Thursday, 21 May 2020

Tutorial 21 May 2020


18
EMQ. Pertussis.
19
Role-play. ERPC after miscarriage. ? mental health issue.
20
Structured discussion. The uses of MgSO4 in O&G.
21
Roleplay. Hydatidiform mole.

Role-players.
Beatrice Lamb.

Candidates.
Shradha Chakhaiyar                  India
Purnima Dalal                             Wales
Namrata Kumar                         India
Sohini Munchi                            India
Nandita Sanyal                           India.

18. EMQ. Pertussis.
Question  1.   
Lead-in. Why is pertussis of current concern in obstetrics?
Option List
A
Research has linked pertussis in the 1st. trimester to 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.   
Lead-in
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.   
Lead-in
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










Lead-in
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.   
Lead-in
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.   
Lead-in
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.        
Lead-in
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.   
Lead-in
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.        
Lead-in
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.     
Lead-in
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.     
Lead-in
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.     
Lead-in
Which of the following best describes the DOH’s advice about pertussis?
Option List
A
The DOH advises that all pregnant women be immunised to maternal death rates.
B
The DOH advises that all pregnant women be immunised to deaths in babies < 3 months.
C
The DOH advises that all babies be immunised at birth.
D
The DOH advised that “Boostrix- IPV should replace “Repevax” from July 2014.
E
The DOH advises that immunisation of pregnant women be continued until 2019
Question  13.     
Lead-in
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.     
Lead-in
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.     
Lead-in
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.     
Lead-in
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.     
Lead-in
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.     
Lead-in
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

19. Role-play. ERPC after miscarriage. ? mental health issue.
Candidate’s instructions.
You are the on-call SpR. The Sister on the gynaecology ward has asked you to see Margaret Barber who had surgical evacuation of retained products under general anaesthesia yesterday evening after incomplete miscarriage. She is physically well, but the Sister is concerned as she appears distressed and depressed. She and some of the nurses have tried to find out what is going on, but she is withdrawn and uncommunicative. They are concerned that she has some kind of mental health problem.
Your task is to deal with the patient as in real life.

20. Structured discussion. The uses of MgSO4 in O&G..
Candidate’s instructions.
This is a station about the uses of MgSO4 in O&G.
The examiner will not ask questions, prompt or otherwise assist. It is up to you to give as full an account of the uses as you can muster.

21. Roleplay. Hydatidiform mole.
Candidate's Instructions.
You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient. She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks. The histology report showed a complete mole.
The GP was contacted and asked to see her. An appointment was sent to her to attend today.
Your task is to take a history and explain the implications of the diagnosis.




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