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Question 1
Correct
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What type of virus is the Rubella virus?
Your 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 2
Correct
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Herpes Simplex is which type of virus
Your 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 3
Incorrect
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When is the highest risk of maternal-fetal transmission of Toxoplasma Gondii during pregnancy?
Your Answer: 10-24 weeks
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 4
Correct
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Which of the following is the primary host for Toxoplasma Gondii?
Your 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 5
Correct
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Which HPV subtypes are chiefly associated with causing cancer?
Your Answer: 16 and 18
Explanation:HPV 16 and 18 are responsible for 70% of cases of HPV related cancers. They are considered the most important high risk genotypes of HPV. As well as cervical cancer they are associated with cancers of the oropharynx and anogenital region.
There are over 100 genotypes of HPV including several other high risk HPV types. Gardasil® is a quadrivalent vaccine against HPV Types 6, 11, 16, and 18
HPV genotypes 6 and 11 are low risk and cause anogenital warts.
Typically 70% of HPV infections are cleared within 1 year and 90% are cleared within 2 years
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This question is part of the following fields:
- Microbiology
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Question 6
Incorrect
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Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?
Your Answer: P53 and P55
Correct Answer: E6 and E7
Explanation:There are over 100 genotypes of HPV including several other high risk HPV types. HPV 16 and 18 are responsible for 70% of cases of HPV related cancers. HPV is thought to induce cancer via onco-proteins. The primary onco-proteins are E6 and E7 which inactivate two tumour suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7)
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This question is part of the following fields:
- Microbiology
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Question 7
Correct
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Rubella belongs to which of the following family of viruses?
Your 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 8
Correct
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The UK childhood vaccination schedule includes vaccination against HPV for girls aged 12 to 13. What HPV subtypes are vaccinated against with the vaccine Gardasil®?
Your Answer: 6, 11, 16, and 18
Explanation:HPV Gardasil® is a quadrivalent vaccine against HPV Types 6, 11, 16, and 18. HPV types16 and 18 are responsible for 70% of cases of HPV related cancers. They are considered the most important high risk genotypes of HPV.
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This question is part of the following fields:
- Microbiology
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Question 9
Incorrect
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Question 10
Correct
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A 32 year old mother is in her first trimester of pregnancy with her second child. She is worried about infections in this pregnancy as her daughter was born with a 'blueberry muffin rash' and was soon found to have sensorineural deafness due to an infection. Which of the following infections is most likely?
Your Answer: Rubella
Explanation:Congenital infections can be the cause of various congenital abnormalities. Infection with the Rubella virus, part of the TORCH infections (toxoplasmosis, other organisms, rubella, cytomegalovirus, and herpes simplex), can lead to cardiac abnormalities, ophthalmic defects, sensorineural deafness and neurodevelopmental delays. At birth congenital rubella syndrome presents with a petechial rash characteristically dubbed a blueberry muffin rash, and hepatosplenomegaly with jaundice. Immunization of the mother against measles is an effective way of reducing the occurrence of congenital rubella syndrome.
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This question is part of the following fields:
- Microbiology
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Question 11
Correct
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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: 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 12
Correct
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Regarding female urinary tract infections, which organism is the most common causative agent?
Your 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 13
Correct
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HPV genotypes 6 and 11 are associated with which of the following?
Your 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 14
Correct
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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: 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 15
Correct
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Which of the following organisms causes toxoplasmosis?
Your 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 16
Correct
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According to NICE guidance what should be used for wound cleansing for the first 48 hours postoperatively?
Your Answer: Sterile saline
Explanation:NICE guidelines (CG74) advise the following regarding postoperative wound management Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus. Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection
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This question is part of the following fields:
- Microbiology
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Question 17
Correct
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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: 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 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: 10%
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
Correct
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A 26 year old patient known to have Group B Streptococcus (GBS) on vaginal swab is going into labour. A normal vaginal delivery is planned. She is penicillin allergic with a history of anaphylaxis. What intrapartum antibiotic treatment is advised?
Your Answer: IV Vancomycin 1g 12 hourly
Explanation:In a person who is infected by streptococcus (Group B) should be started on benzylpenicillin as soon as possible. In case of allergy vancomycin should be started at 1g every 12 hours. Tetracyclines should be avoided in pregnancy.
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This question is part of the following fields:
- Microbiology
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Question 20
Correct
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your 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 21
Incorrect
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Regarding congenital CMV infection, what percentage of infants are symptomatic?
Your Answer: 50-60%
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 22
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: Give Acyclovir 800mg 5 times daily for 5 days
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 23
Incorrect
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Which of the following is a double stranded RNA virus?
Your Answer: Herpes Simplex type 2
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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Question 24
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: Mebendazole
Correct Answer: Spiramycin
Explanation:Toxoplasma gondii is a protozoan parasite found in cat faeces, soil or uncooked meat. Infection occurs by ingestion of the parasite from undercooked meat or from unwashed hands. Spiramycin treatment can be used in pregnancy (a 3-week course of 2–3 g per day). This reduces the incidence of transplacental infection but has not been shown to definitively reduce the incidence of clinical congenital disease. If toxoplasmosis is found to be the cause of abnormalities detected on ultrasound scan of the foetus, then termination of pregnancy can be offered.
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This question is part of the following fields:
- Microbiology
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Question 25
Correct
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Which period during pregnancy has the highest risk of maternal-fetal Toxoplasma Gondii transmission?
Your 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 26
Correct
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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: 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 27
Incorrect
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A 29 year old patient who is 22 weeks pregnant seeks your advice as she was recently exposed to chickenpox. Regarding fetal varicella syndrome (FVS) which of the following statements is correct regarding maternal varicella infection?
Your Answer: FVS may result if there is maternal varicella infection at any time during pregnancy
Correct Answer: FVS may result if there is maternal varicella infection within the 1st 20 weeks gestation
Explanation:(13-20 weeks). If a mother has chickenpox in late pregnancy (5 days prior to delivery) then there is risk of neonatal varicella infection which may be severe.
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This question is part of the following fields:
- Microbiology
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Question 28
Correct
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Question 29
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: Advise vaccination as soon as possible
Correct Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:For pregnant women who are screened and rubella antibody is not detected, rubella vaccination after pregnancy should be advised. Vaccination during pregnancy is contraindicated because of a theoretical risk that the vaccine itself could be teratogenic, as it is a live vaccine. No cases of congenital rubella syndrome resulting from vaccination during pregnancy have been reported. However, women who are vaccinated postpartum should be advised to use contraception for three months.
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This question is part of the following fields:
- Microbiology
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Question 30
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: Rubella
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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SESSION STATS - PERFORMANCE PER SPECIALTY
