Tutorial 26 April 2021

 

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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 5^th. 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 1^st. 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 2^nd. 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 3^rd. 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.

Abbreviations.

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.

Scenario 7.              

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

Scenario 11.           

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 38.2^oC. 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 1^st. 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.