Tutorial 4th. September 2023

 

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39	Role-play. Difficult patient. Wishes to complain
40	Viva. Asymptomatic bacteriuria and pregnancy
41	EMQ. Hepatitis B

 

39.        Role-play. Difficult patient. Wishes to complain.

Candidate’s instructions.

You are an ST5 and are in the gynaecology clinic. Anne Dezibel, a patient, has been aggressive towards the reception and nursing staff, insisting that she must see the consultant, not a junior doctor. She shouted at both the receptionist and the nurses, saying: ‘I want to see the organ grinder, not the bloody monkey’.

The consultant says that she has no intention of seeing her and that you need to learn to deal with difficult patients. The GP referral letter has gone missing. Your task is to deal with the patient.

 

40.      Viva. Asymptomatic bacteriuria and pregnancy.

The examiner will ask 20 questions.

 

41.      EMQ. Hepatitis B.

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, assuming that she became infected early in the partner’s illness?

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?

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?

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?

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?

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