Infection

Question 1

Hib meningitis is a/w which type of hearing loss?

Administration of what can reduce the risk of this? - NOT TO BE GIVEN <3m

Answer 1

Sensorineural
IV dex - NOT TO BE GIVEN <3m

Question 2

Long-term complications of bacterial meningitis

Answer 2

SNHL
Hydrocephalus
Intellectual disability
Epilepsy
Cerebral abscess
CN palsies

Question 3

Most common bacteria causing meningitis in neonates

Answer 3

** GBS **
E.coli
Listeria
S.aureus

Question 4

Most common bacteria causing meningitis in first few months

Answer 4

GBS
E.coli
H.influenzae
S.pneumoniae

Question 5

Most common bacteria causing meningitis in older infants / children

Answer 5

H.influenzae
S.pneumoniae
N.meningitides - meningococcal

Question 6

Protein/glucose/appearance/WBC in bacterial meningitis

Answer 6

Protein high
Glu low
Turbid (can be clear/viscous in TB)
High polymorphs ie neutrophils

Question 7

Protein/glucose/appearance in viral meningitis

Answer 7

Protein normal/slightly high
Glu normal/slightly low
Clear
High lymphocytes

Question 8

IV mx of SUSPECTED meningitis in hospital

Answer 8

<3m cefotaxime + amox/ampicillin (listeria cover)
>3m ceftriaxone
Triple therapy if low GCS/prolonged seizure: IV cef, aciclovir + macrolide (-mycin)
IV aciclovir if herpes virus suspected

Question 9

Treatment of pertussis/whooping cough

Answer 9

Macrolide e.g. erythromycin/clarithromycin
Pertussis = gram -ve

Question 10

Penicillin e.g. amoxicillin increases the risk of erythematous rashes if given in which viral infection?

Answer 10

EBV = human herpes virus 4 (which causes glandular fever = infectious mononucleosis)
Can get itchy macpap rash as SE

Question 11

Diagnosis of EBV

Answer 11

Monospot test (for heterophile ab produced in response to EBV)
Positive EBV serology
Blood film - atypical lymphocytes
LFTs: AST + ALT often raised i.e. can cause hepatitis

Question 12

What is the name of the progressive neuro disorder that arises after a prolonged latency period after infection with measles virus?
Symptoms?

Answer 12

Subacute sclerosing panencephalitis
- key words: NON-VACC / ADOLESCENT
- neuro sx ~6-8y post-infection e.g. severe developmental regression, myoclonic jerks, seizures, coma, death

Question 13

Measles symptoms/signs

Answer 13

Prodrome of high fevers, c+c, conjunctivitis 2-4d
Koplik spots
Blanching, macpap, confluent rash starting on face and behind ears -> trunk, limbs

Question 14

How long to stay off school with measles?

Answer 14

Min 4 days after initial development of rash

Avoid contact with immunocompromised

Notify local health protection team asap based on clinical suspicion rather than lab dx

Question 15

First line abx in lower (or cystitis) / upper (or pyelo) UTI

Answer 15

Lower: 3d trimeth/nitro
Upper: 7-10d co-amox

Question 16

Most common pathogen causing UTI in children

Answer 16

E.coli

Question 17

Follow up for typical/atypical/recurrent UTI in the age categories <6m, 6m-3yo, >3yo

Answer 17

Typical
<6m: USS 6w
6m-3yo: nil
>3yo: nil

Atypical
<6m: USS acute infection, DMSA 4-6m, MCUG
6m-3yo: USS acute infection, DMSA 4-6m
>3yo: USS acute infection

Recurrent
<6m: USS acute infection, DMSA 4-6m, MCUG
6m-3yo: USS 6w, DMSA 4-6m
>3yo: USS 6w, DMSA 4-6m

Question 18

Which vaccine/s CI in HIV?

Answer 18

BCG absolutely CI regardless of viral load/CD4 count as live vaccine

MMR may be CI depending on low CD4 count

Should get
- varicella vaccine (chickenpox, live) unless severe immunosuppression
- Annual flu vaccine from 2yo

Question 19

Mx of C.diff

Answer 19

1. Oral vanc
2. Oral fidaxomicin (or if relapse within 12w)

IV metro may be added to oral vanc in life-threatening infection

Question 20

Commonest cause of reactive arthritis
Other causes?

Answer 20

Chlamydia trachomatis

Question 21

GI causes of reactive arthritis

Answer 21

Salmonella
Shigella
Campylobacter

Question 22

Reactive arthritis triad

Answer 22

Arthritis
Urethritis
Conjunctivitis

Question 23

Which antigen associated with reactive arthritis?

Answer 23

HLA-B27