Infectious Disease

Question 1

Vaccination schedule?

Answer 1

2 months - 6in1, PCV, MenB, rotavirus
4 months - 6in1, MenB, rotavirus
6 months - 6in1, PCV, MenC
12 months - MMR, MenB
13 months - HiB/MenC, PCV

Junior Infants - MMR and 4in1
First Year - HPV, Tdap and Men ACWY

Question 2

What vaccines are in the 6in1?

Answer 2

diphtheria
tetanus
polio
pertussis
Hep B
haemophilus influenza B

Question 3

What vaccines are in the MMR vaccine?

Answer 3

measles
mumps
rubella

Question 4

What vaccines are in the 4in1 vaccine?

Answer 4

diphtheria
tetanus
polio
pertussis

Question 5

What vaccines are in the Tdap vaccine?

Answer 5

tetanus
low dose pertussis
low dose diphtheria

Question 6

Causes of bacterial meningitis?

Answer 6

children and adults -> NHS
neonates -> GBS, E coli, Listeria

Question 7

Presentation of meningitis?

Answer 7

fever
neck stiffness
photophobia
headache
vomiting
reduced consciousness
seizures
neonates -> hypotonia, poor feeding, lethargy, irritability, hypothermia, bulging fontanelle

Question 8

Special tests for meningitis?

Answer 8

Kernig’s test (lying on back with hip flexed and straighten knee- pain and resistance = positive)
Brudzinski’s test (lie on back and flex neck- knee and hip flexion = positive)

Question 9

Mx of meningitis?

Answer 9

in community give stat dose of IM benzylpenicillin before transfer
ideally LP before antibiotics but don’t delay
<3 months -> amoxicillin + cefotaxime
>3months -> ceftriaxone
dexamethasone to reduce hearing loss and neuro damage
acyclovir to cover for viral

prophylaxis to close contacts -> stat dose of ciprofloxacin or rifampicin

Question 10

Causes of viral meningitis?

Answer 10

herpes simplex virus
enterovirus
varicella zoster virus

Question 11

Lumbar puncture viral vs bacterial?

Answer 11

bacterial cloudy, viral clear
protein high in bacterial, normal in viral
glucose low in bacterial, normal in viral
neutrophil-predominant in bacterial, lymphocyte-predominant in viral

Question 12

Complications of meningitis?

Answer 12

sensorineural hearing loss
seizures and epilepsy
cognitive impairment and learning disability
memory loss
cerebral palsy

Question 13

Most common cause of encephalitis?

Answer 13

viruses
bacterial and fungal v rare

Question 14

Viral causes of encephalitis?

Answer 14

HSV (most common)
VZV
CMV
EBV
enterovirus
adenovirus
influenza
polio, mumps, rubella (always ask about vaccines)

Question 15

Presentation of encephalitis?

Answer 15

altered consciousness
altered cognition
unusual behaviour
acute onset of focal neurological symptoms
acute onset of focal seizures
fever

Question 16

Investigations for encephalitis?

Answer 16

LP
CT (if LP contraindicated)
MRI
EEG
swabs
HIV testing

Question 17

Contraindications for LP?

Answer 17

GCS<9
haemodynamically unstable
active seizures
post-ictal
meningococcal septicaemia
raised ICP

Question 18

Mx of encephalitis?

Answer 18

acyclovir (HSV, VZV)
ganciclovir (CMV)

Question 19

Complications of encephalitis?

Answer 19

prolonged recovery
fatigue
change in personality or mood
change to memory or cognition
learning disability
headache
chronic pain
movement disorders
sensory disturbance
seizures
hormonal imbalance

Question 20

What is infectious mononucleosis caused by?

Answer 20

Ebstein-Barr Virus

Question 21

Presentation of infectious mononucleosis?

Answer 21

fever
sore throat
fatigue
lymphadenopathy
tonsillar enlargement
splenomegaly (rarely splenic rupture)

rash after penicillins

Question 22

Complications of infectious mononucleosis?

Answer 22

splenic rupture
glomerulonephritis
haemolytic anaemia
thrombocytopenia
chronic fatigue
malignancy (Burkitt’s lymphoma)

Question 23

Most common complication post-meningitis?

Answer 23

sensorineural hearing loss

Question 24

Protection against mumps provided by the MMR vaccine?

Answer 24

80%

Question 25

Presentation of mumps?

Answer 25

pro-drome flu-like symptoms a few days before parotid swelling fever muscle aches lethargy reduced appetite headache dry mouth parotid gland swelling testicular pain (orchitis) abdo pain (pancreatitis) confusion, neck stiffness, photophobia (meningitis, encephalitis)

Question 26

Mx of mumps?

Answer 26

diagnosis confirmed by PCR of saliva notifiable disease supportive management

Question 27

Complications of mumps?

Answer 27

orchitis pancreatitis meningitis encephalitis sensorineural hearing loss

Question 28

Prevention of HIV transmission during birth?

Answer 28

normal vaginal delivery if viral load <50 C section considered if >50 and done in all >400 IV zidovudine if >10,000

Question 29

Prophylaxis for HIV in neonates?

Answer 29

low-risk babies where maternal viral load <50 should get zidovudine for 4wks high-risk babies should get zidovudine, lamivudine and nevirapine for 4wks

Question 30

Breast feeding in mothers with HIV?

Answer 30

never acceptable

Question 31

Testing of children with HIV positive parents?

Answer 31

HIV viral load at 3 months HIV antibody test at 24 months (antibody test may be falsely positive up to 18 months due to maternal antibodies that crossed the placenta)