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53
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Tutorial.
Neonatal screening
|
|
54
|
SBA. Myocardial infarction.
|
|
55
|
EMQ. APH.
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56
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EMQ. Folic acid & pregnancy
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53. Neonatal screening.
The
slides that will be used are on Dropbox.
54. SBA. Myocardial infarction.
Topic. Myocardial infarction.
Abbreviations.
MBRRACE: MBRRACE-UK: Mothers and Babies: Reducing Risk
through Audits and Confidential Enquiries in the UK
MBRRACE14: MBRRACE
1st. Report. Saving Lives, Improving Mothers’ Care Lessons
learned to inform future maternity care from the UK and Ireland Confidential
Enquiries into Maternal Deaths and Morbidity 2009-012. Published
December 2014
MBRRACE15: MBRRACE
2nd. Report. Saving Lives, Improving Mothers’ Care
Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform
maternity care from the UK and Ireland Confidential Enquiries into Maternal
Deaths and Morbidity 2009-13.
Published December 2015
MI: myocardial
infarction
MMRpt: Maternal
Mortality Report 2006-8: “Saving Mothers’
Lives. Reviewing maternal deaths to make motherhood safer: 2006-2008
Question 1.
Lead-in
Where did
cardiac disease rank in the direct and indirect causes of maternal death for
the years 2011-13 in MBRRACE15?
Option List
|
A.
|
1
|
|
B.
|
2
|
|
C.
|
3
|
|
D.
|
4
|
|
E.
|
5
|
Question 2.
Lead-in
What has
happened to the incidence of maternal death due to cardiac disease in the UK
since 1985?
Option List
|
A.
|
it has
roughly increased by a factor of 1.5
|
|
B.
|
it has
roughly increased by a factor of 2.0
|
|
C.
|
it has
roughly increased by a factor of 3.0
|
|
D.
|
it has
roughly reduced by a quarter
|
|
E.
|
it has
roughly reduced by a half
|
Question 3.
Lead-in
What was
the estimated prevalence of MI in the UKOSS survey?
There is
no option list – what is your figure?
Question 4.
Lead-in
What risk
factors for MI were identified in the UKOSS survey?
Question 5.
Lead-in
What
underlying pathological conditions were noted in the UKOSS survey?
Question 6.
Lead-in
What risk
factors for MI have been mentioned in recent Maternal Mortality Reports?
There is
no option list.
Write your
list and you can compare it with the list in the answers.
Question 7.
Lead in
What risk
factors for MI have been reported in other publications?
A big
question!! Write your list and compare it with mine.
Question 8.
Lead-in
How are
the causes of MI normally categorised and what are the sub-headings in
the main categories.
You know
this or could work it out, certainly the main headings and most of the
sub-headings.
Write your
list and you can compare it with the answer.
Question 9.
Lead-in
What ECG
criteria are used to categorise acute myocardial infarction?
Option List
|
A.
|
presence
of arrhythmia
|
|
B.
|
presence
of QT interval prolongation
|
|
C.
|
presence of ST segment depression
|
|
D.
|
presence
of ST segment elevation
|
|
E.
|
presence
of T wave inversion
|
Question
10.
Lead-in
What ECHO
criteria are used to categorise acute myocardial infarction?
Option List
|
A.
|
presence
of arrhythmia
|
|
B.
|
presence
of atrial dilatation
|
|
C.
|
presence of ventricular dilatation
|
|
D.
|
presence
of mitral valve reflux
|
|
E.
|
none of
the above
|
Question 11.
Lead-in
With
regard to coronary artery dissection, which of the following statements are
false?
Statements.
|
A.
|
only
occurs in women with coronary artery disease
|
|
B.
|
mainly occurs in the right anterior descending branch
of the coronary artery
|
|
C.
|
is most common in the puerperium
|
|
D.
|
is particularly associated with the use of ergometrine
for management of the 3rd. stage and its complications
|
|
E.
|
is associated with mortality rates ≥ 50%, mainly due to
late diagnosis or mis-diagnosis
|
Option List
|
1.
|
A + B +
C
|
|
2.
|
A + C +
D
|
|
3.
|
B + D
|
|
4.
|
B + D +
E
|
|
5.
|
A + B + C +
D + E
|
Question 12.
Lead-in
Which ECG
feature is particularly used to diagnose MI?
Option List
|
A.
|
presence
of arrhythmia
|
|
B.
|
presence
of QT interval prolongation
|
|
C.
|
presence
of ST segment depression
|
|
D.
|
presence
of ST segment elevation
|
|
E.
|
presence
of T wave inversion
|
Question 13.
Lead-in
Which
blood markers are best for the diagnosis of MI?
Markers
|
1.
|
Treponemin
A
|
|
2.
|
Treponemin
B
|
|
3.
|
Troponin
A
|
|
4.
|
Troponin
I
|
|
5.
|
Troponin
T
|
Option List
|
A
|
1 + 2
|
|
B
|
3
|
|
C
|
3 + 4
|
|
D
|
3 + 5
|
|
E
|
4 + 5
|
|
F
|
none of the above
|
Question 14.
Lead-in
Which of
the following statements are true about the blood markers that are best for the
diagnosis of MI?
Statements
|
1.
|
Their
levels are normal in normal pregnancy
|
|
2.
|
Their
levels are increased from about 28 weeks, making pregnancy-specific ranges
mandatory
|
|
3.
|
Their
levels rise with prolonged labour
|
|
4.
|
Their levels
rise with Caesarean section
|
|
5.
|
Their
levels can be elevated in pregnancy-induced hypertension and PET
|
|
6.
|
Their
levels can be elevated in pulmonary embolism
|
Option List
|
A
|
1 + 3
|
|
B
|
1 + 3 + 4
|
|
C
|
2 + 3 + 4
|
|
D
|
1 + 3 + 5
|
|
E
|
1 + 5 + 6
|
|
F
|
none of the above
|
Question 15
Lead-in
How many
maternal deaths due to cardiac disease were reported for the years 2010-12 in
MBRRACE14?
Option List
|
A.
|
10
|
|
B.
|
26
|
|
C.
|
38
|
|
D.
|
47
|
|
E.
|
54
|
Question 16.
What were
the main causes of maternal death from cardiac disease in 2010-12?
List of possible causes.
|
A.
|
aortic
dissection
|
|
B.
|
atherosclerosis
|
|
C.
|
atrial fibrillation
|
|
D.
|
coronary thrombosis
|
|
E.
|
myocardial
infarction
|
|
F.
|
peripartum
cardiomyopathy
|
|
G.
|
sudden
adult death syndrome
|
|
H.
|
ventricular
fibrillation
|
Option List
There is no
option list.
Question 17.
How many
maternal deaths were attributed to myocardial infarction in MBRRACE15?
Option List
|
A.
|
0
|
|
B.
|
5
|
|
C.
|
8
|
|
D.
|
12
|
|
E.
|
36
|
Question 18.
Lead-in
What are
the latest figures for the split between congenital and acquired disease in
deaths due to cardiac disease and what years do they derive from?
Option Lists
List 1
List 2
|
A
|
3: 100
|
|
F
|
2006-08
|
|
B
|
6: 100
|
|
G
|
2007-09
|
|
C
|
13: 100
|
|
H
|
2008-10
|
|
D
|
31: 100
|
|
I
|
2009-11
|
|
E
|
50: 100
|
|
J
|
2010-12
|
Question 19.
Lead-in
Which
causes of death have occupied the number 1 spot in the ranking order of the
causes of direct and indirect maternal deaths in the past 30 years?
List of causes.
|
1.
|
AFE
|
|
2.
|
anaesthesia
|
|
3.
|
early
pregnancy: ectopic, miscarriage & TOP
|
|
4.
|
cardiac
disease
|
|
5.
|
haemorrhage
|
|
6.
|
PET,
eclampsia, pregnancy-induced hypertension
|
|
7.
|
psychiatric
disease including suicide
|
|
8.
|
sepsis
|
|
9.
|
thromboembolism/
thrombosis
|
55. EMQ. APH.
Antepartum haemorrhage.
Lead-in.
The following scenarios relate to APH.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
ART: assisted reproduction technology
FGR: fetal growth restriction
PET: pre-eclampsia
Option list.
A.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the baby
B.
genital tract bleeding ≥ 500 ml. from 24 weeks
until the delivery of the placenta.
C.
genital tract bleeding ≥ 500 ml. from 24 weeks,
or earlier if the baby is live-born, until the delivery of the baby.
D.
1
E.
2
F.
3
G.
4
H.
5
I.
6
J.
7
K.
8
L.
9
M. 10
N.
15
O.
20
P.
30
Q.
50
R.
100
S.
500
T.
1,000
U.
true
V.
false
W. none
of the above
Scenario 1.
What is the definition of APH?
Scenario 2.
What is the upper limit in ml.
for minor APH?
Scenario 3.
What is the upper limit in ml.
of major haemorrhage?
Scenario 4.
What is the % risk of recurrence after 1 abruption?
Scenario 5.
What is the % risk of recurrence after 2 abruptions?
Scenario 6.
What is the major risk factor
for placental abruption?
Scenario 7
List 10 risk factors for
placental abruption.
Scenario 8
List 6 risk factors for
placenta previa.
Scenario 9
In what % of pregnancies does
APH occur?
Scenario 10
With regards to steps that can be taken to reduce the
incidence of APH, what things would you include in a viva in the OSCE?
56. EMQ. Folic acid & pregnancy.
Lead-in.
The following scenarios relate to folic acid and
pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
No option list to make your life harder!
Scenario 1.
What is the incidence of NTD in
the UK?
Scenario 2.
What is the risk of an affected
sibling for the woman who becomes pregnant after having a baby with NTD?
Scenario 3.
Which foods contain significant amounts of folic acid?
Scenario 4.
What percentage of folic acid
is destroyed by cooking / food storage?
How many people in the UK are
estimated to have a folate-deficient diet?
Scenario 5.
What is the significance of the
MTHFR (Methylenetetrahydrofolate
reductase gene)?
Scenario 6.
What is the significance of the Meckel-Gruber syndrome to
this issue?
Scenario 7.
By what gestation has the neural tube closed?
Scenario 8.
What proportion of pregnant women have taken folic acid
preconceptually?
Scenario 9.
What dose and duration of folic acid is advised for routine
periconceptual use?
Scenario 10.
List the women to whom a higher dose should be offered.
Scenario 11.
How effective is periconceptual
folic acid consumption in reducing NTD risk in the low-risk population?
Scenario 12.
How effective is periconceptual
folic acid consumption in reducing NTD risk in women who have had an affected
baby?
Scenario 13.
What is the risk of NTD
recurrence for a woman who has had two affected babies?
Scenario 14.
What is the risk of NTD in Ireland?
Scenario 15.
What is the significance of the name “Bukowski” in relation
to folic acid?
Scenario 16.
What effect does periconceptual
folic acid have on the risk of stillbirth?
Scenario 17.
What effect does periconceptual folic acid have on the risk
of autistic spectrum disorder?
Scenario 18.
What effect does periconceptual folic acid have on maternal
haemoglobin levels?
Scenario 19.
What recommendations have been made by the RCOG to improve
folic acid levels in pregnancy?
Scenario 20.
Which names are of particular importance in the history of
folic acid and NTD?
Scenario 21.
What neurological condition has
been thought potentially problematic with folic acid supplementation?
sir i m starting to solve this blog from jan2016.....but not geting answers .....I M OBGY consultant in India....n preparing for part II MRCOG for Sep 2016. I need your valuable guidance from how to study to what to study?
ReplyDeleteI have emailed you previously for dropbox.....pls let me know the answers from jan 2016...
You need to send me your answers. Then I link you to the answers, which are on Dropbox. I want to know that you have tackled the questions as you don't get much benefit from just reading the answers.
DeleteIn the exam you will not be able to answer everything. This leaves you with "intelligent guessing" as the best way to maximise marks and the only way to get good at this is to practise.
It is also important to answer the questions without preparation. This is what you have to do in the exam, so it is what you should do now. Tom.