Bo5

Question 1

A study shows non smokers compared to smokers had a RR of 0.2 to develop anogenital warts. Explain what does a relative risk of 0.2 mean?

a) Non smokers are 80% less likely compared to smokers to develop anogenital warts
b) Non smokers have 20% the risk of developing anogenital warts compared to smokers
c) Smokers have 20% the risk of developing anogenital warts compared to non smokers
d) Smokers have 80% the risk of developing anogenital warts compared to non smokers
e) Smokers have 120% increased risk of developing anogenital warts compared to non smoker

Answer 1

a) Non smokers are 80% less likely compared to smokers to develop anogenital warts

Question 2

A clinic is considering to add a gonorrhoea NAAT test to their screening chlamydia NAAT test, but the prevalence of positive chlamydia tests  in clinic is low, and gonorrhoea is even more uncommonly found. Which of the following is true of the gonorrhoea NAAT test based on the prevalence of gonorrhoea in the clinic.
A.	The PPV will be low 
B.	The NPV will be low
C.	The sensitivity will be low
D.	The specificity will be low
E.	The PPV will be high

Answer 2

A. The PPV will be low

Question 3

What is the risk of HIV transmission if single episode of insertive vaginal intercourse with HIV positive female ont on ART

a) 1 in 1000
b) 1 in 1200
c) 1 in 900
d) 1 in 800
e) 1 in 1500

Answer 3

b) 1 in 1200

Question 4

In 2019, in which group of people did new HIV diagnoses remain stable?

a) UK born MSM
b) UK born heterosexuals
c) PWID
d) MSM born abroad
e) Black African heterosexuals

Answer 4

c) PWID

Question 5

What is the risk of late HIV diagnosis?

a) 3 fold increased risk of death
b) 10 fold increased risk of death
c) 15 fold increase risk of death
d) No excess risk of death
e) CD4 likely to be higher than those diagnosed early

Answer 5

b) 10 fold increased risk of death

Question 6

Which CD4 parameter is included in the definition of “late HIV diagnosis”?

a) CD4 <50
b) CD4 <100
c) CD4 <200
d) CD4 <350
e) CD4 <500

Answer 6

d) CD4 <350

Question 7

Patient treated for early syphilis with 2 weeks of doxycycline, initial RPR pre-treatment was 1:32, repeat RPR on last day of antibiotics was 1:64, what does this mean?

a) Patient re-infected
b) Failed treatment
c) Likely resistant organism
d) Not clinically significant, repeat 1 month after tx
e) Not clinically significant, repeat 3 months after tx

Answer 7

e) Not clinically significant, repeat 3 months after tx

Question 8

A 25 year old woman needs treatment for positive GC NAAT (culture awaited). She gives a history of rash with Amoxicillin as a child. How will you treat her?

a) Ceftriaxone 1g IM STAT
b) Ceftraixone 500mg IM STAT
c) Ciprofloxacin 500mg PO STAT
d) Azithromycin 2g STAT
e) Doxcycline 100mg BD 7 days

Answer 8

a) Ceftriaxone 1g IM STAT (low risk of penicillin cross allergy is mild allergic reaction only)

Question 9

HIV positive couple recently diagnosed last month.
They have 2 children aged 12yo and 6 yo. The woman thinks she last tested negative 5 years ago at another GUM clinic and during both pregnancies. Her partner was thought to have tested then, but found out he never got tested. What is the next step to ensure children’s HIV status?

a) Test both children
b) Test the youngest child only
c) Test the older child only
d) Try to confirm her negative HIV tests in pregnancy
e) Try to confirm her negative HIV test 5 years ago at the other GUM clinic

Answer 9

e) Try to confirm her negative HIV test 5 years ago at the other GUM clinic

Question 10

Which of the following co-medications/supplement is not contraindicated in people on PEPSE?

a) Magnesium
b) Calcium
c) Iron
d) Multivitamins
e) Omeprazole

Answer 10

e) Omeprazole

Question 11

A 40 year old man noticed a 3 x 1.7cm flesh coloured lump, non tender, on his penis the morning after vigorous sex with RFP of 10 years. What is the likely diagnosis?

a) Syphlitic chancre
b) Hydrocoele
c) Genital wart
d) Lymphocoele
e) Angiokeratoma

Answer 11

d) Lymphocoele

Question 12

A 26yo woman presents with PCB. She is otherwise well, on COCP, has only ever been sexually active with her RMP of 4 years and who both had negative SHS during this relationship. No FH of note. Smear normal last year. What is the MOST likely cause?

a) CIN
b) Cervical cancer
c) Cervical ectropian
d) PID
e) Uterine fibroids

Answer 12

c) Cervical ectropian

Question 13

Which of the following is NOT a feature of SARA?

a) Endocarditis
b) Pericarditis
c) LV dilatation
d) Thrombophlebitis
e) Glomerulonephritis

Answer 13

a) Endocarditis

Question 14

Which progesterone in combined oral contraceptive has the lowest VTE risk?

a) Cyproterone acetate
b) Drosperinone
c) Etonogestrel
d) Levonergestrel
e) Norelgestromin

Answer 14

d) Levonergestrel

Question 15

A 50 year old man who has been on various ART regimens for HIV over the last 20 years complains of long standing facial changes including hollowed out cheeks. What is the likely cause?

a) Lopinavir
b) Elvitegravir
c) Effavirenz
d) Lamivudine
e) Stavudine

Answer 15

e) Stavudine

Question 16

A man with a new diagnosis of HIV and PCP is admitted to hospital. ABG shows good oxygenation but he is very symptatomic with SOB and cough. What management for PCP would you give him?

a) Co-trimoxazole 960mg BD for 3 weeks (IV until clinical improvement then switch to oral)
b) Co-trimoxazole 120 mg/kg/day in three divided doses IV for 3 days then then reduced to 90 mg/kg/day in three divided doses IV to complete 3 weeks
c) Co-trimoxazole 120 mg/kg/day in three divided doses IV for 3 days then then reduced to 90 mg/kg/day in three divided doses IV to complete 6 weeks
d) Oral Co-trimoxazole 960mg BD for 3 weeks
e) No treatment for PCP, just start ART

Answer 16

b) Co-trimoxazole 120 mg/kg/day in three divided doses IV for 3 days then then reduced to 90 mg/kg/day in three divided doses IV to complete 3 weeks

Question 17

Which of the following may have reduced efficacy in women >90kg?

a) COCP
b) POP
c) DMPA
d) CHCP
e) IUS

Answer 17

d) CHCP

Question 18

An MSM attended a chemsex party 2 days ago where he took part in insertive and receptive anal fisting. He is now c/o severe lower abdominal pain which is worsening despite rest and analgesia. What is your immediate next step?

a) Perform proctocopy
b) Offer Hep B booster vaccine
c) Offer triple site NAATs and re-testing after 2 weeks
d) Treat with Doxycycline 100mg BD for 3 weeks to cover for LGV
e) Keep NBM and arrange emergency admission under the surgical team

Answer 18

e) Keep NBM and arrange emergency admission under the surgical team

Question 19

Which of the following is NOT recommended by BHIVA in pregnancy:

a) Bictegravir
b) Effavirenz
c) Rilpivirine
d) Atazanavir/r
e) Darunavir/r

Answer 19

a) Bictegravir

Question 20

Which of the following extra-genital areas is NOT affected by Lichen Planus?

a) Wrist flexures
b) Lower back
c) Small bowel
d) Oesophagus
e) Lactrimal glands

Answer 20

c) Small bowel

Question 21

A woman with RVVC with lots of yeast spores only on microscopy. What is the most likely organism?

a) C albicans
b) C glabrata
c) C parapsilosis
d) C krusei
e) C dubliensis

Answer 21

b) C glabrata

Question 22

A 21yo man with persistent NSU already treated with Doxycycline 100mg BD, what would you next offer him (as well as sending for relevant tests)?

a) Azithromycin 1g STAT then 500mg OD for 2 days plus Metronidazole 400mg BD for 5 days
b) Ceftriaxone 1g IM STAT
c) Moxifloxacin 400mg BD for 14 days
d) Doxycycline 100mg BD plus Metronidazole 400mg TDS for 7 days
e) Doxycycline 100mg BD for 14 days

Answer 22

a) Azithromycin 1g STAT then 500mg OD for 2 days plus Metronidazole 400mg BD for 5 days

Question 23

A 19yo man had UPSI for the first time 5 days ago in Tenerife with a CFP and attends with severe dysuria, a small volume of clear urethral discharge, tender inguinal lymph nodes and also feels generally unwell with lethargy/myalgia. What is the most likely causitive organism to explain all his symptoms?

a) HIV seroconversion
b) Gonorrhoea
c) HSV
d) Chlamydia
e) Trichomona vaginalis

Answer 23

c) HSV

Question 24

A woman attends clinic and is 3 days late restarting her combined oral contraception (COC) and
had unprotected sexual intercourse (UPSI) only on day 6 of her 7-day HFI having previously
taken her pills consistently and correctly. Which one of the following statements is INCORRECT?

a) She is at risk of pregnancy
b) Copper intrauterine device (Cu-IUD) would not be first choice for emergency contraception in this situation.
c) Ulipristal acetate (UPA) is a suitable choice of emergency contraception in this case
d) If UPA is chosen, she needs to wait 120 hours before restarting her COC
e) Levonergestrel EC would be appropriate if she wished to restart her COC immediately

Answer 24

b) Copper intrauterine device (Cu-IUD) would not be first choice for emergency contraception in this situation.

Question 25

A well 18yo woman comes to clinic. She is very well with no PMH of note. Her BP and BMI are normal . She has some questions about the CHC. Which one of the following statements is INCORRECT regarding cancer and CHC use?

a) Use of CHC is contraindicated for a woman whose mother had breast cancer
b) Increased risk of breast cancer associated with CHC use declines to become nonsignificant after 10 years of non-use
c) Use of CHC for more than 5 years is associated with a small increase in the risk of cervical cancer
d) Use of CHC is associated with reduced risk of endometrial cancer and ovarian cancer
e) Use of CHC is associated with reduced risk of large bowel cancer

Answer 25

a) Use of CHC is contraindicated for a woman whose mother had breast cancer

Question 26

The Cu-IUD is the most effective method of EC. A 2012 systemic review reported an overall pregnancy rate of:

a) <0.001%
b) <0.01%
c) <0.1%
d) <1%
e) <10%

Answer 26

c) <0.1%

Question 27

Contraindications to the insertion of a Cu-IUD for EC are the same as those for routine IUD insertion. Which of the following is a contraindication to insertion?

a. Between 48 hours and 28 days after childbirth
b. Risk of sexually transmitted infection
c. Previous ectopic pregnancy
d. Young age and nulliparity
e. PMH of Epilepsy

Answer 27

a. Between 48 hours and 28 days after childbirth

Question 28

A 20yo man attends the clinic with sudden onset right testicular pain which on examination is excutiatingly tender, high sitting and red/swollen. What would be your immediate management?

a) Routine urology referral
b) Emergency admission under urology for testicular doppler US to r/o torsion
c) Urine NAAT for chlamydia, gonorrhoea and mgen and await results
d) Treat empirically for EO with doxycycline 100mg BD for 2 weeks
e) Emergency admission under urology for emergency surgical exploration to r/o torsion

Answer 28

e) Emergency admission under urology for emergency surgical exploration to r/o torsion

Question 29

Which of the following is NOT associated with an increased risk of BV?

a) Smoking
b) New sexual partner
c) Exogenous oestrogen e.g. COCP or HRT
d) Vaginal douching
e) Non-white ethnicity

Answer 29

c) Exogenous oestrogen e.g. COCP or HRT (more associated with POP as oestrogen seems to be protective)

Question 30

A woman with TV cannot tolerate PO Metronidazole and instead is treated with 2 courses of intravaginal Metronidazole gel but has a persistent infection confirmed on microscopy. Her RMP is successfully treated with PO Metronidazole. What is the likely cause for her persistent infection?

a) Resistant organism
b) Re-infection from RMP
c) False positive
d) Re-infection from unclean fomities
e) Untreated TV organisms in urethra

Answer 30

e) Untreated TV organisms in urethra

seems like a weird question but apparently was there one year!

Question 31

Who should also treat their face and scalp with topical treatment for scabies?

a) Old people
b) Young children
c) Immunosuppressed people
d) Those with crusted scabies
e) All of the above

Answer 31

e) All of the above

Question 32

A 35yo woman was treated 10 days ago for scabies. She and her family were all treated with Permethrin 5% on day 1 and day 8. She confirmed that she used the lotion as per the instructions and she washed all their clothes/bedding etc in >60C washes. What is the reason for her ongoing symptoms?

a) Wrong concentration of Permethrin used
b) Fomites not adequetly washed/disinfected
c) Incomplete course of treatment, needs 1 further dose
d) Common for itch to persist up to 2 weeks after treatment and can be managed with emollients and antihistamines
e) Resistant scabies - will need PO Ivermectin

Answer 32

d) Common for itch to persist up to 2 weeks after treatment and can be managed with emollients and antihistamines

Question 33

A 24yo pregnant woman is diagnosed with pubic lice. Which of the following would be your treatment of choice?

a) Permethrin 1%
b) Permethrin 5%
c) Malathion 0.5%
d) Phenothrin 0.2%
e) Ivermectin

Answer 33

a) Permethrin 1% (Permethrin and Malathion both ok in pregnancy but Permethrin usually first line)

Question 34

Vertical transmission of chlamydia can persist in the affected child up to:

a) 2 months
b) 6 months
c) 1 year
d) 2 years
e) 3 years

Answer 34

e) 3 years

Question 35

Which of the following is not a recognised cause of epididymorchitis?

a) Treponema pallidum
b) HSV
c) E.coli
d) Gardnerella vaginalis
e) Trichomonas vaginalis

Answer 35

?? b) HSV (I think!)

Question 36

In which of the following circumstances would you offer PEP to someone following an episode of high risk sex?

a) An MSM on EBD PrEP who took a double dose 3 hours prior to SI and continued it every 24 hours for a further 48 hours
b) An MSM on EDB PrEP who took a double dose 10 hours prior to SI and continued it every 24 hours for a further 7 days
c) A cis-woman on daily PrEP who took a single daily dose for 14 days prior to SI and for 7 days afterwards but missed a single dose in the first week of commencing PrEP
d) An MSM on daily PrEP established on daily PrEP for 1 year but recently started on Omeprazole by his GP which he takes at the same time as his PrEP
e) An MSM on daily PrEP who has forgotten his PrEP on 5 occasions this week.

Answer 36

e) An MSM on daily PrEP who has forgotten his PrEP on 5 occasions this week.

Question 37

Which of the following is NOT recommended as a baseline investigation prior to PrEP initiation?

a) Syphilis serology
b) LFTs
c) U+Es
d) uPCR 1+ or more on urinalysis
e) Pregnany test in women

Answer 37

b) LFTs

Question 38

At what age should a the final HIV antibody test be performed in a non-breast feeding baby born to an HIV positive mother?

a) 6 months
b) 12 months
c) 18 months
d) 22-24 months
e) 36 months

Answer 38

d) 22-24 months (in new BHIVA guidance)

Question 39

Which of the following is NOT a recommended tx for neurosyphilis?

a) Doxycyline 100mg BD for 28 days
b) Procaine penicillin 2.4 MU IM OD for 14 days plus Probenacid
c) Benzyl penicillin 2.4g IV 4 hourly for 14 days
d) Amoxicillin PO 2g TDs plus Probenacid for 28 days
e) Ceftriaxone 2g IV OD for 10-14 days

Answer 39

a) Doxycyline 100mg BD for 28 days

Question 40

Which of the following is NOT one of the categories of prostatism?

a) Acute bacterial prostatitis
b) Chronic bacterial prostatitis
c) Chronic idiopathic prostatitis
d) Chronic pelvic pain syndrome
e) Asympatomic inflammatory prostatitis

Answer 40

c) Chronic idiopathic prostatitis

Question 41

Which of the following statements about epididymorchitis is TRUE:

a) STIs as an underlying cause are more common in those >35yo
b) Insertive anal intercourse does not predispose to EO with enteric pathogens
c) Bilateral EO occurs in 30% of those with Mumps
d) UTI pathogens are more likely to predispose to complications
e) There is strong evidence to suggest subfertility in men following a single episode of EO

Answer 41

d) UTI pathogens are more likely to predispose to complications

Question 42

A man from Zimbabwe is diagosed with Donovanosis. How far back should you trace his sexual partners for testing/treatment?

a) 10 days
b) 14 days
c) 1 month
d) 3 months
e) 6 months

Answer 42

e) 6 months

Question 43

Which of the following is NOT a common cause of false positive RPR?

a) Young age
b) Pregnancy
c) Lyme disease
d) Leprosy
e) TB

Answer 43

a) Young age

Question 44

A woman who wishes to use IUC for long-term contraception presents reporting multiple episodes of unprotected sexual intercourse since her last period. The earliest episode was 10 days ago and the most recent 3 days ago. She is on Day 18 of a regular 28-day cycle. What is the single most appropriate advice to offer her from the list below?

a. Advise that it is too late to use emergency contraception (EC) and to return when she has her period
b. Advise that it is too late to use EC and offer a bridging method
c. Advise that she can have a copper intrauterine device (Cu-IUD) inserted for EC and ongoing contraception
d. Advise that she can have an LNG-IUS inserted for EC and ongoing contraception
e. Advise that she can have any type of EC as they will all be equally effective in this situation

Answer 44

c. Advise that she can have a copper intrauterine device (Cu-IUD) inserted for EC and ongoing contraception

Question 45

A woman with a Cu-IUD in situ presents with pelvic inflammatory disease. She wants to know if she should have the device removed. What is the single most appropriate advice?

a. Clinical outcomes are much worse if the device is removed
b. She can keep the IUD in situ as long as she responds to treatment within the next 3 days
c. Long-term clinical outcomes are better if the device is removed
d. Removal is recommended unless sex has occurred in the last 7 days
e. She can keep the IUD but will require IV antibiotics to treat the PID

Answer 45

b. She can keep the IUD in situ as long as she responds to treatment within the next 3 days

Question 46

Which of the following is NOT a recognised cause of PID?

a) Mycobacterium tuberculosis
b) Actinomyces israeli
c) Mycoplasma genitalium
d) Salmonella typhi
e) Ureaplasma urealyticum

Answer 46

e) Ureaplasma urealyticum

Question 47

When should a CD4 be rechecked on a patient who is on ART with undetectable VL and their CD4 was 374 last year and is now 392.

a) Do not recheck unless clinical change/off ART/detectable viral load
b) Annually until CD4 >500
c) Continue to check 6 monthly as a matter of routine
d) Continue to check 12 monthly as a matter of routine
e) Never again

Answer 47

a) Do not recheck unless clinical change/off ART/detectable viral load

Question 48

A woman taking which of the following medications should be offered a double dose of Levonergestrel EC?

a) Sodium valproate
b) Levetiracetam
c) PrEP (TDF/FTC)
d) Biktarvy (BIC/FTC/TAF)
e) Atripla (TDF/FTC/EFV)

Answer 48

e) Atripla (TDF/FTC/EFV)

Question 49

“Partial or total removal of the clitoris and labia minora with or without excision of the labia majora” is a description of which type of FGM?

a) Type 1
b) Type 2
c) Type 3
d) Type 4
e) Type 5

Answer 49

b) Type 2

Question 50

In the last 10 years in the UK, which STI has seen the largest overall increase?

a) Chlamydia
b) Gonorrhoea
c) Syphilis
d) HSV
e) HPV

Answer 50

b) Gonorrhoea (277% increase)

Chlamydia increased 46%
(Syphilis increased 199%)
(HSV increased 10%)
(HPV decreased 35%)