Contact me
Website
4 March 2024.
40
|
Role-play 1
|
41
|
Role-play
2
|
42
|
EMQ.
Listeriosis
and pregnancy
|
43
|
EMQ.
Toxoplasmosis
|
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?
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?
Option list.
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?
Option list.
A
|
they are not more susceptible
|
B
|
they are more susceptible x 2
|
C
|
they are more susceptible x 5
|
D
|
they are more susceptible x 10
|
E
|
they are more susceptible x 20
|
F
|
they are > 20 times more susceptible
|
G
|
none of the above.
|
Scenario
5.
When does Lm most
often occur?
Option list.
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?.
Option list.
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 ?
Option list.
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.
Option list.
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?
Option list.
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?
Option list.
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?
Option list.
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.
Option list.
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.
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.
A
|
it is Toxoplasma giardia
|
B
|
it is Toxoplasma gondi
|
C
|
it is Toxoplasma gondii
|
D
|
it is Toxoplasma gondola
|
E
|
it is Toxoplasma gung-ho
|
F
|
none of the above
|
Question
2.
Approximately what
proportion of the UK pregnant population shows evidence of
previous Tg infection?
Option list.
A
|
< 10%
|
B
|
10%
|
C
|
20%
|
D
|
30%
|
E
|
40%
|
F
|
50%
|
G
|
> 50%
|
Question
3.
When is maternal
infection believed to be of greatest risk to the fetus?
Option list.
A
|
peri-conceptually
|
B
|
1st. trimester
|
C
|
2nd. trimester
|
D
|
3rd. trimester
|
E
|
during vaginal birth
|
F
|
in the puerperium
|
G
|
in the puerperium if breastfeeding
|
H
|
none of the above
|
Question
4.
Which, if
any, of the following are true with
regard to when tgIgG is detectable after
1ry maternal infection?
Option list.
A
|
2 weeks
|
B
|
4 weeks
|
C
|
2 months
|
D
|
3 months
|
E
|
6 months
|
F
|
none of the above
|
Question
5.
Which, if
any, of the following are true with
regard to when TgIgM is detectable after
1ry maternal infection?
Option list.
A
|
2 weeks
|
B
|
4 weeks
|
C
|
2 months
|
D
|
3 months
|
E
|
6 months
|
F
|
none of the above
|
Question
6.
Which, if
any, of the following are true with regard
to avidity testing for Tg?
Option list.
A
|
avidity testing is of little use
|
B
|
avidity testing requires expert advice
|
C
|
avidity < 30% indicates infection in the previous 3
months
|
D
|
avidity < 30% indicates infection in the previous 6
months
|
E
|
avidity < 30% indicates infection in the previous 9
months
|
F
|
avidity > 40% indicates infection more than 3 months
previously
|
G
|
avidity > 40% indicates infection more than 6 months
previously
|
H
|
avidity > 40% indicates infection more than 9 months
previously
|
I
|
none of the above
|
Question
7.
Which, if
any, of the following are true with
regard to confirmation of fetal infection?
Option list.
A
|
avidity testing is of little use
|
B
|
avidity testing requires expert advice
|
C
|
avidity < 30% indicates infection in the previous 3
months
|
D
|
avidity < 30% indicates infection in the previous 6
months
|
E
|
avidity < 30% indicates infection in the previous 9
months
|
F
|
avidity > 40% indicates infection more than 3 months
previously
|
G
|
avidity > 40% indicates infection more than 6 months
previously
|
H
|
avidity > 40% indicates infection more than 9 months
previously
|
I
|
none of the above
|
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.
A
|
screening should be introduced as soon as practicable
|
B
|
testing would produce a falsely-high prevalence of Tg
in pregnancy
|
C
|
the prevalence of Tg is too low for screening to be
cost-effective
|
D
|
the prevalence of Tg is high enough for screening to be cost-effective
|
E
|
the prevalence of Tg is unknown
|
F
|
there is no treatment in pregnancy of proven benefit to
mother or baby
|
G
|
they would leave the decision until after lunch, but
drank too much wine and did not return
|
H
|
maybe some of the above, please tick the boxes for me
|
I
|
none of the above
|
Question 9.
Which, if any, of
the following are complications of intrauterine Tg infection for the fetus and newborn.
Option list.
A
|
miscarriage
|
B
|
IUGR
|
C
|
stillbirth
|
D
|
chorioretinitis
|
E
|
hepato-splenomegaly
|
F
|
holoprosencephaly
|
G
|
hydrocephalus
|
H
|
intracranial calcification
|
I
|
microcephaly
|
J
|
neural tube defect
|
Question
10. Approximately how common in vertical transmission of Tg in
the 1st. trimester?
Option list.
A
|
< 10%
|
B
|
10-20%
|
C
|
25%
|
D
|
50%
|
E
|
> 50%
|
Question
11. Approximately how common in vertical transmission of Tg in
the 2nd. trimester? Use
the option list for question 4.
Option list.
A
|
< 10%
|
B
|
10-20%
|
C
|
25%
|
D
|
50%
|
E
|
> 50%
|
Question 12.
Approximately how
common in vertical transmission of Tg in the 3rd. trimester? Use the
option list for question 4.
Option list.
A
|
< 10%
|
B
|
10-20%
|
C
|
25%
|
D
|
50%
|
E
|
> 50%
|
Question 13.
Which of the
following are true in relation to reducing the risk of vertical transmission of
Tg?
Option list.
A
|
the SYROCOT trial showed strong evidence of the
efficacy of spiramycin
|
B
|
a Cochrane trial has suggested that pyrimethamine +
sulfadiazine give better results than spiromycin
|
C
|
there is evidence that metronidazole is the most
effective drug
|
D
|
there is a lack of clear evidence about effective
therapies
|
E
|
spiromycin crosses the placenta, so is effective in
reducing MTBT and treating the infected fetus
|
E
|
this is too esoteric for my poor pummelled brain
|
Question 14.
Which, if any, of
the following are features of the classical triad associated with congenital
Tg?
Option list.
A
|
chorioretinitis
|
B
|
deafness
|
C
|
hepatosplenomegaly
|
D
|
hydrocephalus
|
E
|
intracranial calcifications
|
F
|
low birthweight
|
G
|
jaundice
|
H
|
leukopenia
|
Question
15. Which of the following are used in the treatment of cTg?
Option list.
A
|
metronidazole
|
B
|
pyrimethamine
|
C
|
steroids
|
D
|
sulfadiazine
|
E
|
none of the above.
|