ID

Question 1

non bullous impetigo treatment?

Answer 1

TOpical MUPIROCIN!!!

widespread = oral cephalexin

Question 2

cervical lymphadenitis treatment?

Answer 2

clindamycin!!

Question 3

oropharangyeal uclers and vesicles only + fevers.

causative organism?

Answer 3

cocksakie virus!!!
patient has herpangina
treatment is supportive

hand foot and mouth is different condition caused by same virus

Question 4

varicella exposure

varicella immune = prior infection or two doses of vaccine

patient only had 1 dose in past.

next step in management?

Answer 4

varicella vaccine with 5 days of exposure!!!

if patient was immunocompromised, newborn or pregnant woman you would give IVIG

And if patient was varicella immune you would just observe

Question 5

CRS = pda, hearing loss, cataracts

Question 6

nocturnal perianal itching is most likely helminth infection (pinworm). can also cause vulval itching

can be diagnosed using tape test. treat with mebendazole or pyrantel pamoate

Question 7

fever, neck pain with extension, odynophagia, dysphagia, muffled voice,

lateral neck x-ray shows widening of pre-vertebral space (prevertebral thickening)

most likely diagnosis?

Answer 7

retropharyngeal abscess!!

Question 8

cough or nasal discharge/congestion that persists >10 days = acute bacterial rhinosinusitis.

most common risk factor?
treatment?

Answer 8

URTI!!!
treat with co-amoxiclav

(also allergic rhinitis)

NOTE, Viral rhinosinusitis can also cause bilateral yellow discharge from nostrils and enlarged cervical lymph nodes.

Question 9

fever, poor feeding and bulging fontanelle in an infant = concern for meningitis!!!

1st = blood cultures which are pending

next step?

Answer 9

lumbar puncture!!!

only do CT prior to lumbar puncture if there are signs of raised ICP = focal neurological deficit, coma, papilledema

in addition in an infant an open fontanelle means lower risk of herniation as they have a valve to release elvated ICP so rarely require neuroimaging before LP

Question 10

antibiotic prohpylaxis options for meningitis exposure

Answer 10

ceftriaxone!!! AND Rifampin

and ciprofloxacin (adults only)

Question 11

risk factors for acute otitis media in young age, (6-18 months)

Answer 11

smoking exposure!!!

lack of breastfeeding!
daycare attendance!

Question 12

otitis media but penicillin allergy
treatment?

Answer 12

Azithromycin!!!!
or clindamycin

cant give co-amoxiclav

Question 13

microcephaly, periventricular calcifications, hepatospleenomegaly, thrombocytopenia, most likely source of congenital infection?

Answer 13

SALIVA!!!

this is congenital CMV

NOT cat feces or raw meat!!! as this is in keeping with Toxoplasmosis which causes hydrocephalus!!! and parenchymal calcifications NOT periventricular

Question 14

what laboratory test should you check when there are signs of meningococcal meningitis + purpural/petechial rash

Answer 14

fibrinogen!!!

purpura suggests DIC

Question 15

community acquired pneumonia in child BUT bilateral crackles in lung examination.

most likley causative organism?

Answer 15

mycoplasma pneumonia!!! -> causes bilateral pneumonia -> treat with macrolide/azithromycin!!!! or clarithromycin

Contrast focal lobar pneumonia -> step pneumonia most common cause -> oral amoxicillin outpatient or iV ceftriaxone in hospital

Question 16

airborne precautions needed for measles, not just the level of droplet

Question 17

4 month old admited due to siezures + retinal examination showing retinal inflammation - you are given the picture (chorioretinitis) + hepatospleenomegaly

most likely cause of patients presentation?

Answer 17

intrauterine infection!!!

congenital toxoplasmosis!!!

siezures and hepatosplenomegaly are not part of the classic triad but can occur

Question 18

5 year old. abdominal cramping and diarrhea with mucus and occult blood

thus patient has acute gastroenteritis. viral most common. but patient has bacterial gastroenteritis evidenced by blood and mucus.

next step in management following stool studies?

Answer 18

supportive care and close follow up only!!!!

antibiotics not recommended in children due to risk of HUS

Question 19

most common pathogen cystic fibrosis pneumonia in children?

Answer 19

peudomonas aeroginosa!!!!

contrast to staph aureus in adults!!

Question 20

how to prevent neonatal gonococcal conjuctivitis?

Answer 20

topical erythromycin at birth!!!

Question 21

signs of bacterial sinusitis BUT also
focal headache eg pain radiating to right forehead worse with palpation of forehead and early morning vomiting

next step in management?

Answer 21

CT scan of the head!!
likely brain abscess!!!

other possible findings = focal neurological deficits, AMS eg dizziness

otiti media, dental infections and congenital heart disease are other risk factors for brain abscess

Question 22

chronic cough and history of focal pneumonia, cough not resolving w antibiotics. new cxr shows infilitrated and hilar lymphadenopathy, lives in shelter. most likely diagnosis?

Answer 22

primary TB - consolidation or pleural effusion may be seen

secondary reactivation disease marked by upper lung cavitation, is rare in children

Question 23

patient with signs of infectious mononucleosis. severely enelarged tonsils and dysphagia.

what complication is she most at risk of?

Answer 23

acute airway obstruction!!!

treat with corticosteroids

Question 24

in septic arthritis what is the process called when you gain synovial culture samples, eg from the knee

Answer 24

arthrocentesis

Question 25

Kawasaki disease requires at least 5 days of fever, then other things eg swelling of hands and feet, conjuctivitis. contrast scarlet fever. in scarlet fever, the sandpaper rash can be followed by desquamation

Question 26

tiny head, tiny weight and length (symmetrical growth restriction) + hepatosplenomegaly + jaundice = non specific signs of congenital infection!!! so if a patient has these + rhinorrhea + desquamating rash on feet and buttocks!! most likely diagnosis?

Answer 26

congenital syphilis!!!

Question 27

when do you give doxycycline single dose for lyme disease following tick bite?

Answer 27

if tick is attached for >/=36 hours!! if not remove and reassure

Question 28

patient has travellers diarrhea but it is prolonged meaning at least TWO weeks so it PARASITIC not bacterial or viral. when the stools in this situation are also bloody, what is the most likely diagnosis?

Answer 28

entamoeba histolytica!!

Question 29

1 year old with meningococal septicemia. becomes septic and dies. most likley cause of death at autopsy?

Answer 29

adrenal gland failure!!! = waterhouse friederichson syndrome - sudden vasomotor collapse and skin rash (purpuric lesions) due to adrenal hemorrhage

Question 30

3 year old, small puncture wounds on left arm now fevers chills malaise myalgias for a week (non specific prodrome) agitated, disoriented, drooling, facial grimacing, frequently spitting saliva numbness surrounding scar

Answer 30

rabies!!! pain tingling/numness at site is characteristic late stage = hydrophobia/refusal to drink, aerophobia due to pharyngeal spasms, dsyautonomia (hypersalivation), muscle contractions (grimacing, opisothonos) coma respiratory failure and death within weeks ascending paralysis NOT tetanus as it presents with trismus (inability to open mouth) and within 3 weeks of exposure

Question 31

patient with sickle cell disease, fever and signs of sepsis only. causative organism?

Answer 31

strep pneumonia!!! why vaccination and penicillin prophylazis for pneumococcus is key

Question 32

GBS can cause early onset pneumonia at less than 7 days old. symptoms?

Answer 32

respiratory distress, hypoxia CXR = diffuse alveolar opacities with pleural effusions. differentiate from pulmonary hypoplasia as that would have rspiratory distress. but also oligohydramnios/congenital diapragmatic hernia

Question 33

in whooping cough, antibiotic prophylaxis with a macrolide eg azithromycin should be given for all close/household contacts!!!

Question 34

6 day old newborn. difficulty latching and feeding spasms whole body mother not received recommended vaccines umbilical stump is swollen with small amount of drainage mother has been supplementing babies feeds with honey hypertonia, neck stiffness inspiratory stridor most likely diagnosis?

Answer 34

tetanus!!! most common when mother is unvaccinated and there is poor cord hygeine neonates = trismus (feeding difficult due to lock jaw), spasms!!, hypertonicity!! treatment = antibiotics + tetanus immunoglobulin NOT botulism as it causes HYPOTONIA. and weakness and constipation, poor feeding

Question 35

knee swelling -> if hemophilia, would be in a guy most likely as x linked and there would be joint pain

Question 37

Di george syndrome siezures fever early morning vomiting severe morning headaches unresponsive to painkillers right lower extremity decreased strength and hyerreflexic history of TOF/congenital heart disease!!! -> hematogenous spread most likely diagnosis?

Answer 37

brain abscess!!!! -> brain mri

Question 38

conjuctivitis and auricular lymphadenitis should reaise suspicion for infection with?

Answer 38

francisella turalenesis. other causes = bartonella henslae herpes simplex

Question 39

herpes simplez encephalitis -> mri will show whitening in temporal region contrast drug induced encephalicits typically cause sby antihistamines -> but urinary retention and pupil dilation should also be present contrast subacute sclerosing panencephalitis = measles signs first

Question 40

hypoxia, hypotension, tachypnea and immediately following flushing of central venous catheter with small volume heparin. most likely diagnosis?

Answer 40

thromboembolism!!!! can also occur if trying to remove catheter not allergic reaction as you would expect wheezing and urticaria

Question 41

meningitis neutrophil predominance = bacterial lymphocyte predominance = tuberculous or viral. with a preceeding viral prodrome = viral cocksackie B and other enteroviruses is most common viral cause.

Question 42

acute otitis media with perforation was previously taking amoxicillin for AOM but now progressed to peforation. management?

Answer 42

co-amoxiclav

Question 43

1st step management of infants born to mothers with hepb?

Answer 43

administer hep b immunoglobulin and vaccine

Question 44

nauses vomiting and diarrhea 36 hours after school!! cookout. most likely pathogen?

Answer 44

norovirus!!!! NOT staph aureus as begins within 6 hours!! and vomiting is predominant symptom

Question 45

progressive regional lymphadenitis despite treatment with antibiotics. most likely cause? management?

Answer 45

bartonella henslae macrolides

Question 46

bronchiolitis happens under age 2. so 6 months, with viral contacts is in keeping. also diffuse wheezing ancd crackles vs focal findings in penumonia

Question 47

infant with fever cough lethargy respiratory failure chronic cough in mother!! multiple micronodular lesions in liver lung and spleen!!! most likely diagnosis?

Answer 47

miliary tuberculosis!!! mycobacterium tb pathogen infants and immunocompromised at high risk associated with false negative tb tests may present with fever in child so high suspicion if eg chronic cough in household member

Question 48

16 yo girl, maculopapular rash starting at face then spreading down body. auricular lymphadenopathy. and athralgia/athritis. uses condoms inconsitently palms and soles spared most likely diagnosis?

Answer 48

rubella!! not syphilis as will include palms and soles

Question 49

Rocky Mountain spotted fever presentation?

Answer 49

Headache, conjunctivitis, petechial rash including palms!!! . Seizures and encephalitis and thrombocytopenia may occur. Tests = serology for ricketsia antibodies Treatment = doxycycline

Question 50

3 weeks after nail punctures boys foot. Was throughly cleaned and bandaged but continues to have moderate pain at site. Examination shows erythema and warmth with tenderness to palpation. Has recieved tetanus vaccine. Most likely causative organism?.

Answer 50

- Pseudomonas!!!! - patient has osteomyelitis - although staph is most common cause of osteomyelitis eg in sepsis, IV drug use, pseudomonas is most common in puncture wounds!

Question 51

Newborn with Viral picture on Lumbar puncture and concern for meningoenxephalitis. Most likely causal organism?

Answer 51

Herpes simplex virus!!!! - direct inoculation through placenta or via vagina during birth. NOT CMV as it has a typical presentation

Question 52

Signs of influenza induced myositis - myalgias eg bilateral calf pain folllowing an infection, athralgia

Question 53

3 week old girl. I day history of fever and fever days of diarrhea that became bloody during the past 6 hours. Family occasionally eat at fast food restaurants. Two pet lizards at home.Gram-negative rods on stool culture. Most likely causative organism?

Answer 53

- salmonella enteritidis - associated with pets eg turtles, reptiles, chickens

Question 54

4 month old girl at routine visit. What vaccines is recommended to be given at this time?

Answer 54

Rotavirus!!! Recommend between 2 and 6 months

Question 55

Organisms most likely found at laceration site due to human bite?

Answer 55

Mixed flora

Question 56

Newborn with hypoglycaemia. Still hypoglycaemic after administration of glucose water. Temperature is 35.6 (hypothermia). Next step in management?

Answer 56

Ampicillin and gentamicin!!!! Patient has neonatal sepsis - can present with fever or hypothermia. Lethargy, irritability, poor feeding = other signs

Question 57

2 yo. Fatigued red spots over body and facial swelling. Only urinated twice in 24 hours. 7 days ago fever bloody diarrhea. Hematuria on urine dip = Hemolytic uremic syndrome