Website
8
|
EMQ.
Hepatitis B.
|
9
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Role-play.
Breaking
bad news. Non-viable early pregnancy.
|
10
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Role-play.
Anencephaly.
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11
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Structured
discussion. Breastfeeding.
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Role-players.
Beatrice and
Harriet Lamb.
Active
participants.
Parul Aggarwal
Ananya Basu
Purnima Dalal.
Fiona Mackie
Poornima Narendra
8. EMQ. Hepatitis B.
Topic. Hepatitis B and pregnancy.
Lead-in.
These scenarios
relate to hepatitis 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.
HAV: hepatitis
A virus
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
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
HCV: hepatitis
C virus
HEV: hepatitis
E virus
HSV: herpes
simplex virus
VT: vertical
transmission
Option list.
A.
|
acyclovir
|
B.
|
divorce
|
C.
|
HBcAg
+ve
|
D.
|
HBeAg
+ve
|
E.
|
HbsAg
+ve
|
F.
|
HBsAg
+ve; HBsAb –ve; HBcAb –ve; HBeAg +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.
|
HAV
|
FF.
|
HBV
|
GG.
|
HCV
|
HH.
|
HEV
|
II.
|
HSV
|
JJ.
|
none
of the above
|
Question
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 HBV infection?
Question
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 infection?
Question
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?
Question
4.
An
asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV
infection 9 months ago. What results on routine blood testing would show that
she is a chronic carrier of HBV infection?
Question
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?
Question
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?
Question
7.
How
common is chronic HBV carrier status in UK pregnant women?
Question
8.
What
is the risk of death from chronic HBV carrier status?
Question
9.
A
primigravid woman at 8 weeks gestation is found to be non-immune to HBV. She
has recently married and her husband is a chronic carrier. What should be done
to protect her from infection?
Question
10.
A
woman is a known carrier of HBV. What is the risk of vertical transmission in
the first trimester?
Question
11.
What
is the risk of the neonate who has been infected by vertical transmission
becoming a carrier without treatment?
Question
12.
Should
antiviral maternal therapy in the 3rd. trimester be considered for
women with HBeAg or high viral load?
Question
13.
How
effective is hepatitis B prophylaxis for the neonate in preventing chronic
carrier status as a result of vertical transmission?
Question
14.
Can a
woman who is a chronic HBV carrier breastfeed safely?
Question
15.
Hepatitis B
infection is the most dangerous of the viral hepatitis infections in pregnancy.
Question
16.
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?
How long can HBV survive
outside the body?
Option list.
A
|
< 1 hour
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B
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up to 6 hours
|
C
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up to 12 hours
|
D
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up to 24 hours
|
E
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up to 2 days
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F
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up to 5 days
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G
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at least 7 days
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Question
18.
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?
Question
19.
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!
Question 20.
What does 5 log10
copies /mL mean?
A
|
> 10 copies
/ mL
|
B
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> 100 copies
/ mL
|
C
|
> 1,000
copies / mL
|
D
|
> 10,000
copies / mL
|
E
|
> 100,000
copies / mL
|
F
|
this has scared
me witless and I am going straight home to complain to my Mum
|
Question 21.
Which,
if any, of the following statements are true about amniocentesis and CVS and
the risk of vertical transmission if the mother is HbsAg+ve?
Option list.
A
|
they
are contraindicated
|
B
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they
should be done with cover with HBIG
|
C
|
they
should be done with cover with a drug that is
effective for HBV and safe in pregnancy.
|
D
|
none
of the above
|
Question
22.
Which,
if any, of the following statements are true about treatment in the third
trimester to reduce the risk of vertical transmission?
Option list.
A
|
women
who are HbsAg+ve should be offered testing for HBV DNA levels in the 3rd.
trimester
|
B
|
there
is no effective treatment for HBV in the 3rd. trimester
|
C
|
the
risks of treatment for HBV in the 3rd. trimester outweight the
benefits
|
D
|
drug
treatment for HBV in the 3rd. trimester adds nothing
beneficial to the normal use of HBIG +
HB vaccination of the neonate
|
E
|
none
of the above.
|
Question
23.
Which,
if any, of the following drugs is recommended for use in the third trimester to
reduce the risk of vertical transmission?
Option list.
A
|
acyclovir
|
B
|
lamivudine
|
C
|
telbivudine
|
D
|
tenofovir
|
Question
24.
Does
elective Cs before labour and with the membranes intact reduce the vertical
transmission rate?
Question
25.
Which
hepatitis virus normally produces a mild illness, but represents a major risk
to pregnant women, with a mortality rate of up to 5%?
Question
26.
A
pregnant woman has a history of viral hepatitis and informs the midwife at
booking that she is a carrier and that she has a significant risk of cirrhosis
and has been advised not to drink alcohol. Which is the most likely hepatitis
virus?
Question
27.
Which
hepatitis virus is an absolute contraindication to breastfeeding after
appropriate treatment of the infected mother and prophylaxis for the baby?
Question
28.
Which
hepatitis virus is linked to an increased risk of obstetric cholestasis?
9. Breaking bad news: non-viable early pregnancy
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.
Your instructions
are to deal with the patient as you would in clinic.
10. Anencephaly.
Candidate’s instructions.
You are an SpR5
and running the ante-natal clinic – your consultant has been called to help a consultant
colleague with an emergency on the labour unit and is not available for advice.
You are about to
see Jean Hathersage. She is 25 years old and had a 10-week scan last week that
showed anencephaly. She stated that she did not want TOP. She was counselled,
given information leaflets and asked to return to the antenatal clinical today
for further discussion. Your task is to conduct that discussion.
11. Structured discussion. Breastfeeding
Candidate’s instructions.
This is a viva
station about breastfeeding.
The examiner will
ask you 7 questions.
