MRCOGManchester

4 March 2024.

40	Role-play 1
41	Role-play 2
42	EMQ. Listeriosis and pregnancy
43	EMQ. Toxoplasmosis

40 & 41. Role-plays 1 & 2.

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.

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	1^st. trimester
B	2^nd. trimester
C	3^rd trimester
D	1^st. + 2^nd. trimesters
E	2^nd. + 3^rd 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.

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	1^st. trimester
C	2^nd. trimester
D	3^rd. 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.

MRCOGManchester

Sunday, 3 March 2024

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