Questions from S 22 Flashcards
Friday morning, your BMS informs you that 1 of the 2 extraction and PCR platforms is broken.
What information do you want to know?
When did this problem occur
What is nature of this problem - software error code may indicate likely problem
What is anticipated down time
Has an engineer been contacted
do we have a backlog of tests/ how many test are we expecting to do on Saturday
How many of these are urgent tests? How many are routine and can wait until Monday
What is capacity of our 1 remaining platform - will this be enough to cover both? How long does extraction/ PCR take? Can it perform multiple panels - is it verified for GI pathogens for example
What is our contingency plan
Friday morning, your BMS informs you that 1 of the 2 extraction and PCR platforms is broken.
Engineer is coming tomorrow
What are potential solutions?
Plan A - successful repair, and back to normal working
Plan B - activate business continuity plan
use secondary platforms - what are their capacities
use other lab in network - phone them
use reference lab
delay sample testing until Monday
Friday morning, your BMS informs you that 1 of the 2 extraction and PCR platforms is broken.
Engineer is coming tomorrow
You want to send some haematology/ oncology samples to another lab in network.
What are important points of this?
Although it is written in business continuity plan, you should phone their virology team to discuss
Agree on how many samples to send, and when to send it by.
Our platform broke on Friday, and engineer coming Sat.
We should proactively send samples on Friday, in anticipation of it not working
Friday morning, your BMS informs you that 1 of the 2 extraction and PCR platforms is broken.
Engineer is coming tomorrow
UKHSA have sent 36 samples for urgent measles testing.
What information do you want to know, and what action will you take?
How many samples
How many are genuine urgent samples
For example - may be outbreak at school, with children who meet case definition. If we just test couple of these, we can infer an outbreak
Check that our secondary platform can run the 9 urgent samples
Staff phone in sick with gastroenteritis
How will you manage the weekend?
Discuss with BMS
Identify what testing was expected, and how many staff are required
What is minimum staffing level
Ask staff to extend hours/ locum
Check skill mix - do you have enough senior staff
Staff phone in sick with gastroenteritis
You have lots of junior staff, and not enough senior staff
Can they perform testing if they are not signed off for this?
Yes
Signing off final DOPS is just the last step - important for UKAS accrediatation.
They are ok to work with supervision
If platform breaks on Friday, you can sign their DOPS on Friday, so that they can work independently on Saturday
After you activate a business continuity plan, what is the next most important step?
Communication
Communicate to lab, external lab, end users about this issue, when it is intended to be solved, and what the temporary solution is
Say there may be issues:
- report many be different
- may be a delay
70 year old male returns from Saudi Arabia with SOB
What further information do you want?
Symptoms e.g cough, fever, SOB
Fever
PMHx - immunosuppression
DHx
unwell contacts
exposure to animals - bats/ rodents/ camels
Where he went, and what he did
ProMed for outbreak information
Results of initial investigations:
FBC
UE
LFT
CRP - high CRP suggests bacterial
CXR
Blood culture
PneumAg
LegAg
70 year old male returns from Saudi Arabia with SOB
What is the most likely diagnosis?
Possible MERS
Fever >38degC
Respiratory symptoms - cough/ coryza
Plus either:
History of travel to area with MERS
epidemiological link to another case
contact with camels - raw camel milk/ urine
Contact/ travel should be in past 14 days
70 year old male returns from Saudi Arabia with SOB
Blood culture pos for S pneumoniae
Influenza A positive on respiratory run
MERS-Co-V negative
How do you interpret the result?
Would want to know more about the assay, to ensure I am happy to say this is MERS negative
Influenza A with secondary bacterial infection is very common occurrence, and likely explains the full clinical picture
CMV in SoT
VL not decreasing on treatment with valganciclovir
What are possible causes?
Poor compliance
Poor absorption - e.g ongoing enterocolitis
Viral resistance
What is significance of these mutations
N408K
H520Q
N408K - UL54 mutation
confers resistance to ganciclovir and cidofovir
H520K - UL97 mutation
CMV in SoT
N408K mutation
What action to take?
What alternative treatments are available?
UL54 mutation means cannot use ganciclovir or cidofovir.
We could trial cidofovir, to see if overcomes resistance, but this is risky
Options for treatment:
Decrease immunosuppression
start foscarnet
maribavir other option
CMV specific IVIG
CMV in SoT
How long to treat for?
Until symptoms resolve
and 2x negative viral loads, 1 week apart
What is mechanism of action of maribavir
CMV protein kinase inhibitor UL97
