|
60 |
Janette Mill. Progression and assessment of training |
|
61 |
EMQ. Parvovirus |
|
62 |
EMQ. Pertussis |
60. Progression and assessment
of training.
Janette
Mill is a consultant in Durham and gives an excellent insight into this topic.
It is particularly useful for those who have not worked in the NHS, but even
those who do will find it helpful as it is a frequent exam topic.
61. EMQ. Parvovirus.
Parvovirus and pregnancy. EMQ. Question.
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 |
62. EMQ. Pertussis.
JCVI: Joint Committee on Vaccination and
Immunisation .
PIPP: pertussis immunisation programme for pregnancy.
Question 1.
Why is
pertussis of current concern in obstetrics?
|
A |
Research has linked pertussis in the 1st.
trimester to ↑ risk of
congenital heart disease |
|
B |
A
mini-epidemic since 2011 has caused ↑ deaths
of mothers & of babies < 3 months |
|
C |
A
mini-epidemic since 2011 has caused ↑ deaths
of babies < 3 months |
|
D |
The
infecting organism has become increasingly drug-resistant |
|
E |
The
infecting organism has become increasingly virulent |
Question 2.
Which
organism causes whooping cough?
|
A |
Bordella pertussis |
|
B |
Bacteroides pertussis |
|
C |
Rotavirus whoopoe |
|
D |
Respiratory syncytiovirus pertussis |
|
E |
None of the above |
Question 3.
Which, if
any, of the following statements are true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space and there may be more than one correct answer.
|
A |
the
organism is aerobic |
|
B |
the
organism is anaerobic |
|
C |
the
organism is capsulated |
|
D |
the
organism is flagellate |
|
E |
the organism is an obligate intra-cellular
parasite |
|
F |
the
organism is a Gram -ve diplococcus |
|
G |
the
organism is a Gram +ve diplococcus |
|
H |
the
organism requires special transport media |
|
I |
no one
is going to ask me any of this stuff |
Question 4.
Which of the
following statements is true?
|
A |
Pertussis
is no longer a significant threat to infants |
|
B |
Pertussis remains a significant threat to
infants |
|
C |
The risk of death from pertussis is
eliminated by timely antibiotic therapy |
|
D |
the risk of death from pertussis is
eliminated by timely antiviral therapy |
|
E |
None of the above |
Question 5.
Which of the following
statements is true?
|
A |
Pertussis is not a notifiable
disease |
|
B |
Pertussis is a notifiable disease |
|
C |
Pertussis is not a notifiable disease, but cases should be
reported to the local bacteriologist |
|
D |
Pertussis is not a notifiable disease, but cases should be
subject to audit |
Question 6.
What is the
main mode of spread of the organism that causes pertussis?
|
A |
contact with contaminated surfaces |
|
B |
contaminated
food |
|
C |
contaminated
water |
|
D |
respiratory
droplets |
|
E |
none of
the above |
Question 7.
What is the
main reservoir of the organism that causes pertussis?
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of
the above |
Question 8.
What is the
epidemiology of pertussis?
|
A |
the condition is endemic |
|
B |
the condition is endemic with mini-epidemics every 3-5 years |
|
C |
the condition is endemic with mini-epidemics most years in the
winter months |
|
D |
the condition is epidemic, with outbreaks at roughly three-year
intervals |
|
E |
the condition is epidemic, with outbreaks at unpredictable
intervals |
Question 9.
What is the
incubation period for pertussis?
|
A |
3-6
days |
|
B |
7-10
days |
|
C |
11-14 days |
|
D |
15-18 days |
|
E |
none of the above. |
Question 10.
What is the
duration of infectivity of someone with pertussis?
|
A |
2 days from exposure → 5 days after onset
of paroxysms of coughing |
|
B |
3 days from exposure → 10 days after onset
of paroxysms of coughing |
|
C |
4 days from exposure → 14 days after onset
of paroxysms of coughing |
|
D |
6 days from exposure → 21 days after onset
of paroxysms of coughing |
|
E |
none of the above |
Question 11.
What % of
non-immune, close contacts of pertussis will develop the disease?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Which of the
following best describe the DOH’s advice about pertussis? This is not a true
SBA as there may be > 1 connect answer.
|
A |
The DOH advises that all
pregnant women be immunised to ↓ maternal
death rates. |
|
B |
The DOH advises that all pregnant women be immunised to ↓ deaths in babies < 3 months. |
|
C |
The DOH advises that all babies be immunised at birth. |
|
D |
The DOH advised that “Boostrix-
IPV” should replace “Repevax” from July 2014. |
|
E |
The DOH advises that immunisation of pregnant women be continued
permanently |
Question 13.
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routine child immunisation was
introduced?
|
A |
the number was 10,000 |
|
B |
the number was 5,000 |
|
C |
the number was 4,000 |
|
D |
the number was 3,500 |
|
E |
the number was 1,000 |
Question 14.
Which, if
any, of the following statements are true in relation to pertussis vaccine.
|
A |
“Boostrix-
IPV” is a vaccine for pertussis only |
|
B |
“Repevax” is a vaccine for pertussis only |
|
C |
“Boostrix- IPV” & “Repevax” are live,
attenuated vaccines |
|
D |
“Boostrix- IPV” & “Repevax” act against
diphtheria, tetanus and polio as well as pertussis |
|
E |
“Boostrix- IPV” & “Repevax” are
acellular |
Question 15.
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the
above |
Question 16.
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this
subject now |
Question 17.
A pregnant woman misses out on vaccination as part of the PIPP. Should
vaccination still be offered in the puerperium?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I don’t know |
|
E |
I hate this
subject now |
