Tutorial 3 July 2014

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Contact us.

We had the role-play to make you realise that the sooner you start to work on your communication skills the better. if you are in the UK, use every contact with a patient as an exam pratice. If you are not in the UK, you need to get together with other exam candidate and start to practise, though not so much that you don't pass the written!

8	EMQ. Hepatitis B.
27	You have been asked to give a lecture on the Mental Capacity Act 2005 to the junior staff of the department of O&G using illustrative examples. 1. What is the Court of Protection and what does it do?      6 marks 2. Describe the types of cases you will use and the key points you will make.  14 marks.
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
29	Critically evaluate recent trends in the management of the 3rd. stage and its complications.
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
3	Roleplay. PMB. Take a history and explain the initial investigation. See GP referral letter.

A 55 year old woman is referred by her General Practitioner.

Candidate’s Instructions.

You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.

Your task is to take an appropriate history and advise her about the investigations you feel are appropriate.

Referral letter from the General Practitioner.

Manor Lodge,

High Street,

Bestown.

BE5 S00

Re: Mrs. Mary Smith,

5b High Street,

Bestown.

BE5 SO1

Dear Doctor,

Please see Mrs. Smith who has had postmenopausal bleeding.

Yours sincerely,

James Fewords,

General Practitioner.

Roleplayer’s instructions

You are Mary Smith. You had an episode of vaginal bleeding one week ago. It was bright red, slight in amount, but enough for you to wear a pad. It lasted for 4 hours. There was no provocative factor. It has not recurred.

You are 55 years of age. You reached the menopause at age 51. You have not taken HRT.

You health is good apart from type II diabetes which is well-controlled on diet. You have not had any major illness or operation. You are not taking any medicines.

You have two children. The pregnancies and deliveries were normal. The babies weighed 3 and 3.2 kg., were normal and are alive and well.

You have one sister. She is 5 years younger and has had bowel cancer. There is a history of bowel cancer in some of your father’s relatives, but you are not sure of the details. Your father died 10 years ago of a stroke at the age of 70 and you are out of touch with that side of the family. Your mother is alive and well, apart from Alzheimer’s disease at the age of 85.

Don’t provide information unless requested.

You are anxious because a close friend had an episode of PMB a few years ago, was found to have ovarian cancer and was dead within 3 months.

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!