Tutorial 25 March 2021

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21.	Discussion. Balanced translocation.
22.	Role-play. Teach general pre-pregnancy counselling
23.	Role-play. Sterilisation request
24.	EMQ. Hepatitis D. Delta
25	EMQ. Modafinil

 

21.         Discussion. Balanced translocation..

We did not get round to this last week and I have been asked to discuss it tonight. You will need the document I emailed as it has the diagram we will refer to.

 

22.         Role-play. Teach pre-pregnancy counselling.

Candidate’s instructions.

You are an SpR5 and a teaching afternoon is planned for the midwives from the antenatal clinic and junior medical staff. Your consultant recently met a patient who had booked at the clinic. It had been a busy day and the only prepregnancy counselling she received was a booklet which she was told to read. The patient has limited reading skills and the consultant felt that a session on the importance of face-to-face prepregnancy counselling was timely. You have been asked to conduct a teaching session. Maggie Murray, one of the midwives, has volunteered to be a role-player so that you can illustrate appropriate technique.

Your tasks are to explain the importance of prepregnancy counselling and demonstrate appropriate technique, using Maggie both as a midwife attending the teaching session and a patient booking in.

 

23.         Role-play. Sterilisation request.

You are a 5^th. year SpR. You are about to see Mrs. Mary Fecund in the gynaecology clinic. There is a referral letter from the GP.

Read the letter and then conduct the consultation with Mrs. Fecund as you would do in the clinic in your hospital.

Perfect Health Centre,

Paradise Lane, Slagheap. SLH 678.

Your ref: BRI 07/54843.

Re. Mary Fecund,

The Shoe, High Street, Slagheap.

Dear Doctor,

Please see Mrs Fecund who has too many children. She wishes to be sure she has no more and has asked to be sterilised – one of her friends was sterilised recently which has put her in the mood to have it done.

Dr. John Williams.

 

24.         Hepatitis D. Hepatitis Delta. EMQ.

Abbreviations:

HBsAg:       hepatitis B surface antigen

HBsAb:       antibody to hepatitis B surface antigen

HBV:           hepatitis B virus

HCsAg:       hepatitis C surface antigen

HDV:          hepatitis D virus; hepatitis delta virus

HEsAg:       hepatitis E surface antigen

Question 1.             

Which, if any, of the following statements are true in relation to HDV? This is not a true EMQ as there may be >1 correct answer.

Option list.

A	HDV is a large DNA virus
B	HDV is a defective virus
C	HDV gains entry to human cells via the HDV receptor
D	HDV gains entry to human cells by donning a disguise and using the HBV receptor
E	HDV only flourishes when HBsAb is present
F	HDV only flourishes when HbsAg is present
G	Coinfection is when HDV and another viral infection are present at the same time
H	Superinfection is when HDV is present in abnormally high numbers
I	HDV infection is the least serious of the viral hepatitides in relation to pregnancy
J	HDV treatment was revolutionised by analysis of the benefits of drinking bleach as suggested by Donald Trump
K	the WHO has recommended that those who follow medical advice from Donald trump should be categorised as ‘having the DTs’.
L	HDV needs the presence of HBsAg to be a significant pathogen
M	HDV needs the presence of HCsAg to be a significant pathogen
N	HDV needs the presence of HEsAg to be a significant pathogen
O	pegylated interferon alpha is highly effective as treatment
P	mother-to-child transmission is mainly via the placenta
Q	WHO recommends tenofovir prophylaxis from 28 weeks in pregnancy in HDV infected women
R	the infected neonate should be given HDV vaccine

 

25.         Modafinil. EMQ. Question.

Question 1.  What kind of drug is modafinil?

A.	antibiotic
B.	anti-epileptic drug
C.	anti-viral drug
D.	brain stimulant
E.	oral anticoagulant
F.	tumour necrosis factor antagonist

Question 2.  Which of the following are true in relation to pregnancy?

A.	it makes pregnancy more likely for women using hormone contraception
B.	it is a cause of hyperprolactinaemia, making pregnancy less likely
C.	it is believed to be teratogenic and is contraindicated
D.	none of the above

Question 3.

Which, if any, of the following should be done before starting treatment with modafinil?

A.	BP measurement
B.	ECG
C.	EEG
D.	cardiac MRI
E.	liver function tests
F.	psychiatric assessment
G.	renal function tests

 

 

 

 

Tutorial 22 March 2021

 

 

17.	Role-play. Huntington’s disease.
18.	Role-play. PMB
19.	Structured discussion. Breastfeeding.
20.	Discussion. Balanced translocation.
21.	EMQ. Hepatitis C and pregnancy

 

17.         Role-play. Huntington’s disease.

Candidate's Instructions.

You are the SpR in the pre-pregnancy counselling clinic.

Mary Smith has been referred. The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”

Your task is to take a history and advise about appropriate investigations.

 

18.         Role-play. PMB.

Candidate’s Instructions.

You are an SpR in the “one-stop” PMB clinic. Mary Smith, 55 years old, has been referred by her General Practitioner. She has had some bleeding since the menopause. Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.

 

19.         Structured discussion. Breastfeeding.

Candidate’s instructions.

This is a viva station.

The examiner will ask 7 questions.

 

20.         Blurb. Balanced translocation.

This could be part of a station, having to explain BT to a ‘patient’ or ‘trainee’. You would need to adapt the content to the circumstances. Being able to draw a simple diagram helps. Be aware of the need for expert input from a geneticist. It is a good example of the value of preparing a ‘blurb’: you would have a simple diagram and form of words prepared in advance and not have to create them on the day.

 

21.         EMQ. Hepatitis C and pregnancy.

Some of the questions are not true EMQs as more than one of the options is true.

Abbreviations.

DAAD:           Direct-acting, antiviral drug.

HCV:             Hepatitis C virus.

HCAb:           Hepatitis C antibody.

Scenario 1.              

Which, if any, of the following statements are true?

Option list.

A	Hepatitis kills more people world-wide than HIV
B	Hepatitis kills more people world-wide than TB
C	Hepatitis B kills more people world-wide than Hepatitis C
D	Hepatitis B kills more people world-wide than TB
E	None of the above

Scenario 2.              

Which, if any, of the following statements are true in relation to HCV?

Option list.

A	It is a DNA virus
B	It is a RNA virus
C	It is a member of the Flaviviridae family
D	it is a member of the Hepadnaviridae family
E	it is a member of the Herpesviridae family
F	most infections are due to genotypes 1 & 3
G	most infections are due to genotypes 2 & 4

Scenario 3.              

What is the approximate prevalence of HCV infection in the UK?

Option list.

A	0.1 per 1,000
B	0.3 per 1,000
C	0.5 per 1,000
D	1 per 1,000
E	3 per 1,000
F	5 per 1,000
G	10 per 1,000
H	13 per 1,000
I	15 per 1,000
J	None of the above

Scenario 4.              

What are the key aspects of the WHO’s Global Health Sector Strategy in relation to HCV infection?

Option list.

A	elimination as a as a major public health threat by 2020
B	elimination as a as a major public health threat by 2030
C	elimination as a as a major public health threat by 2040
D	reduction in incidence by 50% by 2030
E	reduction in incidence by 75% by 2030
F	reduction in incidence by 80% by 2030
G	reduction in mortality by 50% by 2030
H	reduction in mortality by 65% by 2030
I	reduction in mortality by 70% by 2030

Scenario 5.              

What is the incubation period of HCV infection?

Option list.

A	6 weeks
B	2 months
C	up to 3 months
D	up to 4 months
E	up to 6 months
F	up to 12 months
G	none of the above

Scenario 6.              

What symptoms are most common in acute HCV infection? There is no option list.

Scenario 7.              

How is acute HCV infection diagnosed?

Option list.

A	clinically
B	presence of HCV antibody
C	presence of HCV RNA
D	none of the above

Scenario 8.              

What proportion of those with acute HCV infection are asymptomatic?

Option list.

A	10%
B	20%
C	50%
D	60%
D	70%
E	> 80%

Scenario 9.       

When does continuing infection after initial exposure become defined as chronic infection?

Option list.

A	after 6 weeks
B	after 2 months
C	after 3 months
D	after 4 months
E	after 6 months
F	after 12 months
G	none of the above

Scenario 10.           

Approximately how many of those with acute HCV infection will go on to chronic infection?

Option list.

A	10%
B	20%
C	40%
D	50%
E	>50%
F	>70%

Scenario 11.           

A woman is found to have HCV antibodies. Which, if any, of the following statements could be true?

Option list.

A	she could have acute HCV infection
B	she could have chronic infection
C	she could have had HCV infection that has cleared spontaneously
D	she could have had HCV infection that has responded to drug therapy
E	she could have a false +ve test result
F	she could have chronic HBV infection due to cross reaction with HBcAg
G	she is immune to HCV
H	the antibodies could result from HCV vaccine
I	the antibodies could result from yellow fever vaccine
J	none of the above

Scenario 12.           

Which, if any, of the following statements reflect current thinking about the mechanisms of damage in chronic HCV infection?

Option list.

A	hepatic damage is ∝ to the duration of HCV infection
B	hepatic damage is a direct result of HCV replication within hepatocytes
C	hepatic damage is ∝ to the level of detectable HCV RNA in maternal blood
D	hepatic damage is immune-mediated
E	hepatic damage is due to progressive biliary tract infection, scarring  and stenosis
F	hepatic damage mostly occurs in women who abuse alcohol
G	hepatic damage is worse in women with co-existing HIV infection
H	hepatitis D is end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating from the original name: ‘deadly-stage’ HCV disease

Scenario 13.           

How common is vertical transmission? There is no option list.

Scenario 14.           

Which, if any, of the following statements are true in relation to the hepatitides?.

A	acute hepatitis is notifiable
B	chronic hepatitis is notifiable
C	hepatitis A is notifiable as the main route of spread is faecal contamination of food & water
D	hepatitis D is notifiable as the main source of infection is infected food and water
E	hepatitis E is notifiable as the main source of infection in the UK is raw or undercooked pork
F	none of the above

Scenario 15.           

What anti-viral treatment is recommended for pregnancy? There is no option list.

Scenario 16.           

Which, if any, of the following are true about Ribavirin?

Option list.

A	it is the least expensive of the new DAADs for HCV
B	it is the least toxic of the new DAADs for HCV
C	it is the most effective of the new DAADs for HCV
D	it is contraindicated in pregnancy because of fears of teratogenicity
E	can cause sperm abnormalities
F.	can persist in humans for up to 6 months
G.	none of the above

Scenario 17.           

A woman with chronic HCV wishes to breastfeed. What advice would you give?

Scenario 18.           

How is neonatal infection diagnosed? There is no option list.

Scenario 19.           

How is neonatal infection treated? There is no option list.

Scenario 20.           

Which, if any, of the following conditions is more common in women with HCV infection?

Option list.

A	dermatitis herpetiformis
B	HELLP syndrome
C	obstetric cholestasis
D	postnatal depression
E	thrombocytopenia

Scenario 21.           

By how much is the risk of the condition in question 20 increased in women with HCV?

Option list.

A	by a factor of 2
B	by a factor of 5
C	by a factor of 20
D	by a factor of 50
E	none of the above

Scenario 22.           

Which, if any, of the following statements is true about HCV and the Nobel Prize?

Option list.

A	the Nobel Prize was awarded to Alter, Houghton & Rice in 2020
B	the Nobel Prize was awarded to Alter, Hogg & Rice in 2020
C	the Nobel Prize was awarded to Alter, Houghton & Rees in 2020
D	the Nobel Prize was awarded to Change, Houghton & Rice in 2020
E	the Nobel Prize was awarded to Change, Hogg & Rice in 2020
F	the Nobel Prize was awarded to Change, Hogg & Barleycorn in 2020
G	the Nobel Prize has not been awarded for work on HCV