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Question 1

Name some antifungal drugs and their MoA

Answer 1

Azoles + polyenes: block ergosterol synthesis
Nystatin + amphotericin B: bind to ergosterol in the membrane and cause pores to form
Echinocandins: block beta-glucan synthesis (for cell wall)

Question 1

What are 3 types of fungi and examples?

Answer 1

Moulds: Dermatophytes, Aspergillus
Yeasts: Cryptococcus
Yeast-like: Candida spp

Question 2

What percentage of pregnancies are affected by CMV infection?

Answer 2

About 1/100 or 1% of pregnancies affected by primary infection

Question 3

What percentage of fetuses are affected by CMV if mother had primary infection?

Answer 3

Only 10% symptomatic

Question 4

What are the manifestations of congenital CMV infection?

Answer 4

SNHL
IUGR
Microcephaly
Hepatosplenomegaly and anaemia
Petechial rash

Question 5

When can you test for congenital CMV infection and how?

Answer 5

After 20 weeks GA, 6-8 weeks post infection. Amniocentesis

Question 6

How common is maternal VZV infection?

Answer 6

3/1000

Question 7

Describe the risks of fetal varicella syndrome

Answer 7

2% risk if maternal infection <20 weeks
No risk >20 weeks

Question 8

Describe the manifestations of fetal varicella syndrome

Answer 8

Skin scarring
Hypoplastic limbs
Eye defects
Neurological dysfunction

Question 9

Describe the diagnosis + management of maternal VZV infection

Answer 9

If nonimmune + exposed: Ig testing

If symptomatic: aciclovir (if within 24 hours)
If nonimmune + exposed: VZIG (within 10 days of contact)
Neonatal VZIG: if symptomatic within 8 days of delivery

Question 10

Describe the risk of congenital rubella infection

Answer 10

<13 weeks: almost all affected fetuses will have abnormality
13-16: 1/3 of infected will have abnormality
>16 weeks: rare abnormalities

Question 11

Describe the features of congenital rubella infection

Answer 11

Cataracts
SNHL
Microcephaly and neurological dysfunction
IUGR
Cardiac anomalies: VSD, PDA
Hepatosplenomegaly, anaemia

Question 12

Describe the features of congenital syphilis infection

Answer 12

Skin lesions
Hutchinson teeth
Periostitis
Saddle nose

Question 13

Describe the features of congenital toxoplasmosis

Answer 13

Highest risk in 1st trimester
Chorioretinitis
Neurological dysfunction
Intracerebral calcifications

Question 14

Describe the management of perinatal toxoplasmosis infection

Answer 14

<18 weeks: spiramycin
>18 weeks: pyrimethamine + sulfadiazine

Question 15

What is the rate of vertical transmission of HIV in the UK?

Answer 15

2/1000

Question 16

Describe the types of antiretroviral therapy

Answer 16

NRTIs: tenofivir, lamivudine, abacavir
NNRTIs: efavirenz
PI: ritonavir

Question 17

What are the recommendations for delivery in HIV +ve mums?

Answer 17

Viral load at 36 weeks
<50: vaginal
50-399: consider ELCS
>400: ELCS

Question 18

Describe the risk stratification of neonates for HIV infection

Answer 18

Very low risk: mum on HAART for >10 weeks and 2 viral loads <50 inc 36 weeks onwards
-> 2 weeks ZDT

Low risk: <50 viral load 36 weeks +
-> 4 week ZDT

High risk: PEP

Question 19

Describe the intrapartum management of a HIV+ untreated woman

Answer 19

ZDT infusion intrapartum plus oral HAART

Question 20

When should untreated pregnant women start HAART?

Answer 20

Straight away if viral load >100,000 or CD4 <200
From 2nd trimester if viral load <100,000