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79 Cards in this Set

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Gram-positive cocci in clusters are usually a staphylococcal species and coagulase-positive status makes it
S. aureus.
Gram-positive cocci in clusters are usually a staphylococcal species and coagulase-negative status makes it
S. epidermidis is a coagulase-negative species and is often a contaminant in blood cultures.
A 20-month-old boy is brought to his pediatrician by his parents for evaluation of the child's prolonged fever. He was seen 10 days ago in a community health clinic and was prescribed a 5-day course of amoxicillin for a presumed upper respiratory tract infection. Since then, there is no improvement in the fever. The child has no previous history of serious illness. He currently receives children's Tylenol for treatment of his fever. Vital signs are temperature: 104.5° F, blood pressure: 105/65 mm Hg, heart rate: 105 beats/minute, and respiratory rate: 16 breaths/minute. The child is extremely irritable. Bilateral nonexudative conjunctivitis, pharyngeal edema, strawberry tongue, and dry fissured lips are present. The neck is supplied with left unilateral cervical adenopathy. There is desquamation of the fingers and the toes encroach onto the child's palms and soles.


Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Aspirin
B. Methotrexate
C. Colchicine
D. Penicillamine
E. Nifedipine
F. Ampicillin
G. Streptomycin
H. Chloramphenicol
I. Acyclovir
J. Metronidazole
Option A (Aspirin) is correct. Although other life-threatening illnesses such as meningitis must be ruled out, sufficient signs and symptoms are present to begin empiric treatment for suspected Kawasaki disease. Gamma-globulin and aspirin are the first line combination pharmacotherapy.
KEY POINTS: DIAGNOSTIC FEATURES OF KAWASAKI DISEASE (7)
1. Erythema of oral cavity and dry, chapped lips
2. Conjunctivitis: Bilateral and without discharge
3. Edema/erythema and/or desquamation of hands and feet
4. Cervical lymphadenopathy
5. Polymorphous exanthem on trunk, flexor regions, and perineum
6. Fever, often up to 104°F, lasting ≥5 days
7. No other identifiable diagnostic entity to explain signs/symptoms
A 7-year-old Turkish girl is brought by her Aunt to the emergency department with a complaint of fever and abdominal pain. The child was well until 8 hours ago when the fever and pain abruptly developed. She is now also complaining of pain in her knees and ankles. Vital signs are temperature of 103.3° F, blood pressure: 120/70 mm Hg, heart rate: 90 beats/minutes and respiratory rate: 15 breaths/minute. The patient appears acutely ill. Head and neck examination is normal. Chest examination is normal to auscultation and percussion. Cardiac examination shows normal rhythm without rubs, gallops, or murmurs. The abdomen is board-like with generalized tenderness, decreased bowel sounds and splenomegaly. Knees and ankles are warm, red, and swollen bilaterally with a warm erythematous rash present below the knees. Among the patient's laboratory values is a urinalysis showing 2+ proteinuria.

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Aspirin
B. Methotrexate
C. Colchicine
D. Penicillamine
E. Nifedipine
F. Ampicillin
G. Streptomycin
H. Chloramphenicol
I. Acyclovir
J. Metronidazole
Option C (Colchicine) is correct. A young child of Turkish descent with abrupt onset of fever, abdominal pain, splenomegaly, arthritis, proteinuria, and the characteristic rash described has a likely diagnosis of familial Mediterranean fever. Colchicine therapy significantly reduces the incidence of future attacks and often prevents progression to death from amyloidal-associated renal failure.
A young child of Turkish descent with abrupt onset of fever, abdominal pain, splenomegaly, arthritis, proteinuria, and the characteristic rash described has a likely diagnosis of
Mediterranean fever, Heredofamilial Amyloidosis
A 1-month-old boy is brought to his pediatrician's office with a complaint of fever. The fever began 1 day ago. In addition, the mother reports the child has been crying for much of the past day. He is not consoled by attempts to feed or by physical comforting. No medications have been administered. Vital signs are temperature: 101.4° F, blood pressure: 105/70 mm Hg, heart rate: 88 beats/minutes, and respiratory rate: 17 breaths/min. The child shows no eye contact on examination, does not smile, and does not seem to interact with the environment. He appears mildly jaundiced and shows poor capillary refill. No skin rash is present. His neck is supple. Chest, cardiac, and abdominal examinations are benign. Pan-cultures, screening labs and a chest x-ray are ordered. Initial laboratory tests show:

Blood glucose: 55 mg/dL
Serum bicarbonate: 18 mEq/L
Total bilirubin: 6 mg/dL
WBC: 14,000/cc
Immature to total neutrophil ratio: 0.30. Initial management includes intravenous gentamicin.

End of set

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Aspirin
B. Methotrexate
C. Colchicine
D. Penicillamine
E. Nifedipine
F. Ampicillin
G. Streptomycin
H. Chloramphenicol
I. Acyclovir
J. Metronidazole
Option F (Ampicillin) is correct. Hypoglycemia, metabolic acidosis, and jaundice all are metabolic signs that commonly accompany neonatal sepsis syndrome. WBC counts <15,000/cc in neonates not immunized with pneumococcal vaccine are reported 70% sensitive and specific for occult bacteremia. Immature to total neutrophil ratio of 0.12 is the maximum acceptable level for exclusion of neonatal sepsis. Empiric treatment should not await the outcome of culture results. Combined IV aminoglycoside and penicillin or aminopenicillin and a cephalosporin therapy provide gram-positive and gram-negative coverage especially for group B streptococcus and E. coli.
can help with urticaria and other pruritic rashes
A. Acyclovir
B. Diphenhydramine
C. Eucerin cream
D. Glucocorticoids
E. Neomycin sulfate (Neosporin)
Option B (Diphenhydramine)
topical emollient used in skin conditions such as eczema.

A. Acyclovir
B. Diphenhydramine
C. Eucerin cream
D. Glucocorticoids
E. Neomycin sulfate (Neosporin)
Option C (Eucerin cream)
useful as a topical antibiotic to help with the healing of abrasion and lacerations.

A. Acyclovir
B. Diphenhydramine
C. Eucerin cream
D. Glucocorticoids
E. Neomycin sulfate (Neosporin)
E. Neomycin sulfate (Neosporin)
A 28-year-old man presents to the physician because of a lesion on his penis that has been present for 3 weeks. He denies any symptoms associated with the lesion. Physical examination reveals a 1.5-cm ulcer with raised, indurated margin and nonexudative base. A Venereal Disease Research Laboratory (VDRL) test is positive. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Aqueous penicillin
B. Benzathine penicillin
C. Chest X-ray
D. Fluorescent treponemal antibody absorption (FTA-ABS) test
E. Lumbar puncture
Option D (Fluorescent treponemal antibody absorption [FTA-ABS] test) is correct. The described lesion is characteristic of a chancre, the presenting sign of primary syphilis. The diagnosis of syphilis can be visual, serologic, or molecular methods, because Treponema pallidum does not grow in the laboratory. Serologic methods are the most commonly employed. Patients are first screened with either the VDRL test or a rapid plasma reagin test. If this test is positive, it requires confirmation, as there are numerous causes resulting in false-positive tests. Confirmatory tests are called treponemal tests and are qualitative (i.e., the test is either reactive or nonreactive). The most commonly used is the FTA-ABS test.
treatment for neurosyphilis, which presents with posterior column degeneration (called tabes dorsalis) and the Argyll Robertson pupil (accommodates to light, but does not react).
A. Aqueous penicillin
B. Benzathine penicillin
C. Chest X-ray
D. Fluorescent treponemal antibody absorption (FTA-ABS) test
E. Lumbar puncture
A. Aqueous penicillin
This is appropriate therapy for treatment of primary syphilis.
A. Aqueous penicillin
B. Benzathine penicillin
C. Chest X-ray
D. Fluorescent treponemal antibody absorption (FTA-ABS) test
E. Lumbar puncture
Option B (Benzathine penicillin)
warranted in cases of latent syphilis where the duration of symptoms is unknown.
A. Aqueous penicillin
B. Benzathine penicillin
C. Chest X-ray
D. Fluorescent treponemal antibody absorption (FTA-ABS) test
E. Lumbar puncture
C. Chest X-ray
The purpose is to screen for aortic involvement.
indicated in individuals who have latent syphilis and are human immunodeficiency virus–positive or have evidence of tertiary syphilis or ophthalmic involvement
A. Aqueous penicillin
B. Benzathine penicillin
C. Chest X-ray
D. Fluorescent treponemal antibody absorption (FTA-ABS) test
E. Lumbar puncture
Option E (Lumbar puncture)
A 31-year-old man presents to the physician with an ulcer on his penis, which he has had for the last 3 weeks. He denies any associated symptoms and states that the lesion has not been painful. His previous medical history is notable for a tension pneumothorax after penetrating thoracic trauma. He does not take any regular medications and is allergic to penicillin. He works as an accountant, drinks 20 to 30 g of alcohol weekly, and does not smoke. He is sexually active and has had six sexual partners in the last 12 months. Laboratory investigation reveals a positive Venereal Disease Research Laboratory test and a reactive fluorescent treponemal antibody absorption test. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Ciprofloxacin
B. Doxycycline
C. Penicillin desensitization
D. Spectinomycin
E. Trimethoprim-sulfamethoxazole (TMP-SMX)
Option B (Doxycycline) is correct. This patient has primary syphilis. The most effective form of therapy is with benzathine penicillin. In patients who are allergic to penicillin, doxycycline is the traditional second-line agent. Tetracycline, azithromycin, and ceftriaxone may also be effective.

Option A (Ciprofloxacin) is incorrect. Quinolone antibiotics are not effective against Treponema pallidum.

Option C (Penicillin desensitization) is incorrect. This is the most appropriate management in pregnant patients who cannot be treated with tetracycline.

Option D (Spectinomycin) is incorrect. Spectinomycin is not effective against T. pallidum.

Option E (Trimethoprim-sulfamethoxazole [TMP-SMX]) is incorrect. Traditionally used in cases of urinary tract infections, TMP-SMX does not have any effect against T. pallidum.
This patient has primary syphilis. The most effective form of therapy is with benzathine penicillin. In patients who are allergic to penicillin,
doxycycline is the traditional second-line agent. Tetracycline, azithromycin, and ceftriaxone may also be effective.
A 7-month-old boy is brought to the emergency room with breathlessness over the last 12 hours that is preventing adequate feeding. He has been unwell for the last 3 days, with coryza, a mild cough, and a temperature maximum of 38.4°C (101.1°F). There has not been any diarrhea or vomiting. His immunizations are up-to-date, and he has not had any recent sick contacts. Otherwise, he has been well since birth and was born at term via normal vaginal delivery. Family history is unremarkable. Vital signs are as follows: blood pressure (BP), 90/60 mm Hg; pulse, 135 beats/minute; temperature, 38.2°C (100.7°F); and respiratory rate (RR), 60 breaths/minute. There is moderate intercostal and subcostal retractions with some nasal flaring, but no peripheral cyanosis. Auscultation of the chest demonstrates fine end-inspiratory crackles and high-pitched wheezing throughout the respiratory cycle. A chest x-ray (CXR) demonstrates hyperinflation of the lungs with increased hilar bronchial markings. What is the most likely diagnosis?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Asthma
B. Bronchiolitis
C. Foreign body aspiration
D. Laryngotracheobronchitis
E. Pertussis
Option B (Bronchiolitis) is correct. This child has bronchiolitis. It is most common in children younger than 2 years of age and typically presents with a wheezy cough after a 2- to 3-day history of an upper respiratory tract infection. Remember, not all that wheezing is asthma.
It is most common in children younger than 2 years of age and typically presents with a wheezy cough after a 2- to 3-day history of an upper respiratory tract infection.

A. Asthma
B. Bronchiolitis
C. Foreign body aspiration
D. Laryngotracheobronchitis
E. Pertussis
Option B (Bronchiolitis) is correct.
often confused with bronchiolitis, because of the presence of wheezing. In this case, however, the history of a febrile upper respiratory tract infection more strongly suggests bronchiolitis.
A. Asthma
B. Bronchiolitis
C. Foreign body aspiration
D. Laryngotracheobronchitis
E. Pertussis
Option A (Asthma)
It typically occurs in children between the ages of 3 months to 5 years and classically presents with inspiratory stridor and a barking cough that are worse at night.
A. Asthma
B. Bronchiolitis
C. Foreign body aspiration
D. Laryngotracheobronchitis
E. Pertussis
Option D (Laryngotracheobronchitis )
This is also known as croup and is caused by parainfluenza virus.
croup is caused by:
parainfluenza virus.
pityriasis versicolor causative organism, tx?
Pityrosporum orbiculare is the round form of the yeast previously called Malassezia furfur. A potassium hydroxide examination reveals short, rod-shaped hyphae mixed with spores in clusters (“spaghetti and meatballs”).

Treatment is topical selenium sulfide or ketoconazole.
A potassium hydroxide examination reveals short, rod-shaped hyphae mixed with spores in clusters (“spaghetti and meatballs”). Dx, organism, and tx?
pityriasis versicolor, Pityrosporum orbiculare, Treatment is topical selenium sulfide or ketoconazole.
Reynolds pentad, dx?
Suppurative ascending cholangitis is suggested by Reynolds pentad of right upper quadrant pain, fever, jaundice, hypotension, and delirium. It is caused by an infection in the biliary tree, and all liver function tests (LFTs) are elevated.
conjunctivitis, fever, cervical lymphadenopathy, strawberry tongue (mucositis), and diffuse rash that can lead to erythema of the palms and soles. Dx and tx?
Intravenous immunoglobulin and aspirin are the mainstays of treatment for Kawasaki disease, a form of vasculitis.

Prompt treatment is done to prevent coronary artery aneurysms.
thrombotic thrombocytopenic purpura tx
Plasmapheresis
This is the most common bacterial cause of diarrhea in the United States and is invasive resulting in a bloody diarrhea. It is commonly spread by uncooked meat.
A. Campylobacter jejuni
B. Entamoeba histolytica
C. Giardia lamblia
D. Shigella dysenteriae
E. Vibrio cholerae
A. Campylobacter jejuni
This is an amoeba that is invasive in nature. Initially, there is bloody diarrhea because of tissue destruction. Once the organism penetrates into the portal circulation, it becomes primarily involved in the liver where it forms abscesses.
A. Campylobacter jejuni
B. Entamoeba histolytica
C. Giardia lamblia
D. Shigella dysenteriae
E. Vibrio cholerae
B. Entamoeba histolytica
renowned for being extraordinarily infectious, because a tiny inoculum is required to develop an infection. It is usually fecal-oral in transmission and produces a blood diarrhea.
A. Campylobacter jejuni
B. Entamoeba histolytica
C. Giardia lamblia
D. Shigella dysenteriae
E. Vibrio cholerae
Option D (Shigella dysenteriae)
watery diarrhea and appears as a “comma” under the microscope.
A. Campylobacter jejuni
B. Entamoeba histolytica
C. Giardia lamblia
D. Shigella dysenteriae
E. Vibrio cholerae
Option E (Vibrio cholerae)
This therapy would be appropriate in the case of toxic shock syndrome or scalded skin syndrome.
A. Anti-staphylococcal antibiotic
B. Anti-streptococcal antibiotic
C. Immune globulin
D. Symptomatic treatment
E. Systemic corticosteroid
A. Anti-staphylococcal antibiotic
This therapy would be appropriate in the case of scarlet fever.
A. Anti-staphylococcal antibiotic
B. Anti-streptococcal antibiotic
C. Immune globulin
D. Symptomatic treatment
E. Systemic corticosteroid
Option B (Anti-streptococcal antibiotic)
Question (QID: 32669) You answered this question incorrectly
The mother of a 4-year-old boy calls the office for advice regarding an outbreak of diarrhea at her child's daycare center. The boy is currently asymptomatic and has no significant past medical history. Of the center's 30 children, 5 are ill with mild fevers and copious watery diarrhea. The mother also has a 6-month-old girl at home. What is the most appropriate advice to the mother regarding management of the child's infectious status?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Elective vaccination of all family members is a reasonable precaution in this situation
B. The likely causative agent of the daycare center diarrhea outbreak presents no significant risk to the 4-year-old
C. There are no medical measures that reduce the risk of transmission of the likely agent responsible for the diarrhea outbreak
D. Vaccination for the likely causative agent is no longer available due to associated risk of intussusception
E. Withholding the 4-year-old from attendance at the daycare center is sufficient to prevent transmission of the disease to the child's family members
Explanation
Option A (Elective vaccination of all family members is a reasonable precaution in this situation) is correct. Rotavirus is the likeliest causative agent for the day care center diarrhea outbreak. The 4-year-old may already be exposed and could be infectious. Rotavirus vaccine recently received FDA approval in the United States.

Option B (The likely causative agent of the daycare center diarrhea outbreak presents no significant risk to the 4-year-old) is incorrect. Rotavirus is the most likely causative agent of epidemic daycare diarrhea in the United States. Although it is generally well tolerated with proper oral hydration, an estimated 100 children per year die from complications in the United States. Worldwide, rotavirus diarrhea is estimated to cause 500,000 deaths.

Option C (There are no medical measures that reduce the risk of transmission of the likely agent responsible for the diarrhea outbreak) is incorrect. Rotavirus is the likeliest causative agent for the day care center diarrhea outbreak. Rotavirus vaccine recently received FDA approval in the United States.

Option D (Vaccination for the likely causative agent is no longer available due to associated risk of intussusception) is incorrect. The likeliest causative agent of the daycare center diarrhea outbreak is rotavirus. The original vaccine was withdrawn for the stated reason, but a new vaccine has now received FDA approval.

Option E (Withholding the 4-year-old from attendance at the daycare center is sufficient to prevent transmission of the disease to the child's family members) is incorrect. Rotavirus may be asymptomatic in young children and there is a risk the child is exposed and capable of shedding the virus at this time.
Option A (Elective vaccination of all family members is a reasonable precaution in this situation) is correct. Rotavirus is the likeliest causative agent for the day care center diarrhea outbreak. The 4-year-old may already be exposed and could be infectious. Rotavirus vaccine recently received FDA approval in the United States.
the likeliest causative agent for a day care center diarrhea outbreak
Rotavirus
A 3-year-old boy is brought to the local health clinic for a fever. On examination, his temperature is 39.7°C (103.5°F). There are both vesiculopustular lesions and shallow erosions surrounded by an erythematous halo on the posterior pharynx and hard palate. Tender macules and vesicles on an erythematous base are present on the palms and soles. Which of the following is the most probable cause of these clinical findings?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Coxsackie virus
B. Herpes simplex virus type I
C. Human herpesvirus 6
D. Treponema pallidum
E. Varicella-zoster virus
Option A (Coxsackie virus) is correct. Coxsackie virus infection generally occurs during the warm months and is associated with high-grade fever and refusal of the young child to swallow and drink. Finding a papulovesicular eruption in the posterior pharynx with shallow yellow ulcers surrounded by red halos confirms the diagnosis. On occasion, there may also be an associated exanthema that involves the palmar-plantar surfaces and interdigital areas of the hands and feet with thick-walled gray vesicles on an erythematous base. The condition is known as hand-foot-and-mouth disease. In those cases in which cutaneous manifestations are absent, the process is called herpangina.
infection generally occurs during the warm months and is associated with high-grade fever and refusal of the young child to swallow and drink. Finding a papulovesicular eruption in the posterior pharynx with shallow yellow ulcers surrounded by red halos confirms the diagnosis.
Coxsackie virus

On occasion, there may also be an associated exanthema that involves the palmar-plantar surfaces and interdigital areas of the hands and feet with thick-walled gray vesicles on an erythematous base. The condition is known as hand-foot-and-mouth disease. In those cases in which cutaneous manifestations are absent, the process is called herpangina.
hand-foot-and-mouth disease organism
Coxsackie virus
characterized by discrete ulcerations that are generally seen in the anterior buccal area and the labial mucosa or on the gingival and tongue and only occasionally on the palate and tonsillar pillars.
A. Coxsackie virus
B. Herpes simplex virus type I
C. Human herpesvirus 6
D. Treponema pallidum
E. Varicella-zoster virus
Option B (Herpes simplex virus type I)

Rarely, there is a cutaneous component such as is seen with hand-foot-and-mouth disease.
Roseola (exanthem subitum) is caused by
human herpesvirus 6.
The classic presentation is abrupt onset of high temperature lasting for 3 days. Rapid defervescence is striking, with the onset of a generalized pink morbilliform exanthem. The eruption lasts 2 days and consists of pink papules or blanchable macular erythema. Oral lesions are not usually seen.
A. Coxsackie virus
B. Herpes simplex virus type I
C. Human herpesvirus 6
D. Treponema pallidum
E. Varicella-zoster virus
C. Human herpesvirus 6
Roseola (exanthem subitum) is caused by human herpesvirus 6.
The rash can involve the palms of the hands, soles of the feet, and the oral mucosa, but the lesions are not vesicular.
A. Coxsackie virus
B. Herpes simplex virus type I
C. Human herpesvirus 6
D. Treponema pallidum
E. Varicella-zoster virus
D. Treponema pallidum
rash may involve the oral mucosa with oval vesicles with an erythematous base. Crops of small red papules spread from trunk to face with minimal limb involvement.
A. Coxsackie virus
B. Herpes simplex virus type I
C. Human herpesvirus 6
D. Treponema pallidum
E. Varicella-zoster virus
E. Varicella-zoster virus
A 27-year-old medical student returns home to the coast of California between academic years. Her friends celebrate her return by taking her to the new sushi place that just opened. About 1 day later, she notices some nausea and one episode of emesis. This is followed by seven to eight watery bowel movements each day for 4 days without any dysentery. Which is the most likely organism causing her symptoms?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Campylobacter jejuni
B. Giardia lamblia
C. Salmonella
D. Shigella
E. Vibrio parahaemolyticus
Option E (Vibrio parahaemolyticus) is correct. Transmitted by inadequately cooked shrimp or seafood. This patient ate sushi.
Bilateral radial aplasia with absent thumbs in an infant is most suggestive for
A. Adenosine deaminase deficiency
B. Aplastic anemia
C. Asplenia
D. Congenital thymic dysplasia
E. Human immunodeficiency virus (HIV) infection
Option B (Aplastic anemia) is correct. Bilateral radial aplasia with absent thumbs in an infant is most suggestive for Fanconi anemia, a very rare form of aplastic anemia. Fanconi anemia is a type of familial aplastic anemia with bone abnormalities. A specific diagnosis is usually not made until some illness supervenes, especially acute bacterial infections.
A 33-year-old gravida II, para II female is seen on postpartum day 7 following an emergency cesarean section as a result of arrest of descent. On postpartum day 3 she began experiencing fevers, uterine tenderness, and foul-smelling lochia. She was appropriately treated, but she continues to have a spiking fever between 38.5°C (101.3°F) and 40.5°C (104.9°F). Physical examination of the abdomen and pelvis is unremarkable. A computed tomography (CT) scan of the abdomen is performed and reported as otherwise normal except for changes consistent with cesarean section.

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Clindamycin and gentamicin
B. Computed tomography (CT) guided drainage
C. Dicloxacillin
D. Endometrial culture
E. Heparin
F. Incentive spirometry
G. Laparotomy
H. Nitrofurantoin
I. Surgical debridement
J. Trimethoprim-sulfamethoxazole
Option B (Computed tomography [CT] guided drainage) is correct. This patient has septic pelvic thrombophlebitis, which usually appears as fever on postpartum day 5 through 8. Classically, patients had a postpartum fever earlier that was treated as endometritis but continue with spiking fevers. A computed tomography (CT) scan is ordered to search for a pelvic abscess. If it is normal, the diagnosis of septic pelvic thrombophlebitis is considered, and intravenous (IV) heparin is started. If the fever resolves within 48 and 72 hours, the diagnosis is confirmed and heparin is continued for 2 weeks.
A 33-year-old gravida II, para II female is seen on postpartum day 1 following an emergency cesarean section as a result of arrest of decent. She has been well and begun to breast-feed. She also reports passage of small amounts of pink fluid from her vagina. Her vital signs are blood pressure (BP), 115/75 mm Hg; pulse, 77 beats/minute; temperature 38.5°C (101.3°F); and respirations, 13 breaths/minute. Physical examination reveals mild dullness to percussion at both posterior lung bases and fine bibasilar inspiratory crepitations on auscultation of the lungs.

End of set


Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Clindamycin and gentamicin
B. Computed tomography (CT) guided drainage
C. Dicloxacillin
D. Endometrial culture
E. Heparin
F. Incentive spirometry
G. Laparotomy
H. Nitrofurantoin
I. Surgical debridement
J. Trimethoprim-sulfamethoxazole
Option F (Incentive spirometry) is correct. This patient has atelectasis, the most common cause of postpartum fever on days 0 to 1. It is typically to the result of postoperative pain that results in failure of the lungs to fully expand during inspiration. As a result, atelectasis occurs. Incentive spirometry, where patients are encouraged via a plastic device to inhale and exhale deeply is thought to be both prophylactic and therapeutic.
A 13-month-old girl is brought to the emergency room following the sudden onset of a rash yesterday. She had experienced a fever for the last 3 days to 40.3°C (104.5°F), but review by her local physician found no cause. The rash appeared shortly after the fever subsided. Physical examination demonstrates a pale red, blanching macular rash on the neck and trunk. She has occipital lymphadenopathy.

End of set

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Eczema herpeticum
B. Erythema infectiosum
C. Hand-foot-mouth disease
D. Lyme disease
E. Measles
F. Rocky Mountain spotted fever
G. Roseola
H. Rubella
I. Scarlet fever
J. Varicella zoster
Option G (Roseola) is correct. This patient has roseola, caused most commonly by human herpesvirus (HHV) 6. The classic presentation is a 3- to 4-day history of a high fever that suddenly abates and is followed by a rose-colored macular rash on the neck and trunk. The high fever can result in a febrile convulsion.
The classic presentation is a 3- to 4-day history of a high fever that suddenly abates and is followed by a rose-colored macular rash on the neck and trunk. The high fever can result in a febrile convulsion.
roseola, caused most commonly by human herpesvirus (HHV) 6.
rash is a crops of lesions in different stages. The stages range from papules on an erythematous base to vesicles to crusted lesions. Because the rash is so pruritic, excoriations are often seen.
varicella, also known as chickenpox
tender lymphadenopathy in the retroauricular, posterior cervical, and postoccipital regions. absence of photophobia. The rash is erythematous, maculopapular, and spreads from the head to the trunk.
Rubella
In the month of August, the mother of a 7-year-old boy brings her son to the emergency room (ER) with complaints of headache and fever. These symptoms began 24 hours ago. Vital signs are temperature: 39.3°C (102.8°F), blood pressure (BP): 120/70, heart rate (HR): 100 beats/min, and respiratory rate (RR): 16 breaths/min. Physical exam reveals an ill-appearing child who states that the bright lighting in the examining rooms is painfully irritating. Pain is elicited with neck flexion. Neurological exam is otherwise nonfocal. Blood chemistry, C-reactive protein levels, and white blood cell (WBC) counts are normal. A CT scan is obtained and shows no space occupying lesion or other contraindication for lumbar puncture. Results of lumbar puncture shows clear-appearing cerebrospinal fluid (CSF) fluid with an opening pressure of 140 mm H2O. There is a pleocytotic WBC cell population with WBC count of 6000/mL with a lymphocytic predominance, CSF protein is 100mg/dL, and CSF glucose is 65 mg/dL. Cerebrospinal fluid gram and acid fast stain results are negative. Culture results are pending. What is the examination of the patient's recent medical history would most likely reveal?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Recent history of corticosteroid treatment
B. Recent history of mosquito bites
C. Recent history of painful oral vesicular lesions
D. Recent history of pharyngitis, lymphadenopathy and splenomegaly
E. Recent history of rash and gastroenteritis
Option E (Recent history of rash and gastroenteritis) is correct. Most enteroviral infections are accompanied by rash and gasteroenteritis. In the United States 85% of cases of viral meningitis are caused by nonpolio enteroviruses. These viruses are widely spread during the summer and early fall months.
A 34-year-old woman comes into the emergency department in labor at 34 weeks’ gestation. Her prenatal course has been unremarkable. This morning she woke up at home to find her membranes ruptured. Her labor lasted 30 hours and resulted in the delivery of a 3200-g baby girl with APGAR scores of 9 and 10. During the first 4 hours of life, the baby appeared to be doing well, but then she became lethargic and hypotonic, and did not respond to stimulation. Laboratory data collected showed a white blood cell (WBC) count of 29,000, hematocrit of 51%, and platelets of 249,000. A chest radiograph was within normal limits. Lumbar puncture and testing of cerebrospinal fluid showed glucose of 29, and WBC of 40 with 92% polymorphonuclear cells. Which of the following interventions could have most effectively prevented this baby’s condition?


Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Eliciting a history of genital herpes from the mother
B. Giving intrapartum ampicillin
C. Giving prenatal treatment of the mother with penicillin
D. Testing the mother for toxoplasmosis and treating her as indicated
E. Vaccinating the mother against Haemophilus influenzae
Option B (Giving intrapartum ampicillin) is correct. This newborn has early-onset neonatal sepsis from a group B Streptococcus (GBS) infection. The most effective prevention of neonatal sepsis due to GBS is intrapartum antibiotics. Colonized mothers are at highest risk for transmitting the organism to the baby if there is premature rupture of membranes, leaving the fetus exposed to the potential for infections to ascend from the birth canal.
A 31-year-old gravida I, para 0 female teacher at 6 weeks of gestation notes that one of her students has developed a maculopapular rash on the face. The following day, the child's rash covers the entire body. The child is sent to the school nurse who detects tender posterior cervical and postoccipital lymphadenopathy. The child is diagnosed and treated. Subsequently, at 38 weeks of gestation, the teacher gives birth to a 3.7-kg (8.2 lb) male neonate who has diffuse blueberry muffin skin lesions. What finding would be most likely to be detected on cardiac auscultation of the neonate?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Blowing diastolic murmur best heard at the second right intercostal space
B. Blowing pansystolic murmur best heard at the apex
C. Continuous machinery-like murmur best heard over second left intercostal space
D. Harsh midsystolic murmur best heard over second right intercostal space
E. Midsystolic click best heard at the apex
Option C (Continuous machinery-like murmur best heard over second left intercostal space) is correct. The mother was exposed to rubella in the first trimester and subsequently gave birth to a neonate with congenital rubella syndrome. The blueberry muffin skin lesions are a classic sign. Congenital rubella is associated with sensorineural deafness, microphthalmia, and congenital heart defects. The most common are a patent ductus arteriosus (PDA) and pulmonary artery stenosis. The murmur is consistent with a PDA.
Blowing diastolic murmur best heard at the second right intercostal space
aortic regurgitation.
Blowing pansystolic murmur best heard at the apex
mitral regurgitation.
Harsh midsystolic murmur best heard over second right intercostal space
aortic stenosis.
Midsystolic click best heard at the apex
mitral valve prolapse.
A mother brings her 2-month-old infant to the pediatrician when she notices that she can feel a vibration on the infant’s chest. The infant has been well since birth. On examination, the infant has a palpable thrill. At the lower left sternal border, auscultation of the chest reveals a 2/6 systolic crescendo/decrescendo murmur of mixed frequency with an early cycle peak. The murmur radiates to the neck, louder on the left. An ejection click is present and heard best at the apex. What is the next most appropriate step in management?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Admit to hospital for 24-hour Holter monitoring
B. Antibiotic prophylaxis
C. Gamma globulin and aspirin
D. Immediate surgical repair of the defect
E. Transvenous pacemaker placement
Option B (Antibiotic prophylaxis) is correct. High turbulent flow states such as aortic stenosis are associated with increased risk for bacterial endocarditis sufficient to justify antibiotic prophylaxis.
A 16-year-old female is brought to the emergency room complaining of a sore throat of 3 days duration. She is able to swallow her own secretions and talk, but her voice is muffled. Her immunizations are up to date according to her mother and she has had no sick contacts. Her vital signs are temperature 38.6°C (101.5°F), heart rate 118 beats/min, respiratory rate 22 breaths/min, blood pressure 114/77 mm Hg, and oxygen saturation 95% on room air. She appears uncomfortable secondary to her throat pain. On examination of her oropharynx, she had minimal exudates on her swollen tonsils; and her uvula is pushed to the left of midline. She has significant swelling of her left tonsillar pillar and left posterior soft palate. The area is also very erythematous. She has anterior chain and submandibular adenopathy but no large loculated or indurated areas on visible on her neck. What is the next step in her management?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Computed tomography scan of the neck
B. Intravenous antibiotics
C. Intubation
D. Needle aspiration
E. Plain films of the neck
Question (QID: 32869) You answered this question incorrectly
A 16-year-old female is brought to the emergency room complaining of a sore throat of 3 days duration. She is able to swallow her own secretions and talk, but her voice is muffled. Her immunizations are up to date according to her mother and she has had no sick contacts. Her vital signs are temperature 38.6°C (101.5°F), heart rate 118 beats/min, respiratory rate 22 breaths/min, blood pressure 114/77 mm Hg, and oxygen saturation 95% on room air. She appears uncomfortable secondary to her throat pain. On examination of her oropharynx, she had minimal exudates on her swollen tonsils; and her uvula is pushed to the left of midline. She has significant swelling of her left tonsillar pillar and left posterior soft palate. The area is also very erythematous. She has anterior chain and submandibular adenopathy but no large loculated or indurated areas on visible on her neck. What is the next step in her management?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Computed tomography scan of the neck
B. Intravenous antibiotics
C. Intubation
D. Needle aspiration
E. Plain films of the neck
Explanation
Option D (Needle aspiration) is correct. Needle aspiration is the first line of therapy in the treatment of peritonsillar abscesses. The patient will need oral if not intravenous antibiotics, but first the abscess must be drained. Care must be taken in aspiration of the abscess as the carotid artery lies behind the area of needle introduction. Often a piece of tap is placed on the needle so it may only be introduced 1 to 1.5 cm into the subcutaneous tissue.

Option A (Computed tomography scan of the neck) is incorrect. A computed tomography scan of the neck may be helpful if the location of the abscess is unknown or if aspiration of the abscess is unsuccessful. This patient does not have any neck bulging that would be concerning for retropharyngeal, mastoid, or peripharyngeal abscesses. In the case of peritonsillar abscesses, aspiration can be attempted given the known location of the infection.

Option B (Intravenous antibiotics) is incorrect. Intravenous antibiotics may be necessary, but aspiration is the first-line of therapy because the abscess must be drained for the antibiotics to be truly beneficial.

Option C (Intubation) is incorrect. This patient has a patent airway at the current time. Although a peritonsillar abscess can lead to airway obstruction, this patient does not appear to be in respiratory distress at this time.

Option E (Plain films of the neck) is incorrect. Plain films of the neck are not necessary in peritonsillar abscesses, if a retropharyngeal abscess or epiglottis is a concern, a soft tissue neck film can be taken.
A 14-year-old boy with a history of sickle cell disease presents to the emergency room (ER) for fever. He had been well until 2 days ago when he began to feel tired and have chills. He denies any frank sore throat or ear pain and complains of general malaise. Vital signs show heart rate (HR) 120 beats/min, temperature 38.9°C (102°F), respiratory rate (RR) 18 breaths/min, oxygen saturation of 99%, and blood pressure (BP) 110/60. What infectious organism are you most likely to be concerned about?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Clostridium difficile
B. Escherichia coli
C. Haemophilus influenzae
D. Pseudomonas
E. Staphylococcus aureus
Option C (Haemophilus influenzae) is correct. Possible infection with H. influenzae and other encapsulated organisms are concerning in patients with sickle cell disease and no functional spleens (caused by previous splenic infarcts). The spleen's role in the immune system is imperative to the host response to encapsulated organisms. Prophylaxis with H. influenzae, meningococcus, and pneumococcus vaccination is important in the care of sickle cell patients. Treatment for the acute infection is with appropriate antibiotics, intravenous (IV) hydration, and supportive care. Typical labs such as reticulocyte count, type and screen, and possible peripheral smear are also important to the workup.

Option A (Clostridium difficile) is incorrect. All these organisms can cause disease in patients with sickle cell, but C. difficile causes bloody diarrhea.

Option B (Escherichia coli) is incorrect. All these organisms can cause disease in patients with sickle cell, E. coli causes urinary tract infections (UTIs), and diarrhea.

Option D (Pseudomonas) is incorrect. Pseudomonas is a serious infection; but in sickle cell patients who are functionally asplenic, encapsulated organisms such as Haemophilus influenzae, Streptococcus pneumonia, and Neisseria meningitis are greater concerns.

Option E (Staphylococcus aureus) is incorrect. All these listed organisms can cause disease in patients with sickle cell, but staphylococcus infections usually present as skin or oropharyngeal infections.
3 vaccinations important in the care of sickle cell patients.
Prophylaxis with H. influenzae, meningococcus, and pneumococcus vaccination
the cause of hereditary angioedema. Patients are at risk for laryngeal edema and airway obstruction.
A. Atrial septal defect
B. C1 esterase deficiency
C. Myeloperoxidase deficiency
D. Pancreatic insufficiency
E. Polycystic kidneys
Option B (C1 esterase deficiency)
A 39-year-old man presents to the emergency department after a tonic-clonic seizure. He has a history of human immunodeficiency virus (HIV) infection and has not taken any antiretroviral therapy. On arrival, he is afebrile and disoriented to place and time. A head computed tomography (CT) scan is performed and shows two ring enhancing, spherical lesions at the corticomedullary junction. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Amphotericin B
B. Brain biopsy
C. Fluconazole
D. Pyrimethamine and sulfadiazine
E. Serology for antitoxoplasma antibodies
Option E (Serology for antitoxoplasma antibodies) is correct. The probability of multiple ring-enhancing lesions being toxoplasmosis in a patient not taking trimethoprim-sulfamethoxazole (TMP-SMX) rises to 90% if the patient's serology demonstrates antitoxoplasma antibodies. The test is not specific for current infection, but lifelong exposure. Toxoplasmosis of the CNS in HIV patients typically is a reactivation. If the toxoplasma antibodies are not present, the likelihood drops and brain biopsy must be strongly considered prior to starting anti-infective therapy.
the standard therapy for toxoplasmosis
Pyrimethamine and sulfadiazine
used in the management of patients with cryptococcosis, which presents as a meningitis.

A. Amphotericin B
B. Brain biopsy
C. Fluconazole
D. Pyrimethamine and sulfadiazine
E. Serology for antitoxoplasma antibodies
Option A (Amphotericin B)
A 69-year-old man presents to the physician with a 2-week history of fevers, night sweats, malaise, and shortness of breath. He was previously well and does not take any regular medications. His vital signs are blood pressure, 125/80 mm Hg; pulse, 105 beats/min; temperature, 38.4°C (101.1°F); and respirations, 24 breaths/min. There are grouped petechiae on the distal extremities and over the buccal mucosa. A blowing, high-pitched, pansystolic murmur is best heard over the apex and radiates into the left axilla. Electrocardiogram reveals sinus tachycardia. An echocardiogram shows valvular vegetations. What is the most likely cause of mortality associated with this patient's condition?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Cerebrovascular accident
B. Congestive heart failure (CHF)
C. Myocardial infarction (MI)
D. Overwhelming sepsis
E. Renal failure
Option B (Congestive heart failure [CHF]) is correct. This patient has infective endocarditis (IE). As a result of valve involvement and progressive destruction causing valvular insufficiency, the most common cause of death is CHF.

Option A (Cerebrovascular accident) is incorrect. A cerebrovascular accident is a common occurrence in patients with IE, because of septic emboli. The middle cerebral artery is particularly affected. Fungal endocarditis particularly disposes to septic emboli.

Option C (Myocardial infarction) is incorrect. Myocardial infarction is thought to occur because of embolization of vegetations. Many infarcts are silent. It is not the most common cause of death in patients with IE.

Option D (Overwhelming sepsis) is incorrect. Prior to the institution of antibiotic therapy for infective endocarditis, sepsis was one of the most common causes of death. Now, it is much less common.

Option E (Renal failure) is incorrect. Renal failure as a result of immune-complex glomerulonephritis was very common prior to antibiotics but is now rare. Nevertheless, embolization can cause renal infarction and immunoglobulin deposition can result in glomerulonephritis. Renal failure remains an important cause of mortality in patients with IE but it is not as common as CHF.
A 23-year-old female presents to the university health clinic with a 6-week history of vague abdominal pain and altered stools. Her stools have been unusually bulky and foul-smelling over this period. She has had reduced appetite and lost 4 kg (8.8 lb) unintentionally over the last month. She is a graduate student in anthropology and was on an expedition in India 5 months ago. On examination, there is glossitis, stomatitis, and generalized pallor. Her abdomen is diffusely tender to superficial palpation, and bowel sounds are normal. Laboratory investigations reveal a macrocytic anemia. A 72-hour stool collection reveals elevated fat content. A D-xylose absorption test is also abnormal. Jejunal biopsy reveals mild villous atrophy. What is the most appropriate next step in the management of this patient?

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Gluten-free diet
B. Lactose-free diet
C. Metronidazole
D. Total colectomy
E. Trimethoprim-sulfamethoxazole
Option E (Trimethoprim-sulfamethoxazole) is correct. This patient has tropical sprue. The diagnosis is made by the travel history to an endemic area combined with confirmed malabsorption to two substances as well as biopsy findings of villous blunting. The exact etiology of tropical sprue is unknown, but an infectious agent is strongly suspected. Consequently, tetracycline or trimethoprim-sulfamethoxazole (TMP-SMX) are first-line agents for therapy. Ampicillin can also be used.

Option A (Gluten-free diet) is incorrect. A gluten-free diet is the recommended management of celiac disease. The temporal relationship between travel to an endemic region combined make tropical sprue more likely.

Option B (Lactose-free diet) is incorrect. The history does not provide a link between the symptoms and lactose intolerance. The test of choice is the breath hydrogen test, which is able to detect lactase deficiency.

Option C (Metronidazole) is incorrect. Metronidazole is not known to be effective in the treatment of tropical sprue. It is first-line therapy for pseudomembranous colitis.

Option D (Total colectomy) is incorrect. Total colectomy is not indicated in this patient. It is a treatment option for ulcerative colitis.
presents with the 3 C's: cough, coryza, and conjunctivitis. Small gray-white dots, called Koplik spots, can be found on the buccal mucosa.
Measles
viral exanthem that presents with a high fever for 3 to 4 days that suddenly defervesces and is immediately followed by rash. The rash is maculopapular and begins on the trunk.
Roseola
viral exanthem that is erythematous and maculopapular. It begins on the face and spreads downward. It is usually associated with prominent posterior cervical and postoccipital lymphadenopathy.
Rubella
caused by group A, beta hemolytic streptococci. There is a “sandpaper” rash on the trunk and a “strawberry tongue.” The patient usually complains of pharyngitis.
Scarlet fever
the viral etiology of croup.
Parainfluenza virus
This is the virus that causes measles.
Paramyxovirus
A 61-year-old man with mild jaundice is seen on a follow-up visit by his physician for evaluation of possible hepatitis B infection. The results of his hepatitis B panel are:
HepBsAg positive
anti-HepBsAb negative
anti-HepBcAb positive
Based on the hepatitis B panel, the patient most likely has

Answer Choices Correct AnswerCorrect answer Your AnswerYour answer
A. Acute hepatitis B
B. Been effectively vaccinated with hepatitis B vaccine
C. Chronic infection with hepatitis B
D. Had a previous infection with hepatitis B virus
E. Never been infected with hepatitis B
Option A (Acute hepatitis B) is correct. The pattern for acute infection with hepatitis B is as follows: HepBsAg positive, anti-HepBsAb negative, anti-HepBcAb positive (in particular the IgM).

Option B (Been effectively vaccinated with hepatitis B vaccine) is incorrect. The pattern shown here suggests a person who has had the vaccination and is immune. Remember that this vaccine is usually given in three doses, and in some cases anti-HepBsAb is checked to verify immunity 1 to 2 months after the last dose.

Option C (Chronic infection with hepatitis B) is incorrect. Chronic infection with hepatitis B pattern is as follows: HepBsAg positive, anti-HepBsAb negative, and anti-HBcAb positive (in particular the IgG).

Option D (Had a previous infection with hepatitis B virus) is incorrect. Prior infection with hepatitis B would show a number of different patterns depending on when the infection occurred; HepBsAg may be negative if very low level.

Option E (Never been infected with hepatitis B) is incorrect. A never-been-infected, or “susceptible,” pattern is as follows: HepBsAg negative, anti-HepBsAb negative, and anti-HepBcAb negative.
The pattern for acute infection with hepatitis B
HepBsAg +/-?
anti-HepBsAb +/-?
anti-HepBcAb +/-?
HepBsAg positive, anti-HepBsAb negative, anti-HepBcAb positive (in particular the IgM).
HepBsAg positive, anti-HepBsAb negative, and anti-HBcAb positive (in particular the IgG).
A. Acute hepatitis B
B. Been effectively vaccinated with hepatitis B vaccine
C. Chronic infection with hepatitis B
D. Had a previous infection with hepatitis B virus
E. Never been infected with hepatitis B
C. Chronic infection with hepatitis B
HepBsAg positive, anti-HepBsAb negative, anti-HepBcAb positive (in particular the IgM).
A. Acute hepatitis B
B. Been effectively vaccinated with hepatitis B vaccine
C. Chronic infection with hepatitis B
D. Had a previous infection with hepatitis B virus
E. Never been infected with hepatitis B
Option A (Acute hepatitis B) is correct. The pattern for acute infection with hepatitis B is as follows: HepBsAg positive, anti-HepBsAb negative, anti-HepBcAb positive (in particular the IgM).
HepBsAg negative, anti-HepBsAb negative, and anti-HepBcAb negative.
A. Acute hepatitis B
B. Been effectively vaccinated with hepatitis B vaccine
C. Chronic infection with hepatitis B
D. Had a previous infection with hepatitis B virus
E. Never been infected with hepatitis B
Option E (Never been infected with hepatitis B) is incorrect. A never-been-infected, or “susceptible,” pattern is as follows: HepBsAg negative, anti-HepBsAb negative, and anti-HepBcAb negative.