Tutorial 19 December 2022

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19 December 2022.    

 

46	Role-play. Teach an FY1 the basics of *** topic revealed on the day
47	SBA. Coeliac disease & pregnancy
48	EMQ. Maternal Mortality definitions
49	EMQ. Asymptomatic bacteruria
50	EMQ. ARRIVE trial
51	EMQ. Family origin questionnaire

                                   

46.         Role-play. Teach an FY1 the basics of *** topic revealed on the day.

              I don’t want you to prepare so that the exercise simulates the exam.

47.         SBA. Coeliac disease & pregnancy.

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

A.	allergy to gluten
B.	malabsorption due to large bowel inflammation
C.	an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition
D.	an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition
E.	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

A.	0.1%
B.	0.5%
C.	1%
D.	2-5%
E.	5-10%

Question 3. Which of the following groups have an increased risk of CD?

Option List

A.	1st. degree relatives of those with CD
B.	those with type 1 diabetes
C.	those with iron deficiency anaemia
D.	those with osteoporosis
E.	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

A.	jejunal biopsy
B.	IgA EMA
C.	IgA tTGA
D.	IgA EMA + IgA tTGA
E.	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

A.	amenorrhoea
B.	Down’s syndrome
C.	epilepsy
D.	recurrent miscarriage
E.	Turner’s syndrome
F.	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 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

 

48.         EMQ. Maternal Mortality definitions.

Abbreviations.

AFE:                    Amniotic Fluid Embolism.

APH:                    Antepartum haemorrhage.

CER:                    Confidential Enquiry Report (MBRRACE).

EPNMR:              Extended Perinatal Mortality Rate.

MBRRACE:         NPEU: “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK”.

MCS:                   Medical Certificate of Stillbirth.

MMR:                 Maternal Mortality Rate.

MMRat:              Maternal Mortality Ratio.

MMRpt:             Maternal Mortality Report.

NESST:                UKARCOG’s “National Evaluation of Accuracy of Stillbirth Certificates”.

NMR:                  Neonatal Mortality Rate

NPEU:                 National Perinatal Epidemiology Unit

PNMR:                Perinatal Mortality Rate.

SBR:                    Stillbirth Rate.

NMR:                  Neonatal Mortality Rate.

PPH:                    Postpartum haemorrhage.

SBR:                    Stillbirth rate.

SUDEP:               Sudden Unexplained Death in Epilepsy.

Option List.

A.    Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.

B.    Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.

C.    Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.

D.   Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.

E.    A pregnancy going to 24 weeks or beyond.

F.    A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.

G.   Maternal deaths per 100,000 maternities.

H.   Maternal deaths per 100,000 live births.

I.      Direct + indirect deaths per 100,000 maternities.

J.     Direct + indirect deaths per 100,000 live births.

K.    Direct death.

L.     Indirect death.

M.  Early death.

N.   Late death.

O.   Extra-late death.

P.    Fortuitous death.

Q.   Coincidental death.

R.    Accidental death.

S.    Maternal murder.

T.    Not a maternal death.

U.   Yes

V.    No.

W. I have no idea.

X.    None of the above.

Question 1.        What is a Maternal Death?

Question 2.        Which categories are included in the definition of MD?  >1 answer may be correct.

correct.

Option list.

A	accidental death
B	coincidental death
C	direct death
D	iatrogenic death
E	incidental death
F	indirect death
G	late death

Question 3.        Which categories are included in the discussions in the MMRs?

Option list.

A	accidental death
B	coincidental death
C	direct death
D	iatrogenic death
E	incidental death
F	indirect death
G	late death

Question 4.        When was the latest Maternal Mortality Report published? Which years did it cover?

Question 5.        What was the Maternal Mortality Rate in the most recent Report?

Question 6.        How did the MMR compare with that from the previous Report?

Question 7.        What was the leading cause of maternal death and how many deaths were there?

Question 8.        What was the leading cause of direct death and how many deaths were there?

Question 9.        When was the latest Perinatal Mortality Report published? Which years did it cover?

Question 10.         EPNMR and PNMR are derived from the number of stillbirths + the number of neonatal deaths. Why is the EPNMR used in preference to PNMR in most publications?

A	the EPNMR includes NNDs up to 2 weeks; the NMR NNDs up to 1 week
B	the EPNMR includes NNDs up to 4 weeks; the NMR NNDs up to 1 week
C	the EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 1 week
D	the EPNMR includes NNDs up to 6 weeks; the NMR NNDs up to  4 weeks
E	the EPNMR includes NNDs up to 8 weeks; the NMR NNDs up to 4 weeks
F	the EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 4 weeks
G	none of the above

Question 11.    A woman dies from a ruptured appendix at 10 weeks. What kind of death is it?

Question 12.    A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of

death is it?

Question 13.    A woman dies from a ruptured appendix at 10 weeks. What kind of death is it?

Question 14.    A woman dies from chickenpox at 30 weeks’ gestation. What kind of death is it?

Question 15.    How many categories are there for sepsis in the MMRpts?

Question 16.     

A woman dies of sepsis secondary to pyelonephritis at 20 weeks’ gestation. What kind of death is it?

Question 17.     

A woman dies from sepsis two weeks after C section. The sepsis was due to uterine infection that started as chorioamnionitis. What kind of death is it?

Question 18.    A woman dies from hepatitis C at 40 weeks’ gestation. The infection was transmitted

 sexually. What kind of death is it?

Question 19.    A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?

Question 20.    A woman with a 10-year-history of coronary artery disease dies of a coronary

 thrombosis at 36 weeks’ gestation. What kind of death is it?

Question 21.    A woman has gestational trophoblastic disease, develops choriocarcinomas and dies

from it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?

Question 22.    A woman develops puerperal psychosis from which she makes a poor recovery. She

kills herself when the baby is 18 months old. What kind of death is it?

Question 23.    A woman develops puerperal psychosis from which she makes a poor recovery. She

kills herself when the baby is 6 months old. What kind of death is it?

Question 24.    What is a “maternity”.

Question 25.    What is the definition of the Maternal Mortality Rate?

Question 26.    What is the Maternal Mortality Ratio?

Question 27.    A woman is diagnosed with breast cancer. She has missed a period and a pregnancy

 test is +ve. She decides to continue with the pregnancy. The breast cancer does not respond to treatment and she dies from secondary disease at 38 weeks. What kind of death is it?

Question 28.    A woman who has been the subject of domestic violence is killed at 12 weeks

 by her partner. What kind of death is it?

Question 29.    A woman is struck by lightning as she runs across a road. As a result, she falls under

 the wheels of a large lorry which runs over her abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?

Question 30.    A woman is abducted by Martians who are keen to study human pregnancy. She dies

 as a result of the treatment she receives. As this death could only have occurred because she was pregnant, is it a direct death?

Question 31.    Could a maternal death from malignancy be classified as “direct”?

Question 32.    Could a maternal death from malignancy be classified as “Indirect”?

Question 33.    Could a maternal death from malignancy be classified as “Coincidental”?

Question 34.    A pregnant woman is walking on the beach at 10 weeks when she is struck by lightning

 and dies. What kind of death is this?

Question 35.    A woman is sitting on the beach breastfeeding her 2-year old baby when she is struck

 by lightning and dies. What kind of death is this?

 

49.         EMQ. Asymptomatic bacteruria.

Abbreviations.

ASB:              asymptomatic bacteriuria.

ASBIP:           ASB in pregnancy.

LE:                 leukocyte esterase.

MSU:             mid-stream specimen of urine.

Question 1.            What is the definition of ASB?

Option list.

A	> 1,000,000 colonies per mL on MSU
B	> 100,000 colonies per mL on MSU
C	> 10,000 colonies per mL on MSU
D	> 1,000 colonies per mL on MSU
E	> 1,000,000 organisms per mL on MSU
F	> 100,000 organisms per mL on MSU
G	> 10,000 organisms per mL on MSU
H	> 1,000 organisms per mL on MSU
I	none of the above

Question 2.        Which, if any of the following reflect NICE’s advice  re routine screening for ASBIP?

Option list.

A	routine screening should be offered early in pregnancy
B	screening should be by culture of a MSU
C	screening by dipstick testing for nitrites and leukocyte esterase is acceptable as an alternative to MSU screening
D	routine screening is not recommended
E	talk of urine is indelicate and ill-suited to genteel discourse so please desist

Question 3.        Which, if any of the following reflect the NSC’s advice  re  screening for ASBIP?

Option list.

A	routine screening should be offered early in pregnancy
B	screening should be by culture of a MSU
C	screening by dipstick testing for nitrites and leukocyte esterase is acceptable as an alternative to MSU screening
D	routine screening is not recommended
E	talk of urine is indelicate and ill-suited to genteel discourse

Question 4.        Which, if any, of the following are proven to be more likely in those with ASBIP?

Option list.

A	chorioamnionitis
B	cystitis
C	endometritis
D	↑ perinatal mortality
E	LBW
F	learning difficulty
G	fetal anaemia
H	maternal anaemia
I	premature birth
J	pyelonephritis
K	schizophrenia

Question 5.        What was the main justification for routine screening for ASBIP?

Option list.

A	it reduces the risk of cystitis
B	it reduces the risk of premature labour
C	it reduces the risk of IUGR
D	it reduces the risk of pyelonephritis
E	the laboratory staff like to be busy
F	none of the above.

Question 6.        Which of the following statements is correct about leukocyte esterase?

Option list.

A	LE is a sensitive indicator of UTI
B	LE derives from inflamed bladder mucosa
C	LE derives from bacteria killed by leukocytes
D	LE testing is an acceptable method of screening for ASB
E	a +ve urine LE test usually leads to testing of a MSU
F	none of the above

 

50.         EMQ. ARRIVE trial.

Abbreviations.

EBL:    estimated blood loss.

IOL:    induction of labour.

SGA:   small for gestational age.

Question 7.        What does the acronym ‘ARRIVE’ mean?

Option list.

A	a randomised review of intravenous ergometrine for the prevention of PPH
B	a randomised review of IVF efficacy
C	a retrospective review of IVF efficacy
D	a randomised review of IOL at term versus expectant management of high-risk pregnancy
E	a randomised review of IOL at 39 weeks versus expectant management of high-risk pregnancy
F	a randomised trial of IOL at term versus expectant management of low-risk pregnancy
G	a randomised trial of IOL at 39 weeks versus expectant management of low-risk pregnancy
H	none of the above

Question 8.        What was the primary outcome of the trial?

Option list.

A	C section and instrumental delivery rates versus the spontaneous delivery rate
B	cost-effectiveness of IVF
C	composite outcome of perinatal death or severe neonatal complications
D	estimated blood loss using low-dose ergometrine versus oxytocin for the 3rd. stage
E	frequency and severity of perineal trauma
F	length of labour
G	maternal satisfaction
H	urinary incontinence severity score at 3 months postpartum
I	none of the above

Question 9.        Which, if any, of the following were the important conclusions of the trial?

Option list.

A	C section and instrumental delivery rates were significantly ↓ with IOL at 39/52
B	C section rate but not instrumental delivery rate was significantly ↓with IOL at 39/52
C	instrumental delivery rate but not C section rate was significantly ↓ with IOL at 39/52
D	C section and instrumental delivery rates were significantly ↑ with IOL at 39/52
E	C section rate but not instrumental delivery rate was significantly ↑ with IOL at 39/52
F	instrumental delivery rate but not C section rate was significantly ↑ with IOL at 39/52
G	C section and instrumental delivery rates were unchanged
H	IVF was cost-effective
I	IVF was not cost-effective
J	composite perinatal outcome was better with IOL
K	composite perinatal outcome was unchanged with IOL
L	composite perinatal outcome was worse with IOL
M	EBL using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓
N	EBL using low-dose ergometrine versus oxytocin for the 3rd. stage was ↓↓ but with ↑↑ BP
O	frequency and severity of perineal trauma ↑ with IOL
P	length of labour was ↑↑ with IOL
Q	maternal satisfaction was higher with IOL
R	urinary incontinence at 3 months was reduced by IOL
S	none of the above

 

 

51.         EMQ. Family origin questionnaire.

Abbreviations. 

FBC:      full blood count.

FOQ:     UK Government’s Family Origin Questionnaire. 

Hb:        haemoglobin. 

SCD:      sickle cell disease. 

SCT:       sickle cell trait.

Question 1.        What is the main purpose of the Family Origin Questionnaire?

Option list. 

A	to identify illegal immigrants
B	to identify those who are not entitled to free NHS care
C	to monitor the degree to which different ethnic groups use the NHS
D	to screen for sickle cell disease
E	to screen for α-thalassaemia
F	none of the above.

Question 2.        What is a low-risk area?

Option list. An area in which the prevalence of booking bloods +ve for sickle cell or thalassaemia is less than:

A	1%
B	2%
C	5%
D	7.5%
E	10%

Question 3.        What is a high-risk area?

Question 4.        What screening is offered in low-risk areas?

Option list. 

A	none
B	FOQ
C	maternal testing
D	maternal + paternal testing
E	none of the above

Question 5.        What screening is offered in high-risk areas?

Option list. 

A	none
B	FOQ
C	maternal testing
D	maternal + paternal testing
E	none of the above

Question 6.        What are listed by the NHS as ‘essential elements’ of the FOQ?

Option list. There is none to challenge your brain. But you should be able to work out what they are if you go back to basics.

Question 7.        Whose ancestry is asked about in the FOQ? There may be > one correct answer. 

Option list. 

A	the pregnant woman
B	the woman’s partner/husband
C	the biological father of the pregnancy
D	the postman in case he delivered more than the mail
E	the queen
F	the woman’s mother
G	the woman’s father
H	the woman’s siblings
I	none of the above

Question 8.        Which generations should be included? 

Option list. 

A	the current generation
B	the current generation + the previous generation
C	the current generation + 2 previous generations
D	the current generation + 3 previous generations
E	the current generation + as many previous generations as possible
F	none of the above

Question 9.        Who should complete the FOQ? 

Option list. 

A	the woman
B	the woman’s husband / partner
C	the biological father of the pregnancy
D	the midwife
E	the obstetrician
F	an interpreter if the woman & partner are not fluent in English
G	none of the above

Question 10.    What other responsibilities does the person completing the FOQ have? There is no

option list so as not to make it too easy. 

Question 11.    Which tick boxes are highlighted in yellow on the FAQ. 

Option list. 

A	those that must be completed
B	those that suggest a possible ↑ risk of neonatal jaundice
C	those that suggest a possible ↑ risk of HepB
D	those that suggest a possible ↑ risk of SCD. SCT or thalassaemia
E	those showing areas with a ↑ risk of having SCD. SCT or thalassaemia
F	none of the above

Question 12.    What is the significance of the red ‘hash’ mark # that appears alongside some of the

boxes? 

Option list. 

A	the box that must be completed
B	just decoration to make the form more pleasing to the eye
C	denotes area with ↑ risk of bilharzia
D	denotes area with ↑ risk of falciparum malaria
E	denotes area with ↑ risk of α-thalassaemia
F	denotes area with ↑ risk of β-thalassaemia
G	none of the above

Question 13.    A woman books at 10 weeks in her 1^st. pregnancy. Her husband in Turkish and healthy.

What screening for sickle cell and thalassaemia should be offered? 

Option list. 

A	screening depends on whether the area is high or low risk
B	screening depends on whether the FOQ shows high or low risk
C	the husband should first be screened
D	the woman should be screened using Hb and red cell indices
E	the woman should be screened using electrophoresis
F	none of the above

Question 14.    A woman books at 10 weeks in her 1^st. pregnancy. Her husband is English and healthy.

What screening for sickle cell and thalassaemia should be offered? 

Option list. 

A	screening depends on whether the area is high or low risk
B	screening depends on whether the FOQ shows high or low risk
C	the husband should first be screened
D	the woman should be screened using Hb and red cell indices
E	the woman should be screened using electrophoresis
F	none of the above

Question 15.    A woman books at 10 weeks gestation in a low-risk area. She does not wish to

complete the FOQ. Which, if any, of the following are recommended.

Option list. 

A	accept her wishes if you feel she is fully informed
B	give her a good slapping for being stupid
C	offer blood tests to screen for sickle and haemoglobinopathy
D	refer her to a psychiatrist
E	tell her to have a serious think about the potential benefits
F	none of the above.