Tutorial 14 November 2022

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1	How to prepare. Part 2. What to read. StratOG. TOG CPD. RCOG sample questions. Revision system. Study buddies. Intelligent guessing. Statistics. Urogynae. Other specialist tutorials
2	How to prepare. Part 3. Mention safety at every station. Keep Part 2 knowledge up-to-date. Last-minute revision list. Study partner. Senior doctor thinking: staffing, training, audit, critical incident reporting and analysis etc. Importance of polished introduction to role-plays. Deal with GP referral. Practise agenda setting. Communication skills. What tasks have been set and how do they map to domains? Listen to the ‘patient’. Answer questions. Practise ‘blurbs’. Pick a course that gives exam experience.
3	Basic “blurbs” to prepare and practise. Introducing yourself, dealing with the information in a GP referral letter, setting the scene for breaking bad news, , general pre-pregnancy counselling, recessive inheritance, x-linked inheritance, how to ask if the role-player has questions, dealing with information such as a relative with a serious problem, etc. Make a list. Test them on non-medical friends and relatives.
4	Role-play. The topic will be revealed during the tutorial so you can’t prepare. Explain the topic to the role-player, who is a medical student and keen to learn. Your consultant has said that it is important and they need a clear understanding.
5	EMQ. Cystic fibrosis
6	EMQ. Hepatitis B

 

1.           How to prepare. Part 2.

 

2.           How to prepare. Part 3.

 

3.           Basic “blurbs” to prepare and practise.

 

4.           Role-play.

Candidate’s instructions.

You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain XXX to a medical student who started with the department yesterday.

 

5.           EMQ. Cystic fibrosis.

Cystic fibrosis. EMQ. Questions.

There is no option list to make you behave in a model fashion – best technique is to decide the correct answer before looking at the option list.

Scenario 1. A woman is 8 weeks pregnant and a carrier of CF. Her husband is Caucasian. What is the risk of the child having CF?

Scenario 2. A healthy woman attends for pre-pregnancy counselling. Her brother has CF. Her husband is Caucasian and has a negative CF screen. What is the risk of them having a child with CF?

Scenario 3. A healthy woman is a carrier of CF. She attends for pre-pregnancy counselling. Her husband has CF. What is the risk of them having a child with CF?

Scenario 4. A healthy woman attends for pre-pregnancy counselling. Her sister has had a child with CF. What is her risk of being a carrier?

Scenario 5. A woman attends for pre-pregnancy counselling. Her mother has CF.

What is the risk that she is a carrier?

Scenario 6 . A woman attends for pre-pregnancy counselling. Her mother has CF.

The partner’s risk of being a carrier is 1 in X. What is the risk that she will have a child with CF?

Scenario 7. A healthy Caucasian woman is 10 weeks pregnant. Her husband is a carrier of CF. Which test would you arrange?

Scenario 8. A woman attends for pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF in this way?

Scenario 9. A woman and her husband are carriers of CF. What is the risk of an affected child?

Scenario 10. A woman and her husband are carriers of CF. What can they do to reduce the risk of having an affected child?

Scenario 11. A woman and her husband are carriers of CF. Can CVS exclude an affected pregnancy?

Scenario 12. A woman has CF, her husband is a carrier. What is their risk of an affected child?

Scenario 13. A woman with CF delivers a baby at term. She has been advised not to breastfeed because her breast milk will be protein-deficient due to malabsorption. Is this advice correct?

Scenario 14. A woman with CF delivers a baby at term. She has been advised not to breastfeed because her breast milk will contain abnormally low levels of sodium. Is this advice correct?

 

TOG CPD. 2009. 11. 1. Cystic fibrosis and pregnancy

These are open access so are produced here.

Regarding cystic fibrosis,

1.     there are approximately 8000 people living with this disease in the UK.                     True / False

2.     the main cause of death is liver disease.                                                                      True / False

Women with cystic fibrosis

3.     have an approximately 50% reduced fertility.                                                             True / False

4.     have a life expectancy of approximately 50 years.                                                     True / False

With regard to pregnancy in women with cystic fibrosis,

5.     their babies usually have an appropriate birthweight for their gestational age.      True / False

6.     approximately 70% of babies are born prematurely.                                                True / False

7.     the risk of developing gestational diabetes is higher than in the general population.              True / False

8.     the risk of miscarriage is higher than in the general population.                            True / False

9.     the risk of congenital malformations is similar to that in women who are carriers.             True / False

Women with cystic fibrosis who become pregnant,

10.   have a shortened life expectancy compared with women who do not.                    True / False

If a woman with cystic fibrosis becomes pregnant, the risk of the baby being born with cystic fibrosis

11.   is 50% if the father carries one of the common gene mutations for cystic fibrosis.         True / False

12.   is < 1 in 250 if the father does not carry any of the common CF mutations.                              True / False

During pregnancy, a woman with cystic fibrosis

13.   should be cared for by a multidisciplinary team, including a physician and an obstetrician with a special interest in CF in pregnancy.                                                                                         True / False

14.   should have a GTT if she did not have CF-related diabetes prior to pregnancy. True / False

In pregnant women with cystic fibrosis,

15.   the instrumental delivery rate is approximately 40%.                                               True / False

16.   the use of epidural analgesia during delivery is contraindicated.                            True / False

17.   the risk of poor pregnancy outcome increases if the FEV1 is < 70%.                     True / False

Post- delivery in women with cystic fibrosis

18.   breastfeeding is contraindicated because of the high sodium content of breast milk.         True / False

Which of the following statements about cystic fibrosis are correct?

19.   Menarche in girls with CF occurs at the same time as in unaffected girls.                          True / False

20.   Fertility in women with CF is affected to the same extent as it is in men with CF.      True / False

 

6.           EMQ. Hepatitis B.

Topic. Hepatitis B and pregnancy.

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

HCV:           hepatitis C virus

HEV:           hepatitis E virus

HSV:           herpes simplex virus

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 3^rd. 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?

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