Monday, 16 December 2013

Tutorial 16 December 2013

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https://soundcloud.com/drtmcf/16-december-2013

Tonight we wrote 5 essay plans, answered an EMQ and still finished on time.




8
EMQ. Hepatitis B.
16
Dec
2013
28
With regard to fetal welfare in labour.
1. Critically evaluate the methods available for monitoring the fetal condition.       14 marks
2. List the criteria recommended by NICE for continuous electronic fetal monitoring.  6 marks
16
Dec
2013
29
Critically evaluate recent trends in the management of the 3rd. stage and its complications.
16
Dec
2013
30
With regard to MBRRACE.
1. What is MBRRACE?                                           2 marks
2. What is the role of MBRRACE?                           4 marks
3. How will MBRRACE differ from its precursor?   14 marks
16
Dec
2013
31
You are the sPR in the fertility clinic.
A couple have been referred by their General Practitioner after basic investigation of their three years of infertility. She has a 5-year-old daughter by a previous partner. The pregnancy, delivery and puerperium were normal. Her menstrual cycle is normal and a serum progesterone has confirmed ovulation.
He has never made a partner pregnant and the GP letter states that he has a low sperm count.
1. Justify the history you will take.                         4  marks
2. How do you categorise male infertility?             4 marks
2. Justify the investigations you will arrange.          4 marks
3. Outline the management and available options.   8 marks
16
Dec
2013
32
With regard to cell-free fetal DNA (cffDNA).
a. what is cffDNA?                                                 4 marks
b. detail the current uses of cffDNA in the NHS.      6 marks
c. discuss the potential uses of cffDNA.                 10 marks
16
Dec
2013


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
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

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!


 

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