21 October 2024.
|
90 |
Specialist
talk. Martino Zacchè. Uro-gynae. |
|
91 |
Role-play. Previous stillbirth. |
|
92 |
SBA. Pertussis and pregnancy |
|
93 |
EMQ. Listeriosis and pregnancy |
90. Martino Zacchè. Uro-gynae. Martino gives an excellent introduction to uro-gynae, with all
you need for the exam and is
happy to answer questions. Not to be missed if you are not already expert.
91. Role-play. Previous stillbirth. I have been
kind, letting you know the topic!
Candidate's
Instructions.
You are an SpR in
the booking clinic. You are about to see a woman who is at 10 weeks’ gestation
in her second pregnancy. Her first baby was stillborn.
She has had all
the routine booking, including investigations, dealt with by the midwife who
has asked you to see her to advise about her first pregnancy and its
implications for the management of this pregnancy.
Take an
appropriate history, advise about the necessary investigations and how the
history of stillbirth will influence the management of the pregnancy.
92. SBA. Pertussis and pregnancy.
This is very
topical as there has been a major and exceptional outbreak since 2011.
JCVI: Joint
Committee on Vaccination and Immunisation .
PIPP: pertussis immunisation programme for
pregnancy.
Question 1. Why is pertussis of current concern in obstetrics?
|
A |
Research
has linked pertussis in the 1st. trimester to ↑ risk of congenital heart disease |
|
B |
A mini-epidemic since 2011 has caused ↑ deaths
of mothers & of babies < 3 months |
|
C |
A mini-epidemic since 2011 has caused ↑ deaths
of babies < 3 months |
|
D |
The infecting organism has become
increasingly drug-resistant |
|
E |
The infecting organism has become
increasingly virulent |
Question 2. Which organism causes whooping cough?
|
A |
Bordella pertussis |
|
B |
Bacteroides
pertussis |
|
C |
Rotavirus
whoopoe |
|
D |
Respiratory
syncytiovirus pertussis |
|
E |
None of
the above |
Question 3.
Which, if
any, of the following statements are true about the organism what causes
whooping cough? This is not a true SBA as I have condensed several questions
into one to save space and there may be more than one correct answer.
|
A |
the organism is aerobic |
|
B |
the organism is anaerobic |
|
C |
the organism is capsulated |
|
D |
the organism is flagellate |
|
E |
the
organism is an obligate intra-cellular parasite |
|
F |
the organism is a Gram -ve diplococcus |
|
G |
the organism is a Gram +ve diplococcus |
|
H |
the organism requires special transport
media |
|
I |
no one is going to ask me any of this stuff |
Question 4.
Which of the
following statements is true?
|
A |
Pertussis is no longer a significant threat
to infants |
|
B |
Pertussis
remains a significant threat to infants |
|
C |
The risk
of death from pertussis is eliminated by timely antibiotic therapy |
|
D |
the risk
of death from pertussis is eliminated by timely antiviral therapy |
|
E |
None of
the above |
Question 5. Which of the following statements is true?
|
A |
Pertussis is not a notifiable disease |
|
B |
Pertussis
is a notifiable disease |
|
C |
Pertussis
is not a notifiable disease, but cases should be reported to the local
bacteriologist |
|
D |
Pertussis
is not a notifiable disease, but cases should be subject to audit |
Question 6. What is the main mode of spread of the organism that
causes pertussis?
|
A |
contact
with contaminated surfaces |
|
B |
contaminated food |
|
C |
contaminated water |
|
D |
respiratory droplets |
|
E |
none of the above |
Question 7.
What is the
main reservoir of the organism that causes pertussis?
|
A |
budgerigars |
|
B |
cats |
|
C |
dogs |
|
D |
humans |
|
E |
pigeons |
|
F |
pigs |
|
G |
none of the above |
Question 8. What is the epidemiology of pertussis?
|
A |
the condition is endemic |
|
B |
the
condition is endemic with mini-epidemics every 3-5 years |
|
C |
the
condition is endemic with mini-epidemics most years in the winter months |
|
D |
the
condition is epidemic, with outbreaks at roughly three-year intervals |
|
E |
the
condition is epidemic, with outbreaks at unpredictable intervals |
Question 9.
What is the
incubation period for pertussis?
|
A |
3-6 days |
|
B |
7-10 days |
|
C |
11-14 days |
|
D |
15-18 days |
|
E |
none of the
above. |
Question 10.
What is the
duration of infectivity of someone with pertussis?
|
A |
2 days from
exposure → 5 days after onset of paroxysms of coughing |
|
B |
3 days from
exposure → 10 days after onset of paroxysms of coughing |
|
C |
4 days from
exposure → 14 days after onset of paroxysms of coughing |
|
D |
6 days from
exposure → 21 days after onset of paroxysms of coughing |
|
E |
none of the
above |
Question 11.
What % of
non-immune, close contacts of pertussis will develop the disease?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 12.
Which of the
following best describe the DOH’s advice about pertussis? This is not a true
SBA as there may be > 1 connect answer.
|
A |
The DOH advises that all pregnant women be
immunised to ↓ maternal death rates. |
|
B |
The DOH advises
that all pregnant women be immunised to ↓ deaths
in babies < 3 months. |
|
C |
The DOH advises
that all babies be immunised at birth. |
|
D |
The DOH advised
that “Boostrix- IPV” should
replace “Repevax” from July 2014. |
|
E |
The DOH advises
that immunisation of pregnant women be continued permanently |
Question 13.
Which, if
any, of the following statements is true in relation to average annual number
of deaths due to pertussis in the years before routine child immunisation was
introduced?
|
A |
the number
was 10,000 |
|
B |
the number
was 5,000 |
|
C |
the number
was 4,000 |
|
D |
the number
was 3,500 |
|
E |
the number was
1,000 |
Question 14. Which, if any, of the following statements are true in
relation to pertussis vaccine.
|
A |
“Boostrix- IPV” is a vaccine for pertussis
only |
|
B |
“Repevax” is a
vaccine for pertussis only |
|
C |
“Boostrix-
IPV” & “Repevax” are live, attenuated vaccines |
|
D |
“Boostrix-
IPV” & “Repevax” act against diphtheria, tetanus and polio as well as
pertussis |
|
E |
“Boostrix-
IPV” & “Repevax” are acellular |
Question 15.
Which, if any, of the following statements are true in relation to the
JCVI’s advice of the best time to administer pertussis vaccine in pregnancy?
|
A |
20 - 24 weeks |
|
B |
25- 28 weeks |
|
C |
28 - 32 weeks |
|
D |
28 - 34 weeks |
|
E |
none of the above |
Question 16.
A woman has suspected pertussis in early pregnancy. Should she still be
offered vaccination?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I hate this subject now |
Question 17.
A pregnant woman misses out on vaccination as part of the PIPP. Should
vaccination still be offered in the puerperium?
|
A |
Yes |
|
B |
No |
|
C |
I don’t know |
|
D |
I hate this subject now |
93. Listeriosis.
This is uncommon, but a regular in both Part 2 and Part 3.
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?
|
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?
|
A |
they are not more susceptible |
|
B |
they are similar in susceptibility |
|
C |
they are more susceptible x 2-5 |
|
D |
they are more susceptible x 5-10 |
|
E |
they are more susceptible x 10-20 |
|
F |
they are > 20 times more susceptible |
|
G |
none of the above. |
Scenario
5.
When does Lm most
often occur?
|
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?.
|
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 ?
|
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.
|
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?
|
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?
|
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?
|
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.
|
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.
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