|
46 |
EMQ. Toxoplasmosis |
|
47 |
SBA. Appendicitis in pregnancy |
|
48 |
EMQ. Hand, foot and mouth disease |
|
49 |
EMQ. Measles and pregnancy |
|
50 |
Structured conversation. The uses of
MgSO4 in O&G |
46. EMQ.
Toxoplasmosis.
Abbreviations.
cTg: congenital
toxoplasmosis.
TgIgG: Toxoplasmosis immunoglobulin G.
TgIgM: Toxoplasmosis
immunoglobulin M.
Question
1.
Which,
if any, of the following are true in relation to the organism causing toxoplasmosis.
Option
list.
|
A |
it is Toxoplasma giardia |
|
B |
it is Toxoplasma gondi |
|
C |
it is Toxoplasma gondii |
|
D |
it is Toxoplasma gondola |
|
E |
it is Toxoplasma gungho |
|
F |
none of the above |
Question
2.
Approximately what proportion of the UK pregnant population shows
evidence of previous Tg infection?
Option
list.
|
A |
< 10% |
|
B |
10% |
|
C |
20% |
|
D |
30% |
|
E |
40% |
|
F |
50% |
|
G |
> 50% |
Question
3.
When is maternal infection believed to be of greatest risk to the
fetus?
Option
list.
|
A |
peri-conceptually |
|
B |
1st. trimester |
|
C |
2nd. trimester |
|
D |
3rd. trimester |
|
E |
during vaginal birth |
|
F |
in the puerperium |
|
G |
in the puerperium if breastfeeding |
|
H |
none of the above |
Question
4.
Which, if any, of the
following are true with regard to when tgIgG is detectable after 1ry maternal
infection?
Option
list.
|
A |
2 weeks |
|
B |
4 weeks |
|
C |
2 months |
|
D |
3 months |
|
E |
6 months |
|
F |
none of the above |
Question
5.
Which, if any, of the
following are true with regard to when TgIgM is detectable after 1ry maternal
infection?
Option
list.
|
A |
2 weeks |
|
B |
4 weeks |
|
C |
2 months |
|
D |
3 months |
|
E |
6 months |
|
F |
none of the above |
Question
6.
Which, if any, of the
following are true with regard to avidity testing for Tg?
Option
list.
|
A |
avidity testing is of little use |
|
B |
avidity testing requires expert advice |
|
C |
avidity < 30% indicates infection in the previous 3 months |
|
D |
avidity < 30% indicates infection in the previous 6 months |
|
E |
avidity < 30% indicates infection in the previous 9 months |
|
F |
avidity > 40% indicates infection more than 3 months
previously |
|
G |
avidity > 40% indicates infection more than 6 months
previously |
|
H |
avidity > 40% indicates infection more than 9 months
previously |
|
I |
none of the above |
Question
7.
Which, if any, of the
following are true with regard to confirmation of fetal infection?
Option
list.
|
A |
avidity testing is of little use |
|
B |
avidity testing requires expert advice |
|
C |
avidity < 30% indicates infection in the previous 3 months |
|
D |
avidity < 30% indicates infection in the previous 6 months |
|
E |
avidity < 30% indicates infection in the previous 9 months |
|
F |
avidity > 40% indicates infection more than 3 months
previously |
|
G |
avidity > 40% indicates infection more than 6 months
previously |
|
H |
avidity > 40% indicates infection more than 9 months
previously |
|
I |
none of the above |
Question
8.
Which, if any, of the following are true in relation to the NSC’s
decision on routine toxoplasmosis screening in pregnancy in 2016?
Option
list.
|
A |
screening should be introduced as soon as practicable |
|
B |
testing would produce a falsely-high prevalence of Tg in
pregnancy |
|
C |
the prevalence of Tg is too low for screening to be
cost-effective |
|
D |
the prevalence of Tg is high enough for screening to be cost-effective |
|
E |
the prevalence of Tg is unknown |
|
F |
there is no treatment in pregnancy of proven benefit to mother
or baby |
|
G |
they would leave the decision until after lunch, but drank too
much wine and did not return |
|
H |
maybe some of the above, please tick the boxes for me |
|
I |
none of the above |
Question
9.
Which, if any, of the following are complications of intrauterine Tg
infection for the fetus and newborn.
Option
list.
|
A |
miscarriage |
|
B |
IUGR |
|
C |
stillbirth |
|
D |
chorioretinitis |
|
E |
hepato-splenomegaly |
|
F |
holoprosencephaly |
|
G |
hydrocephalius |
|
H |
intracranial calcification |
|
I |
microcephaly |
|
J |
neural tube defect |
Question
10.
Approximately
how common in vertical transmission of Tg in the 1st. trimester?
Option
list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question
11.
Approximately how common in vertical transmission of Tg in the 2nd.
trimester? Use the option list for question 4.
Option list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question
12.
Approximately how common in vertical transmission of Tg in the 3rd.
trimester? Use the option list for question 4.
Option
list.
|
A |
< 10% |
|
B |
10-20% |
|
C |
25% |
|
D |
50% |
|
E |
> 50% |
Question
13.
Which of the following are true in relation to reducing the risk
of vertical transmission of Tg.
Option
list.
|
A |
the SYROCOT trial showed strong evidence of the efficacy of spiramycin |
|
B |
a Cochrane trial has suggested that pyrimethamine +
sulfadiazine give better results than spiromycin |
|
C |
there is evidence that metronidazole is the most effective drug |
|
D |
there is a lack of clear evidence about effective therapies |
|
E |
spiromycin crosses the placenta, so is effective in reducing
MTBT and treating the infected fetus |
|
E |
this is too esoteric for my poor pummelled brain |
Question
14.
Which, if any, of the following are features of the classical triad
associated with congenital Tg?
Option
list.
|
A |
chorioretinitis |
|
B |
deafness |
|
C |
hepatosplenomegaly |
|
D |
hydrocephalus |
|
E |
intracranial calcifications |
|
F |
low birthweight |
|
G |
jaundice |
|
H |
leukopenia |
Question
15.
Which of the following are used in the treatment of cTg?
Option
list.
|
A |
metronidazole |
|
B |
pyrimethamine |
|
C |
steroids |
|
D |
sulfadiazine |
|
E |
none of the above. |
47. SBA. Appendicitis in pregnancy.
Abbreviations.
AIP: appendicitis
in pregnancy
CRP : C
reactive protein
EFHRM: electronic
fetal heart rate monitoring
RLQP: right
lower quadrant pain
RUQP: right
upper quadrant pain
Question 1.
Lead-in
What is the approximate incidence of
appendicitis in pregnancy?
Option
List
|
A.
|
1 in 500 |
|
B.
|
1 in 1,000 |
|
C.
|
1 in 2,000 |
|
D.
|
1 in 5,000 |
|
E.
|
1 in 10,000 |
Question 2.
Lead-in
Is appendicitis more or less common in
pregnancy?
Option
List
|
A.
|
just as common |
|
B.
|
less common |
|
C.
|
maybe |
|
D.
|
more common |
|
E.
|
no one knows |
|
F.
|
no one cares |
Question 3.
Lead-in
How is maternal death from appendicitis
classified?
Option
List
|
A.
|
coincidental death |
|
B.
|
direct death |
|
C.
|
incidental death |
|
D.
|
indirect death |
|
E.
|
none of the above |
Question 4.
Lead-in
When is appendicitis in pregnancy most
common?
Option
List
|
A.
|
first trimester |
|
B.
|
second trimester |
|
C.
|
trimester |
|
D.
|
1st. and 2nd. stages of labour |
|
E.
|
in the hours after the 3rd. stage of labour |
|
F.
|
during the puerperium |
Question 5.
Lead-in
What eponymous title is given to the surface
marker for the appendix?
Option
List
|
A.
|
McBarney’s point |
|
B.
|
MacBurney’s point |
|
C.
|
McBurney’s point |
|
D.
|
MacBorney’s point |
|
E.
|
McBorney’s point |
Question 6.
Lead-in
Where is the point referred to in the above
question?
Option
List
|
A.
|
1/3 of the way along the line
joining the anterior superior iliac spine and umbilicus |
|
B.
|
1/2 of the way along the line joining the anterior superior
iliac spine and umbilicus |
|
C.
|
2/3 of the way along the line joining the anterior superior
iliac spine and umbilicus |
|
D.
|
1/3 of the way along the line joining the left and right
anterior superior iliac spines |
|
E.
|
1/2 of the way along the line joining the left and right
anterior superior iliac spines |
Question 7.
Lead-in
Which, if any, of the following statements
are true about the person after whom the point in the above questions is named?
Statements
|
A.
|
he spent 2 years as a
postgraduate working in Berlin, London, Paris and Vienna |
|
B.
|
he was Professor of surgery at
the Roosevelt hospital, New York from 1889 to 1894 |
|
C.
|
he presented his classical paper on appendicitis to the NY
Surgical Society in 1889 |
|
D.
|
he was a transvestite |
|
E.
|
he died of a heart attack while on a hunting trip |
Option
List
|
1 |
A + B + E |
|
2 |
A + C + E |
|
3 |
A + B + D |
|
4 |
A + B + C + D |
|
5 |
A + B + C + E |
Question 8.
Lead-in.
Pick the best option from the list below in
relation to right lower quadrant pain in AIP in the pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
RLQP is as common in the
pregnant as in the non-pregnant |
|
C |
RLQP is less common in the
pregnant |
|
D |
RLQP is more common in the pregnant |
|
E |
RLQP is rare in pregnancy |
Question 9.
Lead-in.
Pick the best option from the list below in
relation to right upper quadrant pain in AIP in the pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
RUQP is ½ as common in the
pregnant as in the non-pregnant |
|
C |
RUQP is as common in the
pregnant as in the non-pregnant |
|
D |
RUQP is twice as common in the
pregnant as in the non-pregnant |
|
E |
RUQP is four times as common in
the pregnant as in the non-pregnant |
Question 10.
Lead-in.
Pick the best option from the list below in
relation to nausea in AIP in the pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
nausea is as common in the
pregnant as in the non-pregnant |
|
C |
nausea is less common in the
pregnant |
|
D |
nausea is more common in the pregnant |
|
E |
nausea is rare in pregnancy |
Question 11.
Lead-in.
Which condition did CMACE say should be
excluded in women presenting acutely with gastrointestinal symptoms?
Option
List
|
A |
aortic dissection |
|
B |
appendicitis |
|
C |
Caesarean section scar
pregnancy |
|
D |
ectopic pregnancy |
|
E |
pancreatitis |
|
F |
ovarian torsion |
Question 12.
Lead-in.
Pick the best option from the list below in
relation to abdominal guarding in AIP in the pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
abdominal guarding is as common
in the pregnant as in the non-pregnant |
|
C |
abdominal guarding is less
common in the pregnant |
|
D |
abdominal guarding is more common
in the pregnant |
|
E |
abdominal guarding is rare in
pregnancy |
Question 13.
Lead-in.
Pick the best option from the list below in
relation to rebound
tenderness in AIP in the
pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
rebound tenderness is as common in the pregnant as in the
non-pregnant |
|
C |
rebound tenderness is less common in the pregnant |
|
D |
rebound tenderness is more common in the pregnant |
|
E |
rebound tenderness is rare in pregnancy |
Question 14.
Lead-in.
Pick the best option from the list below in
relation to fever in AIP in the pregnant and non-pregnant.
Option
List
|
A |
comparative figures for the pregnant and non-pregnant are
unknown due to the rarity of appendicitis in pregnancy |
|
B |
fever is as common in the
pregnant as in the non-pregnant |
|
C |
fever is less common in the
pregnant |
|
D |
fever is more common
in the pregnant |
|
E |
fever is rare in
pregnancy |
Question 15.
Lead-in
How useful is the finding of leucocytosis in
making the diagnosis of AIP?
Option
List
|
A.
|
sine qua non |
|
B.
|
very useful |
|
C.
|
not very useful |
|
D.
|
I don’t know |
Question 16.
How useful is the finding of a raised CRP
level in the diagnosis of AIP?
Option
List
|
A.
|
sine qua non |
|
B.
|
very useful |
|
C.
|
not very useful |
|
D.
|
I don’t know |
Question 17.
Lead-in
What are the ultrasound features of
appendicitis?
Option
List
|
A |
appendix with diameter > 6
mm. |
|
B |
appendix with diameter > 1 cm. |
|
C |
blind-ending tubular structure |
|
D |
non-compressible tubular
structure |
|
E |
none of the above |
Question 18.
Lead-in
What figures do W&M give for sensitivity
& specificity for US diagnosis of appendicitis?
Option
List
|
|
Sensitivity |
Specificity |
|
A |
≥65% |
≥80% |
|
B |
≥75% |
≥85% |
|
C |
≥86% |
≥97% |
|
D |
≥91% |
≥98% |
|
E |
≥95% |
≥95% |
Question 19.
Lead-in
Which, if any, of the following statements
are true about CT scanning for the diagnosis of AIP?
Option
List
|
A |
CT scanning has sensitivity
> 85% and specificity >95% |
|
B |
CT scanning exposes mother and fetus to radiation doses of
little concern |
|
C |
CT scanning has replaced ultrasound scanning for AIP |
|
D |
CT scanning is not of proven value after inconclusive ultrasound
scanning |
|
E |
CT scanning is of proven value and most useful after
inconclusive ultrasound scanning |
Question 20.
Lead-in
Which, if any, of the following statements
are true about MRI scanning for the diagnosis of AIP?
Option
List
|
A |
MRI scanning has sensitivity
> 90% and specificity >97% |
|
B |
MRI scanning exposes mother and fetus to radiation doses of
little concern |
|
C |
MRI scanning has replaced ultrasound scanning for AIP |
|
D |
MRI scanning is not of proven value after inconclusive
ultrasound scanning |
|
E |
MRI scanning is of proven value and most useful after
inconclusive ultrasound scanning |
Question 21.
Lead-in
Which, if any, of the following statements
are true about the complications of AIP?
Option
List
|
A |
fetal loss rate in
uncomplicated AIP is about 1.5% |
|
B |
fetal loss rate in AIP complicated by peritonitis is about 6% |
|
C |
fetal loss rate in AIP
complicated by perforation of the appendix is up to 36% |
|
D |
pre-term delivery rates increase in AIP complicated by
perforation of the appendix |
|
E |
a low level of suspicion should apply to the diagnosis of AIP in
relation to surgical intervention |
Question 22.
Lead-in
Which, if any, of the following statements
are true about surgery for AIP?
Option
List
|
A |
laparotomy should be done
through a grid-iron incision with the mid-point the surface marker for the
appendix in the right iliac fossa |
|
B |
laparotomy should be done through a right paramedian incision
starting at the level of the umbilicus |
|
C |
about 35% of laparotomies show
no evidence of appendicitis |
|
D |
the appendix should be removed even if it looks normal |
|
E |
antibiotic therapy is an alternative to surgery in early cases
of acute AIP |
Question 23.
Lead-in
Which, if any, of the following statements
are true about surgery for AIP?
Option
List
|
A |
laparoscopic appendicectomy is
an acceptable alternative to laparotomy, but only in the 1st.
trimester |
|
B |
laparoscopic appendicectomy is an acceptable alternative to
laparotomy, but only in the 1st. & 2nd. trimesters |
|
C |
laparoscopic appendicectomy is an acceptable alternative to
laparotomy, at all gestations |
|
D |
there is evidence that laparoscopic appendicectomy is associated
with doubling of the rate of fetal loss |
Question 24.
Lead-in
Which, if any, of the following statements
are true about C section in relation to AIP?
Option
List
|
A |
C section is rarely necessary |
|
B |
C section increases the risk of
uterine infection if peritonitis is present |
|
C |
C section should be offered if
elective C section is planned |
|
D |
C section should be considered
if the woman is critically ill |
Question 25.
Lead-in
Which, if any, of the following statements
are true about the fetal heart rate?
Option
List
|
A |
EFHRM should be done pre and
post-operatively in surgery for AIP |
|
B |
EFHRM should always be done intra-operatively in surgery for AIP |
|
C |
the drugs used for GA tend to cause fetal tachycardia |
|
D |
the drugs used for GA commonly cause a sinusoidal pattern |
|
E |
C section should be done if abnormal EFHRM patterns occur |
|
F |
fetal scalp pH sampling should be done if abnormal EFHRM
patterns occur |
|
G |
fetal blood sampling should be done if abnormal EFHRM patterns
occur |
TOG
questions. These are open access, so are reproduced
here. Answers are True/
False.
Appendicitis is a likely diagnosis in pregnancy when,
1. ultrasound
shows a non-compressible blind-ending tube in the right iliac fossa measuring
10 mm in diameter.
2. a patient
presents with right-sided abdominal pain, constipation and malaise.
In the
diagnosis of appendicitis in pregnancy,
3. ultrasound is
the best method for imaging in a morbidly obese patient.
4. MRI has the
greatest specificity of all imaging modalities.
With
regard to the management of a pregnant patient with appendicitis,
5. it should be
operative if the diagnosis is certain.
6. it should
primarily aim to reduce any delay in surgical intervention.
7. it should not
involve appendicectomy if the appendix appears normal at the time of surgery.
8. it should
include delivery of the fetus regardless of gestation if the patient is
critically ill.
9. some cases
may be treated with antibiotics alone.
General
anaesthesia for pregnant women undergoing appendicetomy,
10. carries ~ a
25-fold increased risk of complications than regional anaesthesia.
11. has temporary
effects on the fetus as all induction and maintenance agents cross the
placenta.
12. has a
uterotonic effect.
Surgery
for appendicetomy in pregnancy,
13. increases the
rate of miscarriage.
14. has the lowest
risk to the fetus when performed in the second trimester.
15. should be
delayed until antenatal corticosteroids are given (in the absence of severe
maternal sepsis) if the gestation is critical.
Concerning
acute appendicitis in pregnancy,
16. it is the most
common cause of acute surgical abdomen.
17. it most
commonly occurs in the first trimester.
18. it has a fetal
loss rate exceeding 50% if the appendix perforates.
19. the primary
goal is to rule out differential diagnoses.
20. the secondary
goal is to reduce the negative appendicectomy rate.
48. EMQ. Hand, foot and mouth disease.
Abbreviations.
FMD: Foot & mouth disease.
FMDV: Foot & mouth
disease virus.
HFMD: Hand, foot & mouth
disease.
Which,
if any, of the following statements are true in relation to hand, foot and
mouth disease?
Option list.
|
A |
it is the human
form of foot and mouth disease in sheep and cattle |
|
B |
it is most
common in farm workers |
|
C |
it is most
often due to a virus from the Aphthovirus
genus |
|
D |
it is most
often due to the Coxsackie A16 virus |
|
E |
it is most
often due to an enterovirus |
|
F |
the most severe
disease is associated with the Enterovirus A71 |
|
G |
usually causes
a mild and self-limiting illness lasting about a week |
|
H |
none of the
above |
Scenario 2.
Which,
if any, of the following is the main reservoir for HFMD?
Option list.
|
A |
cattle |
|
B |
cloven-hoofed
animals |
|
C |
devils |
|
D |
fish |
|
E |
humans |
|
F |
rodents |
|
G |
sheep |
|
H |
none of the
above |
Which, if any, of the following statements are true
about how HFMD is spread?
Option
list.
|
A |
by osmosis |
|
B |
contact with fluid from the blisters |
|
C |
coughing and sneezing |
|
D |
faeco-oral transmission |
|
E |
mainly by contamination of food |
|
F |
mainly be contamination of water |
|
G |
none of the above |
Scenario
4.
Which, if any, of the following statements are true
about when HFMD is spread?
Option
list.
|
A |
during the acute phase: about 1 week |
|
B |
through contact with infected animals, particularly cows, pigs
and sheep |
|
C |
Tuesday afternoons |
|
D |
up to 8 weeks after the acute phase due to the persistence of
the virus in faeces |
|
E |
vertically |
|
F |
none of the above |
Scenario 5.
In
which, if any, of the following groups do most infections occur?
Option list.
|
A |
adolescents |
|
B |
adults > 75
years of age |
|
C |
children < 1
year of age |
|
D |
children < 5
years of age |
|
E |
children <
10 years of age |
|
F |
agricultural
workers |
|
G |
none of the
above |
Scenario
6.
Which, if any, of the following statements are true about HFMD?
Option
list.
|
A |
it is most common in the autumn |
|
B |
it is most common in the winter |
|
C |
it is most common in the spring |
|
D |
it is most common in the summer |
|
E |
there is little variation in incidence by season |
|
F |
none of the above |
Scenario
7.
What is the incubation period of HFMD?
Option
list.
|
A |
1 - 7 days |
|
B |
3 - 7 days |
|
C |
5 - 7 days |
|
D |
10 - 14 days |
|
E |
14 - 21 days |
|
F |
none of the above |
Which,
if any, of the following statements are true about when an infected child is no
longer contagious?
Option list.
|
A |
once the skin
blisters are healed |
|
B |
once the fever
has resolved |
|
C |
once the oral
lesions are no longer painful |
|
D |
once the skin
blisters are no longer filled with fluid |
|
E |
7 days after
the onset of the 1st. symptoms |
|
F |
none of the
above |
Scenario
9.
How is HFMD usually diagnosed?
Option
list.
|
A |
clinically |
|
B |
detection of IgM in serum |
|
C |
detection of the virus in faeces |
|
D |
detection of the virus in vesicular fluid |
|
E |
none of the above |
Scenario
10.
Which, if any, of the following statements are true in relation to
the risk to the pregnant woman who contracts HFMD?
Option
list.
|
A |
it is associated with an ↑ risk of death from pneumonia |
|
B |
it is associated with an ↑ risk of death from pancreatitis |
|
C |
it is associated with an ↑ risk of death from myocarditis |
|
D |
it is associated with an ↑ risk of neurological complications |
|
E |
it is not known to carry ↑ risk compared to the non-pregnant |
|
F |
none of the above |
Scenario
11.
Which, if any, of the following statements are true in relation to
the embryo / fetus?
Option
list.
|
A |
the risk of miscarriage is ↑ |
|
B |
the risk of neural tube defect is ↑ |
|
C |
the risk of congenital heart defect is ↑ |
|
D |
the risk of microphthalmia is ↑ |
|
E |
the risk of microcephaly is ↑ |
|
F |
none of the above |
Scenario
12.
Which, if any, of the following statements are true in relation to
the neonate?
Option
list.
|
A |
neonatal HFMD may be severe with late pregnancy infection |
|
B |
neonatal HFMD may be severe with maternal immunocompromise |
|
C |
the risk of biliary atresia is ↑ |
|
D |
the risk of encephalitis is ↑ |
|
E |
the risk of meningitis is ↑ |
|
F |
the risk of pancreatitis is ↑ |
|
G |
none of the above |
49. EMQ.
Measles and pregnancy .
Abbreviations.
HNIG: human
normal immunoglobulin.
MIgG: measles
immunoglobulin G.
MMR: measles,
mumps & rubella.
MV: measles
virus.
PEP: post-exposure
prophylaxis.
RSV: Respiratory
Syncitial Virus’.
SSPE: Subacute
sclerosing panencephalitis.
Scenario
1.
Which, if any, of the following are notifiable in the UK? This is
not a true EMQ as there may be more than one correct answer.
Option
list.
|
A |
chickenpox |
|
B |
malaria |
|
C |
measles |
|
D |
mumps |
|
E |
parvovirus |
|
F |
pertussis |
|
G |
plague |
|
H |
polio |
|
I |
rubella |
|
J |
scarlet fever |
|
K |
smallpox |
|
L |
varicella |
Scenario
2.
Which, if any, of the following statements are true in relation to
the approximate level of immunity necessary in the community to provide
effective herd immunity?
Option
list.
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
|
F |
>90% |
|
G |
none of the above |
Scenario
3.
Which, if any, of the following statements is true in relation to
the routine measles vaccination schedule in the UK?
Option
list.
|
A |
Measles vaccine should be given at 3 months with boosters at 12
months and 3 years |
|
B |
Measles vaccine should be given at 3 months with boosters at 12
months and 5 years |
|
C |
Measles vaccine should be given at 6 months with boosters at 12
months and 5 years |
|
D |
Measles vaccine should be given at 6 months with boosters at 12
months and 5 years |
|
E |
Measles vaccine should be given at 12 months with a booster at 3
years + 4 months |
|
F |
Measles vaccine should be given at 12 months with boosters at 2
and 5 years |
|
G |
MMR vaccine should be given at 3 months with boosters at 12
months and 3 years |
|
H |
MMR vaccine should be given at 3 months with boosters at 12
months and 5 years |
|
I |
MMR vaccine should be given at 6 months with boosters at 12
months and 5 years |
|
J |
MMR vaccine should be given at 6 months with boosters at 12
months and 5 years |
|
K |
MMR vaccine should be given at 12 months with a booster at 3
years + 4 months |
|
L |
MMR vaccine should be given at 12 months with boosters at 2 and
5 years |
|
M |
none of the above |
Scenario
4.
How effective is MMR vaccine at preventing measles?
Option
list.
|
A |
20% |
|
B |
3% |
|
C |
40% |
|
D |
50% |
|
E |
60% |
|
F |
70% |
|
G |
80% |
|
H |
90% |
|
I |
>90% |
|
J |
none of the above |
Scenario
5.
What is the main reservoir of the measles virus?
Option
list.
|
A |
cats |
|
B |
dogs |
|
C |
earthworms |
|
D |
house mites |
|
E |
Musca domestica |
|
F |
none of the above |
Scenario
6.
What is the approximate incubation period of measles?
Option
list.
|
A |
5± 4 days |
|
B |
7± 4 days |
|
C |
10 ± 4 days |
|
D |
10± 7 days |
|
E |
14 ± 4 days |
|
F |
14 ± 7 days |
Scenario
7.
When does the typical rash appear?
Option
list.
|
A |
before the development of other symptoms |
|
B |
at the same time as the development of other symptoms |
|
C |
1-2 days after the development of other symptoms |
|
D |
2-4 days after the development of other symptoms |
|
E |
none of the above |
Scenario
8.
Which, if any, of the following are characteristic of the measles
rash? This is not a true EMQ as there may be more than one answer.
Option
list.
|
A |
it is usually the first evidence of the infection |
|
B |
it starts centrally and spreads to the periphery |
|
C |
it starts peripherally and spreads to the
centre |
|
D |
it is erythematous |
|
E |
it is maculo-papular |
|
F |
it is vesicular |
|
G |
secondary infection of the lesions is common and leads to
scarring |
Scenario
9.
How long is the period of infectivity?
|
A |
from 4 days before the first symptoms to 4 days after the rash
appears |
|
B |
from 4 days before the first symptoms to 7 days after the rash
appears |
|
C |
from 7 days before the first symptoms to 4 days after the rash appears |
|
D |
from 7 days before the first symptoms to 7 days after the rash
appears |
|
E |
from the onset of the first symptoms to 4 days after the rash
appears |
|
F |
from the onset of the first symptoms to 7 days after the rash
appears |
|
G |
none of the above |
Scenario
10.
Which, if any, of the following statements are true in relation to
Koplick’s spots? This is not a true EMQ as there may be more than one answer.
Option
list.
|
A |
the spelling is ‘Coplick’ |
|
B |
the spelling is ‘Coplik’ |
|
C |
the spelling is ‘Koplick’ |
|
D |
the spelling is ‘Koplik’ |
|
E |
they are small white spots with blue centres |
|
F |
they are small white spots with red centres |
|
G |
they are small white spots with blue centres |
|
H |
they are small red spots with
blue-green centres |
|
I |
they are small red spots with
white centres |
|
J |
they are small red spots with blue-white centres |
Scenario
11.
Which, if any, of the following statements is true about the spots
mentioned in the previous question? This is not a true EMQ as there may be more
than one answer; this is me being lazy and compressing three EMQs into one.
Option
list.
|
A |
they appear 1-2 days before the rash |
|
B |
they appear with the rash |
|
C |
they appear 1-2 days after the rash |
|
D |
they last for 3-4 days |
|
E |
they last for ~ 7 days |
|
F |
they occur in the mouth |
|
G |
they occur in the peri-anal area |
Which
of the following groups is most at risk of serious morbidity from measles?
Option list.
|
A |
infants < 3
months |
|
B |
infants < 12
months |
|
C |
infants
who are not breastfed |
|
D |
infants with eczema |
|
E |
adolescents |
|
F |
pregnant women |
|
G |
the
elderly |
Scenario
13.
Which, if any, of the following are complications of measles in
the 1st. trimester? This is not a true EMQ as there may be more than
one answer.
Option
list.
|
A |
amblyopia |
|
B |
dermatographia |
|
C |
miscarriage |
|
D |
neural tube defect |
|
E |
optic atrophy |
|
F |
none of the above |
Scenario
14.
Which, if any, of the following are more common for the
non-immune, pregnant woman who develops measles in pregnancy? This is not a
true EMQ as there may be more than one answer.
Option
list.
|
A |
admission to hospital |
|
B |
admission to a passion for fried chicken |
|
C |
admission to a psychiatric ward |
|
D |
appendicitis |
|
E |
meningitis |
|
F |
pneumonia |
|
G |
none of the above |
50. Structured conversation. The uses of MgSO4
in O&G.
This is just to start you thinking about Part 3.
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