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Question 1
Correct
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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: 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 2
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 3
Correct
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Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?
Your 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 4
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 5
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 6
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 7
Correct
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Which of the following is a double stranded RNA virus?
Your 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 8
Incorrect
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When is the highest risk of maternal-fetal transmission of Toxoplasma Gondii during pregnancy?
Your Answer: 24-26 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 9
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 10
Incorrect
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What type of virus is the Rubella virus?
Your Answer: Single stranded DNA (ssDNA)
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 11
Incorrect
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Question 12
Incorrect
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Rubella belongs to which of the following family of viruses?
Your Answer: Retroviruses
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 13
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 400mg TDS orally 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 14
Incorrect
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What is the incidence of listeriosis in pregnancy?
Your Answer: 25 in 10,000
Correct Answer: 1 in 10,000
Explanation:The incidence of listeria infection in pregnant women is estimated at 12 per 100 000 compared to 0.7 per 100 000 in the general population.
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This question is part of the following fields:
- Microbiology
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Question 15
Incorrect
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HPV genotypes 6 and 11 are associated with which of the following?
Your Answer: High grade squamous intraepithelial lesions of the cervix (HSIL)
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 16
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 17
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 18
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 19
Correct
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Question 20
Correct
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The following is a gram positive obligate anaerobe:
Your Answer: Clostridia
Explanation:Obligate anaerobes are a group of bacteria that cannot survive in an oxygen-rich environment. In the body, they are usually found on mucosal membranes such as that of the lower gastrointestinal system, or the vagina. Infection with these organisms is usually suprative and causes abscesses. Examples of gram-negative anaerobes include Bacteroides, Fusobacterium and Prevotella, while gram-positive anaerobes include Actinomyces and Clostridia. Staphylococcus and Streptococcus are both gram-positive facultative anaerobes.
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This question is part of the following fields:
- Microbiology
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Question 21
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 22
Correct
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Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your 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 23
Correct
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A 30 year old patient is due for delivery in about two weeks. She has some concerns after a family member recently gave birth to a baby with profound hearing loss due to an infection. Which of the following would you describe to her as the most common infective cause of congenital hearing loss?
Your Answer: Cytomegalovirus
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. Babies born with congenital CMV are either symptomatic or develop symptoms later 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 24
Correct
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Question 25
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: 50%
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 26
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 27
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. What was the most likely infection?
Your 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 28
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:6 and 11 are considered low risk and are commonly associated with genital warts and low-grade squamous intraepithelial lesions of the cervix (can correspond cytologically to CIN 1)
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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 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 Clindamycin 900 mg 8 hourly
Correct 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 30
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: Neisseria gonorrhoeae
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 31
Correct
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You are asked to explain to a patient the results of her Rubella screen. They are as follows:
Your 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 32
Correct
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Question 33
Correct
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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: 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 34
Correct
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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 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 35
Correct
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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 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 36
Correct
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Question 37
Correct
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A 30 year old women comes to see you and advises she has felt a little unwell with diarrhoea and flu like symptoms. She is 28 weeks pregnant. Upon questioning she discloses she ate a soft cheese and deli meats platter 5 days earlier. A blood culture confirms listeria infection. What is the appropriate treatment (she has no known drug allergies)?
Your Answer: Amoxicillin
Explanation:The diagnosis of listeria depends on clinical suspicion and isolation of the organism from blood, vaginal swabs or the placenta. Meconium staining of the amniotic fluid in a preterm foetus may increase clinical suspicion for listeriosis. For women with listeriosis during pregnancy, intravenous antibiotic treatment (ampicillin 2 g given every 6 hours) is indicated.
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This question is part of the following fields:
- Microbiology
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Question 38
Correct
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Which of the following organisms causes Scarlet Fever?
Your Answer: Streptococcus pyogenes
Explanation:Streptococcus pyogenes, also known as group A beta-haemolytic streptococcus, is the organism responsible for scarlet fever. The bacteria is found in secretions from the nose, ears or the skin, and infections may be preceded by wounds, burns or respiratory infections. Symptoms may include a sore throat, fever, a red skin rash and cervical lymphadenopathy. Untreated scarlet fever in children and adolescents can lead to rheumatic fever, or post-streptococcal glomerulonephritis.
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This question is part of the following fields:
- Microbiology
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Question 39
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 40
Correct
SESSION STATS - PERFORMANCE PER SPECIALTY
