4 March 2024.
|
40 |
Role-play 1 |
|
41 |
Role-play
2 |
|
42 |
EMQ.
Listeriosis
and pregnancy |
|
43 |
EMQ.
Toxoplasmosis |
Candidate’s instructions
will be emailed shortly before the tutorial – I don’t want you to have time to
prepare.
42. EMQ. Listeriosis and pregnancy.
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 38.2oC. 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.
43. 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 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 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. |
