21
August 2025. Role-players: 1.
Role-players:
2.
|
23 |
Role-play. |
|
24 |
Role-play. |
|
25 |
SBA. Chickenpox and pregnancy |
|
26 |
SBA. Yellow card reporting system |
23.
Role-play
1. Candidate’s
instructions will be e-mailed shortly before the tutorial.
24.
Role-play
1. Candidate’s
instructions will be e-mailed shortly before the tutorial.
25.
Chickenpox +
pregnancy.
Introduction.
This is a regular topic in the exam. The “Green Book”
updated its advice on post-exposure prophylaxis in 2022 which probably brought
it to the minds of examiners.
Abbreviations.
FVS: fetal varicella syndrome
VZV: varicella-zoster virus
VZIg: varicella-zoster immunoglobulin
Question 1. What type of virus causes chickenpox?
|
A |
avian
virus |
|
B |
herpes
virus |
|
C |
retrovirus |
|
D |
picovirus |
|
E |
pox
virus |
Question 2. Which of the following best describes the chickenpox
virus
|
A |
DNA
virus |
|
B |
RNA virus |
|
C |
Prion |
|
D |
All of the above |
|
E |
None of the above |
Question 3. What is the main reservoir of the chickenpox virus?
|
A |
domestic
chickens |
|
B |
chickens in battery farms |
|
C |
sparrows |
|
D |
humans |
|
E |
earthworms |
Question 4. Which, if any of the following
are true about how chickenpox is spread?
|
A |
via respiratory
droplets |
|
B |
direct contact with the fluid from the vesicles |
|
C |
contact with fomites |
|
D |
contact with stalactites |
|
E |
from lavatory seats |
Question 5. Fomites - which of the following
statements are true?
|
A |
fomites are bedclothes infested with
bed bugs which can carry the chickenpox virus |
|
B |
“fomites” in Latin is the plural of
“fomes”, the noun meaning “tinder” in English |
|
C |
fomites are inanimate objects that
can effect the transfer of communicable diseases from the infected person to
someone who is not infected |
|
D |
fomites are horizontal stalagmites,
particularly found in the Dolomite mountains and capable of fostering the
growth of viruses, including the chickenpox virus |
|
E |
fomites are the viral particles in
vomit that form the aerosols particularly associated with the respiratory
spread of viruses such as the chickenpox virus. |
Question 6. Which, if any, of the following are listed in GTG13 as
examples of fomites?
|
A |
bathtubs
used by person with chickenpox at the infectious stage |
|
B |
bedding |
|
C |
blood,
fresh or dried, from person with chickenpox at the infectious stage |
|
D |
clothing |
|
E |
hair |
|
F |
paper
money |
|
G |
skin
cells |
|
H |
viral
remnants in vomit from person with chickenpox at the infectious stage |
Question 7. With regard to the epidemiology of
chickenpox in the UK, which of the following statements are true?
|
A |
Chickenpox
is endemic |
|
B |
Chickenpox
is endemic with mini-epidemics every 3-4 years in the early part of the year |
|
C |
The main
reservoir is chickens, particularly those that are reared intensively |
|
D |
The main
reservoir is human sensory nerve root ganglia after primary infection |
|
E |
The main
reservoir is fomites |
Question 8. What proportion of the ante-natal population of the UK is
immune to chickenpox?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
|
F |
≥ 90% |
Question 9. Which population of immigrant women is
least likely to have immunity to chickenpox?
|
A |
Middle-Eastern |
|
B |
Those from Antarctica |
|
C |
Those from the EEC |
|
D |
Those from tropical and sub-tropical Africa |
|
E |
One-eyed Mongolians with the bad habit of spitting in
public |
Question 10. What is the incidence of chickenpox in pregnancy in the
UK?
|
A |
1 in
1,000 |
|
|
|
B |
3 in 1,000 |
|
|
|
C |
5 in 1,000 |
|
|
|
D |
8 in 1,000 |
|
|
|
E |
14 in 1,000 |
|
|
|
|
20 in 1,000 |
|
|
Question 11. What is the usual presentation of chickenpox in a child?
|
A |
Mild
fever with malaise then vesicles which
appear after 2 days and disappear
after 4 – 5 days |
|
B |
Mild
fever with malaise then vesicles which
appear after 2 days and disappear
after about 7 days |
|
C |
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 5 days |
|
D |
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 7 days |
|
E |
Mild fever, malaise, pruritic maculopapules that
develop into vesicles and normally crust over within 10 days |
Question 12. What is the duration of infectivity after primary
infection?
|
A |
From the
onset of fever until 48 hours after the vesicles form |
|
B |
From the onset of fever until 5 days after the vesicles
form |
|
C |
From 48 hours before the development of the vesicles
until 5 days later. |
|
D |
From 48 hours before the development of the vesicles
until they crust over |
|
E |
From the development of the vesicles until 5 days
later. |
|
F |
From the development of the vesicles until they crust
over |
Question 13. A woman books at 8 weeks. Her 6-year-old son lives with
her and has recently
developed
chickenpox? She is tested and found to be non-immune. What is her risk of
infection from the domestic contact with her son?
|
A |
50% |
|
B |
60% |
|
C |
70% |
|
D |
80% |
|
E |
90% |
Question 14. Which of the following contacts with a case of chickenpox
would be significant?
|
A |
contact
with the mother of a child who has just developed the typical chickenpox rash |
|
B |
contact
with the mother of a child who has not developed the typical chickenpox rash |
|
C |
a
four-hour journey on a school bus with 20 children, one of whom develops the
typical chickenpox rash the next day |
|
D |
having a
coffee with a neighbour who is having chemotherapy and has just developed
shingles |
|
E |
visiting
a neighbour who has developed ophthalmic shingles and has been admitted to an
old-fashioned 20-bed ward |
|
F |
having a
coffee with an 80-year-old neighbour who is in good health but has just had
recurrence of thoracic shingles. |
Question 15. In relation to shingles, which, if any, of the following
statements are true?
|
A |
Shingles is due to reactivation of the virus which has
lain dormant in the sensory nerve root ganglia |
|
B |
Shingles is due to reactivation of the virus which has
lain dormant in the motor nerve root ganglia |
|
C |
Shingles is due to reactivation of the virus which has
lain dormant in the autonomic nerve root ganglia |
|
D |
Shingles should always be regarded as infectious. |
|
E |
Shingles in the immuno-compromised should always be
regarded as infectious. |
|
F |
Ophthalmic shingles should always be regarded as
infectious |
Question 16. This is about prophylaxis with chickenpox
vaccine.
Which of
the following statements are true? Pick the best option from the option list.
|
A |
Chickenpox vaccine does not exist. |
|
B |
Chickenpox vaccine uses a killed virus of the Okra
strain. |
|
C |
Chickenpox vaccine uses an attenuated virus of the Oka
strain. |
|
D |
All children who have not had chickenpox should be
offered the vaccine after 1 year of age. |
|
E |
Women should be screened for immune status as part of
pre-pregnancy counselling or fertility treatment with ART |
Question 17. This relates to vaccination in early pregnancy
A
25-year-old woman is given varicella vaccine. Her period is due the next day,
but does not occur. A pregnancy test a few days later is +ve. What should be
the management?
|
A |
She
should be advised that there is a 5% risk of congenital varicella syndrome
and be offered TOP. |
|
B |
She should be advised that there is a 10% risk of
congenital varicella syndrome and be offered TOP. |
|
C |
She should be advised that the level of risk of
congenital varicella syndrome after vaccination in early pregnancy is unknown
and be offered TOP. |
|
D |
She should be advised that the level of risk of
congenital varicella syndrome after vaccination in early pregnancy is unknown
and be offered referral to a feto-maternal medicine expert. |
|
E |
She should be advised that inadvertent vaccination has
been studied for > 20 years no evidence has been found to harm to the
mother or child. |
|
F |
She should be advised that the vaccine contains no live
virus and cannot cause fetal infection. |
Question 18. A woman has been referred to the
booking clinic by her GP. Screening for immunity to chickenpox showed her to be
seronegative. What advice would you give her?
|
A |
Advise
her that there is no risk unless she comes into contact with a case of
chickenpox or shingles and to speak to GP or midwife if possible contact
occurs. |
|
B |
Advise her to have the chickenpox vaccine because of
the 10% risk and high mortality associated with varicella in pregnancy. |
|
C |
Advise her to have VZIG to reduce her risk of
infection. |
|
D |
Advise her to take oral acyclovir until two weeks
post-delivery. |
|
E |
None of the above. |
Question 19. A woman is referred to the booking
clinic by her GP for urgent assessment as she was in contact with a case of
chickenpox two days before. What action should be taken?
|
A |
take a
detailed history to determine the significance of the contact and her history
of and likely immunity to chickenpox. |
|
B |
check
for VZV immunity if there is a history of a significant contact and
possibility that she is not immune. |
|
C |
if the
contact was significant and the tests for VZV immunity show her to be
seronegative, offer oral acyclovir |
|
D |
if the
contact was significant and the tests for VZV immunity show her to be
seronegative, offer VZIg |
|
E |
if the
contact was significant and the tests for VZV immunity show her to be
seronegative, offer oral acyclovir + VZIg |
|
F |
if the
contact was significant and the tests for VZV show her to be seronegative,
discuss TOP. |
|
|
none of
the above |
Question 20. Which, if any, of the following statements about VZIg are
correct?
|
A |
VZIg is
manufactured using recombinant technology |
|
B |
VZIg is effective in pregnancy when given within 10
days of the contact |
|
C |
If VZIg is given, the woman is potentially infectious
for up to 28 days |
|
D |
Repeat doses of VZIg should not be given in the event
of repeated significant contact |
|
E |
There are reliable supplies of VZIg and no problems
regarding availability |
Question 21. How does the administration of VZIG
affect the duration of infectivity for the woman?
|
A |
With no
VZIG she is potentially infectious from day 8 to 28. |
|
B |
VZIG destroys virus and the woman is potentially
infections from day 8 to 21. |
|
C |
VZIG does not alter the period in which the woman is
potentially infections. |
|
D |
VZIG reduces the risk of shingles in later life |
|
E |
None of the above |
Question 22. With regard to established varicella
in pregnancy, which, if any, of the following statements are true? Choose the
best option from the option list.
|
A |
the main
risk to the mother comes from pneumonia, with an incidence of about 10% |
|
B |
the main risk to the mother comes from pneumonia, with
an incidence of about 40% |
|
C |
hepatitis and encephalitis are more common compared to
the non-pregnant state |
|
D |
mortality from varicella pneumonia have fallen to <
15% |
|
E |
the death rate from varicella pneumonia is estimated to
be 5 times greater than in the non-pregnant |
Question 23. A GP phones to say that a patient of
his at 10 weeks’ gestation has developed the typical rash of chickenpox. Her
son had proven chickenpox a couple of weeks previously. She had been tested and
found to be non-immune, but declined VZIG. Which, if any of the following
statements would you include in your advice to the GP.
|
A |
admit
the woman for assessment, VZIG and acyclovir after counselling re risks and
benefits. |
|
B |
arrange
for her to be seen in the next antenatal clinic. |
|
C |
advise
re prevention of secondary bacterial infection of the lesions |
|
D |
advise
about her avoiding contact with susceptible individuals until at least 7 days
after the lesions crust over |
|
E |
advise
the GP of the criteria for hospital admission and the need for the woman to
be informed of them. |
|
F |
advise
the GP to discuss the risks and benefits of acyclovir 800mg five times daily
for seven days and to prescribe it if the woman agrees. |
|
G |
advise
that acyclovir is contraindicated once the rash appears |
|
H |
advise
that VZIG is ineffectual once the rash has appeared |
|
I |
advise
that acyclovir is not licensed for use in pregnancy and any use would be
‘off-label’. |
|
J |
advise
that acyclovir is potentially teratogenic and not to be used in the 1st.
trimester. |
Question 24.What kind of drug is aciclovir?
Question 25. How effective is aciclovir?
Question 26. Which, if any, of the following
statements are true in relation to the diagnosis of fetal varicella syndrome?
|
A |
detailed
ultrasound examination by a fetal medicine expert should be offered |
|
B |
fetal MRI is superior to US examination and should be
the 1ry test if available |
|
C |
amniocentesis should be offered as detection of
varicella DNA makes FVS probable |
|
D |
amniocentesis should be done as early as possible,
avoiding any varicella lesions |
|
E |
PCR which is –ve for varicella DNA in amniotic fluid
has a strong NPV for FVS |
|
|
PCR which is +ve for varicella DNA in amniotic fluid
has a strong PPV for FVS |
Question 27. Which, if any, of the following
statements are true in relation to fetal varicella syndrome?
|
A |
FVS
occurs in relation to 1ry. infection in-utero |
|
B |
FVS occurs in relation to 2ry. infection in-utero |
|
C |
the risk of FVS is ~ 5% when 1ry. infection
in-utero occurs < 13 weeks |
|
D |
the risk of FVS is ~ 10% when 1ry. infection in-utero occurs between 13 and 20 weeks |
|
E |
the risk of FVS is greatest when 1ry. infection
in-utero occurs within 4 weeks of birth |
Question 28. Which, if any, of the following
statements are true in relation to administration of varicella vaccine in
pregnancy.
|
A |
varicella
vaccine is a recombinant vaccine and licensed for use in pregnancy |
|
B |
varicella vaccine contains a live, attenuated vaccine
and is contraindicated in pregnancy |
|
C |
varicella vaccine contains a live, attenuated vaccine
and is safe to use after 12 weeks |
|
D |
TOP should be advised if varicella vaccine is given in
the 1st. trimester |
|
E |
VZV immunoglobulin should be given if varicella vaccine
is given in the 1st. trimester |
|
F |
varicella vaccine should not be given to women who are
breastfeeding |
Question 29. Which, if any, of the following are true in relation to neonatal
varicella (NV)
|
A |
the risk
of NV is 90% with fetal infection in the 1st. trimester |
|
B |
the risk of NV is 50% with fetal infection in the 2nd.
trimester |
|
C |
the risk of NV is 10% with fetal infection in the 4
weeks before delivery |
|
D |
planned delivery should be delayed, if safe, until 7
days after start of the maternal rash |
|
E |
women with active chickenpox should not breastfeed
until 10 days after the lesions crust |
Question 30. Is chickenpox notifiable?
26.
Yellow Card
Reporting System. SBA. Questions.
Abbreviations.
BNF: British National Formulary.
MHRA: Medicines
& Healthcare products Regulatory Agency.
YCRS: Yellow
Card Reporting System.
Scenario 1. What is the purpose of the YCRS?
|
A |
to report suspected side-effects of air pollution |
|
B |
to report suspected side-effects of alcohol |
|
C |
to report suspected side-effects of e-cigarettes |
|
D |
to report suspected side-effects of medical device use |
|
E |
to report defective or fake medical products |
|
F |
to report sellers of defective or fake medical products |
|
G |
none of the above. |
Scenario 2. Which organisation runs the YCRS?
|
A |
British National Formulary |
|
B |
Metropolitan Police |
|
C |
MHRA |
|
D |
NHS |
|
E |
NICE |
|
F |
Royal College of Medicine |
|
G |
none of the above |
Scenario 3. How does one report an issue using the YCRS?
|
A |
completing a form from the BNF and posting it to
‘FREEPOST YELLOW CARD’ |
|
B |
completing a form from the BNF and posting it to ‘Metropolitan
Police’ |
|
C |
completing a form from the BNF and posting it to
‘FREEPOST MHRA’ |
|
D |
completing a form from the BNF and posting it to
‘FREEPOST NHS’ |
|
E |
completing a form from the BNF and posting it to
‘FREEPOST ’NICE’ |
|
F |
completing a form from the BNF and posting it to
‘FREEPOST ’Royal College of Medicine’ |
|
G |
on-line at https://yellowcard.mhra.gov.uk/
|
|
H |
none of the above |
