Tutorial 7th. April

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7 April 2022.

 

35	Role-play. Pre-pregnancy counselling. Anaemia. ↑ MCV.
36	Role-play. Neonatal screening
37	Viva. Obstructive sleep apnoea
38	EMQ. Asymptomatic bacteruria

 

35.   Role-play. Pre-pregnancy counselling. Anaemia. ↑ MCV.

Candidate’s instructions.

This is a role-play station. You are a SpR 5 and running the pre-pregnancy counselling clinic. You are about to see Philomena Blott.

GP referral letter.

Health Horizons,

34 Main Road,

Betterworld. BW9HJ.

Re Philomena Blott,

DOB: 11 January 1995.

57 Ward Way,

Betterworld. BW107HI.

Dear Doctor,

Please see Philomena who is planning her first pregnancy. Her health is good and she has no significant medical or surgical history. She had her first cervical smear recently and that was normal. She had the HPV vaccine at school, so I imagine that this was to be expected. She is a bit overweight and I have advised her about healthy eating in pregnancy.

I arranged some basic blood tests. She is immune to rubella. Her FBC shows her to be a bit anaemic: the Hb was 105 gm/l with an MCV of 105fL. I suspect that she is iron and folate deficient. I have given her a prescription for oral iron and 5mg. folic acid daily. She takes the combined oral contraceptive and I have suggested that she have a repeat FBC before she stops it I have said that if her Hb is normal it would then make sense to switch to a combined iron and vitamin preparation designed for pregnancy that she can get from her chemist.

She works in the Grand Hotel in the village. If you don’t know it, I should mention that it has a very good restaurant, which I can recommend; my favourite is their beef Stroganoff. Delicious! And their house red is excellent and good  value for money.

Her husband is a sales representative for a machine tool company and travels a lot, but he is home most evenings. They seem to get on well and there is no sniff of domestic abuse.

John Williams.

 

36.   Role-play. Neonatal screening.

Candidate’s instructions.

You are a SpR in year 5.

You are in the antenatal booking clinic and about to see Mary Eccles. She has been booked in by a midwife at 10 weeks’ gestation and all is well. She has recently arrived in the UK from the USA and asked about the routine neonatal screening that is done in the UK. She will be having the baby in the UK.

 

 

 

 

 

37.   Viva. Obstructive sleep apnoea.

Candidate's Instructions.

This is a viva station. The examiner will ask you 11 questions. When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.

 

38    EMQ. Asymptomatic bacteruria.

Abbreviations.

AKI:               acute kidney injury.

ASB:              asymptomatic bacteriuria.

ASBIP:           ASB in pregnancy.

LE:                 leukocyte esterase.

MSU:            mid-stream specimen of urine.

NSC:              UK National Screening Committee.

PET:              preeclampsia.

Question 1.             

What is the definition of ASB?

Option list.

A	> 1,000,000 colonies per mL on MSU
B	> 100,000 colonies per mL on MSU
C	> 10,000 colonies per mL on MSU
D	> 1,000 colonies per mL on MSU
E	> 1,000,000 organisms per mL on MSU
F	> 100,000 organisms per mL on MSU
G	> 10,000 organisms per mL on MSU
H	> 1,000 organisms per mL on MSU
I	none of the above

Question 2.             

Which, if any of the following reflect NICE’s advice  about routine screening for ASBIP?

Option list.

A	routine screening should be offered early in pregnancy
B	screening should be by culture of a MSU
C	screening by dipstick testing for nitrites and leukocyte esterase is acceptable as an alternative to MSU screening
D	routine screening is not recommended
E	talk of urine is indelicate and ill-suited to genteel discourse so please desist

Question 3.             

Which, if any of the following reflect the NSC’s advice  about routine screening for ASBIP?

Option list.

A	routine screening should be offered early in pregnancy
B	screening should be by culture of a MSU
C	screening by dipstick testing for nitrites and leukocyte esterase is acceptable as an alternative to MSU screening
D	routine screening is not recommended
E	talk of urine is indelicate and ill-suited to genteel discourse

Question 4.             

Which, if any, of the following are proven to be more likely in those with ASBIP?

Option list.

A	chorioamnionitis
B	cystitis
C	endometritis
D	↑ perinatal mortality
E	LBW
F	learning difficulty
G	fetal anaemia
H	maternal anaemia
I	premature birth
J	pyelonephritis
K	schizophrenia

Question 5.             

What is the main reason for justification for routine screening for ASBIP?

Option list.

A	it reduces the risk of cystitis
B	it reduces the risk of premature labour
C	it reduces the risk of IUGR
D	it reduces the risk of pyelonephritis
E	the laboratory staff like to be busy
F	none of the above.

Question 6.             

Which of the following statements is correct about leukocyte esterase?

Option list.

A	LE is a sensitive indicator of UTI
B	LE derives from inflamed bladder mucosa
C	LE derives from bacteria killed by leukocytes
D	LE testing is an acceptable method of screening for ASB
E	a +ve urine LE test usually leads to testing of a MSU
F	none of the above