Tutorial 28th. November 2016

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28 November 2016.

18	EMQ. MBRRACE
19	EMQ. Cystic fibrosis
20	EMQ. Cancer incidence & mortality
21	Role-play. Communication skills. Pre-pregnancy counselling

18.         MBRRACE.

Lead-in.

The following questions relate to MBRRACE.

Pick one option from the option list.

Question 1.    What is the meaning of the acronym MBRRACE-UK”?

Question 2.      Which organisation does it replace?

Question 3.    How does it differ structurally from its predecessor?

Question 3.    How will the format of its reports differ from those of its predecessor?

Question 5.    When was MBRRACE’s first Report published?

Question 6.    What geographical innovation was included in its first Report?

Question 7.    What alterations were made to the timings of maternal death to be considered in its Reports?

Question 8.    What was the latest MMR reported by MBRRACE?

Question 9.    How did this compare with the final MMR reported by CMACE?

Question 10.  Which topics were reviewed in detail in the first MBRRACE Report?

Question 11.  Which topics were reviewed in detail in the second Report in 2015?

Question 12.  Which topics will be reviewed in detail in the third Report in 2016?

Question 13.  What is the definition of a maternal death?

Question 14.  What is the definition of a direct maternal death?

Question 15.  What is the definition of indirect maternal death?

Question 16.  What was the leading direct cause of death in the first Report?

Question 17.  What was the leading indirect cause of death in the first Report?

Question 18.  What were the 5 top causes of direct maternal death in the triennium 2011 – 2013?

Question 19.  What observation was made in the first Report about deaths due to hypertensive diseases?

Question 20.  Which condition was linked to 1 in 11 maternal deaths in the first Report in 2014?

Question 21.  What key messages were singled out in the first Report?

Question 22.  What key messages were singled out in the second Report in 2015?

Question 23.  What is the definition of the maternal mortality rate?

Question 24.  What is the definition of a “maternity”?

Question 25.  What is the definition of a live birth?

Question 26.  What is the definition of a stillbirth?

Question 27.  What is the definition of the maternal mortality ratio?

19.        This question is about cystic fibrosis.

There is no option list to make you behave in a model fashion: you have to decide the correct answer.

Question 1.

A woman is 8 weeks pregnant and known to be a carrier of cystic fibrosis.

Her husband is Caucasian.

What is the risk of the child having cystic fibrosis?

Question 2.

A healthy woman attends for pre-pregnancy counselling.

Her brother has cystic fibrosis. Her husband is Caucasian.

He has been screened for cystic fibrosis. The test was negative.

What is the approximate risk of them having a child with cystic fibrosis?

Question 3.

A healthy woman is a known carrier of cystic fibrosis.

She attends for pre-pregnancy counselling. Her husband has cystic fibrosis.

What is the risk of them having a child with CF?

Question 4.

A healthy woman attends for pre-pregnancy counselling. Her sister has had a child with cystic fibrosis.

What is her risk of being a carrier?

Question 5.

A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.

What is the risk that she is a carrier?

Question 6.

A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.

The partner’s risk of being a carrier is 1 in X.

What is the risk that she will have a child with CF?

Question 7.

A healthy Caucasian woman is 10 weeks pregnant.

Her husband is a known carrier of cystic fibrosis.

Which test would you arrange?

Question 8.

A woman attends for pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF in this way?

Question 9.

A woman and her husband are known carriers of cystic fibrosis.

What is the risk of them having an affected child?

Question 10.

A woman and her husband are known carriers of cystic fibrosis.

What can they do to reduce the risk of having an affected child?

Question 11.

A woman and her husband are known carriers of cystic fibrosis.

Can CVS exclude an affected pregnancy?

Question 12.

A woman with cystic fibrosis is planning pregnancy. Her husband is a carrier of cystic fibrosis. What is the risk of having an affected child?

Question 13.

A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised not to breastfeed because her breast milk will be protein-deficient due to malabsorption.

Is this advice correct?

Question 14.

A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised not to breastfeed because her breast milk will contain abnormally low levels of sodium.

Is this advice correct?

20. Cancer incidence and mortality.

Abbreviations.

NHL:      non-Hodgkin Lymphoma

Question 1.

Lead-in

Which is the most common female cancer?

Option List

A.	Bowel
B.	Breast
C.	Cervix
D.	Endometrium
E.	Lung

Question 2.

Lead-in

Which is the 2^nd. most common female cancer?

Option List

A.	Bowel
B.	Breast
C.	Cervix
D.	Endometrium
E.	Lung

Question 3.

Lead-in

Which is the 3^rd. most common female cancer?

Option List

A.	Bowel
B.	Breast
C.	Cervix
D.	Endometrium
E.	Lung

Question 4.

Lead-in

Which is the 4^th. most common female cancer?

Option List

A.	Bowel
B.	Breast
C.	Cervix
D.	Endometrium
E.	Lung

Question 5.

Lead-in

Which is the 5^th. most common female cancer?

Option List

A.	Cervix
B.	Malignant melanoma
C.	Non-Hodgkin’s lymphoma
D.	Ovary
E.	Vulva

Question 6.

Lead-in

Which is the 6^th. most common female cancer?

Option List

A.	Cervix
B.	Non-Hodgkin’s lymphoma
C.	Ovary
D.	Skin
E.	Vulva

Question 7.

Lead-in

Where does cervical cancer feature in the list of the most common female cancers?

Option List

A.	10th.
B.	11th.
C.	15th.
D.	20th.
E.	24th.

Question 8.

Lead-in

Where does vulval cancer feature in the list of the most common female cancers?

Option List

A.	10th.
B.	12th.
C.	16th.
D.	20th.
E.	none of the above

Question 9.

Lead-in

Which is the most common cancer causing female death in the UK?

Option List

A.	Breast
B.	Bowel
C.	Lung
D.	Ovary
E.	Pancreas

Question 10.

Lead-in

Which is the 2^nd. most common cancer causing female death in the UK?

Option List

A.	Breast
B.	Bowel
C.	Lung
D.	Ovary
E.	Pancreas

Question 11.

Lead-in

Which is the 3^rd. most common cancer causing female death in the UK?

Option List

A.	Breast
B.	Bowel
C.	Lung
D.	Ovary
E.	Pancreas

Question 12.

Lead-in

Which is the 4^th. most common cancer causing female death in the UK?

Option List

A.	Brain
B.	Oesophagus
C.	Ovary
D.	Pancreas
E.	Uterus

Question 13.

Lead-in

Which is the 5^th. most common cancer causing female death in the UK?

Option List

A.	Brain
B.	Oesophagus
C.	Ovary
D.	Pancreas
E.	Uterus

Question 14.

Which is the 6^th. most common cancer causing female death in the UK?

Option List

A.	Brain
B.	Oesophagus
C.	Ovary
D.	Pancreas
E.	Uterus

Question 15.

Lead-in

The incidence of cervical cancer has fallen from the late 1970s until now. What is the approximate figure for the fall?

Option List

A.	10%
B.	25%
C.	50%
D.	60%
E.	75%

Question 16.

Lead-in

The incidence of cervical cancer fell in the past decade. What is the approximate figure for the fall?

Option List

A.	5%
B.	10%
C.	15%
D.	20%
E.	25%

Question 17.

Lead-in

What proportion of cervical cancer is diagnosed in women < 45 years?

Option List

A.	20%
B.	30%
C.	40%
D.	50%
E.	60%

Question 18.

Lead-in

When was routine HPV vaccination of girls introduced in the UK?

Option List

A.	2000
B.	2002
C.	2004
D.	2006
E.	2008

Question 19.

Lead-in

From what year might we expect to see a reduction in cervical cancer incidence as a result of the HPV vaccination programme?

Option List

A.	2020
B.	2025
C.	2030
D.	2040
E.	2050

Question 20.

Lead-in

When was routine HPV vaccination of boys introduced in the UK?

Option List

A.	2010
B.	2011
C.	2012
D.	2014
E.	None of the above

21.  Basic communication skills. Role-play.

Candidate's Instructions.

You are a 5^th. year SpR. You are about to see Mrs. Jane Brown who has been referred for pre-pregnancy counselling as she is planning her first pregnancy and has a brother with cystic fibrosis.