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Essays 28 January
2013.
16 EMQ. Parvovirus.
You have been
asked to write a protocol for the diagnosis and management of umbilical cord
prolapse.
1. Justify
the steps you will take. 6 marks
2. Justify
the key advice you will include in the protocol. 14 marks
A 30-year-old
woman para 1+1 presents at 34 weeks gestation with right loin pain, frequency
of micturition, dysuria and pyrexia.
1. Justify
the history you will take. 6 marks.
2. Justify
the investigations you will arrange. 6
marks.
3. Justify
your management. 12 marks.
A 20 year-old
woman with a known history of drug abuse attends the hospital antenatal booking
clinic in her first pregnancy.
a. outline
the factors determining her level of risk
4 marks.
b. outline
the risks to the mother 6
marks.
c. outline
the risks to the fetus 4
marks.
d. outline
the risks to the neonate & infant 4
marks.
e. outline
the risk to others 2
marks.
A nulliparous
woman is admitted to the Early Pregnancy Unit with abdominal pain and bleeding.
Her hCG is 2,000 i.u. per litre. An ultrasound scan shows an empty uterus and a
left adnexal mass.
1. Discuss the differential diagnosis. 4
marks.
2. Discuss the treatment options. 10 marks.
3. Discuss the advice you will give for when she
has recovered. 6 marks.
Lead-in.
The following scenarios relate to parvovirus infection
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
GOVRIP: Guidance
on Viral Rash in Pregnancy. HPA. 2011
PSVMCA: peak
systolic velocity middle cerebral artery.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There is none: make up your own
answers!
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 – 4 year
intervals, usually during the summer months.
Scenario 4.
Which animal acts as the main
reservoir for infection?
Scenario 5.
What percentage of UK adults are immune to parvovirus
infection?
Scenario 6.
What names are given to acute
infection in the human?
Scenario 7.
What is the incubation period for parvovirus infection?
Scenario 8
What is the duration of infectivity for parvovirus
infection?
Scenario 9.
What are the usual symptoms of parvovirus infection in
the adult?
Scenario 10.
What is the incidence of parvovirus infection in
pregnancy?
Scenario 11.
How is recent infection diagnosed?
Scenario 12.
How long does PvIgM persist and why is this important?
Scenario 13.
What is the rate of vertical transmission of parvovirus
infection?
Scenario 14.
Are women with parvovirus infection who are asymptomatic
less likely to pass the virus to their fetuses?
Scenario 15.
To what degree is parvovirus infection teratogenic?
Scenario 16.
What proportion of pregnancies infected with parvovirus are
lost?
Scenario 17.
What is the timescale for the onset of hydrops?
Scenario 18.
Laboratories are advised to retain bloods obtained at
booking for at least 2 years for possible future reference. True or false?
Scenario 19.
What ultrasound features would trigger consideration of
cordocentesis?
Scenario 20.
Must suspected parvovirus infection be notified to the
authorities?
Scenario 21.
Possible parvovirus infection
does not need to be investigated after 20 week’s gestation.
Scenario 22
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.
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