Pediatrics (Infectious Disease)

Front 1

Name the organisms detected by the following methods
1) Ziehl-Neelsen Stain
2) Silver stain
3) Fluorescent Ab-Ag staining
4) Dark field microscopy

Back 1

1) Acid fast bacilli
2) Fungal elements
3) Viruses - HSV, WZV, RSV
4) T. palladium

Front 2

Which of the following patients should be admitted for a sepsis work-up?
1) 22-day old with fever of 100.5?
2) 5-year old with fever of 99.5
3) 8 month old with fever of 102.2?

Back 2

1 and 3

ALL neonates (<28 days) with fever must be admitted

Children 3-36 months with fever >39 (102.2)

Front 3

23-day old presents with poor feeding, irritability, and lethargy. Suspecting meningitis, you check for Kerning's and Brudzinski's sign - both are negative. Are you home free?>

Back 3

Nuchal rigidity is often NOT present in the neonate - must do a LP

Front 4

What's the most likely cause of meningitis in the following age groups?

1) 0-1 month
2) 1-3 months
3) 3 months - 3 years

Back 4

1) GBS, E. coli, Listeria - tx with amp and gent
2) GBS, S. pneumo, Listeria - tx with amp and cefotaxime
3) S. pneumo, Hib, N. meningitidis - tx with cefotaxime + vanc (resistant S. pneumo)

Front 5

Brain imaging on a child with meningitis shows BASILAR ENHANCEMENT. What type of meningitis does he have?

Back 5

TB meningitis

Front 6

Is treatment for viral meningitis needed?

Back 6

No - most cases are self-limited

Front 7

In which order do the sinuses develop?

Back 7

1) Ethmoid/maxillary - present at birth
2) Sphenoid - develop btw 3-5 yrs
3) Frontal - develop btw 7-10

Front 8

2-year old child presents with a fever, painful vesicles on the POSTERIOR pharynx, and blisters on the hand and foot. What's the most likely dx?

Back 8

Hand-foot-mouth disease 2/2 coxsackie

Front 9

7-year old child presents with a fever ans sore throat without other URI symptoms. PE shows exudate on the tonsils, petechiae on the soft palate, strawberry tongue, and enlarged anterior LN. What's the most likely dx?

Back 9

GABHS pharyngitis - oral penicillin or macrolide if penicillin allergy

Front 10

5-year old child presents with a sore throat. On PE, you note a gray, adherent tonsillar membrane. What's the most likely dx?

Back 10

Diptheria - tx with oral erythromycin

Front 11

What bacterial pathogens cause an acute otitis media?

Back 11

S. pneumo
Non-typable H. influenzae
M. catarahalis

Tx with amoxicillin

Front 12

6-year old presents with pain, itching, and draining from the ear. He says he's been going swimming a lot in the past week. On PE, you note ERYTHEMA and EDEMA of the EAC. What's the most likely dx?

Back 12

Acute otitis externa - PSa, S. auerus, C. albicans

Tx - acetic acid (mild) or topical Abx (severe cases)

Front 13

Child presents with mobile, tender, and warm cervical LN. You decide it's probably a localized bacterial infection. What are the most likely pathogens?

Back 13

S. aureus - most common
S. pyogenes
Mycobacterial infections
B. henselae (cat scratch disease)

Front 14

Child presents with swelling above the angle of the jaw with a fever. You decide it's probably a parotitis. What are the most likely pathogens?

Back 14

Viral - mumps, CMV, EBV - usually b/l --> supportive tx
Bacterial - S. auerus, S. pyogenes, M. Tb - usually unilateral --> abx

Front 15

Child presents with HONEY-CRUSTED lesions around the nares. What's the most likely diagnosis?

Back 15

Impetigo (skin infection involving upper dermis) - usually S. aureus

Front 16

Child presents with tender, erythematous skin with a DISTINCT border on the face. What's the most likely diagnosis?

Back 16

Erysipelas - skin infection involving dermal lymphatics

Caused by GABHS

Front 17

Name the skin infection:
A child presents with tender, erythematous skin with an INDISTINCT syndrome

Back 17

Cellulitis - skin infections that occurs within dermis

Caused by GABHS/S. aureus

Front 18

Name the skin infection:
A child presents with a unilateral bluish discoloration on the cheek.

Back 18

Buccal cellulitis - caused by Hib

Front 19

Name the skin infection:
A child presents with fever, TENDER skin, and bullae. On PE, a positive Nikolski sign is present.

Back 19

Staph scalded skin syndrome - caused by toxin-producing S. aureus species

Front 20

A child has had a sore throat and fever for 3 days. Today, he presents with a rash. On PE, you note an erythematous, papular rash that has the texture of SANDPAPER. You note that his hands are peeling (DESQUAMATION) What's the most likely diagnosis?

Back 20

Scarlet fever 2/2 GABHS

Front 21

Name the sequelae of GABHS infection

Back 21

1) Post-strep GN
2) Rheumatic fever
3) Post-strep arthritis
4) PANDAS

Front 22

A child presents to your clinic in WINTER with vomiting and diarrhea for 4-7 days. What's the most likely dx?

Back 22

Viral gastroenteritis 2/2 rotavirus

Front 23

A child presents to your clinic with vomiting for the past 48 hrs. His mom says that the rest of his daycare is also sick. What's the most likely dx?

Back 23

Norwalk virus - vomiting is prominent; shorter duration

Front 24

You have a child with suspected HUS. Are Abx an appropriate next step?

Back 24

NO - HUS may worsen with abx

Front 25

Name the diarrhea
1) Major cause of traveler's diarrhea; no stool WBC
2) Responsible for HUS; stool WBC present
3) Bloody diarrhea predominates; stool WBC present
4) Associated with exposure to poultry, milk, eggs, lizards/turtles
5) Most common cause of bloody diarrhea in USA
6) May cause mesenteric adenitis (mimics acute appendicitis)

Back 25

1) Enterotoxigenic E. coli
2)O157:H7 E. coli
3) Shigella
4) Salmonella
5) Campylobacter
6) Yersinia

Front 26

You run a BMP on a child with 2 days of diarrhea. What you expect to find?

Back 26

Non-gap hyperchloremic metabolic acidosis

Front 27

A child presents with FTT, lymphadenopathy, difficult to treat thrush, and severe varicella infection. What are you most worried about?

Back 27

HIV Infection

Front 28

For an HIV-negative infant born to an HIV-positive mother, what do you expect the results from the following tests to be at 4 months?
1) ELISA
2) HIV PCR

Back 28

1) ELISA - positive for 18-24 months (have transplacentally acquired maternal Ab)
2) HIV PCR - negative

Front 29

How should infants born to HIV-infected mothers be manged?

Back 29

1) Zidovudine for 6 weeks
2) Bactrim for PCP ppx until HIV PCR is negative
3) No breastfeeding

Front 30

An HIV-positive child presents with fever, hypoxia, and interstial pulmonary infiltrates. What's the most likely dx?

Back 30

PCP - tx with bactrim

Front 31

An HIV-positive child presents with constitutional symptoms and elevated ALT/AST. What's the most likely dx?

Back 31

MAC

Front 32

11-year old presents with a fever and a sore throat. On PE, you note posterior cervical lymphadenopathy with HMS. On CBC, you note ATYPICAL LYMPHOCYTES. You correctly suspect mono. What's the best diagnostic test in children < 4 yrs and > 4 yrs?

Back 32

< 4 yrs: EBV Ab titers
1) Acute infection: elevated IgM-VCA (viral capsid)
2) Ab against Epstein-Barr nuclear Ag

> 4 yrs
+ anti-heterophile Ab

Front 33

What is the classic clinical course of measles?

Back 33

1) Prodrome: cough, conjunctivitis, coryza
2) Enanthem with koplik spots - small, gray papules on erythematous base on buccal mucosa
3) Exanthem - erythematous maculopapular rash that begins on face and spreads to chest/upper extremities

Front 34

What is the treatment of measles and what are the complications?

Back 34

Treatment
1) Supportive
2) Vitamin A

Complications
1) Bacterial pna is most common complication
2) Otitis media
3) Encephalomyelitis
4) Subacute sclerosing pancephilitis

Front 35

What is congenital rubella syndrome?

Back 35

Fetal anomalies that occur after primary maternal infection during first trimester
1) Blueberry muffin baby
2) Congenital cataracts and PDA
3) Sensorineural hearing loss

Front 36

A child with CF presents with wheezing. CXR shows pulmonary infiltrates and a CBC shows eosinophilia. What's the most likely dx?

Back 36

ABPA - elevated aspergillus-specific IgE

Front 37

Child from SOUTHWESTERN USA presents with a mild pna. You suspect a fungal infection. What's the most likely cause?

Back 37

Coccidiodomycosis

Front 38

A child travels to MEXICO and eats from a street vendor. 4 days later, he develops cramping abd pain, tenesmeus, and diarrhea. What's the most likely dx?

Back 38

Entamoeba histolytica - can also form ANCHOVY PASTE abscess in liver

1) Dx - trophozite/cysts in stool or serum Ab assay
2) Tx - metronidazole

Front 39

Child presents with voluminous, watery, and foul-smelling diarrhea. His mom says that they went camping one week ago and he drank CONTAMINATED MOUNTAIN WATER. What's the most likely dx?

Back 39

Giardia

1) Dx - cysts/trophozites in stool or stool ELISA
2) Tx - metronidazole

Front 40

A child who's been traveling in India presents with fevers every 48-72 hrs. A CBC shows a hemolytic anemia. What's the most likely dx?

Back 40

Malaria - Plasmodium (P. falciparum - most severe dz) - transmitted by anopheles mosquito

1) Clinical features - cyclic fevers correlate with RBC rupture and subsequent parasitemia
2) Dx - thick and thin Giemsa-stained peripheral blood smear

Front 41

A child who enjoys playing in CAT FECES presents with a mono-like illness. What's the most likely dx?

Back 41

T. gondii - usually don't need treatment

Front 42

What congenital infection is associated with following classic triad
1) Hydrocephalus
2) Intracranial calcifications
3) Chorioretinitis

Back 42

T. gondii

Front 43

How are parasitic infections diagnosed?

Back 43

3 stool examinations for ova and parasites

Front 44

Name the helminth infection
1) Most common helminthic infection
2) Anal pruritis

Back 44

Pinworm

Front 45

A child from MEXICO presents with seizures. A head CT/MRI shows solitary parenchymal cyst in FOURTH VENTRICLE. What's the most likely dx?

Back 45

Cysticerocosis - caused by T. solium --> encysts in muscle, subcu tissue, brain

1) Dx - ova and parasite stool eval
2) Tx - anti-convulsants

Front 46

A child who recently traveled to SE AMERICA presents with a fever, HMS with jaundice, hypotension, and a petechial rash that began on the extremities (hands/soles included) and moved toward his trunk. His labs are significant for THROMBOCYTOPENIA and HYPONATREMIA. What's the most likely dx and tx?

Back 46

Rocky mountain spotted fever (rickettsia rickettsii) - tx with doxycycline

Front 47

A child presents with all the features of RMSF but without the rash. What's the most likely dx?

Back 47

Ehrlichiosis - caused by ehrlichia chaffeensis - Tx with doxycycline

Front 48

A 5-year old child with a new kitten presents with regional lymphadenopathy. His mom can't remember if the kitten every scratched him but says it's possible. What's the most likely dx?

Back 48

Cat scratch disease 2/2 Bartonella henselae - develop regional lymphadenopathy distal to and after a cat scratch

Only need supportive treatment

Front 49

Tb disease is called what in the following areas:
1) Cervical lymphadenitis
2) Skeletal disease

Back 49

1) Scrofula
2) Pott's disease

Front 50

What is the treatment for latent Tb?

Back 50

9 months of INH

Front 51

What is the treatment for active Tb?

Back 51

2 months of INH, rifampin, pyrazinamide followed by 4 months of INH and rifampin