With regard to different aspects of risk and safety which of the following is/are true?

• a)
  

  Error is intrinsically bad.

  
  
• b)
  

  Safety skills cannot be taught.

  
  
• c)
  

  Loss of situational awareness applies to individual surgeons only.

  
  
• d)
  

  Latent conditions increase the likelihood of active failures.

  
  
• e)
  

  Latent conditions are the decisions and responsibilities of managers only.

Further regarding different aspects of risk and safety which of the following is/are true?

• a)
  

  The bionomic approach is founded on engineering systems.

  
  
• b)
  

  The bionomic approach favours the ‘blame’ culture.

  
  
• c)
  

  In a surgical unit with high safety resilience, accidents are anticipated and their effects mitigated.

  
  
• d)
  

  Safety resilience has no parallel in ecology.

  
  
• e)
  

  Leadership is all about heading a team.

The risk of retained swabs and instruments increases with:

• a)
  

  The involvement of multiple theatre teams.

  
  
• b)
  

  Handover during surgery.

  
  
• c)
  

  Easy simple surgery.

  
  
• d)
  

  The surgical team’s fatigue.

  
  
• e)
  

  Increase in the workload.

The National Patient Safety Agency recommended that all the NHS organisations in England and Wales that provide maternity services should:

• a)
  

  Have written procedures in place for swab counts at all births except for perineal suturing.

  
  
• b)
  

  Audit swab count practices.

  
  
• c)
  

  Provide education and training about the counting procedure for midwives only.

  
  
• d)
  

  Consider using X-ray detectable swabs.

  
  
• e)
  

  Cascade the clinical briefing sheet to relevant staff.

Factors that contribute to difficulty in diagnosing retained swabs and instruments after surgery include:

• a)
  

  The radio-opaque line in retained swab may become twisted or hidden behind dense tissue.

  
  
• b)
  

  Small-size needles or parts of needles.

  
  
• c)
  

  Late presentation after surgery.

  
  
• d)
  

  Non-specific symptom presentation.

  
  
• e)
  

  X-ray is not 100 sensitive.

Regarding the causes of error in prenatal diagnosis:

• a)
  

  Individual rather than system errors account for most mistakes.

  
  
• b)
  

  Non-detection of fetal abnormalities on scan is the commonest reason for litigation and claims in Obstetric practice.

  
  
• c)
  

  Miscarriage following amniocentesis is most commonly due to a faulty technique by the operator.

  
  
• d)
  

  In obese women detection of fetal abnormality by ultrasound is not markedly improved by scanning at a later gestation.

  
  
• e)
  

  The average detection rate for significant fetal abnormality exceeds 90% in centres where a routine anomaly scan is offered.

Regarding prenatal diagnosis for twin pregnancy the following is/are true:

• a)
  

  The risk of miscarriage following amniocentesis for twins is at least double that for singleton pregnancies.

  
  
• b)
  

  Chorionicity determination is highly significant in screening for aneuploidy.

  
  
• c)
  

  Amniocentesis for diamniotic twin pregnancy should always involve two separate transabdominal needle insertions to minimise the risk of sample mixture and contamination.

  
  
• d)
  

  The determination of fetal nuchal translucency should not be combined with serum marker quantification for estimating the risk of Downs syndrome to ensure fetus-specific risk estimates.

  
  
• e)
  

  A transvaginal approach to chorionic villus sampling may sometimes be required to reduce the risk of sample contamination.

Which of the following statement(s) is/are true about adverse events in health care?

• a)
  

  Adverse events can occur only as a result of an incorrect diagnosis.

  
  
• b)
  

  Adverse events can be defined as complications arising from a patient’s underlying disease.

  
  
• c)
  

  Adverse events can prolong hospital stay.

  
  
• d)
  

  The mortality and preventability of adverse events in developing countries are considerably higher than in developed countries.

  
  
• e)
  

  The rate of adverse events among hospital patients is an indication of patient safety.

Which of the following factors lead(s) to unsafe care?

• a)
  

  A breakdown of the organisational structure of the health system.

  
  
• b)
  

  A breakdown of communication within the health system.

  
  
• c)
  

  Misdiagnosis, as it is only a problem in developing countries.

  
  
• d)
  

  Lack of medical technology.

  
  
• e)
  

  Human resource deficit, especially in developing countries.

Which of the following is/are true about surgical adverse events?

• a)
  

  Pre-surgical briefings using checklists are designed to ensure that the correct instruments are on the instrument tray.

  
  
• b)
  

  Operating theatre and manufacturing industry environments have been described similarly as being high risk and stressful.

  
  
• c)
  

  One of the key factors responsible for surgical adverse event is lack of surgical skills.

  
  
• d)
  

  A change in staff attitudes in the operating theatre will provide a safety climate that can lead to a reduction of surgical adverse events.

  
  
• e)
  

  Team-based patient safety education in the operating theatre is essential to preventing surgical adverse events.

Which of the following is/are true about healthcare-acquired infection (HAI)?

• a)
  

  HAI is defined as an infection acquired by a patient on admission as a complication of their disease.

  
  
• b)
  

  Infection occurring immediately after discharge, which was not manifesting or incubating at the time of admission, can be regarded as an HAI.

  
  
• c)
  

  The common HAIs are respiratory infection, gastrointestinal infection, and wound infection.

  
  
• d)
  

  One of the measures used in preventing HAI in developing countries is potent antibiotics for managing these infections.

  
  
• e)
  

  Patients admitted to intensive care units are at risk high of HAIs.

Which of the following is/are true about electronic fetal monitoring?

• a)
  

  It provides a reliable tool for establishing fetal wellbeing.

  
  
• b)
  

  It is a reliable predictor of neonatal neurologic outcome.

  
  
• c)
  

  The false–positive rate of abnormal cardiotograph (CTG) in predicting cerebral palsy is 99%.

  
  
• d)
  

  Spontaneous or induced accelerations exclude significant acidaemia.

  
  
• e)
  

  Half of fetuses with no acceleration on stimulation have a pH greater than 7.20.

In appropriately grown term fetuses with clear liquor and a reactive CTG, the following is/are true regarding the average time taken to develop acidosis in 50% of cases occurring the following CTG patterns?

• a)
  

  The average time taken to develop acidosis in 50% of cases with repeated late decelerations is 2 hours.

  
  
• b)
  

  The average time taken to develop acidosis in 50% of cases with repeated variable decelerations is 2.5 hours.

  
  
• c)
  

  The average time taken to develop acidosis in 50% of cases with a flat trace is 3 hours.

  
  
• d)
  

  Fetal blood sampling is required early to exclude acidosis in fetuses with reduced physiological reserves.

  
  
• e)
  

  95% of fetal bradycardias 80/min or over with good variability will recover within 10 min.

Which of the following is/are true about normal fetal behaviour?

• a)
  

  Before 20 weeks, fetuses move all the time with 5 min or less of no movements.

  
  
• b)
  

  From 32 weeks, absent movement range from 15–37 min.

  
  
• c)
  

  Fetal heart rate accelerations are mostly caused by to fetal movements.

  
  
• d)
  

  Term and near-term fetuses reduce their movements because of reduced space in the uterus.

  
  
• e)
  

  Initial fetal heart rate response to hypoxaemia is a deceleration and increased BLV.

Which of the following is/are true about fetal adaptation to hypoxia?

• a)
  

  Fetal cardiac output (ml/kg/min) is much greater than cardiac output in the adult.

  
  
• b)
  

  In the absence of antecedent fetal heart rate decelerations, isolated fetal heart rate tachycardia or reduction in variability there is unlikely to be intrapartum hypoxia.

  
  
• c)
  

  The fetus with a normal fetal heart rate variability is at low risk of asphyxia or injury regardless of the amplitude and morphology of the fetal heart rate decelerations.

  
  
• d)
  

  Fetal umbilical venous oxygen saturation is the same as maternal arterial blood.

  
  
• e)
  

  Fetal umbilical arterial blood pO ₂ saturation is about 25%.

Which of the following modules is/are found in the MORE ^OB Program?

• a)
  

  Reflective learning.

  
  
• b)
  

  Learning together.

  
  
• c)
  

  Working together.

  
  
• d)
  

  Changing the culture.

  
  
• e)
  

  Risk reduction.

With respect to clinical core knowledge how much has the inter-professional range differences decreased from pre-test scores to tests scores following the completion of module three?

• a)
  

  3%.

  
  
• b)
  

  6%.

  
  
• c)
  

  9%.

  
  
• d)
  

  12%.

  
  
• e)
  

  15%.

In the six scales tested in the MORE ^OB Culture Assessment Survey tool, which of the following showed the most improvement over time?

• a)
  

  Learning.

  
  
• b)
  

  Open communication.

  
  
• c)
  

  Patient safety.

  
  
• d)
  

  Valuing individuals.

  
  
• e)
  

  Teamwork.

Which of the following is/are true about quality indicators?

• a)
  

  Quality indicators are the only tool used for improving quality of care.

  
  
• b)
  

  In obstetrics, maternal mortality is considered a sensitive quality indicator.

  
  
• c)
  

  Other obstetrical quality indicators should be considered, because traditional quality measures such as maternal and neonatal mortality have became obsolete.

  
  
• d)
  

  Maternity units have a list of standardised quality indicators that must be monitored.

  
  
• e)
  

  There is a well agreed UK national consensus on which quality indicators should be measured in obstetric care.

A maternity unit decides to monitor quality indicators using cumulative sum (CUSUM) charts. Which of the following is/are true regarding this?

• a)
  

  A CUSUM chart is a statistical process control method that can be used to monitor clinical indicators.

  
  
• b)
  

  The CUSUM chart is the only statistical process control that has been adapted for use in medicine.

  
  
• c)
  

  The CUSUM approach requires that the entire history of the healthcare activity is considered.

  
  
• d)
  

  The CUSUM chart can detect small dips in performance.

  
  
• e)
  

  The unacceptable performance rate is the quality indicator rate seen when activity in the maternity unit is considered in need of audit.

Which of the following is/are true about The Delphi technique?

• a)
  

  It is a consensus method.

  
  
• b)
  

  It uses a single “snap shot in time” approach.

  
  
• c)
  

  It is a non-systematic approach that can be used to select quality indicators.

  
  
• d)
  

  It involves meetings among participants for discussion of the quality indicators.

  
  
• e)
  

  It involves a limited number of participants.

Regarding the RADICAL framework, which of the following is/are true?

• a)
  

  The RADICAL framework stipulates that individuals rather than organisations should be the guardians of patient safety.

  
  
• b)
  

  The framework comprises five silos.

  
  
• c)
  

  The framework is simply a procedural framework.

  
  
• d)
  

  Data collected under the ‘Collect and Analyse data’ domain is quantitative only.

  
  
• e)
  

  The framework has theoretical underpinnings.

Before administering intravenous antibiotics in suspected sepsis the following is/are necessary:

• a)
  

  One must always wait for blood culture results.

  
  
• b)
  

  Blood cultures are not necessary due to the clinical urgency.

  
  
• c)
  

  Blood cultures should be obtained before antibiotic administration, but should not delay antibiotic treatment.

  
  
• d)
  

  Blood cultures should be obtained after antibiotic administration.

  
  
• e)
  

  Blood culture may subsequently alter antibiotic usage.

In considering antibiotics prophylaxis at Caesarean Section which of the following is/are true?

• a)
  

  Oral antibiotics are favoured pre-operatively.

  
  
• b)
  

  A single intravenous dose of an antibiotic effective against gram-positive and gram-negative bacteria is favoured.

  
  
• c)
  

  Multiple doses of antibiotics are favoured.

  
  
• d)
  

  No antibiotics are required.

  
  
• e)
  

  Anaerobic cover is the single most important prophylactic.

Which of the following is/are true about maternal and neonatal risks that can be affected by clinical teamwork?

• a)
  

  About one-half of all maternal deaths are avoidable.

  
  
• b)
  

  Avoidable maternal deaths commonly have a failure of communication at their root.

  
  
• c)
  

  Misinterpretation of electronic fetal monitoring is the usual cause of all cases of cerebral palsy.

  
  
• d)
  

  Brachial plexus injury following shoulder dystocia is not preventable.

  
  
• e)
  

  The cost of maternity claims in England represents 20% of medical litigation costs for all specialties.

Which of the following is/are effective and essential strategies used by good clinical teams?

• a)
  

  Overall situation awareness.

  
  
• b)
  

  Open-loop communication.

  
  
• c)
  

  SBAR (situation, background, assessment, recommendation).

  
  
• d)
  

  Leadership by the medically qualified member of the team.

  
  
• e)
  

  Designation of specific team member to communicate with women and their companions.

Which of the following strategies has/have been shown to optimise team working and improve clinical outcomes?

• a)
  

  Team training from an undergraduate level.

  
  
• b)
  

  Training for all members of the healthcare team within uni-professional staff groups.

  
  
• c)
  

  Mandatory training for 100% of staff.

  
  
• d)
  

  Formal assessment of participants after training.

  
  
• e)
  

  Hybrid simulation to train communication alongside technical skills.

Population-based data collection systems such as The UK Obstetric Surveillance System (UKOSS) can be used to:

• a)
  

  Undertake randomised-controlled trials of new treatments.

  
  
• b)
  

  Monitor the effect of the introduction of a new treatment.

  
  
• c)
  

  Address concerns about rare adverse effects of new treatments.

  
  
• d)
  

  Address concerns about common complications of new treatments.

  
  
• e)
  

  Test the efficacy of new treatments.

Individual hospital units can use UKOSS information to address patient safety in the following ways:

• a)
  

  Auditing adherence to guidelines.

  
  
• b)
  

  Monitoring patient outcomes.

  
  
• c)
  

  Planning tailored services.

  
  
• d)
  

  Detailed investigation of variation in disease incidence.

  
  
• e)
  

  Examining quality of care in individual cases.

UKOSS studies have shown the following:

• a)
  

  Uterine rupture is common in women who have had a prior caesarean delivery planning vaginal delivery in the next pregnancy.

  
  
• b)
  

  Up to one-quarter of women have a hysterectomy for the ultimate control of postpartum haemorrhage after the use of specific second-line treatments, such as uterine compression sutures.

  
  
• c)
  

  Maternal 2009 A(H1N1) infection is not associated with adverse perinatal outcomes.

  
  
• d)
  

  Black African and Black Caribbean women have more than double the risk of specific severe maternal morbidities compared with white women.

  
  
• e)
  

  Eclampsia is more common in the UK than in the Netherlands and Scandinavia.