|
53. |
Role-play. Teach FY1 about complaint
procedures. |
|
54. |
EMQ. Toxoplasmosis |
|
55. |
Role-play. Mis-filed combined Ds test
report |
|
56. |
EMQ. Listeriosis |
53. Role-play.
Teach FY1 about complaint procedures.
Candidate’s instructions.
You are a 5th.
year SpR. It is a quiet day on the labour ward. The consultant on duty happens
to be responsible for risk management and has asked you to teach a new O&G
trainee about complaints.
54. Toxoplasmosis.
EMQ. Question.
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. |
55.
Candidate's
Instructions.
You are the SpR in the
ante-natal clinic. The consultant has been called to the labour ward to help
with a case of placenta accreta and you have been put in charge of the clinic.
Mrs Jones had a “combined
test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report was
filed in the notes in error by a clerk without being shown to any of the
medical or midwifery staff.
She attended today for the
routine 20-week scan. The ultrasonographer found the report in the notes,
realised that no action had been taken, informed the patient and made arrangements
for her to see you urgently.
56. Listeriosis.
EMQ. Question.
Lm: Listeria
monocytogenes.
TOC: test
of cure.
Scenario 1.
Which organism is responsible for human
listeriosis?
|
A |
Listeria diogenys |
|
B |
Listeria frigidaire |
|
C |
Listeria hominis |
|
D |
Listeria monocytogenes |
|
E |
Listeria xenophylus |
Scenario 2.
Which, if any, of the following statements
are true about Lm? This is not a true EMQ as there may be >1 correct answer.
Option list.
|
A |
it is a small, Gram -ve rod |
|
B |
it is a Gram +ve coccus |
|
C |
it is flagellated |
|
D |
it has no cell wall |
|
E |
it is an obligate aerobe |
|
F |
it functions within host cells |
|
G |
it can easily be mistaken for commensal
organisms |
|
H |
none of the above |
Scenario 3.
Which of the following are associated with
an increased risk of contracting listeriosis? This is not a true EMQ as there
may be >1 correct answer.
|
A |
age > 60 years |
|
B |
age < 1 year |
|
C |
blond hair |
|
D |
pregnancy |
|
E |
strabismus |
Scenario 4.
Which of the following is true of the
susceptibility of pregnant women to Lm? This is not a true EMQ as there may be
>1 correct answer.
Option list.
|
A |
they are not more susceptible |
|
B |
they are more susceptible x 2 |
|
C |
they are more susceptible x 5 |
|
D |
they are more susceptible x 10 |
|
E |
they are more susceptible x 20 |
|
F |
they are > 20 times more susceptible |
|
G |
none of the above. |
Scenario 5.
When does Lm most often occur? This is not
a true EMQ as there may be >1 correct answer.
Option list.
|
A |
1st. trimester |
|
B |
2nd. trimester |
|
C |
3rd trimester |
|
D |
1st. + 2nd.
trimesters |
|
E |
2nd. + 3rd
trimesters |
|
F |
all trimesters equally |
|
G |
puerperium |
|
H |
none of the above |
Scenario 6.
What is the incubation period for Lm?.
Option list.
|
A |
7±3 days |
|
B |
7±5 days |
|
C |
10±3 days |
|
D |
10±5 days |
|
E |
14±3 days |
|
F |
14±5 days |
|
G |
none of the above. |
What
is the significance of Granulomatosis Infantisepticum ?
Option
list.
|
A |
it
is a fabrication by the author and of no significance |
|
B |
it
is pathognomonic of Lm infection |
|
C |
it
is the cause of vertical transmission of Lm |
|
D |
I
refuse to answer Latin questions as they make me think of Boris Johnson |
|
E |
none
of the above |
Scenario 8.
Which of the following are accurate about
cervico-vaginal infection? This is not a true EMQ as there may be >1 correct
answer.
Option list.
|
A |
Lm is as often found in the cervix as in
the bowel. |
|
B |
Lm is as often found in the vagina as in
the bowel. |
|
C |
Lm is less often found in the cervix than in the bowel. |
|
D |
Lm is less often found in the vagina than in the bowel. |
|
E |
Lm is more often found in the cervix than in the bowel. |
|
F |
Lm is more often found in the cervix than in the bowel. |
|
G |
no one knows and no one cares |
Scenario 9.
A GP phones about a primigravida at 28
weeks’ gestation. She has possibly ingested food contaminated by Lm. She is
asymptomatic and afebrile. What advice will you give?
Option list.
|
A |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
H |
admit to hospital for investigation and
intensive treatment if Lm infection found |
|
I |
none of the above |
Scenario 10.
A GP phones about a primigravida at 28
weeks’ gestation. She has possibly ingested food contaminated by Lm. She has
mild symptoms but is afebrile. What advice will you give?
Option list.
|
A |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
H |
admit to hospital for investigation and
intensive treatment if Lm infection found |
|
I |
none of the above |
A GP phones about a primigravida at 28
weeks’ gestation. She has possibly ingested food contaminated by Lm. She is
symptomatic and her temperature is 38.2oC. What advice will you
give?
Option list.
|
A |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 2 weeks |
|
B |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 4 weeks |
|
C |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 6 weeks |
|
D |
reassure and advise her about avoiding
exposure and to reattend if she develops signs or symptoms within 8 weeks |
|
E |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
F |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
G |
prescribe appropriate antibiotic(s) for
7 days with follow-up for TOC |
|
H |
admit to hospital for investigation and
intensive treatment if Lm infection found |
|
I |
none of the above |
Scenario 12.
Which, if any, of the following would be
appropriate for consideration as 1st. line treatment of Lm in
pregnancy? This is not a true EMQ as there may be more than 1 correct answer.
Option list.
|
A |
ampicillin |
|
B |
ampicillin + gentamycin |
|
C |
ampicillin + streptomycin |
|
D |
amoxicillin + clavulanic acid |
|
E |
clarithromycin |
|
F |
erythromycin |
|
G |
erythromycin + metronidazole |
|
H |
trimethoprim |
|
I |
none of the above |
Scenario 13.
Is listeriosis a notifiable infection in
the UK? Yes/No.
