Infections and immunity

Question 1

Which vaccines are given at 8 weeks old?

Answer 1

6-in-1 vaccine (DTaP, IPV, Hib, Hep B), Pneumococcal conjugated vaccine, Men B vaccine, Rotavirus vaccine.

Question 2

Which vaccines are given at 12 weeks old?

Answer 2

6-in-1 vaccine, rotavirus

Question 3

Which vaccines are given at 16 weeks old?

Answer 3

6-in-1 vaccine, pneumococcal conjugated vaccine, Men B vaccine.

Question 4

Which vaccines are given at 1 year old?

Answer 4

Hib/Men C vaccine, Pneumococcal conjugated vaccine, MMR vaccine, Men B.

Question 5

Which vaccines are given at 3 years 4 months old?

Answer 5

DTaP/IPV vaccine, MMR vaccine

Question 6

Which vaccine is given to girls aged 12 or 13?

Answer 6

HPV vaccine

Question 7

Which vaccines are given at 14 years old?

Answer 7

Tetanus/Diphtheria/Polio vaccine, Men ACWY vaccine

Question 8

Which vaccine has the strongest (still very rare) association with febrile convulsions?

Answer 8

MMR - live vaccine

Question 9

What are the most common causative organisms of bacterial meningitis in neonates?

Answer 9

Group B streptococcus
Listeria
E.coli

Question 10

What are the most common causative organisms of bacterial meningitis in children above 3 months?

Answer 10

Neisseria meningitides
Strep. pneumoniae
(Haemophilus influenza type B)

Question 11

Besides antibiotics, what can be given to help prevent complications associated with meningitis, e.g. deafness?

Answer 11

Dexamethasone to reduce inflammation

Question 12

Which antibiotic should be given to household contacts as prophylaxis for meningitis?

Answer 12

Rifampicin

or ciprofloxacin

Question 13

Where is the rash of Henoch-Schonlein Purpura commonly seen?

Answer 13

Buttocks and back of legs

Question 14

Is the MMR vaccine safe to give to children with HIV?

Answer 14

Yes, as long as the HIV isn’t too severe.

Question 15

Which antibiotics should a baby who develops neonatal septicaemia in the first 48 hours of life be given?

Answer 15

Benzylpenicillin and gentamicin.

If meningococcal septicaemia: cefotaxime and amoxicillin

Question 16

Which antibiotics should a baby who develops neonatal septicaemia after the first 48 hours of life be given?

Answer 16

A 3rd generation cephalosporin e.g. cefotaxime or ceftriaxone

Question 17

Which organism causes chicken pox?

Answer 17

Varicella Zoster Virus (a type of Herpes zoster virus)

Question 18

Which patient group should get active treatment for chicken pox and what should they get?

Answer 18

Immunocompromised kids: IV aciclovir then oral aciclovir if no organ dissemination.
Adolescents and adults: consider valaciclovir due to increased severity
Immunocompromised kids with deficient T cell function: Human Varicella Zoster Immunoglobulin (VZIG)
Pregnant women: if not immune to varicella, give VZIG as soon as possible.(effective up to 10 days post exposure)
Oral aciclovir should be given if pregnant women with chickenpox present within 24 hours of onset of the rash

Question 19

What’s the difference between food allergy and food intolerance?

Answer 19

In true food allergy, there is an abnormal IgE mediated response to the food.
In food tolerance, adverse reactions are not immunologically mediated.

Question 20

What test is used to test for infectious mononucleosis due to Epstein-Barr Virus?

Answer 20

Monospot test

Question 21

Which antibiotic must not be used in sore throat infections due to the risk of a maculopapular rash eruption if the sore throat is due to infection with EBV?

Answer 21

Amoxicillin

Question 22

What important advice should be offered to patients infected with EBV?

Answer 22

Avoid contact sports for 1 month if splenomegaly present.

Avoid alcohol.

Question 23

What is the most important complication of Kawasaki’s disease?

Answer 23

Coronary artery aneurysm

Affects ~1/3 within first 6 weeks of illness

Question 24

What is needed for the clinical diagnosis of Kawasaki’s disease?

Answer 24

> = 5 days of fever and 4 of: non-purulent bilateral conjunctivitis, cervical lymphadenopathy, macular erythematous rash, dry/cracked lips or red tongue, extremities changes (erythema/oedema/desquamation).

Question 25

How is Kawasaki’s disease managed?

Answer 25

Prompt treatment with IV immunoglobulins. Aspirin to reduce the risk of thrombosis.

Question 26

What are some important complications of measles?

Answer 26

Otitis media: the most common complication
Pneumonia: the most common cause of death
Encephalitis: typically occurs 1-2 weeks following the onset of the illness)
Subacute Sclerosing PanencEphalitis: very rare, may present 5-10 years following the illness

Question 27

What clinical sign is seen in the mouth of a patient infected with measles?

Answer 27

Koplik spots

Question 28

Where does the rash in measles tend to start?

Answer 28

Behind the ears

Question 29

How should periorbital cellulitis be managed?

Answer 29

Prompt Rx with iv antibiotics for 5-7 days

Question 30

How can the risk of vertical HIV transmission be reduced?

Answer 30

Maternal antiretroviral therapy during the pregnancy
Caesarean section delivery
Neonatal antiretroviral therapy with Zidovudine or triple ART therapy if high viral load
Bottle feeding - avoid breastfeeding

Question 31

What is the risk if a pregnant women becomes infected with Rubella in early pregnancy?

Answer 31

Risk of congenital rubella syndrome - can lead to deafness, congenital heart disease, cataracts.
Beyond 18 weeks, risk to fetus is minimised