OSCE Flashcards

Question

COMMUNICATION: Brain Stem Test (B1P98)

Answer 1

- Indicate space - Describe how you usually perform a spinal - which of the following needles would you prefer to use? - what would you do if fluid was blood stained? - how much local anaesthetic would you use for each spinal segment to be blocked - Name 2 factors affecting the spread of local anaesthetic in spinal anaesthesia? - 4 contra-indications to performing spinal anaesthesia - Blood supply to spinal cord

Answer 2

- Name this device - what does it measure - mechanism involved? - can it be used to measure bidirectional flow - Advantage of Wright respirometer? - Disadvantages? - Resistance to breathing through this? - Name 2 devices to measure flow? - Principle behind a pneumotachograph? - Advantages of pneumotachohraph?

Answer 3

- name the structures labelled - origin of vagus nerve - how many nuclei does it have and what are they - through which foramen does it leave the skull? - name 2 other structures that pass through this foramen - state the relations of vagus nerve in the neck? - what is the course of the R vagus inside the thorax - what is the course of the L vagus nerve inside the thorax? - apart from the laryngeal branches can you name 3 other branches of the vagus nerve?

Answer 4

- what is this equipment and what is its clinical use? - Name 2 factors which determine the energy requirement to propagate a nerve impulse? - Why would you use a supramaximal stimulus? - Indicate where you would place the electrodes for stimulating the ulnar nerve? - Indicate how you would connect the leads? - Which muscle contraction would you observe when the ulnar nerve is stimulated? - State 3 methods available to assess muscle contractio? - What is DBS? - What is PTC? - What is the mechanism behind a PTC? - What is the significance of a PTC?

Answer 5

- check leads: position on pt and monitor - confirm rhythm - applies gel pads and correctly places paddles - charges safely to correct energy level (150-360J) in a biphasic defibrillator or 360J on monophasic defibrillator - Visual sweep prior to delivering shock "stand clear" - Removes oxygen - Delivers shock while looking at monitor - how would you place the paddles if someone has a pacemaker - what do these symbols indicate?Type BF and CF equipement - what types of defib are there - how do external defib work - what are the advantages of biphasic defibrillators - look at this defib circuit diaphragm and name the components? and their role?

Answer 6

- Name the structures - Name the nerves supply areas - how would you block the lateral cutaneous nerve of the forearm - what movements would you elicit by stimulating the median nerve of the axilla? - how would you block the lateral cutaneous nerve of the forearm? - what movements would you elicit by stimulating the median nerve of the axilla? - how would you block the median nerve at the elbow? - how would you block the ulnar nerve at the elbow? - where would you find the radial nerve in the cubital fossa and how would you block it? - What would be the response if the radial nerve was stimulated at this level? - Know boundaries/contents/radial nerve block at elbow/ median nerve block at elbow/ulnar nerve block at elbow/use of PNS for nerve blocks

Answer 7

- name nerves that need to be blocked in order to provide anaesthesia for this surgical procedure? - what are the other 2 nerves in the ankle that are required to be blocked for a complete ankle block? - of the 5 nerves which one is not a branch of the sciatic nerve? - name the structures labelled - name the terminal branches of the tibial nerve - how would you block the tibial nerve at ankle - how would you block the deep peroneal nerve - where would you inject LA to block the sural nerve? - where would inject LA to block the saphenous nerve? - indications for ankle block? - what dose of adrenaline would you use to prolong the block?

Answer 8

- check if connected to electrical supply - check monitoring devide and recognise that there is no EtCO2 monitor - check O2 analyser on the machine that is working and calibrates it for 100% and 21% - Tug test - check pipe line pressure gauge (4 bar) - check that O2 cylinder available - check that blanking plug is fitted to empty cylinder yoke - flow meters (check all 3 valves operational / check for anti-hypoxia device (mention it)/ check for emergency flush) - check vaporisers (adequately filled / correctly seated / check for leak (on off position) / turns vaporiser off when check completed) - what precautions would you take before fitting a cylinder to machine - why would you do this?

Answer 9

- Pacemaker generic code 5 letter format - - 1st letter chamber paced (Atrium A Ventricule V or Dual D) - - 2nd letter chamber sensed (Atrium A Ventricule V or Dual D) - - 3rd letter response to sensing (None N Triggered T, Inhibited I or Dual D) - - 4th letter rate modulation or programmability (Rate modulated R, Communicating C, Multiprogrammable M, Simple programmable P, None N) - - 5th letter anti-tachycardia function: Paced P, Shocks S, Dual D

Answer 10

- Dose of platelet tranfusion = "one adult pack" or 10 ml/kg BW in children - Aim for PT and APTT < 1.5x mean control (to minimise surgical bleeding) and fibrinogen <1 g/L - Dose of FFP is 4 units (about 1L) in adults or 10-15 ml/kg in children - Fibrinogen <0.5g/L associated with microvascular bleeding - Low fibrinogen prolongs both PT and APTT - Cryoprecipitate specific for replacing fibrinogen - Dose is 2x5 donation pools for adult

Answer 11

- name the structures labelled - name 3 structures encountered during surgical tracheostomy - know anatomy relevant to tracheostomy

Answer 12

- ensure appropriate monitoring - ... - what to do if unable to re-insert the tube? - available options to manage the airway?

Answer 13

- Position - Inspection - Palpation - Percussion - Auscultation

Answer 14

- Identify equipment - principle behind its function - advantage? - disadvantages? - what are the non-electrical methods available to measure temperature? - name 3 other sites to measure temperature - what are the disadvantages of mercury thermometer - what electrical methods of measuring temperature are you aware of ? - what is the physical principle behind the thermocouple? - what are thermistors - name one disadvantage of thermistor

Answer 15

- how would you treat - what clinical signs indicate that pt is unstable - how would you ttt the pt considering he is stable - how much amiodarone would you give - the pt now deteriorates and has a BP of 70 and HR 160. how would you ttt the pt - what energy level would you choose - know really well the ALS algorithm - know about narrow complex tachycardia

Answer 16

- which cranial nerve provide sensory innervation to face - describe the origin of the trigeminal nerve - what is the intracranial course of the roots soon after their origin - what is the other name for this ganglion - where is this ganglion located and what other structures is it related to - name the 3 divisions of the trigeminal nerve - state the course of the opthalmic nerve - what is the course of the maxillary nerve - distribution of the maxillary nerve - what structures does the maxillary nerve innervate - indicate where the foramen ovale is in the base of the skull - what division passes through the foramen ovale

Answer 17

- order of pre-anaesthetic Hx taking | - if pts on meds, ask about side effects

Answer 18

- what does ST depression imply - how would you manage this suspected intra-operative ischemia? - monitor shows HR of 126 BP 190/120 and progressive ST depression. What would you do? - despite the above measures ST segment depression and HTN persists. Is there any other drug you would consider? - Even after optimising fluid status, balanced anaesthesia, and EtCO2, the HR remains high HR 140. how to manage tachycardia - how would you manage this patient postoperatively

Answer 19

- what are the components of the pulse oximeter - what are the 2 wavelengths of the source of light - know the absorbance spectrum graph - what is the name of the point where the absorbance for the 2 forms of Hb meet? - what is the principle of a pulse oximeter - what are beer and lamber's law - at what range of SO2 does the pulse oximeter maintain reasonable accuracy - give 4 situations where pulse oximeter readings may not be accurate - does anemia affect the accuracy of pulse oximetry how is the background noise such as that due to bright external lights eliminated

Answer 20

- check the wrist band - check cross-match report form - check the blood bag (pt details, blood group, unit number, expiry date, volume of blood) - what would you record on the X-match form - What parameters would you monitor during transfusion - during GA how would you recognise a transfusion reaction in this patient - how would you manage a transfusion reaction - what are the indications for cryoprecipitate

Answer 21

- Know different types of hematomas and CT scans observations

Answer 22

- identify equipment - what is the pressure in the entonox cylinder - state how entonox is formed - what is the critical temperature of the gas mixture in this cylinder - what is the Poynting effect - what would the problem be of storing the cylinder at a very low temperature (e.g. -10oC) - at what temperature would these gases separate in a pipeline at 4 bar - what precautions should be taken during storage of this cylinder - how does this pressure relief valve differ from others - name some clinical uses of entonox - what advice would you give for its use during labour - what are the contra-indications for its use - what is the maximum recommended concentration of nitrous oxide in the theatre atmosphere?

Answer 23

- what is the indication for IO infusion of fluids - can you demonstrate how you would perform intra-osseous puncture - why should the needle be directly caudally - how would you confirm the correct placement of the needle - what are the complications - state 2 relative contra-indications for IO infusion

Answer 24

- Know Indications / CI / Drug to be used / recommended dose / checks required beforehand...

Answer 25

- connects all components correctly - connects proximal end to common gas outlet - visually inspects the outer tubing - sets FGF at 5L/min - Confirms flow into system by occluding tube at pt end and ensures that reservoir bag fills, turns off the flow meter and ensures that the reservoir bag does not collapse - makes sure that inner tube not disconnected, sets gas flow at 5L/min, then occludes the inner tube using a plunger of a 2ml syringe, and the bobbin should dip due to back pressure - checks function of APL valve - checks the filter and angle piece for any defect or blockage - what happens if inner tube is disconnected at the machine end - what is the FGF required for SV for avoiding rebreathing - what should the FGF during CV to maintain normocapnia

Answer 26

- what is a vitalograph | - know vitalograph and different types of pathologies observed

Answer 27

- AV block - RBBB - LBBB - ECG criteria for LVH - Indications for implantation of permanent pacemaker - Blood supply / RCA/LCA

Answer 28

- name the foramen labelled - what structures pass through this foramen - name structures labelled - what structure pass through fissure - what is the normal axial length of the eye ball and what is the significance - describe the motor nerve supply to the extra-ocular muscles - what are the various regional techniques available in providing anaesthesia for eye surgery - can you describe the procedure of subtenon block - where would you inject the LA - what LA would you use and what volume is needed - why is hyaluronidase used - know anatomy of orbit - complications related to ophtalmic regional block

Answer 29

- Anaesthetic Mx for JW - Pre-op Mx - Intra-op Mx - Post-op Mx

Answer 30

- choose correct size of LMA for this pt - insert LMA on this manikin - what material used in manufacturing these masks - does it contain latex - advantages of LMA over tracheal intubation - limitations of LMA - size of LMA to choose in a 2y old child weighing 13kg. how much air would you use to inflate t - what is function of mask aperture bars

Answer 31

- Inspection front and side - MO and measure inter-incisor distance - mandible protrusion - Mallampati test - Sternomental distance - TM distance - Full range of neck movements - patency of nasal passages - what would you see and what info would you obtain from Mallampati test - what are the risk factors included in Wilson risk sum scoring - what is the significance of this scoring system

Answer 32

- identify equipment - use of Bourdon gauge - can this be used for measuring BP - what P does it measure - gauge or absolute? - what P does a mercury barometer measure - what is the difference btw absolute and gauge pressure - what is principle of measuring P in Bourdon gauge - what units are used to measure cylinder pressure - what is the pressure in a full oxygen cylinder - what factors affect the pressure in an oxygen cylinder - what are the uses of an aneroid gauge

Answer 33

- how would you treat this pt - what clinical features will help you in deciding whether this pt is stable or unstable - pt maintaining an airway, conscious, no CP, and SBP 105. how would you ttt this pt? - how would you dilute amiodarone - what is the max dose of amiodarone in 24h - what are the AEs of amiodarone - what is the differential diagnosis - how would you ttt previously confirmed SVT with BBB - If this pt unstable, what ttt would you instigate? - know mx of broad cpx tachycardia

Answer 34

- name the structures - name intrinsic muscles of larynx - nerve supply to larynx - what happens if unilateral recurrent laryngeal nerve is damaged - techniques of anaesthetising the larynx for awake intubation - blood supply to larynx - at what vertebral level is the thyroid notch - when can recurrent laryngeal nerve be damaged - clinical difference btw unilateral and bilateral recurrent laryngeal nerve damage

Answer 35

- Introduce and confirm pt's identity - confirm proposed surgical procedure, side and indication - consider presenting symptoms and whether they have any systemic effect - Cause of current surgical condition, and does it have any systemic complications? Any predisposing or risk factors for the presenting problem - PSH: previous anaesthetics - FHx of anaesthetic related concerns, diabetes and heart attack - PMHX - Drugs and AEs from them - Allergy - Smoking and alcohol - Hx of reflux - Airway assessment

Answer 36

- Recognition - Check for other vital parameters - Structured approach: ABC, replenishing circulating volume (fluids), maintaining perfusion (vasopressors), increasing O2 carrying capacity (blood transfusion), and surgical control of bleeding - ask for help and inform the surgeon to proceed to laparotomy to control bleeding

Answer 37

- Name equipment (galvanic fuel cell) - indicate which one of these figures best match the above equipment - name the parts labelled - how would you check the calibration of this equipment - explain the principle of oxygen measurement used in a fuel cell - can you use this equipment for breath to breath analysis of FiO2 - list some other methods of measuring oxygen

Answer 38

- Identify the problem with regards to positioning of pt (arm hyperabducted and neck rotated to other side) - nerves likely to be damaged in this position - precautions to be taken to avoid nerve damage - nerves likely to be damaged in position of proning - ...

Answer 39

- hiatus hernia

Answer 40

- Introduction - Pt concerns - details about previous epidural (duration, resiting) - details about backache and any neuro problems - Procedure: explain - Complications

Answer 41

- ensure procedure has been explained - correctly locate cricoid cartilage on manikin - uses correct method of applying pressure - purpose of cricoid pressure - why is cricoid cartilage chosen - how much pressure should you apply - who first described the technique and when - what are the complications of this technique - name parts labelled

Answer 42

- name the structures - how is sacral hiatus formed - at what level do the spinal cord and dura end - describe the technique of performing a caudal block - volume used in adults? - benefits of caudal block in child - complications of caudal block - anatomy of caudal epidural space

Answer 43

- name the equipment: * *gum elastic bougie (Eschmann tracheal tube introducer) * *Magill's forceps * *Intubating stylet - what are Magill's forceps used for - what is the bougie used for - how would you grade the laryngoscopic view - manoeuvres useful in improving the laryngoscopic view - what signs would indicate that the bougie is in the trachea rather than in the oesophagus - complications of using bougie - what should you do if the bougie is in the correct place but the tube is caught at laryngeal inlet - name the laryngoscope (McCoy)

Answer 44

- FEV1, FEV1/FVC/ TLC...

Answer 45

- name the nerve supplying the following (label) - describe the origin of the sciatic nerve and its relation in the gluteal region - name the various approaches to blocking the sciatic nerve - describe the technique of sciatic nerve block using the classic posterior approach - what is the desired motor response after placement of the stimulator needle, while performing a sicatic nerve block? - how much LA is required - anatomy of femoral nerve

Answer 46

- pt SO2 is 90% on 100% oxygen and most likely have a tension pneumothorax on the R side. Immediate management? - how would you perform the procedure? indicate the landmarks (on manikin or actor) - how would you locate the 2nd intercostal space - on insertion of the cannula there is a sudden escape of air and now the oxygen saturation is 96% - what would you do next - how would you insert the chest drain? indicate the landmarks - complications of chest drain insertion? State 3

Answer 47

- Introduction - Feel radial pulses - Elicit rate and rhythm - Look for collapsing pulse - Feel for brachial and carotid pulse, listen for carotid bruits - correctly measure BP (values +/- 10 mmHg of the examiner's readings) - Measures or mentions that he will measure on both sides - uses correct method of examining the jugular venous pulse - how would you measure the height of the JVP - how would you differentiate btw JVP and carotid pulse

Answer 48

- state how you would measure PaCO2 from a given blood sample - Name the parts labelled - What is the principle involved measuring PCO2 using this electrode - How would you calibrate a CO2 electrode - What methods are available for measuring CO2 in a gas mixture? - What is the principle of an infrared analyser? - At what wavelength does CO2 absorb infrared light? - What are the sources of error in an infrared analyser?

Answer 49

Surgical pt post-laparoscopy - Safe approach - Assess - Help (+ surgeon) - Apply pads and assess rhythm - PEA. CPR for 2 min, IV access, tracheal intubation, ventilate with 100% oxygen, adrenaline 1 mg every 3-5 min - Reversible causes: 4H and 4T - Most likely cause in this patient - Next management

Answer 50

- name the parts labelled - which arteries can you cannulate in the forearm - what precaution would you take before cannulating the radial artery? - what test would you do? - what are the relations of the radial artery at the wrist? - describe the collateral circulation in the hand? - how would you perform Allen's test (demonstrate on the actor) - what are the complications of radial artery cannulation - what nerve is most likely to be damaged? - what are the indications for wrist block - describe landmark technique for blocking the median and ulnar nerves - complications of wrist blocks

Answer 51

- Specifically about OSA

Answer 52

- Recognised increased airway pressure - check sats, HR and BP - hand ventilates and confirm the reduced compliance of the bag - auscultate chest and identifies wheezing - checks ETT position/suction the ETT - increase depth of anaesthesia - Administer bronchodilator (nebs salbutamol through catheter mount) - ask for IV salbutamol or IV aminophylline - inform surgeon and ask for help - what dose of aminophylline - what to do if despite all above measures pt still wheezy and Sats 92%

Answer 53

- Check arterial pressure monitoring system and outline faults (infusion bag not pressurised/transducer system loosely attached/wrong catheter tubing (catheter tubing not stiff) / nb of 3 way stopcocks more than required / arterial cannula (22G IV) too narrow for adult pt - What info can be obtained from arterial waveform - describe how you would perform zero calibration of transducer? - how would you calibrate for higher pressure - which of these is a normal arterial waveform? what is the problem with the other two - what will happen if the reading in a trace which is overdamped?

Answer 54

- Position shown in picture? (knee elbow position) - for what surgical procedures is this position used? - problems associated with this position? - which nerves can be injured and what is the mechanism? - problems associated with lateral position - problems associated with lithotomy position - problems associated with sitting position

Answer 55

- Name the vertebrae in picture (cervical, thoracic and lumbar) and the different structures - what are the differences btw thoracic and lumbar vertebrae - you are asked to perform epidural at L1-L2. describe procedure - how much of the catheter would you insert into the space - would you use a test dose? what is a purpose of test dose?

Answer 56

- describe relations of brachial plexus in the neck - indications for supraclavicular brachial plexus block - technique of performing the supraclavicular block - indicate the landmarks and point of needle entry (on actor) - what part of the brachial plexus would you stimulate with this approach - what are contra-indications for this block - what movements are elicited when you stimulate 1) the lateral cord and 2) the posterior cord

Answer 57

Cross-section C5 - Label structures - what are proximal and distal borders of the trachea - what forms the wall of the trachea - which type of mucosa lines the trachea - what lies immediately posterior to trachea - which major vascular structures traverse the trachea anteriorly - what is the blood supply to the trachea - what is the nerve supply to the trachea

Answer 58

- Label - origins of brachial plexus - course of brachial plexus until it reaches clavicle - branches of lateral cord - branches of medial cord - how would you perform a block of the plexus using an axillary approach - which nerves may be missed using the axillary approach - what complications are associated with supraclavicular nerve blocks

Answer 59

- Label - which arteries supply circle of Willis - where do they enter the skull - what is normal cerebral blood flow - how does the blood flow to white matter and grey matter differ - list the factors affecting cerebral blood flow - describe the production and circulation of CSF

Answer 60

- Label branches of aorta - where do L and R coronary arteries arise from - describe the venous drainage of the heart - what is the innervation of the heart - what signs and symptoms might arise from reduced blood flow to the R coronary artery

Answer 61

- Label structures - at what levels are the 3 diaphragmatic foramina - what does each of them transmit - what is the function of the diaphragm - what is it composed of - what are its attachments - what is the nerve supply - what is a Bochdalek hernia

Answer 62

- Label structures - functions of spinothalamic tracts - blood supply to spinal cord - what is artery of Adamkiewicz - what is its venous drainage - what is anterior spinal artery syndrome - how many pairs of spinal nerves are there - what are the anterior primary rami - what are the features of spinal shock

Answer 63

- Name the different laryngoscopes - features of Macintosh laryngoscope blade - how should reusable laryngoscopes be cleaned - why are there straight and curved laryngoscopes blades - outline the cormack and lehane grades of view at laryngoscopy - what is the difference btw a traditional Macintosh laryngoscope and a rigid fibreoptic laryngoscope such as the glidescope or McGrath video laryngoscope - there are a large nb of different rigid fibreoptic laryngoscopes available. why have these not replacd flexible fibreoptic laryngoscopes - pt presents for emergency laparotomy, and tells you that due to previous radiotherapy he has very limited MO (only 1.5cm) and poor neck movement. outline a reasonable technique for intubation of this patient

Answer 64

- Look at picture. What is it? - explain the different types of cuffs found on tracheal tubes and the rationale for each type - when are uncuffed tubes used - what are the hazards of ETT - what is an endobronchial blocker? how is it placed? - what is the alternative to an endobronchial blocker? - Name different ETT on pictures - how does jet ventilation work? when is it CI? - outline the differences btw a percutaneous and surgical tracheostomy

Answer 65

- What is the name of this circuit? - what is Mapleson circuit - the circuit is attached to an anaesthetic machine at the common gas outlet. Check that circuit is safe to use - you discover a tear in the bag. if you had not discovered it, what problems could this generate during anaesthesia - what could you do to eliminate this problem - name 2 components commonly attached to all circuits that are not on this one - what is the volume of the bag? what is the volume of the reservoir tubing - what group of pts is this circuit used for? up to what weight? - name 2 advantages of using it in this population - name 2 disadvantages - what modifications could eliminate these disadvantages - what is the minimum FGF required for SV to prevent rebreathing - how does one perform IPPV with this circuit - how can PEEP be applied for SV - Which MApleson system is most efficient for SV breathing pts and which for ventilated pt

Answer 66

- What are the components of an anaesthetic mask - what airway adjuncts are available - what are the indications for using an LMA - what are the CI - what are the 2nd generation supraglottic airway devices

Answer 67

- Define the term vapour - What is saturated vapour pressure - What classes of vaporisers are there - What does Tec stand for in the Tec 7 vaporiser - How is this achieved - Which volatile anaesthetic agents can be used in a sevoflurane analyser - why does the desflurane vaporiser require mains electricity to function - what is the pumping effect - What is the Datex-Ohmeda Aladin Cassette vaporiser?

Answer 68

- What does a scavenging system do? - What are the key components of a scavenging system? - Why is the receiving system open to air - How does the Cardiff Aldasorber work - What are the potential risks of chronic nitrous oxide and volatile anaesthetic agent exposure - Name some situations where exposure is more likely

Answer 69

- what are oxygen cylinder made of - what P exists in a half-full size D oxygen cylinder? what volume of oxygen remain? - what pressure exists in a 1/2 full size D cylinder of nitrous oxide? What volume of nitrous oxide remains? - what is the filling ratio and why is it important? - what colour is a heliox 2L cylinder - What is the pin-index system? - what are the key features of a vacuum insulated evaporator (VIE) - what safety features are there to prevent the wrong gas being piped to the anaesthetic machine

Answer 70

- What levels of temperature and humidity are normal in - the oropharynx - What problems can be caused by dry inspired gases - Explain how an HME device works - What sort of filters are commonly added to HME devices? - What problems can be causes by HME devices?

Answer 71

- explain how ventilators may be classified in terms of cycling - explain the difference btw pressure and volume control - draw the pressure-time and flow-time curves produced during PCV - explain the differences btw CMV, SIMV and PSV - what is PEEP - outline the ventilation strategy for a pt with adult respiratory distress syndrome ARDS

Answer 72

- what are the potentially harmful effects of electric current passing through the body - what is the frequency of mains (AC) current - what magnitude of mains current is required to produce: * * pain * * muscle contraction * * VF - what is microshock - how do we prevent shocks in the theatre setting - what do these safety symbols represent?

Answer 73

- what does the acronym LASER mean - what are the benefits of using laser in clinical practice - what are the potential hazards of laser use in the theatre - how are these hazards mitigated - name some different types of laser and their surgical uses - what does Nd-YAG stand for - how would you manage an airway fire in an intubated patient

Answer 74

- What are the 3 most common nerves injured as a result of pt positioning during surgery - What risk factors are associated with perioperative peripheral nerve injury - What are the signs and symptoms of ulnar nerve damage - What areas may be injured during lithotomy positioning on the operating table - what are the hazards of the prone position - how can anaesthetists reduce the incidence if peri-operative peripheral nerve injury - what is bone-cement implantation syndrome - in relation to clinical errors, what are human factors

Answer 75

- What determines ABO blood grouping - what is meant by the terms universal donor and universal recipient - in what media can packed red cell be stored - what is Prothrombin cpx concentrate - what is recombinant factor VII - what are the different modes of life threatening transfusion rxns - what signs of severe/life-threatening transfusion reaction might a pt under GA display - What would be your initial management of a severe transfusion reaction

Answer 76

- brief obs history, covering previous pregnancies, modes of delivery. - ask about problems during this pregnancy (hyperemesis, back trouble and reflux) - enquire about date of last scan and what the scan has showed (breech, placental position)