13. Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome. 14. Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding. 15. Structured discussion. Pertussis. 16. EMQ. Hepatitis B 13. Prepregnancy counselling. Sister has 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. 14. Role-play. Break 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. Manage the patient as you would in real life. 15. Structured discussion. The examiner will ask 10 questions about pertussis and pregnancy. 16. EMQ. Hepatitis B and pregnancy.. Many of the questions have no option list to make things harder. Abbreviations. GDM: gestational diabetes mellitus. 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 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. Is 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? Question 17. How long can HBV survive outside the body? 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 > 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 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 outweigh 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? Question 29. Which, if any, of the following statements is true in relation to HepB and the risk of GDM? Option list. A the risk is about the same B the relative risk is about 0.1. C the relative risk is about 0.2. D the relative risk is about 0.5. E the relative risk is about 1.2. F the relative risk is about 1.5. G the relative risk is about 2.0 H the relative risk is about 3.0 I the risk is unknown