Tutorial 5 January 2023

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5 January 2023.    

57	Role-play. Trans man
58	SBA.   Lynch syndrome.
59	EMQ. Toxoplasmosis
60	SBA. Quinolone antibiotics
61	EMQ. Listeriosis and pregnancy

            

57.         Role-play.

Candidate’s instructions.

You are an ST5 doctor in the gynaecology clinic, your next patient is Mr Vic Williams; you have received the following letter from the GP. Take a history from the patient and make a management plan.
Dear Doctor,
I should be most grateful if you would see Vic Williams, a 35-year-old transgender man. He appears to have a premature menopause and I have no idea about the implications. He was referred to the gender identity clinic one year ago but the waiting list for a first appointment is two years, so he is not yet on any hormone therapy. He has two children, both by normal delivery before he decided to transition and was ‘Victoria’. The children are 12 and 14 and seem well-adjusted to the maternal gender change. Vic has no significant medical history. I shall be most grateful for your expert opinion. Dr. P.E.R. Plexed.

 

58.         SBA.   Lynch syndrome.

Lynch syndrome.

Abbreviations

CRC:              colorectal cancer.

EC:                 endometrial cancer.

IBD:               inflammatory bowel disease: Crohn’s & ulcerative colitis.

IDDM:           insulin-dependent diabetes mellitus.

Ls:                  Lynch syndrome.

MLH:             mutL-homolog family of DNA, mismatch repair genes.

MMR:           mismatch repair.

MSH:             mutS homolog family of DNA, mismatch repair genes.

Question 1.        What is Lynch syndrome?

Option List

A	auto-immune condition leading to reduced factor X levels in blood
B	hereditary condition which increases the risk of many cancers, particularly breast
C	hereditary condition which increases the risk of many cancers, particularly breast & colorectal
D	hereditary condition which increases the risk of many cancers, particularly colorectal & endometrial
E	none of the above

Question 2.        How is Lynch syndrome inherited?

Option List

A	it is an autosomal dominant condition
B	it is an autosomal recessive condition
C	it is an X-linked dominant condition
D	it is an X-linked recessive condition
E	none of the above

Question 3.        Which, if any, of the following genes can cause Lynch syndrome?

Option List

A	MLH1 + MLH2 + MOH1
B	MLH1 + MLH2 + MSH1
C	MLH1 + MLH2 + MSH6
D	MLH1 + MSH2 + MSH6
E	None of the above

Question 4.        Mutations of which 2 of the following genes cause most cases of Lynch syndrome?

Option List

A	MLH1 + MLH2
B	MLH1 + MSH1
C	MLH1 + MSH2
D	MLH2 + MSH1
E	MLH2 + MSH2

Question 5.        What is the approximate prevalence of Ls in the UK population?

Option List

A	1 in 50
B	1 in 100
C	1 in 1,000
D	3 in 1,000
E	none of the above

Question 6.        Approximately what % of individuals with Ls have had the diagnosis established?

Option List

A	< 5%
B	5 -10%
C	10-20%
D	20-30%
E	>30%

Question 7.        Which, if any, of the following conditions are associated with an ↑ risk of Ls?

Option List

A	acromegaly + Addison’s disease + coeliac disease + IBD + IDDM
B	acromegaly + disease + anosmia + coeliac disease + IBD
C	acromegaly + IBD + IDDM
D	acromegaly + IBD
E	Addison’s disease + anosmia + coeliac disease + IBD + IDDM
F	acromegaly + Addison’s disease + anosmia + coeliac disease + IBD + IDDM
G	none of the above

Question 8.        Which 2 cancers are most likely in women with Lynch syndrome?

Option List

A	breast + bowel
B	breast + pancreas
C	breast + endometrium
D	bowel + cervix
E	bowel + endometrium
F	bowel + ovary
G	bowel + pancreas
H	endometrium + ovary

Question 9.        What does NICE recommend about screening for Lynch syndrome for the population

with no personal history of colorectal cancer?

Option List

A	offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative
B	offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative
C	offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis
D	offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis
E	none of the above

Question 10.    What does NICE recommend in relation to screening for Lynch syndrome in those with

a new diagnosis of colorectal cancer?

Option List

A	offer screening to everyone, regardless of age and family history
B	offer screening to those aged < 50 years at diagnosis
C	offer screening to those aged < 60 years at diagnosis
D	offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative
E	offer screening to those aged < 60 years at diagnosis with + ≥ 1 affected 1st.O relative

Question 11.    What does NICE recommend about screening for Lynch syndrome for the population

with no personal history of thyroid cancer?

Option List

A	offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative
B	offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative
C	offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis
D	offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis
E	none of the above

Question 12.         What does NICE recommend in relation to screening for Lynch syndrome in those

with a new diagnosis of thyroid cancer?

Option List

A	offer screening to everyone, regardless of age and family history
B	offer screening to those aged < 50 years at diagnosis
C	offer screening to those aged < 60 years at diagnosis
D	offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative
E	none of the above

Question 13.    What does NICE recommend about screening for Lynch syndrome for the population

 with no personal history of endometrial cancer?

Option List

A	offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative
B	offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative
C	offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis
D	offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis
E	none of the above

Question 14.    What does NICE recommend in relation to screening for Lynch syndrome in those with

a new diagnosis of endometrial cancer?

Option List

A	offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative
B	offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative
C	offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis
D	offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis
E	none of the above

Question 15.    What does NICE recommend about screening for Lynch syndrome for the population

with no personal history of colorectal cancer?

Option List

A	offer screening to those aged < 50 years with  ≥ 1 affected 1st.O relative
B	offer screening to those aged < 60 years with ≥ 1 affected 1st.O relative
C	offer screening to those with ≥ 1 affected 1st.O relative aged < 50 years at diagnosis
D	offer screening to those with ≥ 1 affected 1st.O relative aged < 60 years at diagnosis
E	none of the above

Question 16.    What does NICE recommend in relation to screening for Lynch syndrome in those with

a new diagnosis of colorectal cancer?

Option List

A	offer screening to everyone, regardless of age and family history
B	offer screening to those aged < 50 years at diagnosis
C	offer screening to those aged < 60 years at diagnosis
D	offer screening to those aged < 50 years at diagnosis with + ≥ 1 affected 1st.O relative
E	offer screening to those aged < 60 years at diagnosis with + ≥ 1 affected 1st.O relative

Question 17.    What relationship, if any, exists between Ls and acromegaly?

Option List

A	the risk of Ls is ↓ in those with acromegaly compared with the general population
B	the risk of Ls is ↑ in those with acromegaly compared with the general population
C	the risk of Ls is unchanged in those with acromegaly compared with the general population
D	the risk of Ls in unknown in those with acromegaly
E

Question 18.    What is the effect of aspirin consumption on the risk of EC and CRC?

Option List

A	aspirin reduces the risk of EC and CRC
B	aspirin reduces the risk of EC but not CRC
C	aspirin reduces the risk of CRC but not EC
D	aspirin does not reduce the risk of EC or CRC
E	aspirin reduces the risk of EC and CRC, but the risks outweigh the benefits

Question 19.    A healthy woman of 35 years is diagnosed with Ls? What are the key elements of the

National Screening Programme for people with Ls?

There is no option list – just write down everything you know.

Question 20.    Which, if any, of the following were recommendations made by Monahan et al, the 30

experts who wrote to the BMJ in 2017.

Option List

A	creation of a national register of people with Ls
B	creation of a post of Consultant in Ls for each NHS Trust
C	creation of a post of Clinical Champion for Ls in each NHS Region.
D	creation of a post of Clinical Champion for Ls in the DOH.
E	none of the above

With regard to Lynch syndrome,

1.     loss of mismatch repair protein expression on immunohistochemistry of cancer is diagnostic.

True/False

2.     most carriers of the mutation associated with the syndrome know they have the condition.

True/False

3.     the first cancers associated with the syndrome are predominantly endometrial or ovarian cancers.                                                                                                                               True/False

4.     when cancers occur, they have in them an unusually high immune infiltrate.    True/False

With regard to testing for Lynch syndrome,

5.     consent must be sought before definitive germline testing for Lynch syndrome by a trained professional.                                                                                                                       True/False

6.     immunohistochemical staining of tumours for the mismatch repair proteins or microsatellite instability analysis are recognised ways of screening cancers for characteristics suggestive of the syndrome.                                                                                                                     True/False

7.     the National Institute for Health and Care Excellence endorses universal screening of colorectal cancer patients for Lynch syndrome.                                                                               True/False

8.     most gynaecological cancers found to have aberrant mismatch repair immunohistochemical staining will be in those with the syndrome.                                                  True/False

9.     the addition of MLH1 promotor hypermethylation testing in a Lynch syndrome diagnostic pathway improves specificity.                                                                               True/False

Regarding gynaecological surveillance in women with Lynch syndrome,

10.   there is strong evidence to recommend its use.                                                         True/False

11.   this should be offered to women around 25 years of age.                                       True/False

12.   counselling should include education on red flag symptoms of cancer and risk-reducing surgery.

True/False

With regard to risk-reducing strategies for women with Lynch syndrome,

13.   hysterectomy is strongly recommended for all those with the syndrome.               True/False

14.   the timing of risk-reducing surgery depends on the syndrome gene.                     True/False

15.   where possible, a laparoscopic approach is recommended.                                    True/False

16.   aspirin is not recommended as a means of reducing their overall cancer risk.              True/False

Regarding Lynch syndrome-associated gynaecological cancers,

17.   endometrial types that arise as a result of the syndrome have a poorer prognosis than sporadic types.                                                                                                                                 True/False

18.   checkpoint inhibition of the PD-1/PD-L1 pathway has been shown to be very effective in mismatch repair-deficient cancers.                                                                                       True/False

19.   vaccination against these cancers is currently the focus of research.                     True/False

20.   the Manchester International Consensus guideline is a useful reference for gynaecologists managing women with these cancers.                                                                True/False

 

59.        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 gung-ho
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	hydrocephalus
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.

 

60.         Quinolone & fluoroquinolone antibacterial drugs

Abbreviations.

FQ:              fluoroquinolone.

MHRA:       UK’s Medicines and Healthcare products Regulatory Agency.

SLE:             systemic lupus erythematosus.

QUI:            quinolone.

Question  1.      Which, if any, of the following drugs are QUIs or FQs?  

Drugs

A	cimetidine
B	ciprofloxacin
C	nalidixic acid
D	neomycin
E	nitrofurantoin

Option List

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

Question  2.      Which, if any, of the following statements are true in relation to QUIs & FQs? This is

not a true SBA as there may be more than one answer.

Statements

A	nalidixic acid is an older quinolone and is mainly excreted in the urine
B	ciprofloxacin is effective against most Gram +ve and –ve bacteria and 1st- line treatment for pneumococcal pneumonia.
C	ciprofloxacin is contraindicated in pregnancy due to the ↑ risk of neonatal haemolysis
D	many staphylococci are resistant to quinolones
E	quinolones are particularly useful in the treatment of MRSA

Question  3.      Which was the first QUI antibiotic?

Option List

A	acetylsalicylic acid
B	nalidixic acid
C	oxalic acid
D	pipemidic acid
E	none of the above

Question  4.      How do QUI and FQ antibiotics work? There is only one correct answer.

Option List

A	impair bacterial DNA coiling
B	impair bacterial DNA binding
C	impair bacterial RNA action
D	impair bacterial mitochondrial action
E	none of the above.

Question  5.      Which, if any, of the following QUIs & FQs is not available for prescription in the UK.

There is only one correct answer.

Option List

A	ciprofloxacin
B	levofloxacin
C	nalidixic acid
D	moxifloxacin
E	ofloxacin

Question  6.      Which, if any, of the following statements are true in relation to the quinolones and

fluoroquinolones and pregnancy? This is not a true SBA as there may be more than one answer.

Option list.

A	FQs are newer than QUIs with better systemic spread and efficacy
B	QUIs concentrate in urine but have a special affinity for cartilage
C	consumption of a FQ in the 1st. trimester is grounds for TOP
D	if an FQ is used, norfloxacin and ciprofloxacin should be considered 1st.
E	FQs are linked to a risk of discolouration of the teeth of offspring

Question  7.      Which of the following is true about the warning issued by the FDA in 2008 in relation

to QUIs & FQs?

Option List

A	they may cause congenital cartilage defects
B	they may cause congenital deafness
C	they may cause tendonitis and tendon rupture
D	they may cause prolongation of the Q-T interval
E	none of the above

Question  8.      Which of the following is true about the warning issued by the FDA in 2011 in relation

to QUIs & FQs?

Option List

A	they may cause exacerbation of eczema
B	they may cause exacerbation of hypertension
C	they may cause exacerbation of multiple sclerosis
D	they may cause exacerbation of myasthenia gravis
E	they may cause exacerbation of SLE

Question  9.      Which of the following is true about the warning emphasised by the FDA in 2013 in

relation to QUIs & FQs?

Option List

A	they may cause aortic dissection
B	they may cause mitral stenosis
C	they may cause pancreatitis
D	they may cause peripheral neuropathy
E	they may cause flare of SLE

Question  10.  FDA issued a warning in July 2016. Which, if any, of the following were included? This

is not a true SBA as there may be more than one answer.

Option List

A	the risks generally outweigh the benefits
B	QUIs & FQs should not be used for acute sinusitis,
C	QUIs & FQs should not be used for exacerbation of chronic bronchitis
D	QUIs & FQs should not be used for uncomplicated UTI
E	QUIs & FQs may be useful for anthrax and plague

Question  11.  FDA issued a warning in July 2018 about the use of FQs in pregnancy. Which, if any, of

the following were included in the reasons for its publication?

Option List

A	to strengthen previous warnings about hyperglycaemia and mental health risks
B	to strengthen previous warnings about hypoglycaemia and mental health risks
C	to strengthen previous warnings about the risk of ASD in the offspring
D	to strengthen previous warnings about the risk of acute pancreatitis
E	to strengthen previous warnings about the risk of PET

Question  12.  The FDA issued a warning in December 2018 about the use of FQs in pregnancy.

Which, if any, of the following was included? This is an SBA with only one correct answer.

Option List

A	↑ risk of atrial fibrillation
B	↑ risk of aortic aneurysm and rupture
C	↑ risk of mitral stenosis
D	↑ risk of pulmonary hypertension
E	↑ risk of ulcerative colitis

 

61.         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? 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. 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.