Tutorial 19 December 2019

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36	EMQ. Renal transplant
37	SBA. Endometrial hyperplasia
38	EMQ. Clue cells, koilocytes etc.
39	SBA.   Coeliac disease & pregnancy
40	EMQ. Anatomy of fetal skull and maternal pelvis

36.         Renal transplant & pregnancy.

Abbreviations.

AST:      American Society for Transplantation

Question 1

Approximately how many women who have had renal transplant have pregnancies annually in the UK?

Option list.

A	10-20
B	30-40
C	50-100
D	100-200
E	200-300
F	300-400
G	400-500
H	>500

Question 2

Which, if any, of the following statements are true about the findings of the UKOSS survey of renal transplant in pregnancy?

Option list.

A	the incidence of PET was ~ 25%, roughly six times higher than the general population
B	the incidence of PET was ~ 25%, roughly ten times higher than the general population
C	the incidence of PET was ~ 50%, roughly ten times higher than the general population
D	the incidence of PET was ~ 50%, roughly twenty times higher than the general population
E	none of the above

Question 3

Various sources, such as AST, give factors linked to reduced risks associated with pregnancy after RT. A lot of this is common sense. Write down all the factors that would be in your list.

Question 4

What is the risk of graft rejection in the year after RT?

Option list.

A	< 5%
B	10-15%
C	15-20%
D	20-25%
E	unknown

Question 5

Which of the following factors are the 3 main ones affecting pregnancy outcome?

Factors

1	anaemia
2	diabetes
3	hypertension
4	number of immunosuppressive drugs being used
5	obesity
6	pre-pregnancy graft function
7	proteinuria
8	urinary tract infection

Option list.

A	1 + 2 + 3
B	1 + 2 + 6
C	2 + 3 + 4
D	2 + 4 + 6
E	3 + 6 +7
F	3 + 6 + 8
G	4 + 5 + 6
H	4 + 6 + 8

Question 6

Which of the following statements is true in relation to the prevalence of hypertension in women after RT?

Option list.

A	> 20% have hypertension
B	> 30% have hypertension
C	> 40% have hypertension
D	> 50 % have hypertension
E	none of the above

Question 7

State whether these drugs are regarded as safe or unsafe in pregnancy.

	Drug	Safe / unsafe
A	ACE inhibitor	Safe / unsafe
B	angiotensin receptor antagonist	Safe / unsafe
C	azathioprine	Safe / unsafe
D	ciclosporin	Safe / unsafe
E	clopidogrel	Safe / unsafe
F	erythropoietin	Safe / unsafe
G	hydroxychloroquine	Safe / unsafe
H	mycophenolate	Safe / unsafe
I	prednisolone	Safe / unsafe
J	tacrolimus	Safe / unsafe
K	warfarin	Safe / unsafe

TOG CPD. These are open access.

With regard to renal transplant,

1.     most recipients have a successful pregnancy outcome. T F

2.     pregnancy is associated with a 10% reduction in GFR in recipients with prepregnancy eGFR >90 ml/ min/1.73m² . T F

3.     hypertension complicates pregnancy in over 50% of recipients who did not require antihypertensive treatment prior to pregnancy. T F

4.     proteinuria is a predictor of poor pregnancy outcome in recipients.  T F

5.     the risk of damage to the allograft at caesarean delivery is about 1%. T F

6.     a positive serological screening test for aneuploidy in recipients is a recognised consequence of impaired renal function. T F

7.     superimposed pre-eclampsia in recipients has defined diagnostic criteria. T F

8.     erythropoietin requirements in recipients fall in pregnancy. T F

9.     breastfeeding is safe in recipients on angiotensin converting enzyme inhibitors. T F

10.   conception is not advised in recipients within the first year following transplantation. T F

11.   continuous electronic fetal monitoring is recommended during labour in recipients. T F

12.   the progesterone implant is a safe form of postpartum contraception in recipients. T F

Women who have donated a kidney,

13.   are at increased risk of gestational hypertension. T F

Combined kidney-pancreas transplant recipients,

14.   have a higher risk of gestational diabetes than kidney transplant recipients. T F

Liver transplant recipients,

15.   have a lower risk of pregnancy complications than renal transplant recipients. T F

With regard to pregnancy in cardiothoracic transplant recipients,

16.   lung transplant recipients have the highest risk of adverse outcome of all solid organ transplants. T F

17.   due to denervation, the transplanted heart responds poorly to the physiological changes of pregnancy. T F

18.   cardiothoracic transplant recipients should be delivered by caesarean section. T F

Regarding medications prescribed in patients with solid organ transplants,

19.   tacrolimus levels require monitoring during pregnancy. T F

20.   warfarin is safe for breastfeeding mothers. T F

37.         Endometrial hyperplasia.

Abbreviations.

BSO:      bilateral salpingo-oophorectomy

c.f.         compared with

EC:         endometrial cancer

EH:        endometrial hyperplasia

ES:         endometrial surveillance

Question 1.

What is the definition of endometrial hyperplasia?

Option List

A.	endometrial thickness ≥ twice that of proliferative endometrium
B.	endometrial thickness ≥ twice that of proliferative endometrium in the absence of oestrogenic stimulation
C.	premenopausal endometrial thickness ≥ 6 mm; postmenopausal thickness ≥ 4 mm.
D.	proliferation of endometrial glands with ↑ gland to stroma ratio c.f. proliferative endometrium
E.	proliferation of endometrial stroma with ↑ stroma to gland ratio c.f. proliferative endometrium

Question 2.

Approximately how many cases of endometrial cancer are diagnosed annually in the UK?

Option List

	≤ 1,000
	1,000 - ≤ 1,500
	1,500 - ≤ 3,000
	3,000 - ≤ 5,000
	5,000 - ≤ 10,000

Question 3.

Where does endometrial cancer rank in the list of gynaecological cancers by incidence?

Option List

A.	1st.
B.	2nd.
C.	3rd.
D.	4th.
E.	5th.

Question 4.

Where does endometrial cancer rank in the list of gynaecological cancers causing death?

Option List

A.	1st.
B.	2nd.
C.	3rd.
D.	4th.
E.	5th.

Question 5.

What is the prevalence of EH compared with that of EC.?

Option List

A.	~ ¼
B.	~ ½
C.	similar
D.	> double
E.	> treble

Question 6.

What classification system does the RCOG recommend for EH?

Option List

A.	BSGE 2015 classification based on endometrial thickness
B.	FIGO 2000 classification based on risk of malignancy assessment
C.	FIGO 2005 classification based on histological grading
D.	WHO 2014 classification based on endometrial thickness
E.	WHO 2014 classification based on cytological atypia

Question 7.

A 48-year-old woman presents with erratic bleeding and menopausal symptoms. Endometrial histology shows hyperplasia with no cytological anomaly. What is the risk of progression to endometrial cancer in the next 10 years?

Option List

A.	< 1%
B.	≤ 5%
C.	5% - ≤ 10%
D.	10% - ≤ 15%
E.	> 15%

Question 8.

A 48-year-old woman presents with menopausal symptoms. Endometrial histology shows hyperplasia with no cytological anomaly. What is the chance of spontaneous regression of the endometrial hyperplasia?

Option List

A.	< 1%
B.	1% - ≤ 10%
C.	10% - ≤ 15%
D.	15% - ≤ 25%
E.	> 25%

Question 9.

A 48-year-old woman presents with erratic bleeding and menopausal symptoms. An outpatient endometrial sample shows atypical hyperplasia. What is her lifetime risk of EC?

Option List

A.	≤ 5%
B.	5% - ≤ 10%
C.	10% - ≤ 25%
D.	25% - ≤ 50%
E.	> 50%

Question 10.

Which of the following are risk factors for the development of endometrial hyperplasia?

Option List

A.	aromatase inhibitors
B.	clomiphene used for induction of ovulation
C.	continuous combined HRT
D.	obesity
E.	tamoxifen

Question 11.

Which of the following should be used for the diagnosis of endometrial hyperplasia?

Option List

A.	endometrial histology
B.	CT scan
C.	hystero-salpingography
D.	MRI scan
E.	trans-vaginal ultrasound scan

Question 12.

Which of the following are true of the management of endometrial hyperplasia without cytological abnormality?

Option List

A.	identified risk factors should be discussed with the woman
B.	observation with follow-up endometrial biopsies is acceptable
C.	progestogens improve the chance of regression
D.	progestogen should not be used when women show no regression after B
E.	progestogen should not be used when women have abnormal bleeding

Question 13.

Which of the following are true of the management of endometrial hyperplasia without cytological abnormality?

Option List

A.	brachytherapy is the recommended 1st. line treatment in the GTG
B.	cyclical oral progestogen therapy is the recommended 1st. line treatment in the GTG
C.	intra-cavity methotrexate is the recommended 1st. line treatment in the GTG
D.	the COC is the recommended 1st. line treatment in the GTG
E.	the LNG-IUS is the recommended 1st. line treatment in the GTG

Question 14.

Which of the following statements are true in relation to the management of endometrial hyperplasia without cytological abnormality?

Option List

A.	treatment should be for a minimum of 6 months
B.	women should be encouraged to continue with the LNG-IUS for at least 3 years
C.	endometrial surveillance with biopsy should be provided at a minimum of 12 monthly
D.	review schedules should be individualised
E.	two consecutive 6-monthly biopsies should be negative before discharge is considered

Question 15.

Which of the following are true in relation to hysterectomy as management of endometrial hyperplasia without cytological abnormality?

Option List

A.	treatment to achieve regression should be for at least 6 months before surgery is considered
B.	treatment to achieve regression should be for at least 12 months before surgery is considered
C.	treatment to achieve regression should be for at least 24 months before surgery is considered
D.	recurrence of endometrial hyperplasia without cytological abnormality after progestogen therapy is grounds for considering hysterectomy
E.	hysterectomy should be recommended to the woman who declines surveillance

Question 16.

 Which of the following statements are true in relation to women with endometrial hyperplasia without cytological atypia for whom hysterectomy is being considered?

Option List

A.	post-menopausal women should have bilateral salpingo-oophorectomy
B.	pre-menopausal women should have bilateral salpingo-oophorectomy
C.	bilateral salpingectomy should be offered to all women not having BSO
D.	laparoscopic hysterectomy should be offered in preference to abdominal
E.	the GTG uses the term “total hysterectomy” which is really stupid

Question 17.

Which of the following are true in relation to the management of atypical hyperplasia of the endometrium?

Option List

A.	endometrial ablation is satisfactory if ES can be done for at least 5 years
B.	brachytherapy is satisfactory if ES can be done for at least 5 years
C.	hysterectomy ± BSO or bilateral salpingectomy should be offered
D.	frozen section should be done at the time of hysterectomy to determine the need for lymphadenectomy
E.	continuous oral progestogen therapy should given for at least 12 months post-op

Question 18.

A woman with atypical hyperplasia of the endometrium wishes to retain her fertility. Which of the following are true?

Option List

A.	endometrial and ovarian cancer must be ruled out to start with
B.	the MDT should decide management after reviewing the results of the histology, imaging and tumour markers
C.	the woman should be advised is that medical advice is to have hysterectomy because of the risk of cancer
D.	the LNG-IUS is the first-line preference for conservative management
E.	oral progestogens should not be used
F.	she should have at least one clear endometrial biopsy before conceiving
G.	referral to a fertility specialist should be arranged to discuss ART

Question 19.

What follow-up should be offered to the woman with atypical hyperplasia of the endometrium who wishes conservative management?

Option List

A.	surveillance includes endometrial biopsy
B.	surveillance should be at intervals of not more than 6 months until 2 consecutive, clear biopsies have been obtained
C.	surveillance should be at intervals of not more than 3 months until 2 consecutive, clear biopsies have been obtained
D.	long-term follow-up after 2 consecutive, clear biopsies have been obtained can be at 6 – 12 month intervals
E.	long-term follow-up after 2 consecutive, clear biopsies have been obtained can be at 12 – 24 month intervals

Question 20.

A woman who has had successful conservative treatment for atypical hyperplasia of the endometrium wishes to go onto HRT. Which of the following are true?

Option List

A.	continuous progestogen therapy is necessary regardless of the type or mode of administration of oestrogen replacement
B.	LNG-IUS or depot progestogens are preferred to oral therapy
C.	hysterectomy should be recommended if not already done
D.	six-months TV scans should be done for endometrial thickness
E.	none of the above

Question 21.

Which of the following are true in relation to the woman with endometrial hyperplasia who has been treated for breast cancer and are taking tamoxifen or aromatase inhibitors.

Option List

A.	she should be informed that tamoxifen ↑the risk of endometrial cancer
B.	she should be informed that aromatase inhibitors ↑the risk of endometrial cancer
C.	she should be informed that the LNG-IUS ↓ the risk of endometrial cancer for women on tamoxifen
D.	she should be informed that the LNG-IUS ↓ the risk of endometrial cancer for women on aromatase inhibitors
E.	she should be informed that the effect of the LNG-IUS on the risk of breast cancer recurrence is unknown and that it is not recommended as a result

Question 22.

A woman is found to have endometrial hyperplasia on an endometrial polyp. Which of the following are true of the best management?

Option List

A.	complete removal of the polyp must be checked
B.	hysteroscopy and curettage must be done to check the endometrium
C.	an LNG-IUS should be recommended
D.	hysterectomy should be recommended
E.	none of the above.

38.         Clue cells, koilocytes etc.

Lead-in.

Pick one option from the option list. Each option can be used once, more than once or not at all.

Abbreviations.

Ct:                     Chlamydia trachomatis

FPA:                  Family Planning Association

HSV:                 Herpes simplex virus

LGV:                 lymphogranuloma venereum

Ng:                    Neisseria gonorrhoeae

Tv:                    Trichomonas vaginalis

Option list.

A	Actinomyces
B	Bacterial vaginosis
C	Bacteroides
D	Chlamydia trachomatis
E	Chlamydial infection of the genital tract
F	Herpes Simplex
G	Human Papilloma Virus
H	Lymphogranuloma venereum
I	Monilia
J	Neisseria gonorrhoeae
K	Trichomonas vaginalis

Scenario 1

Which option or options from the option list best fit with “clue cells”

Scenario 2

Which option or options from the option list best fit with “fishy odour”?

Scenario 3

Which option or options from the option list best fit with “flagellate organisms”?

Scenario 4

Which option or options from the option list best fit with “inflammatory smear”?

Scenario 5

Which option or options from the option list best fit with “koilocytes”?

Scenario 6

Which option or options from the option list best fit with “non-specific urethritis in the male”?

Scenario 7

Which option or options from the option list best fit with “strawberry cervix”?

Scenario 8

Which option or options from the option list best fit with “thin grey/ white discharge”?

Scenario 9

Which option or options from the option list best fit with “white, curdy discharge”?

Scenario 10

Which option or options from the option list best fit with “frothy yellow discharge”?

Scenario 11

Which option or options from the option list best fit with “protozoan”?

Scenario 12

Which option or options from the option list best fit with “obligate intracellular organism”?

Scenario 13

Which option or options from the option list best fit with “blindness”?

Scenario 14

Which option or options from the option list best fit with “LGV”?

Scenario 15

Which option or options from the option list best fit with “multinucleated cells”?

Scenario 16

Which option or options from the option list best fit with “serotypes D–K”?

Scenario 17

Which option or options from the option list best fit with “serovars L1-L3”?

Scenario 18

Which of the following are true in relation to Amsel’s criteria?

A	used for the diagnosis of bacterial vaginosis
B	used for the diagnosis of trichomonal infection
C	clue cells present on microscopy of wet preparation of vaginal fluid
D	flagellate organism present on microscopic examination of vaginal fluid
E	pH ≤ 4.5
F	pH > 4.5
G	thin, grey-white, homogeneous discharge present
H	frothy, yellow-green discharge present
I	fishy smell on adding alkali (10%KOH)
J	fishy smell on adding acid (10%HCl)
K	koilocytes present
L	absence of vulvo-vaginal irritation

Scenario 19

Which of the following are true in relation to Nugent’s Amsel’s criteria?

A	used for the diagnosis of bacterial vaginosis
B	used for the diagnosis of trichomonal infection
C	clue cells present on microscopy of wet preparation of vaginal fluid
D	pH ≤ 4.5
E	pH > 4.5
F	count of lactobacilli
G	count of Gardnerella and Bacteroides
H	count of white cells

Scenario 20

Garnerella vaginallis can be cultured from the vagina of what proportion of normal women?

A	< 10%
B	11 - 20%
C	21 - 30%
D	31 - 40%
E	41 - 50%
F	> 50%

39.         Coeliac disease and pregnancy.

Abbreviations.

AGA:                            anti-gliadin antibodies 

CD:                              coeliac disease.

DGP:                            IgG deamidated gliadin peptide.

EMA:                           IgG endomysial antibodies. 

FGR:                            Fetal growth restriction.

HLA:                            Human leucocyte antigen.

IgA:                              immunoglobulin A. 

tIgA:                            total immunoglobulin A.

tTGA:                           IgA tissue transglutaminase antibody.

vLBW:                         very low birth weight.

vPTB:                           very pre-term birth (<30/52).

Question 1.

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.

What is the prevalence of coeliac disease in women of reproductive age?

Option List

F.	0.1%
G.	0.5%
H.	1%
I.	2-5%
J.	5-10%

Question 3.

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.

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.

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.

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

F.	jejunal biopsy
G.	IgA EMA
H.	IgA tTGA
I.	IgA EMA + IgA tTGA
J.	tIgA + tTGA

Question 8.

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 diet that includes gluten ≥ once daily for at least 1 month
B.	continue with a diet that includes gluten ≥ once daily for at least 6 weeks
C.	continue with a diet with ≥ 10 gm. gluten daily for at least 1 month
D.	continue with a diet with ≥ 10 gm. gluten daily for at least 6 weeks
E.	follow a strict gluten-free diet for at least 3 months

Question 9.

What advice should be given to those who have gone on to a gluten-free diet in the month before testing?

Option List

A.	the gluten-free diet may render the serological tests –ve, but not intestinal biopsy
B.	the gluten-free diet may render the intestinal biopsy –ve, but not the serological tests
C.	the gluten-free diet may render all the tests -ve
D.	if she is happy with the gluten-free diet, there is no  point in testing
E.	she is not qualified to make medical decisions and should not be so stupid on future occasions

Question 10.

Which of the following conditions should make consideration of testing for CD sensible?

Option List

F.	amenorrhoea
G.	Down’s syndrome
H.	epilepsy
I.	recurrent miscarriage
J.	Turner’s syndrome
K.	unexplained infertility

Question 11.

What recommendation does NICE make about the information to be provided to healthcare professionals with the results of serological tests for CD?

Option List

A.	the results alone should be provided
B.	the results with the local reference values for children, adult men and adult women
C.	the results with the local and national reference values for children, adult men and adult women
D.	the results with interpretation of their meaning
E.	the results with interpretation of their meaning + recommended actions

Question 12.

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 13.

Which skin condition is particularly associated with CD?

Option List

A.	atopic eczema
B.	dermatitis herpetiformis
C.	dermatitis multiforme
D.	dermatographia
E.	psoriasis

Question 14.

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 15.

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 16.

Which of the following do not contain gluten?

Option List

A.	barley
B.	oats
C.	rapeseed oil
D.	rye
E.	wheat

40.         Anatomy of fetal skull and maternal pelvis.

Scenario 1.                

How many bones make up the vault of the skull?

Option list.

A.	3
B.	5
C.	6
D.	7
E.	8

Scenario 2.                

What is the origin of the word “bregma”?

Option list.

A.	the Greek word meaning “arrow”
B.	the Greek word meaning “front of the head”
C.	the Greek word meaning “top of the head”
D.	the Greek word meaning “where lines intersect”
E.	none of the above

Scenario 3.                

What is the origin of the word “lambdoid”?

Option list.

A.	it is derived from “lambda”, the 11th. letter of the Greek alphabet, with the symbol “λ”
B.	it is derived from the shape of the rear end of a newborn lamb, with legs apart for balance in the shape of an inverted “V”
C.	it derives from the Norse noun “lam” meaning to hit

Scenario 4.                

What is the origin of the word “sagittal”?

Option list.

A.	it derives from the Latin verb “sagire” meaning to be wise
B.	it derives from the Latin noun “sagitta” meaning “arrow”
C.	it derives from the Latin adjective “sagitta” meaning “pointing north”
D.	it derives from the Latin adjective “sagitta” meaning “lacking tension”

Scenario 5.                

What is the meaning of the word “coronal”.

Option list.

A.	it is the 11th. letter of the Greek alphabet
B.	it derives from the Latin “corona” meaning “crown”.
C.	it derives from the sun’s corona, meaning equator

Scenario 6.                

What is the definition of “vertex”?

Option list.

A.	the most prominent part of the occiput
B.	the area around the posterior fontanelle
C.	the area bounded by the anterior fontanelle and the posterior fontanelle
D.	the area bounded by the anterior & posterior fontanelles and the parietal bones
E.	the area bounded by the anterior & posterior fontanelles and the parietal eminences
F.	the area bounded by the anterior & posterior fontanelles and the parietal cardinals

Scenario 7.                

What is the definition of the anterior fontanelle?

Option list.

A.	the anterior end of the sagittal suture
B.	the area where the sagittal and coronal sutures meet
C.	the area between the frontal and parietal bones
D.	the posterior end of the sagittal suture
E.	the area between the parietal bones and the occiput

Scenario 8.                

What is the definition of the posterior fontanelle?

Option list.

A.	the anterior end of the sagittal suture
B.	the area where the sagittal and lambda sutures meet
C.	the area between the frontal and parietal bones
D.	the posterior end of the sagittal suture
E.	the area between the parietal bones and the occiput

Scenario 9.                

How many other fontanelles are there?

A.	0
B.	2
C.	3
D.	4
E.	6

Scenario 10.            

What is the falx cerebri?

Option list.

A.	an area of dura mater at the back of the skull like a roof over the cerebellum
B.	is an artefact on ultrasound suggesting the presence of cerebral tissue where there is none
C.	is the horizontal fibrous platform on which the cerebellum rests
D.	is a crescent-shaped fold of dura mater separating the cerebral hemispheres

Scenario 11.            

What is the importance of the falx cerebri in relation to delivery, particularly breech delivery?

Option list.

A.	the falx cerebri is inserted into the tentorium cerebelli and traction on the base of the skull may lead to tentorial tears and intracranial bleeding
B.	the falx cerebri is inserted into the bone of base of the skull and traction on the base of the skull may lead to tears of the falx and intracranial bleeding
C.	the falx cerebri is inserted into the tentorium cerebelli and traction on the base of the skull may lead to tentorial tears leaving the cerebellum unsupported and liable to trauma

Scenario 12.            

What diameter presents to the pelvis with vertex presentation?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 13.            

What diameter presents to the pelvis with typical occipito-posterior position?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 14.            

What diameter presents to the pelvis with brow presentation?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 15.            

What diameter presents to the pelvis with mento-anterior face presentation?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 16.            

What diameter presents to the pelvis with mento-posterior face presentation?

Option list.

A.	suboccipito-bregmatic
B.	suboccipito-frontal
C.	occipito-frontal
D.	mento-vertical
E.	submento-bregmatic

Scenario 17.            

What is the average length of the suboccipito-bregmatic diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.

Scenario 18.            

What is the average length of the suboccipito-frontal diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.

Scenario 19.            

What is the average length of the occipito-frontal diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.

Scenario 20.            

What is the average length of the mento-vertical diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.

Scenario 21.            

What is the average length of the submento-bregmatic diameter in a term baby?

Option list.

A.	9.0 cm.
B.	9.5 cm.
C.	10.0 cm.
D.	10.5 cm.
E.	11.0 cm.
F.	11.5 cm.
G.	12.0 cm.
H.	12.5 cm.
I.	13.0 cm.
J.	13.5 cm.
K.	14.0 cm.