Monday, 1 February 2016

Tutorial 1st. February 2016

1 February 2016.

47
EMQ. Abortion Act.
48
SBA. Recurrent miscarriage
49
EMQ. Needle-stick injuries
50
Communication skills

47.        EMQ. Abortion Act.
Scenario 1
Lead in.
What was the approximate rate of abortion in the UK in 2014?
Option list
A
1 per 1,000 resident women aged 15-44
B
10 per 1,000 resident women aged 15-44
C
15 per 1,000 resident women aged 15-44
D
20 per 1,000 resident women aged 15-44
E
50 per 1,000 resident women aged 15-44
F
100 per 1,000 resident women aged 15-44

Scenario 2
Lead in.
The rate of abortion has declined by > 20% in the UK in the past ten years.
Pick the answer from the option list that best matches the above statement.
Option list
A
False
B
Haven’t a clue
C
Maybe
D
No data exist
E
True

Scenario 3
Lead in.
What proportion of TOPs were performed at gestations < 10 weeks in 2014?
Option list
A
50%
B
60%
C
70%
D
80%
E
90%

Scenario 4
Lead in.
There has been a significant improvement in the proportion of TOPs performed early in the past decade.
Option list
A
False
B
Haven’t a clue
C
Maybe
D
No data exist
E
True

Scenario 5
Lead in.
What proportion of TOPs were performed using medical, not surgical techniques?
Option list
A
20%
B
30%
C
40%
D
50%
E
60%
F
70%
G
80%

Scenario 6
Lead in.
Which age had the highest rate of TOP?
Option list
A
18
B
19
C
20
D
21
E
22
F
23
G
24
H
25

Scenario 7
Lead in.
What happened to the rate of TOP in 2014 for girls < 18 years compared with 2013?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged

Scenario 8
Lead in.
What happened to the rate of TOP in 2014 for girls < 16 years compared with 2013?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged

Scenario 9
Lead in.
What happened to the rate of TOP in 2014 for girls < 16 years compared with 2004?
Option list
A
the rate was much lower
B
the rate was slightly lower
C
the rate was much higher
D
the rate was slightly higher
E
the rate was unchanged

Scenario 10
Lead in
Approximately what proportion of women having TOP in 2014 had previously had one or more TOPs?
Option list
A
1%
B
5%
C
10%
D
20%
E
30%
F
40%
G
50%

Scenario 11
Lead in
There were 190,092 TOPs in 2014. How many deaths occurred?
Option list
A
0
B
10
C
22
D
40
E
56

Scenario 12
Lead in
There were 190,092 TOPs in 2014. What was the rate of significant complications?
Option list
A
<1%
B
1%
C
3%
D
5%
E
10%

Scenario 13
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) a”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
3
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Scenario 14
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) b”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above

Scenario 15
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) c.
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above

Scenario 16
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) d”?
Option list
1
that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5
none of the above

Scenario 17
Lead in.
The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) e”?
Option list
1
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
2
the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3
the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5
there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Scenario 18
Lead in.
With regard to the he Abortion Act and grounds “F” and “G”. Which of the following statements are true?

1
“F” & “G” are grounds for TOP in an emergency with only one doctor needing to sign the legal form necessary for the TOP to take place
2
 “F” & “G” are grounds for TOP after 24 weeks.
3
“F” relates to TOP to save the woman’s life
4
“F” relates to TOP to prevent grave permanent injury her physical or mental health
5
“F” & “G” do not exist.
Option list
A
1  + 3
B
1  + 4
C
2 + 3
D
2 + 4
E
5

Scenario 19
Lead in
In relation to terms such as “substantial risk”, “grave permanent injury” and “seriously handicapped”, which of the following is true?
Option list
A
The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (b) to the Act.
B
The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (c) to the Act.
C
The terms were defined by the General Medical Council, examples were given and the information can be downloaded from the GMC website.
D
The terms were defined by the RCOG, examples were given and the information can be downloaded from the RCOG website.
E
The terms have not been defined.

Scenario 20
Lead in
Which of the following statement is true about the most common grounds for TOP?
Option list
1
TOP is most commonly done on ground A from Certificate A.
2
TOP is most commonly done on ground B from Certificate A.
3
TOP is most commonly done on ground C from Certificate A.
4
TOP is most commonly done on ground D from Certificate A.
5
TOP is most commonly done on ground E from Certificate A.
6
TOP is most commonly done on ground F from Certificate A.
7
TOP is most commonly done on ground G from Certificate A.
8
TOP is most commonly done on ground H from Certificate A..

Scenario 21
Lead in
Which of the following statements is true in relation to the upper gestational limit for TOP to be legal in the UK.

1
Termination of pregnancy is legal to 24 weeks
2
Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly.
3
Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly, but only if approved by the Department of Health’s “Late Termination of Pregnancy Assessment Panel”.
4
Termination of pregnancy is illegal after 24 weeks, but is still done if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly and there is a long-standing agreement that the police and legal authorities will “turn a blind eye”.
Option list
A
1 + 2 
B
1 + 3
C
1 + 4
D
2 + 4
E
5

Scenario 22
Lead in
Which of the following statement are true in relation to TOP after 24 weeks?
Statements
1
TOP is illegal after 24 weeks
2
The mother must agree to feticide pre-TOP
3
Feticide must be offered
4
There must be very serious grounds for the TOP
5
Gender-selection TOP is unacceptable
Option list
A
1
B
1 + 2
C
2 + 3 + 5
D
3 + 4
E
3 + 4 + 5

Scenario 23
Lead in
Which form relates to certifying that a woman requesting a TOP can have it done legally?
Option list
A
HSA1
B
HSA2
C
HSA3
D
HSA4
E
HSA5

Scenario 24
Lead in
Which form must the practitioner performing the TOP complete to notify the and return to Department of Health?
Option list
A
HSA1
B
HSA2
C
HSA3
D
HSA4
E
HSA5

Scenario 25
Lead in
A doctor signing the form giving the grounds for a TOP must have seen the woman.
Option list
A
True
B
False
C
Sometimes
D
Don’t know & don’t care

Scenario 26
Lead in
A doctor performing a TOP must be one of the doctors who signed the initial form giving the grounds for the TOP.
Option list
A
True
B
False
C
Sometimes
D
Don’t know & don’t care

Scenario 27
Lead in
What is the time scale for the return of the form notifying that a TOP has taken place?
Option list
A
3 working days
B
5 working days
C
1 week
D
2 weeks
E
1 month

Scenario 28
Lead in.
A woman seeks 1st. trimester TOP on social grounds which she declines to discuss in detail.
Which of the following statements apply?
Option List
A
TOP can be done under clause A of Certificate A
B
TOP can be done under clause B of Certificate A
C
TOP can be done under clause C of Certificate A
D
TOP can be done under clause D of Certificate A
E
TOP can be done under clause E of Certificate A
F
TOP can be done under clause F of Certificate A
G
TOP can be done under clause G of Certificate A
F
there is no clause authorising TOP on social grounds

Scenario 28
A woman seeks 1st. trimester TOP. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.
Which of the following statements apply?
A
TOP can be done under clause A of Certificate A
B
TOP can be done under clause B of Certificate A
C
TOP can be done under clause C of Certificate A
D
TOP can be done under clause D of Certificate A
E
TOP can be done under clause E of Certificate A
F
TOP can be done under clause F of Certificate A
G
TOP can be done under clause G of Certificate A
F
there is no clause authorising TOP on these grounds

Scenario 29
A woman books at 26 weeks. She has an unplanned pregnancy. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.
Which of the following statements apply?
A            TOP should be offered under clause A of Certificate A
B            TOP should be offered under clause B of Certificate A
C            TOP should be offered under clause C of Certificate A
D            TOP should be offered under clause D of Certificate A
E            TOP should be offered under clause E of Certificate A
F            TOP should be offered under clause F of Certificate A
G            TOP should be offered under clause G of Certificate A
H            there is no clause authorising TOP on these grounds

48.         EMQ. Recurrent miscarriage
Abbreviations.
EPAS:            early pregnancy assessment service.
EPU:              dedicated early pregnancy assessment unit.
PCOS:            polycystic ovary syndrome.
PIGD:            pre-implantation genetic diagnosis.
PIGS:             pre-implantation genetic screening.
RM:               recurrent miscarriage.
TORCH:         Toxoplasmosis, rubella, cytomegalovirus & herpes. (Other definitions include HIV, syphilis and other infections.) Fortunately, TORCH screening is out-of-date, exact definitions are not important, though I’d stick with the first if asked.
UA:                uterine anomaly.

Question 1.
Lead-in
In relation to miscarriage, which, if any, of the following statements are correct?
  1. the term “spontaneous miscarriage” is really stupid
  2. most miscarriages are genetic in causation.
  3. most women who miscarry do not get a diagnosis of causation
  4. the majority of women have significant levels of psychological distress after miscarriage.
  5. counselling is of significant benefit in reducing levels of psychological distress after miscarriage.

Option List
A.       
i + ii
B.       
i + ii + iii
C.       
i + ii + iii + iv
D.       
i + ii + iii + v
E.        
i + ii + iii + iv + v

Question 2.
Lead-in
Which of the following statements are true.
  1. miscarriage occurs in 11% of women with age 20-24 years
  2. miscarriage occurs in 25% of women with age 35-39 years
  3. miscarriage occurs in > 90% of mothers with age ≥ 45 years
  4. recurrent miscarriage affects about 1% of couples
  5. recurrent miscarriage affects about 5% of couples
Option List
A.       
i + ii
B.       
i + iii
C.       
i + ii + iv
D.       
i + iii + v
E.        
i + ii + iii + iv

Question 3.
Lead-in
What figure is usually given for the overall incidence of miscarriage?
Option List
A.       
< 10 %
B.       
10 - 20%
C.       
20 - 25%
D.       
25 – 30 %
E.        
>30%

Question 4.
Lead-in
A healthy, 26-year-old, woman attends the booking clinic at 6 weeks in her first pregnancy. A pregnancy test is +ve. Her best friend recently had an early miscarriage. What risk will you quote?
Option List
A.       
≤ 5%
B.       
5 – 10%
C.       
10 – 15%
D.       
15 – 20%
E.        
≥ 20%

Question 5.
Lead-in
The same healthy woman attends the ANC at 8 weeks for a dating scan. Before she has the scan she asks you what her risk is now. She has had no abnormal symptoms. What risk will you quote?
Option List
A.       
≤ 5%
B.       
5 – 10%
C.       
10 – 15%
D.       
15 – 20%
E.        
≥ 20%

Question 6.
Lead-in
The same healthy, nulliparous woman comes back to see you after the scan. The scan is normal and shows a viable fetus. She asks what her risk is now. What risk will you quote?
Option List

  1.  
≤ 5%

  1.  
5 – 10%

  1.  
10 – 15%

  1.  
15 – 20%

  1.  
≥ 20%

Question 7.
Lead-in
Pick the best option from the list below for the definition of RM.
Option List

  1.  
two or more miscarriages
B.
two or more miscarriages in healthy women
C.
three or more miscarriages
D.
three or more miscarriages in women with no children
E.
none of the above.

Question 8.
Lead-in
The following are possible causes of RM except for one. Pick the best option for the exception.
Option List

  1.  
increased maternal age

  1.  
maternal cigarette smoking

  1.  
maternal alcohol consumption

  1.  
exposure to anaesthetic gases

  1.  
exposure to emissions from video display terminals

Question 9.
Lead-in
A woman presents to antenatal clinic for booking at 6 weeks. She has a history of 3 RMs with no explanation found after full investigation. What is her risk of miscarriage in this pregnancy?
Option List
A.       
≤ 10%
B.       
   20%
C.       
   25%
D.       
   50%
E.        
   75%

Question 10.
Lead-in
4) A 35-year-old woman with a history of 3 RMs presents to you for advice regarding the risk of miscarriage if she conceives. Pick the best option to describe her risk from the list below.
Option List
A.       
20%
B.       
30%
C.       
40%
D.       
50%
E.        
55%

Question11.
Lead-in
The following statement relates to women with arcuate uteri.
There is evidence to suggest that women with arcuate uteri:
                i.     tend to miscarry more in first trimester
              ii.     tend to miscarry more in second trimester
            iii.     have no increased risk of miscarriage
            iv.     are at increased risk of cephalo-pelvic disproportion
              v.     are at increased risk of Caesarean section
Pick the best option from the list below.
Option List
A.       
i
B.       
i + v
C.       
ii + iv
D.       
ii + v
E.        
iii + v

Question 12.
Lead-in
With regards to EPUs, which of the following statements, if any, are true.
         i.            all women with pain + bleeding in early pregnancy can self-refer to an EPU
       ii.            all women with pain + bleeding in early pregnancy should be seen by a health professional before referral to an EPU
     iii.            women with a history of ectopic pregnancy, molar pregnancy or recurrent miscarriage should be able to self-refer to an EPU
     iv.            women with a history of puerperal psychosis should be able to self-refer to an EPU
Option List
A.       
i
B.       
ii
C.       
iii
D.       
iv
E.        
iii + iv

Question 13.
Lead-in
Which, if any, of the following investigations should be done for a couple with 1st trimester RM?
         i.            APS screen
       ii.            Fragile X syndrome screen
     iii.            HbA1c
     iv.            hysterosalpingogram
       v.            inherited thrombophilia screen
     vi.            karyotyping
    vii.            NK cells in peripheral blood
  viii.            thyroid function tests
     ix.            TORCH screen
Option List
A.       
i
B.       
i +  v
C.       
i + ii + v + vi + viii + ix
D.       
i + iii + iv + v + vi + vii + viii + ix
E.        
all of the above except vii

Question 14.
Lead-in
Which, if any of the following treatments should be offered to women with RM and evidence of APS?
Option List
         i.             
low-dose aspirin + clopidogrel
       ii.             
low-dose aspirin + LMWH
     iii.             
low-dose aspirin + LMWH + low-dose corticosteroids
     iv.             
low-dose aspirin + unfractionated heparin
       v.             
low-dose aspirin  + unfractionated heparin + low-dose corticosteroids

Question 15.
Lead-in
Which, if any, of the following treatments are of proven benefit in improving outcomes in unexplained RM?
         i.            cervical cerclage
       ii.            hCG
     iii.            leptin
     iv.            LH
       v.            metformin
     vi.            rectal or vaginal progesterone
    vii.            supportive therapy in a dedicated EPU
  viii.            PIGS
Option List
A.       
i + ii
B.       
i + vi + vii
C.       
ii + vi + vii + vii
D.       
 vii
E.        
none of the above

Question 16 .
Lead-in
With regard to the role of PIGS in the management of women with unexplained RM, which, if any, of the following statements are true.
         i.            PIGS is of proven benefit in unexplained RM
       ii.            PIGS is regulated by the HFEA
     iii.            PIGD and PIGS are different names for the same process
Option List
A.       
i
B.       
ii
C.       
i + ii
D.       
i + ii + iii
E.        
none of the above

Question 17.
Lead-in
Pick the most appropriate option from the list below about the risk of miscarriage in women with PCOS and a history of RM who conceive spontaneously.
Option List
A.       
increased serum LH levels predict an increased risk of miscarriage
B.       
Increased testosterone levels predict an increased risk of miscarriage
C.       
Decreased androgen levels predict an increased risk of miscarriage
D.       
Typical PCOS ovarian morphology predicts an increased risk of miscarriage
E.        
Hyperinsulinaemia predicts an increased risk of miscarriage

49.         SBA. Needle-stick & related injuries
Abbreviations.
CMV:    cytomegalovirus
GBCV:   GB virus C
HAV:     hepatitis A virus
HBV:     hepatitis B virus
HCV:     hepatitis C virus
HDV:     hepatitis D virus
SOE:      significant occupational exposure to blood-borne infective agent.
TTV:      transfusion-transmitted virus
VL:         viral load.

Question 1.
Lead-in
Approximately how many SOEs are reported annually in the UK?
Option List
F.        
~    100
G.       
~    250
H.       
~    500
I.         
~ 1,000
J.         
~ 5,000

Question 2.
Lead-in
Who was Ignac Phillip Semmelweis?
Option List

F.        
the person credited with demonstrating the infective nature of puerperal sepsis
G.       
the horticulturist who first grew the white flower subsequently popularised in the musical, “The sound of music”, naming it after his first wife, Eidel.
H.       
the person who first used antisepsis in aerosol form to reduce the risk of infection during  C. section.
I.         
the inventor of catgut sutures
J.         
the inventor of the Dalkon shield

Question 3.
Lead-in
Why does the name of Semmelweis’s colleague Kotecha live on in medical history?
Option List
F.        
he was the first doctor to perform hysterectomy
G.       
he was the first doctor know to undergo transgender surgery
H.       
he died of infection akin to puerperal sepsis after a SOE
I.         
he performed the first successful repair of a 3rd. degree perineal tear
J.         
none of the above

Question 4.
Lead-in
Which of the following have been described as causing infection after a SOE.
Infective agents
1.        
hepatitis A virus
2.        
hepatitis B virus
3.        
hepatitis C virus
4.        
human T cell leukaemia virus
5.        
malaria parasites
Option List
A.       
1 + 2 + 3 + 4 + 5
B.       
1 + 2 + 3 + 5
C.       
2 + 3 + 4 + 5
D.       
2 + 3 + 4
E.        
2 + 3 + 5

Question 5.
Lead-in
Which are the main causes of infection to cause concern in the UK in relation to SOEs?
Infective agents.
1.        
hepatitis A virus
2.        
hepatitis B virus
3.        
hepatitis C virus
4.        
HIV
5.        
treponema pallidum
Option List
A.       
1 + 2 + 3 + 4 + 5
B.       
1 + 2 + 3 + 4
C.       
1 + 2 + 3 + 5
D.       
2 + 3 + 4 + 5
E.        
2 + 3 + 4

Question 6.
Lead-in
Which group features most in the list of those reporting SOEs?
Option List
A.       
doctors
B.       
midwives
C.       
phlebotomists
D.       
nurses
E.        
other healthcare workers.

Question 7.
Lead-in
Which clinical activity generates most SOEs?
Option List
A.       
acupuncture
B.       
assisting in the operating theatre
C.       
intramuscular drug / vaccine injection
D.       
subcutaneous drug / vaccine injection
E.        
venepuncture

Question 8.
Lead-in
Approximately how many cases of HIV seroconversion after SOE were recorded in the UK between 2004 and 2013?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500

Question 9.
Lead-in
Rate the following body fluids as: high or low risk in relation to infectivity.
Option List
A.       
amniotic fluid

B.       
blood

C.       
breast milk

D.       
cerebro-spinal fluid

E.        
faeces

F.        
peritoneal fluid

G.       
saliva

H.       
urine

I.         
urine – blood stained

J.         
vaginal fluid

K.        
vomit


Question 10.
Lead-in
Rate the following types of contact with body fluids as:
high-risk
low-risk
minimal or zero risk
Answer
A.       
exposure to faeces: not bloodstained

B.       
exposure to saliva: not bloodstained

C.       
exposure to urine: not bloodstained

D.       
exposure to vomit: not bloodstained

E.        
exposure via broken skin

F.        
exposure via intact skin

G.       
injury deep, percutaneous

H.       
exposure via mucosa

I.         
injury superficial

J.         
needle not used on source’s blood vessels

K.        
needle used on source’s blood vessels

L.        
sharps old

M.     
sharps recently used

N.       
sharps with blood not visible

O.      
sharps with blood visible sharps


Question 11.
Lead-in
Rate the following types of sources of potentially infective body fluids as:
high-risk
low-risk
minimal or zero risk
Answer
A.       
infected but VL and treatment details unknown

B.       
recent blood test negative for all relevant viruses

C.       
source has known risk factors but recent tests negative

D.       
viral status not known but source has known risk factors

E.        
viral status not known but source has no known risk factors

F.        
VL detectable

G.       
VL not detectable

H.       
VL unknown but on treatment with good adherence


Question 12.
Lead-in
Approximately how many cases of HBV seroconversion after SOE have been recorded in the UK since 1997?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500

Question 13.
Lead-in
Approximately how many cases of HCV seroconversion after SOE have been recorded in the UK since 1997?
Option List
A.       
0
B.       
1
C.       
20
D.       
100
E.        
500

Question 14.
Lead-in
What is the estimated risk of transmission of infection of HBV in a SOE involving sharps in a patient +ve for HBe antigen?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less

Question 15.
Lead-in
What is the estimated risk of transmission of infection of HCV in a SOE involving sharps?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less

Question 16.
Lead-in
What is the estimated risk of transmission of infection of HIV in a SOE involving sharps?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less

Question 17.
Lead-in
What is the estimated risk of transmission of infection of HIV in a SOE involving mucosal splashing?
Option List

  1.  
1 in 2

  1.  
1 in 3

  1.  
1 in 30

  1.  
1 in 300

  1.  
 1 in 1,000 or less

Question 18.
Lead-in
Which of the following carries the highest risk of transmission of an infective agent after a SOE.
Option List
A.       
a bite on the bottom by an HIV-infected patient who finds your buttocks irresistible
B.       
deep injury from a scalpel wielded by a psychopathic surgeon
C.       
deep needle-stick after venepuncture
D.       
spitting by a patient with HIV
E.        
splash SOE from beating a disagreeable patient round the head with a frozen turkey because you are sick to death of their whingeing and perennial misery

Question 19.
Lead-in
List the steps you would take in relation to immediate first aid, including the things that might be suggested but you know are contraindicated.

Question 20.
Lead-in
Which tests should be performed on the source after obtaining consent?
List what you think should be done.
Option List
A.       
HBV surface antigen
B.       
HCV antibody
C.       
HCV RNA
D.       
HIV antigen and antibody (fourth generation HIV immunoassay)
E.        
TTV antibody

Question 21.
Lead-in
What consent is required from the source individual?
Option List
A.       
consent to having the tests
B.       
consent to having the results given to the occupational health department
C.       
consent to having the results given to the person who sustained the SOE
D.       
consent to having the results given to the hospital’s legal team
E.        
consent to notifying the hospital staff if the results are +ve.

Question 22.
Lead-in
What tests should be done on the person who has sustained the SOE and there is a significant risk of infection?
Option List
A.       
a baseline sample should be taken and stored for possible future use
B.       
HBV surface antibody
C.       
HCV antibody
D.       
HIV antigen and antibody

Question 23.
Lead-in
If there is a significant risk of HIV transmission, which of the following statements are correct in relation to when should PEP be given?
Option List
A.       
before the results of the tests done on the source are available
B.       
after the results of the tests done on the source are available
C.       
as soon as is practical
D.       
within 24 hours
E.        
within 72 hours

Question 24.
Lead-in
What are the recommended drugs for PEP in the UK?
Option List
A.       
Kaletra (200 mg lopinavir and 50 mg ritonavir)
B.       
Raltegravir 400 mg twice daily
C.       
Rifampicin 450-600mg daily as a single dose 
D.       
Tenofovir + lamivudine or emtricitabine
E.        
Truvada (245 mg tenofovir disoproxil fumarate and 200 mg emtricitabine)

Question 25.
Lead-in
Which of the following statements are correct in relation to PEP in early pregnancy
Option List
A.       
PEP is contraindicated until after 12 weeks
B.       
PEP should be started as for the non-pregnant
C.       
PEP should be started, but TOP should be offered
D.       
PEP should be started, but not until the puerperium

Question 26.
Lead-in
Which of the following statements is true in relation to reducing the risk of HCV infection.
Option List
A.       
HCV vaccine is safe in pregnancy and should be offered immediately
B.       
HCV vaccine is a live vaccine and contraindicated in pregnancy
C.       
acyclovir is an effective drug for prophylaxis
D.       
there is no known effective prophylactic drug
E.        
early treatment of HCV infection is effective, so SOE staff should be closely followed up for evidence of infection.

50.         Communication skills.

Introduce yourself and explain recessive inheritance to a woman who has been found to be a carrier of cystic fibrosis.
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