26 August 2024.
|
Role-play.
|
|
|
41 |
Viva. |
|
42 |
EMQ.
Mycoplasma
Genitalium |
|
43 |
EMQ.
Peutz-Jeghers
syndrome |
40. Role-play. Candidate’s
instructions will be sent by email shortly before the tutorial.
41. Viva. The examiner
will ask a series of questions. Topic revealed during the tutorial.
42. Mycoplasma
genitalium.
Abbreviations.
MG: Mycoplasma genitalium.
MSSU: mid-stream specimen of
urine.
NAAT: nucleic acid amplification
test.
NCSP: National
Chlamydia Screening Programme.
NHSCS: NHS
Cervical Screening Programme
PID: pelvic inflammatory disease.
STI: sexually-transmitted infection.
EMQ as there may be more than one correct answer.
|
A |
MG
was first isolated in 2001 |
|
B |
MG
was first isolated from men with non-gonococcal urethritis (NGU) |
|
C |
MG
belongs to the Cutemollies class |
|
D |
MG
is the smallest known yeast with the ability to self-replicate |
|
E |
MG
is the smallest known bacterium with the ability to self-replicate |
|
F |
MG
has an unusual, double-layered cell wall |
|
G |
MG
has an unusual protrusion at one end |
|
H |
MG’s
protrusion enables it to adhere to epithelial cells |
|
I |
MG’s
protrusion enables it to invade epithelial cells |
|
J |
MG
is best seen on a Gram stain |
Scenario 2.
Which, if any, of
the following statements are true in relation to Mycoplasmas?
|
A |
are the largest known bacteria |
|
B |
have no cell wall |
|
C |
have no nuclei |
|
D |
are resistant to ß-lactam antibiotics |
|
E |
are resistant to sulphonamides |
|
F |
colonies show a ‘scrambled egg’ appearance
on culture on agar |
|
G |
particularly affect mucosal surfaces. |
Scenario 3.
Which, if any, of
the following statements are true in relation to Mg?
|
A |
when the organism was originally found,
culture took 50 days |
|
B |
Mg is facetious |
|
C |
Mg is a facultative aerobe |
|
D |
Mg is a facultative anaerobe |
|
E |
Mg is a facultative aerobe & anaerobe |
|
F |
Mg is fastidious |
Scenario 4.
Which, if any, of
the following are true in relation to the approximate prevalence of
MG?
|
A |
it is ~ 0.1% |
|
B |
it is ~ 1.0% |
|
C |
it is ~ 5.0% |
|
D |
it is ~ 5-10% |
|
E |
it is > 10% |
|
F |
none of the above |
Scenario 5.
Which, if any, of
the following is true in relation to screening for MG? This is a true
EMQ with only one
correct answer.
|
A |
screening for MG is now included in the
NCSP |
|
B |
screening for MG is now offered as part of
the NHSCS |
|
C |
screening should be offered to all
sexually active women < 30 years old |
|
D |
screening should only be offered to those
with symptoms suggestive of infection |
|
E |
screening should be offered to all
partners of those with MG infection |
|
F |
none of the above |
Scenario 6.
Which, if any, of
the following are included in BASHHMG as risk factors for infection
with MG?
|
A |
Cigarette smoking |
|
B |
Multiple dancing partners |
|
C |
Multiple sexual partners |
|
D |
Non-white ethnicity |
|
E |
Younger age |
|
F |
None of the above |
Scenario 7.
Which of the
following statements is true in relation to MG and co-infection with
other organisms?
|
A |
MG excretes bactericidal toxins and
co-infection is rare |
|
B |
MG co-infection is most often with
chlamydia |
|
C |
MG co-infection is most often with E. coli |
|
D |
MG co-infection is most often with HIV |
|
E |
MG co-infection is most often with TB |
|
F |
None of the above |
Scenario 8.
Which of the
following statements is true in relation to MG and men?
|
A |
It is the most common cause of NGU |
|
B |
It is the most common cause of
epididymitis |
|
C |
It is the most common cause of prostatitis |
|
D |
It is a well-recognised cause of male
sub-fertility |
|
E |
Most men with MG infection are
asymptomatic |
|
F |
None of the above |
Scenario 9.
Which, if any, of
the following statements are true in relation to MG and women?
|
A |
MG is linked to an ↑ risk of cervicitis |
|
B |
MG is linked to an ↑ risk of endometritis |
|
C |
MG is linked to an ↑ risk of female infertility |
|
D |
MG is linked to an ↑ risk of miscarriage |
|
E |
MG is linked to an ↑ risk of otitis media |
|
F |
MG is linked to an ↑ risk of pelvic inflammatory
disease |
|
G |
MG is linked to an ↑ risk of postcoital bleeding |
|
H |
MG is linked to an ↑ risk of postmenopausal
bleeding |
|
I |
MG is linked to an ↑ risk of preterm birth |
|
J |
MG is linked to an ↑ risk of damage to Fallopian
tube cilia |
|
K |
MG is linked to an ↑ risk of puerperal psychosis |
|
L |
MG is linked to an ↑ risk of puerperal sepsis |
|
M |
Most infected women are asymptomatic |
|
N |
None of the above |
Scenario 10.
Which, if any, of
the following statements are true in relation to current concerns
about Mg?
|
A |
It could become a ‘superbug’, resistant to
most antibiotics, within a decade |
|
B |
Infection is often misdiagnosed as
chlamydia with ↑
risk of antibiotic resistance |
|
C |
‘superbug’ status would be likely to lead
to an ↑
in renal failure |
|
D |
‘superbug’ status would be likely to lead
to an ↑
in female infertility |
|
E |
‘superbug’ status would be likely to lead
to an ↑
in male infertility |
Scenario 11.
Which, if any, of
the following are used in the recommended test for MG infection in
women?
|
A |
blood testing for MG IgG |
|
B |
blood testing for MG IgM |
|
C |
cervical smears checked microscopically
for the diagnostic intracellular inclusion bodies |
|
D |
culture and sensitivity of cervical swab
specimens using MG-specific culture medium |
|
E |
culture and sensitivity of 1st. void MSSU
using MG-specific culture medium |
|
F |
culture and sensitivity of vaginal swab
specimens using MG-specific culture medium |
|
G |
NAATs that detect the MG G-antigen |
|
H |
NAATs that detect MG DNA |
|
I |
NAATs that detect MG RNA |
|
J |
serum testing for MG-specific antigen |
|
K |
vaginal swabs taken by the woman |
|
L |
none of the above |
Scenario 12.
Which, if any, of
the following statements are true in relation to testing for antibiotic
resistance after
initial tests are +ve for MG?
|
test
for resistance to cephalosporins |
|
|
B |
test
for resistance to macrolides |
|
C |
test
for resistance to penicillin |
|
D |
test
for resistance to quinolones |
|
E |
test
for resistance to macrolides |
|
F |
test
for resistance to streptomycin |
|
F |
test
for resistance to sulphonamides |
|
F |
test
for resistance to tetracyclines |
|
G |
None
of the above |
Scenario 13.
Which, if any, of
the following statements are true in relation to estimates of
antibiotic resistance in current strains of MG in the UK?
|
A |
20%
are resistant to cephalosporins |
|
B |
40%
are resistant to macrolides |
|
C |
50%
are resistant to penicillin |
|
D |
50%
are resistant to quinolones |
|
E |
10%
are resistant to streptomycin |
|
F |
90%
are resistant to sulphonamides |
|
F |
40%
are resistant to tetracyclines |
|
F |
None
of the above |
Scenario 14.
Which, if any, of
the following is BASHHMG’s recommended 1st. line treatment of
uncomplicated MG?
|
A |
azithromycin 1 gram daily for 7 days |
|
B |
doxycycline 100 mg twice daily for 7 days |
|
C |
doxycycline 100 mg twice daily for 10 days |
|
D |
doxycycline 100 mg twice daily for 7 days |
|
E |
doxycycline 100 mg twice daily for 7 days
then azithromycin 1 gram daily for 2 days |
|
F |
moxifloxacin 400mg orally once daily for 7
days |
|
G |
moxifloxacin 400mg orally once daily for
10 days |
|
H |
none of the above |
Scenario 15.
Which, if any, of the
following is BASHHMG’s recommended 1st. line treatment of
complicated MG?
|
A |
doxycycline 100 mg twice daily for 10 days |
|
B |
doxycycline 100 mg twice daily for 14 days |
|
C |
moxifloxacin 400mg orally once daily for 10
days |
|
D |
moxifloxacin 400mg orally once daily for
14 days |
|
E |
none of the above |
Scenario 16.
This is not an EMQ
or SBA! Fill in the gaps in the table below, using option list.
|
Drug name |
Category of drug |
|
azithromycin |
|
|
doxycycline |
|
|
moxifloxacin |
|
Option List.
|
Category of drug |
|
macrolide |
|
tetracycline |
|
quinolone |
Scenario 17.
Which, if any, of
the following statements is true in relation to test of cure (TOC) after
treatment of MG?
|
A |
TOC should be offered to everyone who has
been treated for MG |
|
B |
TOC should only be offered to those who
had signs of infection before treatment |
|
C |
TOC should only be offered to those who
had symptoms of infection before treatment |
|
D |
TOC should only be offered to those who
had signs and symptoms before treatment |
|
E |
TOC should only be offered to those who
continue to have signs or symptoms two weeks or more after the start of
treatment |
|
F |
none of the above |
Scenario 18.
Which, if any, of
the following statements are true in relation to the timing of test of
cure (TOC) after
treatment of MG?
|
A |
TOC is best done at 3 weeks after start of
treatment |
|
B |
TOC is best done at 4 weeks after start of
treatment |
|
C |
TOC is best done at 5 weeks after start of
treatment |
|
D |
TOC is best done at 6 weeks after start of
treatment |
|
E |
TOC should not be done < 2 weeks from
the start of treatment |
|
F |
TOC should not be done < 3 weeks from
the start of treatment |
|
G |
TOC should not be done < 4 weeks from
the start of treatment |
43. Peutz-Jeghers
syndrome.
Abbreviations.
PJS: Peutz-Jeghers syndrome.
Scenario
1. Which, if any, of the following are characteristics of PJS?
|
A |
buccal
pigmentation |
|
B |
gastro-intestinal
hamartomas |
|
C |
perianal
pigmentation |
|
D |
increased risk
of breast cancer |
|
E |
increased risk
of cervical adenoma malignum |
|
F |
increased risk
of colo-rectal cancer |
|
G |
increased risk
of endometrial cancer |
|
H |
increased risk
of ovarian cancer |
|
I |
increased risk
of pancreatic cancer |
|
J |
increased risk
of prostate cancer |
|
K |
increased risk
of stomach cancer |
Scenario
2. What is the approximate prevalence of PJS?
|
A |
< 1 in
1,000 |
|
B |
1 in 1,000 to
1 in 10,000 |
|
C |
1 in 10,000 to
1 in 100,000 |
|
D |
1 in 25,000 to
1 in 100,000 |
|
E |
1 in 25,000 to
1 in 200,000 |
|
F |
1 in 25,000 to
1 in 300,000 |
|
G |
1 in 300,000
to 1 in 500,000 |
|
H |
< 1 in
500,000 |
Scenario
3. What is the mode of inheritance in PJS?
|
A |
autosomal
dominant |
|
B |
autosomal
recessive |
|
C |
X-linked
dominant |
|
D |
X-linked
recessive |
|
E |
Y-linked
dominant |
|
F |
Y-linked
recessive |
|
G |
triplet repeat |
Scenario
4. Which, if any, of the following statements are true of PJS?
|
A |
PJS only
occurs in families with other affected members |
|
B |
PJS mainly
occurs in families with other affected members |
|
C |
PJS may arise
de-novo in families with no other affected members |
|
D |
PJS may arise
de-novo in families with other affected members |
|
E |
PJS does not arise
de-novo in families with no other affected members |
Scenario
5. What is the approximate lifetime risk of developing cancer
in PJS?
|
A |
10% |
|
B |
20% |
|
C |
30% |
|
D |
40% |
|
E |
50% |
|
F |
60% |
|
G |
70% |
|
H |
80% |
|
I |
90% |
|
J |
>90% |
Scenario
6. What is the relevance of STK11 to PJS?
|
A |
It is part of
the postcode of the Peutz-Jeghers Society |
|
B |
It is the name
of the gene most commonly associated with PJS |
|
C |
It is the
Ornithological Society’s code for the Orkney Skua |
|
D |
Somatic mutations
have been found in cervical cancer |
|
E |
None of the
above |
