Monday, 21 August 2017

Tutorial 21st. August 2017




21st. August 2017.

61
SBA. Pertussis & pregnancy
62
EMQ. Cervical smears, colposcopy & referral
63
SBA. Needle-stick and related injuries


61. Pertussis & pregnancy.
Question 1.
Lead-in. Why is pertussis of current concern in obstetrics?
Option List
A
Recent research has linked pertussis in the 1st. trimester with an ↑risk of congenital heart disease
B
There has been a mini-epidemic of pertussis since 2011 with an increase in maternal deaths and deaths of babies < 3 months
C
There has been a mini-epidemic of pertussis since 2011 with an increase in deaths of babies < 3 months
D
The infecting organism causing pertussis has become increasingly drug-resistant
E
Pertussis in the 2nd. trimester doubles the risk of premature delivery < 32 weeks
Question 2.
Lead-in
Which of the following statements is true?
Option List
A
Pertussis is not a notifiable disease
B
Pertussis is a notifiable disease
C
Pertussis is not a notifiable disease, but cases should be reported to the local bacteriologist
D
Pertussis is not a notifiable disease, but cases should be subject to audit
Question 3.
Lead-in
Which organism causes whooping cough?
Option List
A
Bordella pertussis
B
Bacteroides pertussis
C
Rotavirus whoopoe
D
Respiratory syncytial virus pertussis
E
None of the above
Question 4.
Lead-in
What is the origin of the name of the infecting organism?
Option List
A
It is named after one of doctors who first isolated it
B
It is named after the town where the first recorded outbreak occurred
C
The organism was first isolated from the staff of a bordello in Madrid
D
None of the above
E
I refuse to answer this stupid question
Question 5.
Lead-in
What is the main reservoir of the organism that causes pertussis?
Option List
A
pigs
B
pigeons
C
budgerigars
D
humans
E
none of the above
Question 6.
Lead-in
What is the epidemiology of pertussis?
Option List
A
the condition is endemic
B
the condition is endemic with mini-epidemics every 3-5 years
C
the condition is endemic with mini-epidemics most years in the winter months
D
the condition is epidemic, with outbreaks at roughly three-year intervals
E
the condition is epidemic, with outbreaks at unpredictable intervals
Question 7.
Lead-in
Which, if any, of the following statements are true in relation to pertussis infection in unvaccinated but otherwise healthy pregnant women?
Statements
A
< 10% will need to be admitted to hospital
B
20-30% will need to be admitted to hospital
C
> 50% will need to be admitted to hospital
D
20% will get pneumonia
E
1% will die of the infection
Option List
1
A + C + D + E
2
A + C + E
3
B + C + D
4
B + D + E
5
B + E
Question 8.
Lead-in
Which, if any, of the following statements are true in relation to pertussis infection in unvaccinated but otherwise healthy babies < 2 months old?
Statements
A
< 10% will need to be admitted to hospital
B
20-30% will need to be admitted to hospital
C
> 50% will need to be admitted to hospital
D
20% will get pneumonia
E
1% will die of the infection
Option List
1
A + D
2
B + E
3
A + D + E
4
B + D + E
5
C + D + E
Question 9.
Lead-in
What is the incubation period for pertussis?
 Option list
A
<6 days
B
6-10 days
C
6-20 days
D
10-20 days
E
none of the above
Question 10.
Lead-in
The following statements relate to practical issues that are current for obstetricians in relation to pertussis?
Statements
A
The DOH has advised that all pregnant women be immunised to reduce maternal death rates.
B
The DOH has advised that all pregnant women be immunised to reduce deaths in babies < 3 months.
C
The DOH has advised that all babies be immunised at birth.
D
The DOH advised that “Boostrix- IPV” would replace “Repevax” for use in pregnancy from July 2014.
E
The DOH has advised that immunisation of pregnant women be continued until 2019
Option List
1
A + C + D + E
2
A + C + E
3
B + C + D
4
B + D + E
5
B + E
Question 11.
Lead-in
Which, if any, of the following statements are true in relation to pertussis vaccine.
Option List
A
“Boostrix- IPV” is a vaccine for pertussis only
B
“Repevax” is a vaccine for pertussis only
C
“Boostrix- IPV”& “Repevax” are live, attenuated vaccines
D
“Boostrix- IPV” & “Repevax” are vaccines against diphtheria, tetanus and polio as well as pertussis
E
“Boostrix- IPV”  & “Repevax” are acellular
Question 12.
Lead-in
Which, if any, of the following statements are true in relation to pertussis vaccine.
Statements
A
The currently recommended vaccine is a live vaccine using a strain that does not produce pertussis toxin but generates a strong immune response
B
The currently recommended vaccine is an activated vaccine
C
The currently recommended vaccine is an inactivated vaccine
D
The currently recommended vaccine is acellular
E
The currently recommended vaccine is made using recombinant technology
Option List
1
A + B + C + D +E
2
A + B + C + D +E
3
A + B + C + D +E
4
A + B + C + D +E
5
A + B + C + D +E
Question 13.
Lead-in
Which, if any, of the following statements are true in relation to pertussis vaccine.
Statements
A
adult antibody response to a pertussis booster peaks after two weeks
B
adult antibody response to a pertussis booster declines significantly in the months after it peaks
C
adult antibody response to a pertussis booster declines gradually from about 1 year after it peaks
D
mother-baby antibody transfer occurs at the same rate at all gestations after 16 weeks
E
mother-baby antibody transfer occurs maximally from about 28 weeks
Option List
1
A + B
2
A + B + D
3
A + C + D
4
B + D
5
C + E
Question 14.
Lead-in
Which, if any, of the following statements are true in relation to the JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
Option List
A
20 - 24 weeks
B
25- 28 weeks
C
28 - 32 weeks
D
28 - 34 weeks
E
30 - 36 weeks


62. Cervical smears, colposcopy & referral. Triage & “test of cure”.
Lead-in.
Abbreviations.
ALOs:            actinomyces-like organisms
ART:              antiretroviral therapy
ASCUS:          atypical squamous cells of undetermined significance.
BCE:              borderline change in endocervical cells
BCC:              borderline change in squamous cells
cART:            combination antiretroviral therapy, now preferred to the term “HAART”.
CIN:               cervical intraepithelial abnormality
CGIN:            cervical glandular intraepithelial abnormality
?GNE:            ? glandular neoplasia of endocervical type
?GNNC:         ? glandular neoplasia (non-cervical)
GUM clinic:  genito-urinary medicine clinic
HAART:         highly active antiretroviral therapy
HGD:             high-grade dyskaryosis (? invasive squamous carcinoma)
HGD?I:          high-grade dyskaryosis (? invasive squamous carcinoma)
HGDM:         high-grade dyskaryosis (moderate)
HGDS:           high-grade dyskaryosis (severe)
HPV:              human papilloma virus
HPVT:            HPV triage
HRHPV:         high-risk HPV
LBC:               liquid-based cytology
LGD:              low-grade dyskaryosis
LLETZ:           large loop excision of the transformation zone
MDT:             multi-disciplinary team
NEC:              normal endometrial cell
POP:              progesterone-only Pill
SCJ:                squamo-columnar junction
SIL:                squamous intraepithelial lesion
TZ:                 transformation zone
VaIN:             vaginal intraepithelial neoplasia

Lead-in.
The following questions relate to the management of cervical smears.

Option list.
A.        repeat the test
B.         repeat the test after 6 months
C.         repeat the test at 6 and 12 months
D.        repeat the test at 6 and 12 months and then annually until she has had 10 years’ follow-up followed by repeat tests at the normal intervals for her age
E.         repeat the test after 3 or 5 years according to her age as per routine follow-up
F.         repeat the test after HPV testing
G.        management according to HRHPV triage
H.        repeat the test after giving an appropriate antibiotic
I.           repeat the test after removing her IUCD.
J.          repeat the test after removing the IUCD and giving an appropriate antibiotic
K.         repeat the test after treating the TZ with diathermy
L.          repeat the test after treating the TZ with cryocautery
M.      discharge from follow-up
N.        refer for colposcopy
O.        refer for colposcopy within 2 weeks
P.         refer for colposcopy within 8 weeks
Q.        refer for colposcopy within 12 weeks
R.         refer for colposcopy only if she has other significant signs or symptoms
S.         refer for cone biopsy
T.         refer for fractional curettage
U.        refer for “see and treat” LLETZ
V.        refer to GUM clinic
W.      recommend that she go back to America
X.         there is insufficient information to formulate a management plan
Y.         false
Z.         true
AA.    none of the above
BB.     age 24 years
CC.     age 24.5 years
DD.   age 25 years

Question 1.
At what age is the first invitation to have a smear test sent?
Option list.
A
20 years
B
22 years
C
24 years
D
24.5 years
E
25 years
Question 2.
Which of the following statements is used by the NHSCSP to justify not offering routine screening to younger women?
Option list.
A
most low-grade changes in younger women regress spontaneously
B
most high-grade changes in younger women regress spontaneously
C
HPV induced changes are common in younger women and screening would cause large numbers of unnecessary colposcopy referrals and be prohibitively expensive
D
colposcopic treatments may cause pre-term labour in subsequent pregnancies
E
there is no evidence that screening younger women reduces incidence of cervical cancer or resulting mortality.
Question 3.
How often should women of 30 have routine smear tests?
Option list.
A
every year
B
every 2 years
C
every 3 years
D
every 4 years
E
every 5 years
Question 4.
A woman of 30 years is due to have a routine smear. How long after the previous smear should the invitation be sent?
Option list.
A
34 months
B
36 months
C
58 months
D
60 months
E
none of the above
Question 5.
How often should women of 50 have routine smear tests?
Option list.
A
every year
B
every 2 years
C
every 3 years
D
every 4 years
E
every 5 years
Question 6.
A woman of 50 years is due to have a routine smear. How long after the previous smear should the invitation be sent?
Option list.
A
34 months
B
36 months
C
58 months
D
60 months
E
none of the above
Question 7.
Which, if any, of the following are grounds for continuing smear tests beyond the age of 64?
Option list.
A
no adequate screening test after the age of 50
B
no adequate screening test after the age of 55
C
no adequate screening test after the age of 60
D
patient’s request due to family history of fatal cervical cancer
E
presence of genital warts
Question 8.
Which, if any, of the following are grounds for smear tests in addition to routine tests?
Option list.
A
history of heavy cigarette consumption
B
1st. use of the combined oral contraceptive
C
diagnosis of genital warts involving the cervix
D
new sexual partner
E
multiple sexual partners
Question 9.
Which, if any, of the following are grounds for smear tests in addition to routine tests in the GUM clinic?
Option list.
A
1st. attendance at a GUM clinic
B
any  attendance at a GUM clinic with proven STI
C
diagnosis of genital warts involving the cervix
D
new sexual partner with history of STI
E
multiple sexual partners – simultaneous
F
multiple sexual partners – not simultaneous
Question 10.
Which, if any, of the following are true of cervical cytology as a means of diagnosing STIs?
Option list.
A
cervical cytology can be used to diagnose chlamydial infections
B
cervical cytology can be used to diagnose gonococcal infections
C
cervical cytology can be used to diagnose herpes
D
cervical cytology can be used to diagnose syphilis
E
cervical cytology can be used to diagnose trichomonal infections
Question 11.
Which of the following should be used in the initial investigation of the woman, younger than the age for inclusion in the NHSCSP programme, who presents with a three month history of intermenstrual and postcoital bleeding?
Option list.
A
inspection of the cervix using a speculum
B
inspection of the cervix using a colposcope
C
pregnancy test
D
screening for chlamydia
E
cervical smear
Question 12.
Which, if any, of the following statements are true with regard to HRHPV as primary screening.
Option list.
A
HRHPV is about 10% more sensitive than LBC in detecting borderline or worse changes
B
HRHPV is about 25% more sensitive than LBC in detecting borderline or worse changes
C
HRHPV detects > 70% of CIN2, CIN3 and invasive cancer
D
HRHPV detects > 90% of CIN2, CIN3 and invasive cancer
E
HRHPV is about 6% less specific in detecting borderline or worse changes
Question 13.
Approximately how much of the NHSCSP was covered by the six sentinel sites used to evaluate modern approaches to cervical screening?
Option list.
A
  1%
B
  5%
C
10%
D
15%
E
20%
Question 14.
Which of the following statements are true in relation to the data obtained from the six sentinel sites?
Option list.
A
16% of women with low-grade dyskaryosis were HRHPV –ve and returned to routine screening
B
26% of women with low-grade dyskaryosis were HRHPV –ve and returned to routine screening
C
45% of women with borderline changes were HRHPV –ve and returned to routine screening
D
65% of women with borderline changes were HRHPV –ve and returned to routine screening
E
colposcopy referral rates increased by > 60%
Question 15.
Which, if any, of the following statements are true in relation to the NHSCSP in the year ending 31 March 2015?
Statements.
A
85% of eligible women were screened in the year up to 31 March 2015
B
72% of eligible women aged 25-49 years were screened
C
78% of eligible women aged 50-64 years were screened
D
4.31 million women were invited for screening & 3.12 million women were tested
E
98% of women should receive their smear reports within 2/52, but only 91% did
F
3.2 million samples were examined by the laboratories
G
198,216 referrals were made to colposcopy, a 0.6% ↓ from the previous year
H
2.5% of smears were inadequate
Question 16.
Which, if any, of the following statements are true in relation to LBC and the traditional cervical smear?
Statements.
A
both involve drying the slide on which the smear is made in air by the person taking the smear
B
the sensitivity of LBC is superior
C
the specificity of LBC is superior
D
inadequate smears ↓ from about 9% with traditional smears to 1-2% with LBC
E
LBC is now the NHSCSP standard for cervical screening
F
HPV testing cannot be done on routine LBC samples
Question 17.
Lead in.
Which, if any, of the following statements are true in relation to inadequate smears?
A
inadequate smears are defined as those showing insufficient squamous cells
B
inadequate smears are defined as those showing inflammatory changes
C
a smear should not be defined as inadequate if there are borderline or dyskaryotic changes
D
a repeat LBC sample should be obtained within 1 month of an initial inadequate sample
E
a repeat LBC sample should be obtained within 2 months of an initial inadequate sample
F
a repeat LBC sample should be obtained after an initial inadequate sample, but not within 3 months
G
referral for colposcopy is required after 2 consecutive inadequate cervical smear reports
H
referral for colposcopy is required after 3 consecutive inadequate cervical smear reports
I
referral for colposcopy is required after 4 consecutive inadequate cervical smear reports
J
the appointment for initial colposcopy after inadequate smears should be within 6/52 of referral
K
the appointment for initial colposcopy after inadequate smears should be within 12/52 of referral
L
referral for colposcopy after inadequate smears is to exclude invasive cancer
Question 18.
A woman with no previous abnormal smears has a routine smear showing an inadequate sample . What management will you suggest?
Question 19.
A woman with no previous abnormal smears has had a smear showing borderline nuclear changes.  What management will you suggest?
Question 20.
A woman with no previous abnormal smears has had a smear showing borderline nuclear changes. Cervical ectopy is noted.  What management will you suggest?
Question 21.
A woman with no previous abnormal smears has had a smear showing borderline cells of endocervical origin. What management will you suggest?
Question 22.
A woman with no previous abnormal smears has had a smear showing inflammatory changes.  What management will you suggest?
Question 23.
A woman with no previous abnormal smears has had a smear showing inflammatory changes and ALOs. What management will you suggest?
Question 24.
A woman with no previous abnormal smears has had a smear showing inflammatory changes. She takes the COC for contraception. What management will you suggest?
Question 25.
A woman with no previous abnormal smears has had a smear showing inflammatory changes. She has a copper IUCD. What management will you suggest?
Question 26.
A woman with no previous abnormal smears has had a smear showing inflammatory changes and ALOs. She has had hysteroscopic sterilisation with ESSURE. What management will you suggest?
Question 27.
A woman with no previous abnormal smears had a smear showing borderline changes. A repeat smear after 6 months was normal. A repeat smear after 3 years showed mild atypia. A repeat smear after 6 months was normal. A recent repeat smear, 3 years after the previous one, showed borderline changes. What management will you suggest?
Question 28.
A woman with no previous abnormal smears has had a smear showing mild dyskaryosis of squamous cells. What management will you suggest?
Question 29.
A woman with no previous abnormal smears has had a smear showing moderate dyskaryosis of squamous cells. What management will you suggest?
Question 30.
A woman with no previous abnormal smears has had a smear showing severe dyskaryosis of squamous cells. What management will you suggest?
Question 31.
A woman with no previous abnormal smears has had a smear suggestive of invasive disease. What management will you suggest?
Question 32.
A woman with no previous abnormal smears has had a smear showing borderline nuclear changes in glandular cells. What management will you suggest?
Question 33.
A woman with no previous abnormal smears has had a smear showing ? glandular neoplasia. What management will you suggest?
Question 34.
A 30-year-old woman with no previous abnormal smears has had a smear showing ? glandular neoplasia. She is nulliparous and would like to have children. Colposcopic appearances suggest high-grade CGIN. What management will you suggest?
Question 35.
A 50-year-old woman with no previous abnormal smears has had a smear showing ? glandular neoplasia. Colposcopic appearances suggest high-grade CGIN. What management will you suggest?
Question 36.
A 50-year-old woman with no previous abnormal smears has had a smear showing ? glandular neoplasia. Colposcopic appearances suggest high-grade CGIN. An appropriate excisional biopsy is taken which shows no abnormality. What management will you suggest?
Question 37.
A woman with no previous abnormal smears has had a smear showing normal endometrial cells. What management will you suggest?
Question 38.
A woman with no previous abnormal smears has had a smear showing atypical endometrial cells. What management will you suggest?
Question 39.
A woman with no previous abnormal smears and no symptoms has had a smear with a normal result. Clinical examination was normal, but contact bleeding was noted when the smear was taken. The Practice Nurse who took the smear phones you for advice about her management. What advice will you give?
Question 40.
An American woman with no previous abnormal smears has been used to having annual smears. She has had a smear with a normal result and requests a repeat in 12 months. What management will you suggest?
Question 41.
A woman with no previous abnormal smears is on renal dialysis and has had a smear with a normal result. What management will you suggest?
Question 42.
Which, if any, of the following statements are true in relation to women who are HIV +ve compared to those who are HIV -ve?
A
there is an increased incidence of false –ve smear reports
B
there is an increased incidence of false +ve smear reports
C
the prevalence of SILs is 10-20%, 10 times higher than for HIV-ve women
D
the prevalence of SILs is 20-40%, 10 times higher than for HIV-ve women
E
HIV +ve women taking HAART have higher rates of abnormal cytology than HIV –ve women
F
HAART may reduce the prevalence of squamous intraepithelial lesions
G
LGD is less likely to regress
H
LGD is more likely to regress
I
HGD responds less well to standard treatments
J
HGD responds better to standard treatments
K
Close co-operation between the HIV medical team and colposcopists / smear takers is essential
Question 43.
A woman recently diagnosed as HIV +ve has had a smear with a normal result. Previous smears have been normal. Which, if any, of the following statements are true?
A
twice yearly smears should be arranged
B
annual smears should be arranged
C
colposcopy should be arranged if resources permit as part of the initial assessment
D
annual colposcopy should be arranged if resources permit
E
ablation of low-grade CIN should be offered as such lesions are more likely to progress than in HIV –ve women
F
surgical removal of the cervix should be offered if high-grade CIN is diagnosed
G
screening should continue until at least the age of 75
H
women with good response to HAART and normal cytology can safely return to routine screening
Question 44.
A woman with no previous abnormal smears has had a smear with a normal result. She smokes 20 cigarettes daily and has a long history of recurrent genital warts. What management will you suggest?
Question 45.
A woman of 70 presents with postmenopausal bleeding. She had smears at the recommended intervals from the age of 22. All were normal. The last was taken at the age of 64. What is your management in relation to taking a smear?
Question 46.
A woman of 55 presents with hot flushes since her periods stopped at the age of 54. She wishes to go on HRT and there are no contraindications. She had smears at the recommended intervals from the age of 25. All were normal. The last was taken two years ago. What is your management in relation to taking a smear?
Question 47.
Which, if any, of the following statements are true about women who have been treated for CIN compared to women who have not been treated?
A
their risk of developing cervical cancer is increased by a factor of 2 – 5 compared to women who have not been treated
B
women should be returned to community-based recall
C
women should have a cervical sample taken for cytology at 6 months, but only if the excision margins were clear. Where the excision margin was, or may have been involved, colposcopy should be done at 6 months
D
if the 6 months cytology is normal, borderline or low-grade and the HRHPV test is –ve, women should return to routine recall based on their age
E
if the 6 months cytology is normal, borderline or low-grade and the HRHPV test is –ve, women should have repeat cytology at 3 years, regardless of their age
F
if the 6 months cytology shows changes worse than low-grade, colposcopy should be done and HRHPV testing is not required
G
if “test of cure” cytology is done in hospital, it should be in a cytology clinic, not the colposcopy clinic
Question 48.
 More than 50% of women who develop cervical cancer have been lost to follow-up. True or false?
Question 49.
Which of the following statements are true and which false in relation to treatment of CIN?
a.  cone biopsy is linked to ↓risk of recurrence compared to LLETZ.
b.  the Tz must be seen in its entirety if ablative techniques are to be used
c.   excision margins that are not CIN-free ↑ the risk of recurrence, with endocervical margins that are not CIN-free posing a greater risk that similar ectocervical margins.
d.  age > 35 years increases the risk of recurrent disease.
e.  the “see and treat” policy should no longer be used.
f.   excisional treatments should be used in women > 50 years.
d.  follow-up after treatment for CIN should start between 3 & 6 months from the time of treatment.
e.  the initial follow-up examination after treatment for CIN should be with colposcopy plus cytology.
f.   a failure to achieve negative results in the year after treatment means cone biopsy should be done.
g.  a required standard for treatment success is that ≥ 90% of women should have no evidence of dyskaryosis in the year after treatment.
h.  a required standard for treatment success is that there should be ≤ 5% of histologically-confirmed treatment failures by 1 year after treatment.
Question 50
Women who have had normal follow-up results for 2 years after treatment of CIN 1 can revert to the routine recall. True / False.
Question 51.
Follow-up should continue with increased frequency for 5 years after treatment of CIN 2 & 3, after which recall at routine intervals is OK if all the follow-up has been normal. True or false?
Question 52.
A woman with LLETZ for CIN3 twelve months ago had a normal smear 6 months later. A smear taken 12 months after treatment is also normal. What management will you suggest?
Question 53.
A woman with LLETZ for CIN3 twelve months ago had a normal smear 6 months later. A smear taken 12 months after treatment shows mild dyskaryosis. What management will you suggest?
Question 54.
A woman on normal recall has hysterectomy for menorrhagia. There is no evidence of CIN on histology. What follow-up would you recommend?
Question 55.
A woman who was not on normal recall has hysterectomy for menorrhagia. There is no evidence of CIN on histology. What follow-up would you recommend?
Question 56.
Women who have had hysterectomy and require follow-up with vault smears cannot be managed within the NHSCSP. True or False?
Question 57.
A woman who was not on normal recall has hysterectomy for menorrhagia. There is evidence of completely excised CIN3 on histology. What follow-up would you recommend?
Question 58.
A woman who was not on normal recall has hysterectomy for menorrhagia. There is evidence of incompletely excised CIN3 on histology. What follow-up would you recommend?
Question 59.
A woman is referred with severe dyskaryosis, but colposcopy is normal. What follow-up should be recommended?
Question 60.
A woman has FIGO stage 1a1 cervical cancer. She wishes to retain her fertility. Which of the following treatments should be offered?
A
brachytherapy
B
cone biopsy
C
cryocautery
D
laser ablation
E
LLETZ
F
radical trachelectomy
G
simple trachelectomy
Question 61.
A woman has local excision for early cervical cancer. What follow-up should be arranged by the NHSCSP?
A
colposcopy and smears six monthly for 1 year, then annually for 9 years
B
colposcopy and smears six monthly for 2 years, then annually for 8 years
C
smears six monthly for 1 year, then annually for 9 years
D
smears six monthly for 2 years, then annually for 8 years
E
smears six monthly for 5 years, then annually for 5 years
F
none of the above
Question 62.
A woman has conservative treatment for early stage cancer of the cervix. What follow-up should be recommended?
Question 63.
Which, if any, of the following statements are true in relation to pregnancy?
A
routine smear tests should be deferred until after delivery
B
colposcopy requires more expertise than in the non-pregnant
C
all smears suggesting CIN should have initial colposcopic assessment in late 1st. or early 2nd. trimester
D
women with low-grade changes who have been referred to colposcopy because of a +ve HPV test can had colposcopy delayed until after delivery
E
if CIN1 is diagnosed, follow-up can be delayed until after delivery
F
“test of cure” appointments after treatment of CIN 2 or 3 can be deferred until after delivery
G
follow-up assessment after treatment of CGIN can be left until after the delivery if the excision margins were disease-free.

63. Needle-stick, sharps and related risks.
Abbreviations.
CMV:    cytomegalovirus
GBCV:   GB virus C
HAV:     hepatitis A virus
HBV:     hepatitis B virus
HCV:     hepatitis C virus
HDV:     hepatitis D virus
SOE:      significant occupational exposure to blood-borne infective agent.
VL:         viral load.
Question 1.
Lead-in
Approximately how many SOEs are reported annually in the UK?
Option List
A.       
~    100
B.       
~    250
C.       
~    500
D.       
~ 1,000
E.        
~ 5,000
Question 2.
Lead-in
Who was Ignac Phillip Semmelweis?
Option List
A.       
the person credited with demonstrating the infective nature of puerperal sepsis
B.       
the horticulturist who first grew the white flower subsequently popularised in the musical, “The sound of music”, naming it after his first wife, Eidel.
C.       
the person who first used antisepsis in aerosol form to reduce the risk of infection during  C. section.
D.       
the inventor of catgut sutures
E.        
the inventor of the Dalkon shield
Question 3.
Lead-in
Why does the name of Semmelweis’s colleague Kotecha live on in medical history?
Option List
A.       
he was the first doctor to perform hysterectomy
B.       
he was the first doctor know to undergo transgender surgery
C.       
he died of infection akin to puerperal sepsis after a SOE
D.       
he performed the first successful repair of a 3rd. degree perineal tear
E.        
none of the above
Question 4.
Lead-in
Which of the following have been described as causing infection after a SOE.
Infective agents
1.        
hepatitis A virus
2.        
hepatitis B virus
3.        
hepatitis C virus
4.        
human T cell leukaemia virus
5.        
malaria parasites
Option List
A.       
1 + 2 + 3 + 4 + 5
B.       
1 + 2 + 3 + 5
C.       
2 + 3 + 4 + 5
D.       
2 + 3 + 4
E.        
2 + 3 + 5
Question 5.
Lead-in
Which are the main causes of infection to cause concern in the UK in relation to SOEs?
Infective agents.
1.        
hepatitis A virus
2.        
hepatitis B virus
3.        
hepatitis C virus
4.        
HIV
5.        
treponema pallidum
Option List
A.       
1 + 2 + 3 + 4 + 5
B.       
1 + 2 + 3 + 4
C.       
1 + 2 + 3 + 5
D.       
2 + 3 + 4 + 5
E.        
2 + 3 + 4
Question 6.
Lead-in
Which group features most in the list of those reporting SOEs?
Option List
A.       
doctors
B.       
midwives
C.       
phlebotomists
D.       
nurses
E.        
other healthcare workers
Question 7.
Lead-in
Which clinical activity generates most SOEs?
Option List
A.       
acupuncture
B.       
assisting in the operating theatre
C.       
intramuscular drug / vaccine injection
D.       
subcutaneous drug / vaccine injection
E.        
venepuncture
Question 8.
Lead-in
Approximately how many cases of HIV seroconversion after SOE were recorded in the UK between 2004 and 2013?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500
Question 9.
Lead-in
Rate the following body fluids as: high or low risk in relation to infectivity.
Option List
A.       
amniotic fluid

B.       
blood

C.       
breast milk

D.       
cerebro-spinal fluid

E.        
faeces

F.        
peritoneal fluid

G.       
saliva

H.       
urine

I.         
urine – blood stained

J.         
vaginal fluid

K.        
vomit

Question 10.
Lead-in
Rate the following types of contact with body fluids as:
high-risk
low-risk
minimal or zero risk
Answer
A.       
exposure to faeces: not bloodstained

B.       
exposure to saliva: not bloodstained

C.       
exposure to urine: not bloodstained

D.       
exposure to vomit: not bloodstained

E.        
exposure via broken skin

F.        
exposure via intact skin

G.       
injury deep, percutaneous

H.       
exposure via mucosa

I.         
injury superficial

J.         
needle not used on source’s blood vessels

K.        
needle used on source’s blood vessels

L.        
sharps old

M.     
sharps recently used

N.       
sharps with blood not visible

O.      
sharps with blood visible sharps

Question 11.
Lead-in
Rate the following types of sources of potentially infective body fluids as:
high-risk
low-risk
minimal or zero risk
Answer
A.       
infected but VL and treatment details unknown

B.       
recent blood test negative for all relevant viruses

C.       
source has known risk factors but recent tests negative

D.       
viral status not known but source has known risk factors

E.        
viral status not known but source has no known risk factors

F.        
VL detectable

G.       
VL not detectable

H.       
VL unknown but on treatment with good adherence

Question 12.
Lead-in
Approximately how many cases of HBV seroconversion after SOE have been recorded in the UK since 1997?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500
Question 13.
Lead-in
Approximately how many cases of HCV seroconversion after SOE have been recorded in the UK since 1997?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500
Question 14.
Lead-in
What is the estimated risk of transmission of infection of HBV in a SOE involving sharps in a patient +ve for HBe antigen?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less
Question 15.
Lead-in
What is the estimated risk of transmission of infection of HCV in a SOE involving sharps?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less
Question 16.
Lead-in
What is the estimated risk of transmission of infection of HIV in a SOE involving sharps?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less
Question 17.
Lead-in
What is the estimated risk of transmission of infection of HIV in a SOE involving mucosal splashing?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less
Question 18.
Lead-in
Which of the following carries the highest risk of transmission of an infective agent after a SOE.
Option List
A.       
a bite on the bottom by an HIV-infected patient who finds your buttocks irresistible
B.       
deep injury from a scalpel wielded by a psychopathic surgeon
C.       
deep needle-stick after venepuncture
D.       
spitting by a patient with HIV
E.        
splash SOE from beating a disagreeable patient round the head with a frozen turkey because you are sick to death of their whingeing and perennial misery
Question 19.
Lead-in
List the steps you would take in relation to immediate first aid, including the things that might be suggested but you know are contraindicated.
Question 20.
Lead-in
Which tests should be performed on the source after obtaining consent?
List what you think should be done.
Option List
A.       
HBV surface antigen
B.       
HCV antibody
C.       
HCV RNA
D.       
HIV antigen and antibody (fourth generation HIV immunoassay)
E.        
TTV antibody
Question 21.
Lead-in
What consent is required from the source individual?
Option List
A.       
consent to having the tests
B.       
consent to having the results given to the occupational health department
C.       
consent to having the results given to the person who sustained the SOE
D.       
consent to having the results given to the hospital’s legal team
E.        
consent to notifying the hospital staff if the results are +ve.
Question 22.
Lead-in
What tests should be done on the person who has sustained the SOE and there is a significant risk of infection?
Option List
A.       
a baseline sample should be taken and stored for possible future use
B.       
HBV surface antibody
C.       
HCV antibody
D.       
HIV antigen and antibody

Question 23.
Lead-in
If there is a significant risk of HIV transmission, which of the following statements are correct in relation to when should PEP be given?
Option List
A.       
before the results of the tests done on the source are available
B.       
after the results of the tests done on the source are available
C.       
as soon as is practical
D.       
within 24 hours
E.        
within 72 hours
Question 24.
Lead-in
What are the recommended drugs for PEP in the UK?
Option List
A.       
Kaletra (200 mg lopinavir and 50 mg ritonavir)
B.       
Raltegravir 400 mg twice daily
C.       
Rifampicin 450-600mg daily as a single dose 
D.       
Tenofovir + lamivudine or emtricitabine
E.        
Truvada (245 mg tenofovir disoproxil fumarate and 200 mg emtricitabine)
Question 25.
Lead-in
Which of the following statements are correct in relation to PEP in early pregnancy
Option List
A.       
PEP is contraindicated until after 12 weeks
B.       
PEP should be started as for the non-pregnant
C.       
PEP should be started, but TOP should be offered
D.       
PEP should be started, but not until the puerperium
Question 26.
Lead-in
Which of the following statements is true in relation to reducing the risk of HCV infection.
Option List
A.       
HCV vaccine is safe in pregnancy and should be offered immediately
B.       
HCV vaccine is a live vaccine and contraindicated in pregnancy
C.       
acyclovir is an effective drug for prophylaxis
D.       
there is no known effective prophylactic drug
E.        
early treatment of HCV infection is effective, so SOE staff should be closely followed up for evidence of infection.