Infectious disease

Question 1

Which vaccines are live attenuated

Answer 1

Can’t be given in immunocompromsied

MMR
BCG
Chicken pox
Flus

Question 2

What is the child’s vaccination schedule before 1 year

Answer 2

8 weeks
6 in 1 (dip, tet, pertussis, polio, Hib, Heb B)
Men B
Rotavirus

12 weeks
6 in 1
Pneumococcal
Rotavirus

16 weeks
6 in 1
Men B

Question 3

What is a child’s vaccination schedule from 1 year onwards

Answer 3

1 yr
2 in 1 (Hib and Men C)
Pneumococcal
MMR
Men B

3 years and 4 months
4 in 1 (diptheria, tetanus, pertussis, polio)
MMR

12-13 HPV

Question 4

What are the most common causes of bacterial meningitis in children

Answer 4

Neonates- GBS

Children- Neiserria meningitidis and strep pneumoniae

Question 5

When is a lumbar puncture indicated in suspected meningococcal sepsis

Answer 5

Under 1 month with fever
1-3 months with fever and unwell
Under 1 yr with unexplained fever and serious illness features

Question 6

What are kernig’s and brudzinski’s tests

Answer 6

For meningitis
Kernigs- flex one hip and straighten knee- stretch on meninges - pain

Brudzinski’s test- lie flat on bed and left head and neck off bed- flex chin to chest - flexion of hips and knees

Question 7

How is bacterial meningitis managed

Answer 7

Comminity- IM benzylpenicillin before transfer

Hospital- Blood culture and lumbar puncture
Meningococcal PCR bloods

Under 3 months- cefotaxime + amoxicillin

Over 3 months - ceftriaxone

Can add vanc if risk of resistance if pneumococcal

Steroids can reduce neuro damage- Dex 4 times daily for 4 days

Question 8

What post exposure prophylaxis is used in meningococcal meningitis

Answer 8

Prolonged contact within 7 days of onset of illness

Single dose of ciprofloxacin within 24 hrs of diagnosis

Question 9

What is the main cause of viral meningitis

Answer 9

HSV, enterovirus and VZV

Aciclovir to treat

Question 10

What are the CSF findings in a bacterial infection of meningitis

Answer 10

Cloudy
High protein
Low glucose
WCC- high neutrophils

Bacteria are big (need high protein and use lot’s of glucose to grow)

Question 11

What are the CSF findings in Viral meningitis

Answer 11

Clear
Normal/ slightly raised protein
Normal glucose
High lymphocytes

Viral- less problemation just lymphocytes

Question 12

What are the main causes of paeds encephalitis

Answer 12

Herpes simplex virus
Children - HSV1 cold sores
Neonates- HSV2- genital herpes during birth

Can also be VZV, EBV, CMV

Question 13

What is the presentation of paeds encephalitis

Answer 13

Altered concious
Confused
Acute Neuro symptoms
Acute seizures
Fever

Question 14

How is encephalitis managed

Answer 14

Aciclovir for HSV and VZV
Ganciclovir for CMV

Repeat lumbar puncture before stopping antivirals

Question 15

What are the features of glandular fever (infectious mononucleosis/EBV)

Answer 15

Sore throat
Fever
Intensly itchy maculopapular rash after amoxicillin
Fatigue
Lymphadenopathy
Splenomegaly
Tonsil inlargement

Question 16

What tests are done for glandular fever/ EBV

Answer 16

Monospot test- test for heterophile antibodies - can take 6 weeks for these to show up

IgM - acute infection
IgG- immunity post infection

Question 17

What advice should be given post EBV

Answer 17

-Long lasting fatigue after
-Avoid alcohol- affects liver processing it
-Avoid contact sports for 4-6 weeks- splenic rupture risk
-Risk of glomerulonephritis
-Risk of haemolytic anaemia
-Risk of burkitt’s lymphoma

Question 18

What are the features of mumps

Answer 18

Flu like prodrome
Fever
Muscle aches
Parotid gland swelling
Pancreatitis (abdo pain)
Testicular pain

Supportive management

Question 19

How is HIV transmission prevented during birth

Answer 19

Normal vag delivery if viral load <50

C-section option if >50 and compulsory if >400

IV zidovudine given during section if viral load >1000

Prophylaxis given to baby
Low risk- mum <50- zidovudine for 4 weeks

High risk- mum >50 - zidovudine, lamivudine and nevirapine for 4 weeks

Breastfeeding never recommended

Question 19

When are babies to HIV positive parents tested for HIV

Answer 19

-HIV viral load test at 3 months- if neg- no HIV

-HIV antibody test ar 24 months- if contracted since previous 3 month eg. breastfeeding

Antibody test can be positive for up to 18 months from mothers antibodies crossing placenta

Question 19

When are children screened for hep B

Answer 19

Hep B positive mum (screen at or after 12 months)
Migrants from endemic areas
Close contacts of patients with Hep B

Question 20

How are babies treated if their mother has Hep B

Answer 20

Within 24 hrs of birth
Neonate given
-Hep B vaccine
-Hep B immunoglobulin infusion

Safe to breastfeed if child is properly vaccinated