Tutorial 21st. November 2016

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21 November 2016.

12	EMQ. Parvovirus
13	EMQ. Mental Capacity Act
14	SBA. Cowden syndrome
15	Air Travel & Pregnancy. How to read exercise & SBA. Extract the key facts for Qs. from SIP 1. 2013
16	Communication skills. Pre-pregnancy counselling

12    EMQ. Parvovirus

Lead-in.

The following questions relate to parvovirus infection

Abbreviations.

PvB19:          parvovirus B19

PvIgG:           parvovirus B19 IgG

PvIgM:          parvovirus B19 IgM

Option list.

There is none: make up your own answers!

Question 1.

What type of virus is parvovirus?

Question 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?

Question 3.

PVB19 in the UK occurs in mini-epidemics at 3 – 4 year intervals, usually during the summer months.

Question 4.

Which animal acts as the main reservoir for infection?

Question 5.

What percentage of UK adults are immune to parvovirus infection?

Question 6.

What names are given to acute infection in the human?

Question 7.

What is the incubation period for parvovirus infection?

Question 8

What is the duration of infectivity for parvovirus infection?

Question 9.

What are the usual symptoms of parvovirus infection in the adult?

Question 10.

What is the incidence of parvovirus infection in pregnancy?

Question 11.

How is recent infection diagnosed?

Question 12.

How long does PvIgM persist and why is this important?

Question 13.

What is the rate of vertical transmission of parvovirus infection?

Question 14.

Are women with parvovirus infection who are asymptomatic less likely to pass the virus to their fetuses?

Question 15.

To what degree is parvovirus infection teratogenic?

Question 16.

What proportion of pregnancies infected with parvovirus are lost?

Question 17.

What is the timescale for the onset of hydrops?

Question 18.

Laboratories are advised to retain bloods obtained at booking for at least 2 years for possible future reference. True or false?

Question 19.

What ultrasound features would trigger consideration of cordocentesis?

Question 20.

Must suspected parvovirus infection be notified to the authorities?  Yes or No.

Question 21.

Possible parvovirus infection does not need to be investigated after 20 week’s gestation.  True or false?

Question 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?

13    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 2^nd. 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?

14    EMQ. Cowden syndrome.

Cowden syndrome.

Scenario 1.

Lead in.

Which feature is associated with Cowden syndrome?

Option list.

A.     albinism

B.     hamartoma

C.     hammer-toe

D.     hypertrichosis

E.     stammer

Scenario 2.

Lead in. Which condition has the highest risk of occurrence in women with Cs?

Option list.

A.     breast cancer

B.     bowel cancer

C.     congenital absence of Müllerian tract derivatives

D.     hypertension

E.     hypothyroidism

Scenario 3.

Lead in. Which gynaecological cancer is a particular risk for women with Cs?

Option list.

A.     Bartholin’s gland cancer

B.     cervical cancer

C.     choriocarcinoma

D.     endometrial cancer

E.     vulval cancer

Scenario 4.

Lead in. Which cancer is more common in men with Cs?

Option list.

A.     breast cancer

B.     colon cancer

C.     melanoma

D.     renal cancer

E.     thyroid cancer

F.      all of the above

15    Air travel & pregnancy. How to read exercise & SBA.

         Extract the key facts from SIP1.

16    Basic communication skills. Role-play.

Candidate's Instructions.

You are a 5^th. year SpR. You are about to see Mrs. Jane Brown who has been referred for pre-pregnancy counselling as she is planning her first pregnancy and has a brother with cystic fibrosis.