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16 October 2023.
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73
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Role-play. TBA.
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74
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Role-play. TBA.
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75
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EMQ. Flu and pregnancy
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76
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EMQ. The Term Breech Trial
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73 & 74. Role-play.
Candidate’s
instructions will be sent shortly before the tutorial.
75. Flu and pregnancy
Abbreviations.
JCVI: Joint Committee on Vaccination and Immunisation
MBRRACE: MBRRACE-UK:
Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries
across the UK.
Question 1. What did MBRRACE say about flu & pregnancy in its first report in
2014?
Option List
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A
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1 in 11
women died from flu
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B
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1 in 11 women died from flu and flu vaccination could
have prevented ½ of the deaths
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C
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1 in 21 women died from flu
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D
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1 in 21 women died from flu and flu vaccination could
have prevented ½ of the deaths
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E
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1 in 51 women died from flu
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F
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1 in 51 women died from flu and flu vaccination could
have prevented ½ of the deaths
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Question 2. How many types of flu virus are recognised?
Option List
Question 3. Why can’t we have a universal flu vaccine?
List of statements.
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A
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The main
surface antigens are haemagglutinin and neuraminidase
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B
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The main surface antigens are haemolysin and
neuroxidase
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C
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The main surface antigens change frequently rendering
existing vaccines impotent
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D
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The main core antigens change frequently, rendering
existing vaccines impotent
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E
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The big drug companies avoid making a universal vaccine
for financial reasons.
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Question 4. When is flu’ most often a problem in the UK?
Option List
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A
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Spring
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B
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Summer
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C
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Autumn
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D
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Winter
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E
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None of the above.
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Question 5. How is flu spread?
Option List
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A
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via
aerosol or droplets from respiratory tract of an infected person
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B
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via aerosol or droplets from respiratory tract or
direct contact with respiratory secretions of an infected person
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C
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from getting drenched in cold winter showers
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D
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from thinking lascivious thoughts
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E
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from toilet seats
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Question 6. What is the incubation period for flu?
Option List
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A
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1 – 3
days
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B
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1 – 7 days
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C
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5 – 10 days
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D
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up to 2 weeks
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E
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up to 3 weeks
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Question 7. Who decides which viruses will be used in the vaccine for seasonal flu?
Option List
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A
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Department of Health
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B
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JCVI
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C
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the Prime Minister
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D
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the vaccine manufacturers
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E
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World Health Organisation
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Question 8. How long has flu vaccination been recommended in the UK?
Option List
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A
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since
the 1950s
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B
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since the 1960s
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C
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since the 1970s
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D
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since the 1980s
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E
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since the 1990s
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Question 9. What is the recommendation about when the vaccine should be given?
Option List
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A
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May - July
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B
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June - August
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C
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July - September
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D
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August - October
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E
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September - November
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Question 10. What advice is given about vaccination in pregnancy?
Option List
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A
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flu
vaccine is potentially teratogenic and should be avoided before 16 weeks
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B
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the vaccine contains an attenuated virus with no
evidence of risk in pregnancy
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C
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the vaccine recommended for pregnancy has no live viral
material and all pregnant women are encouraged to have the seasonal vaccine
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D
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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
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Question 11. What is the H1N1 virus?
Option List
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A
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The
avian virus which causes outbreaks of “bird flu”
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B
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The virus associated with “swine” flu, which caused a
pandemic in 2009
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C
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The virus associate with MERS, currently causing deaths
particularly in Saudi Arabia
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D
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The virus associated with simian flu
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E
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The virus associated with the pandemic of 1915.
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Question 12. What advice should be given to pregnant women about protection against
the H1N1 virus?
Option List
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A
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to have
vaccination against H1N1 in addition to the seasonal vaccine
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B
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to have vaccination against H1N1 in preference to the
seasonal vaccine
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C
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to await evidence of epidemic H1N1 flu and then have
vaccination against H1N1
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D
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to have the seasonal vaccine as it gives good
protection against H1N1
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E
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not to have any flu vaccination, but to take antiviral
drugs if symptoms of flu occur
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Question 13. Which of the following conditions have been linked to flu in pregnancy?
Conditions.
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A
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risk of flu complications for the mother
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B
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risk of low birthweight
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C
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risk of maternal death
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D
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risk of perinatal death
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E
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risk of
prematurity
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Question 14. What is the estimated uptake of flu vaccination by pregnant women in the
UK?
Pick the
best option from the following list.
Option List
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A
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20-30%
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B
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30-40%
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C
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40-50%
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D
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50-60%
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E
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> 60%
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Question 15. 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
Question 16. With regard to the probable explanation for the numbers of maternal
deaths from ‘flu in 2012 and 2013, which, if any, of the following statements
is true?
Option List
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A
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the
numbers reflected increased prevalence of ‘flu
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B
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the numbers reflected reduced prevalence of ‘flu
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C
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the numbers reflected improved uptake of ‘flu vaccine
in pregnancy
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D
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the numbers reflected the introduction of Tamiflu for
pregnant women with ‘flu
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E
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none of the above
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76. Term Breech Trial.
Abbreviations.
Cs: Caesarean section.
ECV: external cephalic version.
VB: vaginal birth.
VBD: vaginal breech delivery.
Question 1.
What is the
approximate incidence of breech presentation at 28 weeks?
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A
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3%
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B
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5%
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C
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7%
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D
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10%
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E
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12%
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F
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15%
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G
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20%
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Question
2.
What is the
approximate incidence of breech presentation at 32 weeks?
Option list. Use that from Q1.
Question
3.
What is the
approximate incidence of breech presentation at 36 weeks?
Question
4.
What is the
approximate incidence of breech presentation at 40 weeks?
Question
5.
What is the
approximate incidence of breech presentation at 40 weeks after
successful ECV at 36 weeks?
Don’t get bogged down looking for trick questions. You could argue that to be
successful, ECV would need to ensure that all babies were cephalic at T, but
the simplest meaning is that the baby was successfully turned at 36 weeks.
Question
6.
What is the
approximate incidence of cord prolapse with breech presentation in term
labour?
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A
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1%
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B
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3%
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C
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5%
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D
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7%
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E
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10%
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F
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12%
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G
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15%
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H
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20%
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I
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none of the
above
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Question
7.
Which, if any, of
the following are included in the RCOG’s PIF about the risks
associated with Cs?
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A
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damage to
bowel
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B
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damage to
bladder
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C
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damage to
ureter
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D
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damage to
partner from fainting / falling
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E
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endometriosis
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F
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gestational trophoblastic
disease
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G
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hysterectomy
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H
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miscarriage
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I
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placental
accreta
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J
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placenta
previa
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K
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postnatal
depression
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L
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PPH
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M
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scar
dehiscence
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N
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scar
herniation
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O
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scar pregnancy
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P
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stillbirth
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Q
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thromboembolism
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Question 8.
What are the 3 key
questions in the RCOG’s PIF that patients are advised to ask?
Question
9.
Which, if any, of
the following were in the main conclusions of the Term Breech Trial?
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A
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stillbirths
were significantly fewer with planned C section
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B
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neonatal
mortality was reduced significantly by planned C section
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C
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neonatal
morbidity was reduced significantly by planned C section
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D
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serious
neonatal morbidity was reduced significantly by planned C section
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E
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perinatal mortality
was reduced significantly by planned C section
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F
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perinatal
morbidity was reduced significantly by planned C section
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G
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serious perinatal
morbidity was reduced significantly by planned C section
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H
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none of the
above
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Question
10. Which, if any, of the following were in the main
conclusions of the follow up at 2 years
of the children in the Term
Breech Trial?
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A
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neonatal
mortality was reduced significantly by planned C section
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B
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neonatal morbidity
was reduced significantly by planned C section
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C
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planned C
section reduced the risk of child death up to 2 years
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D
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planned C
section reduced the risk of child morbidity up to 2 years
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E
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planned C
section improved child neurodevelopment at 2 years of age
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F
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none of the
above
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Question
11. Which, if any, of the following were included in the
conclusions of the Premoda Trial?
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A
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fetal mortality was reduced by planned cs
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B
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neonatal mortality was reduced by planned cs
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C
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neonatal morbidity was reduced by planned cs
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D
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surgeons’ sleep patterns were improved planned cs
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E
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Cs should be offered as superior to planned vaginal
delivery even in expert centres
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F
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VBD is a safe option in centres where it is commonly
practised and strict criteria are met
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Question
12. Which, if any, of the following are listed as
contraindications to VBD in GTG20a.
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A
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maternal height < 1.6 metres
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B
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maternal BMI > 30
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C
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gestation < 36 weeks
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D
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failed ECV at 36 weeks
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E
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reversion to breech presentation after successful ECV
at 36 weeks
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F
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estimated fetal weight > 3.5 kg.
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G
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estimated fetal weight <25th. centile.
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H
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hyperextended fetal neck
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I
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footling presentation
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