Tutorial 23rd. June 2011

Tutorial a.
Tutorial b.
Website.

I somehow managed to record the tutorial in 2 parts and have no way to put them back together. Tutorial a deals with the EMQ discussion. Tutorial b deals with the essay discussion. Perhaps having it in 2 parts will be an improvement - let me know.

The EMQ was as follows. Please attempt to answer before you listen to the discussion or you miss out on the main benefit. E-mail your answer and I'll send mine.

Hepatitis B and pregnancy.

Lead-in.

Each of the following scenarios relates to hepatitis B and pregnancy.

Instructions.

For each scenario, select the most appropriate option from the option list.

Each option can be used once, more than once or not at all.

Abbreviations.

HBcAg:     hepatitis B core antigen

HBeAg:     hepatitis B e antigen         

HBsAg:     hepatitis B surface antigen

HBcAb:     antibody to hepatitis B core antigen

HBeAb:     antibody to hepatitis B e antigen

HBsAb:     antibody to hepatitis B surface antigen

HBIG:       hepatitis B immunoglobulin

HBV:         hepatitis B virus

Scenario 1.

An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she has an acute infection?

Scenario 2.

An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of natural infection?

Scenario 3.

An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?

Scenario 4.

An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 6 months ago. What results on routine blood testing would indicate that she is a chronic carrier of HBV infection?

Scenario 5.

Testing shows that he is positive for HBsAg, positive for HBcAb but negative for IgM HBcAb. What does this mean in relation to his HBV status?

Scenario 6.

Testing shows that he is negative for HBsAg, positive for HBcAb and positive for HBsAb.

What does this mean in relation to his HBV status?

Scenario 7

A primigravid woman at 8 weeks gestation is found to be non-immune to the HBV. She has recently married and her husband is a chronic carrier. What should be done to protect her from infection?

Scenario 8

A woman is a known carrier of Hepatitis B. What is the risk of vertical transmission in the first trimester?

Scenario 9

A woman is a known carrier of Hepatitis B. What is the risk of the neonate who has been infected by vertical transmission in the third trimester becoming a carrier without treatment?

Scenario 10

How effective is hepatitis B prophylaxis in preventing chronic carrier status developing in a neonate infected as a result of vertical transmission?

Scenario 11

Can a woman who is a chronic HBV carrier breastfeed safely?

Scenario 12.

Hepatitis B infection is the most dangerous of the viral hepatitis infections in pregnancy.

Scenario 13.

A pregnant woman who is not immune to HBV has a partner who is a chronic carrier. Can HBV vaccine be administered safely in pregnancy?

Scenario 14.

A pregnant woman who is not immune has a partner with acute hepatitis due to HBV. He cuts his hand and bleeds onto the kitchen table. How should she clean the surface to ensure that she gets rid of the virus?

Scenario 15.

Is it true that the presence of HBeAg in maternal blood is a particular risk factor for vertical transmission? Not really a scenario, but never mind!

Option list.

A.        acyclovir

B.        divorce

C.        HBcAg +ve

D.       HBeAg +ve

E.        HbsAg +ve

F.         HBsAg +ve; HBsAb –ve; HBcAb -ve

G.       HBsAg +ve; HBsAb –ve on two tests six months apart

H.       HBsAG –ve; HBsAb -ve on two tests six months apart

I.          HBsAg –ve; HBsAb +ve; HBcAb –ve

J.          HBsAg –ve; HBsAb +ve; HBcAb +ve

K.        HBsAg –ve; HBsAb +ve

L.         HBsAg +ve; HBcAg +ve

M.     HBV vaccine.

N.       HBIG

O.       HBV vaccine + HBIG

P.        immune as a result of infection

Q.       immune as a result of vaccination

R.        not immune

S.         chronic carrier of HBV infection

T.        10%

U.       30%

V.        50%

W.     60%

X.        70 - 90%

Y.        soap and boiling water

Z.        10% dilution of bleach in water

AA.   10% dilution of formaldehyde in alcohol

BB.   ultraviolet irradiation

CC.   yes

DD.  no

EE.    none of the above

The essays were as follows. We only managed to discuss the first two, having taken so long over the EMQ. However, getting our heads round hepatitis B and its various antigens and antibodies was useful as it is bound to feature in the MCQs or EMQs.

Essays 23 June 2011.

Question 1.

Your consultant is on leave. The Secretary gives you an histology report relating to a 24-year-old woman who had suction evacuation for incomplete miscarriage 10 days before. The histology report is diagnostic of a complete hydatidiform mole.

1.  Justify your immediate management.     8 marks

2.  Detail the subsequent management.    12 marks.

Question 2.

A nulliparous 26-year-old woman with cystic fibrosis presents for pre-pregnancy counselling.

1.   Critically evaluate the factors that would lead you to conclude that pregnancy is contraindicated.                 6 marks.

2.   Critically evaluate the advice you would give about the effect of pregnancy on progression of the disease.    2 marks.

3.   Critically evaluate the advice you would give about the effect of the disease on pregnancy.                             4 marks.

4.   Critically evaluate the advice you would give re the management of the pregnancy, labour and delivery.    6 marks.

5.   Justify the advice you would give re the baby and inheritance of cystic fibrosis.                                                                                          

                          2 marks.

Question 3.

You see a 25-year-old primigravida in the antenatal clinic after referral by the community midwife who feels that the uterus is large-for-dates.

1.      Justify your immediate management.                                           6 marks.

2.      Justify the management of the remainder of the pregnancy.   4 marks.

3.      Justify the management of the delivery.                                       6 marks.

4.      Justify the advice you will give post-delivery.                               4 marks.

Question 4.

A 30-year-old nulliparous woman is referred for pre-pregnancy counselling. Her BMI is 40.

1.  Outline the history you will take.                  4 marks.

2.  Justify the investigations you will arrange.  2 marks.

3.  Justify your management.                               6 marks.

4.  Ouline the issues you will discuss with her about the problems linked to obesity in pregnancy.

                                                                                          8 marks.