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4 March 2024.
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40
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Role-play 1
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41
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Role-play
2
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42
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EMQ.
Listeriosis
and pregnancy
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43
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EMQ.
Toxoplasmosis
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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?
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A
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Listeria diogenys
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B
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Listeria frigidaire
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C
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Listeria hominis
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D
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Listeria monocytogenes
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E
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Listeria xenophylus
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Scenario
2.
Which, if any, of
the following statements are true about Lm?
Option list.
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A
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it is a small, Gram -ve rod
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B
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it is a Gram +ve coccus
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C
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it is flagellated
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D
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it has no cell wall
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E
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it is an obligate aerobe
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F
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it functions within host cells
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G
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it can easily be mistaken for commensal organisms
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H
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none of the above
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Scenario
3.
Which of the
following are associated with an increased risk of contracting LM?
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A
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age > 60 years
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B
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age < 1 year
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C
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blond hair
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D
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pregnancy
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E
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strabismus
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Scenario 4.
Which of the following
are true of the susceptibility of pregnant women to Lm?
Option list.
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A
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they are not more susceptible
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B
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they are more susceptible x 2
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C
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they are more susceptible x 5
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D
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they are more susceptible x 10
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E
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they are more susceptible x 20
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F
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they are > 20 times more susceptible
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G
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none of the above.
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Scenario
5.
When does Lm most
often occur?
Option list.
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A
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1st. trimester
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B
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2nd. trimester
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C
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3rd trimester
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D
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1st. + 2nd. trimesters
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E
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2nd. + 3rd trimesters
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F
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all trimesters equally
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G
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puerperium
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H
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none of the above
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Scenario
6.
What is the incubation
period for Lm?.
Option list.
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A
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7±3 days
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B
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7±5 days
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C
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10±3 days
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D
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10±5 days
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E
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14±3 days
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F
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14±5 days
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G
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none of the above.
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Scenario
7.
What is the
significance of Granulomatosis Infantisepticum ?
Option list.
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A
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it is a
fabrication by the author and of no significance
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B
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it is pathognomonic
of Lm infection
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C
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it is the cause
of vertical transmission of Lm
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D
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I refuse to
answer Latin questions as they make me think of Boris Johnson
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E
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none of the above
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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.
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A
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Lm is as often found in the cervix as in the bowel.
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B
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Lm is as often found in the vagina as in the bowel.
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C
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Lm is less often found in the cervix than in the bowel.
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D
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Lm is less often found
in the vagina than in the bowel.
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E
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Lm is more often found in the cervix than in the bowel.
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F
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Lm is more often found in the cervix than in the bowel.
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G
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no one knows and no one cares
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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.
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A
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
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B
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
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C
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
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D
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reassure and advise her about avoiding exposure and to reattend
if she develops signs or symptoms within 8 weeks
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E
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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F
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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G
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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H
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admit to hospital for investigation and intensive
treatment if Lm infection found
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I
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none of the above
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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.
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A
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
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B
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
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C
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
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D
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks
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E
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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F
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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G
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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H
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admit to hospital for investigation and intensive
treatment if Lm infection found
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I
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none of the above
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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.
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A
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 2 weeks
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B
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 4 weeks
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C
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 6 weeks
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D
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reassure and advise her about avoiding exposure and to
reattend if she develops signs or symptoms within 8 weeks
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E
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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F
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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G
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prescribe appropriate antibiotic(s) for 7 days with
follow-up for TOC
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H
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admit to hospital for investigation and intensive
treatment if Lm infection found
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I
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none of the above
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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.
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A
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ampicillin
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B
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ampicillin + gentamycin
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C
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ampicillin + streptomycin
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D
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amoxicillin + clavulanic acid
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E
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clarithromycin
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F
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erythromycin
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G
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erythromycin + metronidazole
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H
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trimethoprim
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I
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none of the above
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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.
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A
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it is Toxoplasma giardia
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B
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it is Toxoplasma gondi
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C
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it is Toxoplasma gondii
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D
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it is Toxoplasma gondola
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E
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it is Toxoplasma gung-ho
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F
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none of the above
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Question
2.
Approximately what
proportion of the UK pregnant population shows evidence of
previous Tg infection?
Option list.
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A
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< 10%
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B
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10%
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C
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20%
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D
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30%
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E
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40%
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F
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50%
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G
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> 50%
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Question
3.
When is maternal
infection believed to be of greatest risk to the fetus?
Option list.
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A
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peri-conceptually
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B
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1st. trimester
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C
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2nd. trimester
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D
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3rd. trimester
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E
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during vaginal birth
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F
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in the puerperium
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G
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in the puerperium if breastfeeding
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H
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none of the above
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Question
4.
Which, if
any, of the following are true with
regard to when tgIgG is detectable after
1ry maternal infection?
Option list.
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A
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2 weeks
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B
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4 weeks
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C
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2 months
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D
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3 months
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E
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6 months
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F
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none of the above
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Question
5.
Which, if
any, of the following are true with
regard to when TgIgM is detectable after
1ry maternal infection?
Option list.
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A
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2 weeks
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B
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4 weeks
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C
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2 months
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D
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3 months
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E
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6 months
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F
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none of the above
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Question
6.
Which, if
any, of the following are true with regard
to avidity testing for Tg?
Option list.
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A
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avidity testing is of little use
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B
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avidity testing requires expert advice
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C
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avidity < 30% indicates infection in the previous 3
months
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D
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avidity < 30% indicates infection in the previous 6
months
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E
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avidity < 30% indicates infection in the previous 9
months
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F
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avidity > 40% indicates infection more than 3 months
previously
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G
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avidity > 40% indicates infection more than 6 months
previously
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H
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avidity > 40% indicates infection more than 9 months
previously
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I
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none of the above
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Question
7.
Which, if
any, of the following are true with
regard to confirmation of fetal infection?
Option list.
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A
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avidity testing is of little use
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B
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avidity testing requires expert advice
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C
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avidity < 30% indicates infection in the previous 3
months
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D
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avidity < 30% indicates infection in the previous 6
months
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E
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avidity < 30% indicates infection in the previous 9
months
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F
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avidity > 40% indicates infection more than 3 months
previously
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G
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avidity > 40% indicates infection more than 6 months
previously
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H
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avidity > 40% indicates infection more than 9 months
previously
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I
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none of the above
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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.
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A
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screening should be introduced as soon as practicable
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B
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testing would produce a falsely-high prevalence of Tg
in pregnancy
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C
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the prevalence of Tg is too low for screening to be
cost-effective
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D
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the prevalence of Tg is high enough for screening to be cost-effective
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E
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the prevalence of Tg is unknown
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F
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there is no treatment in pregnancy of proven benefit to
mother or baby
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G
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they would leave the decision until after lunch, but
drank too much wine and did not return
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H
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maybe some of the above, please tick the boxes for me
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I
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none of the above
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Question 9.
Which, if any, of
the following are complications of intrauterine Tg infection for the fetus and newborn.
Option list.
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A
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miscarriage
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B
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IUGR
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C
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stillbirth
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D
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chorioretinitis
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E
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hepato-splenomegaly
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F
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holoprosencephaly
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G
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hydrocephalus
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H
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intracranial calcification
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I
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microcephaly
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J
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neural tube defect
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Question
10. Approximately how common in vertical transmission of Tg in
the 1st. trimester?
Option list.
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A
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< 10%
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B
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10-20%
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C
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25%
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D
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50%
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E
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> 50%
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Question
11. Approximately how common in vertical transmission of Tg in
the 2nd. trimester? Use
the option list for question 4.
Option list.
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A
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< 10%
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B
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10-20%
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C
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25%
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D
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50%
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E
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> 50%
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Question 12.
Approximately how
common in vertical transmission of Tg in the 3rd. trimester? Use the
option list for question 4.
Option list.
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A
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< 10%
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B
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10-20%
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C
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25%
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D
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50%
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E
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> 50%
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Question 13.
Which of the
following are true in relation to reducing the risk of vertical transmission of
Tg?
Option list.
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A
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the SYROCOT trial showed strong evidence of the
efficacy of spiramycin
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B
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a Cochrane trial has suggested that pyrimethamine +
sulfadiazine give better results than spiromycin
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C
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there is evidence that metronidazole is the most
effective drug
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D
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there is a lack of clear evidence about effective
therapies
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E
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spiromycin crosses the placenta, so is effective in
reducing MTBT and treating the infected fetus
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E
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this is too esoteric for my poor pummelled brain
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Question 14.
Which, if any, of
the following are features of the classical triad associated with congenital
Tg?
Option list.
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A
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chorioretinitis
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B
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deafness
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C
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hepatosplenomegaly
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D
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hydrocephalus
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E
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intracranial calcifications
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F
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low birthweight
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G
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jaundice
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H
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leukopenia
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Question
15. Which of the following are used in the treatment of cTg?
Option list.
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A
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metronidazole
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B
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pyrimethamine
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C
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steroids
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D
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sulfadiazine
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E
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none of the above.
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