Thursday, 28 November 2013

Tutorial 28 November 2013

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https://soundcloud.com/drtmcf/28-november-2013

Tonight we had an EMQ, 4 essay plans and a bit of a roleplay.


EMQ3. Parvovirus infection and pregnancy
Cytomegalovirus infection.
A woman books at 8 weeks’ gestation in her first pregnancy. She is concerned because she works in a nursery where there has been an outbreak of cytomegalovirus infection. Critically evaluate the management.
Critically evaluate the “Top Ten Recommendations” in “Saving Mothers’ Lives”, The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. 2006–2008.
Delayed cord clamping.
A 25-year-old primigravida attends the antenatal clinic at 36 weeks. She has read a magazine article about delayed cord clamping. Critically evaluate the issues relating to delayed cord clamping.
With regard to anti-phospholipid syndrome:
1. outline the clinical manifestations of APS.        4 marks.
2. outline the implications of APS for pregnancy  4 marks.
3. critically evaluate how the diagnosis is made.   4 marks.
4. critically evaluate the management in the woman wishing to be pregnant.    8 marks.
Roleplay. Healthy, nulliparous woman referred for pre-pregnancy counselling. Brother has cystic fibrosis. You are asked to explain cystic fibrosis and the implications for her.





Lead-in.
The following scenarios relate to parvovirus infection
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Abbreviations.
GOVRIP:        Guidance on Viral Rash in Pregnancy. HPA. 2011
                         http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1294740918985
HPA:               Health Protection Agency
PSVMCA:      peak systolic velocity middle cerebral artery.
PvB19:            parvovirus B19
PvIgG:            parvovirus B19 IgG
PvIgM:           parvovirus B19 IgM

Option list.
There is none: make up your own answers!
Scenario 1.
What type of virus is parvovirus?
Scenario 2.
Is the title B19 something to do with the American B19 bomber, its potentially devastating bomb load and the comparably devastating consequences of the parvovirus on human erythroid cell precursors?
Scenario 3.
PVB19 in the UK occurs in mini-epidemics at 3 – 4 year intervals, usually during the summer months.
Scenario 4.
Which animal acts as the main reservoir for infection?
Scenario 5.
What percentage of UK adults are immune to parvovirus infection?
Scenario 6.
What names are given to acute infection in the human?
Scenario 7.
What is the incubation period for parvovirus infection?
Scenario 8
What is the duration of infectivity for parvovirus infection?
Scenario 9.
What are the usual symptoms of parvovirus infection in the adult?
Scenario 10.
What is the incidence of parvovirus infection in pregnancy?
Scenario 11.
How is recent infection diagnosed?
Scenario 12.
How long does PvIgM persist and why is this important?
Scenario 13.
What is the rate of vertical transmission of parvovirus infection?
Scenario 14.
Are women with parvovirus infection who are asymptomatic less likely to pass the virus to their fetuses?
Scenario 15.
To what degree is parvovirus infection teratogenic?
Scenario 16.
What proportion of pregnancies infected with parvovirus are lost?
Scenario 17.
What is the timescale for the onset of hydrops?
Scenario 18.
Laboratories are advised to retain bloods obtained at booking for at least 2 years for possible future reference. True or false?
Scenario 19.
What ultrasound features would trigger consideration of cordocentesis?
Scenario 20.
Must suspected parvovirus infection be notified to the authorities?  Yes or No.
Scenario 21.
Possible parvovirus infection does not need to be investigated after 20 week’s gestation.  True or false?
Scenario 22
If serum is sent to the laboratory from a woman with a rash in pregnancy for screening for rubella, the laboratory should automatically test for parvovirus infection too.  True or false?

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