Tutorial 8th. June 2023

 

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27	Julie Morris . Basic statistics
28	EMQ. Galactosaemia
29	EMQ. Parvovirus
30	EMQ. Maternal Mortality definitions

 

Try to answer all the questions before the tutorial – doing this helps facts stick in long-term memory.

 

27.   Julie Morris . Basic statistics.

There are usually a couple of questions on basic statistics in the Part 2. Julie covers the likely issues and is happy to answer the most basic questions, so this tutorial is invaluable for most.

Read the attached documents, particularly the flow chart to get the most of the talk. She starts by categorising data, then talking about whether it is normally distributed and proceeds in a logical fashion. Go through the flowchart to familiarise yourself with the terminology and it will make much more sense.

 

28.   EMQ. Galactosaemia.

Abbreviations.

GA:             galactose

GAA:           galactosaemia

GALT:         galactose-1-phosphate uridylyltransferase

Scenario 1.         What is galactosemia? There is no option list.

Scenario 2.         What is the mode of inheritance? There is no option list.

Scenario 3.         Which of the following is the most common cause of galactosemia in Caucasians?

Option list.

A	mutation of the GALE gene
B	mutation of the GALF gene
C	mutation of the GALK gene
D	mutation of the GALk1 gene
E	mutation of the GALT gene

Scenario 4.         What is the mutation which causes Classical Galactosaemia?

Option list.

A	Q188L
B	Q188M
C	Q188R
D	R188L
E	R188M
F	R188R
G	None of the above

Scenario 5.         What is the Duarte mutation? There is no option list.

Scenario 6.         What are the main sources of galactose? There is no option list.

Scenario 7.         What is the approximate prevalence of galactosemia? There is no option list.

Answer. GHR says: 1 in 30,000 to 1 in 60,000.

Scenario 8.         Which of the following groups has the highest prevalence of galactosaemia?

Option list.

A	Armenians
B	Ashkenazi Jews
C	French absinthe drinkers
D	Irish campers
E	Irish travellers
F	Masai
G	Scottish campers
H	None of the above

Scenario 9.               Which is the most common mutation in the group with the highest incidence of galactosemia? There is no option list.

Scenario 10.      Which, if any, of the following are linked to untreated GAA in the newborn?

Option list.

A	­ risk of coagulation problems
B	­ risk of congenital hypothyroidism
C	­ risk of diabetes
D	­ risk of diarrhoea
E	­ risk of failure to thrive
F	­ risk of liver failure
G	­ risk of renal failure
H	­ risk of staphylococcal infection

Scenario 11.           What are the main problems associated with non-treatment of galactosaemia in adults? There is no option list.

Scenario 12.           Which, if any, of the following statements are true in relation to the effects of a galactose-reduced diet (GRD) on long-term complications (LTCs)?

Option list.

A	a GRD has a major protective effect on LTCs, but only if started within 2 weeks of birth
B	a GRD has a major protective effect on LTCs, but only if started within 12 weeks of birth
C	a GRD has a major protective effect on LTCs, but only if followed meticulously
D	a GRD has a major protective effect on LTCs, but only if started within 2 weeks of birth and continued for life
E	a GRD has a major protective effect on LTCs, but only if started within 2 weeks of birth and continued for life
F	none of the above

Scenario 13.           Is screening for galactosaemia included in the UK neonatal screening programme? If not, why not?

 

29.   EMQ. Parvovirus.

Abbreviations.

PvB19:          parvovirus B19

PvIgG:           parvovirus B19 IgG

PvIgM:          parvovirus B19 IgM

Option list.

There are no option lists apart from the last few questions. Make up your own answers! In the exam it is best if you decide the answer without reference to the option list and then identify it on the list.

Scenario 1.               What type of virus is parvovirus?

Scenario 2.               Is the title B19 something to do with the American B19 bomber, its potentially devastating bomb load and the comparably devastating consequences of the parvovirus on human erythroid cell precursors?

Scenario 3.               PVB19 in the UK occurs in mini-epidemics at 3 to 4-year intervals, usually during the summer.

Scenario 4.               Which animal acts as the main reservoir for infection?

Scenario 5.               What is the approximate incidence of maternal parvovirus infection in the UK?

Scenario 6.               What percentage of UK adults are immune to parvovirus infection?

Scenario 7.               What names are given to acute infection in the human?

Scenario 8.               What is the incubation period for parvovirus infection?

Scenario 9.               What is the duration of infectivity for parvovirus infection?

Scenario 10.           What are the usual symptoms of parvovirus infection in the adult?

Scenario 11.           What is the incidence of parvovirus infection in pregnancy?

Scenario 12.           How is recent infection diagnosed?

Scenario 13.           How long does PvIgM persist and why is this important?

Scenario 14.           What is the rate of vertical transmission of parvovirus infection?

Scenario 15.           Are women with parvovirus infection who are asymptomatic less likely to pass the virus to their fetuses?

Scenario 16.           To what degree is parvovirus infection teratogenic?

Scenario 17.           What proportion of pregnancies infected with parvovirus are lost?

Scenario 18.           What is the timescale for the onset of hydrops?

Scenario 19.           Laboratories are advised to retain bloods obtained at booking for at least 2 years for possible future reference. True or false?

Scenario 20.           What ultrasound features would trigger consideration of cordocentesis?

Scenario 21.           Must suspected parvovirus infection be notified to the authorities?

Scenario 22.           Possible parvovirus infection does not need to be investigated after 20 week’s gestation. True or false?

Scenario 23.           If serum is sent to the laboratory from a woman with a rash in pregnancy for screening for rubella, the laboratory should automatically test for parvovirus infection too?

Scenario 24.           A woman attends the pre-pregnancy counselling clinic as she is planning her first pregnancy. She wants to know what screening for parvovirus is recommended.

Scenario 25.           A pregnant woman has had a significant contact with a child with PARV infection. She has had urgent tests for PvIgG and PvIgM. Both results were -ve. Which of the options best fits the advice she should be given?

Option list.

1	the tests show acute parvovirus infection
2	the tests show chronic parvovirus infection
3	the tests show that she has not had PARV infection and is susceptible to it
4	the tests show no evidence of PARV infection but she should have repeat tests in 1 month
5	the tests show old PARV infection and immunity
6	the tests show recent PARV infection
7	none of the above

Scenario 26.           A pregnant woman has had a significant contact with a child with PARV infection. She has had urgent tests for PvIgG and PvIgM. Both results were +ve. Which of the options best fits the advice she should be given?

Option list.

1	the tests show acute parvovirus infection
2	the tests show chronic parvovirus infection
3	the tests show that she has not had PARV infection and is susceptible to it
4	the tests show no evidence of PARV infection but she should have repeat tests in 1 month
5	the tests show old PARV infection and immunity
6	the tests show recent PARV infection
7	none of the above

Scenario 27.           A pregnant woman has had a significant contact with a child with PARV infection. She has had urgent tests for PvIgG and PvIgM. The results were PvIgG +ve and PvIgM -ve. Which of the options best fits the advice she should be given?

Option list.

1	the tests show acute parvovirus infection
2	the tests show chronic parvovirus infection
3	the tests show that she has not had PARV infection and is susceptible to it
4	the tests show no evidence of PARV infection but she should have repeat tests in 1 month
5	the tests show old PARV infection and immunity
6	the tests show recent PARV infection
7	none of the above

Scenario 28.           A pregnant woman has had a significant contact with a child with PARV infection. She has had urgent tests for PvIgG and PvIgM. The results were PvIgG -ve and PvIgM +ve. Which of the options best fits the advice she should be given?

Option list.

1	the tests show acute parvovirus infection
2	the tests show chronic parvovirus infection
3	the tests show that she has not had PARV infection and is susceptible to it
4	the tests show no evidence of PARV infection but she should have repeat tests in 1 month
5	the tests show old PARV infection and immunity
6	the tests show recent PARV infection
7	none of the above

Scenario 29.           A pregnant woman has had a significant contact with a child with PARV infection. What prophylaxis should be offered?

Option list.

1	acyclovir orally
2	acyclovir i.m.
3	acyclovir i.v.
4	hand-washing and avoiding small children
5	i.v. hyperimmune globulin
6	PVV vaccine
7	there is no proven prophylaxis

 

30.   EMQ. Maternal Mortality definitions.

Abbreviations.

EPNMR:              Extended Perinatal Mortality Rate.

MMR:                 Maternal Mortality Rate.

NMR:                  Neonatal Mortality Rate

PNMR:                Perinatal Mortality Rate.

NMR:                  Neonatal Mortality Rate.

Option List.

A.    Death of a woman during pregnancy and up to 6 weeks later, including accidental and incidental causes.

B.    Death of a woman during pregnancy and up to 6 weeks later, excluding accidental and incidental causes.

C.    Death of a woman during pregnancy and up to 52 weeks later, including accidental and incidental causes.

D.   Death of a woman during pregnancy and up to 52 weeks later, excluding accidental and incidental causes.

E.    A pregnancy going to 24 weeks or beyond.

F.    A pregnancy going to 24 weeks or beyond + any pregnancy resulting in a live-birth.

G.   Maternal deaths per 100,000 maternities.

H.   Maternal deaths per 100,000 live births.

I.      Direct + indirect deaths per 100,000 maternities.

J.     Direct + indirect deaths per 100,000 live births.

K.    Direct death.

L.     Indirect death.

M.  Early death.

N.   Late death.

O.   Extra-late death.

P.    Fortuitous death.

Q.   Coincidental death.

R.    Accidental death.

S.    Maternal murder.

T.    Not a maternal death.

U.   Yes

V.    No.

W. I have no idea.

X.    None of the above.

Question 1.        What is a Maternal Death?

Question 2.        Which categories are included in the definition of MD?  >1 answer may be correct.

correct.

Option list.

A	accidental death
B	coincidental death
C	direct death
D	iatrogenic death
E	incidental death
F	indirect death
G	late death

Question 3.        Which categories are included in the discussions in the MMRs?

Option list.

A	accidental death
B	coincidental death
C	direct death
D	iatrogenic death
E	incidental death
F	indirect death
G	late death

Question 4.        When was the latest Maternal Mortality Report published? Which years did it cover?

Question 5.        What was the Maternal Mortality Rate in the most recent Report?

Question 6.        How did the MMR compare with that from the previous Report?

Question 7.        What was the leading cause of maternal death and how many deaths were there?

Question 8.        What was the leading cause of direct death and how many deaths were there?

Question 9.        When was the latest Perinatal Mortality Report published? Which years did it cover?

Question 10.         EPNMR and PNMR are derived from the number of stillbirths + the number of neonatal deaths. Why is the EPNMR used in preference to PNMR in most publications?

A	the EPNMR includes NNDs up to 2 weeks; the NMR NNDs up to 1 week
B	the EPNMR includes NNDs up to 4 weeks; the NMR NNDs up to 1 week
C	the EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 1 week
D	the EPNMR includes NNDs up to 6 weeks; the NMR NNDs up to  4 weeks
E	the EPNMR includes NNDs up to 8 weeks; the NMR NNDs up to 4 weeks
F	the EPNMR includes NNDs up to 12 weeks; the NMR NNDs up to 4 weeks
G	none of the above

Question 11.    A woman dies from a ruptured appendix at 10 weeks. What kind of death is it?

Question 12.    A woman dies from a ruptured ectopic pregnancy at 10 weeks’ gestation. What kind of

death is it?

Question 13.    A woman dies from a ruptured appendix at 10 weeks. What kind of death is it?

Question 14.    A woman dies from chickenpox at 30 weeks’ gestation. What kind of death is it?

Question 15.    How many categories are there for sepsis in the MMRpts?

Question 16.     

A woman dies of sepsis secondary to pyelonephritis at 20 weeks’ gestation. What kind of death is it?

Question 17.    A woman dies from sepsis two weeks after C section. The sepsis was due to uterine

infection that started as chorioamnionitis. What kind of death is it?

Question 18.    A woman dies from hepatitis C at 40 weeks’ gestation. The infection was transmitted

 sexually. What kind of death is it?

Question 19.    A woman dies from suicide at 10 weeks’ gestation. What kind of death is it?

Question 20.    A woman with a 10-year-history of coronary artery disease dies of a coronary

thrombosis at 36 weeks’ gestation. What kind of death is it?

Question 21.    A woman has gestational trophoblastic disease, develops choriocarcinomas and dies

from it 24 months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?

Question 22.    A woman develops puerperal psychosis from which she makes a poor recovery. She

kills herself when the baby is 18 months old. What kind of death is it?

Question 23.    A woman develops puerperal psychosis from which she makes a poor recovery. She

kills herself when the baby is 6 months old. What kind of death is it?

Question 24.    What is a “maternity”.

Question 25.    What is the definition of the Maternal Mortality Rate?

Question 26.    What is the Maternal Mortality Ratio?

Question 27.    A woman is diagnosed with breast cancer. She has missed a period and a pregnancy

 test is +ve. She decides to continue with the pregnancy. The breast cancer does not respond to treatment and she dies from secondary disease at 38 weeks. What kind of death is it?

Question 28.    A woman who has been the subject of domestic violence is killed at 12 weeks

 by her partner. What kind of death is it?

Question 29.    A woman is struck by lightning as she runs across a road. As a result, she falls under

 the wheels of a large lorry which runs over her abdomen, rupturing her spleen and provoking placental abruption. She dies of haemorrhage, mostly from the abruption. What kind of death is it?

Question 30.    A woman is abducted by Martians who are keen to study human pregnancy. She dies

 as a result of the treatment she receives. As this death could only have occurred because she was pregnant, is it a direct death?

Question 31.    Could a maternal death from malignancy be classified as “direct”?

Question 32.    Could a maternal death from malignancy be classified as “Indirect”?

Question 33.    Could a maternal death from malignancy be classified as “Coincidental”?

Question 34.    A pregnant woman is walking on the beach at 10 weeks when she is struck by lightning

 and dies. What kind of death is this?

Question 35.    A woman is sitting on the beach breastfeeding her 2-year old baby when she is struck

 by lightning and dies. What kind of death is this?