MRCOG tutorial Monday 16th. October 2023

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16 October 2023.

 

73	Role-play. TBA.
74	Role-play. TBA.
75	EMQ. Flu and pregnancy
76	EMQ. The Term Breech Trial

 

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

A	1 in 11 women died from flu
B	1 in 11 women died from flu and flu vaccination could have prevented ½ of the deaths
C	1 in 21 women died from flu
D	1 in 21 women died from flu and flu vaccination could have prevented ½ of the deaths
E	1 in 51 women died from flu
F	1 in 51 women died from flu and flu vaccination could have prevented ½ of the deaths

Question 2. How many types of flu virus are recognised?

Option List

A	3
B	5
C	10
D	15
E	>100

Question 3. Why can’t we have a universal flu vaccine?

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 change frequently rendering existing vaccines impotent
D	The main core antigens change frequently, rendering existing vaccines impotent
E	The big drug companies avoid making a universal vaccine for financial reasons.

Question 4. When is flu’ most often a problem in the UK?

Option List

A	Spring
B	Summer
C	Autumn
D	Winter
E	None of the above.

Question 5. How is flu spread?

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. What is the incubation period for flu?

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. Who decides which viruses will be used in the vaccine for seasonal flu?

Option List

A	Department of Health
B	JCVI
C	the Prime Minister
D	the vaccine manufacturers
E	World Health Organisation

Question 8. How long has flu vaccination been recommended in the UK?

Option List

A	since the 1950s
B	since the 1960s
C	since the 1970s
D	since the 1980s
E	since the 1990s

Question 9. What is the recommendation about when the vaccine should be given?

Option List

A	May - July
B	June - August
C	July - September
D	August - October
E	September - November

Question 10. What advice is given about vaccination in pregnancy?

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. What is the H1N1 virus?

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. What advice should be given to pregnant women about protection against the H1N1 virus?

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. 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

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

A	20-30%
B	30-40%
C	40-50%
D	50-60%
E	> 60%

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

A	0
B	5
C	10
D	15
E	20

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

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

 

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?

A	3%
B	5%
C	7%
D	10%
E	12%
F	15%
G	20%

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.

A	1%
B	2%
C	3%
D	4%
E	5%

Question 6.        What is the approximate incidence of cord prolapse with breech presentation in term

labour?

A	1%
B	3%
C	5%
D	7%
E	10%
F	12%
G	15%
H	20%
I	none of the above

Question 7.        Which, if any, of the following are included in the RCOG’s PIF about the risks

associated with Cs?

A	damage to bowel
B	damage to bladder
C	damage to ureter
D	damage to partner from fainting / falling
E	endometriosis
F	gestational trophoblastic disease
G	hysterectomy
H	miscarriage
I	placental accreta
J	placenta previa
K	postnatal depression
L	PPH
M	scar dehiscence
N	scar herniation
O	scar pregnancy
P	stillbirth
Q	thromboembolism

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?

A	stillbirths were significantly fewer with planned C section
B	neonatal mortality was reduced significantly by planned C section
C	neonatal morbidity was reduced significantly by planned C section
D	serious neonatal morbidity was reduced significantly by planned C section
E	perinatal mortality was reduced significantly by planned C section
F	perinatal morbidity was reduced significantly by planned C section
G	serious perinatal morbidity was reduced significantly by planned C section
H	none of the above

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?

A	neonatal mortality was reduced significantly by planned C section
B	neonatal morbidity was reduced significantly by planned C section
C	planned C section reduced the risk of child death up to 2 years
D	planned C section reduced the risk of child morbidity up to 2 years
E	planned C section improved child neurodevelopment at 2 years of age
F	none of the above

Question 11.    Which, if any, of the following were included in the conclusions of the Premoda Trial?

A	fetal mortality was reduced by planned cs
B	neonatal mortality was reduced by planned cs
C	neonatal morbidity was reduced by planned cs
D	surgeons’ sleep patterns were improved planned cs
E	Cs should be offered as superior to planned vaginal delivery even in expert centres
F	VBD is a safe option in centres where it is commonly practised and strict criteria are met

Question 12.    Which, if any, of the following are listed as contraindications to VBD in GTG20a.

A	maternal height < 1.6 metres
B	maternal BMI > 30
C	gestation < 36 weeks
D	failed ECV at 36 weeks
E	reversion to breech presentation after successful ECV at 36 weeks
F	estimated fetal weight > 3.5 kg.
G	estimated fetal weight <25th. centile.
H	hyperextended fetal neck
I	footling presentation