Tutorial 27 December 2021

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56	Role-play. Complaint. Mis-filed combined Ds test report
57	SBA.   Coeliac disease & pregnancy
58	EMQ. Abortion Act
59	EMQ. Surrogacy
60	EMQ. Listeriosis and pregnancy

 

56.         Role-play. Complaint. Mis-filed combined Ds test report.

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.

 

57.         SBA.   Coeliac disease & pregnancy.

Abbreviations.

AGA:        anti-gliadin antibodies 

CD:          coeliac disease.

DGP:        IgG deamidated gliadin peptide.

EMA:       IgG endomysial antibodies. 

FGR:        Fetal growth restriction.

HLA:        Human leucocyte antigen.

IgA:          immunoglobulin A. 

tIgA:        total immunoglobulin A.

tTGA:       IgA tissue transglutaminase antibody.

vLBW:      very low birth weight.

vPTB:       very pre-term birth (<30/52).

Question 1. What is coeliac disease?

Option List

A.	allergy to gluten
B.	malabsorption due to large bowel inflammation
C.	an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the descending colon in individuals with a genetic predisposition
D.	an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the gastric mucosa in individuals with a genetic predisposition
E.	an auto-immune disorder triggered by gluten sensitivity causing villous atrophy of the small bowel in individuals with a genetic predisposition

Question 2. What is the prevalence of coeliac disease in women of reproductive age?

Option List

A.	0.1%
B.	0.5%
C.	1%
D.	2-5%
E.	5-10%

Question 3. Which of the following groups have an increased risk of CD?

Option List

A.	1st. degree relatives of those with CD
B.	those with type 1 diabetes
C.	those with iron deficiency anaemia
D.	those with osteoporosis
E.	those with unexplained infertility

Question 4. Which of the following are features of CD in the non-pregnant population?

Option List

A.	abdominal bloating and pain
B.	amenorrhoea
C.	anaemia
D.	recurrent miscarriage
E.	unexplained infertility

Question 5. How do pregnant women with CD present most commonly?

Option List

A	anaemia
B	failure to gain weight in pregnancy
C	intra-uterine growth retardation
D	low BMI
E	no recognised abnormality

Question 6. Which of the following commonly occur in pregnant women with CD?

Option List

A	anaemia
B	failure to gain weight in pregnancy
C	intra-uterine growth retardation
D	low BMI
E	no recognised abnormality

Question 7. How should the woman with suspected CD be investigated initially?

Option List

A.	jejunal biopsy
B.	IgA EMA
C.	IgA tTGA
D.	IgA EMA + IgA tTGA
E.	tIgA + tTGA

Question 8. Which, if any, of the following statements are true in relation to the woman due to have testing for suspected CD?

Option List

A.	continue with a diet that includes gluten ≥ once daily for at least 1 month
B.	continue with a diet that includes gluten ≥ once daily for at least 6 weeks
C.	continue with a diet with ≥ 10 gm. gluten daily for at least 1 month
D.	continue with a diet with ≥ 10 gm. gluten daily for at least 6 weeks
E.	follow a strict gluten-free diet for at least 3 months

Question 9. What advice should be given to those who have gone on to a gluten-free diet in the month before testing?

Option List

A.	the gluten-free diet may render the serological tests –ve, but not intestinal biopsy
B.	the gluten-free diet may render the intestinal biopsy –ve, but not the serological tests
C.	the gluten-free diet may render all the tests -ve
D.	if she is happy with the gluten-free diet, there is no  point in testing
E.	she is not qualified to make medical decisions and should not be so stupid on future occasions

Question 10. Which of the following conditions should make consideration of testing for CD sensible?

Option List

A.	amenorrhoea
B.	Down’s syndrome
C.	epilepsy
D.	recurrent miscarriage
E.	Turner’s syndrome
F	unexplained infertility

Question 11. What recommendation does NICE make about the information to be provided to healthcare professionals with the results of serological tests for CD?

Option List

A.	the results alone should be provided
B.	the results with the local reference values for children, adult men and adult women
C.	the results with the local and national reference values for children, adult men and adult women
D.	the results with interpretation of their meaning
E.	the results with interpretation of their meaning + recommended actions

Question 12. How is the diagnosis of CD confirmed after +ve serological testing?

Option List

A.	colonoscopy
B.	enteroscopy
C.	gastroscopy
D.	rectal biopsy
E.	small bowel biopsy

Question 13. Which skin condition is particularly associated with CD?

Option List

A.	atopic eczema
B.	dermatitis herpetiformis
C.	dermatitis multiforme
D.	dermatographia
E.	psoriasis

Question 14. Which of the following are likely to be absorbed less well than normally in women with CD?

Option List

A.	carbohydrate
B.	fat
C.	folic acid
D.	protein
E.	vitamins B12, D & K

Question 15. What is the appropriate treatment of CD?

Option List

A.	antibiotics: long-term in low-dosage
B.	azathioprine
C.	cyclophosphamide
D.	rectal steroids
E.	none of the above

Question 16. Which of the following do not contain gluten?

Option List

A.	barley
B.	oats
C.	rapeseed oil
D.	rye
E.	wheat

 

58.         EMQ. Abortion Act.

Abbreviations.

Scenario 1. How many abortions were performed on residents of E&W aged 15-44 in 2020?

Option list

A	about 50,000
B	about 100,000
C	about 150,000
D	about 200,000
E	about 250,000
F	> 250,000

Scenario 2. What was the approximate rate of abortion in E&W residents in 2020?

Option list

A	1 per 1,000 resident women aged 15-44
B	10 per 1,000 resident women aged 15-44
C	15 per 1,000 resident women aged 15-44
D	25 per 1,000 resident women aged 15-44
E	50 per 1,000 resident women aged 15-44
F	100 per 1,000 resident women aged 15-44

Scenario 3. The rate of abortion in residents of E&W has declined by >20% from 2008-2020.

Option list

A	False
B	Haven’t a clue
C	Maybe
D	No data exist
E	True

Scenario 4. What proportion of TOPs were performed at gestations <10 weeks in E&W in 2020?

Option list

A	50%
B	60%
C	70%
D	80%
E	90%

Scenario 5. There was a significant improvement in the proportion of TOPs performed early from 2008-2020.

Option list

A	False
B	Haven’t a clue
C	Maybe
D	No data exist
E	True

Scenario 6. What % of abortions were performed after 24 weeks in 2020?

Option list

A	< 1%
B	1 - 3%
C	4 - 6%
D	7 - 9%
E	≥ 10%

Scenario 7. What proportion of TOPs were performed using medical techniques in 2020?

Option list

A	20%
B	30%
C	40%
D	50%
E	60%
F	70%
G	80%

Scenario 8. Which age group had the highest rate of TOP in 2020?

Option list

A	18
B	19
C	20
D	21
E	22
F	23
G	24
H	25

Scenario 9. What happened to the rate of TOP in 2020 for girls <18 years compared with 2008?

Option list

A	the rate was much lower
B	the rate was slightly lower
C	the rate was much higher
D	the rate was slightly higher
E	the rate was unchanged

Scenario 10. What happened to the rate of TOP in 2020 for girls <16 years compared with 2006?

Option list

A	the rate was much lower
B	the rate was slightly lower
C	the rate was much higher
D	the rate was slightly higher
E	the rate was unchanged

Scenario 12. Approximately what proportion of women having TOP in 2020 had previously had one or more TOPs?

Option list

A	1%
B	5%
C	10%
D	20%
E	30%
F	40%
G	50%

Scenario 13. What age group of women 1n 2020 were most likely to have had previous TOP?

Option list

	Age
A	< 18
B	18-19
C	20-24
D	25-29
E	30-34
F	≥ 35

Scenario 14. There were 185,824 TOPs in 2015. How many deaths occurred?

Option list

A	0 - 9
B	10 - 19
C	20 - 39
D	40 - 59
E	≥ 60

Scenario 15. What was the rate of significant complications of TOP in 2020?

Option list

A	<1%
B	1%
C	3%
D	5%
E	10%

Scenario 16. The RCOG recommends that women having TOP should have chlamydia screening. What proportion of women had this done in 2020?

Option list

A	<10%
B	10- 24%
C	25- 49%
D	50- 79%
E	80- 89%
F	≥ 90%

Scenario 17. The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) a”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Scenario 18. The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) b”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 19. The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) c.

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 20. The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) d”?

Option list

1	that the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
3	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
5	none of the above

Scenario 21. The Abortion Act gives a number of legal grounds for TOP. Which of the following is listed as “1 (1) e”?

Option list

1	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
2	the pregnancy has not exceeded its 24th. week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman
3	the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
4	the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
5	there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
6	none of the above

Scenario 22. With regard to the wording of the Abortion Act and grounds “F” and “G”. Which of the following statements are true?

1	“F” & “G” are grounds for TOP in an emergency with only one doctor needing to sign the legal form necessary for the TOP to take place
2	“F” & “G” are grounds for TOP after 24 weeks.
3	“F” relates to TOP to save the woman’s life
4	“F” relates to TOP to prevent grave permanent injury her physical or mental health
5	“F” & “G” do not exist.

Option list

A	1  + 3
B	1  + 4
C	2 + 3
D	2 + 4
E	5

Scenario 23. In relation to terms such as “substantial risk”, “grave permanent injury” and “seriously handicapped”, which of the following is true?

Option list

A	The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (b) to the Act.
B	The terms were defined by a Parliamentary sub-committee, examples were given and are included in Appendix 2 (c) to the Act.
C	The terms were defined by the General Medical Council, examples were given and the information can be downloaded from the GMC website.
D	The terms were defined by the RCOG, examples were given and the information can be downloaded from the RCOG website.
E	The terms have not been defined.

Scenario 24. Which of the following statement is true about the most common grounds for TOP?

Option list

1	TOP is most commonly done on ground A from Certificate A.
2	TOP is most commonly done on ground B from Certificate A.
3	TOP is most commonly done on ground C from Certificate A.
4	TOP is most commonly done on ground D from Certificate A.
5	TOP is most commonly done on ground E from Certificate A.
6	TOP is most commonly done on ground F from Certificate A.
7	TOP is most commonly done on ground G from Certificate A.
8	TOP is most commonly done on ground H from Certificate A.

Scenario 25. Which of the following statements is true in relation to the upper gestational limit for TOP to be legal in the UK?

1	Termination of pregnancy is legal to 24 weeks
2	Termination of pregnancy is legal after 24 weeks if the mother is at serious risk of death or grave, permanent injury or there is a major risk of the fetus having a serious anomaly.
3	Termination of pregnancy is legal after 24 weeks if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly, but only if approved by the Department of Health’s “Late Termination of Pregnancy Assessment Panel”.
4	Termination of pregnancy is illegal after 24 weeks, but is still done if the mother’s life is at serious risk or there is a major risk of the fetus having a serious anomaly and there is a long-standing agreement that the police and legal authorities will “turn a blind eye”.

Option list

A	1 + 2
B	1 + 3
C	1 + 4
D	2 + 4
E	5

Scenario 26. Which of the following statement are true in relation to TOP after 24 weeks?

Statements

1	TOP is illegal after 24 weeks
2	The mother must agree to feticide pre-TOP
3	Feticide must be offered
4	There must be very serious grounds for the TOP
5	Gender-selection TOP is unacceptable

Option list

A	1
B	1 + 2
C	2 + 3 + 5
D	3 + 4
E	3 + 4 + 5

Scenario 27. TOPs done under ground E are those done at any gestation because of fetal abnormality. The anomalies are coded using ICD10. The HSA4 notification form relating to each TOP should have details of the ICD10 code for the fetal anomaly.

Which of the following statements is the most accurate in relation to the percentage of HSA4 forms that contain the required information?

A	0- 24%
B	25- 49%
C	50- 59%
D	60- 69%
E	≥ 70%

Scenario 28. TOPs done under ground E are those done at any gestation because of fetal abnormality. Which, if any, of the following statements are true of TOPs under ground E in 2015?

A	the average of the woman was 34, compared to 21 for the average for all grounds
B	congenital malformations were the grounds in > 80% of cases
C	Down’s syndrome was the most common reason for ground E TOP
D	fetal cardiac anomalies were the most common reason for ground E TOP
E	fetal nervous system anomalies were the most common reason for ground E TOP

Scenario 29. Which form relates to certifying that a woman requesting a TOP can have it done legally?

Option list

A	HSA1
B	HSA2
C	HSA3
D	HSA4
E	HSA5

Scenario 30. Which form must the practitioner performing the TOP complete to notify the Department of Health that a TOP has been done?

Option list

A	HSA1
B	HSA2
C	HSA3
D	HSA4
E	HSA5

Scenario 31. A doctor signing the form giving the grounds for a TOP must have seen the woman.

Option list

A	True
B	False
C	Sometimes
D	Don’t know & don’t care

Scenario 32. A doctor performing a TOP must be one of the doctors who signed the initial form giving the grounds for the TOP.

Option list

A	True
B	False
C	Sometimes
D	Don’t know & don’t care

Scenario 33. What is the time scale for the return of the form notifying that a TOP has taken place?

Option list

A	3 working days
B	5 working days
C	1 week
D	2 weeks
E	1 month

Scenario 34/ A woman seeks 1^st. trimester TOP on social grounds which she declines to discuss in detail. Which of the following statements apply?

Option List

A	TOP can be done under clause A of Certificate A
B	TOP can be done under clause B of Certificate A
C	TOP can be done under clause C of Certificate A
D	TOP can be done under clause D of Certificate A
E	TOP can be done under clause E of Certificate A
F	TOP can be done under clause F of Certificate A
G	TOP can be done under clause G of Certificate A
F	there is no clause authorising TOP on social grounds

Scenario 35. A woman seeks 1st. trimester TOP. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist. Which of the following statements apply?

A	TOP can be done under clause A of Certificate A
B	TOP can be done under clause B of Certificate A
C	TOP can be done under clause C of Certificate A
D	TOP can be done under clause D of Certificate A
E	TOP can be done under clause E of Certificate A
F	TOP can be done under clause F of Certificate A
G	TOP can be done under clause G of Certificate A
F	there is no clause authorising TOP on these grounds

Scenario 36. A woman books at 26 weeks. She has an unplanned pregnancy. She has pulmonary hypertension and has been advised of the risks of pregnancy by her cardiologist.

Which of the following statements apply?

A	TOP should be offered under clause A of Certificate A
B	TOP should be offered under clause B of Certificate A
C	TOP should be offered under clause C of Certificate A
D	TOP should be offered under clause D of Certificate A
E	TOP should be offered under clause E of Certificate A
F	TOP should be offered under clause F of Certificate A
G	TOP should be offered under clause G of Certificate A
F	there is no clause authorising TOP on these grounds

Scenario 37. Which, if any,  of the following statements are correct about abortion law in Ireland?

Option list

A	abortion was legalised in the Republic of Ireland in 2018
B	abortion was legalised in the Republic of Ireland in 2019
C	abortion was legalised in the Republic of Ireland in 2020
D	abortion remains illegal in the Republic of Ireland
E	abortion was legalised in the Northern Ireland in 2018
F	abortion was legalised in the Northern Ireland in 2019
G	abortion was legalised in the Northern Ireland in 2020
H	abortion remains illegal in Northern Ireland

Scenario 38. Which, if any,  of the following statements are correct in relation to mifepristone and misoprostol?

Option list

A	mifepristone must be taken in an approved hospital or clinic
B	mifepristone may be taken at home
C	misoprostol must be taken in an approved hospital or clinic
D	misoprostol may be taken at home
E	none of the above

 

59.         EMQ. Surrogacy.

Surrogacy.

Piick the best choice from the option list for each scenario.

Abbreviations.

CF:              commissioning father

CM:            commissioning mother

CPs:            commissioning parents

PO:             parental order

SM:             surrogate mother

Option List.

a)      CM

b)      CF

c)      CPs

d)      SM

e)      Chairman of the HFEA

f)       Senior judge at the Children and Family Court

g)      traditional surrogacy

h)      gestational surrogacy

i)       HFEA

j)       SSAEW

k)      RCOG Surrogacy Sub-Committee

l)       false

m)    true

n)      none of the above

Scenario 1.  List the different types of surrogacy.

Scenario 2. “Gestational” surrogacy has better “take-home-baby” rates than “traditional” surrogacy.

Scenario 3. There are approximately 1,000 surrogate pregnancies per annum in the UK. True/False

Scenario 4. Which national body regulates surrogacy in England?

Scenario 5. Privately-arranged surrogate pregnancies are illegal and those involved are liable to up to 2 years in prison. True/False

Scenario 6. List the risks of surrogacy.

Scenario 7. Obstetricians are legally obliged to take the CPs’ wishes into consideration in managing pregnancy complications or problems.

Scenario 8. The psychological outcomes of surrogacy are fully understood. True/False.

Scenario 9. The psychological outcomes of surrogacy are more severe after traditional surrogacy. True/False

Scenario 10. Who has the right to arrange TOP if the fetus is found to have a major congenital abnormality?

Scenario 11. A SM decides at 10 weeks that she does not wish to be pregnant and arranges to have a TOP. The CPs. hear about this and object strongly. To whom should they apply to have the TOP blocked?

Scenario 12. A woman has hysterectomy and BSO to deal with extensive endometriosis at the age of 30. She marries two years later and her sister offers to act as surrogate. She undergoes IVF and 4 embryos are created. One is transferred and a successful pregnancy ensues. The baby is adopted by the woman and her husband. The 3 remaining embryos were frozen. Four years later the woman falls out with her sister, but finds another surrogate and wishes to proceed with another pregnancy. The sister says she does not want her eggs to be used and that the frozen embryos should not be transferred. Does the sister have the legal right to block the use of the embryos? Yes / No.

Scenario 13. A girl born from donor sperm reaches the age of 16 and wishes to know the identity of her genetic father. Does she have the right to this information?  Yes / No.

Scenario 14. A girl born from donor sperm reaches the age of 18 and wins a place at Oxford University to read medicine. Does she have the legal right to get the donor to contribute to her fees? Yes / No.

Scenario 15. A PO is active from the moment it is completed and signed by the relevant parties.  True/False

Scenario 16. A SM can change her mind at any time and keep the child, even if the egg was not hers.  True/False

Scenario 17. The CPs can change their mind, leaving the SM as the legal mother.  True/False

Scenario 18. A SM’s husband is the legal father until adoption is completed or a PO comes into force.

Scenario 19. A lesbian couple in a stable, co-habiting relationship can be CPs and become the legal parents of the child of a SM.

Scenario 20. CPs are likely to get faster legal status as the legal parents through application for a PO rather than applying for adoption.

 

60.         EMQ. Listeriosis and pregnancy.

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?

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 Lm?

A	age > 60 years
B	age < 1 year
C	blond hair
D	pregnancy
E	strabismus

Scenario 4.             Which of the following are true of the susceptibility of pregnant women to Lm? 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?

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?

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. 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. 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. 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.