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Question 1
Incorrect
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Regarding listeria infection during pregnancy, what is the fetal case mortality rate?
Your Answer: 95%
Correct Answer: 25%
Explanation:Listeria Monocytogenes is a cause of congenital infection. The most common source of the bacteria is food, especially unpasteurised milk. Congenital listeriosis can lead to spontaneous abortions, premature birth and chorioamnionitis. At birth, neonates may present with septicaemia, respiratory distress and inflammatory granulomatosis. The case mortality rate for listeriosis is thought to be between 20-30%.
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This question is part of the following fields:
- Microbiology
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Question 2
Incorrect
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Which of the following organisms causes toxoplasmosis?
Your Answer:
Correct Answer: Toxoplasma Gondii
Explanation:Toxoplasma gondii, an intracellular protozoan, is the main causative agent for Toxoplasmosis. Though the primary host for the organism is the domestic cat, humans can become infected by eating undercooked meat of animals harbouring cysts, consuming water or food contaminated with cat faeces, or through maternal-fetal transmission. Toxoplasmosis can cause complications in pregnancy such as miscarriages and congenital infection which can lead to hydrocephalus, microcephaly, mental disability and vision loss.
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This question is part of the following fields:
- Microbiology
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Question 3
Incorrect
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Herpes Simplex is which type of virus
Your Answer:
Correct Answer: double stranded DNA
Explanation:Herpes simplex is a double stranded DNA virus. There are two viral types, HSV-1 and HSV-2. The majority of orolabial infections are caused by HSV-1. These infections are usually acquired during childhood through direct physical contact such as kissing. Genital herpes is a sexually transmitted infection and is most commonly caused by HSV-2.
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This question is part of the following fields:
- Microbiology
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Question 4
Incorrect
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Rubella belongs to which of the following family of viruses?
Your Answer:
Correct Answer: Togaviruses
Explanation:The Rubella virus, also known as German measles, is found in the Togavirus family and is a single-stranded RNA virus. The virus, which is acquired through contact with respiratory secretions, primarily replicates in the nasopharynx and lymph nodes, and produces a mild and self-limiting illness. Congenital infection, however, is associated with several anomalies including sensorineural deafness, cataracts and cardiac abnormalities.
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This question is part of the following fields:
- Microbiology
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Question 5
Incorrect
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Which period during pregnancy has the highest risk of maternal-fetal Toxoplasma Gondii transmission?
Your Answer:
Correct Answer: 26-40 weeks
Explanation:Toxoplasma Gondii is an intracellular parasite which is excreted in cat faeces and then transferred to humans through secondary hosts. During pregnancy, it can be transmitted to the neonate. The risk of transplacental transmission from mother to foetus is greater in later pregnancy i.e. 26-40 weeks but during this time period it is less dangerous as compare to the transmission during 0-10 weeks of gestation. It may lead to abortion, microcephaly, hydrocephalus, cerebral calcifications, cerebral palsy and seizures.
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This question is part of the following fields:
- Microbiology
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Question 6
Incorrect
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your Answer:
Correct Answer: 50%
Explanation:Human Papillomavirus has been is implicated in the development of genital warts as well as, head and neck, anogenital and cervical cancers, with the most important high-risk strains being 16 and 18. Over 50% of women worldwide are thought to possess antibodies against various strains of HPV after natural infection. Many infections are asymptomatic and are cleared within 2 years. Several vaccines have been formulated against HPV, one of which is Gardasil, a quadrivalent vaccine against HPV types 6,11, 16,18.
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This question is part of the following fields:
- Microbiology
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Question 7
Incorrect
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During a speculum examination, a lady was found to have a firm, 12mm ulcerated, indurated lesion on her cervix. She was otherwise asymptomatic. Most likely cause would be?
Your Answer:
Correct Answer: Treponema pallidum
Explanation:This lady is most likely suffering from primary syphilis. Since the chancre is asymptomatic, it is often only found on deep examination of the vulvo-vaginal mucosa. The chief organism causing syphilis is Treponema Pallidum which is a spirochete and one of the most widely distributed sexually transmitted infections.
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This question is part of the following fields:
- Microbiology
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Question 8
Incorrect
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You are asked to speak to a 27 year old patient who is pregnant for the first time. She is concerned as her friend recently gave birth and the baby was found to have profound hearing loss. Her friend was told this was due to an infection whilst she was pregnant. What is the most common infective cause of congenital hearing loss?
Your Answer:
Correct Answer: Cytomegalovirus
Explanation:CMV is the most common congenital infection causing sensorineural deafness.
10-15% of infected infants will be symptomatic at birth. A further 10-15% who are asymptomatic at birth will develop symptoms later in life. Transmission can also be via breastmilk and the incubation period for CMV is 3-12 weeks. Diagnosis of fetal CMV infection is via amniocentesis however this should not be performed for at least 6 weeks after maternal infection and not until the 21st week of gestation -
This question is part of the following fields:
- Microbiology
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Question 9
Incorrect
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What type of virus is the Rubella virus?
Your Answer:
Correct Answer: Single stranded RNA (ssRNA)
Explanation:Rubella virus is the only member of the genus Rubivirus and is a type of Togavirus (Togaviridae). It is a single stranded RNA virus. Note for the exam if you are unsure – most RNA viruses encountered in clinical practice are single stranded. The exception is rotavirus which is dsRNA virus. RNA viruses that use DNA during their replication are classed as retroviruses (HIV is an example)
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This question is part of the following fields:
- Microbiology
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Question 10
Incorrect
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You see a 23 year old women in clinic complaining of vaginal discharge. The lab phone to tell you microscopy and staining shows a gram negative diplococcus. Which organism is most likely to be responsible?
Your Answer:
Correct Answer: Neisseria gonorrhoeae
Explanation:The most common gram negative diplococci include Neisseria, haemophilus and Moraxella.
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This question is part of the following fields:
- Microbiology
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Question 11
Incorrect
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When is the highest risk of maternal-fetal transmission of Toxoplasma Gondii during pregnancy?
Your Answer:
Correct Answer: 26-40 weeks
Explanation:The risk of transplacental transmission from mother to foetus is greater in later pregnancy i.e. 26-40 weeks. Although the risk of transmission is lower in early pregnancy, if infection does occur earlier, particularly before 10 weeks, then complications are typically more severe.
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This question is part of the following fields:
- Microbiology
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Question 12
Incorrect
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HPV genotypes 6 and 11 are associated with which of the following?
Your Answer:
Correct Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)
Explanation:HPV types 6 and 11 are associated with low risk, low grade squamous intraepithelial lesion. While types 16,18,31 and 33 are associated with high risk, high grade neoplasia.
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This question is part of the following fields:
- Microbiology
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Question 13
Incorrect
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A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. She tells you he was born with a 'blueberry muffin' rash. What was the most likely infection?
Your Answer:
Correct Answer: Rubella
Explanation:The ‘Blueberry muffin’ rash is a descriptor for the rash seen in Congenital Rubella Syndrome. A similar petechial rash may also occur in CMV infection but shouldn’t be termed ‘blueberry muffin’
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This question is part of the following fields:
- Microbiology
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Question 14
Incorrect
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Regarding congenital CMV infection, what percentage of infants are symptomatic?
Your Answer:
Correct Answer: 10-15%
Explanation:Congenital cytomegalovirus infections are the most common cause of sensorineural hearing loss in babies. Cytomegalovirus infection during the perinatal period can be transferred to the foetus especially if the primary infection is during pregnancy. In babies born with congenital CMV about 10-15% are symptomatic, while 10-15% of those who are asymptomatic will develop symptoms in life. Some of the features of CMV infection include sensorineural hearing loss, visual impairment, cerebral palsy, microcephaly and seizures. Other causes of infective congenital sensorineural hearing loss include: Rubella, HIV, Herpes Simplex Virus, Measles, Varicella Zoster virus, Mumps and West Nile Virus.
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This question is part of the following fields:
- Microbiology
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Question 15
Incorrect
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You are asked to explain to a patient the results of her Rubella screen. They are as follows:
Your Answer:
Correct Answer: Acute Rubella Infection
Explanation:IgM rise is typically seen with acute infection. IgG is produced in response to infection but is produced later than IgM. IgG is also produced in response to vaccination. If IgG and IgM are negative the patient is susceptible to Rubella infection. If IgG +ve and IgM -ve the patient should be considered immune. If IgM +ve this suggests acute infection or false positive IgM (not uncommon)
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This question is part of the following fields:
- Microbiology
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Question 16
Incorrect
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You are asked to see a 26 year old patient following her first visit to antenatal clinic. She is 9 weeks pregnant and bloods have shown her to be non-immune to Rubella. She is concerned about congenital rubella syndrome (CRS). What is the most appropriate advice to give?
Your Answer:
Correct Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:Congenital rubella infection that occurs after 16 weeks gestation does not typically cause fetal abnormalities. This however plays no part in vaccination advice. Rubella vaccine is live and should not be given during pregnancy. The mother should be offered vaccination after giving birth. It is safe for the vaccine (typically given as combined MMR) to be administered if the mother is breastfeeding.
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This question is part of the following fields:
- Microbiology
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Question 17
Incorrect
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Question 18
Incorrect
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A 10 day old infant present with signs of disseminated Herpes Simplex Virus (HSV) infection. Her mother had her first episode of HSV three weeks prior to delivery. The infant was treated with antivirals upon clinical suspicion. What is the case fatality rate of infants who develop disseminated HSV despite treatment?
Your Answer:
Correct Answer: 30%
Explanation:Congenital Herpes Simplex Virus infection may cause high levels of morbidity and mortality in neonates. Risk of infection with HSV 1 and 2 is highest within 6 weeks of delivery and is transferred to the neonate via maternal secretions at birth. Affected babies can present as skin manifestations, CNS infection, or disseminated infection, which carries an 85% risk of mortality if left untreated. Treatment with high dose antivirals such as acyclovir can help decrease the case mortality rate to 30% in cases of disseminated infection.
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This question is part of the following fields:
- Microbiology
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Question 19
Incorrect
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Question 20
Incorrect
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A 24 year old woman presents to the clinic with foul smelling vaginal discharge. Which facultative anaerobic bacteria is most likely to be the cause?
Your Answer:
Correct Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram indeterminate bacteria, which is also a facultative anaerobe. Patients often complain of foul-smelling fishy discharge and dysuria. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Of the other organisms listed in the options, Neisseria is an obligate anaerobe, while Chlamydia trachomatis is an obligate intracellular aerobe. Treponema Pallidum is an aerophilic bacteria and Mycoplasma hominis is a pleomorphic parasitic bacterium.
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This question is part of the following fields:
- Microbiology
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Question 21
Incorrect
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Which of the following is the primary host for Toxoplasma Gondii?
Your Answer:
Correct Answer: Cats
Explanation:Toxoplasma gondii, an intracellular protozoan, is the main causative agent for Toxoplasmosis. The primary host for the organism is the domestic cat. Humans can become infected by eating undercooked meat of animals harbouring cysts, consuming water or food contaminated with cat faeces, or through maternal-fetal transmission. Toxoplasmosis can cause complications in pregnancy such as miscarriages and congenital infection can lead to hydrocephalus, microcephaly, mental disability and vision loss.
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This question is part of the following fields:
- Microbiology
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Question 22
Incorrect
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A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. What was the most likely infection?
Your Answer:
Correct Answer: CMV
Explanation:TORCH infections are responsible for perinatal complications. CMV is the most common amongst them. Primary infection often produces no symptoms or mild non-specific flu-like symptoms in the mother. The diagnosis is often made after abnormalities are seen in the foetus on ultrasound scan. The main features seen in an affected foetus are FGR, microcephaly, ventriculomegaly, ascites or hydrops. Some foetuses which are infected may not show any features on ultrasound, but may later be found to have neurological damage such as blindness, deafness or developmental delay. The neonate can also be anaemic and thrombocytopenic, with hepatosplenomegaly, jaundice and a purpureal rash.
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This question is part of the following fields:
- Microbiology
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Question 23
Incorrect
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Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer:
Correct Answer: B
Explanation:Chorioamnionitis occurs due to prolong rupture of the fetal membranes. It is most commonly caused by B streptococcus.
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This question is part of the following fields:
- Microbiology
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Question 24
Incorrect
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A 29 year old patient who is 15 weeks pregnant comes to see you. She currently has chickenpox. She is concerned her baby may get congenital fetal varicella syndrome (FVS). What would you advise her the risk of this is?
Your Answer:
Correct Answer: 2.00%
Explanation:FVS has been reported to complicate maternal chickenpox that occurs as early as 3 weeks and up to 28 weeks of gestation. The risk appears to be lower in the first trimester (0.55 per cent). No case of FVS has been reported when maternal infection has occurred after 28 weeks.
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This question is part of the following fields:
- Microbiology
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Question 25
Incorrect
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A 32 year old patient develops painful ulcerated genital lesions and inguinal lymphadenopathy. She is 32 weeks pregnant. You suspect genital herpes and send swabs. Which of the following is appropriate management according to the 2014 BASHH/RCOG guidelines?
Your Answer:
Correct Answer: Send bloods to check antibody status. If this supports this is a first episode genital HSV then patient should be advised to have C-section delivery
Explanation:Although acyclovir should be given, this patient is in the 3rd trimester so the course should continue until delivery. Dose will be 400mg TDS unless disseminated disease. If this is a primary HSV infection (This should be confirmed by lesion swabs to confirm HSV infection and bloods to check no antibody response i.e. evidence previous infection) then C-section is indicated.
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This question is part of the following fields:
- Microbiology
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Question 26
Incorrect
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You see a 23 year old women in clinic with cervicitis. Which gram negative intracellular organism is most likely to be responsible?
Your Answer:
Correct Answer: Chlamydia trachomatis
Explanation:Chlamydia trachomatis (D-K subtypes) is the most common cause in this age group and fits the descriptors given.
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This question is part of the following fields:
- Microbiology
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Question 27
Incorrect
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Regarding female urinary tract infections, which organism is the most common causative agent?
Your Answer:
Correct Answer: Escherichia Coli
Explanation:The most common causative agent found in female urinary tract infections is Escherichia Coli. E. Coli is a bacteria found in the environment and the human gastrointestinal system. Other common causes of UTI include Klebsiella sp, Proteus sp and various Enterococci.
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This question is part of the following fields:
- Microbiology
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Question 28
Incorrect
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Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer:
Correct Answer: B
Explanation:Chorioamnionitis is a complication of pregnancy caused by bacterial infection of the fetal amnion and chorion membranes. Group B Streptococcus is associated with chorioamnionitis
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This question is part of the following fields:
- Microbiology
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Question 29
Incorrect
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A 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?
Your Answer:
Correct Answer: Spiramycin
Explanation:There are 2 treatment options: Spiramycin ASAP if foetus not infected or status of the foetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Pyrimethamine, sulfadiazine and folic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required. Pyrimethamine should be avoided in the 1st trimester as teratogenic
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This question is part of the following fields:
- Microbiology
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Question 30
Incorrect
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Which of the following is a double stranded RNA virus?
Your Answer:
Correct Answer: Rotavirus
Explanation:RNA viruses are almost always single stranded whilst DNA viruses are almost always double stranded. The exceptions are rotavirus and Parvovirus B19 respectively.
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This question is part of the following fields:
- Microbiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
