Monday 14 January 2019

Tutorial 14th. January 2019



68
Rachel Owen. Perinatal mental health.
69
Role-play. Fragile X syndrome
70
EMQ. Hand, foot and mouth disease
71
EMQ. Measles and pregnancy.



69. Role-play. Fragile X syndrome. Father has FXTAS.
Candidate’s instructions.
You are a 4th. year SpR and about to see Louise Hagerman who is planning her first pregnancy.
GP referral letter.
Jacquemont Medical Centre,
Upper Ridge,
Jacquemont,
Surrey.
Re: Louise Hagerman, Age 25.
58 Main Street,
Jacquemont.

Please see Mrs Hagerman who is planning her first pregnancy. Her father was recently diagnosed with Fragile-X tremor ataxia syndrome. I am not well-acquainted with this condition, but understand that the genetics are complex.
Mrs Hagerman’s health is good, she does not smoke and recently had a normal cervical smear test.

70. EMQ. Hand, foot and mouth disease
Abbreviations.
FMD:     Foot & mouth disease.
FMDV:  Foot & mouth disease virus.
HFMD:  Hand, foot & mouth disease.
Which, if any, of the following statements are true in relation to hand, foot and mouth disease?
Option list.

A
it is the human form of foot and mouth disease in sheep and cattle
B
it is most common in farm workers
C
it is most often due to a virus from the Aphthovirus genus
D
it is most often due to the Coxsackie A16 virus
E
it is most often due to an enterovirus
F
the most severe disease is associated with the Enterovirus A71
G
usually causes a mild and self-limiting illness lasting about a week
H
none of the above
Scenario 2.                
Which, if any, of the following is the main reservoir for HFMD?
Option list.

A
cattle
B
cloven-hoofed animals
C
devils
D
fish
E
humans
F
rodents
G
sheep
H
none of the above
Which, if any, of the following statements are true about how HFMD is spread?
Option list.

A
by osmosis
B
contact with fluid from the blisters
C
coughing and sneezing
D
faeco-oral transmission
E
mainly by contamination of food
F
mainly be contamination of water
G
none of the above
Scenario 4.                
Which, if any, of the following statements are true about when HFMD is spread?
Option list.

A
during the acute phase: about 1 week
B
through contact with infected animals, particularly cows, pigs and sheep
C
Tuesday afternoons
D
up to 8 weeks after the acute phase due to the persistence of the virus in faeces
E
vertically
F
none of the above

Scenario 5.                
In which, if any, of the following groups do most infections occur?
Option list.

A
adolescents
B
adults > 75 years of age
C
children < 1 year of age
D
children < 5 years of age
E
children < 10 years of age
F
agricultural workers
G
none of the above
Answer. E. Children < 10 years.  NICECKS says: “outbreaks occur frequently among groups of children
Which, if any, of the following statements are true about HFMD?
Option list.
A
it is most common in the autumn
B
it is most common in the winter
C
it is most common in the spring
D
it is most common in the summer
E
there is little variation in incidence by season
F
none of the above
Scenario 6.                
What is the incubation period of HFMD?
Option list.
A
1 - 7 days
B
3 - 7 days
C
5 - 7 days
D
10 - 14 days
E
14 - 21 days
F
none of the above
Which, if any, of the following statements are true about when an infected child is no longer contagious?
Option list.

A
once the skin blisters are healed
B
once the fever has resolved
C
once the oral lesions are no longer painful
D
once the skin blisters are no longer filled with fluid
E
7 days after the onset of the 1st. symptoms
F
none of the above

Scenario 8.                
How is HFMD usually diagnosed?
Option list.
A
clinically
B
detection of IgM in serum
C
detection of the virus in faeces
D
detection of the virus in vesicular fluid
E
none of the above
Scenario 9.                
Which, if any, of the following statements are true in relation to the risk to the pregnant woman who contracts HFMD?
Option list.
A
it is associated with an ↑ risk of death from pneumonia
B
it is associated with an ↑ risk of death from pancreatitis
C
it is associated with an ↑ risk of death from myocarditis
D
it is associated with an ↑ risk of neurological complications
E
it is not known to carry ↑ risk compared to the non-pregnant
F
none of the above
Scenario 10.            
Which, if any, of the following statements are true in relation to the embryo / fetus?
Option list.
A
the risk of miscarriage is ↑
B
the risk of neural tube defect is ↑
C
the risk of congenital heart defect is ↑
D
the risk of microphthalmia is ↑
E
the risk of microcephaly is ↑
F
none of the above
Scenario 11.            
Which, if any, of the following statements are true in relation to the neonate?
Option list.
A
neonatal HFMD may be severe with late pregnancy infection
B
neonatal HFMD may be severe with maternal immunocompromise
C
the risk of biliary atresia is ↑
D
the risk of encephalitis is ↑
E
the risk of meningitis is ↑
F
the risk of pancreatitis is ↑
G
none of the above

71. EMQ. Measles and pregnancy.
Scenario 1.                
Which, if any, of the following statements are true in relation to the measles virus?
Option list.
A
it belongs to the arthropod virus family
B
it belongs to the pox virus family
C
it belongs to the paramyxovirus family
D
it belongs to the rhinovirus family
E
it is a DNA virus
F.
it is one of the most infectious viruses spread by respiratory droplets
Which, if any, of the following statements is true in relation to the incubation period?
Option list.
A
the incubation period is about 5 days
B
the incubation period is about 7 days
C
the incubation period is about 10 days
D
the incubation period is about 14 days
E
the incubation period is about 21 days
Scenario 3.        
What is the duration of infectiousness in cases of measles?
Option list.
A
from onset of the rash until it clears
B
from onset of the rash until 7 days later
C
from 4 days before until 4 days after the onset of the rash
D
from 7 days before until 7 days after the onset of the rash
E
from 7 days before until 7 days after the onset of the rash
F
from the 1st. symptoms until 4 days after the onset of the rash
G
from the 1st. symptoms until 7 days after the onset of the rash
H
from the 1st. symptoms until 10 days after the onset of the rash
Scenario 4.        
Which, if any, of the following are recognised features of measles.
A
Cowpat spots
B
Coplick spots
C
Kowlick spots
D
Koplick spots
E
Koplik spots
Scenario 5.        
What are the spots referred to in the previous question?
Scenario 6.        
Which, if any, of the following are features of measles rash.
A
It starts in the head and spreads peripherally
B
It starts in the limbs and spreads centrally
C
It is typically pink and blanches on pressure
D
It is typically red and does not blanch on pressure
E
It is maculo-papular
Scenario 7.        
Which, if any, of the following are recognised complications of measles?
Option list.
A
convulsions
B
death
C
diarrhoea
D
encephalitis
E
otitis media
F
pneumonia
G
sub-acute combined degeneration of the cord
H
sub-acute sclerosing pan-encephalitis
Scenario 8.        
Which, if any, of the following are true of measles infection in pregnancy.
A
there is an risk of miscarriage
B
there is an risk of neural tube defect
C
there is an risk of pre-eclampsia
D
there is an risk of optic atrophy in the neonate
E
there is an risk of premature delivery
F
there is an risk of severe intrauterine growth retardation
G
there is an risk of severe measles complications in the mother
H
there is an risk of stillbirth
Scenario 9.        
Which, if any, of the following statements are true in relation to the pregnant woman who has not been immunised against measles and has been in contact with a case?
Option list.
A
offer the MMR vaccine
B
assess the risk and consider offering HNIG
C
assess the risk and consider offering acyclovir
D
assess the risk and consider offering acyclovir + HNIG
E
none of the above




1 comment:

  1. The questions are quite good.How can we access the answers. thks

    ReplyDelete