Sunday, 20 October 2024

Tutorial 21 October 2024

 

21 October 2024.                                         

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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.

Abbreviations.

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.