Tutorial 13 December 2012

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Tonight we had a mock exam, so there was no tutorial and there is no podcast.
We had one EMQ and four essays.
I would like you to complete them in 2 hours, which would be roughly the time available in the exam.
Send me your answers and I'll send my versions.
Note that we are now up to essay number 19 - I hope you are keeping up.
Essays:

16. You have been asked to give a tutorial on essay-writing to MRCOG part II candidates.

Outline the key aspects of the advice you will wish to convey.

17. With regard to ovarian hyperstimulation syndrome:

a. Outline the risk factors.                                            4 marks

b. Discuss the classification system.                         6 marks

c. Outline the key aspects of the management. 10 marks             

18. A 30-year-old woman presents for booking at 8 weeks. Her father has recently been diagnosed with TB. She wishes to know what the risks are to her and the pregnancy of possible TB.

1. Critically evaluate the investigation.                                            4 marks

2. Outline the management in pregnancy.                                    2 marks

3. Critically evaluate the issues relating to the puerperium.  14 marks

19. With regard to Systemic Lupus Erythematosis (SLE):

1.  outline the clinical manifestations of SLE.             4 marks.

2.  outline the implications of SLE for pregnancy .    4 marks.

3.  critically evaluate how the diagnosis is made.      4 marks.

4.  critically evaluate the management in the woman wishing to be pregnant.  8 marks.

4a.critically evaluate the management of a woman booking at 8 weeks.           8 marks.            

EMQ.

  

Hepatitis B and pregnancy.

Lead-in.

Each of the following scenarios relates to hepatitis B and pregnancy.

Instructions.

For each scenario, select the most appropriate option from the option list.

Each option can be used once, more than once or not at all.

Abbreviations.

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

Option list.

A.      acyclovir

B.      divorce

C.      HBcAg +ve

D.     HBeAg +ve

E.      HbsAg +ve

F.       HBsAg +ve; HBsAb –ve; HBcAb -ve

G.     HBsAg +ve; HBsAb –ve on two tests six months apart

H.     HBsAG –ve; HBsAb -ve on two tests six months apart

I.        HBsAg –ve; HBsAb +ve; HBcAb –ve

J.        HBsAg –ve; HBsAb +ve; HBcAb +ve

K.      HBsAg –ve; HBsAb +ve

L.       HBsAg +ve; HBcAg +ve

M.   HBV vaccine.

N.     HBIG

O.     HBV vaccine + HBIG

P.      immune as a result of infection

Q.     immune as a result of vaccination

R.      not immune

S.       chronic carrier of HBV infection

T.      10%

U.     30%

V.      50%

W.   60%

X.      70 - 90%

Y.      soap and boiling water

Z.      10% dilution of bleach in water

AA. 10% dilution of formaldehyde in alcohol

BB. ultraviolet irradiation

CC. yes

DD.no

EE.  none of the above

Scenario 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 infection?

Scenario 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 natural infection?

Scenario 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?

Scenario 4.

An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 6 months ago. What results on routine blood testing would indicate that she is a chronic carrier of HBV infection?

Scenario 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?

Scenario 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?

Scenario 7

A primigravid woman at 8 weeks gestation is found to be non-immune to the HBV. She has recently married and her husband is a chronic carrier. What should be done to protect her from infection?

Scenario 8

A woman is a known carrier of Hepatitis B. What is the risk of vertical transmission in the first trimester?

Scenario 9

A woman is a known carrier of Hepatitis B. What is the risk of the neonate who has been infected by vertical transmission in the third trimester becoming a carrier without treatment?

Scenario 10

How effective is hepatitis B prophylaxis in preventing chronic carrier status developing in a neonate infected as a result of vertical transmission?

Scenario 11

Can a woman who is a chronic HBV carrier breastfeed safely?

Scenario 12.

Hepatitis B infection is the most dangerous of the viral hepatitis infections in pregnancy.

Scenario 13.

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?

Scenarios 14 & 15 overleaf.

Scenario 14.

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?

Scenario 15.

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!