2021TrialShort answer

Q33 (d)

3 marks

Question

Rubella is an infectious disease caused by Rubivirus rubella. The disease is frequently mild, with a characteristic rash often appearing two weeks after exposure and lasting for three days. Other symptoms include fever, sore throat and fatigue, with joint pain common in adults. Up to half of infected cases are asymptomatic. Rubella is usually spread from one person to the next through the air via coughs of people who are infected. People are infectious during the week before and after the appearance of the rash. Only humans are infected. Once recovered, people are immune to future infections. In the early 1940s, Australian ophthalmologist Norman Gregg noticed a high incidence of congenital cataracts in babies whose mothers had suffered from rubella during pregnancy. It was then statistically shown that infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). The main defects result almost exclusively from rubella infection occurring in the first 16 weeks of gestation and include deafness due to cochlea malformation, eye and cardiovascular defects and central nervous system damage leading to mental retardation. Rubella is preventable with a single dose of the rubella vaccine being more than 95% effective. When rubella vaccination became feasible around 1971, both the United States and the United Kingdom embarked on vaccination programs. In the United States, the strategy was to vaccinate infants, so that eventually the reservoir in childhood would be abolished. In contrast, the United Kingdom decided on a program of vaccinating adolescent girls. Both strategies were partial successes, in that CRS incidence began to decrease. Figure 1: Number of Rubella and Congenital Rubella Syndrome Cases in the United States 1966-2011

Today, most developed countries have a comprehensive immunization program and rubella has been eliminated in many areas of the world. However, in a number of developing countries rubella infections are common and significant number of babies are born with CRS.
Explain how a named medical technology could be used to treat a symptom of CRS and propose a reason why this is not routinely done.

Uncropped source page 32 for question 33.d; requires human review and cropping — Reviewed visual · source page 32

Uncropped source page 34 for question 33.d; requires human review and cropping — Reviewed visual · source page 34

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Solution

Criteria	Marks
• Uses cause and effect to link a medical technology to the birth defect.<br>• Proposes a suitable reason it is not routinely used.	3
• Uses cause and effect to link the technology to the defect, OR identifies a suitable technology.<br>• Proposes a suitable reason it is not routinely used.	2
• Identifies a suitable technology, OR justifies a suitable reason it is not routinely used.	1

Additional guidance from the source:

As many children with CRS are born with a malformed cochlea, a cochlear implant could be used to replace the function of the cochlea. This would use a microphone to collect and process sounds outside the ear, and then send them to the implant which stimulates the auditory nerve, bypassing the malformed ear and partially correcting deafness. This is unlikely to be used routinely as nowadays children with CRS are almost exclusively born in developing countries which can’t afford to vaccinate against rubella, let alone perform expensive surgery. Range: 0-3; Average: 1.7 Comments: Explain means cause and effect, and in order to answer the question properly you needed to show how the correctly named technology would replace the specific non- functioning parts of the body. Misconceptions addressed: CRS is congenital (they are born with it, not acquired which comes later in life). It is not a genetic disease (there are no more damaged alleles or chromosomes than would normally be expected from a child without CRS). The main ear defect is a malformed cochlea, which requires a cochlear implant (which transmits an electrical signal to the brain via the auditory nerve), not a hearing aid or bone conduction implant. The main eye defect is cataracts, which could be treated with lens replacement, not laser surgery. The question did not ask about a medicine, or about treating rubella.

Supplied marking guidance · human reviewed

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Syllabus alignment

Module 8 · Non-infectious Disease and Disorders

Technologies and DisordersEvaluate a technology used to manage or assist with a disorder.
Technologies and DisordersInvestigate assistive technologies for hearing loss, visual disorders and kidney failure.

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