepsy
|
C
|
hyperglycaemia
|
D
|
hypertension
|
E
|
hypotension
|
F
|
tachycardia
|
Question 66. MBRRACE 16 records that
investigation ceased once a particular diagnosis had been excluded in a number
of cases of cardiovascular compromise and the women died later of undiagnosed
cardiac disease. What was the diagnosis?
Option list.
A
|
acute coronary syndrome
|
B
|
aortic stenosis
|
C
|
atrial fibrillation
|
D
|
pulmonary embolism
|
E
|
ventricular fibrillation
|
Question 67. When are women with
peripartum cardiomyopathy most likely to die?
Option list.
A
|
1st. trimester
|
B
|
2nd. trimester
|
C
|
3rd. trimester
|
D
|
1st. stage of labour
|
E
|
2nd. stage of labour
|
F
|
3rd. stage of labour
|
G
|
1st. 24 hours after delivery
|
H
|
in the puerperium
|
I
|
from 6 weeks to 1 year after the delivery
|
Question 68. Which, if any, of the
following statements are true in
relation to obesity-related cardiomyopathy (ORC) ?
Option list.
A
|
ORC is not a recognised condition
|
B
|
MBRRACE16 reported 2 deaths from ORC
|
C
|
ORC is associated with cardiac enlargement
|
D
|
ORC is associated with fatty infiltration of
the ventricular muscle
|
E
|
is characterised by myocyte depletion and left
ventricular hypoplasia
|
F
|
is characterised by myocyte hypertrophy and
left ventricular hypertrophy
|
Question 69. How many deaths were due to
valvular heart disease ?
Option list.
A
|
1
|
B
|
2
|
C
|
3
|
D
|
4
|
E
|
5
|
F
|
6
|
G
|
7
|
H
|
8
|
I
|
9
|
J
|
10
|
K
|
11
|
Question 70. Why am I going to write a
separate EMQ on valvular heart disease?
Option list.
A
|
I am now bored with this topic
|
B
|
I find it so fascinating that I feel it
deserves its own EMQ
|
C
|
I don’t know enough about it and need to do
some research
|
D
|
UKOSS conducted a study from 2013 – 2015 and
this needs to be included
|
E
|
none of the above.
|
Question 71. What were the key messages
re hypertensive disease in MBRRACE16?
Option list. There
is none. Write as many as you can think of.
Question 72. Which, if any, of the
following was the most common cause of death from hypertensive disease in
2009-14?
Option list.
A
|
acute fatty liver of pregnancy
|
B
|
eclampsia / cerebral oedema
|
C
|
haemorrhage due to thrombocytopenia
|
D
|
HELLP /hepatic necrosis
|
E
|
hepatic rupture
|
F
|
intracranial haemorrhage
|
G
|
left ventricular failure
|
H
|
pulmonary oedema
|
Question 73. Which, if any, of the
following conditions does MBRRACE16 say are usually attributable to poor fluid management?
Option list.
A
|
acute fatty liver of pregnancy
|
B
|
eclampsia / cerebral oedema
|
C
|
haemorrhage due to thrombocytopenia
|
D
|
HELLP /hepatic necrosis
|
E
|
hepatic rupture
|
F
|
intracranial haemorrhage
|
G
|
left ventricular failure
|
H
|
pulmonary oedema
|
Question 74. What upper gestational
limit was used by MBRRACE16 in the definition of early pregnancy?
Option list.
A
|
10 weeks
|
B
|
12 weeks
|
C
|
16 weeks
|
D
|
18 weeks
|
E
|
20 weeks
|
F
|
24 weeks
|
G
|
26 weeks
|
Question 75. Which of the following
ranked top in the causes of death < 24 weeks in 2009-2014?
Option list.
A
|
Cardiac
|
B
|
Ectopic
|
C
|
Haemorrhage
|
D
|
Mental health problems
|
E
|
Miscarriage
|
F
|
Sepsis
|
G
|
Thrombosis & thrombo-embolism
|
H
|
TOP
|
Question 76. Why did MBRRACE16 recommend
FAST for women presenting to emergency departments with pulmonary embolism in
the list of differential diagnoses?
Option list.
A
|
to exclude aortic dissection before
thrombolysis
|
B
|
to exclude acute coronary syndrome before
thrombolysis
|
C
|
to exclude intra-peritoneal bleeding from
ectopic pregnancy before thrombolysis
|
D
|
to exclude intra-uterine pregnancy before
thrombolysis
|
E
|
to exclude Bornholm disease before
thrombolysis
|
Question 77. What were the key messages
in relation to early pregnancy deaths in MBRRACE16?
Option list. There
is none. Write as many as you can think of.
Question 78. What proportion of pregnant
/ recently delivered women needing critical care survive?
Option list.
A
|
50%
|
B
|
60%
|
C
|
70%
|
D
|
80%
|
E
|
90-94%
|
F
|
≥ 95%
|
Question 79. MBRRACE16 looked at the
cause of death in 144 women admitted to critical care from 2009-14. What was
the most common cause of death?
Option list.
A
|
Amniotic fluid embolism
|
J
|
Anaesthetic
|
I
|
Cardiac
|
L
|
Coincidental
|
B
|
Early pregnancy death
|
D
|
Haemorrhage
|
E
|
Neurological
|
K
|
Other indirect
|
C
|
PET / eclampsia
|
H
|
Psychiatric
|
G
|
Sepsis
|
F
|
Thrombosis / thrombo-embolism
|
M
|
Unascertained
|
Question 80. What are the key facts to
remember about critical care?
Option list. There
is none. Write what you think are the key facts and numbers.
Question 81. What “red flags” does
MBRRACE highlight in relation to maternal sepsis?
Option list. There
is none.
Question 82. What were MBRRACE16’s “key
messages” for critical care?
Option list. There
is none.
Question 83. What were MBRRACE16’s “key
messages” for critical care?
Option list.
Question 84.
The
following topics were covered in the first 3 MBRRACE Reports? Sort them by
Report
AFE,
|
|
anaesthesia,
|
|
cardiac causes,
|
|
coincidental deaths,
|
|
early pregnancy deaths,
|
|
eclampsia & PET,
|
|
haemorrhage,
|
|
late deaths,
|
|
malignancy,
|
|
neurological disorders,
|
|
psychiatric causes,
|
|
respiratory, endocrine
and other indirect causes,
|
|
sepsis.
|
|
thrombosis and
thromboembolism.
|
|
women admitted to
critical care
|
|
women with artificial
heart valves
|
Question 85. How many anaesthetic deaths
were recorded in MBRRACE17?
Option list.
A
|
1
|
B
|
2
|
C
|
5
|
D
|
8
|
E
|
10
|
F
|
12
|
Question 86. Which, if any, of the
following statements are included by MBRRACE17?
Option list.
A
|
BP is the best measure of cardiac output
|
B
|
pulse rate is a good indicator of cardiac
output
|
C
|
external cardiac compressions should be
started early if cardiac output is inadequate
|
D
|
external cardiac compressions are
contraindicated in the presence of cardiac activity because of the risk of
ventricular rupture
|
E
|
if there has been massive haemorrhage,
extubation should not be done until the bleeding has ceased and adequate
resuscitation has taken place.
|
Question 87. Which, if any, of the
following sizes of endotracheal tubes are recommended for inclusion in
resuscitation carts by MBRRACE17?
Option list.
A
|
4 mm
|
B
|
5 mm
|
C
|
6 mm
|
D
|
7 mm
|
E
|
8 mm
|
F
|
9 mm
|
73.
Vulval conditions.
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. 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
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.
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.
|
74.
The “CAESAR” trial
Question
1.
Lead-in
What was the CAESAR trial?
Which, if any, of the following statements
are true?
Statements
|
A
|
a prospective, cohort study
|
|
B
|
a randomised, controlled trial
|
|
C
|
a comparison of selected techniques used during C section
|
|
D
|
a study of the risks of C section on maternal request without
medical grounds
|
|
E
|
a study of the outcomes of C section performed after failed
instrumental delivery
|
Option
List
|
1
|
A + C
|
|
2
|
A + D
|
|
3
|
B + C
|
|
4
|
B + D
|
|
5
|
B + E
|
Question
2.
Lead-in
Where did the questions addressed by the trial come from?
Option
list
|
A
|
the RCOG council
|
|
B
|
the RCOG exam committee
|
|
C
|
a survey of UK obstetricians asking what questions they would
like to have answered
|
|
D
|
Dr. Johnstone, Consultant Obstetrician, Falkirk
|
|
E
|
National Childbirth Trust
|
Question
3.
Lead-in
The questionnaire also asked about the issues
that the respondents would like to see addressed in a research programme. What
issues were include in the CAESER trial?
Statements
|
A
|
outcome of C. section depending on aqueous versus alcohol-based
skin preparation
|
|
B
|
outcomes of cord traction versus manual removal of the placenta
|
|
C
|
outcomes of digital versus ‘swab on a holder’ exploration of the
uterine cavity to exclude RPOC
|
|
D
|
outcomes of Joel-Cohen compared
with Pfannenstiel incision
|
|
E
|
outcome of elective C. section at 38 versus 39 weeks
|
|
F
|
outcome of elective C. section with staff wearing masks versus
not wearing masks
|
|
G
|
outcome of prophylactic antibiotics versus no prophylactic
antibiotics
|
|
H
|
outcome of pre-op vaginal antiseptic “painting”
|
|
I
|
outcome of blunt v. sharp opening of the lower segment
|
|
J
|
outcomes of manual versus forceps delivery of the fetal head in
cephalic presentations
|
|
K
|
outcome of single v double closure of the lower segment
|
|
L
|
outcome of closure v non-closure of parietal & pelvic
peritoneum
|
|
M
|
outcome of liberal v restricted use of pelvic drains
|
|
N
|
outcome of glue v subcuticular suturing of the skin
|
|
O
|
none of the above
|
Option
List
|
1
|
A + B + C + D + E + F + G + H +
I + J + K+ L + M + N + O
|
|
2
|
D + F + G + H + K+ L
|
|
3
|
G + H + K+ L + M
|
|
4
|
K + M
|
|
5
|
O
|
Question
4.
Lead-in
Which of the following statements is true of
the definition of the 1ry. outcome?
Option
list
|
A
|
use of antibiotics for maternal
infectious morbidity during the hospital stay
|
|
B
|
use of antibiotics for maternal infectious morbidity during the
1st. six weeks
|
|
C
|
duration of postnatal hospital stay
|
|
D
|
abdominal and pelvic pain as measured on an analogue scale at 6
weeks
|
|
E
|
none of the above.
|
Question
5.
Lead-in
Which, if any, of the following describe the
2ry. outcomes?
Statements
|
A
|
additional treatments to the abdominal
wound
|
|
B
|
haematoma formation
|
|
C
|
pain
|
|
D
|
breast feeding at discharge
|
|
E
|
breast feeding at 6 weeks
|
|
F
|
unexpected maternal morbidity
|
|
G
|
postnatal depression at 6 weeks
|
|
H
|
puerperal psychosis
|
Option
List
|
1
|
A + C
|
|
2
|
A + D
|
|
3
|
B + C
|
|
4
|
B + D
|
|
5
|
B + E
|
|
6
|
none of the above
|
Question
6.
Lead-in
Which if any of the following statements are
true of the findings of the study?
Statements
|
A
|
there were no significant
differences for any outcome
|
|
B
|
there was more endometritis after non-closure of the pelvic
peritoneum
|
|
C
|
there was more 2ry. bleeding after interrupted-suture closure of
the lower segment
|
|
D
|
there was more evidence of pelvic infection with liberal use of
pelvic drains
|
|
E
|
none of the above.
|
75. 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
|
A.
|
the Barker hypothesis
|
|
B.
|
the Baker’s dozen
|
|
C.
|
the Broadbank theory
|
|
D.
|
PIPAD: Placental Insufficiency Programmes Adult Disease
|
|
E.
|
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
|
76.
‘Flu’ and 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.
|
F.
|
1 in 11 women died from flu
|
|
G.
|
1 in 11 women died from flu and flu vaccination could have
prevented ½ of the deaths
|
|
H.
|
1 in 21 women died from flu
|
|
I.
|
1 in 21 women died from flu and flu vaccination could have
prevented ½ of the deaths
|
|
J.
|
1 in 51 women died from flu
|
|
K.
|
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
|
A.
|
3
|
|
B.
|
5
|
|
C.
|
10
|
|
D.
|
15
|
|
E.
|
>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
|
|
DOH
|
|
|
JCVI
|
|
|
the Prime Minister
|
|
|
the vaccine manufacturers
|
|
|
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
|
A.
|
to have vaccination against
H1N1 in addition to the seasonal vaccine
|
|
B.
|
to have vaccination against H1N1 in preference to the seasonal
vaccine
|
|
C.
|
to await evidence of epidemic H1N1 flu and then have vaccination
against H1N1
|
|
D.
|
to have the seasonal vaccine as it gives good protection against
H1N1
|
|
E.
|
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
|
A.
|
20-30%
|
|
B.
|
30-40%
|
|
C.
|
40-50%
|
|
D.
|
50-60%
|
|
E.
|
> 60%
|
Question
15.
Lead-in
How many maternal deaths from flu 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 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
|
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