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FOP Infection

The document appears to be a series of medical questions and scenarios related to pediatric infections and treatments, including discussions on conditions like EBV infection, Kawasaki disease, and Lyme disease. It emphasizes the importance of timely diagnosis, appropriate antimicrobial therapy, and vaccination strategies for preventing infections in children. Additionally, it provides clinical guidelines for managing various pediatric health issues and outlines the implications of certain infections during pregnancy.

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Tabarak Bhuiyan
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50 views207 pages

FOP Infection

The document appears to be a series of medical questions and scenarios related to pediatric infections and treatments, including discussions on conditions like EBV infection, Kawasaki disease, and Lyme disease. It emphasizes the importance of timely diagnosis, appropriate antimicrobial therapy, and vaccination strategies for preventing infections in children. Additionally, it provides clinical guidelines for managing various pediatric health issues and outlines the implications of certain infections during pregnancy.

Uploaded by

Tabarak Bhuiyan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity © rate 1068) pte por Fite Question 1 of 90 Them Common infections LES) 3 Varceli-zostr vies Answer Select one ¥ Select one ¥ 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity Oo@ Pett 10) ps mp pet {12-year-old boy has 2 painful erythematous throat for which he is prescribed 9 broad is given when a child has EBV infection, it will cause a florid maculopapular rash, This is ne ‘some vesicles on her palms and toes. —_ \escls onthe hands an! foot and probably in the mouth it refusing food, are the reason cere) ©. mostimponant detarminan |; My account| RcPCH I MyPatest x [hom - 9 © rate 1068) mp ptr * ee & rabably inthe mouth if refusing food, are the reason ooo by Coranclil aus Ale rel 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ | Pats 0 [6 mp eco . k* £LeO Question 2 of 90 “Theme: Antimicrobial therapy Poco | {CCeftioxone 80 mara iv nous cefurosime SO ma/ko H Ora co-smoncinw {A S-year-od child oes 3s to the Emergency Department unwell achycardic and with an Answer frown group 8 S05 on the postnatal ward with probable sepsis. His mother had (ona high vaginal swab at 32 wooks answer select one ¥ 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Pate 1068 ppm paces koe & Scenario2 signs of respiratory distress and is systemically wall ©. mostimponant detarminan |; My account| RcPCH I MyPatest x [hom - 9 © Pate 0,68) mpm patercon . kt £LE peniclin - th treatment of choi. However would not Be used as a monotherapy ‘or the child is unwell, admission and use of intravenous antibiatics (@.3 tobramycin) should be reriousy considered eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ fe Pate 0,68) mpm patercon k* kLe Question 3 of 90 C_Trest those contacts as advised by the Consultant for Cm Contra CeBC) 1 Fi) most important determinan My account| RCPCH i] MyPastest - 9 © @ — & rmenti0(ce Question 3 of 90 Explanation aon Toa 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto Question 4 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x © Patt (08) protest pesto Question 4 of 90 Explanation er 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto : eee Question 5 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x © Patt (08) protest pesto Question 5 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto Question 6 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity O@ Pett 10) 5 mp pet m Blood testing is recommended to confirm diagnosis Exclude trom nursery for 7 days ater onset of rash Explanation ‘This ea descrition of parovirus infection, Avoid immunacompromised natent, pregnant ‘women and those with haematological conitions Parvowrus can cause a transient aplastic cris (ond thrombocytopensa ane neutropenia) ‘Slapped cheek is a aid ilness with a ash and id fever acd aceurs in rainy inthe spring. Itis aso known as Fifth dsease or human parvovirus infection. The face rash (reddening ofthe cheeks) is fllowed by 8 lace-tke rash on the Wunk and pation period fs 4-20 days. Chikiren are NOT contagious aftr the appearance ot he rach, Urls the child is obviously unwell, ther ater the onset of the ash Most women who are infected with parvovirus 9 in pregnancy have a satisfactory ‘utcome, However, infection before 20 weeks’ gestation may result in hycrops or death Mortality rate trom untreated hyerops is SO% (reduced to 18% by transfusion >20/40 no Replication of pervovirus inthe bone marrow can lad to red cel apes. Parvovius con cause transient aplastic crisis in patiants with ehronie anaemias seko col thalassemia essncateoman on 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ fe Pate 0,68) mpm patercon k* kLe ‘what i the MOST likey diagnosis? A kawaski cisease © Rubell ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | OB Pose) mypatentptereami Tenr : ek ene ———k—=E B Measles 7 Streptococcal infection = E Toxic shock syncrome arson Cae: ° Explanation eroone Tot ® Diagnostic criteria for Kawasaki cease: + Fever persisting for 5 days or more + Four ofthe folowing: -biatrel non- suppurative conjunctivitis - polwmorohous ‘mucosa -osdems and arythems of the hands ard feet -ilness not explained by 8 known desaee process ‘A.cinical sign which snot part of the casscal clinical eiteria for Kawasaki disease sa Inauration atthe Bac Calmette-Guerin (BCG) ste, may be presenti up to 5O% oF patients with Kawasaki cease, (Reza et a) ‘Atypical Kawaski disease imples that not all the agnostic criteria are met but clinically {he chide fle to have Kawasaki cease. and later coronary artery catation or other ppathegnemanic eters develop, Atyoical Kawasaki ceeage is more common minfant than In alder enren, 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity | SO RB Paes 0 68) mp ptertcom om x) he 2 Induration atthe Bact Caimette-Guérn (BCG) Ste, k may Be present in up to 50% at the child is felt to have Kawasaki disease, and later coronary artery dilatation or other [pathesnemanic erters develon, Atypical Kawasaki deense is more comman in infants than Inalder iron rita the folowing fining may sid ogra + erianal erythema + children are very miserable + Induraton at te of BCS 1 Acute stage (days): favor, conjunctivitis, oral changos,iertbilty, rash an function in the acute stage. 2. Subacute stage (11-50 days) lasts for 2! days and is when skin peeling, thrombocytosis and coronary artery aneurysms occur Thromboeytaris ea nte feature after eek | 5 Convalescent phase (730 days): expansion of aneurysm and possible myocarcal infection, Smaller seuryams may resolve 60% cases), CComalications: coronary artery aneurysms occur in 10-40% of untreated pationts. Most have a higher incidence of coronary artery aneurysms Intravenous immunoglobulin (VIG) i given within the fist 10 days of the ness ata cose of Bafa. This azoclated with 9 roduction in aymptoms and the Incidence of coronary arty Aneurysms. Aspinn antiinflammatory and antiplatelet effects. A high ose of 100 ma/ka er day Is used inthe acute phase, with a maintenance dose of S ma/ka per day in the Convalescent phase. Follow-up: al chien in whom the chagnosi of Kawasaki disease Is Suspectea should be referred for an echacardagram, 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ fe Pate 0,68) mpm patercon k* kLe Question 8 of 90 {6 year-old boy is involved ina oad tro ‘What i the BEST advice to avoid future pneumacoccal infections? A None of the below 1B Recommend immunisation with IS-valent PCV Recommend immunisation with 7-valent aneumococcal conjugate vaccine (PCV) Recommend immy ony {ation with 25-alent pneumacoceal paysaccharide vaccine ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | SOB Paes 68) mp pte cami Teton {A 6 year-old boy is involved in road trafic accident and requires 9 spionectomy, EZ \What is the BEST advice to avoid future pneumacoccal infections? ‘A None ofthe below . 18 Recommend immunisation with IS-valent PCV : Recommend immunisation with 7-alent pneumococcal conjugate vaccine (PCV) ————— Treat suspected bacteril sepsis erly end with intravenous antibiotics ‘ereones Covet: ° Explanation esoona Tot: 2 There shouldbe continued viglnce and early use of intravenous antilatis for suspected bactera spi. Proumococe:(Straptocaccus aneumonise) ar Gram positive ciplococs: and there are more ‘than 80 aistine serotypes. More than 6% ofthe population carry prounococc! in tele nasopharynx most of these being strains of low weulence Diseases caused by & pneumoniae + Ottis media + Sinusitis + Scarlat fever + Portoniis + Septic arthritis + Meningitis 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest » | dha | > OB Paes) mp pteream i Te : ek ene + Osteomysite + Meninaitis + Brain abscess, ‘Serious infection nthe UK Gnfermation fram the HPA 2003). Chen aged 2 years who fare at rk and aduite 965 years shoud receive the 28-alent PPV. Reimmunsation i= Fecommanded every § years. The Department of Health has a wealth of information fvalableonine (often rafered to a the Green mmmunieations Book) ~ tos gov uk/government/coletions/immunisaton-aceinst-nfetious-sseas0-the= green back Clinical at-risk aroun + Aaplenia or splenic dysfunction + Chronic resniratory dessee: cystic foros, cerebral paley or neuromuscular deorder with risk of aspration, bronchopulmonary dysplasia + Chronic heart dsaase + Chvonic renal cisease(nephvoti, chron renal falar and renal transplantation) + Diabetes requiting medication + Immunosuppression (antibody deficioney, immunodeficiency, HV. loukeemi) + Inaviduais with cochlear impnts + Incviduais with CSF lak aftr trauma or major skal surgery). The childhood immunisation schedule + The original Prevenar (was 7-valens PCY introduce in 2008 + The latest Prevenar 15x is now TS-valent (six extra strain) htos//wwo. gow uk/aovernment/uploads/systony/vooads/ttachment_data/tie/75570/9406_PHE_2015_Complete_immunisation Schedule At 21% riche ston @ eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © @ fe Pate 0,68) mpm patercon k* kLe 4 29-neek gestation ‘ith regard to childhood immunisations, what isthe BEST advice to ive to parents? © Immune Je from neonatal unt immunize now 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ fe Pate 068) mpm patercom . kt &£LeE \with regard to childhood immunizations, what isthe BEST advice to give to parents? A. mmunise at corrected gestational age of 2 months C_Immunise just before discharge from neonatal unt a Explanation arson Tota = Preterm babies may beat inroased risk of infection, They should be immuieed in ine with Reports corset OW he recommended schedule ftom 2 months of age after birth, no matter ow areterm they tps//awn gow uk/government/uplonds/systom/uploads/attachment_dataie/655695/Compiete_inm_schedule_2017 pa eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty Oo @ what is the next best step? © Preseribe doxeytine ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | SO Pass) myptesiptestcamessises/one 7 ek eae ‘8 10-year-clé ai is brought into hospital after a camping trp inthe New Forest She has Joie aveooe | developed a ringlke rash on her lea, What is the next bast step? Poor Responses % a © Prescrite doxyeyline . Take acute and convalescent borrelaserloay and arrange outpatient follow-up E _Take blood for borrala seroloay ‘erpones Coe: ° Explanation esoonse Tot “ ‘This history is typeal of Lyme clsease (https//mww. gov.uk/government/colletions/yme clsease-guidance-data-and-analysis). Lyme borreliosis is an infection caused by spirochaete ‘acter carried by ticks The indi ck i fen found on der, Late spring, erly summer and autumn are peak times for tick Feeding Cand camping). At last SO% of infections lscquted inthe Uk aro known to have occured in the southern counties, Highrise aees the Uk include the New Forest, Exmdar, the Lake Distt end the Scottish highlands Avoidance ofteinfosted areas, tho use of insect repellents and early removal of teks are Important because there no vaccine against Borrelia spp, ‘The most common symptom is 0 rash (may anpear after 3-50 days, spreading trom the se ofthe bite), The-bulls eye rash or erythema mgrans(lormeriy erythema ehveneu ‘migrans) may be seen with Lyme disease: may be painless or can feel ech an not. Fli- lke symotoms, fatal (Ge) palsy, nerve damage, meningitis, chronic fatigue, headaches. Empieal treatment with antblatis is advised. Blood should also be taken to confirm the clagnosis (with acute and convalescent samples akan for borrela serology). IM antibodies ©. mostimponant detarminan |; My account| RcPCH I MyPatest » | dha | > OB Posen) emptor : ek ene The most camman symptom I a ash (may appear after 5-40 days spreading from the ste lof the bite) The bullseye rash or erythema marans (former erythema chyoncum ‘migrans) may be seen with Lyme disease: may be painiess or can feel itchy and Not, Fi Fike symptoms, facil Ba) palsy, nerve damage, meningitis, chronic fatigue, headaches, Empcical treatment with antibiotics is advised. Blood should alsa be taken to confien the clagnosis (with acute and convalescent samples taken for borrela serology). IgM antibodies Inleated by high tres of loM antiooges. Treatment wth antioiatis is useful fr al stages of Lyme disease but is most successful cary inthe couree ofthe ines, + Oral ameoxélinCeilren 212 year: doxyeyeine) + 2/52: erythema migrans and itolated facial palsy (Bel palsy) + 4/52: Lyme artis ust please cay that standard treatment two weeks [Antnstomines may be tied. Doxyeyeine is prescribed in hose aged >12 years oF 09 an indviual bass after mierobiology advice incviual basis after microbiology advice, http//eks rice org.uk/lvme-disease eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Staphylococcus aureus ©. mostimponant detarminan |; My account| RcPCH I MyPatest > 0 @ se L068) mp pats am ‘What is the most key actiolony? [A Disseminated intravascular coagulation Staphylococcus aureus Staphylococcus epidermiais E Staphylococcal toxin Explanation Necrotising aseits shouldbe suspected in any child with a istry of varicella infection and an increasing complaint of pan and sweling In an extremity or other body area, associated ‘ith mreasing fever, erythema and letharay. ‘seth + Early and aggresive surgical debridement + Intensive antbitie therapy (usualy including clindamycin). Clinicians shouldbe alert tothe possibilty of increased risk of necrotisingfascitis when lbuprofen (non-steroidal antiinfiammatory drug or NSAID) i acministere for varieala vue infection. The mechanism may be by ether impairment ofthe immune response or masking the symptoms of secondary infection. leeding to delayed disanosis and treatment. NSAIDS tare cycloroxygenase nhibtors and may have adverse fects on neuroahis celhmeciated caemnalle kK eee ———— eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ fe Pate 0,68) mpm patercon k* kLe Question 12 of 90 A i2year- ol ot ith unper respiratory tract symptoms and a high fever for 3 Ez what is the next BEST stop? A Commence intravenous antibiotics and organise urgent CT scan of hea © Preserve ora ant 1D Rosssess after 48 hours of intravenous antibiotics ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | SO GB Pate 10468) 5 mypaespatesteam Sours iebromerS170 e £ee a B Commence oral antibiotics “ © Prescribe oral antihistamines e E Refer for ophthalmoloay outpatient assessment sessonas Cone ° Explanation pespones Tort ® ‘This sa case of orbital celultis which may cause bidness ands potential fatal Management wuld be to commence intravenous antbitics and organise an urgent CT scan ofthe nena “The following may be associated with fever headache and systemic malaise + ain asociated with blurred vision - painful ophthalmopieaia + Evidence of optic neuropathy (optic asc eedema) + Orta cet may occur asa result of ether extension of periorbital (oresepta cells ~ secondary to sinusitis or orbital rou, Management of orbital celui: + CT of the sinuses ane obit intracranial abscess is suspected + Rofer to ophthalmologists and ENT surgeons infection eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity © Pate 1068 ppm paces Le jestion 13 of 90 What isthe MOST Hy diagnosis? ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty > 0 @ Pett 1 ot protest psestcm/sherBomer 78 [A Aascular necrosis of femoral head 5 irtablehio © Post-streptococcal arthritis Septic arthritis Explanation Children with sickle elt disease are at risk of vascular occlusive erses Cand the long-term ‘complication of avascular necrosis), septic arthritis and osteomyelitis of the joints ‘This child had a fever. making infection most likely. A normal ultrasound scan makes the days (usually 2-3/52) after the infection has cleared and is fit to be an autoimmune: ‘There is some debate as to whether Salmonella so. or Staphylococcus aureus causes the ‘Slmonella osteomyelitis is rare in children: however. n patients with sickle cel disease itis the responsible pathogen in more than 50% of cases ‘The ifferentiation between the much more common bone crisis due to vascular occlusive crises and osteomyelitis i dificult to make. Antibiatic therapy should cover for Salmenella sp. and Staah. aureus. ‘Adequate analgesia and fi hydration are important aspects in the management of sickle caemnalle kK eee eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto Question 14 of 90 ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | 50 | renen 10460 sperma pentose et £LhO 'A7-yea-od develops fever with sore throat, cvicel ymphedencpathy and palatal os Wich investigations mos ely t ead tos agnosis? Per Responses A Blood eure for cas Fs aT C1 Cextomepsovins) in rine . Explanation ‘moose Tt * This sa descrition of Epstein-Barr virus Infectious mononucleosis (olanuar fever) is caused by infection withthe EBY. An infectious mononocieoss-ike illness cn be caused by other agents including CMV, adenovirus and toxoplosmosis EBV infection is often subcinial Clinical infection is are in the preschool group, Spread is by transmission of oral secretions Cessing cease), ‘The clinical features are of fever, pharynattis and lmohadenopathy. ‘The syndrome often petits for some wooks and @ postr fatigue syndrome can occur characteristic. Splenomegaly is seen in SOX. A smaller number of patents develop mid [auncice and hepatomenaly transient elevation of the transaminases. onfrmation Is by the Paul Bunn est or EBV seroloay/PCR ‘negative in glandular fever due to EBV infection. In such cass the presence of IgM antibody 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity | > OB Paes 068) mp prea Tes ek ene transient elevation ofthe transaminases, Confrmation ls by the Paul Bunnll est or EBV seroloay/PCR. tis important to realise that particularly n chilren 0 @ Pest L108) espn pate ee Explanation The orl contraceptive pill does cause erythema nodosum but. with cervical lymphadenopaty and history ofa kitten catscrateh case ete mort likly disgnosis in this caso (httos//wmw evidence nhssk/Searen?ascat scratch Catserotch cisease often begins witha small papule developing at the sito ofa et Cotten latte) serateh. Nearby lymph nodes become Swallen and ean persist for months. Other Symptoms include fever, malaise, headache and poor appetite A blood test for Bartonella + Streptococcal infection +18 + EBV infection + Systemic lupus erythematosus (SLE) + Crotn esoase + Borat synsrome + Sarcoidosis + Hodokin sence oY ry 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity what i the most Hel dingnosis? A Adenovirus © Cateraten sense 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity © @ | Pats 0 [6 mp eco kt ene jiuestion 16 of 90 Ccatscratch dsoase om mo = oo _Mycoboctorim tuberculosis sessones ncorect 2 Explanation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity | > OB Paste) emptor ek eae Explanation eseonar Kewrece OF ‘The is kel to prove to be a diagnosis of stypical mycobacterial infection (ATB). The key [Needle aspiration and incomplete excision of atypical mycobacteria result in ehvonic snus or Important eiferentis of persistent cervical Kmphadenonathy cM + Cat-scrateh oisense + Brucellosis + Actinomycosis + Malignancies (especially Iymohoma) Coneraisedlymahadenopathy is associated with most vial causes Kawasaki disease an + TB: often a history of TB contact weight loss or fevers, Mantoux/other TB testing incicated + Cat-scrateh aisear: history ofseratch from kitten (check fr Barton henseiae antibodies), + Lymphoma/leukaemia: usualy arsociated with larger nodes 3 em diameter), may be fem, hed and painless. Look fr associated hepatosplenomegaly pallor and bruising + Adenovirus often associated with fulness and generalised lymphadenapathy eee) oy €1_ Fi] mostimportant determinan | My account| RCPCH Bh mprastest x | © @ a rmentr0 (0 jestion 17 of 90 what i the most Hey dingnosis? © Congenital rubella ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | >0 a ses LD (8) mp pterteamis e : ek eae {aby is born with growth retardation, microcephaly, hepatosplenomegaly and pelechioe k= What i tne most key diagnosis? Poor Responses A Congenital CHV 2 © Congenital eubela | Congenital syphilis ‘sesion roms Explanation arson Tot » ‘The most likely agnosis is congenital toxoplasmosis, The TORCH screen (toxoplasmosis, ‘Smal-for-dte babies It is beter to test for specific conltions depending on clinical, ysrocephalus ea characteristic of congenital toxonlaemesis and not seen in congenital rubala or CMY infections, Mierocepnaly ana growth retardation may be seen inal tives infections Congenital rubs + Sensorineual hearing ass Growth retardation + Hepatesplanomeaaly + Petechiae blue berry muti ash + Bony involvement 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest » | dha | > OB Posen) emptor : ek ene + Cardiac anomalies + Bony involvement, Congenital CMY + Sensorinaural hearing loss + Mieracephaly caleficatons) + Pronounced growth reterdation (coneertel averse! High transmission rat; 40% mortality rate if untreated, Consider in very snufy’ child with hepatosplenomegoly and rash Osteachondrits ond perostitis CCongerital herpes simplex vis - Cutaneous scars or vesicles, Microcephaly and intracranial In pregnancy, the inflection can be passed on tothe fetus and cause cangenta tonoplaemasis There sa 40% risk of transmission f the mother ls infected during pregnancy. The rk of infection is higher the more advanced the pregnancy. However ‘manifestations are more serous the eal infection accute The caste tad of Fetinochoroicits, hydrocephalus and intracerebral coetention is uncommon. and the clinica ‘manifestations ae usually non-specte I infection siagnosed during prognoncy ten termination son option: alternatively spiramyein has been ven (se wr Naa.org uk for flow chart of management in pregnancy ) Nether pyrimethamine or sulfadiazine can be ‘iven during the fst trimester of pregnancy because both are teratogenic. They are used Tater n pregnancy, OF congenitally infected infants 90% are asymptomatic in the neonatal Perio. The infant may develo cnical symptoms months or years after birth, usually with eee) 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Patt (08) protest pesto + eee Question 18 of 90 8 Enterovius Human herpesvirus 6 (HHY-6) E Porvovius B19 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp peta + eee ‘hati the MOST lhkely dlagnosie? Poor Response 8 Enterovius E Porvovius B19 sesoo ° Explanation Peroni Toa 2 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x | Oo @ ‘what is the MOST likey diagnosis? © DiGeorge syncrome ©. mostimponant detarminan |; My account| RcPCH I MyPatest x |p SOB Paes 68) mp pte cami Teton ‘A S-year-od cid presents with chronic dlatrhoea, qeneralised lymphadenopathy, oral candida infection ana bilateral parcits What i the MOST lhkly dlagnosis? Chronic granulomatous cisease DI George syndrome E Wiscatt-Alarich syncrome: Explanation ‘This eile has signs of immunodeficiency and the key point nthe history that points to HIV Chien with HIV can present as failure to thrive or pyrexia of unknown oxgin, and have ‘generalised lymphadenopathy and/or hepatosplenomegaly with cancidlass and parotis ‘They may presant with infections secondary to immunodeficiency Diagnosis (WHO recommendations) In infants exposed to HV, the mother’s antibodies to HIV may be found inthe childs blood Up ta age 18 months, Accurate HIV testing <1/12 requires specioied testing, The ‘appropriate resource depends on availabilty oF resources and expertise. + Age <9 months PCR + Age 29 months, consider antibody testing) Note that antibody testing may not be diagnostic in children <18/12 Virology testing is recommended for chiren 18/12, += avoid lve vaccines including ive polio ond BCG essen cores = eee) 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity | > OB Posen) emptor x) he 2 + Avoid lve vaccines including ive polio and BCS Co-trimoxazole prophylaxis when CD4 counts low cto protect against Preumacysts highly active antiretroviral therpy (HAART) ~ nucleoside analogues (og :idovudine) and non-nucloside inhibitors (09 nevarapine) and protease inhibitors Cf children with AIDS inthe UK. 85% ocqure the elsease vertically. This can occur during pregnancy, during childbirth or through bresstfeeding. Current date show that HIV is passed (nto 258 of babies born to untreated HIV-infected mothers, but ony 4% of treated HIV Infected incviduals inthe USA, International, the rak of transmission is up to 48% 9 breastfed infant, but 24% no breaetfeecing occurs, Ris factors for vertical transmission of HW: + Higher viral load, + Vaginal delivery + Preterm and nostterm delivery + longed rupture of membranes + Breastfeeding + Cigarette smoking cere) Poe Fectors that redace the transmission rate 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty | 5 OG rae 10168 pnt po . kt &£LeE Factors that reduce the transmission rate: + Avoidance of breastteeaing + Zidovudine nucleoside reverse trenserbtase inhibitor) + Orally from second temester onwards + Oral to newborn for 6 weeks, + Combination antiretroviral therapy to women with more advanced disease or higher viral load (zidovudine plus second nucleside reverse transcrgtase inhibitor Dis non rncleosie reverse transcriptase inhibtr or protease inhibitor + Avoidance of rupturing of membranes i possible + Avodance of invasive procedures a fetal scalp blood somping + Passive immunisation of mathe and eid with HIV hyperimmune mmunoglodin ‘This ie a rare genetic dzorder resulting in abnarmaty of neutrophil membrane and inabilty te produce sunerocde radials. tis most usceptibie to cataose-portive bacteria (°3 ‘Staph. aureus, Solmonolis sp. €. eo, Candida and Aspergillus spp. Most common presentation swith severe infections ofthe skin ona mph nodes with abscess eemation. DiGeorge syndrome ‘Syndrome caused by 224 deletion affecting third ard feurth pharyngeal pouches. Features ‘vary widely. Characteristic features: congenital haart detect (especialy conetruncal ‘malformations such as tuncus arteriosus), palate Gefacts,larning dleabilty and recurrent Infections. Thsmic hypoplasia (absent thymus on neonatal cnet radiograph) eeu in ‘edieed T ces and increased infections, Hypoeslcasmia ress rom sbsent parathyroid ‘lands and may cause hypocalcnemic tetany inked corer of B calls (reuting in Haemonhilis sp. and Strep. pneumoniae) and Teele (esulting in nerpes, CHV and Pneumocystis =p) causing 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity - 9 $B | Bret 9 ep mpage * kL + Aveldance of rupturing of membranes if possible + Ayodance ot invasive procedures, 2 fetal scalp blood sampling + Passive immunisation of mathe and eid with HIV hyperimmune immunoglobulin CChronic granulomatous disease ‘This ea rare genetic deorder resulting in abnormalty of neutrophil membrane and inabilty fe produce superoxide radicals. kis most susceptible to catalase-portive bacteria (03 ‘Chronic aaernoes, npatosplenomegaly, preumonia and faltering growth are common ‘Syndrome caused by 224 deletion affecting thd and feurth pharyngeal pouches. Features \vary widely. Characteristic features: congenital hart detect (especialy conetruncal ‘malformations such as tuneus arteriosus), palate defects, learning dieabilty and recurrent Infections. Thsmic hypoplasia (obeant thymus on neonatal! chet raciograph) resus reduead T cols and increased infections, Hypocalcasmis rests rom absent parathyroid ‘lands and may cause hypocalesemie tetany. inked dsorder of B cals (resuting in Haemophilis sp. and Strep. prewmoniag ond T eels (fesulting in herpes, CHV and Pneumocystis sp) causing + chronic eczema + thrombocytopenia (very small platelets) eee) 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Patt (08) protest pesto m os [eeenel Question 20 of 90 HBsAg postive, HBeAg & hati the best advice? A Hepatitis @immunaglabulin should be even within 72 hours of birth 1B _The baby should receive bath the hepatitis B immunisation (at bith, 1 anc 6 months) and hepatitis B immunoglobulin © the hould receive only hep 1 8 mmunosjobulin a bith The baby should receive only hepatitis 8 immunisation Ct bith and 6 months) ©. mostimportant detarminan | My account| RCPCH > 0 @ Bh pest Pete 11 ot protest pesto kK eee {A mother who is hepatitis 8 postive asks you about the sk of vertical transmission. She is ‘A. Hepatitis 8 immunoglobulin shouldbe given within 72 hours of bith The baby should eceive only hepatits immunoglobulin at birth The baby should receive only hepatitis & immunisation (at th. | and 6 months) E the rk of transmission is 90% Explanation ‘Vertical transmission s thought to account for 40% of hepatitis @ worlawide. The hallmark of ongoing infection s the presence of HBsAg, The presence af antibody ta HBSAg alone Suggests Successful immunisation: ts presence along with ant-HEcAg suogests resolved Infection. Ths is mainly thought to occur around the time of bith “The risk of tranamission is increased to 290% if the mothers hepatitis Be’ antigen positive: dice immunisation and hepatitis 8 immunoslobuln Hepattis 8 immunosiobulin given a birth alone raduces the rik of vertical transmission. The tect of giving active immunisation (hepatitis B ynecine at ith, 1,2 and 12 months) and passive imeunsstion with hepatitis B immunoglobulin aditive ‘Active immunisation does nt seem to be affected by transmitted maternal SG. Hepatitis Bis spread by an infected mother passing itt her baby or by sexual contact or from blood/bieed products or sharing of nesdles ts important to prevent transmission and be immunize. eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest » | dha | SOB Pret 068) empresas ee : e+ eae expianation Response ON of ongoing infection isthe presence of HBsAg, The presence af antibody ta HBSAg alone Suggests Successful immunisation: ts presence along with ant-HCAg suggests resolved Infection. Ths is mainy thought to occur around the time of bi “The risk of transmission is increased to >90% if the mothers hepatitis Be’ antigen positive: dice mmunisston and hepatitis B immunoslobuln tect of giving active immunisation (hepatitis Bvnecine at rth, 1.2 and 12 months) ond passive immunisation with hepatitis B immunoglobulin ative Protection is achieved in 93% of neonates [Active immunisation does not seem to be affected by transmitted maternal IgG. Hepatitis is spread by an infected mother passing it to her boby oF by sexvol contact or from blood/biood products or sharing of needles lets important to prevent transmission Hepatitis B immunisation is indicated for anyone at increased risk of infection, eg workers live in close contact with someone infected wth hepatitis 8. Also: ” + Those with haemophia requiring Weotment eee) oy Blog About Pastest Contact Us Help 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto + eee Question 21 of 90 ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | 50 | renen 10460 sperma pentose et eLe ‘After rave to nda, a child develops massive splenomegaly, pancytopenia and hepatic ov fair, Sho hes very ry stn and he kins dork in pcos, Wats the MOST ley gnosis? eer errs A bricetoss © Epsten-Bor wins < © Motria | TT Schistosomisis Explanation eseones Tort = ‘This cincal picture ie simlar to that of malaria bu the key poin in the history isthe ory DARK skin blackening ofthe skin gave veceral eihmanaseits common name in indi eal-azar block Fever Causes of massive splenomesaly + Vacerl leishmaniasis + Malan (hyper-reactve malaria eplenomegaly) + Schistosomiasis: symptoms vary with species of the parasite invasion of the skin may + Gaucher syndrome (genetic disorder resulting fom glucocerebrosidase enzyme Sefcioney- storage diseases Fatty substance accumlates in Speen, iver and bone marrow) + (yatoibrsisy + (Chronic myeloid leukaemia) eee) 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest » | dha > OB Posen) emptor : Leishmaniasis Leishmaniasis isa zoonotic infection caused by a protozoon that belongs to Leishmania so Its traramitted by sande (not found on beaches but in forest/stone or md wal) Reported by US troops stationed in Saudis Arabia an faq, anal Soles in Alhanston, + Cutaneous Leishmania tropica and L, brass) <90% in Afghanistan Ian, Per, Saudia Arabia leer to granulation based wieers agnosie: skin smear with Giemsa stain andl microscopy mucoestaneous: 90% in S. America viscera L,donavan infantum and L. chagos) the mast serous and potently fatal presents with Fevers, weight loss, salenomegaly (may be massive), thrombocytopenia anaemia, leukopenia and hypergamvmolabulinaemia| Mice East and Africa, ‘visceral and cutaneous are the types most commonly dlagnased inthe UK. The incidence of leishmaniasis is increasing because of environmental changes (urbanisation) that increase exposure to the sandy. Covinfection with HIV has led to the spread of leshmonasi typicaly a rural disease to cies Leishmaniasis accelerates the Diagnosis 8y direct visualisation of Leishman-Donovan bodies, stains with Giemsa or cultore PCR and No vaccine for prevention curently Insect avoidance meosures Impregnate mosauito net Treatment cere) Poe 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle Oo@ Pass 1D ‘mypastest pastestcom’ * wk £he mucocutaneous: 90% in , Amer visceral (L.Gonavani infantum and. chagas) the mast serious and potently fata presents with fevers, welght los, splenomegaly (may be massive), thrombocytopenia, anaemia, leukopenia and hypergammolebuliaemia disease of reticuloendothelil system ~ mainly Inca, dangladesh S. America Visceral and cutaneous are the types most commonly clagnosed inthe UK “The incidence of lelmaniass i Increasing because of envrcrmental changes (urbanisation) that increase exposure to the sandy. Co-infection with HIV has led to the spread of leishmaniasis typically a rural dzease, to cles Leishmaniasis accelerates the 2 direct visualisation of Leishman-Donovan bodies, stains with Giemsa or cute. PCR and "No vaccine for provention curently Insect avoidance measures Impregnate mosquito net stinogluconate (pentivalent antimenial) and amphotericin Neve Been sea 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle o@ Pes L068) mp patsy + oe Question 22 of 90 & ‘What i the BEST advice to giv ater handling animals atthe farm? cH 7 provide extra benshit © Hanciashing with water is sufficient ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | SOB Paes 68) mp pte cami Teton ek ene | primary school rp is planned to a petting farm Many parents have expressed concerns ‘bout far-related infections sia! ‘What is the BEST advice to give ater handling animals atthe farm? Poor Responses A Mand gels alone are adequate protection es C Handwashing with hot unning water and soap, drying fllowed! by santising hand . ‘gels may provide extra benefit Handwashing witn waters suficent Session Poses E Hand wipes alone ae adequate protection arson cores = Explanation ferponae-Kearect \Weshing hends in hot runing weter with soepfolowed by ceeful doying after children have touched animals, removed shoes, touched fences or any surface within the frm zone. Whist Adattional use of hana ges may confer addtional benefit this does not form part ofthe ‘The HPA (Apri 2010) rovewed infections betwen 1992 and 2009, Diarrhoea. and even haemolytic uraemic syndrome, have been linked with petting farms Hand gels and wipes ae not effective in kiling Ecol or Crystosporcium sp. which can be found in animal droppings and on contaminated surfaces around farms so are nat sufcient rttes//www gov uk/aovernment/uplonas/=ystenv/uploade/attachment cata ie/sZ2usb/Farm_wsts_avorsing eee) oy 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty Oo @ ‘what is the best NEXT investigation? Stool tor microscopy, culture, ovo ystea and parasites ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | SO Paster) mypatesiptestcamessis es/ome 7 ek ene ‘yaleia ond dirrhoss. ‘what i the best NEXT investigation? Poor Respontae A Lumber puncture Bi B Rapid inluenza ciognostic test RIOT) « se) Stool for microscopy, culture, ova, cysts and parasites . Throet swab for MAS. ‘esooses Cone ° Explanation asoona Tota: ” Flustike symptoms of lethargy, headache and mala with larhosa and fever are malar Lunt proven otherws in a chic who hae bsen to an infected rea. Malaria should bs ‘Sinoectedf symptoms occur within 8 vear of return from infected area. Malaria is a potential fatal aiseas caused by the bite ofan infected female (Anopheles) ‘mosquito withthe peotozeen, Plasmodium sp. Malaria one ofthe leading causes of death + Thick lm = qui asgrosis ‘The god standard isa thick flm because t screens a greater quantity of blood than atin fim but ene appearance of the organism = distorted, Thin fms allow speciesdentieation ‘The film should bo repeated thee is any doubt. Blood cultures are Important because the ‘malaria screen may prove negative. Malaria Fever along with tu-ike symptoms ar common. aware ofthe predominance ‘gastrointestinal symatoms. Incorrect or delayed diagnosis is often mage assuming Val linesses, nfuenza, gatroenterts and hepattis, Palo, splenomegaly and thrombocytopenia 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity | > 0 @ ses LD 8) p/p pattem ek kh e Fever along with thi-ike symptoms are common. 88 aware ofthe predominance of nesses, niuenza gastroenteritis and hepatitis Palo, splenomegaly and tivombocytopenia + Seizures + rostration (inability t9 st/stand normally) + Respiratory distress + Haemoslobin <9. ypoatycaomi is common and is exacerbated by quinine trostment (which stimulates Insulin secretion. + Then oral quinine for 1/52 + + Fansidar(sulfdoxine pyrimethamine) ry oy €1_ Fi) mostimportant determina © My account| RCPCH O@ Bh mprastest x Question 24 of 90 Infra-red tympanic thermometers should routinely be use for infants under the age 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle Oo @ Pass 1D (8 mypastest pastestcom’ c ek £h According to NICE guidelines regarding the measurement of body temperature, which ONE EE ofthe following statements is considered to.be tue? A Tho routine use of oral thermometers is recommenced fr children aged 0-5 years orage: A 1B The routing use of rectal thermometers is recommended! for ehidren aged 0-5 < years of ae : C _nraved tympanic thermometers should routinely be used for infants under the age ofa weeks o 8m wm Forehead thermometers shouldbe used fist line by hestheare professionals in Explanation acer > ‘ed tympanic thermometer are all acceptable in children from 4 weeks to 5 years, electronic ‘ily readings should be ured for infants under tha age of 4 weeks perception of fever. eee) oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Patt (08) protest pesto + eee Question 25 of 90 cs ee ee oe oe CES sy) ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | > OB Fase 68) tmp percocet ek eae Regarcing the assessment of children with a fever (NICE 2018), which one ofthe following ks features suagests at least an intermediate risk fr serious liness? ‘A. heart rate of 40 in an 8 month ola a ——= 1D heortrate of 120 na 2 year ole 0 20 39 40 50 9 70 00 heart rate of 40 na your old sexs Progra Explanation a Knowledge af he advanced paedatife suppor (APLS) eer and NCE gudelnes ae epost » stent fr ths examination Resa eeareal See or Tachycaraia may reflect a serous febrile ness and measurement ofthe pulse rate Isa critical component ofthe assessment in these chlren ‘The following table is taken from NICE and isa guide for atleast an intermediate risk for sens ines, hite//wwwniceorauk/auidance/eat60/ Age Heart ate oem) - OB ae 68) tmp perenne ek eae ‘Regarding the risk of acquting foetal varicella syndrome, which one ofthe following ko ‘A. The rk of foetal varicella Infection s minimised through routine vaccination at age 8 The risk of foetal varicella infection i high in women whe have been ante-natally « ‘vaccinated against varceli zoster virus _— The ris of foetal varcla infection is high in women who have been ant : exposed varcel 20ster vias © me » mw» 0 @ E _Motezna! shingles isa mejor risk actor for foetolvariela infection ersones Tot * Explanation Fost! varcelin syndrome may manifest with microcephaly, learning cific, seizures and lye, bladder and im defects Cchickon pox infection during the fst hat of preananey poses the highest risk particulary ‘Ther sno routine vaccination programme although alive vaccine is availble. Infection after 36 weeks may cause neonatl chicken 90x eee) etn esion oy © Oo @ c [FD mostimportant determinan My account| RCPCH Bh mprastest x n tuberculosis (TE) world-wide over th constitute arise factor for caviring Tuberculosis? 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle o@ Pes L068) mp patsy + oe stion 38 of 90 & Which ofthe folowing is least likely to constitute a rsk factor for seauiring Tuberculosis? Explanation eso 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Patt (08) protest pesto m os [eeenel stion 39 of 90 A itisa vaccine preventable disease that mainly affects chidren aged 5-10 years and can take a matter of hours before parlisis develops & take a matter of hours before paralysis develops: . 1 itiea vaccine preventable bacterial infection that mainiyaffacts children blow E It lea vaccine preventable viral infection that mainly affects chilkiren over three ‘years of age and can take a matter of cays before paralysis develone ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | > OB Fase 68) tmp percocet we) eee ‘hich one ofthe fliowing statements s tue regarding polo? k= A. itis a vaccine preventobe disease that mainly atfets children aged 510 yours and Peer enconet can take a matter of hous before perayss develope e itis a bscteria infection that typical affects chien under the age of thre and . fakes year heen paraysis alone _— 1 itisa vaccine preventable bacteria infection that mainiy affects children blow sesion romress three yoors of age and can take a matter of hours before parle develops ———— - E _itisa vaccine preventable viral infecion that mainly affects chiren over thre os Bl ‘years of 936 and can tke a matter of cays before paralysis develons arson Tot “s Explanation Polo isa viral infection that is preventable through vaccination Ie typcally affects chleren under the age of three and it may only take afew haurs before paraiyis develops Most infected poopie are not affected but may transmit the disease to thousands of others {rough foseal mater oF respiratory dropot. ‘Symatomatiechiliran may present with f and vomiting ue and mois, headache, mo pain, headache (0.5% of atfected chitren wil develop flacld poral. ed remnant eerie eopecaera/oom eee) oN 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Patt (08) protest pesto m os [eeenel Question 40 of 90 ‘A S-year-old cid is brouaht to the en chils and vomiting 2 week & -gency department by his far with fx Which one ofthe folowing tests shouldbe arranged next to establish a rapid diagnosis of © Creactive protein Fullblood count ©. mostimponant detarminan |; My account| RcPCH I MyPatest x\ty | >0 a ses LD (8) mp pterteamis e : ek ene ‘A year-old chi is brovaht to the emergency department by his family with fever, sweats, k= headache, chils and vomiting 2 week after returning tothe UK from Uganda Which one ofthe following tests shouldbe arranged next to establish a rapid diagnosis of Poor Responses % his eonction? Blood fim ne a © Creactive protein om mo = 6 Full i009 count seein Progress Explanation eines Rear "Malaria is endemic in the tropical worl, especially sub-Saharan Africa and parts of south fast Arla. falciparum malaria isthe mast severe and potently atl cissase and isthe precominant species in Afi. This end may have P falciparum malaria In the Uk itis assumed thet al cases of Pflciparum malaria are chioroauine resistant and pid clognostic dipstick toting for parasite antigon is rogue given the eid is unwol 'Nevertholess, other infective agents should be considered including dengue fever, hsemorrhaaic fevers, hepatts and HIV. 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Patt (08) protest pesto m os [eeenel uestion 41 of 90 1 about their dauahter whom they believe may EEE & ‘what is the typical incubation peri of hepatitis A? A. The incubation prio is 17 days ©The incubation period is 7-21 anys The incubation peri is 4-21 dave 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle Oo @ & Pes L068) mp patsy eo ek uestion 41 of 90 Explanation ea is by Fooco-oral route, usualy by ingest ontaminated with infected Peter parece Drea 2 deel se torr tei lees! Sete worn “> 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp pet Question 42 of 90 ©. mostimponant detarminan |; My account| RcPCH I MyPatest - | SOB Pret 068) impatient x) he 2 ‘hich one ofthe following infections is notifiable disease in England? = mM fea Poor Respontae 8 Glandular fever D Leptospirosis a Explanation aaa ‘cal fever ithe only notiable seas, See ae S ttn. oovsk/ dance /octiable-dsaces and cavsatveorgaisms-how-t0 SESS report#ist-oF-notifiable-cseases “Typically the incubation period for scarlet fever i around 25 days although the range ie anything from a day toa week itis caused by group A streptocaccus. Those affected are infectious for up to 5 week Clinical features: + Fever 288.9%) + Lymhadenopathy + Rosh (doye2-5 of tlness, starts on neck and face, then spreads) + Rod chooks | Red/aurulent toni + Sore throat eee) + strawbery tongue + Tecryearsia 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x > 0 @ Pest L108) espn pate ee + Rash (days 2-5 of tness, stats on neck ond face, thon soreads) Rea/purl Strawberry tongue + Corebra sbecest + Glomeralonephrie + Meninaitis + Osteomyits + Sinusitis + Sepsis + Skin desquamation youn pater conSeveecna 705 ry oy 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x © Patt (08) protest pesto Question 43 of 90 ther fries? : Oo ® ses LD) smypatestpstestca m * In order to reduce the spread of norovrus, how would you advise Infected patents anc Posicutr avoae | their fies? a Recovery usualy occurs within 2 days but children should nat return to schoo for : at loast 3 days ator the last episode of vomiting and diarrhooa at least seven days after the lst episode of vomiting and daehoes esoones Tot ” Explanation eres etree ere eed se eee) rere rete es ethers mar vemiting Bug classically coures vomiting and darthoea. Alcohol gels may not kil viral partials hence eaping away from insttutlons suchas school and nursery fora east 48 hours ater the as fplcode of vomiting or larinoes, Pets sion @ eee) oy 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty © Patt (08) protest pesto + eee Question 44 of 90 a Somont-ol ils brouart to S60 you with bro a ©. mostimponant detarminan |; My account| RcPCH I MyPatest SO RB Paes 68) tmp {A S-month-ld ci is brought to see yeu with bronchitis k= ‘what oxygen saturation (whilst breathing in i ean ingieation For admission to hospital? 7 ee © Lesson 95% . Explanation a : ronchiolts typically occusin wnter/sprng and may be cased by respiratory syria —EEE win (RS. onrtignsn wn fens or agen monaco estan See Re Sreyeor a ge Promotors ar thse with congonta dears ae porary a 4 oF cision Breastfeeding corsidereato be protective ‘Admission eter RICE Guidance 9 Sek below nen assesingo cil no seconde core Sting, a thr o hosp! hey have any oF the folowing + epnoea (observed or reported) + positon onyoen stration of ss hon 92% when breathing air + nodequate oa Fi intake (0-755 of usual volume aking SEcount of isk {see recommendation|33] and ving cineal denen) 2 respiratory ate of over 70 bresths/minute eee https//mww nice orguk/guidance/na® 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp pet Question 45 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © @ | Pats 0 [6 mp eco . k* £LeO A ites ean survive aay from skin for up to 12 hours —— [Eyes ae aS Crowded conditions such as nursing homes, Skin contact fora significant time is required for a ea Clinical features: Patients may be asymptomatic for 4 wooks unless proviously infected Prrtic skin lesion ‘permethrin 5%, Secondary infections should be treated with systemic antibiotics and 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty o@ Question 46 of 90 ©. mostimponant detarminan |; My account| RcPCH I MyPatest SO RB Paes 68) tmp Which one ofthe following infections is typiesly associated with orchits? A Chicken pox 8 Moonee © Rubeta E Scarlet fever Explanation [Mums is a viral infection ang ntifiable illnes= httes//www. gov uk/guidance/nctitable-iseases-and-causative-organisms:howto report#list-ofnotifiable-ceeases Epidemiology Clinical features: + orchitie Complications + teri cmaied + Meninaitis + Encophaiits eee) 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity > 0 @ Pett 16 ps mp pst coma Searle fever Explanation Mums is a viel infection and natiabe less tos//uwn gov uk/auidonce/notitable- 0 @ {child prosonts with joint and abdominal pain. A nor-blanching rath ie notedion the Pete 1 ot ppt psec buttocks and leg hati the most Healy dingnosis? Acute lymphoblastic leukaemia Immune thrombocytepsenic purpura seu Explanation Clinical features of HSP include Abdominal pin Joint sweling one pain sh (ourpure,paticulrly on buttocks and lo98) Small vessel varcultie CComelicatins ince: Bowl infarction Glhaemorrhage Intussusception Myocardial infarction M1) eee) ©. mostimponant detarminan |; My account| RcPCH I MyPatest xity © @ fe Pate 068) mpm gaercom . ae Explanation ‘conn Tt “ + Rash (ourpuric, + Bowel infarction 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle wt . x) ee Question 51 of 90 & ry infectious and that there continue to be petiocic ‘mati the incubation period of sariet fever? 5 SAO days > 721¢e 8 days 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest xity caemnalle © rate 106) pte por . mia 8 + Red/purtont toni cael + Skin desquamation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity ° © Patt (08) protest pesto te aS juestion 52 of 90 For what length of time should the child be excluded ater their last eizode of cnrhoen? 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest © @ fe Pate 0,68) mpm patercon k* kLe Question 52 of 90 For what lenath of time should the child be excluded ater their last eizode of cnrhoen? Poor Responses % Explanation aon Toa 6 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty © Patt (08) protest pesto + eee Question 53 of 90 yen oe fe otowing commu vanes rene amor econ rm = €1_ Fi) mostimportant determina © My account| RCPCH Bh mprastest x © @ — & rmenti0(ce - 9 Question 53 of 90 Explanation aoomae nent ” 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty o@ Question 54 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest © Pate t10 (08) 5s mp paste Question 54 of 90 \Wihich one ofthe following is considered to bea ak factor for 8 Prolonged rupture of Explanation er * 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © @ Patent 6) matter * ee Question 55 of 90 ‘ofthe following microbes isthe most likely ae in this age group? 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x * &£Le © Patt (0) protest pesto Question 55 of 90 hich one ofthe following microb Explanation aon Toa ° 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp paste Question 56 of 90 Which one ofthe following sions is NOT a feature of serious fbi lines in infants 12 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate 1068 ppm paces awe Which one ofthe fllowsra sorts NOT Festi of serious fable tiness me 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest xity caemnalle © Patt (0) protest pesto + eee Question 57 of 90 You ore investigating a chil for suspected UT a Which one ofthe folowing a refrigerated within 4 hours? Js should urine be preserved in fit cannot be cultured oF en pectimportant determinan 5 My account| RCPCH J] MyFastest x\|ty © Pate t10 (08) 5s mp paste Question 57 of 90 Which one of the following acids should urine be preserva init refrigerated within hours not be cultured or Explanation "Okke ©. mostimponant detarminan |; My account| RcPCH I MyPatest xity - 9 o@ se D8) ip ype pico et kL EO uestion 58 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest © Patt (08) protest pesto Question 58 of 90 Explanation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp peta + eee Question 59 of 90 Wich oe ofthe folowing orl antibiotics shouts be ured ra nein the treatment of | en pectimportant determinan 5 My account| RCPCH J] MyFastest © Pate t10 (08) 5s mp peta WTS a[ol pote Rol mc ]0) Explanation saomae merece s 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty © Patt (08) protest pesto Question 60 of 90 Bh press x\|ty - @ © @ — & rmenti0(ce Explanation 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty © Patt (ot) protest pesto + eee Question 61 of 90 Which one ofthe folowing conditions are complications of impetigo? s 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp paste Question 61 of 90 Which one ofthe following conditions are complica ey eee Explanation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Pate t10 (08) 5s mp paste + eee Question 62 of 90 tite ul sat reatmnt dose fol exomatasone inthe retmentfehehond Fl pectimportant determinan 5 My account| RCPCH J] MyFastest xity caemnalle © @ Patent 6) matter * ee uestion 62 of 90 \what is the usual stat treatment dose of oral dexamethasone in the treatment of chilchood Explanation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle Oo@ ses L068) mp pats cay m ek eae ‘mats the usual stat treatment dose of oral dexamethasone in the trestment of chichood k= A o0smaria 8 o10ms/g © 025ma/ka 3 = oSmars sess Progres Explanation a Croup i vial acute laryngeracheobronchts and is unusual above 6 years of age. Causes eae Tt “ Ince paranfuenss adenovius, RSV. thus influenza and even measles Rengone-8Conect OX sea-tke cough, sore that, unny nose mila/maderate fever, Clinical features are a bark + stridor 1 Fi) mostimportant determinan | Myaccount|RCPCH | Myrastest x\|ty © Patt (08) protest pesto + eee Question 63 of 90 According to NCE what =the approrate tion of trestment wth rl abot or = Bh press x © @ — & rmenr0.ce uestion 63 of 90 Explanation 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp peta + eee Question 64 of 90 en pectimportant determinan 5 My account| RCPCH J] MyFastest xity caemnalle © @ Patent 6) mater * ee Question 64 of 90 Explanation saomae merece « 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp peta + eee Question 65 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x © Patt (08) protest pesto uestion 65 of 90 Explanation saomae merece 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x\|ty © Pate t10 (08) 5s mp peta + eee Question 66 of 90 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest © Pate t10 (08) 5s mp peta Question 66 of 90 Explanation saomae merece 0 © externa Links 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest x © Patt (08) protest pesto Question 66 of 90 ‘Won advising parents on the natural history ofthe common cold, whats the average total Explanation uponae nec 70 1 Fi) mostimportant determinan «My account| RCPCH i] MyPastest xity caemnalle © Pate t10 (08) 5s mp pet + eee Question 67 of 90 cere) proper OneDrive ©.) Frost teportnt deter |, + Mayor ACPO | Mri it - 9 OR Prstest 10 (38) eps /mppasest pastest.com’s iMe/Brome et £ Le ee ae == 24 months Explanation

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