PPS COMPILED SAMPLEX [PART 3 OF 5] - 652 items total with Rationale Flashcards
"A case of 6yo cough. After 3-4 days became productive. On Pe, noted with coarse crackles, occasional wheeze rr 38. Labs: wbc 20000 neutrophilic predominance A. Acute bronchitis B. Nonsevere pneumonia C. Acute brochiolitis D. Bacterial tracheitis"
B
“Nelson 21st p3335
GBS may follow administration of vaccines against rabies, influenza, and conjungated meningococcal vaccine.
PAPP 2021 PCAP CPG p15-16
Criteria for severe pneumonia (requiring admission)
- Respiratory signs - cyanosis/hypoxemia, head bobbing, retractions, apena, grunting
- CNS signs - lethargic/stuporous/comatose/GCS <13, seizures
- Circulatory signs - capillary refill >3s or shock, pallor
- General considerations - moderate to severe malnutrition, refusal or inability to take food/drink per orem, some to severe dehydration, age <6 months
- Ancillary parameters - CXR or UTZ findings of consolidation, multifocal disease, moderate to large effusion, abscess, air leak; sustained O2 sat at room air <=93% “
"Patient with painless purging of rice-water stools with fishy odor? Drug of choice? A. Doxycycline B. Pen G C. Ciprofloxaxin D. TMP-SMX"
A
“Nelson 21st p1516
Following an incubation period of 1-3 days, acute watery diarrhea and vomiting ensue. Diarrhea can progress to painless puring of profuse rice-water stools (suspended flecks of mucus) with a fishy smell, which is the hallmark of the disease.
Cholera gravis, the most severe form of the disease, results when puring rates of 500-1000 ml/hr occur.
Antibiotics should only be given in patients with moderately severe to to severe dehydration. Antibiotics shorten the duration of illness, decrease fecal excretion of vibrios, decrease the volume of diarrhea, and reduce the fluid requirement during rehydration.
Single dose antibiotics increase compliance; doxycycline, ciprofloxacin, and azithromycin are effective against cholera. “
"What is a major risk factor for poor prognosis in meningococcemia? A. Hypertension B. Petichiae more than 24 hrs C. Seizure D. None of the above"
C
“Nelson 21st
Poor prognostic factors on presentation include hypothermia or extreme hyperpyrexia, hypotension or shock, purpura fulminans, seizures, leukopenia, thrombocytopenia (including DIC), acidosis, and high circulating levels of endotoxin and TNF-α. The presence of petechiae for <12 hr before admission, absence of meningitis, and low or normal ESR indicate rapid, fulminant progression and poorer prognosis”
"What is the least helpful in the diagnosis of meningo infection? A. Isolation from petichiae and purpura B. Isolation from nasopharynx C. Titers from csf studies D. Blood culture"
B
“Nelson 21st p1472
The initial diiagnosis of meningococcal disease should be made on clinical assessment to avoid delay in implementation of appropriate therapy.
A confirmed diagnosis of meningococcal disease is established by isolation of N. meningitides from a normally sterile body fluid such as blood, CSF, or synovial fluid. Meningococci may be identified in a gram stain preparation and/or culture of petechial or purpuric skin lesions, although this procedure is rarely undertaken, and occasionally are seen on Gram stain of the buffy coat layer of a centrifuged blood sample.
Isolation of the organism from the nasopharynx is not diagnostic of invasive disease because the organism is a common commensal. “
"Case of mother with chlamydia. What will you do with newborn? A. Oral erythromycin for 14 days B. Observe until symptoms arise C. Oral clarithromycin for 14 days D. Amoxicillin for 7 days"
A
“Nelson 21st p1617-1618
The most effective method of controlling perinatal chlamydial infection is screening and treatment of pregnant women.
The recommended treatment regimens for C. trachomatis conjunctivitis or pneumonia in infants are:
- Erythromycin (50mg/kg/day QID PO x 14 days)
- Azithromycin (20mg/kg/day OD PO x 3 days) “
"Case of SSPE. Most important part of history? A. History of rubeola B. History of trauma C. Depression D. None of the above"
A
“Nelson 21st p1673-1674
Subacute sclerosing panencephalitis (SSPE) is a chronic complication of measles with a delayed onset and an outcome that is nearly always fatal.
The diagnosis of SSPE can be eastablished through documentation of a complatible clinical course and at least one of the following supporting findings:
- Measles antibody detected in CSF
- Characteristic EEG findings
- Typical histologic findings in and/or isolation of virus or viral antigen from brain tissue obtained by biopsy or postmortem examination”
"Case of strider with hoarseness and dysphagia. Most important part of diagnosis? A. History and PE B. Chest xray C. Blood CS D. CBC"
A
“Nelson 21st p2203
Most patients have an URTI with some combination of rhinorrhea, pharyngitis, mild cough, and low grade fever before signs and symptoms of upper airway obstruction become apparent. The child then develops the characteristic barking cough, hoarseness and inspiratory stridor.
Croup is a clinical diagnosis and does not require a radiograph of the neck. Radiographs of the neck can show the typical subglotting narrowing, or steeple sign, of croup on the posteroanterior view. “
"Case of proven untreated syphillic mother with both VDRL and FTA positive. Newborn is asymptomatic and titers are the same or less than four fold increase from mother's. Management? A. No treatment B. Pen G IM single dose C. Pen G IV for 10 days D. Pen VK for 14 days"
C
“Nelson 21st p1597 Fig. 245.10 Algorithm for evaluation and treatment of infants born to mothers with reactive serologic tests for syphilis
Fetal titers are he same or less than fourfold of the maternal titers + asymptomatic - infant has possible congenital syphilis
Nelson 21st p1599
Congenital syphilis is treated with:
1. Aqueous Penicllin G (100,000 - 150,000 units/kg/day BID IV x 1 week, then q8 thereafter)
2. Procaine penicillin G (50,000 units/kg IM OD x 10 days) “
"True of congenital syphillis A. Most symptoms occur at 1 yr old B. Most are asymptomatic at birth C. Withholding treatment will result to death at 6 months D. None of the above are true"
B
“Nelson 21st p1593
Untreated syphilis during pregnancy results in a vertical transmission rate approaching 100% with profound effects on pregnancy outcome, reflecting obliterating endarteritis. Fetal or perinatal death occurs in 40% of affected infnats.
Most infected infants are asymptomatic at birth, including up to 40% with CSF seeding, and are identified only by routine prenatal screening.
The early signs appear during the first 2 yr of life, and the late signs appear gradually during the first 2 decades. “
"Why is aspirin contraindicated in dengue. Most dangerous effect A. Affects hemostasis B. Can lead to bloody stools C. Can lead to anaphylaxis D. None of the above"
A
"When is antibiotics recommended? A. Croup B. Laryngitis C. Epiglottitis D. Bronchitis"
C
“Nelsons 21st p2202-2203
With the exceptions of diphtheria, bacterial tracheitis, and epiglottitis, most acute infections of the upper airway are caused by viruses.
The parainfluenza viruses account for approximately 75% of cases. Other viruses associated with croup include influenza, adenovirus, RSV, and measles.
In the past, H. influenza type b was the most commonly identified etiology of acute epiglottitis. Other agents such as S. pyogenes, S. pneumoniae, nontypeable H. influenza, and S. aureus represent a larger portion of pediatric cases of epiglottitis in vaccinated children.
Nelsons p2206
Bacterial tracheitis is an acute bacterial infection of the upper airway that is potentially life-threatening. S. aureus is the most commonly associated pathogen.
Nelsons 21st p2912
GAS is the most important bacterial cause of acute pharyngitis, but viruses predominate as acute infectious causes of pharyngitis. “
“When is mumps infectious?
A. 7 days before to 7 days after appearance of the swelling
B. 2-3 days before prodrome and 3 days after swelling
C. 2 days before and after swelling
D. Whole duration”
A
“Nelsons 21st p1680
Mumps is spread from person to person by respiratory droplets. Virus appears in the saliva from up to 7 days before to as long as 7 days after onset of parotid swelling. The period of manixmum infectiousness is 1-2 days before to 5 days after onset of parotid swelling. “
"Varicella infectious in mother to child A. 5 days before to 2 days after appearance of rash B. 2 days to 3 days C. At birth D. Anytime after"
A
“Nelsons 21st p1709-1710
Persons with varicella may be contagious 24-48hr before the rash is evident and until vesicles are crusted, usually 3-7 days after the onset of rash, consistent with evidence that VZV is spread by aerosolization of virus in cutaneous lesions; spread from oropharyngeal secretions may occur but to a much lesser extent
Infants whose mothers demonstrate varicella in the period from 5 days prior to delivery to 2 days afterward are at high risk for severe varicella. “
“When is Hepa A most infectious
A. 2 weeks before to 7 days after jaundice appears
B. 1 week to 5 days after jaundice appears
C. 1 month before and 1 month after jaundice appears
D. None of the above”
A
“Nelsons 21st p2108
HAV is highly contagious. Transmission is almost always by person-to-person through the fecal-oral route.
Patients infected with HAV are contagious for 2wk before and approximately 7 days after the onset of symptoms. “
"Rabies prophylaxis is in someone with dog abrasions that did not bleed? A. Rabies vaccine only B. Rabies vaccine and lg C. Rabies lg only D. Coamoxiclav"
A
“Fundamentals of Pediatrics vol 1 p638 Table 26-4 Categories of rabies exposure and corresponsing management
Category I
- Feeding/touching an animal
- Licking of intact skin
- Casual contact and routine delivery of health care to patient with signs and symptoms of rabies
Category II
- Nibbling of uncovered skin with or without bruising/hematoma
- Minor scratches/abrasions without bleeding
- Minor scratches/abrasions induced to bleed
Category III
- Transdermal bites (puncture wounds, lacerations, avulsions) or scratches/abrasions with spontaneous bleeding
- Licks on broken skin
- Exposure to a rabies patient through bites, contamination of mucous membranes or open skin liesions with body fluids through splattering and mouth-to-mouth resuscitation
- Handling of infected caracass or ingestion of raw infected meat
- All category II exposures on head and neck
Management
- Cat I - wash with soap and water, no vaccine or RIG needed; pre-exposure prophylaxis in high risk persons
- Cat II - wash with soap and water, start rabies vaccine immediately, RIG not indicated
- Cat III - wash with soap and water, start rabies vaccine and RIG immediately “
“2 yo with cheek lesions that wrinkles and peels when touched
a. SJS
b. TEN
c. SSSS
d. Kawasaki”
C
“Nelson 21st p3483 SJS
Cutaneous lesions in SJS generally consist initially of erythematous macules that rapidly and variably develop central necrosis to form vesicles, bullae, and areas of denudation on the face, trunk, and extremities. The skin lesions are acommpanied by involvement of 2 or more mucosal surfaces, namely the eyes, oral cavity, upper airway or esophagus, gastrointestinal tract, or anogenital mucosa
Nelson 21st p3484 TEN
TEN is defined by:
1. Widespread blister formation and morbilliform or confluent erythema, associated with skin tenderness
2. Absence of target lesions
3. Sudden onset and generalization within 24-48hr
4. Histologic findings of full-thickness epidermal necrolysis and a minimal-to-absent dermal infiltrate.
Nelson 21st p3553 SSSS
SSSS, which occurs predominantly in infants and children younger than 5 yr of age, includes a range of disease from localized bullous impetigo to generalized cutaneous involvement with systemic illness.
Scarlatiniform erythema develops profusely and is accentuated in flexural and perorificial areas. The brightly erythematous skin may rapidly acquire a wrinkled appearance, and in severe cases, flaccid blisters and erosions develop profusely. At this stage, areas of the epidermis may separate in response to gentle shear force (Nikolsky sign). As large sheets of epidermis peel away, moist, glistening areas become apparent, initially in the flexures and subsequently over much of the body surface.
Nelson 21st p1310 Kawasaki
In addition to fever, the 5 principal criteria of KD are:
1. Bilateral nonexudative conjunctival injection with limbal sparing
2. Erythema of the oral and pharyngeal mucosa with strawberry tongue and red, cracked lips
3. Edema and erythema of the hands and feet
4. Rash of various forms (maculopapular, erythema multiforme, scarletiniform or less often psoriatic-like, urticarial, or micropustular)
5. Nonsuppurative unilateral cervical lymphadenopathy (>1.5cm) “
"Mother with this hepatitis has increaed risk for HCC on the newborn A. Hepa A B. Hepa B C. Hepa C D. Hepa D"
B
“Nelson 21st p2114-2115
In general, the outcome after acute HBV infection is favorable, despite the risk of ALF. The risk of developing chronic infection brings the risks of liver cirrhosis and HCC to the forefront. Perinatal transmission leading to chronicity is responsible for the high incidence of HCC in young adults in edemic areas. “
"Case of stridor, hoarseness and barking paroxysm. Most common cause A. Parainflunza B. Hib C. Strep D. RSV"
A
“Nelson 21st p2203
Most patients have an URTI with some combination of rhinorrhea, pharyngitis, mild cough, and low grade fever before signs and symptoms of upper airway obstruction become apparent. The child then develops the characteristic barking cough, hoarseness and inspiratory stridor.
The parainfluenza viruses account for approximately 75% of cases. Other viruses associated with croup include influenza, adenovirus, RSV, and measles.
Croup is a clinical diagnosis and does not require a radiograph of the neck. Radiographs of the neck can show the typical subglotting narrowing, or steeple sign, of croup on the posteroanterior view. “
"What vaccine needs a booster at during convalescence since disease does not confer lifelong immunity A. Diphtheria B. Pertussis C. Mumps D. Varicella"
B
“Nelson 21st p1492
Neither natural disease nor vaccination provides complete or lifelong immunity against pertussis reinfection or disease.
Although the DTaP series is protective short-term, vaccine effectiveness wanes rapidly, with estimates of only 10% protection 8.5yr after the 5th dose. Tdap protection is also short-lived, with efficacy falling from >70% initially to 34% within 2-4yr. “
“A girl from Samar came in for 3-day history of watery diarrhea, crampy abdominal pain. Sister has the same problem. What is the diagnosis?
a) Giardiasis
b) Amoebiasis
c) Cryptosporidiasis
d) Schistosomiasis”
C
“Nelson 21st p1836 Cryptosporidium
Cryptosporidium is recognized as a leading protozoal cause of diarrhea in children worldwide and is a common cause of outbreaks in childcare centers.
Diarrhea is initiated by ingestion of infectious oocyts that were ingested in the feces of infected humans and animals.
Cryptosporidium infection is associated with profuse, watery, nonbloody diarrhea that can be accompanied by diffuse crampy abdominal pain, nausea, vomiting, and anorexia
Nelson 21st p1834 Giardia
Most symptomatic patients usually have a limited period of acute diarrheal disease with or without low grade fever, nausea, and anorexia. In an small proportion of patients, an intermittent or more protracted course characterized by diarrhea, abdominal distension and cramps, bloating, malaise, flatulence, nausea, anorexia, and weight loss occurs.
Stools may initially be profuse and watery and later become foul smelling and may flloat. Stools do not contain blood, mucus, or fecal leukocytes. Varying degrees of malabsorption may occur.
Nelson 21st p1832 Amebiasis
The onset of amebic colitis is usually gradual, with colicky abdominal pains and frequent bowel movements (6-8x/day). Diarrhea is frequently associated with tenesmus. Almost all stool is heme-positive, but most patients do not present with greasy bloody stools. Generalized constitutional symptoms and signs are characteristically absent, with fever documented in only 1/3 of patients.
Nelson 21st p1891 Schistosoma
Two main clincal syndromes arise from Schistosoma infection: urogenital schistosomiasis caused by S. hematobium and intestinal schistosomaisis caused by S. mansoni or S. japonicum.
Children with chronic schistosomiasis may have intestinal symptoms; colicky abdominal pain and bloody diarrhea are the most common. However, the intestinal phase may remain subclinical, and the late syndrome of hepatosplenomegaly, portal hypertension, ascites, and hematemesis may be the first clinical presentation. “
“Another girl from Samar came in for 2-week history of diarrhea, greasy stools, and tenesmus. Stool exam showed no fecal blood, mucus, leukocytes. What is the pathologic agent?
a) Giardia lamblia
b) Entamoeba histolytica
c) Shigella dysenteriae
d) Cryptosporidium”
A
”
Nelson 21st p1836 Cryptosporidium
Cryptosporidium is recognized as a leading protozoal cause of diarrhea in children worldwide and is a common cause of outbreaks in childcare centers.
Diarrhea is initiated by ingestion of infectious oocyts that were ingested in the feces of infected humans and animals.
Cryptosporidium infection is associated with profuse, watery, nonbloody diarrhea that can be accompanied by diffuse crampy abdominal pain, nausea, vomiting, and anorexia
Nelson 21st p1834 Giardia
Most symptomatic patients usually have a limited period of acute diarrheal disease with or without low grade fever, nausea, and anorexia. In an small proportion of patients, an intermittent or more protracted course characterized by diarrhea, abdominal distension and cramps, bloating, malaise, flatulence, nausea, anorexia, and weight loss occurs.
Stools may initially be profuse and watery and later become foul smelling and may flloat. Stools do not contain blood, mucus, or fecal leukocytes. Varying degrees of malabsorption may occur.
Nelson 21st p1832 Amebiasis
The onset of amebic colitis is usually gradual, with colicky abdominal pains and frequent bowel movements (6-8x/day). Diarrhea is frequently associated with tenesmus. Almost all stool is heme-positive, but most patients do not present with greasy bloody stools. Generalized constitutional symptoms and signs are characteristically absent, with fever documented in only 1/3 of patients.
Nelson 21st p1509 Shigella
Bacillary dysentery is clinically similar regardless of infecting serotype. The diarrhea may be watery and of large volume initially, evolving into frequent, small-volume, bloody mucoid stools. “
A chronic complication of measles
SSPE
“Nelson 21st p1673-1674
Subacute sclerosing panencephalitis (SSPE) is a chronic complication of measles with a delayed onset and an outcome that is nearly always fatal.
The diagnosis of SSPE can be eastablished through documentation of a complatible clinical course and at least one of the following supporting findings:
1. Measles antibody detected in CSF
2. Characteristic EEG findings
3. Typical histologic findings in and/or isolation of virus or viral antigen from brain tissue obtained by biopsy or postmortem examination
“
“Most devastating copious watery diarrhea.
a) Cholera
b) ETEC
c) EHEC
d) Giardia”
A
“Nelson 21st p1516
Following an incubation period of 1-3 days, acute watery diarrhea and vomiting ensue. Diarrhea can progress to painless puring of profuse rice-water stools (suspended flecks of mucus) with a fishy smell, which is the hallmark of the disease.
Cholera gravis, the most severe form of the disease, results when puring rates of 500-1000 ml/hr occur. The purging leads to dehydration manifested by decreased urine output, sunken fontanel, sunken eyes, absence of tears, dry oral mucosa, shriveled hands and feet, poor skin turgor, thready pulse, tachycardia, hypotension, and vascular collapse.
Although patients may initially be thirsty and awake, they rapidly progress to obtundation and coma. If fluid losses are not rapidly corrected, death can occur within hours. “
Infection that initially presents with acute fever, then rapidly progresses to shock and purpura.
acute meningococcemia
“Nelson 21st p1471-1472
THe most common form of meningococcal infection is asymptomatic carriage of the organism in the nasopharynx. In the rare cases where invasive disease occurs, the clinical spectrum of meningococcal disease varies widely, but the highest proportion of cases present with meningococcal meningitis (30-50%)
Acute meningococcal septicemia cannot be distinguished from other viral or bacterial infections early after onset of symptoms. Typical nonspecific early symptoms include fever, irritability, lethargy, respiratory symptoms, refusal to drink, and vomiting.
As disease progresses, cold hands or feet and abnormal skin color may be important signs, capillary refill time becomes prolonged, and a nonblanching or petechial rash will develop in >80% of cases. In fulminant meningococcal septicemia, the disease progresses rapidly over several hours from fever with nonspecific signs to septic shock characterized by prominent petechiae and purpura (purpura fulminans) with poor peripheral perfusion, tachycardia (to compensate for reduced blood volume resulting from capillary leak), increased respiratory rate (to compensate for pulmonary edema), hypotension (a late sign of shock in young children), confusion, and coma (resulting from decreased cerebral perfusion). Coagulopathy, electrolyte disturbance (esp. hypokalemia), acidosis, adrenal hemorrhage, renal failure, and myocardial failure may develop. Meningitis may be present. “
“Patient came in with nodules on the shin. These lesions are also found in patients infected with Group A strep and Inflammatory Bowel Disease?
a) Erythema multiforme
b) Erythema nodosum
c) Erythema marginatum
d) Erythema toxicum”
B
“Proven causal relationship in vaccination
a) MMR and autism
b) injection-related events and syncope
c) BCG and pneumonia
d) None of the above”
B
“3 yr old male was seen at the ER for high fever and difficulty in breathing. He was noted to have drooling, and was sitting upright with neck hyperextended.
a) epiglottitis
b) acute pharyngitis
c) diphtheric pharyngit is
d) laryngotracheobronchitis”
A
“Nelson 21st p2203
Epiglottitis is characterized by an acute rapidly progressive and potentially fulminating course of high fever, sore throat, dyspnea, and rapidly progressing respiratory obstruction…Within a matter of hours, the patient appears toxic, swallowing is difficult, and breathing is labored. Drooling is usually present, and the neck is hyperextended in an attempt to maintain the airway. The child may assume the tripod position, sitting upright and leaning forward with the chin up and mouth open while bracing the arms. The diagnosis requires visualization under controlled circumstances of a large, cherry red, swollen epiglottis by laryngoscopy. “
“Most common cause of watery diarrhea worldwide.
a) Rotavirus
b) ETEC
c) Cholera
d) Giardia”
A
“Nelson 21st p2012
Rotavirus is the most common cause of AGE among children throughout the world. Several other viruses occur less frequently: Norovirus, sapovirus, adenovirus. “
“Patient presented with pink macules that progress to hemorrhagic nodules and eventually to ulcers with ecchymotic and gangrenous centers with eschar formation.
a) Pseudomonas aeruginosa
b) Staphylococcus aureus
c) Streptococcus pyogenes
d) Fusobacterium necrophorum”
A
“Nelson 21st p1529
The characteristic skin lesions of P. aeruginosa, ecthyma gangrenosum, whether caused by direct inoculation or a metastatic focus secondary to septicemia, begin as pink macules and progress to hemorrhagic nodules nd eventually to ulcers with ecchymotic and gangrenous centers with eschar formation, surrounded by an intendse red areola. “
“A 2-year old boy was seen at the ER with 3-dayhistory of cough and fever. He is noted to have inspiratory wheezing and fine crackles.
a) pneumonia
b) bronchiolitis
c) bronchitis
d) tracheitis”
C
“Nelson 21st p2220 Acute bronchitis
The child first presents with nonspecific upper respiratory infectious symptoms such as rhinitis. 3 to 4 days later, a frequent dry hacking cough develops, which may or may not be productive. After several days the sputum can become purulent. Chest pain may be a prominent complaint in older children and is exacerbated by coughing.
Early findings include no or low grade fever and upper respiratory signs such as nasopharyngitis, conjunctivitis, and rhinitis. Auscultation of the chest may be unremarkable at this early phase. As the syndrome progresses and cough worsens, breath sounds become coarse, with coarse and fine crackles and scattered high pitched wheezing. CXR is normal or can have increased bronchial markings
Nelson 21st p2219 Acute bronchiolitis
Acute bronchiolitis is usually preceded by exposure to contacts with a minor respiratory illness within the prevous week. The infant first develops signs of upper respiratory tract infection with sneezing and clear rhinorrhea. This may be accompanied by diminished appetite and fever. Gradually, respiratory distress ensues, with paroxymal cough, dypnea, and irritability.
The physical exam is often dominated by wheezing and crackles. Expiratory time may be prolonged. Work of breathing may be markedly increased, with nasal flaring and retractions.
Nelson 21st p2206 Tracheitis
Typically the child has a brassy cough, apparently as part of a viral laryngotracheobronchitis. High fever and toxicity with respiratory distress can occur immediately or after a few days of apparent improvement. The patient can lie flat, does not drool, and does not hav the dysphagia assocaited with epiglottitis.
The major pathologic feature appears to be mucosal swelling at the level of the cricoid cartilage, complicated by copious thick purulent secretions, sometimes causing pseudomembranes.
Nelson 21st p2269
Pneumonia is frequently preceded by several days of symptoms of an upper respiratory tract infection, typically rhinitis and cough. Tachypnea is the most consistent clinical manifestation of pneumonia.
Increased work of breathing accompanied by intercostal, subcostal, and suprasternal retractions, nasal flariing, and use of accessory muscles is common. Auscultation of the chest may reveal crackles and wheezing. “
“One of the causes of moderate to severe diarrhea, where WHO patterned management for diarrhea.
a) Vibrio cholera
b) Rotavirus
c) ETEC
d) Giardia”
A
“Nelson 21st p1516
Following an incubation period of 1-3 days, acute watery diarrhea and vomiting ensue. Diarrhea can progress to painless puring of profuse rice-water stools (suspended flecks of mucus) with a fishy smell, which is the hallmark of the disease.
Cholera gravis, the most severe form of the disease, results when puring rates of 500-1000 ml/hr occur. The purging leads to dehydration manifested by decreased urine output, sunken fontanel, sunken eyes, absence of tears, dry oral mucosa, shriveled hands and feet, poor skin turgor, thready pulse, tachycardia, hypotension, and vascular collapse.
Although patients may initially be thirsty and awake, they rapidly progress to obtundation and coma. If fluid losses are not rapidly corrected, death can occur within hours. “
“Most common bacterial isolate in an infected dog-bitten wound.
a) Gram negative
b) Tetanus
c) S. pneumoniae
d) S. aureus”
D
“Nelson 21st p3819
The predominant bacterial species isolated from infected dog bite wounds are S. aureus (20-30%), Pasteurella multocida (20-30%), Staphylococcus intermedius (25%) and Capnocytophaga canimorsus; approximately 50% of dog bite wound infections also contain mixed anaerobes
Similar species are isolated from infected cat bite wounds, however Pasteurella multocida is the predominant species in at least 50% of cat bite wound infections.
At least 50% of rats harbor strains of Streptobacillius miniliformis in the oropharynx, and approximately 25% harbor Spirillum minor, an anareobic gram negative organism.
In human bite wounds, nontypeable strains of H. influenzae, Eikenella corrodens, S. aureuus, alpha hemolytic streptococci, and B-lactamase producing aerobes (~50%) are the predominant species. Clenched fist injuries are particularly prone to infection by Eikenella (25%) and anaerobic bacteria (50%)”
“Which vaccine would you NOT give in a patient undergoing chemotherapy?
a. IPV
b. Varicella
c. Influenza
d. Tdap”
B
Live attenuated vaccines are contraindicated in immunocompromised patients and patients undergoing chemotherapy
“A child has recurrent pneumonia treated with amoxicillin, cephalosporin etc. On history the patient was noted not to be
compliant with medications. Now admitted, Chest x- ray showed lobar consolidation of the right lung. What is the antibiotic of choice
a. Ceftriaxone
b. Linezolid
c. Vancomycin
d. Meropenem”
A
“PAPP 2021 PCAP CPG p32
Starting with broad spectrum antibiotics to treat uncomplicated PCAP is highly discouraged and such antibiotics should be reserved for more complicated forms of the disease and for drug-resistant pathogents.
Amoxicillin is still the treatment of choice because it is effective against the majority of pathogens causing PCAP in this age group. High dose amoxicillin is recommended for treatment of suspected or confirmed penicillin-resistant S. pneumonia; the resistance of which can be overcome at higher drug concentrations.
Because the pharmacokinetics of oral cephalosporins are far inferior to amoxicillin, their use in PCAP should be reserved for patients who are allergic to penicillin or patients with isolates known to be resistant to amoxicillin but sensitive to cephalosporins. “
“In a patient with pneumonia, What is the drug of choice in a child who is not allergic to penicillin?
a. Amoxicillin
b. Azithromycin
c. Cefuroxime
d. Ceftriaxone”
A
”"”PAPP 2021 PCAP CPG p32
Starting with broad spectrum antibiotics to treat uncomplicated PCAP is highly discouraged and such antibiotics should be reserved for more complicated forms of the disease and for drug-resistant pathogents.
Amoxicillin is still the treatment of choice because it is effective against the majority of pathogens causing PCAP in this age group. High dose amoxicillin is recommended for treatment of suspected or confirmed penicillin-resistant S. pneumonia; the resistance of which can be overcome at higher drug concentrations.
Because the pharmacokinetics of oral cephalosporins are far inferior to amoxicillin, their use in PCAP should be reserved for patients who are allergic to penicillin or patients with isolates known to be resistant to amoxicillin but sensitive to cephalosporins. “””
“2nd to rotavirus, which is the next most prevalent cause of diarrhea in the Philippines?
a. ETEC
b. EHEC
c. Shigella
d. E. histolytica”
A
“Fundamentals of Pediatrics vol 2 p1296
Rotavirus is the leading cause of severe watery diarrhea globally and is responsible for 527,000 deaths annually. It counts for 29% of diarrheal diseases among children under 5 years old.
E. coli is the cause of 25% of diarrheas in the developing countries. Of the 5 groups of E. coli, the most common agent is ETEC , which causes acute water diarrhea in developing countries.
Shigella is the cause of 10-15% of acute diarrheas in children under 5 years. Known as the prototype organism causing bloody diarrhea, it is the most common cause of dysentery in children.”
“Child with peri-anal pruritus at night?
a. E. vermicularis
b. Ascaris lumbricoides
c. Trichuris trichuira
d. Hookworm”
A
”
Nelson 21st p1882
Pinworm infection is innocuous and rarely causes serious medical problems. The most common complaints include itching and restless sleep secondary to nocturnal perianal or perineal pruritis. “
“A teenager went camping with friends and went into caves. Came back with pulmonary symptoms (cough), hepatomegaly etc. Diagnosis?
a. Histoplasmasmosis
b. HIV
c. Tuberculosis
d. Coccidiomycosis”
A
“Nelson 21st p1650 Histoplasmosis
H. capsulatum thrives in soil rich in nitrates such as areas that are heavily contaminated with bird or bat droppings or decayed wood. Focal outbreaks of histoplasmosis have been reported after intense exposure to bat guano in caves and along bridges frequented by bats.
Acute pulmonary histoplasmosis follows initial or recurrent respiratory exposure to microconidia. The prodrome is not specific and usually consists of flu-like symptoms, including headache, fever, chest pain, cough, and myalgias. Hepatosplenomegaly occurs more often in infants and young children. Symptomatic infections may be associated with significant respiratory distress and hypoxia and may require intubation, mechanical ventilation, and steroid therapy.
Nelson 21st p1654-1655 Coccidiomycosis
Coccidioides spp. inhabit soil in arid regions in the USA, Mexico, and South America. Incidence increases during windy, dry periods that follow rainy seasons. Seismic events, archeologic excavations, and other activities that disturb contaminated sites have caused outbreaks.
The clinical constellation of erythema nodosum, fever, chest pain, and arthralgias (esp. knees and ankles) has been termed desert rheumatism and valley fever. “
“A child with microcytic hypochromic anemia was on iron for 3 months. Repeat CBC still showed anemia. Stool exam was done and showed Necator americanus. What is the pathophysiology of anemia?
a. Rupture of the capillaries
b. Ingestion of blood by the parasite
c. Blood loss in stool
d. Attachment of the parasite to the GI tract”
A
“Nelson 21st p1880
The major morbidity of human hookworm infection is a direct result of intestinal blood loss. Adult hookworms adhere tenaciously to the mucosa and submucosa of the proximal small intestine by using their cutting plates or teeth and a muscular esophagus that creates negative pressure in their buccal capsules.
At the attachment site, host inflammation is downregulated by the release of anti-inflammatory polypeptides by the hookworm. Rupture of capillaries in the lamina propria is followed by blood extravasation, with some of the blood ingested directly by the hookworm. After ingestion, the blood is anticoagulated, the RBCs are lysed, and the hemoglobin released and digested.
Each adult A. duodenale hookworm causes loss of an estimated 0.2ml of blood per day; blood loss is less for N. americanus. “
“A history of which condition is a clue to diagnose a child with chronic regional lymphadenopathy?
a. Cat scratch disease
b. EBV
c. TB adenitis
d. Leukemia”
A
“Nelson 21st p1540-1541
The most common presentation of Bartonella infection is cat-scratch disease, which is a subacute, regional lymphadenitis caused most frequently by B. henselae. It is the most common cause of chronic lymphadenitis that persists for >3wk
After an incubation period of 7-12 days. 1 or more 3-5mm red papules develop at the site of cutanous inoculation, often reflecting a linear cat scratch.
Lymphadenopathy is generally evident within 1-4 wk. Chronic regional lymphadenitis is the hallmark, affecting the 1st or 2nd set of nodes draining the entry site. Affected lymph nodes in order of frequency include the axillary, cervical, submandibular, preauricular, epitrochlear, femoral, and inguinal nodes. “
“Case about sinusitis. What is the 1st line drug of choice?
a. Amoxicillin
b. Co- amoxiclav
c. Clindamycin
d. Cefuroxime”
A
“Nelson 21st p2190
Initial therapy with amoxicillin (45mkd BID) is adequate for most children with uncomplicated mild to moderate severity acute bacterial sinusitis. Alternative treatments for the penicillin-allergic patients include cefdinir, cefuroxime, cefpodoxime, or cefixime. In older children, levofloxacin is an alternative antibiotic. “
"Case: epiglotitittis. Agent? a. Influenza b. Parainfluenza1,2,3 C. Hib d. RSV"
C
“Nelsons 21st p2202-2203
With the exceptions of diphtheria, bacterial tracheitis, and epiglottitis, most acute infections of the upper airway are caused by viruses.
The parainfluenza viruses account for approximately 75% of cases. Other viruses associated with croup include influenza, adenovirus, RSV, and measles.
In the past, H. influenza type b was the most commonly identified etiology of acute epiglottitis. Other agents such as S. pyogenes, S. pneumoniae, nontypeable H. influenza, and S. aureus represent a larger portion of pediatric cases of epiglottitis in vaccinated children. “
“Child previously had varicella. After several weeks the patient would fall to one side, difficult walking. Diagnosis?
a. Cerebellar ataxia
b. Encephalitis
c. Friedrichs ataxia
d. Medulloblastoma”
A
“Nelsons 21st p1712
Encephalitis and acute cerebellar ataxia are well-described neurologic complications of varicella. Morbidity from CNS complications is highest among patients younger than 5yr and older than 20yr.
Nuchal rigidity, altered consciousness, and seizures characterize meningoencephalitis. Patient with cerebellar ataxia have a gradual onset of gait disturbance, nystagmus, and slurred speech.
Neurologic symptoms usually begin 2-6 days after the onset of the rash but may occur during the incubation period or after resolution of the rash. “
“Patient traveled to malaria endemic area (Mindoro), came back after 16 days with fever every 48 hours with defervescence and fatigue in between. Diagnosis:
a. Malariae
b. Ovale
c. Vivax
d. Falciparum”
C
"Incubation period Falciparum 9-14 days Vivax 12-17 days Ovale 16-18 days Malariae 18-40 days
Fever pattern
Vivax, ovale - every other day
Malariae - every 3rd day
Falciparum - periodicity less apparent
Plasmodium ovale least common, primarily africa
Plasmodium vivax found in SE Asia”
“Preterm neonate, 1 month at the NICU, noted to have decreased tone and apnea. The patient has a central line with CONS. How to definitively diagnose CONS?
a. Hx of prolonged nicu stay, presence of new signs and symptoms and previous iv antibiot ic tx
b. Culture IV site
c. Blood culture showed S. epidermidis after 48 hours
d. Blood culture central and peripheral line and then start antibiotics”
D
“Nelson 21st p1436
True bacteremia should be suspected if blood cultures grow rapidly (within 24hr), >1 blood culture is positive with the same CONS strain, cultures from both line and peripheral sites are positive, and clinical and laboratory signs and symptoms compatible with CONS sepsis are present and subsequently resolve with appropriate therapy.
Before initiating presumptive antibiotic therapy in such patients, it is always prudent to draw 2 separate blood cultures to facilitate subsequent interpretation if CONS is grown.
Nelson 21st p1411
Blood cultures collected before beginning antibiotic therapy are gneerally positive from both the CVC and the peripheral blood. It is important not to collect cultures unless infection is suspected, as blood culture contamination may occur and lead to inappropriate therapy. To help interpret positive cultures with common skin contaminants, blood cultures should be collected from at least 2 sites, preferably including all lumens of CVC and the peripheral blood, before intiation of antibiotic therapy. “
“A 5 year old child, previously well suddenly had changes in behavior, irritability plus choreoathetosis. What infection is important to know in the history?
a. Rubeola
b. Enterovirus
c. Herpes
d. Varicella”
C
“Nelson 21st p1705
HSV encephalitis is the leading cause of sporadic, nonepidemic encephalitis in children and adults in the US. It is an acute necrotizing infection generally involving the frontal and/or temporal cortex and limbic system and, beyond the neonatal period, is almost always caused by HSV-1.
The infection may manifest as nonspecific findings, including fever, headache, nuchal rigidity, nausea, vomiting, generalized seizures, and alteration of consciousness. Injury to the frontal or temporal cortex or limbic system may produce findings more indicative of HSV encephalitis, including anosmia, memory loss, peculiar behavior, expressive aphasia and other changes in speech, hallucinations, and focal seizures.
Nelson 21st p3182 Anti-N-methyl-D-aspartate receptor encephalitis
In a small number of patients, anti-NMDAR encephalitis occurs simultaneously with or after infection with a variety of pathogens, including Mycoplasma pneumoniae, HSV1, HHV6, enterovirus, and influenza virus.
There is evidence that some patients with HSV encephalitis develop antibodies aginst the GluN1 subunit of the NMDAR and other neuronal cell surface proteins and receptors, which leads to the presentation of new or relapsing neurologic symptosm 2-12 wk after completing treatment for HSV encephalitis.
In children younger than 4yr, this type of autoimmune encephalitis usually manifests with choreoathetosis and dyskinesias (known as choreoathetosis post-HSV encephalitis). In contrast, older children and adults more often develop predominantly behavioral symptoms. “
“True regarding gonococcal infection in children?
a. Gram stain of the urethral discharge shows intracellular gram negative organisms seen equally in males and females
b. Males with the disease will not resolve if not treated
c. 1 dose of ceftriaxone is needed to cure neonatal disease
d. None of the above”
C
“Nelson 21st p1481
In males with symptomatic urethritis, a presumptive diagnosis of gonorrhea can be made by identification of gram negative intracellular diplococci (within leukocytes) in the urethral discharge. A similar finding in females is not sufficient because Mima polymorpha and Moraxella, which are normal vaginal flora, have a simlar appearance. The sensitivity of the Gram stain for diagnosing gonococcal cervicitis and asymptomatic infections is also low.
Nelson 21st p1480
Urethritis is usually characerized by a purulent discharge and by dysuria without urgency or frequency. Untreated urethritis in males resolves spontaneously in several weeks or may be complicated by epididymitis, penile edema, lymphangitis, prostatitis, or seminal vesiculitis.
Nelson 21st p1482 Table 219.1 Recommended treatment of gonococcal infections
Neonates
- Ophthalmia neonatorum: Ceftriaxone IM SD
- Disseminated infection, scalp abscess, septic arthritis: Ceftriaxone OR cefotaxime IV x 7 days
- Meningitis: Ceftriaxone or cefotaxime IV x 10-14 days
- Endocarditis: Ceftriaxone or cefotaxime IV x 28 days minimum”
“Up until when is Hib vaccine given?
a. 12 months
b. 24 months
c. 48 months
d. 60 months”
D
“Prev Ped 2018 p72
Hemophilus influenza type B conjugate vaccine (Hib)
- Given IM
- Indicated for children aged 12-59mos
a. unimmunized or with one Hib vaccine dose vaccine dose recieved before age 12 months, given 2 additional doses 8 weeeks apart
b. With >=2 Hib vaccine doses recieved before age 12 months, give 1 additional dose “
“Baby with previous antibiotic use. Now with satellite lesions in the diaper area. Treatment?
a. Topical clotrimazole
b. 1% hydrocortisone ointment
c. Mupirocin ointment
d. Oral azole”
A
“Nelson 21st p3564
Candidal diaper dermatitis is an ubiquitous problem in infants and, although relatively benign, is often fustrating because of its tendency to recur. Predisposed infants usually carry C. albicans in their intestinal tracts, and the warm, moist, occluded skin of the diaper airea provides an optimal environment for its growth. A seborrheic, atopic, or irritant contact dermatitis usually provides a portal of entry for the yeast.
The primary clinical manifestation consists of an intensely erythematous confluent plaque with a scalloped border and a sharply demarcated edge. It is formed byt he confluence of numerous plaques and vesicular pustules. Satellite pustules, those that stud the contiguous skin, are a hallmark of localized candidal infection. The perianal skin, inguinal folds, perineum, and lower abdomen are usually involved.
Treatment consists of an imidazole cream 2 times daily. The combination of a corticosteroid and an antifungal agent may be justified if inflammation is severe but may confuse the situation if diagnosis is not firmly established. Corticosteroid should not be continued for more than a few days. Protection of the diaper area by an application of a thick zinc oxide paste overlying the candidal preparation may be helpful.
“
“Case of adolescent with peritonsillar cellulitis. Which is true?
a. Abscess is prone to rupture with risk of aspiration
b. Surgically drain and give antibiotics
c. Draining does not help in the disease, do tonsillectomy instead
d. Do incisional drainage to isolate GABHS”
B
“Nelson 21st p2198
Peritonsillar cellulitis and/or abscess is caused by bacterial invasion through the capsule of the tonsil, leading to cellulitis and/or abscess formation in the surrounding tissues.
The typical patient is an adolescent with a recent history of acute pharygotonsillitis. Clinical manifestations include sore throat, fever, trismus, muffled or garbled voice, and dysphagia. Physical examination reveals an asymmetric tonsillar bulge with displacement of the uvula (diagnostic).
Group A streptococci and mixed oropharyngeal anaerobes are the most common pathogens, with more than four bacterial isolates per abscess typically recovered by needle aspiration.
Treatment includes surgical drainage and antibiotic therapy effective against group A streptococci and anaerobes. Surgical drainage may be accomplished through needle aspiration, incision and drainage, or tonsillectomy.
Tonsillectomy should be considered if there is failure to improve within 24hr of antibiotic therapy and needle aspiration, history of recurrent peritonsillar abscess or recurrent tonsillitis, or complications from peritonsillar abscess
The feared, albeit rare, complication is rupture of the abscess with resultant aspiration pneumonitis. “
“Mother is 37 weeks pregnant. 3-year-old daughter contracted hand foot mouth disease. What will you advise?
a. Isolate the mother from the family
b. Give mother methisiprinol
c. Let the mother reach term so she can pass the antibodies to the newborn
d. None of the above”
A
“Nelson 21st p1692
Hand-foot-and-mouth disease is most frequently caused by coxsackievirus A16, sometimes in large outbreaks, and can also be caused by coxsackievirus A71.
It is usually a mild illness, with or without low grade fever. When the mouth is involved, the oropharynx is inflamed and often contains scattered, painful vesicles on the tongue, buccal mucosa, posterior pharynx, palate, gingiva, and/or lips. These may ulcerate, leaving 4-8mm shallow lesions with surrounding erythema.
Maculopapular, vesicular and/or pustular lesions may occur on the hands and fingers, feet, and buttocks and groin. Skin lesions occur mmore commonly on the hands than feet and are more common on dorsal surfaces, but frequently also affect palms and soles. Hand and feet lesions are usually tender 3-7mm vesicles that resolve in about 1 wk.
Nelson 21st p1697
Pregnant women near term should avoid contact with individuals ill with possible enterovirus infections. If a pregnant woman experiences a suggestive illness, it is advisable not to proceed with emergency delivery unless there is concern for fetal compromise or obstetric emergencies cannot be excluded. Rather, it may be advantageous to extend pregnancy, allowing the fetus to passively acquire protective antibodies. “
“Patient with ascariasis, suddenly had difficulty in breathing. What happened?
a. Ingestion of worm
b. Aspiration of worm
c. Worm migrated to lungs
d. None of the above”
C
“Nelson 21st p1877 Ascariasis
The most common clinical problems are from pulmonary disease and obstruction of the intestinal or biliary tract.
The pulmonary manifestation resemble Loeffler syndrome and include transient respiratory symptoms such as cough and dyspnea, pulmonary infiltrates, and blood eosinophilia.
A more serious complication occurs when a large mass of worms leads to acute bowel obstruction. Ascaris worms also occasionally migrate into the biliary and pancreatic ducts, where they cause cholecystitis or pancreatitis. “
“16 year old who ate a hamburger, green stool, mucoid, blood tinged, abdominal pain.
a. E. histolytica
b. ETEC
c. EPEC
d. Shigella”
D
“Nelson 21st p1509 Shigella
Bacillary dysentery is clinically similar regardless of infecting serotype. Ingestion of shigellae is followed by an incubation period of 12hr to several days before symptoms ensue. Severe abdominal pain, emesis, anorexia, generalized toxicity, urgency, and painful defecation characteristically occur. The typically high fever with shigellosis distinguishes it from EHEC.
The diarrhea may be watery and of large volume initially, evolving into frequent, small volume, bloody mucoid stools. Significant dehydration is related to the fluid losses in feces and emesis.
Nelson 21st p1512 ETEC
The typical signs and symptoms include explosive watery, nonmucoid, nonbloody diarrhea, abdominal pain, nausea, vomiting, and little or now fever. The illness is usually self-limited and resolves in 3-5 days but can occasionally last >1wk
Nelson 21st p1513 EPEC
EPEC causes acute, prolonged, and persistent diarrhea, primarily in children <2 yr old in developing countries. Profuse watery, nonbloody diarrhea with mucus, vomiting, and low-grade fever are common symptoms. Prolonged diarrhea (>7d) and persistent diarrhea (>14d) can lead to malnutrition.
Nelson 21st p1832 Amebiasis
The onset of amebic colitis is usually gradual, with colicky abdominal pains and frequent bowel movements (6-8x/day). Diarrhea is frequently associated with tenesmus. Almost all stool is heme-positive, but most patients do not present with greasy bloody stools. Generalized constitutional symptoms and signs are characteristically absent, with fever documented in only 1/3 of patients.
“
“Why no need to treat salmonella with antibiotics
a. Resolves spontaneously
b. Prolongs salmonella excretion
c. Emergence of resistance
d. None of the above”
B
“Why no need to treat salmonella with antibiotics
a. Resolves spontaneously
b. Prolongs salmonella excretion
c. Emergence of resistance
d. None of the above”
“Phase of Viral shedding in measles
a. Incubation
b. Prodromal
c. Exanthematous
d. Recovery “
B
“Nelsons 21st p1670
Measles infection consists of 4 phases: incubation period, prodromal illness, exanthematous phase, and recovery.
During incubation, measles virus migrates to regional lymph nodes. A primary viremia ensues that disseminates the virus to the reticuloendothelial system. A secondary viremia spreads the virus to body surfaces.
The prodromal illness begins after the secondary viremia and is associated with epithelial necrosis and giant cell formation in body tissues. Cells are killed by cell-to-cell plasma membrane fusiion associated with viral replication. Virus shedding begins in the prodromal phase
With onset of the rash, antibody production begins, and viral replication and symptoms begin to subside. “
"Associated with favorable outcome in tetanus A. Long incubation period B. Presence of fever C. Onset of trismus <7 days D. Tetanic spasms"
A
“Nelson 21st p1552
The most important factor that influences outcome is the quality of supportive care. Mortality is highest in very young and very old patients.
A favorable prognosis is associated with a long incubation period, absence of fever, and localized disease.
An unfavorable prognosis is associated with onset of trismus <7 days after injury and onset of generalized tetanic spasms <3 days after onset of trismus. “
"Associated with fulminant/ poorer prognosis in meningococcemia A. Purpura fulminans B. Leukopenia C. Low or normal ESR D. seizure"
C
“Nelson 21st
Poor prognostic factors on presentation include hypothermia or extreme hyperpyrexia, hypotension or shock, purpura fulminans, seizures, leukopenia, thrombocytopenia (including DIC), acidosis, and high circulating levels of endotoxin and TNF-α. The presence of petechiae for <12 hr before admission, absence of meningitis, and low or normal ESR indicate rapid, fulminant progression and poorer prognosis”
"Treatment of a child with cough, in distress, with dehydration, given Hib vaccine. Treatment of choice? A. Amoxicillin B. Penicillin G C. Ampicillin D. Co-amoxiclav"
B
“Diagnosis: PCAP C
PAPP 2021 PCAP CPG p28
For patients classified as having non-severe PCAP, regardless of
immunization status against S. pneumonia and H. influenza, any of the following is considered:
1. Amoxicillin trihydrate x 7 days
2. Amoxicillin-clavulanate x 5-7 days OR cefuroxime x 7 days in settings with documented high level penicillin resistant pneumococci or B-lactamase producing Hib
For patients classified as having severe PCAP, regardless of immunization status against S. pneumonia, any of the following is considered:
- Penicillin G q6 if with complete Hib vaccination OR Ampicillin q6 if none, incomplete or unknown Hib vaccination
- Cefuroxime q8 OR ceftriaxone q12 to q24 OR ampicillin sulbactam in settings with documented high level penicillin resistant pneumococci or B-lactamase producing Hib
- Add clindamycin q6 to q8 when staphylococcal pnuemonia is highly suspected based on clinical and CXR features
- In cases of severe and life threatening conditions such as sepsis or shock, vancomycin q6 to q8 is preferred”
"A case of an infant with respiratory distress with fever, IC retractions, etc A. PCAP A B. PCAP B C. PCAP C D. None of the above"
C
“PAPP 2021 PCAP CPG p15-16
Criteria for severe pneumonia (PCAP C or D requiring admission)
- Respiratory signs - cyanosis/hypoxemia, head bobbing, retractions, apena, grunting
- CNS signs - lethargic/stuporous/comatose/GCS <13, seizures
- Circulatory signs - capillary refill >3s or shock, pallor
- General considerations - moderate to severe malnutrition, refusal or inability to take food/drink per orem, some to severe dehydration, age <6 months
- Ancillary parameters - CXR or UTZ findings of consolidation, multifocal disease, moderate to large effusion, abscess, air leak; sustained O2 sat at room air <=93% “
"Preferred diagnostic test for HIV suspect below 18 months A. HIV RNA PCR B. HIV DNA PCR C. HIV Culture D. HIV p24"
A
“HIV RNA used in the Philippines
Nelson 21st p1787
Viral diagnostic assays, such as HIV DNA or RNA PCR, are considerably more useful in young infants, allowing a definitive diagnosis in most infected infants by 1-4mo of age. By 4mo of age, HIV PCR testing identifies all infected nonbreastfed infants.
Almost 40% of infected newborns have positive test results in the first 2 days of life, with >90% testing positive by 2 wk of age. Either the DNA or RNA PCR is considered acceptable for infant testing.
Nelson 21st p1787 Table 302.3 Laboratory diagnosis of HIV infection
HIV DNA PCR
- historically preferred to diagnosis HIV-1 subtype B infection in infants and children younger than 24mo of age
- highly sensitive and specific by 2wk of age, available
- performed on peripheral blood mononuclear cells
- false negatives can theoretically occur in non-B subtype HIV-1 infections
- historically had been preferred for testing in young infants
HIV RNA PCR
- preferred test to identify non-B subtype HIV-1 infections
- similar sensitivity and specificity to HIV DNA PCR in infants and children younger than 24mo of age “
