4 June 2015.
12
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Air Travel & Pregnancy. SIP 1. 2013. Extract key
facts for EMQs.
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13
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EMQ. Cystic fibrosis.
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14
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Communication skills: explain recessive inheritance
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15
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EMQ. Parvovirus & pregnancy.
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16
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EMQ. Mental Capacity Act.
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12. Air Travel & Pregnancy. SIP 1. 2013.
Extract key facts for EMQs.
13. EMQ. Cystic fibrosis.
This question is
about cystic fibrosis.
For each scenario choose the option that gives the
best answer.
Each option can be used once, more than once or not
at all.
And, to make you
behave in a model fashion, there is no option list, so you have to decide the
correct answer.
Scenario 1.
A woman is 8 weeks pregnant and known to be a carrier of cystic
fibrosis.
Her husband is Caucasian.
What is the risk of the child having cystic fibrosis?
Scenario 2.
A healthy woman attends for pre-pregnancy counselling.
Her brother has cystic fibrosis. Her husband is Caucasian.
He has been screened for cystic fibrosis. The test was negative.
What is the risk of them having a child with cystic fibrosis?
Scenario 3.
A healthy woman is a known carrier of cystic fibrosis.
She attends for pre-pregnancy counselling. Her husband has cystic
fibrosis.
What is the risk of them having a child with CF?
Scenario 4.
A healthy woman attends for pre-pregnancy
counselling. Her sister has had a child with cystic fibrosis.
What is her risk of being a carrier?
Scenario 5.
A woman attends for pre-pregnancy counselling. Her mother has cystic
fibrosis.
What is the risk that she is a carrier?
Scenario 6 .
A woman attends for pre-pregnancy counselling. Her mother has cystic
fibrosis.
The partner’s risk of being a carrier is 1 in X.
What is the risk that she will have a child with CF?
Scenario 7.
A healthy Caucasian woman is 10 weeks pregnant.
Her husband is a known carrier of cystic fibrosis.
Which test would you arrange?
Scenario 8.
A woman attends for pre-pregnancy counselling. She has read about
diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF
in this way?
Scenario 9.
A woman and her husband are known carriers of cystic fibrosis.
What is the risk of them having an affected child.
Scenario 10.
A woman and her husband are known carriers of cystic fibrosis.
What can they do to reduce the risk of having an affected child?
Scenario 11.
A woman and her husband are known carriers of cystic fibrosis.
Can CVS exclude an affected pregnancy?
Scenario 12.
A woman with cystic fibrosis is planning pregnancy. Her husband is
a known carriers of cystic fibrosis.
What is the risk of having an affected child?
Scenario 13.
A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg.
baby at term. She has been advised not to breastfeed because her breast milk
will be protein-deficient due to malabsorption.
Is this advice correct?
Scenario 14.
A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg.
baby at term. She has been advised not to breastfeed because her breast milk
will contain abnormally low levels of sodium.
Is this advice correct?
14. Role-play.
Explain recessive inheritance
as you would in a station on cystic fibrosis.
15. EMQ. Parvovirus & pregnancy.
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.
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?
16. EMQ. Mental Capacity Act.
Lead-in.
The following scenarios relate
to the Mental Capacity Act 2005.
Pick one option from the option
list.
Each option can be used once,
more than once or not at all.
Abbreviations.
CAD: Court-appointed Deputy.
COP: Court of Protection.
FGR: fetal growth restriction.
LPA: Lasting Power of Attorney.
MCA: Mental
Capacity Act 2005.
PoA: Power of Attorney.
Option list.
A.
Yes
B.
No
C.
True
D.
False
E.
Does not exist
F.
The husband
G.
A parent
H.
The child
I. The
General Practitioner
J. The
Consultant
K.
The Registrar
L.
The Consultant treating the
patient
M.
A Consultant not
involved in treating the patient
N.
The Medical Director
O.
A person with Powers
of Attorney
P.
The sheriff or
sheriff’s deputy
Q.
Balance of
probabilities
R.
Beyond reasonable
doubt
S.
None of the above.
Scenario 1.
A
person with LPA is normally not a family member.
Scenario 2.
A
Sheriff’s Deputy is normally not a family member.
Scenario 3.
A
person with PoA can consent to treatment for the patient who lacks capacity.
Scenario 4.
A Court-appointed Deputy can
consent to treatment for the patient who lacks capacity, but must go back to
the Court of Protection if further consent is required for additional
treatment.
Scenario 5.
A
person with PoA can authorise withdrawal of all care except basic care in cases
of individuals with persistent vegetative states.
Scenario 6.
An
advance decision can authorise withdrawal of all but basic care in cases of
persistent vegetative states.
Scenario 7
A
person with PoA cannot overrule an advance direction about withdrawal or
withholding of life-sustaining care.
Scenario 8
A
woman is seen in the antenatal clinic at 39 weeks’ gestation. Her blood
pressure is 180/110 and she has +++ of proteinuria on dipstick testing. She has
mild epigastric pain. A scan shows evidence of FGR with the baby on the 2nd.
centile. Doppler studies of the umbilical artery are abnormal and a non-stress
CTG shows loss of variability and variable decelerations. She is advised that
she appears to have severe pre-eclampsia and is at risk of eclampsia and of
intracranial haemorrhage. She is told of the associated risk of mortality and
morbidity. She is also advised that the baby is showing evidence of severe FGR
and has abnormal Doppler studies and CTG which could lead to death or hypoxic
damage. She declines admission or treatment. She says she trusts in God and wishes
to leave her fate and that of her baby in His hands. She is seen by a
psychiatrist who assesses her as competent under the MCA and with no evidence
of mental disorder. The obstetrician wants to apply to the COP for an order for
compulsory treatment. Can he do this?
Scenario 9
A
woman is admitted at 36 weeks’ gestation with evidence of placental abruption.
She is semi-comatose and shocked. There is active bleeding and the cervical os
is closed. Fetal heart activity is present but with bradycardia and decelerations.
The consultant decides that Caesarean section is the best option to save her
live and that of the baby. When reading the notes, the registrar comes across
an advance notice drawn up by the woman and her solicitor. It states that she
does not wish Caesarean section, regardless of the risk to her and the baby.
The consultant tells the registrar that they can ignore it now that she is no
longer competent and get on with the Caesarean section for which she will be
thankful afterwards. The registrar says that the advance notice is binding. Who
is correct?
Scenario 10
An 8
year old girl is admitted with abdominal pain. Appendicitis is diagnosed with
peritonitis and surgery is advised. The parents decline treatment on religious
grounds. Can the consultant in charge overrule the parents and give consent?
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