- Email: [email protected]
JOGC Self-Assessment Test
SOGC CONTINUING PROFESSIONAL DEVELOPMENT
JOGC Self-Assessment Test Objective journal of Obstetrics and Gynaecology Canada This Self-Directed Learning Exercise is provided to assist SOGC members in their continuing professional development. Thi activity qualifies for credits under Section 3 of the Maintenance of
Certification Program ofthe Royal Colkge ofPhysicians and SU1"geons of Canada. " Addiriona credits under Section 4 of the Maintenance of Certification Program may be earned through the development of a personal learning project related to this educational subject.
offers a new opportunity for self-assessment. The following educational exercise was compiled by the editorial board to provide JOGC readers with the opportunity to review their understanding of the information contained in guidelines published in JOGC over the past 24 months. The intent of this reflective learning exercise is to assist your integmion of the knowledge contained in these guidelines into daily clinical practice. Answers to the questions, and direction to the articles from which they were derived, can be found on pages 1053-1054. We welcome your participation in and your evaluation of this educational exercise.
To complete this self-directed learning exercise: • Complete the Self-Directed Learning Exercise • Send the answer sheet back for acknowledgement of the exercise • Keep on file the Self-Directed Learning Exercise for auditing purposes
of<
For more information, please contact us:
SOGe
780 Echo Drive Ottawa, Ontario K I S 5R7 Phone: 1·800·561·2416 Fax: (613) 730·4314 Web: www.sogc.org
PERFECTIONNEMENT PROFESSIONNEL PERMANENT DE LA SOGC
Test d'auto-evaluation du JOGC Objectif Cet exercice d' apprentissage aurogere se veut un instrument de formation medicale continue au service des membres de Ia SOGe. Lactivite qui suit permet d' obtenir des credits au titre de la section 3 du
Programme de maintien du certificat du College royal des medecins et chirurgiens du
Canada. " Des credits additionnels peuvent etre obtenus au titre de la section 4 du Programme de maintien dll cerrificat dans Ie cadre dll projet d'apprentissag individud lie ace sujet.
1046
Le journal dobstetrique et gynicologie du Canada vous offre une nouvelle occasion de vous auto-evaluer. Cet exercice a ete prepare par les membres du conseil de redaction, dans Ie but de donner I'occasion aux lectrices et aux lecteurs du JOGC de passer en revue I'information presentee dans les directives publiees par Ie JOGC au cours des 24 derniers mois. Cet exercice d'apprentissage vise a vous aider a integrer les connaissances transmises par ces directives dans votre pratique c1inique quotidienne. Les reponses aux questions et les references auxquelles e1les vous renvoient se trouvent aux pages 1053-1054. Votre participation a cet exercice et votre evaluation seront grandement appreciees.
Pour completer cet exercice d'apprentissage autogere: • Faites I'exercice d'apprentissage autogere • Faites-now parvenir la feuille de reponse comme preuve que vous avez fait I'exercice • Conservez I'exercice d'apprentissage autogere dans vos dossiers pour verification
of<
Pour de plus amples renseignements, veuillez communiquer avec nous :
SOGe
780, promenade Echo Ottawa (Ontario) KIS 5R7 Tel.: 1-800-561·2416 Telec. : (613) 730-4314 Web: www.sogc.org CE312
QUESTIONS Thank you for taking the time to participate in this Self-Assessment Test. Once you have completed the exercises, please clip out the answer portion, place in an envelope and mail. No scoring wiD be recorded. Answers to these questions can be found in this issue on pages 1053-4.
1
a) Mode of delivery b) Fetal growth c) Risk of prelabour rupture of membranes d) Risk of threatened preterm labour
2
Immunoprophylaxis for the infant of a hepatitis B surface antigen-positive woman includes: a) hepatitis B vaccination b) hepatitis B immunoglobulin c) hepatitis B e vaccination d) hepatitis B vaccination and hepatitis B immunoglobulin e) hepatitis B e vaccination and hepatitis B immunoglobulin.
4
c) To take some dimenhydrinate, so she will not vomit d)To take ipecac syrup, to avoid an overdose
7
If given between 49 and 72 hours after a single episode of unprotected intercourse, levonorgestrelonly emergency contraception can reduce the risk of pregnancy by what approximate percentage?
d) None of the above e) All of the above
8
b)85% d)30%
5
b) is masked by an associated prolapse c) occurs infrequently d) is associated with urinary hesitancy e) occurs late in the day
9
6
Sally, 32 years old, requested emergency contraception following unprotected sex. She was prescribed 2 tablets of levonorgestrel, 0.75 mg each, 1 tablet to be taken immediately and 1 tablet to be taken 12 hours later. Sally accidentally took both tablets together. What is the best advice for Sally?
A 39-year-old woman with HIV requests advice regarding prenatal genetic testing. Which investigation is most appropriate? a) Combined, integrated, or triple marker screening b) Anatomic ultrasound at 18 to 20 weeks' gestation c) Chorionic villus sampling d) Amniocentesis
10
Which of the following physiologic changes is observed in pregnant women compared to women who are not pregnant? a) Higher heart rate at rest b) Higher heart rate during sub maximal exercise c) Blunted heart rate response to maximal exercise d) Reduced heart rate reserve e) All of the above f) Only three of the above
Which of the following methods are recommended to prescribe and monitor the intensity of exercise during pregnancy? a) Pulse rate target zones revised for pregnant women b) Borg's perception of exertion scale c) The "talk test" d)AlI of the above e) Only two of the above
Latent stress incontinence refers to incontinence that: a) is inhibited by the patient
a) 95% c) 60%
The risk of hepatitis C vertical transmission is increased by which of the following maternal characteristics? a) Active liver disease b) Co-infection with HIV c) Hepatitis C virus ribonucleic acids levels greater than 1Q6/m L
Which of the following is true regarding the effects of properly prescribed maternal exercise on lactation? a) The quantity of breast milk is reduced. b)The composition of breast milk is altered. c) Infant growth is negatively affected. d) None of the above
3
b)To do nothing, because a double dose is as effective as 2 single doses
The presence of uterine fibroids in pregnancy is likely to affect which of the following?
11
Transient or permanent evidence of ovarian failure has been reported in what proportion of women following uterine artery embolization for fibroids? a) Less than 1% b) Up to 10% c) More than 20% d) Has never been reported
a) To take another tablet in 12 hours
1047
12
13
14
15
b) Repeat courses of corticosteroids on a weekly basis have been definitely shown to reduce respiratory distress syndrome without adverse perinatal outcome.
The strength of an association between a factor and a disease is best measured by: a) the incidence of the disease in the entire population b) the incidence of the disease in the exposed c) the prevalence of the factor d) the relative risk e) the attributable risk Which of the following is considered the best time for a previously inactive woman to begin a new prenatal exercise program? a) Immediately after learning that she is pregnant b)At the start of the second trimester c) At the start of the third trimester d)Mter receiving medical clearance from her obstetrical care provider e) band d Which of the following is considered first-line therapy for women with hirsutism who are not attempting to conceive? a) Oral contraceptives b) Antiandrogens c) Combined oral contraceptives plus antiandrogens d) Insulin-sensitizing agents Urodynamic testing prior to surgery for urinary incontinence is not necessary for women with:
c) One should consider giving corticosteroids between 20 and 34 weeks' gestation to women at risk of preterm delivery. d) Corticosteroids should not be given to women with premature rupture of membranes.
19
a) Mter miscarriage, threatened abortion, or induced abortion after 12 weeks' gestation, a woman should be given 120 p.g anti-D. b)Anti-D should be given to non-sensitized D-negative women following ectopic pregnancy. c) At amniocentesis, anti-D 300 p.g should be given to non-sensitized D-negative women. d) Verbal or written informed consent must be obtained prior to administration of anti-D. e) A woman with "weak 0" should not receive anti-D.
20
a) mixed symptoms of urge and stress incontinence b) pure urge incontinence d) pure stress incontinence
b) It is too late for Barb to use any form ofEC, since EC should be used within 72 hours of unprotected intercourse.
e) pelvic organ prolapse accompanying incontinence The public health impact of an exposure is best measured by: a) the b) the c) the d) the e) the
17
incidence of the disease in the entire population incidence of the disease in the exposed prevalence of the factor relative risk attributable risk
The rate of hepatitis B in the prenatal population is 1%. IdentifY the most important factor in determining the risk for vertical transmission. a) Hepatitis b) Hepati tis c) Hepatitis d) Hepatitis
18 1048
c) At this point, only an IUD will be effective in preventing pregnancy. d) Barb should wait to see if she gets her menstrual period before taking any further action.
21
a) Appropriate courses of corticosteroids for women at risk of preterm delivery are betamethasone 12 mg 1M Q24 hours for 2 doses, or dexamethasone 6 mg 1M Q12 hours for 4 doses.
Assessment of bladder neck mobility prior to surgery for stress incontinence is important because: . a) increased mobility is associated with a higher failure rate b) decreased mobility is associated with a higher failure rate c ) increased mobility is associated with a higher success rate
B surface antigen B e antigen B core antibody B core antigen
Regarding the use of corticosteroids in women at risk of preterm delivery, which of the following statements is TRUE?
Barb is a 22-year-old woman who had unprotected sex 4 days ago. She asks her physician to outline her options regarding emergency contraception (EC). Which of the following options is applicable in her situation? a) Barb may be prescribed hormonal EC, because it is effective up to 5 days after unprotected intercourse.
c) overflow incontinence
16
Regarding prevention of Rh alloimmunization, which of the following statements is FALSE?
d) the degree of mobility guides the choice of surgery e) increased mobility confirms the diagnosis of stress incontinence
22
In chromosomally normal fetuses with increased nuchal translucency, there is a higher risk of: a) open neural tube defects b) congenital heart disease c) placental abruption d) all of the above
JOGC Self-Assessment Test Objective journal of Obstetrics and Gynaecology Canada This Self-Directed Learning Exercise is provided to assist SOGC members in their continuing professional development. Thi activity qualifies for credits under Section 3 of the Maintenance of
Certification Program ofthe Royal Colkge ofPhysicians and SU1"geons of Canada. " Addiriona credits under Section 4 of the Maintenance of Certification Program may be earned through the development of a personal learning project related to this educational subject.
offers a new opportunity for self-assessment. The following educational exercise was compiled by the editorial board to provide JOGC readers with the opportunity to review their understanding of the information contained in guidelines published in JOGC over the past 24 months. The intent of this reflective learning exercise is to assist your integmion of the knowledge contained in these guidelines into daily clinical practice. Answers to the questions, and direction to the articles from which they were derived, can be found on pages 1053-1054. We welcome your participation in and your evaluation of this educational exercise.
To complete this self-directed learning exercise: • Complete the Self-Directed Learning Exercise • Send the answer sheet back for acknowledgement of the exercise • Keep on file the Self-Directed Learning Exercise for auditing purposes
of<
For more information, please contact us:
SOGe
780 Echo Drive Ottawa, Ontario K I S 5R7 Phone: 1·800·561·2416 Fax: (613) 730·4314 Web: www.sogc.org
PERFECTIONNEMENT PROFESSIONNEL PERMANENT DE LA SOGC
Test d'auto-evaluation du JOGC Objectif Cet exercice d' apprentissage aurogere se veut un instrument de formation medicale continue au service des membres de Ia SOGe. Lactivite qui suit permet d' obtenir des credits au titre de la section 3 du
Programme de maintien du certificat du College royal des medecins et chirurgiens du
Canada. " Des credits additionnels peuvent etre obtenus au titre de la section 4 du Programme de maintien dll cerrificat dans Ie cadre dll projet d'apprentissag individud lie ace sujet.
1046
Le journal dobstetrique et gynicologie du Canada vous offre une nouvelle occasion de vous auto-evaluer. Cet exercice a ete prepare par les membres du conseil de redaction, dans Ie but de donner I'occasion aux lectrices et aux lecteurs du JOGC de passer en revue I'information presentee dans les directives publiees par Ie JOGC au cours des 24 derniers mois. Cet exercice d'apprentissage vise a vous aider a integrer les connaissances transmises par ces directives dans votre pratique c1inique quotidienne. Les reponses aux questions et les references auxquelles e1les vous renvoient se trouvent aux pages 1053-1054. Votre participation a cet exercice et votre evaluation seront grandement appreciees.
Pour completer cet exercice d'apprentissage autogere: • Faites I'exercice d'apprentissage autogere • Faites-now parvenir la feuille de reponse comme preuve que vous avez fait I'exercice • Conservez I'exercice d'apprentissage autogere dans vos dossiers pour verification
of<
Pour de plus amples renseignements, veuillez communiquer avec nous :
SOGe
780, promenade Echo Ottawa (Ontario) KIS 5R7 Tel.: 1-800-561·2416 Telec. : (613) 730-4314 Web: www.sogc.org CE312
QUESTIONS Thank you for taking the time to participate in this Self-Assessment Test. Once you have completed the exercises, please clip out the answer portion, place in an envelope and mail. No scoring wiD be recorded. Answers to these questions can be found in this issue on pages 1053-4.
1
a) Mode of delivery b) Fetal growth c) Risk of prelabour rupture of membranes d) Risk of threatened preterm labour
2
Immunoprophylaxis for the infant of a hepatitis B surface antigen-positive woman includes: a) hepatitis B vaccination b) hepatitis B immunoglobulin c) hepatitis B e vaccination d) hepatitis B vaccination and hepatitis B immunoglobulin e) hepatitis B e vaccination and hepatitis B immunoglobulin.
4
c) To take some dimenhydrinate, so she will not vomit d)To take ipecac syrup, to avoid an overdose
7
If given between 49 and 72 hours after a single episode of unprotected intercourse, levonorgestrelonly emergency contraception can reduce the risk of pregnancy by what approximate percentage?
d) None of the above e) All of the above
8
b)85% d)30%
5
b) is masked by an associated prolapse c) occurs infrequently d) is associated with urinary hesitancy e) occurs late in the day
9
6
Sally, 32 years old, requested emergency contraception following unprotected sex. She was prescribed 2 tablets of levonorgestrel, 0.75 mg each, 1 tablet to be taken immediately and 1 tablet to be taken 12 hours later. Sally accidentally took both tablets together. What is the best advice for Sally?
A 39-year-old woman with HIV requests advice regarding prenatal genetic testing. Which investigation is most appropriate? a) Combined, integrated, or triple marker screening b) Anatomic ultrasound at 18 to 20 weeks' gestation c) Chorionic villus sampling d) Amniocentesis
10
Which of the following physiologic changes is observed in pregnant women compared to women who are not pregnant? a) Higher heart rate at rest b) Higher heart rate during sub maximal exercise c) Blunted heart rate response to maximal exercise d) Reduced heart rate reserve e) All of the above f) Only three of the above
Which of the following methods are recommended to prescribe and monitor the intensity of exercise during pregnancy? a) Pulse rate target zones revised for pregnant women b) Borg's perception of exertion scale c) The "talk test" d)AlI of the above e) Only two of the above
Latent stress incontinence refers to incontinence that: a) is inhibited by the patient
a) 95% c) 60%
The risk of hepatitis C vertical transmission is increased by which of the following maternal characteristics? a) Active liver disease b) Co-infection with HIV c) Hepatitis C virus ribonucleic acids levels greater than 1Q6/m L
Which of the following is true regarding the effects of properly prescribed maternal exercise on lactation? a) The quantity of breast milk is reduced. b)The composition of breast milk is altered. c) Infant growth is negatively affected. d) None of the above
3
b)To do nothing, because a double dose is as effective as 2 single doses
The presence of uterine fibroids in pregnancy is likely to affect which of the following?
11
Transient or permanent evidence of ovarian failure has been reported in what proportion of women following uterine artery embolization for fibroids? a) Less than 1% b) Up to 10% c) More than 20% d) Has never been reported
a) To take another tablet in 12 hours
1047
12
13
14
15
b) Repeat courses of corticosteroids on a weekly basis have been definitely shown to reduce respiratory distress syndrome without adverse perinatal outcome.
The strength of an association between a factor and a disease is best measured by: a) the incidence of the disease in the entire population b) the incidence of the disease in the exposed c) the prevalence of the factor d) the relative risk e) the attributable risk Which of the following is considered the best time for a previously inactive woman to begin a new prenatal exercise program? a) Immediately after learning that she is pregnant b)At the start of the second trimester c) At the start of the third trimester d)Mter receiving medical clearance from her obstetrical care provider e) band d Which of the following is considered first-line therapy for women with hirsutism who are not attempting to conceive? a) Oral contraceptives b) Antiandrogens c) Combined oral contraceptives plus antiandrogens d) Insulin-sensitizing agents Urodynamic testing prior to surgery for urinary incontinence is not necessary for women with:
c) One should consider giving corticosteroids between 20 and 34 weeks' gestation to women at risk of preterm delivery. d) Corticosteroids should not be given to women with premature rupture of membranes.
19
a) Mter miscarriage, threatened abortion, or induced abortion after 12 weeks' gestation, a woman should be given 120 p.g anti-D. b)Anti-D should be given to non-sensitized D-negative women following ectopic pregnancy. c) At amniocentesis, anti-D 300 p.g should be given to non-sensitized D-negative women. d) Verbal or written informed consent must be obtained prior to administration of anti-D. e) A woman with "weak 0" should not receive anti-D.
20
a) mixed symptoms of urge and stress incontinence b) pure urge incontinence d) pure stress incontinence
b) It is too late for Barb to use any form ofEC, since EC should be used within 72 hours of unprotected intercourse.
e) pelvic organ prolapse accompanying incontinence The public health impact of an exposure is best measured by: a) the b) the c) the d) the e) the
17
incidence of the disease in the entire population incidence of the disease in the exposed prevalence of the factor relative risk attributable risk
The rate of hepatitis B in the prenatal population is 1%. IdentifY the most important factor in determining the risk for vertical transmission. a) Hepatitis b) Hepati tis c) Hepatitis d) Hepatitis
18 1048
c) At this point, only an IUD will be effective in preventing pregnancy. d) Barb should wait to see if she gets her menstrual period before taking any further action.
21
a) Appropriate courses of corticosteroids for women at risk of preterm delivery are betamethasone 12 mg 1M Q24 hours for 2 doses, or dexamethasone 6 mg 1M Q12 hours for 4 doses.
Assessment of bladder neck mobility prior to surgery for stress incontinence is important because: . a) increased mobility is associated with a higher failure rate b) decreased mobility is associated with a higher failure rate c ) increased mobility is associated with a higher success rate
B surface antigen B e antigen B core antibody B core antigen
Regarding the use of corticosteroids in women at risk of preterm delivery, which of the following statements is TRUE?
Barb is a 22-year-old woman who had unprotected sex 4 days ago. She asks her physician to outline her options regarding emergency contraception (EC). Which of the following options is applicable in her situation? a) Barb may be prescribed hormonal EC, because it is effective up to 5 days after unprotected intercourse.
c) overflow incontinence
16
Regarding prevention of Rh alloimmunization, which of the following statements is FALSE?
d) the degree of mobility guides the choice of surgery e) increased mobility confirms the diagnosis of stress incontinence
22
In chromosomally normal fetuses with increased nuchal translucency, there is a higher risk of: a) open neural tube defects b) congenital heart disease c) placental abruption d) all of the above