Pediatrics - Infectious diseases

Question 1

PED - 4.1
From which age can influenza vaccination be administered?
A) 6 months
B) 12 months
C) 5 years
D) 18 years

Answer 1

ANSWER
A) 6 months

EXPLANATION
The safety and efficacy of the tetravalent inactivated split vaccine have been demonstrated in children over 6 months of age.

Question 2

PED - 4.2
Against which infectious disease is not post-exposure prophylactic vaccination available?
A) Hepatitis A
B) Tetanus
C) Varicella
D) Pertussis

Answer 2

ANSWER
D) Pertussis

EXPLANATION
Post-exposure prophylaxis vaccination against pertussis is not available.

Question 3

PED - 4.3
In case of injury with suspected tetanus infection, in addition to tetanus toxoid vaccination, the injured person should be given passive immunisation if the wound is severely damaged or contaminated with soil, a foreign body is present, in case of head injury, shock, bleeding, severe burn injury, radioactivity and if the time elapsed since the last vaccination of the person receiving the booster dose is more than:

A) 3 years
B) 5 years
C) 10 years
D) in all cases, the injured person must be given passive immunisation, regardless of the time elapsed since the previous tetanus vaccination

Answer 3

ANSWER
C) 10 years

EXPLANATION
As postulated in the National Centre for Public Health’s 2021 Methodology Letter on Vaccinations.

Question 4

PED - 4.4
Minimum interval between therapeutic intravenous immunoglobulin (IVIG) and live virus vaccine is:
A) 4 weeks
B) 3 months
C) 11 months
D) 2 years

Answer 4

ANSWER
C) 11 months

EXPLANATION
Different types of blood products made from human blood and/or plasma may contain specific immunoglobulins (IVIG products have specifically high levels) that neutralise the vaccine virus (measles, rubella, mumps, varicella).

Question 5

PED - 4.5
Contraindications to vaccination, EXCEPT:

A) Convulsions in the family history
B) Febrile illness
C) Vaccination of a pregnant woman with a live virus vaccine
D) Suspected or existing congenital immunodeficiency

Answer 5

ANSWER
A) Convulsions in the family history

EXPLANATION
Convulsions in the family history should not be considered as a contraindication to vaccination

Question 6

PED - 4.6
Administered as an oral vaccine:
A) DTaP
B) DTap + IPV + Hib
C) Varilrix/Varivax
D) Rotarix

Answer 6

ANSWER
D) Rotarix

EXPLANATION
Rotavirus vaccine is an oral suspension for oral use only.

Question 7

PED - 4.7
Effective antibiotic against Pseudomonas aeruginosa, EXCEPT:
A) piperacillin / tazobactam
B) ceftazidime
C) ciprofloxacin
D) cefotaxime

Answer 7

ANSWER
D) cefotaxime

EXPLANATION
Among the third generation cephalosporins, cefotaxime and ceftriaxone are both ineffective against P. aeruginosa.

Question 8

PED - 4.8
Common pathogens in endocarditis, EXCEPT:
A) Staphylococcus aureus
B) Alpha-hemolytic Streptococci
C) Enterococcus faecalis
D) Listeria monocytogenes

Answer 8

ANSWER
D) Listeria monocytogenes

EXPLANATION
Listeria monocytogenes is a short Gram-positive bacteria that causes self-limited gastroenteritis in otherwise healthy individuals. Also it can cause severe invasive illness including bacteremia, meningitis, meningoencephalitis but not endocarditis in susceptible patients like neonates, older persons, a patient with immunosuppression and pregnant women.

Question 9

PED - 4.9
Antibiotic therapy expected to be effective against community-acquired MRSA infection:
A) amoxicillin/clavulanic acid
B) cefixime
C) co-trimoxazole
D) cefprozil

Answer 9

ANSWER
C) co-trimoxazole

EXPLANATION
Ciprofloxacin (which is not routinely recommended in children) and clindamycin could still be effective against CA-MRSA. The latter can only be used for definitive treatment, not for empirical therapy, as its sensitivity is around 20%. (Based on antibiotic susceptibility of MRSA isolates reported by NNK in 2017).

Question 10

PED - 4.10
The minimum duration of intravenous treatment for paediatric osteomyelitis should ideally be:
A) intravenous treatment is not recommended
B) 3-4 days
C) 3-4 weeks
D) 6 weeks

Answer 10

ANSWER
B) 3-4 days

EXPLANATION
For uncomplicated osteomyelitis, the minimum duration of intravenous treatment is 3-4 days. If associated with bacteraemia, 4-7 days of intravenous treatment may be sufficient. After that, switching to oral therapy can be evaluated. (McMullan BJ et al. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children, Lancet Infect Dis. 2016)

Question 11

PED - 4.11
Extrapulmonary manifestations of Mycoplasma pneumoniae may include:
A) acute disseminated encephalomyelitis (ADEM)
B) hepatitis
C) erythema multiforme
D) A, B and C are all correct

Answer 11

ANSWER
D) A, B and C are all correct

EXPLANATION
Extrapulmonary manifestations of M. pneumoniae infection can be very diverse. In addition to the examples listed above, other forms of neurological, gastrointestinal, cardiovascular, haematopoietic, musculoskeletal, respiratory, urogenital, and sensory disorders may occur.

Question 12

PED - 4.12
A 13-month-old baby has monosymptomatic fever for 3 days. After resolution of fever maculopapular rash appears on the neck and torso which spread onto the limbs. The baby is in relatively good general condition throughout the course of the disease; appetite, fluid intake is not reduced. What is the most likely diagnosis?
A) Varicella
B) Exanthema subitum
C) Meningococcemia
D) Scarlet fever

Answer 12

ANSWER
B) Exanthema subitum

EXPLANATION
Exanthema subitum (roseola infantum, three-day-fever, sixth disease) is a common disease associated with rash in infancy. Its pathogens are HHV-6 and -7. It is also a common cause of febrile seizures in infancy and young children. In laboratory tests after initial leukocytosis, leukopenia, neutropenia, and a slight increase in serum GOT levels may occur.

Question 13

PED - 4.13
Which therapy would you choose in RSV bronchiolitis?
A) dexamethasone
B) inhalatory ribavirin
C) supportive care only
D) remdesivir

Answer 13

ANSWER
C) supportive care only

EXPLANATION
Current evidence suggests the use of supportive care only.

Question 14

PED - 4.14
A 7-year-old child is hospitalised for 5 days with fever and bloody diarrhoea. Which pathogen is unlikely based on the symptoms?
A) Campylobacter jejuni
B) Salmonella enterica enteritidis
C) EHEC
D) Rotavirus

Answer 14

ANSWER
D) Rotavirus

EXPLANATION
Rotavirus infection is not typically associated with bloody diarrhoea. Compared to adults, salmonellosis in children is more often associated with bloody stools.

Question 15

PED - 4.15
For a 3 years old, febrile child, who is returning from a tropical vacation, which test should always be performed?
A) Dengue virus detection
B) Thick and thin smear
C) Stool culture
D) Pharyngeal swab culture

Answer 15

ANSWER
B) Thick and thin smear

EXPLANATION
In the case of a febrile illness following a tropical trip malaria should be ruled out on each occasion.

Question 16

PED - 4.16
After camping in the forest a 7 years old child is presented with a 10 cm diameter ring-shaped, non-painful, mildly pruritic erythematous macule on the back of his neck. What antibiotic therapy should be recommended?
A) amoxicillin
B) doxycycline
C) azithromycin
D) streptomycin

Answer 16

ANSWER
A) amoxicillin

EXPLANATION
The lesion can be identified as erythema migrans, which is sufficient to make the diagnosis of Lyme disease. Adequate therapeutic response can be achieved with amoxicillin, while doxycycline is not recommended under 8 years of age.

Question 17

PED - 4.17
A 18 month old child experiences sore throat, fever for 2 days, and loss of appetite. On physical examination, you notice enlarged tonsils with white patches and nodules. Which empirical antibiotic treatment do you recommend?
A) amoxicillin
B) amoxicillin-clavulanic acid
C) cefixime
D) you don’t recommend antibiotic therapy

Answer 17

ANSWER
D) you don’t recommend antibiotic therapy

EXPLANATION
Under the age of 3 years in case of acute tonsillopharyngitis the usual pathogens are viruses (eg. adenovirus).

Question 18

PED - 4.18
A patient who came from Ukraine with unknown vaccination status temporarily gets better after a few days of fever, headache, and gastroenteric symptoms. After a few fever-free days, headache, neck and spinal pain, vegetative symptoms, and ascending paralytic flaccid paralysis appear. Which pathogen is essential to rule out?
A) Listeria monocytogenes
B) West Nile virus
C) Clostridium tetani
D) Poliovirus

Answer 18

ANSWER
D) Poliovirus

EXPLANATION
Among the pathogens listed, paralysis can be caused by Clostridium tetani and poliovirus. While C. tetani causes cramps in the affected muscles, poliovirus causes flaccid paralysis of the muscles.

Question 19

PED - 4.19
A few hours after Christmas dinner, all members of a family (except the oldest sibling who is vegetarian) of a 9 years old patient are presented with vomiting and diarrhoea. How would you manage your 9 years old patient?
A) Start antibiotic therapy effective against Staphylococcus aureus, as it is the most likely pathogen
B) Start antibiotic therapy effective against Bacillus cereus, as it is the most likely pathogen
C) Put the patient in epidemiological isolation
D) If necessary initiate parenteral fluid replacement therapy

Answer 19

ANSWER
D) If necessary initiate parenteral fluid replacement therapy

EXPLANATION
Food poisoning is a disease typically mediated by preformed toxins. Accordingly, if only symptoms consistent with the toxin effect occur, antimicrobial therapy and epidemiological isolation of the patient are not required.

Question 20

PED - 4.20
HIV infection can be transmitted through the following body secretions, EXCEPT
A) breast milk
B) blood
C) saliva
D) semen
E) vaginal secretions

Answer 20

ANSWER
C) saliva

EXPLANATION
HIV infection does not spread through saliva, but it does through the other body fluids listed. It is important to note that a properly treated HIV-positive mother can give life to a healthy newborn, and vertical infection can be avoided.

Question 21

PED - 4.21
An 8 months old patient is referred to the emergency department with constipation, acute-onset hypotension and ptosis. An anamnesis recording reveals that 1 day earlier he consumed honey for the first time in his life. Which pathogen’s role is most likely?
A) Trichuris trichiura
B) Poliovirus
C) Neisseria meningitidis
D) Clostridium botulinum
E) Streptococcus agalactiae

Answer 21

ANSWER
D) Clostridium botulinum

EXPLANATION
In the intestinal tract of adults and older children Clostridium botulinum is unable to colonise and produce toxins, therefore consuming honey at these ages is not dangerous. However in babies even small amounts pose a risk for botulism. Honey put in a baby’s food, tea or put on a pacifier are all risky. At older ages the symptoms are caused by preformed toxins consumed with food (mainly raw or improperly cooked meat dishes prepared during the slaughter of domestic pigs).

Question 22

PED - 4.22
What are TORCH pathogens?
A) Toxoplasma gondii, “Others”, Rubella Virus, Cytomegalovirus, Herpes Simplex Viruses
B) Toxoplasma gondii, “Others”, Rubella Virus, Chlamydia spp., Herpes Simplex Viruses
C) Toxoplasma gondii, “Others”, Rubella Virus, Chlamydia spp., Human Papilloma Viruses
D) Toxoplasma gondii, “Others”, Rubella Virus, Chlamydia spp., Human Immunodeficiency Virus

Answer 22

ANSWER
A) Toxoplasma gondii, “Others”, Rubella Virus, Cytomegalovirus, Herpes Simplex Viruses

EXPLANATION
The TORCH acronym is well known in neonatology.

Question 23

PED - 4.23
Complications of intrauterine Zika-virus infection may include:
A) subacute sclerosing panencephalitis
B) microcephaly
C) chorioretinitis
D) saddle nose

Answer 23

ANSWER
B) microcephaly

EXPLANATION
Subacute sclerosing panencephalitis is a neurological complication of measles, while saddle nose is characteristic of late congenital syphilis. Chorioretinitis can be a complication of many congenital infections, the most common of which are infections caused by Toxoplasma gondii and cytomegalovirus.

Question 24

PED - 4.24
Peptidoglycan and glycopeptide. What are these?
A) antiretroviral drugs
B) component of certain cells and an antibiotic group
C) oral antidiabetics
D) antimycoticums

Answer 24

ANSWER
B) component of certain cells and an antibiotic group

EXPLANATION
Peptidoglycan is a polymer consisting of sugar and amino acid molecules that forms a layer outside the plasma membrane of most bacteria, forming the cell wall. Glycopeptides form one group of antibiotics. Members of this group are vancomycin, teicoplanin, corbomycin. Telavancin is a lipoglycopeptide type antibiotic.

Question 25

PED - 4.25 Which viruses from the list below can cause arthritis quite frequently? A) HIV, VZV B) virus HSV, measles C) Yellow fever virus D) Human parvovirus B19, rubella virus

Answer 25

ANSWER D) Human parvovirus B19, rubella virus EXPLANATION Arthritis can be symptome of two illnesses only, out of the infections caused by viruses listed above. These are Parvovirus B19 caused erythema infectiosum (slapped cheek syndrome) and rubella (German measles).

Question 26

PED - 4.26 Which ones are the typical pathogens in neonatal infection? A) S. pyogenes, H. influenzae B) S. agalactiae, E. coli C) S. aureus, VZV D) S. pneumoniae, M catarrhalis E) CONS, K. oxytoca

Answer 26

ANSWER B) S. agalactiae, E. coli EXPLANATION Leading cause of neonatal sepsis is GBS (Group B Streptococcus – Streptococcus agalactiae) infection. Second most frequent pathogen is Escherichia coli. CONS – Coagulase negative Staphylococcus causes intravascular catheter related infections mainly.

Question 27

PED - 4.27 Generally, how long a patient with chickenpox is infectious? A) 3-4 days B) 14-21 days C) 6-7 days D) longer than 21 days E) 14 days

Answer 27

ANSWER C) 6-7 days EXPLANATION Incubation period of varicella can range from 10-21 days. The period of infectivity generally lasts from 1-2 days prior to the onset of rash until all skin lesions have crusted.

Question 28

PED - 4.28 Which one is the most frequent agent causing acute hepatitis all over the world? A) EBV B) HAV C) HEV D) Ethyl alcohol E) CMV

Answer 28

ANSWER C) HEV EXPLANATION The World Health Organisation estimates that hepatitis E virus causes 20 million new infections yearly, with more than 3 million cases of acute hepatitis and more than 55 000 deaths all over the world. Globally, an estimated 1.4 million hepatitis A infections occur every year

Question 29

PED - 4.29 Which virus does not belong to the herpesviridae family? A) VZV B) EBV C) HHV7 D) WNV E) CMV

Answer 29

ANSWER D) WNV EXPLANATION Varicella zoster virus – VZV, HHV3 – is a genus in the subfamily Alphaherpesvirinae, Ebstein-Barr virus – EBV, HHV4 – is a genus in the subfamily Gammaherpesvirinae, Cytomegalovirus – CMV, HHV5 - is a genus in the subfamily Betaherpesvirinae, and HHV7 is a genus in the subfamily Betaherpesvirinae too. West Nile virus - WNV – is a member of the family Flaviviridae and causes West Nile fever.

Question 30

PED - 4.30 During the first week of April a 2 months old baby was taken to your surgery who was born at 29 weeks of gestation and has been suffering from BPD. The infant was discharged from NICU a week ago. What vaccination would you recommend for the baby to have beside the scheduled ones? A) 1 dose influenza split vaccine in autumn B) 1 dose of inactivated influenza vaccine immediately C) no vaccine is recommended D) 2 doses of split vaccine in autumn 1 month apart E) 2 doses of inactivated influenza vaccine, first one urgently, second one in autumn

Answer 30

ANSWER D) 2 doses of split vaccine in autumn 1 month apart

Question 31

PED - 4.31 Patients with the following risk factors should receive PCP prophylaxis as they are at high risk for PCP, EXCEPT: A) patients with acute lymphocytic leukaemia B) patients with certain primary immunodeficiencies like SCID, hyper IgM syndrome C) solid organ transplant recipients, often for at least 6 months to one year following transplantation D) asthmatic patients who receive 2 mg/kg prednisolone for 5 days during acute attack

Answer 31

ANSWER D) asthmatic patients who receive 2 mg/kg prednisolone for 5 days during acute attack EXPLANATION Among others patients with acute lymphoid leukaemia, SCID, hyper IgM syndrome, solid organ recipients, in HIV infected patients with high viral load and CD4 count less than 200 cells/microlitre or less than 14%, allogeneic hematopoietic cell transplant recipients as long as immunosuppression is given, patients on alemtuzumab, fludarabine with cyclophosphamide therapy or patient receiving a glucocorticoid dose equivalent to ≥20 mg prednisone for a month or longer who have another cause of immunosuppression also should receive PCP prophylaxis. Prednisolon in a dose of 2 mg/kg/day does not increase the risk of PCP.

Question 32

PED - 4.32 Which one was the most frequent bacterial diarrheal disease over the past years in Hungary? A) yersiniosis B) salmonellosis C) campylobacteriosis D) shigellosis

Answer 32

ANSWER C) campylobacteriosis EXPLANATION According to the table entitled ’Reported Communicable Diseases – Hungary, 2016-2020’ issued by Epidemiological and Infection Control Department of National Centre for Public Health, reported case numbers of campylobacteriosis every year were higher than incidence of salmonellosis. The occurrence of the other two illnesses is smaller by orders of magnitude.

Question 33

PED - 4.33 Patient suffering from one of the following diarrheal diseases should be isolated on Infectology Ward: A) Salmonellosis B) Campylobacteriosis C) Clostridioides difficile infection D) None of them

Answer 33

ANSWER D) None of them EXPLANATION According to the prevailing departmental order 18/1998.(VI.3.) of the Ministry of Welfare, patients with cholera have to be isolated on Infectology Ward only and shigellosis if a patient needs to be admitted to hospital due to severity of illness.

Question 34

PED - 4.34 One of the following clinical pictures is not related to any of human herpes viruses: A) Mononucleosis infectiosa B) Erythema infectiosum C) Varicella D) Burkitt-lymphoma E) Exanthema subitum

Answer 34

ANSWER B) Erythema infectiosum EXPLANATION Erythema infectiosum is caused by human Parvovirus B19 which belongs to the Parvoviridae family. This illness occurs mainly in children or young adults.

Question 35

PED - 4.35 Most frequent cause of serous meningitis with a cumulative number of cases in the summer and in early autumn: A) Neisseria meningitidis B) Non-polio enterovirus C) Leptospira interrogans D) West Nile virus E) Herpes simplex virus 1 and 2

Answer 35

ANSWER B) Non-polio enterovirus EXPLANATION The most frequent pathogens causing serous meningitis are non-polio enteroviruses. Case number shows seasonal fluctuation, there is an epidemic in the summer and in early autumn (in children’s communities there is a rise of numbers at the time of summer camps and set out of school).

Question 36

PED - 4.36 Congenital CMV infection can be confirmed with one of the following laboratory test: A) Maternal CMV serology B) Baby's CMV serology is enough to confirm the diagnosis C) CMV PCR test on baby's urine sample during the first three weeks of life D) CMV PCR test on maternal blood sample

Answer 36

ANSWER C) CMV PCR test on baby's urine sample during the first three weeks of life EXPLANATION Baby’s or mother’s serology test itself should not be done. Always coupled samples should be processed but based on the results only, in most of the cases we can not confirm the diagnosis. Performing CMV PCR test on baby’s urine (or saliva) sample is the best method. If it is processed beyond three weeks of life then positive results can not distinguish between congenital or postnatally acquired infections.

Question 37

PED - 4.37 Pregnant woman around 34 weeks of gestation had a flu-like illness. Couple of days later she gave birth to a preterm newborn with a birth weight of 2200 gs. Soon after birth the baby develops symptoms of RDS. Examining the placenta on the foetal side small white nodes can be seen. Newborn had neutropenia and thrombocytopenia. In gastric aspiration with Gram stain Gram-positive rods can be detected. What is the most likely causative agent from the list below? A) C. botulinum B) E. coli C) Group B Streptococcus D) L. monocytogenes E) S. aureus

Answer 37

ANSWER D) L. monocytogenes EXPLANATION Listeria monocytogenes is an intracellular pathogen and can cause severe, life threatening infections in neonates. It is sensitive to ampicillin.

Question 38

PED - 4.38 A 4 year old girl has been taken to GP surgery with fever (38.8°C) and cough. There is no severe illness in her medical history, on physical examination symptoms of URTI can be found. Chest x-ray shows a 5 x 6 cm inhomogeneous consolidation on the right side in the middle lobe. Which antibiotic would you choose from the list below to treat the patient? A) amoxicillin B) cefixime C) oxacillin D) tazocin E) ceftriaxone

Answer 38

ANSWER A) amoxicillin EXPLANATION Based on the spectrum of the pathogens causing mild to moderate pneumonia in this age-group amoxicillin is an appropriate choice.

Question 39

PED - 4.39 A patient attended at A&E with paleness, oedema and reduced urine output a week after he had recovered from bloody gastroenteritis. What could be the diagnosis? A) Hemolytic uremic syndrome B) Salmonella sepsis C) Reye syndrome D) Invasion of dysenteric toxin E) Clostridioides difficile infection

Answer 39

ANSWER A) Hemolytic uremic syndrome EXPLANATION Symptoms mentioned above are typical of HUS. In case of Reye syndrome the patient is comatose. There is high fever present in case of Salmonella sepsis and toxic dysentery. Persistent diarrhoea is typical of Clostridioides infection.

Question 40

PED - 4.40 How would you manage an otherwise healthy patient with Salmonella gastroenteritis? A) Ampicillin treatment B) Electrolyte and fluid substitution C) Sumetrolim treatment D) Reasec tablet (antimotility agent) E) Torecan suppository (antiemetic)

Answer 40

ANSWER B) Electrolyte and fluid substitution EXPLANATION Giving antibiotics is rarely indicated to treat Salmonellosis in immunocompetent patients. Antibiotic treatment can increase the risk of becoming Salmonella-carrier.

Question 41

PED - 4.41 Which infection from the forthcoming ones can mimic acute appendicitis causing mesenteric lymphadenitis? A) Campylobacter jejuni infection B) Yersinia enterocolitica infection C) Salmonella sp. infection D) Shigella infection E) Rotavirus infection

Answer 41

ANSWER B) Yersinia enterocolitica infection EXPLANATION In case of Yersiniosis inflammation of periappendicular lymph nodes can mimic the symptoms of acute appendicitis.

Question 42

PED - 4.42 Your patient went hiking to the hills and 2 weeks later complained of flu-like symptoms. Following a couple of asymptomatic days he developed fever again accompanied by strabism, ataxia and paralysis in his shoulder. What could be the diagnosis? A) Lyme disease B) Epidemic meningitis C) Lymphocytic choriomeningitis D) Tick-borne encephalitis E) Guillain-Barré syndrome

Answer 42

ANSWER D) Tick-borne encephalitis EXPLANATION The biphasic type illness, paralysis of the eye-muscles and of the musculature of the shoulders are typical symptoms of tick-borne encephalitis.

Question 43

PED - 4.43 Having this condition increases the risk of Candida infection in the highest degree: A) atopic/allergic diseases in anamnesis B) birth weight less than 2000 gs C) immunosuppressed condition D) indwelling bladder catheter E) tonsillectomy

Answer 43

ANSWER C) immunosuppressed condition EXPLANATION Neutropenia particularly increases the risk of disseminated Candida infections. Most frequent Candida species are: C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei.

Question 44

PED - 4.44 A 6 year old boy has been brought to GP practice by parents with a 3 days history of high temperature (>39°C), malaise and vomiting. Fever is difficult to control. He has taken paracetamol 4 times a day and he also had two doses of sulfametoxazol/trimethoprime. Today he developed a widespread rash. On physical examination itchy, diffuse, pinpoint maculopapular rash can be seen which is more marked in the groin and axilla. Bilateral red cheeks are accompanied by circumoral pallor. White strawberry tongue and exudative tonsillopharyngitis are present with spotted redness on the soft palate. Palms and soles are not red and the hand is not oedematous. Which do you think is the most likely illness? A) Measles B) Rubella C) Scarlet fever D) Kawasaki disease E) Exanthema subitum

Answer 44

ANSWER C) Scarlet fever EXPLANATION Based on clinical signs like the nature of the rash, perioral pallor and strawberry tongue making the diagnosis of scarlet fever is obvious.

Question 45

PED - 4.45 What is the first line treatment in case of scarlet fever? A) penicillin B) third generation cephalosporin C) second generation cephalosporin D) first generation cephalosporin E) erythromycin

Answer 45

ANSWER A) penicillin EXPLANATION Drug of choice to treat scarlet fever is penicillin. Scarlet fever is caused by Streptococcus pyogenes and 100% of the strains are sensitive to penicillin.

Question 46

PED - 4.46 Which one of the forthcoming infections is followed by exuberant desquamation mainly on the palms and the soles? A) scarlet fever B) exanthema subitum C) erythema infectiosum D) rubella E) measles

Answer 46

ANSWER A) scarlet fever

Question 47

PED - 4.47 A 6 year old boy presents with vomiting, hepatomegaly and coma soon after varicella infection. What illness do you think of? A) Kawasaki disease B) Reye syndrome C) VZV hepatitis D) Still's disease E) Septic shock

Answer 47

ANSWER B) Reye syndrome EXPLANATION If a comatose patient’s medical history includes vomiting and he/she has got elevated transaminase levels as well we need to think of the possibility of Reye syndrome especially if the patient has had chickenpox or influenza combined with salicylate treatment.

Question 48

PED - 4.48 What age below tetracycline should not be used because of the risk of tooth discoloration? A) 3 years B) 6 years C) 9 years D) 12 years E) 15 years

Answer 48

ANSWER C) 9 years EXPLANATION Tetracyclines have strong affinity to calcium constituting calcium-tetracycline-phosphate compounds. These molecules are deposited in dentin and enamel of developing teeth causing discoloration. Development of enamel comes to the end by 8 years of age so using tetracycline beyond 9 years of age is certainly safe.

Question 49

PED - 4.49 Which microorganism is the leading cause of serious infection in HIV infected children? A) Cryptococcus neoformans B) Mycobacterium tuberculosis C) Pneumocystis jirovecii D) Toxoplasma gondii E) Yersinia enterocolitica

Answer 49

ANSWER C) Pneumocystis jirovecii EXPLANATION P. jirovecii is the most frequent opportunistic pathogen causing infection in HIV positive children so preemptive trimethoprim-sulfamethoxazole therapy is a must.

Question 50

PED - 4.50 HBsAg positive mother gave birth to a term baby, birthweight is 3.3 kg. Following a careful wash of the baby which vaccination order would you apply from the list below? A) Hepatitis B immunoglobulin (HBIG) and HBV vaccine at birth, 1 month and 6 month of age B) HBV vaccine at 2, 4, 6 and 18 month of age C) HBIG at birth, 1 and 6 month of age D) HBIG and HBV vaccine at 2,4,6 and 18 month of age E) HBIG at birth and 1 month of age and HBV vaccine at 2,4,6 and 18 month of age

Answer 50

ANSWER A) Hepatitis B immunoglobulin (HBIG) and HBV vaccine at birth, 1 month and 6 month of age EXPLANATION HBV infection leads to chronic disease in 90% of the cases if it occurs in neonates or young infants and the likelihood of hepatocellular carcinoma or cirrhosis to develop is 25%. All HBsAg positive mothers’ newborn have to be vaccinated with HBIG and HBV vaccine as well. HBV vaccine and HBIG should be administered at different anatomic sites.

Question 51

PED - 4.51 There is a contagion in a nursery school. Children showing symptoms of upper airway infections, bronchitis, pneumonia, conjunctivitis and watery diarrhoea. Which virus is the most likely causative agent from the list below? A) adenovirus B) enterovirus C) herpesvirus D) parvovirus E) rhinovirus

Answer 51

ANSWER A) adenovirus EXPLANATION Adenovirus infected patients can have a wide spectrum of symptoms because the virus can have an effect on the upper and the lower airways, the conjunctiva and the intestinal tract at the same time.

Question 52

PED - 4.52 A one year old infant has a three days history of fever of 39.4°C which is difficult to relieve. During the physical examination the baby is noted to have a maculo-papular, blanching rash on his trunk but his upper extremities, the face and the lower extremities are spared. At the time of attendance the infant is afebrile. Which virus is the most probably infective agent in this case? A) Adenovirus B) Enterovirus C) Human herpesvirus 6/7 D) Parvovirus B19 E) Rubella-virus

Answer 52

ANSWER C) Human herpesvirus 6/7 EXPLANATION Most of the cases roseola infantum (exanthema subitum) is caused by HHV 6 or occasionally by HHV7. In sporadic cases Adenovirus, Enterovirus and Parainfluenza virus can be the causative agent.

Question 53

PED - 4.53 One of the following statements is true in reference to toxoplasmosis: A) pregnant women are treated with pyrimethamine and sulfadiazine if they had tainted with toxoplasma before conception B) in case of congenital toxoplasmosis confirmed with serology test infants are treated with pyrimethamine and sulfadiazine C) to prevent congenital toxoplasmosis pregnant women should be treated with spiramycin during the first trimester D) lymphadenopathy due to toxoplasma infection should be treated with spiramycin E) in case of ocular toxoplasmosis systemic steroid therapy is sufficient

Answer 53

ANSWER C) to prevent congenital toxoplasmosis pregnant women should be treated with spiramycin during the first trimester EXPLANATION Spiramycin treatment applied during the first 16 weeks of pregnancy generally prevents the foetal infection

Question 54

PED - 4.54 A 6 year old boy presents with right sided, multiple, prae-auricular and cervical lymphadenopathy. It was noticed for the first time 5 weeks ago when he had right sided conjunctivitis as well, which has healed since. What is the most probable diagnosis? A) Staphylococcus aureus infection B) Cat scratch disease C) Tularemia D) Atypical mycobacterial infection E) Actinomycosis

Answer 54

ANSWER B) Cat scratch disease EXPLANATION Children frequently transfer the pathogen by their hands from cat’s hair to their conjunctiva. Evolving conjunctivitis is followed by same-sided cervico-facial lymphadenopathy.

Question 55

PED - 4.55 There is a valvulotomy in a 10 year old boy's distant anamnesis which was performed 7 years ago due to aorta stenosis. 10 days ago he developed chickenpox. Currently he has been sickly, has had a lack of appetite for six days, he has got low grade fever and has lost 2 kgs of weight. On examination he was found to have 4/6, high pitched diastolic murmur. What is the most probable diagnosis? A) congestive heart failure B) endocarditis C) myocarditis D) pericarditis E) rheumatic fever

Answer 55

ANSWER B) endocarditis EXPLANATION Staphylococcus or Streptococcus infections are frequent complications of varicella, which can lead to bacteraemia. Having heart surgery increases the risk of endocarditis.

Question 56

PED - 4.56 A 4 year old girl who attends day-nursery has been taken to A&E with a two days history of flu-like symptoms, loose stools, low grade fever of 38°C and loss of appetite. Laboratory test results show elevated ALT (651 U/l) and bilirubin (30 mmol/l) levels. What diagnostic investigation would you suggest to perform? A) HAV antigen detection in stool sample B) HBsAg detection in serum C) Measurement of anti-HBsAg level in seum D) Measurement of anti-HAV IgM level in serum E) Stool culture to detect HAV

Answer 56

ANSWER D) Measurement of anti-HAV IgM level in serum EXPLANATION Serum anti-HAV Ig M can be detected at the time of icterus and symptom onset. Detecting Ig M antibodies is the principle of the diagnosis.

Question 57

PED - 4.57 What is the tailored therapy in established streptococcal toxic shock syndrome? A) iv penicillin G + iv gentamicin B) iv amoxicillin + clavulanic acid C) iv penicillin G + iv clindamycin D) iv vancomycin + iv clindamycin E) iv gentamicin + iv vancomycin

Answer 57

ANSWER C) iv penicillin G + iv clindamycin EXPLANATION Penicillin is the drug of choice to treat Streptococcus pyogenes infections as all strains are sensitive to penicillin and it has a bactericidal effect. Clindamycin inhibits the toxin protein synthesis of Streptococcus.

Question 58

PED - 4.58 One of the following infections caused by Parvovirus B19. This one is: A) Mononucleosis infectiosa B) Typhus exanthematicus C) Exanthema subitum D) Erythema infectiosum E) Scarlet fever

Answer 58

ANSWER D) Erythema infectiosum EXPLANATION Mononucleosis infectiosa – EBV; Typhus exanthematicus – Rickettsia prowazekii; Exanthema subitum – HHV6; Erythema infectiosum – Parvovirus B19; Scarlet fever – Streptococcus pyogenes

Question 59

PED - 4.59 Which virus from the following list is the leading cause of congenital infections? A) EBV B) Zika-virus C) CMV D) HSV E) Rubella-virus

Answer 59

ANSWER C) CMV EXPLANATION CMV is the leading cause of congenital viral infections. Birth prevalence is 0,5-1,5% in recent years.

Question 60

PED - 4.60 How many percent of neonates with congenital CMV infection do have symptoms at birth? A) 5-10% B) 10-15% C) 15-20% D) 20-25% E) 25-30%

Answer 60

ANSWER B) 10-15% EXPLANATION 85-90% of CMV infected newborns are asymptomatic at birth.

Question 61

PED - 4.61 A seven year old girl had 7 days of cefixime treatment for UTI. Two days later she developed abdominal pain and diarrhoea with raised temperature up to 38.6 ºC. Her stool was mucous, bloody and has had loose bowel movements five times a day. On her physical examination distended abdomen and diffuse tenderness has been found. Which investigation would you perform to confirm the diagnosis? A) Detection of protozoa in stool sample B) Detection of Clostridioides difficile toxin and toxigenic C. difficile in stool sample C) Blood culture D) Detection of Rotavirus in stool sample E) Colonoscopy

Answer 61

ANSWER B) Detection of Clostridioides difficile toxin and toxigenic C. difficile in stool sample EXPLANATION Clostridioides difficile infection in otherwise healthy children is mostly self limited infection and the patient does not require antibiotic treatment. To confirm the diagnosis the presence of the toxigenic bacteria and the toxin should be detected in stool samples.

Question 62

PED - 4.62 A 4 year old girl has been brought to the Emergency Department with a 2 days history of fever up to 40°C, frequent vomiting and left sided upper quadrant abdominal pain. Urine microscopy results suggest UTI. According to the parents and previous medical records she has not got any underlying condition and anomaly in her urinary tract. At 11 month of age she was hospitalised with purulent meningitis and she spent 1 week on PICU. As part of mandatory surveillance from her anal swab a vancomycin resistant Enterococccus faecium strain was isolated. In view of this information after taking appropriate microbiological samples which antibiotic treatment would you start from the list below? A) iv. amoxicillin-clavulanic acid B) iv. ampicillin + gentamicin C) iv. ceftriaxone D) iv. linezolid E) per os trimethoprim-sulfamethoxazole

Answer 62

ANSWER C) iv. ceftriaxone EXPLANATION Ceftriaxone is an appropriate choice as empiric therapy. The most likely pathogen is Escherichia coli in this case. Earlier confirmed VRE colonisation is irrelevant this time.

Question 63

PED - 4.63 It is not typical manifestation of HIV infection in infancy and babyhood: A) Chronic weight loss B) Anaemia C) Infections with opportunistic pathogens D) Kaposi sarcoma E) Hepatosplenomegaly

Answer 63

ANSWER D) Kaposi sarcoma EXPLANATION HHV8 (KSHV) caused Kaposi sarcoma almost always occurs in HIV infected adult patients as a so-called indicator illness. In childhood it is extremely rare.

Question 64

PED - 4.64 Clinical pictures related to Pseudomonas aeruginosa infection are, except: A) malignant external otitis B) erysipelas C) neutropenic patients' blood-stream infection D) ecthyma gangrenosum

Answer 64

ANSWER B) erysipelas EXPLANATION Erysipelas is a superficial skin infection, involves the upper dermis, spreads through lymphatics and the patient generally has systemic symptoms like fever, chills and malaise. Most of the cases are caused by Streptococcus pyogenes, less frequently other beta-hemolytic streptococci or Staphylococcus aureus. Malignant external otitis typically occurs in older diabetic patients and there is an increasing number of cases in HIV infected patients.

Question 65

PED - 4.65 A 16 year old adolescent 18 months ago had myeloablative therapy followed by HSCT due to hematologic malignancy. His GP initiated amoxicillin/clavulanic acid therapy and on the 6th day of the treatment he developed a mucus-watery diarrhoea, abdominal pain, distension and confusion. What test would you choose first to perform? A) CMV serology B) CMV PCR on blood and stool sample C) detection of Clostridioides difficile antigen and toxin in stool sample D) routine stool culture (suitable to demonstrate presence of Salmonella, Shigella, Campylobacter spp. and Yersinia enterocolitica) E) Rotavirus antigen detection with bedside test

Answer 65

ANSWER C) detection of Clostridioides difficile antigen and toxin in stool sample EXPLANATION Risk factors for Clostridioides difficile infection are underlying hematologic disease, wide spectrum antibiotic treatment, chronic hospitalisation in anamnesis.

Question 66

PED - 4.66 You examine a 4 year old child at A&E with a 2 weeks history of coughing spells which sometimes terminate with vomiting. Child was born in Hungary and he has had all scheduled vaccines. Preceding current symptoms she had had mild URTI, low grade fever and conjunctivitis treated by GP with Tobrex eye drops. 7-10 days before the onset of her illness, grandparents who live in Australia, spent a couple of days with the family. Which pathogen from the list below is the most likely causative agent in this case? A) Bordetella pertussis B) Mycobacterium tuberculosis C) Streptococcus pneumoniae D) Haemophilus influenzae E) Corynebacterium diphtheriae

Answer 66

ANSWER A) Bordetella pertussis EXPLANATION Clinical presentation is typical of pertussis (whooping cough) so it should fall under suspicion. Prevalence of Bordetella pertussis pertactin-deficient strains in some countries is remarkably high (in Australia and USA it is above 70%).

Question 67

PED - 4.67 How many patients will die due to antibiotic resistant bacterial infection in 2050 according to WHO's forecast? A) 2.5 million B) 10 million C) 25 million D) 100 million

Answer 67

ANSWER B) 10 million EXPLANATION 10 million people per year.

Question 68

PED - 4.68 What is the most frequent infectious cause of death in childhood globally? A) bacterial pneumonia B) influenza C) malaria D) cholera

Answer 68

ANSWER C) malaria EXPLANATION Estimated child mortality due to malaria is around 2 million all over the world.

Question 69

PED - 4.69 One year old child of a family living in rural areas has been taken to hospital due to purulent meningitis. Family also keeps poultry, goats and neats around the house. The CSF microscopy shows Gram-positive rods. What antibiotic would you choose to treat this child? A) ceftriaxone B) ampicillin C) meropenem D) ceftriaxone + metronidazole

Answer 69

ANSWER B) ampicillin EXPLANATION People most frequently acquire Listeria monocytogenes by consuming not properly heat-treated milk and dairy products. It can rarely cause meningitis and more frequently gastroenteritis. Listeria has an intrinsic resistance against cephalosporins. First line antibiotic to treat Listeria infection is ampicillin.

Question 70

PED - 4.70 A 13 year old girl has been transferred to the hospital with fever, malaise following a week long summer holiday spent in a forest camp in the hills. At the time of the admission she seemed to be confused and complained of headache only. Taking her medical history we have found out that she had had mandatory vaccinations only and over the last year she has had irregular periods. On physical examination an outstanding erythema was noted all over her body. Her blood pressure was 83/42 mmHg. What is the most likely diagnosis? A) Dengue fever B) Lyme borreliosis C) Meningitis caused by Neisseria meningitidis D) Toxic shock syndrome

Answer 70

ANSWER D) Toxic shock syndrome EXPLANATION Based on the symptoms mentioned above the most likely diagnosis is toxic shock syndrome. This is a toxin mediated, life threatening, rapidly deteriorating illness. Bacteria producing toxin (TSST) responsible for the symptoms can get into the body by inappropriate use of tampons under non-hygienic circumstances

Question 71

PED - 4.71 A 7 year old child attends your GP practice with a 2 days history of fever, blood diarrhoea and spasmodic abdominal pain related to bowel motions. A few of his classmates have had similar symptoms over the last week. Not long before the class received a terrarium as a present with two painted turtles. All children from the class look after the animals. What contagious disease is spreading in the class? A) Giardiasis B) Shigellosis C) Salmonellosis D) COVID-19

Answer 71

ANSWER C) Salmonellosis EXPLANATION The correct answer is salmonellosis. Salmonella most of the cases acquired by consuming food like white meat, eggs which are contaminated with animals’ faeces. Reptiles kept as pets can be carriers of salmonella as well.

Question 72

PED - 4.72 A 17 year old adolescent has been taken to the hospital by Ambulance with a couple of hours history of raised temperature, headache, vomiting with suspected meningitis. On physical examination neck stiffness, Kernig positivity and one-sided serous nasal discharge was noted. He was accompanied by his sister who in answer to questions explained that his brother has not got any chronic illness, has never had operation or long term hospitalization. 6 months ago he was a victim of a ski-accident and had been observed in a Northern Italian hospital for 24 hrs with minor head injury. They can not show any documentation regarding this hospital stay. What is the most likely organism causing meningitis in this case? A) Neisseria meningitidis B) Staphylococcus aureus C) Haemophilus influenzae D) Streptococcus pneumoniae

Answer 72

ANSWER D) Streptococcus pneumoniae EXPLANATION Head injury in the anamnesis makes the Pneumococcus the most likely causative agent. Such an event can be found in the background in nearly 20% of the cases of bacterial meningitis. Often these injuries are minor

Question 73

PED - 4.73 These organisms can cause atypical pneumonia, except: A) Myoplasma pneumoniae B) Ureaplasma urealyticum C) Chlamydophila pneumoniae D) Respiratory viruses E) Chlamydophila psittaci

Answer 73

ANSWER B) Ureaplasma urealyticum EXPLANATION Ureaplasma urealyticum can cause genitourinary tract infections in pregnant women and has been isolated in association with neonatal infections as well.

Question 74

PED - 4.74 Different live virus vaccines can be given at the same time (eg. MMR and varicella or MMR and yellow fever). However, if they are not given at the same time, there should be an interval of at least 4 weeks between the administration of live virus vaccines. A) true B) false

Answer 74

ANSWER A) true EXPLANATION Shorter duration provides less protection due to interference in antibody responses.

Question 75

PED - 4.75 Target-like, non-growing erythema smaller than 5 cm is definitely not erythema migrans characteristic of Lyme disease. A) true B) false

Answer 75

ANSWER A) true EXPLANATION According to the Ministry of Human Resources Health Professional Guidelines for the Diagnosis and Treatment of Lyme Borreliosis 2020.

Question 76

PED - 4.76 Number one risk factor for childhood Streptococcal toxic shock syndrome is chickenpox. A) true B) false

Answer 76

ANSWER A) true EXPLANATION Bacterial superinfection of chickenpox eruptions may result in impetigo, cellulitis, severe bloodstream infection, and toxic shock syndrome.

Question 77

PED - 4.77 Passive immunisation against RSV in preterm (<32 gestational weeks) infants who exclusively consume breast milk is not recommended because maternal antibodies provide adequate protection against infection. A) true B) false

Answer 77

ANSWER B) false EXPLANATION The risk of developing severe RSV infection in preterm infants is high. Infection with the virus does not generate lasting and effective immunity, so antibodies that pass through breast milk do not provide an adequate level of protection.

Question 78

PED - 4.78 In infants less than one year of age, the classic symptoms of increased intracranial pressure in bacterial meningitis are observed in all cases. A) true B) false

Answer 78

ANSWER B) false EXPLANATION Due to the presence of fonticles, an increase in intracranial pressure does not always cause classical symptoms. However, protrusion and pulsation of the fonticles may be characteristic.

Question 79

PED - 4.79 Scarlet fever can only occur in association with Streptococcus pyogenes tonsillopharyngitis. A) true B) false

Answer 79

ANSWER B) false EXPLANATION Scarlet fever can also be caused by an erythrogenic toxin-producing S. pyogenes wound infection.

Question 80

PED - 4.80 BCG vaccine is primarily used to prevent pulmonary tuberculosis. A) true B) false

Answer 80

ANSWER B) false EXPLANATION BCG vaccination is primarily used to prevent two severe forms of tuberculosis in infants and young children: miliary tuberculosis, and tuberculous meningitis.

Question 81

PED - 4.81 Most neonates with HSV disease are born to mothers with a history of genital HSV infection. A) true B) false

Answer 81

ANSWER B) false EXPLANATION Most of the cases there is no history of maternal HSV infection or any other risk factors.

Question 82

PED - 4.82 Age-related mandatory vaccination in Hungary: 1) BCG 2) DTPa + IPV + Hib 3) Varicella 4) HPV A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 82

ANSWER A) Answers 1, 2 and 3 are correct EXPLANATION According to the Methodological Letter on Vaccinations 2021 of National Centre for Public Health BCG, DTPa + IPV + Hib and varicella are all age-related mandatory vaccinations. Vaccination against HPV is voluntary, free of charge and is part of school-based vaccination campaigns.

Question 83

PED - 4.83 Against which pathogens would you recommend vaccinations for a patient undergoing splenectomy? 1) S. pneumoniae 2) HPV 3) N. meningitidis 4) TBE A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 83

ANSWER B) Answers 1 and 3 are correct EXPLANATION Severe sepsis caused by bacteria with a polysaccharide envelope may develop after splenectomy, therefore immunisation against S. pneumoniae and N. meningitidis is of paramount importance (in addition to H. influenzae b). (TBE: tick-borne encephalitis)

Question 84

PED - 4.84 In which cases can the possibility of rabies be ruled out even with significant exposure? 1) bite caused by a laboratory animal 2) the animal causing the exposure is healthy and observable for 14 days 3) bite caused by an animal kept in a zoo 4) milk from a rabid animal has been consumed raw and undiluted 5 days before the onset of symptoms of the animal and mucosal injury of the person consuming the milk is also suspected (there was a wound, lack of epithelium in the mouth) A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 84

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION According to the Methodological Letter on Vaccinations 2021 of the National Centre for Public Health, the 4th answer listed above is considered suspected rabies infection only.

Question 85

PED - 4.85 Possible complications of invasive salmonellosis may include: 1) osteomyelitis 2) endocarditis 3) meningitis 4) splenic abscess A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 85

ANSWER E) All of the answers are correct EXPLANATION As a result of a bloodstream infection, each of the complications listed above may occur. The most common is osteomyelitis. Salmonella meningitis usually occurs in patient with an immunosuppressed condition.

Question 86

PED - 4.86 Antimicrobials used in the treatment of invasive aspergillosis: 1) fluconazole 2) voriconazole 3) acyclovir 4) amphotericin B A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 86

ANSWER C) Answers 2 and 4 are correct EXPLANATION Azoles for use in invasive aspergillosis: voriconazole, posaconazole, isavuconazole. Amphotericin and echinocandins are also effective. The latter are not the first line treatments.

Question 87

PED - 4.87 Which antiviral drugs are effective against CMV? 1) ganciclovir 2) oseltamivir 3) foscarnet 4) there's no approved treatment against CMV A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 87

ANSWER B) Answers 1 and 3 are correct EXPLANATION Oseltamivir is used in the treatment of influenza infections.

Question 88

PED - 4.88 Adequate therapy of laryngitis subglottica: 1) dexamethasone 2) inhalatory epinephrine 3) cold air 4) salbutamol A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 88

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Bronchial smooth muscles are not involved in the pathomechanism of laryngitis subglottica. To relieve symptoms inflammation and edema can be reduced by inhaling cold air, using steroids or using inhaled epinephrine.

Question 89

PED - 4.89 The following tests have to be performed on a 3 week old febrile neonate in all cases, EXCEPT: 1) lumbar puncture 2) blood culture 3) urinalysis and culture 4) abdominal ultrasound A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 89

ANSWER D) Only answer 4 is correct EXPLANATION At this age performing abdominal ultrasound scan is not an essential part of the investigations in case of febrile illness.

Question 90

PED - 4.90 Possible complications of tonsillopharyngitis caused by group A Streptococcus may include: 1) Rheumatic fever 2) Glomerulonephritis 3) Toxic shock syndrome 4) Ritter's disease A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 90

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Rheumatic fever, post-streptococcal glomerulonephritis, and toxic shock syndrome may all be complications of S. pyogenes infection. Ritter’s disease, also known as Staphylococcal scalded skin syndrome (SSSS), is a disease caused by an exfoliative toxin-producing Staphylococcus aureus.

Question 91

PED - 4.91 Part of the MIS-C diagnostic criteria, EXCEPT: 1) rash 2) acute gastrointestinal symptoms 3) cheilitis 4) confirmed COVID-19 infection A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 91

ANSWER A) Answers 1., 2 and 3 are correct

Question 92

PED - 4.92 A two week old newborn has been transferred to A&E by Ambulance with high fever, vomiting and seizures. What are the most likely pathogens in this case? 1) Streptococcus agalactiae 2) Herpes simplex virus 3) Listeria monocytogenes 4) Adenovirus A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 92

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION An infant at this age can have late-onset GBS sepsis. Listeria monocytogenes transplacental transmission can result in granulomatosis infantiseptica. If a neonate acquires infection after birth it can manifest as sepsis around a couple of weeks of age and symptoms often include meningitis. If the baby has high temperature and seizures we have to think of HSV and start acyclovir treatment as well.

Question 93

PED - 4.93 It could be symptom of congenital CMV infection: 1) microcephaly 2) intracranial calcification 3) hepatomegaly 4) conjugated hyperbilirubinemia A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 93

ANSWER E) All of the answers are correct EXPLANATION Newborns with congenital CMV infection show signs of infection in 10-15% of the cases. Symptoms can be severe, sepsis like syndrome with hepatosplenomegaly, petechial rash, conjugated jaundice. Newborns also can have microcephaly, intracranial calcification, hearing impairment.

Question 94

PED - 4.94 Clinical features of congenital varicella syndrome could be: 1) cutaneous scars in a dermatomal pattern 2) ocular abnormalities – optic nerve atrophy, cataracts, microphthalmos 3) limb abnormality – hypoplasia, atrophy, paresis 4) cheiloschisis A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 94

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Congenital VZV infection is rare but can have devastating effects on the foetus. Cheiloschisis is not part of the syndrome.

Question 95

PED - 4.95 Pathogens can cause hemorrhagic cystitis in patients with bone marrow transplantation are: 1) BK polyomavirus 2) CMV 3) Adenovirus 4) ESBL producing Klebsiella pneumoniae A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 95

ANSWER A) Answers 1, 2 and 3 are correct EXPLANATION ESBL producing Klebsiella pneumoniae can cause UTI but not hemorrhagic cystitis.

Question 96

PED - 4.96 Which clinical pictures could be manifestation of Bartonella infection? 1) monosymptomatic fever 2) cat scratch disease 3) trench fever 4) blood culture 'negative' endocarditis A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 96

ANSWER D) Only answer 4 is correct EXPLANATION Cat scratch disease mostly caused by Bartonella henselae, trench fever by Bartonella quintana. At least eight Bartonella species have been reported to cause infective endocarditis in humans.

Question 97

PED - 4.97 What are the characteristics of lipophilic antibiotics? 1) they have high volume of distribution 2) they have higher intracellular penetration and effectiveness 3) they reach damaged tissues and are degraded in the liver 4) they are cleared in kidneys A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 97

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Lipophilic antibiotics are for example fluoroquinolones, macrolides and tigecycline. Hydrophilic ones are β-lactams (penicillins, cephalosporins, carbapenems), aminoglycosides, vancomycin, colistin.

Question 98

PED - 4.98 What would you take into consideration initiating empiric antibiotic therapy in paediatric outpatient settings? 1) at least 90% of bacteria come into question should be sensitive to the chosen at least 90% of bacteria come into question should be sensitive to the chosen antibiotic antibiotic 2) the antibiotic should be as cheap as possible 3) the antibiotic should be administered the fewest possible occasion (ideally 1-2 times a day) 4) the medicine should have savouriness A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 98

ANSWER E) All of the answers are correct EXPLANATION All options should be considered to achieve maximal compliance and therapeutic success.

Question 99

PED - 4.99 Antibiotic treatment is justified in case of salmonellosis in childhood if: 1) the patient is younger than 3 months 2) patient with immunosuppression 3) if blood culture grows Salmonella sp. 4) if patients' stool culture is still positive beyond 2 weeks A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 99

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Prolonged stool culture positivity is not a reason for antibiotic treatment. On the contrary: having antibiotics can make the patient Salmonella carrier. Immunocompetent patients older than 3 month of age without complications need symptomatic treatment only.

Question 100

PED - 4.100 Which illness/illnesses has/have been eradicated due to the global vaccination programme? 1) diphtheria 2) poliomyelitis 3) measles 4) variola A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 100

ANSWER D) Only answer 4 is correct EXPLANATION Not more than two illnesses have been eradicated so far. These are smallpox (variola) and cattle plague. The latter is not a human illness.

Question 101

PED - 4.101 Which one(s) is (are) not a live vaccine(s)? 1) PCV 13 2) MMR 3) DTaP 4) BCG A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 101

ANSWER B) Answers 1 and 3 are correct EXPLANATION Trivalent MMR vaccine comprises attenuated viruses, BCG – mandatory for newborns in Hungary – has attenuated Mycobacterium bovis strain (Bacille Calmette Guérin) in it.

Question 102

PED - 4.102 Illnesses mainly (or partially) transferred by mosquitoes occuring in Hungary are the followings: 1) West Nile fever 2) Chikungunya fever 3) Tularemia 4) Trench fever A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 102

ANSWER B) Answers 1 and 3 are correct EXPLANATION In Hungary until present transported Chikungunya fever cases have been detected only. This disease is spread by Aedes aegypti and Aedes albopictus mosquitoes. Bartonella quintana caused trench fever can occur in Hungary but this infection is transferred by body louse (Pediculus humanus humanus).

Question 103

PED - 4.103 A 2 year old boy has been taken to A&E with a couple of hours of fever, confusion and vomiting. On examination he was pale, somnolent, it was difficult to communicate with him. There were a couple of petechiae on his extremitas distally and throughout the examination they have been spreading and have become confluent. There were no neck stiffness or any other signs of meningism present. Heart rate was 210 beats per minute. What diagnostic and therapeutic steps would you make immediately? 1) lumbal puncture 2) taking blood culture followed by initiation of ceftriaxone therapy 3) head CT with contrast 4) starting excessive parenteral fluid supplementation A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 103

ANSWER C) Answers 2 and 4 are correct EXPLANATION Based on clinical signs, very likely the patient has Neisseria meningitidis infection. The worst manifestation of the illness is Waterhouse-Friderichsen syndrome which can lead to death up to 80% of the cases and its symptoms could be apoplexy of adrenal glands, extensive ecchymosis and rapid collapse of circulation. Immediate start of antibiotic therapy and excessive fluid replacement can improve the outcome.

Question 104

PED - 4.104 Gastroenteritis with blood in the stool can be caused by: 1) Campylobacter jejuni 2) Giardia lamblia 3) Entamoeba histolytica 4) Calicivírus A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 104

ANSWER B) Answers 1 and 3 are correct EXPLANATION Viral pathogens and G. lamblia do not cause bloody diarrhoea. In the case of bacterial infection like Salmonellosis, Shigellosis, Campylobacteriosis patients can have symptoms of bloody stool. Similar symptoms can be present in 95-100% of the cases of Entamoeba infection and patients can have bloody stool.

Question 105

PED - 4.105 The first generation cephalosporins: 1) have good effect against most Gram-positive cocci 2) provide effective treatment in skin and soft tissue infections 3) have no effect against Enterococci and Listeria monocytogenes 4) are first line antibiotics to treat Escherichia coli caused UTIs A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 105

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION First generation cephalosporins have good effect against Gram-positive bacteria and they penetrate to soft tissue, skin and joints well but do not reach therapeutic concentration in CSF. They do not have an effect against Gram-negative bacteria, enterococci and Listeria.

Question 106

PED - 4.106 Complications of mumps could be: 1) meningitis 2) oophoritis 3) facial palsy 4) pancreatitis A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 106

ANSWER E) All of the answers are correct EXPLANATION Beside the above mentioned symptoms complication of mumps can be encephalitis, deafness, arthritis, myocardial involvement as well.

Question 107

PED - 4.107 Symptoms of acute giardiasis could be: 1) diarrhoea 2) urticaria 3) foul smelling, fatty stools 4) bloody stools A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 107

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Diarrhoea, fatty stools are frequent symptoms and in 10% of the cases urticaria is a concomitant phenomenon in Giardia infection.

Question 108

PED - 4.108 A five year old boy has been taken to your GP surgery by his parents with 2 days of fever and bilateral non-suppurative conjunctivitis. What illnesses does the differential diagnosis include from the list below? 1) Kawasaki disease 2) Mumps 3) Measles 4) Chickenpox A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 108

ANSWER B) Answers 1 and 3 are correct EXPLANATION Fever and ’red eyes’ – nonsuppurative conjunctivitis – can be symptoms of couple of infectious - measles, listeriosis, Staphylococcus and Streptococcus toxic shock syndrome – and non-infectious - Kawasaki disease, MIS-C, Stevens-Johnson syndrome - illnesses. Conjunctivitis can be a concomitant phenomena of adeno- and enterovirus infection. Patients with mumps or chickenpox typically won’t have conjunctivitis.

Question 109

PED - 4.109 Manifestations of Coxiella burnetii caused Q-fever could be: 1) granulomatous hepatitis 2) atypical' pneumonia 3) endocarditis 4) arthritis A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 109

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Arthritis is not symptome of Q-fever.

Question 110

PED - 4.110 Kawasaki disease symptoms are beside fever: 1) non-purulent conjunctivitis 2) mucositis 3) lymphadenopathy 4) rash with vesicles, blisters A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 110

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Rash in Kawasaki disease can be variable but never vesiculosus

Question 111

PED - 4.111 The following are typical features of animal bite wounds: 1) on the average five different types of bacteria grow from wound swab 2) 60% of the infections caused by mixed aerob and anaerob bacteria 3) human skin flora can be detected 40% of the cases 4) Pasteurella multocida rarely isolated from bite wound A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 111

ANSWER A) Answers 1., 2 and 3 are correct EXPLANATION Pasteurella sp. can be isolated from 50% of dog bite wounds and cat bite wounds it is 75%.

Question 112

PED - 4.112 Which immunocompetent patient should be treated with aciclovir? 1) 21 year old woman with recurrent genital HSV infection 2) 5 days old newborn with HSV skin infection 3) 9 year old child with herpes zoster 4) pregnant woman with varicella A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 112

ANSWER C) Answers 2 and 4 are correct EXPLANATION Newborns’ skin infection can become generalised causing severe, life threatening infection. Varicella in pregnant individuals can lead to significant morbidity and mortality.

Question 113

PED - 4.113 A 19 year old undergraduate who lives in a student hostel was admitted to hospital with hepatitis A infection. To whom would you give prophylactic hepatitis A vaccine out of his contacts? 1) his room-mate 2) his parents 3) his girlfriend 4) his teachers at university A) Answers 1., 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct

Answer 113

ANSWER B) Answers 1 and 3 are correct EXPLANATION Hepatitis A is transmitted in a faeco-oral way so those ones are at risk to get the infection who live close together or have intimate relationship with the infected individual. His teachers and his parents who live far away do not need vaccination

Question 114

PED - 4.114 CRP testing is essential for all children with fever, because the use of CRP as a diagnostic marker is as useful as in adults. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 114

ANSWER E) Both the statement and the reasoning are false EXPLANATION CRP testing is not suitable for making a diagnosis in children.

Question 115

PED - 4.115 Asymptomatic bacteriuria should be treated with antibiotics in pregnant women because of the association between pyelonephritis during pregnancy and low birth weight. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 115

ANSWER A) Both the statement and the reasoning are true, there is a connection between them

Question 116

PED - 4.116 Influenza vaccination can be given safely during pregnancy and is recommended because it protects not the pregnant woman only but passively the newborn for approximately 6 months after birth also. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 116

ANSWER A) Both the statement and the reasoning are true, there is a connection between them

Question 117

PED - 4.117 If the diagnostic criteria for erythema migrans are met, the diagnosis of Lyme disease cannot be made with complete certainty and serological testing for Borrelia burgdorferi should be performed in all cases. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 117

ANSWER E) Both the statement and the reasoning are false EXPLANATION Diagnostic criteria for erythema migrans (EM) vary depending on whether or not there has been a recognized tick bite in the area of erythema. In the former case, a diagnosis (and initiation of treatment) should be made if after 1 days of incubation a gradually increasing erythema of at least 5 cm in diameter that continues to grow for 3 days. If no tick bite is detected, erythema of at least 8 cm in diameter that is growing for another 5 days can suggest a clinical diagnosis. Elements of multiplex EM may be less than 5 cm. Thus, the diagnosis can be made based on clinical symptoms and no further serological testing is required.

Question 118

PED - 4.118 For patients with progressive varicella or immunosuppressed condition who also have atypical rash, intravenous acyclovir is recommended because no oral treatment is available for the causal treatment of varicella. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 118

ANSWER C) The statement is true in itself, but the reasoning is false EXPLANATION Intravenous acyclovir is recommended in the severe conditions mentioned above. However, a variety of oral acyclovir formulations are available.

Question 119

PED - 4.119 Shiga toxin-producing enterohemorrhagic E. coli (EHEC) infection requires immediate initiation of antibiotic therapy, as timely initiation of antibiotic therapy reduces the likelihood of developing HUS. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 119

ANSWER E) Both the statement and the reasoning are false EXPLANATION In the case of Shiga toxin-producing Enterohaemorrhagic E. coli (EHEC) infection, the use of antibiotics is contraindicated because Shiga toxin released from disintegrating microbes increases the chance of developing HUS

Question 120

PED - 4.120 Congenital heart defects in childhood are not considered to be an independent risk factor for infective endocarditis, as atherosclerotic plaques on the heart valves do not usually develop at this age. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 120

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION Congenital heart defects are independent risk factors for childhood infective endocarditis, central venous catheter, and rheumatic heart disease.

Question 121

PED - 4.121 Treatment of chickenpox rashes with a zinc solution is recommended as impetiginization is a possible complication of excoriated vesicles. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 121

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION Topical treatment of chickenpox rash is not recommended. Trimming of the nails and showers with lukewarm water or use of oral antihistamines to relieve the itching can be recommended

Question 122

PED - 4.122 Passive immunity provided by maternal IgG antibodies that pass through the placenta develop in the third trimester of pregnancy, therefore the shortening of this period in preterm infants is accompanied by a decreased ability to fight against infections. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 122

ANSWER A) Both the statement and the reasoning are true, there is a connection between them EXPLANATION IgG-type antibodies pass primarily through the placenta, while IgA antibodies pass through breast milk into the foetus and neonate. Disruption of these routes will result in loss of defences.

Question 123

PED - 4.123 Every pregnant woman with non-complicated varicella should receive oral aciclovir therapy because primary VZV infection during pregnancy has significant implications for maternal and foetal health. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 123

ANSWER A) Both the statement and the reasoning are true, there is a connection between them EXPLANATION If the varicella is uncomplicated then oral aciclovir is enough.

Question 124

PED - 4.124 Corticosteroid should be given in conjunction with anti-Pneumocystis therapy in case of moderate and severe PCP to HIV infected patients because its use improves the clinical outcome and mortality without increasing the risk of other opportunistic infections. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 124

ANSWER A) Both the statement and the reasoning are true, there is a connection between them

Question 125

PED - 4.125 Congenital CMV infection is the leading cause of non-hereditary sensorineural hearing loss so all newborn diagnosed with congenital CMV infection should receive ganciclovir therapy. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 125

ANSWER C) The statement is true in itself, but the reasoning is false EXPLANATION Newborns who have symptoms or hearing impairment at birth should get treatment only and it should be initiated within the first month of life. Therapy started later has not had a beneficial effect on infants’ hearing.

Question 126

PED - 4.126 A two month old infant can't have herpes zoster infection because the first manifestation of VZV infection is chickenpox. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 126

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION If the mother has chickenpox during the pregnancy then her child can have herpes zoster in early infancy. In this case the baby's primary infection occurs in utero unperceived.

Question 127

PED - 4.127 Children who have had invasive Hib infection before 24 months of age can remain at risk for a subsequent episode of invasive Hib disease because natural infection at this age does not reliably result in protective antibody levels. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 127

ANSWER A) Both the statement and the reasoning are true, there is a connection between them EXPLANATION Currently used Hib conjugate vaccines, as they have increased immunogenicity, induce T cell-dependent memory in children under 2 years of age, so the impotance of complete vaccination of all infants should be emphasized.

Question 128

PED - 4.128 Hepatitis A infected patients should be put in two weeks quarantine following the diagnosis has been established because hepatitis A infected patients become non-infectious a couple of days after they have turned jaundiced. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 128

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION Jaundice patients suffering from hepatitis A infection should not be put in quarantine because they are not infectious soon after they have become icteric

Question 129

PED - 4.129 As there is no viraemia during zoster infection so maternal zoster infection is as risky for the foetus as maternal varicella. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 129

ANSWER C) The statement is true in itself, but the reasoning is false EXPLANATION Maternal zoster is not risky for the foetus as zoster does not cause viraemia.

Question 130

PED - 4.130 Campylobacteriosis in childhood should be treated with antibiotics because this infection in this age-group presents as bloody diarrhoea in more than 50% of the cases. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 130

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION Campylobacter infection, generally mild, self limited disease, heals by itself without antibacterial treatment in most of the cases. Antibiotics need to be given to patients with severe presentations like high fever, extraintestinal infection, worsening or relapsing symptoms, or when symptoms last for more than a week. Patients at risk for severe disease are older, pregnant and immunocompromised individuals.

Question 131

PED - 4.131 Amoxicillin/clavulanic acid combination is a good choice to treat otitis media caused by Pneumococcus with reduced penicillin/amoxicillin sensitivity because the rise of penicillin/amoxicillin resistance is due to changes in the structure of penicillin binding protein. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 131

ANSWER D) The statement is false, but the reasoning is true in itself EXPLANATION Beta-lactam resistance among pneumococci is mainly dose dependent, it can be overcome by giving higher doses of amoxicillin – regular dose 30-50 mg/kg/day, increased dose 80-90 mg/kg/day. There is no role of beta-lactamase inhibitors like clavulanic acid when the increase of penicillin resistance is due to PBP structural changes.

Question 132

PED - 4.132 Tailored antibioticum therapy of established MSSA infection is one of the anti-staphylococcal penicillins or first generation cephalosporin because vancomycin's effect against enterococci is bacteriostatic only. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 132

ANSWER B) Both the statement and the reasoning are true, but there is no connection between them EXPLANATION Treatment of MSSA infection with anti-staphylococcal penicillin like flucloxacillin gives better outcome than vancomycin treatment. On the other hand vancomycin is bacteriostatic only against enterococci

Question 133

PED - 4.133 Newborn with Chlamydia conjunctivitis should be treated with oral macrolide because the use of topical erythromycin or tetracycline does not eradicate the pathogen agent. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 133

ANSWER A) Both the statement and the reasoning are true, there is a connection between them EXPLANATION Total eradication can be achieved with systemic antibiotic treatment only.

Question 134

PED - 4.134 In case of animal bites to treat wound infections the first choice antibiotic is amoxicillin/clavulanic acid combination, because this antibiotic is effective against most of the bacteria constituting the skin flore, the anaerobic bacteria and Pasteurella multocida as well. A) Both the statement and the reasoning are true, there is a connection between them B) Both the statement and the reasoning are true, but there is no connection between them C) The statement is true in itself, but the reasoning is false D) The statement is false, but the reasoning is true in itself E) Both the statement and the reasoning are false

Answer 134

ANSWER A) Both the statement and the reasoning are true, there is a connection between them EXPLANATION Infection of bite wounds in 60% of the cases is mixed, aerobic-anaerobic infection and in case of dogbites Pasteurella spp grows from 50% of the wound cultures.