Some PastPapers MCQs

Hello Dr. Paul,

I have been attempting some questions and need your kind help to Check my Answers, if u please..

Q: In a woman with Primary Cytomegalovirus (CMV) Infection in Pregnancy:

1. There is more than 50% chance of her delivering a baby with CMV related Damage.  F 

2.There is less than 5% chance of her delivering a baby with CMV related damage. T

3. There is Less than 1% Chance of the baby having serious Long Term Sequale.  F

4. Antenatal Treatment reduces the risk of neonatal complications. F  (there is no ttt)

Q:The Following Regarding Toxoplasmosis and Pregnancy are correct:

1. The incidence of infection in the UK is approximately 2/1000 pregnancies.  T

2. Spiramycin is used in the treatment of in utero toxoplasma infections. F  (maternal ?for isolated fetal ?pyrimethamine , sulphadiazine , folinic acid.. Why is it Toxic to fetus and how?)

3. Toxoplasma gondii is a cause of recurrent miscarriage. F

4. severe disease in the fetus is most likely to occur if the mother acquired the infection during the first two trimesters of pregnancy. T

5. Among mothers known to have acquired toxoplasmosis during the first trimester of pregnancy the spontaneous abortion rate is above 20% . T

6. if antibodies are present before conception, the fetus will be unaffected. F

Q: The following maternal infections may be transmitted to the newborn as a result of vaginal delivery:

1. Human papilloma virus .  T

2. Tricomonas Vaginalis.  F

3. Candida Albicans. T

Q: Eye Damage is a recognised consequence of fetal infection with:

1. Treponema pallidum. T

2. Toxoplasma gondii .  T

3. The Epstein - Barr Virus.  T??

Hope to Post and Share More..

Thanks for Your Help.. :-)

Busyspr notes on Toxoplasmosis

TOXOPLASMOSIS 

• Toxoplasma gondii - obligate intracellular protozoan 

• Incubation period = 5-23 days

• Becomes sexually mature in cat intestines, producing oocysts which are excreted in stool. Infection occurs through ingestion of contaminated food including vegetable or infected meat. 

• Human infection usually asymptomatic / produces glandular fever - like illness. Lymphadenopathy involving the posterior cervical chain is commonest clinical manifestaton.

• About 14% of women of reproductive age are immune to toxoplasmosis and about 30% of 30 year olds are immune. Immunity is life-long unless the individual becomes immuno-compromised

• About 1:500 women become infected during pregnancy 

Fetal risks

• Spontaneous first trimester miscarriage - Chorioretinitis - IUGR 

• Microcephaly - Hydrocephalus - Intra-cranial calcification

• Learning disability - Hepatosplenomegaly

• Risk of fetal infection increases while risk of affection decreases with increasing gestation age. 

• Primary infection in first trimester - ~17% of fetuses affected; 25% affected in second and 65% in third trimester

• Overall, 60% of fetuses are born without obvious damage, 10% have chorioretinitis only and 20- 30% have multiple anomalies typical of the TORCH syndrome - hydrocephalus, chorioretinitis, intra-cranial calcification, jaundice, microcephaly, anaemia

Diagnosis 

• Biopsy of lymph node 

• Serology - commonly used, potentially confusing. An initial positive IgM serology does not necessarily imply current infection. Acute infection confirmed by finding either a 4 fold rise in IgG titres in blood drawn 3 weeks apart or high IgM titres (> 1:256)

• Positive antibodies may persist for several years after acute infection 

• Ultrasonography or invasive testing to diagnose fetal infection. No accurate method to predict severity of fetal disease. 

Management 

• Prevention - Avoid contact with cat faeces / raw meat

• Cost-effectiveness of antenatal screening not proven

• Spiramycin therapy to infected mothers - 60% reduction in the risk of fetal infection

• Scans / amniocentesis / cordocentesis to diagnose fetal infection

• TOP / pyramethamine + sulfonamide + folinic acid if fetal infection - helps arrest progression of fetal disease

• Infected neonates require treatment for the first year of life

Busyspr notes on CMV

CYTOMEGALOVIRUS (CMV) 

• DNA virus

• Commonest congenital viral infection in pregnancy

• Causes self-limiting febrile illness in immunocompetent individuals 

• Causes severe illness in immunocompromised, including pneumonia and hepatitis 

• Fetal infection occurs with primary as well as re-activated infection 

• Primary infection occurs in ~2% of pregnant women (40-50% are susceptible) 

• Can be isolated from ~1% of all neonates

• Mortality from neonatal CMV disease 20-30%, with 90% of survivors having long-term sequelae 

• 5-10% of infected neonates are symptomatic at birth. Of asymptomatic neonates, 5-15% develop symptoms by the second year of life, usually sensori-neural deafness

• Fetus / neonate infected by trans-placental passage of virus or exposure to virus from birth canal / breast milk / exposure to other babies in nursery 

• Infected neonates shed virus in urine / respiratory secretions for long periods 

• Risk of maternal viral shedding from genital tract increases with increasing gestation age 

• Number of sexual partners and early age at onset of sexual activity correlates positively with CMV isolation from cervix

• Present in semen

Fetal risks 


• Commonest cause of congenital sensorineural deafness

• Hepatosplenomegaly 

• IUGR

• Microcephaly, learning disability 

• Thrombocytopaenia 

• Jaundice 

• Haemolytic anaemia 

• Seizures 

Diagnosis 

• Clinical diagnosis of maternal infection is unreliable

• Requires paired sera to demonstrate sero-conversion or a rise in antibody titres 

• CMV is shed intermittently from infected patients and antibody titres may rise intermittently

• Isolation of CMV does not necessarily imply CMV disease

Management 


• Counsel women in high-risk professions - child care workers

• Consider TOP if primary infection diagnosed in first trimester

• Counsel re: fetal risks, consider invasive testing to diagnose fetal infection, detailed scans and monitor fetal growth

• Clinical and serological assessment of neonate with follow-up if positive