Monday, 30 November 2015

Tutorial 30th. November 2015

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30th. November 2015.

10
SBA. Perinatal morbidity and mortality
11
EMQ. Maternal mortality
12
SBA. Cancer incidence and mortality.
13
SBA. Cowden syndrome.
14
Communication skills. Recessive inheritance

10.   Perinatal morbidity and mortality
Abbreviations.
EPND:           extended perinatal death.
EPNMR:        extended perinatal mortality rate.
NMR:            neonatal mortality rate.
NND:             neonatal death.
PND:              perinatal death.
PNMR:          perinatal mortality rate.
SB:                 stillbirth
SBR:              stillbirth rate.

Question 1.
Lead-in
What was the UK stillbirth rate in 2013?
Option List
A.       
4.2 per 1,000 births
B.       
4.2 per 1,000 live births
C.       
5.5 per 1,000 births
D.       
5.5 per 1,000 live births
E.        
none of the above

Question 2.
Lead-in
What was the UK perinatal mortality rate in 2013?
Option List
A.       
5.50 per 1,000 births
B.       
5.50 per 1,000 live births
C.       
6.04 per 1,000 births
D.       
6.04 per 1,000 live births
E.        
none of the above

Question 3.
Lead-in
What was the UK extended perinatal mortality rate in 2013?
Option List
A.       
5.90 per 1,000 births
B.       
5.90 per 1,000 live births
C.       
6.04 per 1,000 births
D.       
6.04 per 1,000 live births
E.        
none of the above

Question 4.
Lead-in
Which, if any of the following statements is true about the change in the stillbirth rate from 2003 to 2013?
Option List
A.       
The SBR rose by 5%, attributable to the increase in the average maternal age.
B.       
The SBR rose by 10%, attributable to the increase in the average maternal age.
C.       
The SBR fell by about 10%.
D.       
The SBR fell by about 20%.
E.        
The SBR fell by about 50%.

Question 5.
Lead-in
Which, if any of the following statements is true about the change in the perinatal mortality rate from 2003 to 2013?
Option List
A.       
The PNMR rose by 10%, attributable to the increase in the average maternal age.
B.       
The PNMR rose by 10%, attributable to the increase in the average maternal age.
C.       
The PNMR fell by about 10%.
D.       
The PNMR fell by about 10%.
E.        
The PNMR fell by about 10%.

Question 6.
Lead-in
Which, if any of the following statements is true about the SBR and NMR in relation to the PNMR in 2013?
Option List
A.       
The SBR: NMR ratio is about 1.0 : 10.
B.       
The SBR: NMR ratio is about 1.0 : 5.
C.       
The SBR: NMR ratio is about 1.0 : 1.
D.       
The SBR: NMR ratio is about 1.5 : 1.
E.        
The SBR: NMR ratio is about 5.0 : 1.

Question 7.
Lead-in
What is the definition of stillbirth?
Option List
F.        
A baby delivered at or after 20+0 weeks gestational age showing no signs of life, irrespective of when the death occurred
G.       
A baby delivered at or after 22+0 weeks gestational age showing no signs of life, irrespective of when the death occurred
H.       
A baby delivered at or after 24+0 weeks gestational age showing no signs of life, irrespective of when the death occurred
I.         
A baby delivered at or after 24+0 weeks gestational age showing no signs of life, the death having occurred after 16+0 weeks
J.         
A baby delivered at or after 24+0 weeks gestational age showing no signs of life, the death having occurred after 20+0 weeks

Question 8.
Lead-in
What is the definition of stillbirth if the gestation is unknown?
Option List
A.       
A baby with no signs of life at birth with birthweight ≥ 100 gm.
B.       
A baby with no signs of life at birth with birthweight ≥ 200 gm.
C.       
A baby with no signs of life at birth with birthweight ≥ 300 gm.
D.       
A baby with no signs of life at birth with birthweight ≥  400 gm.
E.        
A baby with no signs of life at birth with birthweight ≥ 500 gm.

Question 9.
Lead-in
What is the definition of neonatal death?
Option List
A.       
A live-born baby who died before 7 completed days after birth.
B.       
A live-born baby who died before 14 completed days after birth.
C.       
A live-born baby who died before 28 completed days after birth.
D.       
A live-born baby who died before 56 completed days after birth.
E.        
None of the above.

Question 10.
Lead-in
What is the definition of late fetal loss?
Option List
A.       
Still birth as a result of FDIU after 34 weeks
B.       
Still birth as a result of FDIU after 36 weeks
C.       
Still birth as a result of FDIU after 38 weeks
D.       
A baby delivered between 20+0 and 23+6 weeks with no signs of life
E.        
A baby delivered between 22+0 and 23+6 weeks with no signs of life

Question 11.
Lead-in
A baby is born at 18 weeks gestation. The midwife believes that it attempted to breathe and that she detected a pulse. The baby was pronounced dead by the paediatrician on her arrival two minutes later. How would the death be categorised for the purposes of notifying MBRRACE?
Option List
A.       
Early neonatal death
B.       
Late fetal loss
C.       
Miscarriage
D.       
Stillbirth
E.        
None of the above.

Question 12.
Lead-in
A woman with no antenatal care arrives in labour and delivers a baby 10 minutes later. The midwife believes that it attempted to breathe and that she detected a pulse. The baby was pronounced dead by the paediatrician on her arrival two minutes later. The woman has no idea of the date of her LMP. The baby weighs 350 gm.
How would the death be categorised for the purposes of notifying MBRRACE?
Option List
A.       
Early neonatal death
B.       
Late fetal loss
C.       
Miscarriage
D.       
Stillbirth
E.        
None of the above.

Question 13.
Lead-in
Which of the following apply to the definition of early neonatal death?
Option List
A.       
A neonatal death occurring within 24 hours of birth
B.       
A neonatal death occurring within 48 hours of birth
C.       
A neonatal death occurring within  6 completed days of birth
D.       
A neonatal death occurring within  14 completed days of birth
E.        
A neonatal death occurring within  28 completed days of birth

Question 14.
Lead-in
What is the time limit used in the definition of late neonatal death?
Option List
A.       
A neonatal death occurring within  24 days of birth
B.       
A neonatal death occurring within  28 days of birth
C.       
A neonatal death occurring within  56 days of birth
D.       
A neonatal death occurring within  12 weeks of birth
E.        
A neonatal death occurring within  24 weeks of birth

Question 15.
Lead-in
What is the definition of perinatal death?
Option List
A.       
any stillbirth or neonatal death
B.       
any stillbirth or early neonatal death
C.       
any stillbirth or late neonatal death
D.       
any stillbirth, neonatal death or late fetal loss
E.        
any stillbirth, early neonatal death or early fetal loss

Question 16.
Lead-in
What is the definition of extended perinatal death?
Option List
A.       
Any stillbirth or early neonatal death
B.       
Any stillbirth or late neonatal death
C.       
Any stillbirth or neonatal death
D.       
Any stillbirth or neonatal death up to 6 weeks from birth
E.        
Any stillbirth or neonatal death up to 12 months from birth

Question 17.
Lead-in
Which coding system is used for stillbirths and neonatal death?
Option List
A.       
CODAC
B.       
CODEC
C.       
KODAC
D.       
KODAK
E.        
KOJAK

Question 18.
Lead-in
What proportion of babies in the extended perinatal death category had post-mortem examinations?
Option List
A.       
< 10%
B.       
10 – 24%
C.       
25 – 49%
D.       
50 – 74%
E.        
≥ 75%

Question 19.
Lead-in
Which ethnic group had the highest EPNR?
Option List

  1.  
Afro-Caribbean

  1.  
Arabic

  1.  
Asian

  1.  
Eastern European

  1.  
Eskimos

Question 20.
Lead-in
Which age group has the highest SBR?
Option List

  1.  
< 20

  1.  
20 - 29

  1.  
30 - 34

  1.  
35 - 39

  1.  
≥40

Question 21.
Lead-in
Which age group has the highest EPNR?
Option List

  1.  
< 20

  1.  
20 - 29

  1.  
30 - 34

  1.  
35 - 39

  1.  
≥40

Question 22.
Lead-in
What percentage of women with stillborn babies smoked throughout pregnancy?
Option List

  1.  
5%

  1.  
10%

  1.  
11- 15%

  1.  
16 - 20%

  1.  
21 - 30%

Question 23.
Lead-in
What percentage of women with babies who died in the neonatal period smoked throughout pregnancy?
Option List

  1.  
5%

  1.  
10%

  1.  
11- 15%

  1.  
16 - 20%

  1.  
21 - 30%

Question 24.
Lead-in
What percentage of women with stillborn babies had BMI > 30?
Option List

  1.  
10%

  1.  
20%

  1.  
25%

  1.  
30%

  1.  
35%

11.         Maternal Mortality.

Lead-in.
The following scenarios relate to maternal mortality.
Pick the option that best answers the question in each scenario.
Each option can be used once, more than once or not at all.
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.
Abbreviations.
MMR:      Maternal Mortality Rate.
MMRat:  Maternal Mortality Ratio.
SUDEP:    Sudden Unexplained Death in Epilepsy.           

Scenario 1.
What is a Maternal Death?
Scenario 2.
A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of death is it?
Scenario 3.
A woman dies from a ruptured appendix at 10 weeks’ gestation. What kind of death is it?
Scenario 4.
A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?
Scenario 5.
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?
Scenario 6.
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?
Scenario 7
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?
Scenario 8
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?
Scenario 9
What is a “maternity”?
Scenario 10
What is the definition of the Maternal Mortality Rate?
Scenario 11
What is the Maternal Mortality Ratio?
Scenario 12
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?
Scenario 13
A woman who has been the subject of domestic violence is killed at 12 weeks’ gestation by her partner. What kind of death is it?
Scenario 14
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 abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?
Scenario 15
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?
Scenario 16
Could a maternal death from malignancy be classified as “Direct”?
Scenario 17
Could a maternal death from malignancy be classified as “Indirect”?
Scenario 18
Could a maternal death from malignancy be classified as “Coincidental”?

12.   SBA. Cancer incidence and mortality.

Question 1.
Lead-in
What is the most common female cancer?
Option List
A
Bowel
B
Breast
C
Cervix
D
Endometrium
E
Lung

Question 2.
Lead-in
What is the 2nd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung

Question 3.
Lead-in
What is the 3rd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung

Question 4.
Lead-in
What is the 4th. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung

Question 5.
Lead-in
What is the 5th. most common female cancer?
Option List
A.       
Cervix
B.       
Non-Hodgkin’s lymphoma
C.       
Ovary
D.       
Skin
E.        
Vulva

Question 6.
Lead-in
What is the most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas

Question 7.
Lead-in
What is the 2nd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas

Question 8.
Lead-in
What is the 3rd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas

Question 9.
Lead-in
What is the 4th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus

Question 10.
Lead-in
What is the 5th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus

13.         Cowden syndrome.
Scenario 1.
Lead in.
Which feature is associated with Cowden syndrome?
Option list.
A.     albinism
B.     hamartoma
C.     hammer-toe
D.     hypertrichosis
E.     stammer
Scenario 2.
Lead in. Which condition has the highest risk of occurrence in women with Cs?
Option list.
A.     breast cancer
B.     bowel cancer
C.     congenital absence of Müllerian tract derivatives
D.     hypertension
E.     hypothyroidism
Scenario 3.
Lead in. Which gynaecological cancer is a particular risk for women with Cs?
Option list.
A.     Bartholin’s gland cancer
B.     cervical cancer
C.     choriocarcinoma
D.     endometrial cancer
E.     vulval cancer
Scenario 4.
Lead in. Which cancer has increased risk for men with Cs?
Option list.
A.     breast cancer
B.     colon cancer
C.     melanoma
D.     renal cancer
E.     thyroid cancer
F.      all of the above

14.   Communication skills.


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