Pediatrics- infectious diseases Flashcards by שני דוידפור

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

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

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

D)Pertussis
EXPLANATION
Post-exposure prophylaxis vaccination against pertussis is not available

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In case of injury with suspected tetanus infection, in addition to tetanus toxoid vaccination, the injured person should be given passive immunization 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 immunization, regardless of the time elapsed since the previous tetanus vaccination

C) 10 years
EXPLANATION
As postulated in the National Centre for Public Health’s 2021 Methodology Letter on Vaccinations.

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

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 neutralize the vaccine virus (measles, rubella, mumps, varicella).

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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

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

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

D) Rotarix
EXPLANATION
Rotavirus vaccine is an oral suspension for oral use only.

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

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

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

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.

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

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).

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

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)

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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

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.

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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

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.

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Which therapy would you choose in RSV bronchiolitis?

A) dexamethasone
B) inhalatory ribavirin
C) supportive care only
D) remdesivir

C) supportive care only
EXPLANATION
Current evidence suggests the use of supportive care only.

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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

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.

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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

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.

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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

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.

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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

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).

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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

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

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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

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.

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

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.

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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

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).

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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

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

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

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.

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

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.

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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

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).

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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

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.

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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

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.

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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

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

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

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.

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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

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

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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

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.

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

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.

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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

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.

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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

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.

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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

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).

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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

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.

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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

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

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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

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

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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

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.

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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

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.

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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

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

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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

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.

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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

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.

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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

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

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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

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.

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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

A) scarlet fever

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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

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.

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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

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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

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.

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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

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.

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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

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.

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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

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.

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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

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

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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

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

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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

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

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

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.

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

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.

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

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

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

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

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%

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

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

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.

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

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 colonization is irrelevant this time.

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

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.

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

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.

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

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.

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

A) Bordetella pertussis
EXPLANATIONClinical 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%)

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

B) 10 million
EXPLANATION
10 million people per year.

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

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

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

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.

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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.

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

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.

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

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

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

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.

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

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

Age-related mandatory vaccination in Hungary:
1) BCG
2) DTPa + IPV + Hib
3) Varicella
4) HPVA) 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

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.

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

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

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

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.

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

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.

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

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.

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

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

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

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.

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

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.

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

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.

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

A) Answers 1., 2 and 3 are correct

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) AdenovirusA) 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

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.

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

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.

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

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

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

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

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

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.

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

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.

What would you take into consideration initiating empiric antibiotic therapy in pediatric outpatient settings?1) at least 90% of bacteria come into question should be sensitive to the chosen 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

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

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

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.

Which illness/illnesses has/have been eradicated due to the global vaccination program?
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

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.

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

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.

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

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).

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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

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

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

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

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%.

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

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.

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

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

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

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

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

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

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

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

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

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.

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

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.

Shiga toxin-producing enterohemorrhagic E. coli (EHEC) infection requires immediate initiation of antibiotic therapy, as timely initiation of antibiotic therapy reduces the likelihood
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

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.

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

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.

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

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.

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

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.

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

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.

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

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

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

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.

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

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.

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

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 importance of complete vaccination of all infants should be emphasized.

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

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

As there is no viremia during zoster infection so maternal zoster infection is as risky for the fetus 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

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.

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

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.

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

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.

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

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.

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

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.

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

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

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Pediatrics- infectious diseases Flashcards

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