Pediatrics - Infectious diseases (133) Flashcards
PED - 4.1
From which age can influenza vaccination be administered?
A) 6 months
B) 12 months
C) 5 years
D) 18 years
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.
PED - 4.2
Against which infectious disease is not post-exposure prophylactic vaccination available?
A) Hepatitis A
B) Tetanus
C) Varicella
D) Pertussis
ANSWER
D) Pertussis
EXPLANATION
Post-exposure prophylaxis vaccination against pertussis is not available.
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
C) 10 years
EXPLANATION
As postulated in the National Centre for Public Health’s 2021 Methodology Letter on Vaccinations.
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
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).
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
A) Convulsions in the family history
EXPLANATION
Convulsions in the family history should not be considered as a contraindication to vaccination
PED - 4.6
Administered as an oral vaccine:
A) DTaP
B) DTap + IPV + Hib
C) Varilrix/Varivax
D) Rotarix
ANSWER
D) Rotarix
EXPLANATION
Rotavirus vaccine is an oral suspension for oral use only.
PED - 4.7
Effective antibiotic against Pseudomonas aeruginosa, EXCEPT:
A) piperacillin / tazobactam
B) ceftazidime
C) ciprofloxacin
D) cefotaxime
ANSWER
D) cefotaxime
EXPLANATION
Among the third generation cephalosporins, cefotaxime and ceftriaxone are both ineffective against P. aeruginosa.
PED - 4.8
Common pathogens in endocarditis, EXCEPT:
A) Staphylococcus aureus
B) Alpha-hemolytic Streptococci
C) Enterococcus faecalis
D) Listeria monocytogenes
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.
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
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).
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
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)
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
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.
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
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.
PED - 4.13
Which therapy would you choose in RSV bronchiolitis?
A) dexamethasone
B) inhalatory ribavirin
C) supportive care only
D) remdesivir
ANSWER
C) supportive care only
EXPLANATION
Current evidence suggests the use of supportive care only.
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
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.
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
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.
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
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.
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
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).
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
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.
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
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.
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
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.
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
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).
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
A) Toxoplasma gondii, “Others”, Rubella Virus, Cytomegalovirus, Herpes Simplex Viruses
EXPLANATION
The TORCH acronym is well known in neonatology.
PED - 4.23
Complications of intrauterine Zika-virus infection may include:
A) subacute sclerosing panencephalitis
B) microcephaly
C) chorioretinitis
D) saddle nose
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.
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
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.
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
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).
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
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.
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
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.
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
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
PED - 4.29
Which virus does not belong to the herpesviridae family?
A) VZV
B) EBV
C) HHV7
D) WNV
E) CMV
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.
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
D) 2 doses of split vaccine in autumn 1 month apart
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
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.
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
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.
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
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.
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
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.
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
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).
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
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.
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
D) L. monocytogenes
EXPLANATION
Listeria monocytogenes is an intracellular pathogen and can cause severe, life threatening infections in neonates. It is sensitive to ampicillin.
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
A) amoxicillin
EXPLANATION
Based on the spectrum of the pathogens causing mild to moderate pneumonia in this age-group amoxicillin is an appropriate choice.
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
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.
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
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.
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
B) Yersinia enterocolitica infection
EXPLANATION
In case of Yersiniosis inflammation of periappendicular lymph nodes can mimic the symptoms of acute appendicitis.
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
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.
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
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.
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
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.
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
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.
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
A) scarlet fever
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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
