Pediatrics - Infectious diseases Flashcards

Question 1

Q

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

ANSWER
A) 6 months

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

Question 2

Q

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

Answer

A

ANSWER
D) Pertussis

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

Question 3

Q

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

A

ANSWER
C) 10 years

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

Question 4

Q

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

A

ANSWER
C) 11 months

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

Question 5

Q

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

ANSWER
A) Convulsions in the family history

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

Question 6

Q

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

Answer

A

ANSWER
D) Rotarix

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

Question 7

Q

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

Answer

A

ANSWER
D) cefotaxime

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

Question 8

Q

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

Answer

A

ANSWER
D) Listeria monocytogenes

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

Question 9

Q

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

A

ANSWER
C) co-trimoxazole

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

Question 10

Q

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

A

ANSWER
B) 3-4 days

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

Question 11

Q

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

A

ANSWER
D) A, B and C are all correct

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

Question 12

Q

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

A

ANSWER
B) Exanthema subitum

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

Question 13

Q

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

Answer

A

ANSWER
C) supportive care only

EXPLANATION
Current evidence suggests the use of supportive care only.

Question 14

Q

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

A

ANSWER
D) Rotavirus

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

Question 15

Q

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

A

ANSWER
B) Thick and thin smear

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

Question 16

Q

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

ANSWER
A) amoxicillin

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

Question 17

Q

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

A

ANSWER
D) you don’t recommend antibiotic therapy

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

Question 18

Q

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

A

ANSWER
D) Poliovirus

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

Question 19

Q

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

A

ANSWER
D) If necessary initiate parenteral fluid replacement therapy

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

Question 20

Q

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

A

ANSWER
C) saliva

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

Question 21

Q

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

A

ANSWER
D) Clostridium botulinum

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

Question 22

Q

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

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

EXPLANATION
The TORCH acronym is well known in neonatology.

Question 23

Q

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

Answer

A

ANSWER
B) microcephaly

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

Question 24

Q

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

A

ANSWER
B) component of certain cells and an antibiotic group

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

Question 25

Q

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

A

ANSWER
D) Human parvovirus B19, rubella virus

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

Question 26

Q

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

A

ANSWER
B) S. agalactiae, E. coli

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

Question 27

Q

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

A

ANSWER
C) 6-7 days

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

Question 28

Q

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

A

ANSWER
C) HEV

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

Question 29

Q

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

Answer

A

ANSWER
D) WNV

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

Question 30

Q

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

A

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

Question 31

Q

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

A

ANSWER
D) asthmatic patients who receive 2 mg/kg prednisolone for 5 days during acute attack

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

Question 32

Q

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

A

ANSWER
C) campylobacteriosis

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

Question 33

Q

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

A

ANSWER
D) None of them

EXPLANATION
According to the prevailing departmental order 18/1998.(VI.3.) of the Ministry of Welfare, patients with cholera have to be isolated on Infectology Ward only and shigellosis if a patient needs to be admitted to hospital due to severity of illness.

Question 34

Q

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

A

ANSWER
B) Erythema infectiosum

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

Question 35

Q

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

A

ANSWER
B) Non-polio enterovirus

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

Question 36

Q

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

A

ANSWER
C) CMV PCR test on baby’s urine sample during the first three weeks of life

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

Question 37

Q

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

A

ANSWER
D) L. monocytogenes

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

Question 38

Q

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

ANSWER
A) amoxicillin

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

Question 39

Q

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

ANSWER
A) Hemolytic uremic syndrome

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

Question 40

Q

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

A

ANSWER
B) Electrolyte and fluid substitution

EXPLANATION
Giving antibiotics is rarely indicated to treat Salmonellosis in immunocompetent patients. Antibiotic treatment can increase the risk of becoming Salmonella-carrier.

Question 41

Q

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

A

ANSWER
B) Yersinia enterocolitica infection

EXPLANATION
In case of Yersiniosis inflammation of periappendicular lymph nodes can mimic the symptoms of acute appendicitis.

Question 42

Q

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

A

ANSWER
D) Tick-borne encephalitis

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

Question 43

Q

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

A

ANSWER
C) immunosuppressed condition

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

Question 44

Q

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

A

ANSWER
C) Scarlet fever

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

Question 45

Q

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

ANSWER
A) penicillin

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

Question 46

Q

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

ANSWER
A) scarlet fever

Question 47

Q

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

A

ANSWER
B) Reye syndrome

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

Question 48

Q

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

A

ANSWER
C) 9 years

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

Question 49

Q

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

A

ANSWER
C) Pneumocystis jirovecii

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

Question 50

Q

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

ANSWER
A) Hepatitis B immunoglobulin (HBIG) and HBV vaccine at birth, 1 month and 6 month of age

EXPLANATION
HBV infection leads to chronic disease in 90% of the cases if it occurs in neonates or young infants and the likelihood of hepatocellular carcinoma or cirrhosis to develop is 25%. All HBsAg positive mothers’ newborn have to be vaccinated with HBIG and HBV vaccine as well. HBV vaccine and HBIG should be administered at different anatomic sites.

Question 51

Q

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

ANSWER
A) adenovirus

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

Question 52

Q

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

A

ANSWER
C) Human herpesvirus 6/7

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

Question 53

Q

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

A

ANSWER
C) to prevent congenital toxoplasmosis pregnant women should be treated with spiramycin during the first trimester

EXPLANATION
Spiramycin treatment applied during the first 16 weeks of pregnancy generally prevents the foetal infection

Question 54

Q

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

Answer

A

ANSWER
B) Cat scratch disease

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

Question 55

Q

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

Answer

A

ANSWER
B) endocarditis

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

Question 56

Q

PED - 4.56
A 4 year old girl who attends day-nursery has been taken to A&E with a two days history of flu-like symptoms, loose stools, low grade fever of 38°C and loss of appetite. Laboratory test results show elevated ALT (651 U/l) and bilirubin (30 mmol/l) levels. What diagnostic investigation would you suggest to perform?

A) HAV antigen detection in stool sample
B) HBsAg detection in serum
C) Measurement of anti-HBsAg level in seum
D) Measurement of anti-HAV IgM level in serum
E) Stool culture to detect HAV

Answer

A

ANSWER
D) Measurement of anti-HAV IgM level in serum

EXPLANATION
Serum anti-HAV Ig M can be detected at the time of icterus and symptom onset. Detecting Ig M antibodies is the principle of the diagnosis.

Question 57

Q

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

Answer

A

ANSWER
C) iv penicillin G + iv clindamycin

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

Question 58

Q

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

Answer

A

ANSWER
D) Erythema infectiosum

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

Question 59

Q

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

Answer

A

ANSWER
C) CMV

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

Question 60

Q

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

Answer

A

ANSWER
B) 10-15%

EXPLANATION
85-90% of CMV infected newborns are asymptomatic at birth.

Question 61

Q

PED - 4.61
A seven year old girl had 7 days of cefixime treatment for UTI. Two days later she developed abdominal pain and diarrhoea with raised temperature up to 38.6 ºC. Her stool was mucous, bloody and has had loose bowel movements five times a day. On her physical examination distended abdomen and diffuse tenderness has been found. Which investigation would you perform to confirm the diagnosis?

A) Detection of protozoa in stool sample
B) Detection of Clostridioides difficile toxin and toxigenic C. difficile in stool sample
C) Blood culture
D) Detection of Rotavirus in stool sample
E) Colonoscopy

Answer

A

ANSWER
B) Detection of Clostridioides difficile toxin and toxigenic C. difficile in stool sample

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

Question 62

Q

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

A) iv. amoxicillin-clavulanic acid
B) iv. ampicillin + gentamicin
C) iv. ceftriaxone
D) iv. linezolid
E) per os trimethoprim-sulfamethoxazole

Answer

A

ANSWER
C) iv. ceftriaxone

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

Question 63

Q

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

Answer

A

ANSWER
D) Kaposi sarcoma

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

Question 64

Q

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

Answer

A

ANSWER
B) erysipelas

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

Answer 65

A

ANSWER
C) detection of Clostridioides difficile antigen and toxin in stool sample

EXPLANATION
Risk factors for Clostridioides difficile infection are underlying hematologic disease, wide spectrum antibiotic treatment, chronic hospitalisation in anamnesis.

Answer 66

A

ANSWER
A) Bordetella pertussis

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

Answer 67

A

ANSWER
B) 10 million

EXPLANATION
10 million people per year.

Answer 68

A

ANSWER
C) malaria

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

Answer 69

A

ANSWER
B) ampicillin

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

Answer 70

A

ANSWER
D) Toxic shock syndrome

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

Answer 71

A

ANSWER
C) Salmonellosis

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

Answer 72

A

ANSWER
D) Streptococcus pneumoniae

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

Answer 73

A

ANSWER
B) Ureaplasma urealyticum

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

Answer 74

A

ANSWER
A) true

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

Answer 75

A

ANSWER
A) true

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

Answer 76

A

ANSWER
A) true

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

Answer 77

A

ANSWER
B) false

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

Answer 78

A

ANSWER
B) false

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

Answer 79

A

ANSWER
B) false

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

Answer 80

A

ANSWER
B) false

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

Answer 81

A

ANSWER
B) false

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

Answer 82

A

ANSWER
A) Answers 1, 2 and 3 are correct

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

Answer 83

A

ANSWER
B) Answers 1 and 3 are correct

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

Answer 84

A

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

EXPLANATION
According to the Methodological Letter on Vaccinations 2021 of the National Centre for Public Health, the 4th answer listed above is considered suspected rabies infection only.

Answer 85

A

ANSWER
E) All of the answers are correct

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

Answer 86

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Azoles for use in invasive aspergillosis: voriconazole, posaconazole, isavuconazole. Amphotericin and echinocandins are also effective. The latter are not the first line treatments.

Answer 87

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Oseltamivir is used in the treatment of influenza infections.

Answer 88

A

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

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

Answer 89

A

ANSWER
D) Only answer 4 is correct

EXPLANATION
At this age performing abdominal ultrasound scan is not an essential part of the investigations in case of febrile illness.

Answer 90

A

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

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

Answer 91

A

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

Answer 92

A

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

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

Answer 93

A

ANSWER
E) All of the answers are correct

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

Answer 94

A

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

EXPLANATION
Congenital VZV infection is rare but can have devastating effects on the foetus. Cheiloschisis is not part of the syndrome.

Answer 95

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
ESBL producing Klebsiella pneumoniae can cause UTI but not hemorrhagic cystitis.

Answer 96

A

ANSWER
D) Only answer 4 is correct

EXPLANATION
Cat scratch disease mostly caused by Bartonella henselae, trench fever by Bartonella quintana. At least eight Bartonella species have been reported to cause infective endocarditis in humans.

Answer 97

A

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

EXPLANATION
Lipophilic antibiotics are for example fluoroquinolones, macrolides and tigecycline. Hydrophilic ones are β-lactams (penicillins, cephalosporins, carbapenems), aminoglycosides, vancomycin, colistin.

Answer 98

A

ANSWER
E) All of the answers are correct

EXPLANATION
All options should be considered to achieve maximal compliance and therapeutic success.

Answer 99

A

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

EXPLANATION
Prolonged stool culture positivity is not a reason for antibiotic treatment. On the contrary: having antibiotics can make the patient Salmonella carrier. Immunocompetent patients older than 3 month of age without complications need symptomatic treatment only.

Answer 100

A

ANSWER
D) Only answer 4 is correct

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

Answer 101

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Trivalent MMR vaccine comprises attenuated viruses, BCG – mandatory for newborns in Hungary – has attenuated Mycobacterium bovis strain (Bacille Calmette Guérin) in it.

Answer 102

A

ANSWER
B) Answers 1 and 3 are correct

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

Answer 103

A

ANSWER
C) Answers 2 and 4 are correct

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

Answer 104

A

ANSWER
B) Answers 1 and 3 are correct

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

Answer 105

A

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

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

Answer 106

A

ANSWER
E) All of the answers are correct

EXPLANATION
Beside the above mentioned symptoms complication of mumps can be encephalitis, deafness, arthritis, myocardial involvement as well.

Answer 107

A

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

EXPLANATION
Diarrhoea, fatty stools are frequent symptoms and in 10% of the cases urticaria is a concomitant phenomenon in Giardia infection.

Answer 108

A

ANSWER
B) Answers 1 and 3 are correct

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

Answer 109

A

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

EXPLANATION
Arthritis is not symptome of Q-fever.

Answer 110

A

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

EXPLANATION
Rash in Kawasaki disease can be variable but never vesiculosus

Answer 111

A

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

EXPLANATION
Pasteurella sp. can be isolated from 50% of dog bite wounds and cat bite wounds it is 75%.

Answer 112

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Newborns’ skin infection can become generalised causing severe, life threatening infection. Varicella in pregnant individuals can lead to significant morbidity and mortality.

Answer 113

A

ANSWER
B) Answers 1 and 3 are correct

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

Answer 114

A

ANSWER
E) Both the statement and the reasoning are false

EXPLANATION
CRP testing is not suitable for making a diagnosis in children.

Answer 115

A

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

Answer 116

A

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

Answer 117

A

ANSWER
E) Both the statement and the reasoning are false

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

Answer 118

A

ANSWER
C) The statement is true in itself, but the reasoning is false

EXPLANATION
Intravenous acyclovir is recommended in the severe conditions mentioned above. However, a variety of oral acyclovir formulations are available.

Answer 119

A

ANSWER
E) Both the statement and the reasoning are false

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

Answer 120

A

ANSWER
D) The statement is false, but the reasoning is true in itself

EXPLANATION
Congenital heart defects are independent risk factors for childhood infective endocarditis, central venous catheter, and rheumatic heart disease.

Answer 121

A

ANSWER
D) The statement is false, but the reasoning is true in itself

EXPLANATION
Topical treatment of chickenpox rash is not recommended. Trimming of the nails and showers with lukewarm water or use of oral antihistamines to relieve the itching can be recommended

Answer 122

A

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

EXPLANATION
IgG-type antibodies pass primarily through the placenta, while IgA antibodies pass through breast milk into the foetus and neonate. Disruption of these routes will result in loss of defences.

Answer 123

A

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

EXPLANATION
If the varicella is uncomplicated then oral aciclovir is enough.

Answer 124

A

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

Answer 125

A

ANSWER
C) The statement is true in itself, but the reasoning is false

EXPLANATION
Newborns who have symptoms or hearing impairment at birth should get treatment only and it should be initiated within the first month of life. Therapy started later has not had a beneficial effect on infants’ hearing.

Answer 126

A

ANSWER
D) The statement is false, but the reasoning is true in itself

EXPLANATION
If the mother has chickenpox during the pregnancy then her child can have herpes zoster in early infancy. In this case the baby’s primary infection occurs in utero unperceived.

Answer 127

A

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

EXPLANATION
Currently used Hib conjugate vaccines, as they have increased immunogenicity, induce T cell-dependent memory in children under 2 years of age, so the impotance of complete vaccination of all infants should be emphasized.

Answer 128

A

ANSWER
D) The statement is false, but the reasoning is true in itself

EXPLANATION
Jaundice patients suffering from hepatitis A infection should not be put in quarantine because they are not infectious soon after they have become icteric

Answer 129

A

ANSWER
C) The statement is true in itself, but the reasoning is false

EXPLANATION
Maternal zoster is not risky for the foetus as zoster does not cause viraemia.

Answer 130

A

ANSWER
D) The statement is false, but the reasoning is true in itself

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

Answer 131

A

ANSWER
D) The statement is false, but the reasoning is true in itself

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

Answer 132

A

ANSWER
B) Both the statement and the reasoning are true, but there is no connection between them

EXPLANATION
Treatment of MSSA infection with anti-staphylococcal penicillin like flucloxacillin gives better outcome than vancomycin treatment. On the other hand vancomycin is bacteriostatic only against enterococci

Answer 133

A

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

EXPLANATION
Total eradication can be achieved with systemic antibiotic treatment only.

Answer 134

A

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

EXPLANATION
Infection of bite wounds in 60% of the cases is mixed, aerobic-anaerobic infection and in case of dogbites Pasteurella spp grows from 50% of the wound cultures.

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Pediatrics - Infectious diseases Flashcards

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