Tutorial 12th. March 2020

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8	Pertussis SBA
9	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
10	Structured discussion. Pertussis.
11	Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.
12	Structured discussion. Labour ward scenario 1.

8.     Pertussis SBA.

Question  1.   

Why is pertussis of current concern in obstetrics?

Option List

A	Research has linked pertussis in the 1st. trimester with an ↑ risk of congenital heart disease
B	A mini-epidemic since 2011 has caused ↑ deaths of mothers & of babies < 3 months
C	A mini-epidemic since 2011 has caused ↑ deaths of babies < 3 months
D	The infecting organism has become increasingly drug-resistant
E	The infecting organism has become increasingly virulent

Question  2.   

Which organism causes whooping cough?

Option List

A	Bordella pertussis
B	Bacteroides pertussis
C	Rotavirus whoopoe
D	Respiratory syncytiovirus pertussis
E	None of the above

Question  3.   

Which, if any, of the following statements is true about the organism what causes whooping cough? This is not a true SBA as I have condensed several questions into one to save space, there are more than 5 options and there may be more than one correct answer.

Option List

A	the organism is aerobic
B	the organism is anaerobic
C	the organism is capsulated
D	the organism is flagellate
E	the organism is an obligate intra-cellular parasite
F	the organism is a Gram -ve diplococcus
G	the organism is a Gram +ve diplococcus
H	the organism requires special transport media
I	no one is going to ask me any of this stuff

Question  4.        

Which of the following statements is true?

Option List

A	Pertussis is no longer a significant threat to infants
B	Pertussis remains a significant threat to infants
C	The risk of death from pertussis is eliminated by timely antibiotic therapy
D	the risk of death from pertussis is eliminated by timely antiviral therapy
E	None of the above

Question  5.   

Which of the following statements is true?

Option List

A	Pertussis is not a notifiable disease
B	Pertussis is a notifiable disease
C	Pertussis is not a notifiable disease, but cases should be reported to the local bacteriologist
D	Pertussis is not a notifiable disease, but cases should be subject to audit

Question  6.   

What is the main mode of spread of the organism that causes pertussis?

Option List

A	contact with contaminated surfaces
B	contaminated food
C	contaminated water
D	respiratory droplets
E	none of the above

Question  7.        

What is the main reservoir of the organism that causes pertussis?

Option List

A	budgerigars
B	cats
C	dogs
D	humans
E	pigeons
F	pigs
G	none of the above

Question  8.   

What is the epidemiology of pertussis?

Option List

A	the condition is endemic
B	the condition is endemic with mini-epidemics every 3-5 years
C	the condition is endemic with mini-epidemics most years in the winter months
D	the condition is epidemic, with outbreaks at roughly three-year intervals
E	the condition is epidemic, with outbreaks at unpredictable intervals

Question  9.        

What is the incubation period for pertussis?

Option List

A	3-6     days
B	7-10   days
C	11-14 days
D	15-18 days
E	none of the above.

Question  10.     

What is the duration of infectivity of someone with pertussis?

Option List

A	2 days from exposure → 5 days after onset of paroxysms of coughing
B	3 days from exposure → 10 days after onset of paroxysms of coughing
C	4 days from exposure → 14 days after onset of paroxysms of coughing
D	6 days from exposure → 21 days after onset of paroxysms of coughing
E	none of the above

Question  11.     

What % of non-immune, close contacts of pertussis will develop the disease?

Option List

A	50%
B	60%
C	70%
D	80%
E	90%

Question  12.     

Which of the following best describes the DOH’s advice about pertussis?

Option List

A	It advises that all pregnant women be immunised to ↓ maternal death rates.
B	It advises that all pregnant women be immunised to ↓ deaths in babies < 3 months.
C	It advises that all babies be immunised at birth.
D	It advised that “Boostrix- IPV” should replace “Repevax” from July 2014.
E	It advises that immunisation of pregnant women be continued until 2019

Question  13.     

Which, if any, of the following statements is true in relation to average annual number of deaths due to pertussis in the years before routing child immunisation was introduced?

Option List

A	the number was 10,000
B	the number was    5,000
C	the number was    4,000
D	the number was    3,500
E	the number was <1,000

Question  14.     

Which, if any, of the following statements are true in relation to pertussis vaccine.

Option List

A	“Boostrix- IPV” is a vaccine for pertussis only
B	“Repevax” is a vaccine for pertussis only
C	“Boostrix- IPV” & “Repevax” are live, attenuated vaccines
D	“Boostrix- IPV” & “Repevax” act against diphtheria, tetanus and polio as well as pertussis
E	“Boostrix- IPV” & “Repevax” are acellular

Question  15.     

Which, if any, of the following statements are true in relation to the JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?

Option List

A	20 - 24 weeks
B	25- 28 weeks
C	28 - 32 weeks
D	28 - 34 weeks
E	none of the above

Question  16.     

A woman has suspected pertussis in early pregnancy. Should she still be offered vaccination?

Option List

A	Yes
B	No
C	I don’t know
D	I don’t know
E	I hate this subject now

Question  17.     

A woman has proven pertussis in early pregnancy. Should she still be offered vaccination?

Option List

A	Yes
B	No
C	I don’t know
D	I don’t know
E	I hate this subject now

Question  18.     

A pregnant woman misses out on vaccination as part of the TIPP. Should vaccination still be offered in the puerperium?

Option List

A	Yes
B	No
C	I don’t know
D	I don’t know
E	I hate this subject now

9. Role-play. Pre-pregnancy counselling. Sister has a baby with Down’s syndrome.

Candidate’s instructions.

You are the SpR in the gynaecology clinic. You have been asked to see Jenny Williams, who has come for pre-pregnancy counselling.

Letter from the General Practitioner.

5 High Street,

Deersworthy,

Kent.

DO9 1JY.

Re Mrs. J. Williams,

Manor Place,

Deersworthy.

Dear Dr.,

Please see this woman who is planning pregnancy. I understand that her sister has had a baby with Down’s syndrome.

Regards,

Dr. Jolly.

10. Pertussis SBA. Structured discussion. Pertussis.

Candidate’s instructions.

The examiner will ask you 9 questions about pertussis and pregnancy.

11. Role-play. Break bad news. Primigravida. Bleeding at 8 weeks.

Candidate’s instructions.

You are the SpR in the ante-natal clinic. The Consultant who was in clinic has been asked to assist her Consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary. 

One of the midwives asks you to see a patient who has just had a scan in the EPU.  She is primigravid and the gestation is 8 weeks. She has had some bleeding.   

An ultrasound scan = IUP.  CRL = 12 mm.  No fetal heart activity.  No adnexal masses.

12. Structured discussion. Labour ward scenario 1.