ID - 2019 Updated!

Question 1

Newborn who is IUGR, failed hearing screening, positive CMV PCR from urine, what do you do?

a) Reassure and follow up in 6 months
b) Ganciclovir for 2 weeks
c) Valganciclocir for 4 weeks
d) Valganciclocir for 6 months

Answer 1

d) Valganciclocir for 6 months

Question 2

A 5 year old by has had a one week history of fever and cough. He was started on amoxicillin. He develops this rash (there was a blurry photo of what looked like Erythema Multiforme). What is the most likely etiology of the rash?

Mycoplasma
HSV
Amoxicillin

Answer 2

Mycoplasma

Question 3

Pregnant woman in contact with meningococcal meningitis. Tx:

a. Cipro
b. Rifampin
c. Ceftriaxone
d. Penicillin

Answer 3

c. Ceftriaxone

• cipro and rifampin would treat it but should not be given to pregnant women (Rifampin teratogenic, Cipro bad for cartilage)
• close contacts should get prophylaxis regardless of immunization status

Question 4

Strep throat in children aged 1 to 3 years may present with all of the following EXCEPT:

a) low grade temperature
b) prolonged fever
c) decreased appetite
d) exudative tonsillopharyngitis
e) seromucoid rhinorrhea

Answer 4

d) exudative tonsillopharyngitis

- kids under 3 rarely have strep but when they do they present atypically

Question 5

One year old child with exudative tonsillopharyngitis. Most likely?

a) viral
b) mono
c) GAS

Answer 5

a) viral

Question 6

Pre-splenectomy immunization

a) polysacc meng A+E, polysacc pneumo and hep B
b) hep B, conjugated mening, conjugated pneumo
c) Hep A + B, mening

Answer 6

b) hep B, conjugated mening, conjugated pneumo

- at least 2 weeks prior to surgery

Question 7

A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it?
Today
1 month
6 months
11 months

Answer 7

Today

According to HamReview -
If systemic steroids 2 mg/kg/day (>20 mg/day) for >14 days, wait 1 month

In general, live vaccines may be given 1 month after discontinuation of high dose steroid therapy, 3 months or more after completion of other immunosuppressive chemotherapy, or 6 months after treatment with anti-B-cell antibodies, provided that the underlying disease is not immunosuppressive or is no longer active.

Question 8

Teen can’t open mouth. Has fever. Dx?

a. Retropharyngeal abscess
b. Peritonsillar abscess

Answer 8

b. Peritonsillar abscess

Question 9

A 13-year-old aboriginal female who lives on a reserve presents with tender erythematous induration of her shins bilaterally. What should you investigate for:

a) sarcoidosis
b) tuberculosis
c) Cat-scratch disease
d) inflammatory bowel disease
e) drug hypersensitivity

Answer 9

tuberculosis
- erythema nodosum can be caused by TB, cat scratch, sarcoid, IBD - so multiple answers could be correct but given Aboriginal on reserve has increased risk of TB

Question 10

Description of child with Necrotizing fasciitis lower leg- some respiratory distress. Already started IV fluids and oxygen. 5 additional things in the management.

Answer 10

• abx: piptazo + vanco (MRSA) + clinda (antitoxin effect)
• consult surgery - exploration and debridement
• pain control (morphine)
• anticipate multiorgan failure (watch U/O, BP, may need pressors)
• blood cultures
• consult ID, consider IVIG

Question 11

What are the five major criteria for rheumatic fever?

Answer 11

Joints: migratory polyarthritis
Carditis: new murmur/valve disease on echo
Subcutaneous nodules
Erythema marginatum
Sydenham's chorea

Question 12

A 10-year-old who underwent recent dental surgery now presents with fever, arthralgias, splenomegaly, and lesions on the hands and feet.

a) septic emboli
b) subacute endocarditis
c) acute rheumatic fever
d) juvenile rheumatoid arthritis
e) coxsackie virus

Answer 12

b) subacute endocarditis

Question 13

Bite in daycare Q. What to do:

a) Reassure mom of low risk of hiv infection
b) HIV serologies for both kids
c) initiate HIV prophylaxis for both kids
d) HIV prophylaxis for kid who was bitten only

Answer 13

a) Reassure mom of low risk of hiv infection
- PEP after a bite by a child known to be infected with HIV is rarely indicated and should only be given in consult with ID

Question 14

One of your patients has mono like symptoms. Your
blood work comes back. IgM negative; IgG positive; Early D antigen negative; Nuclear capsid antigen was positive. Interpret these results.

Answer 14

This patient had a previous (remote) infection, but this is not the explanation for current symptoms
● IgM = early rise and then drop off by 1-2 mo.
● IgG = early rise and stay elevated
● Early D antigen = peak week two then decreases by 4 mo. = (+) in acute or
recent primary infection
● Nuclear capsid antigen= low then rise 6 mo. onwards

Question 15

pneumonia, LLL + effusion in a 10 year old, most likely bug:

a) Staph Aureus
b) strep pneumonia
c) Group A Strep
d) H.influ

Answer 15

b) strep pneumonia

Question 16

Family comes to you from an area endemic for Lyme disease

What is the organism and vector causing it (2)?

What are two antibiotics that are effective against it (2)

What are three things to do for prevention if you live in an endemic area (3)

Answer 16

1. borrelia burgdorferi; black legged tick (ixodes sp)
2. doxycycline, amoxicillin (kids under 8), cefuroxime
3. 20-30% deet to clothes and skin
   - shower within 2 hours of coming inside
   - full body tick check daily
   - landscape to create barriers where play areas adjoin wooded areas

Question 17

influenza vaccine, 5 year old, got the shot last year, what to give this year

a) one dose 0.5 ml
b) split dose 1 month later volume 0.25 + 0.25
c) give one then second one a month later 0.5 + 0.5

Answer 17

a) one dose 0.5 ml

Question 18

Just finishing examining baby with diarrhea. You are taking off your gloves and you get some poop on your hands. What to wash with?

a) Soap and water
b) Antibacterial Soap and Water
c) Alcohol hand sanitizers
d) Rinse with water

Answer 18

a) Soap and water

Question 19

Management of a child with asplenia:

a) pneumococcal vaccine at 6 months
b) meningococcal vaccine at 2 years
c) antibiotic prophylaxis with daily Septra
d) antibiotic prophylaxis until pneumococcal vaccine given

Answer 19

a) pneumococcal vaccine at 6 months
- PCV13 (prevnar-13) at 2, 4, 6, 12-15 months
- quadrivalent meningococcal conjugate vaccine (MCV4 - menveo) at 2, 4, 6, 12-15 months
- antibiotic prophylaxis (with pen V) until age 5 and 2 years post splenectomy

Question 20

A four year child presents with pertussis. His 3 month old sibling has had her first immunization. What would you do regarding the sibling:

a. treat with erythromycin if she becomes symptomatic
b. isolate from her brother for 5 days
c. treat her with erythromycin for 2 weeks

Answer 20

c. treat her with erythromycin for 2 weeks (is one option; azithro x5d, claritho x7d, TMP-SMX x14d also options)
- continue pertussis vaccination according to routine schedule

Question 21

A 3-month-old child has had tender swelling over the mandible bilaterally for 1 week, along with fever and irritability. There is hyperostosis on x-ray. Most likely diagnosis:

a) Caffey’s
b) parotitis
c) cherubism
d) osteomyelitis
e) hypervitaminosis A

Answer 21

a) Caffey’s (infantile hyperostosis of jaw, scapula, clavicles, diaphysis of long bones, can have fever and irritability)- resolves by 2y
● Cortical hyperostosis (bone thickening) with inflammation of fascia and muscle
● Avg onset 10 weeks (can be prenatal and severe- hydrops)
● Most commonly involves mandible

Question 22

Which of the following infections would not prevent a child from attending daycare:

a. Chicken pox
b. Impetigo
c. Hepatitis A
d. Hepatitis B
e. Pertussis

Answer 22

d. Hepatitis B
- impetigo exclude until 24h after treatment started
- VZV can also go if well enough

Impetigo - exclude if draining lesions can’t be covered. For GAS wait until 24hr ABx
Hep A: exclude for 1 week after onset
Pertussis - until 5 days Abx or 3 weeks if not Tx

Question 23

New immigrant got 4 DPT and 3 oral polio vaccines before coming to Canada. He’s 10 months. What vaccine to give him now?

A.. pneumococcus and Hib
B. pnuemococimmcul, Hib, and polio
C. DTaP-IPV-Hib and pneumococcus
D.. pneumococcus and meninogoccu

Answer 23

?b

Question 24

3 week child with suspected meningitis. Initial antibiotics?

Answer 24

Ampicillin and cefotaxime (amp for gram positive coverage, cefotax for gram negative coverage - gent does not have good CNS penetration)

Question 25

2 mo baby comes in with meningitis and focal seizure. Symptoms of shock described. GCS 6. What is the FIRST step in management? a) Culture and antibiotics b) Intubation c) CT d) LP

Answer 25

b) Intubation

Question 26

Picture of lateral neck xray (++ prevertebral soft tissue swelling), febrile with difficulty opening the mouth. Presents with neck pain, what is the dx? a. bacterial trachieitis b. peritonsillar abscess c. retropharyngeal abscess d. epiglottis

Answer 26

c. retropharyngeal abscess

Question 27

CF child admitted with pneumonia, green sputum best choice of antibiotics a) cefixime and piperacillin/tazobactam b) Ceftazadime and Tobra - c) Clox and ceftazidime

Answer 27

b) ceftaz and cobra Should do double coverage for pseudomonas

Question 28

A 4 year old presents to the emergency department with abdominal pain and diarrhea. On further history, you note that he went to visit his aunt a few weeks ago; she lives on a farm. Further investigations reveal a diagnosis of ileitis. What is the most likely underlying etiology? a) Crohn’s disease b) Yersinia c) Mycobacterium tuberculosis d) Lymphoma

Answer 28

b) Yersinia | - Associated with pigs, and contaminated water. Can cause pseudoappendicitis and ileitis.

Question 29

12 yo girl presents with >5 days of fever, unwell. Hepatomegaly. HR 85 despite the temperature of 39.5, BP normal. CBC und urine tests normal. Blood culture shows gram negative bacilli. What is the cause? a) pyelonephritis b) ovarian torsion c) typhoid fever

Answer 29

c) typhoid fever | - salmonella typhi

Question 30

An epileptic who has been on carbamazepine for the past year presents with otitis media. You prescribe Ceclor for the otitis. Two days later he returns with an urticarial rash. The otitis is still present. What would be the next drug of choice: a) amoxicillin b) erythromycin-sulfa c) clarithromycin d) TMP-sulfa e) cefixime

Answer 30

a) amoxicillin- 1 st line for AOM; if you have a cephalosporin allergy it is usually to the side chain, not the beta lactam, so don't tend to have penicillin allergy cefixime is also a cephalosporin so not a good idea (though is a good choice for kids with pen allergies because does not cross react with penicillins eryrtho, clarithro and septa all have interaction with carbamazepine (could induce toxicity)

Question 31

Girl returns from mexico and begins to have vomiting, diarrhea and jaundice. Her abdomen is tender. Her LFTS are elevated. When can she return to daycare? a) 7 days b) When symptoms stop c) When LFTs normal d) Now

Answer 31

a) 7 days | - risk of transmission minimal 1 week after jaundice onset

Question 32

Child with history of fever 2 weeks ago with bloody stools. Now arthalgias/arthritis. What is the pathogen a) E.coli b) Campylobacter c) Yersinia

Answer 32

b) Camplobacter Campylobacter infections = reactive arthritis occurs in up to 3% of patients, though up to 13% may have joint symptoms. Tx: NSAIDs

Question 33

GBS positive mom.11 days old. On TPN from peripheral line. Three attempts at obtaining central access failed.In a tertiary care center. Now is septic. Culture shows gram positive cocci in clusters. What is the bug? What is the treatment

Answer 33

1. staph aureus (or coagulase negative staph) | 2. vancomycin

Question 34

7 month old child has recently been adopted from another country. All immunizations are up to date. Should you vaccinate against meningitis? (1) If so, what would you use and what schedule (2 lines)

Answer 34

1. Yes should vaccinate 2. give Meningococcal conjugate vaccine for serotype C: 2 - 3 doses given 8 weeks apart (booster needed between 12-23 mos)

Question 35

Adolescent male whose partner is positive for gonorrhea. Your management would be a. Amoxil b. tetracycline c. ceftriaxone d. doxycycline e. erythromycin

Answer 35

c. ceftriaxone 250mg IM x1 - same treatment for partners as for confirmed cases - also give one dose of azithro 1g PO (or 7d doxy)

Question 36

An 11-month-old child develops nephrotic syndrome and is going to be on prednisone. He has completed his 2, 4, and 6 month immunizations. Which is true regarding subsequent immunizations: a) he should continue his regular immunization schedule b) he should not receive any further immunizations until he has been off prednisone for 2 years c) he should not receive live-virus vaccines while on prednisone

Answer 36

c) he should not receive live-virus vaccines while on prednisone - inactivated vaccines can be given during immunosuppressive treatment, but need to be repeated once off as will not mount sufficient immune response - live vaccines cannot be given as are dangerous to the patient - common live vaccines: flu, rotavirus, MMR, varicella, BCG

Question 37

A 13 year old boy has had a 3 week history of fever, malaise and a weight loss of ten pounds. On examination he has diffuse lymphadenopathy including a right supraclavicular node and his spleen tip is palpable. His WBCs are 10, Hgb is 120 and Plts are 150. HIV and mono testing are negative. Which of the following tests is the next step in your investigations: a. CT abd b. BM aspirate c. ANA d. CXR

Answer 37

d. CXR | - mediastinal mass for cancer; hilar adenopathy for TB

Question 38

Greatest risk of mortality with parvovirus B19 infection is associated with: a) prematurity b) sickle cell disease c) ALL on chemotherapy d) congenital heart disease e) fetus of a mother infected with parvovirus B19

Answer 38

e) fetus of a mother infected with parvovirus B19 ~5%

Question 39

Neonate born to mom who just revealed HIV positive status. | a.) What treatment(s) would you start this baby on (1 line). How long would you treat for?

Answer 39

Zidovudine x 6 weeks + 3 doses of nevirapine during 1 st week of life (@ birth, 48h after first dose and 96h after 2nd dose)

Question 40

Child with edema, protenuria 4 +, ascites. Presents with abdo pain and fevers. Most likely organism. a) Strep Pneumo b) E. Coli c) Klebsiella

Answer 40

a) Strep pneumo

Question 41

teen girl with sickle cell anemia with evidence of pneumonia, what do you do a. discharge home on po antibiotic b. treat with cefuroxime and erythro IV c. treat with ceftriaxone IV

Answer 41

b. treat with cefuroxime and erythro IV - need macrolide since atypicals are common cause of chest crisis Check this - would actually treat Ceftriaxone and Azithro - are they trying to trick us with the cefuroxime??

Question 42

A 10 year old boy comes in with gradual onset of testicular pain over the last few days. On exam there is focal induration at the upper pole of the testis with a bluish hue. Testicular ultrasound with doppler shows increased blood flow and an enlarged epididymis. What is the best management? 1. Urine cultures and antibiotics 2. Call surgery 3. NSAIDs and bedrest

Answer 42

3. NSAIDS and bedrest

Question 43

A 7 year old boy visited a farm recently. He now presents with a cough, hepatomegaly and a slight elevation of his AST and ALT. What is the likely diagnosis? what is the treatment? a. Psittacosis b. Legionella c. Q fever

Answer 43

c. Q fever - coxsiella burnetti (rickettsial infection) - supportive only; can treat with doxycycline if diagnosed within 3 days of onset (otherwise abx ineffective)

Question 44

The most common bug in febrile neutropenia: a. Pseudomonas b. PCP c. gram positive organisms d. candida

Answer 44

c. gram positive organisms

Question 45

Neutropenic child with central line site red. Which antibiotic?

Answer 45

Piptazo (for febrile neutropenia) + Vancomycin (for central line infection)

Question 46

What are 3 major criteria for staph toxic shock?

Answer 46

- fever (T>38.8) - hypotension - eryrthroderma rash

Question 47

Neonate with purpura and thrombocytopenia. Diagnosed with CMV. Give six other features of congenital CMV infection.

Answer 47

- hearing loss - microcephaly - IUGR - chorioretinitis - jaundice - HSM

Question 48

First line for treatment for sinusitis: 1. Amoxicillin 2. Azithromycin 3. Clarithromycin 4. TMP/SMX

Answer 48

1. Amoxicillin

Question 49

A child has bacterial meningitis. Soon after starting his vancomycin infusion, he breaks out in a red rash. Blood pressure is normal. What is your IMMEDIATE management? What are TWO things that can be done so this doesnʼt happen the next time?

Answer 49

1. stop infusion; give benadryl and ranitidine 2. premedicate with diphenydrydramine +/- ranitidine - run infusion at slower rate Red man syndrome - not true allergy; is a rate dependent infusion reaction

Question 50

Teenager with Sickle cell disease presents with cough and fever. CXR shows LLL pneumonia. She looks toxic. What do you treat her with a) Cefuroxime and eryhtromycin b) Ceftriaxone and erythromycin c) Amoxicillin

Answer 50

a) Cefuroxime and eryhtromycin - cefuroxime better than ceftriaxone because ceftriaxone can increase hemolysis in sickle cell patients CHECK THIS - NOT WHAT WE ANSWERED.

Question 51

A child is brought to ER very unwell. She has a preceding sore throat, headache and fever. She is beginning to have a purple rash that doesn’t blanche. How do you prophylaxis her family? a. Penicillin b. Ceftiaxone c. Rifampin

Answer 51

c. Rifampin | - can also use ceftriaxone and cipro

Question 52

Girl goes to Ghana has diarrhea then comes back hypertension a) Schistosomiasis b) HUS c) coagulopathy

Answer 52

b) HUS - STEC is present everywhere and may be increased with poor sanitation a) Schistosomiasis - Only causes in chronic infection with renal disease or portal hypertension. Acute schisto - fever + eosinophilia

Question 53

Child presents with pinworms. How do you treat?

Answer 53

Albendazole - single dose repeated 2 weeks later to kill any worms that have hatched from eggs in the meantime

Question 54

A mother is exposed to parvovirus B19 in her first trimester. Most common result: a) IUGR b) microcephaly c) limb abnormalities d) cardiac malformation e) non-immune hydrops fetalis

Answer 54

e) non-immune hydrops fetalis (from fetal anemia)

Question 55

A child has diffuse rash, oral ulcers, eye involvement. What is the most likely drug that is the cause? - amoxicillin - Septra - Clarithromycin - Cefixime

Answer 55

Septra

Question 56

Baby born to HIV-positive mother discovered during pregnancy and treatment initiated. How to test the baby to confirm diagnosis: a. ELISA b. Western blot c. HIV DNA PCR

Answer 56

c. HIV DNA PCR

Question 57

You are seeing a child with a very itchy rash. The older sibling has (or had?) a similar itchy rash. Photo shown of child’s ankle. (scabies) What is the diagnosis and how do you treat?

Answer 57

1. scabies | 2. 5% permethrin cream from neck down; leave on for 12 hours, then rinse; repeat in 7 days

Question 58

Name two organ systems and two organisms that are typically affected by granulocyte defects

Answer 58

1. skin (abscesses, cellulitis), LNs (suppurative adenitis), internal organ abscesses, osteomyelitis 2. staphylococcus, aspergillosis, burkholderia cepacia, serratia, nocardia, klebsiella, pseudomonas, salmonella, fungi and parasites

Question 59

11 year old girl with vague abdominal pain, vomiting, and jaundice. Her labs show ALT 1000, total bilirubin 100. What test will likely confirm the diagnosis? a) Hep A IgM b) CMV urine c) Heb B serology d) monospot

Answer 59

a) Hep A IgM - Hep A accounts for 50% of all clinically apparent acute viral hepatitis - clinical presentation of hep A - fever, malaise, jaundice, anorexia, nausea, vomiting

Question 60

Contraindication to breastfeeding e. Hep B f. Bilateral mastitis g. Active TB

Answer 60

g. Active TB

Question 61

Child with symptoms consistent with orbital cellulitis. What should be done? a) IV Ceftriaxone b) surgical drainage c) PO clindamycin

Answer 61

a) IV Ceftriaxone

Question 62

Treatment of measles in child who is HIV positive a) acyclovir b) amantadine c) Vit A d) Vit E

Answer 62

c) Vitamin A

Question 63

What antibiotic do you give to GBS + mom who’s allergic to penicillin? a) Clinda b) Erythromycin

Answer 63

a) Clinda

Question 64

A 2 year old presents with a fever for 5 days and soft stools. Urine culture, urinalysis and blood tests are negative. What would be your next investigation? a) CXR b) ECHO c) serology for hep A d) stool cultures

Answer 64

d) stool cultures | - 2 year old unlikely to be symptomatic with Hep A

Question 65

Winnipeg Doc..calls family concerned about west nile. 4 suggestions to help prevent west nile virus in his patients

Answer 65

o community-level mosquito control programs to reduce vector density o personal protective measures to decrease exposure of infected mosquitoes (e.g. long sleeved shirts, limit outdoor from dusk to dawn, mosquito repellent, using air conditioning, installing window screens) o screen of blood and organ donors

Question 66

Boy with recurrent staph abscesses and serratia UTI. What investigation? a) Nitrozolium blue b) Oxidative Burst Test

Answer 66

b)Oxidative Burst Test Serratia is a catalase-positive organism commonly seen in Chronic Granulomatous disease. NOBI is the recommended diagnostic test. Other organisms: Burkholderia cepacia, Aspergillus, Staph aureus, Serratia, Nocardia

Question 67

Name 4 indications for VZIG

Answer 67

PEP in high risk kids who are exposed: - immunocompromised without immunity (e.g. leukaemia, on steroids) - newborns of mom with varicella 5d before of 48h after delivery - pregnant women without immunity - hospitalized prems <28 weeks or <1000g

Question 68

What antibiotic do you give for a child with pneumonia with effusion? a) Ceftriaxone b) Ceftriaxone + Erythromycin c) Vancomycin

Answer 68

a) Ceftriaxone

Question 69

``` An infant is born to a mother with a history of recurrent genital herpes which was not active at the time of vaginal delivery. For how long after delivery is it possible for this infant to develop herpes: a) 1-2 weeks b) 4-6 weeks c) 12-16 weeks d) 20-24 weeks e) up to 36 weeks ```

Answer 69

b) 4-6 weeks

Question 70

Biologics what to do? a) TB test b) Varicella c) MMR d) ?

Answer 70

a) TB Test Do prior to starting - TST and CXR Live vaccines contraindicated

Question 71

Baby born to a Hep B positive mom. He gets immunoglobulin and vaccine at birth. At nine months he is asymptomatic. What would his blood tests show? 1. HbeAg+, HbcAg+, HbsAg+, HbsAb+ 2. HbeAg-, HbcAg-, HbsAg+, HbsAb+ 3. HbeAg-, HbcAg-, HbsAg-, HbsAb+ 4. HbeAg+, HbcAg-, HbsAg+, HbsAb- 5. HbeAg-, HbcAg+, HbsAg+, HbsAb

Answer 71

3. HbeAg-, HbcAg-, HbsAg-, HbsAb+ surface antigen should be negative (if it's positive he has Hep B), and surface antibody should be positive (has immunity from vaccine)

Question 72

Needle stick injury in playgroup. No blood on needle but blood on child. After Hep B serology and vaccine, HIV serology and Hep C serology what do you do: a) reassure low risk of HIV b) post-exposure prophylaxis for HIV

Answer 72

a) reassure Antiretroviral prophylaxis should be recommended only in cases of high risk, in which the source is considered likely to have HIV, the incident involved a needle and syringe with visible blood and blood may have been injected.

Question 73

Rotavirus question: what do you tell her regarding vaccine: a) Protects 95 against rotavirus b) 75% against all diarrhea c) Significantly Decreased hospitalizations d) Decreased virus shedding

Answer 73

c) Significantly Decreased hospitalizations - 85% efficacy in kids under age 2 years - decreased incidence of rotavirus hospitalization in areas with immunization programs - 79% decrease in rota hospitalizations for kids under 1 and 73% decrease for kids 12-23 months in Ontario after vaccine introduced

Question 74

Baby with tachypnea, afebrile, nontoxic, has eosinophilia. CXR shows bilateral interstitial markings, areas of atelectasis. What is the likely pathogen? a) GBS b) Chlamydia trachomatis c) Ureaplasma urealiticum d) RSV

Answer 74

b) Chlamydia trachomatis - onset of cough 1-3 months; no fever; staccato cough, eosinophilia - treat with erythromycin (can cause pyloric stenosis)

Question 75

The leading cause of HIV in women in Canada is due to: a. homosexual transmission b. heterosexual transmission c. IV drug use d. blood transfusion e. occupational exposure

Answer 75

b. heterosexual transmission

Question 76

18 month old child with URTI. He develops higher fever 3 days later, pulling at ear and has erythematous right tympanic membrane, not bulging. Do you treat for AOM? Explain why or why not?

Answer 76

No treatment. No bulge suggests there is no middle ear effusion, and erythematous TMs are common in viral infections. Since patient is over 6 months watchful waiting x24-48 hours is appropriate

Question 77

Child has worsening swelling around an eye. List 2 signs that would make you worried about orbital cellulitis.

Answer 77

- proptosis - pain with extraoccular movements - decreased visual acuity

Question 78

White out of R lung CXR what antibiotics do you start - Ceftrixone - Ceftriaxone and Vanco - Ceftriaxone and Erythromycin

Answer 78

- Ceftriaxone and Vanco

Question 79

Toddler, presents with fever, looking toxic. Drooling. Neck pain with lateral movement, but full ROM extension and flexion. Oropharynx – mildly erythematous, no tonsillar enlargement, no exudate. Most likely diagnosis? a) Retropharyngeal abcess b) Peritonsillar abcess c) Bacterial tracheitis d) Mastoiditis

Answer 79

a) Retropharyngeal abscess

Question 80

Infant born to mother with no prenatal care. Hepatosplenomegaly and copper rash especially on palms and soles. Rhinitis and cough. Diffuse consolidation on CXR. Appropriate investigation: a. urine CMV b. VDRL/FTA abs c. blood culture

Answer 80

b. VDRL/FTA abs

Question 81

Mom wants to know where her 18 month old daughter acquired perineal warts. You tell her from: a. perinatal acquisition b. sexual abuse c. day care d. from bathing with her older sister e. from dad changing diapers

Answer 81

a. perinatal acquisition

Question 82

12 month old girl is seen with fever, tachypnea and vomiting. She appears unwell but her vitals are stable. On CXR there is a lobar consolidation. What antibiotics do you start: a. IV cefuroxime b. IV cefuroxime and IV azythromycin c. IV vancomycin and cefotaxime d. IV ampicillin

Answer 82

d. IV ampicillin

Question 83

``` Child recently visited farm, presents with high fever, hepatosplenomegaly and pneumonia a. legionella b . Q fever c . cat scratch d. Psittacosis ```

Answer 83

ANSWER: b . Q fever (goat, sheep, cattle) - coxsiella burnetti (gram negative) - treatment decreases duration and severity a. legionella (usually contaminated water) c . cat scratch (cat bite/scratch, kittens, HSM can occur) d. Psittacosis (usually caged birds)

Question 84

3 year old with a bite on his cheek. List 4 characteristics of the bite that would have an impact on the management of this patient.

Answer 84

- depth - signs of infection - what bit him - animal versus human (puncture wound vs graze) - infective/immune status of biter if known - tetanus status - duration since bite (do not close if >24 hours)

Question 85

Child with eczema and recurrent pneumonia. Hepatomegaly, petechiae, otitis media and low platelets. What do you expect? a. elevated IgA and IgE b. immune response to polysaccharide vaccine c. oral Candida d. abnormal mitogen proliferation

Answer 85

a. elevated IgA and IgE - poor response to polysaccharide vaccines (important they get conjugate) - Wiscott-Aldrich

Question 86

Biting incident at daycare, breaks skin superficially, both kids are previously healthy and have all their immunizations but no HepB shots. What do you do? a. screen them for HIV b. start Hep B vaccinations in both kids c. test Hep B serology only in the biter d. tetanus immunoglobulin

Answer 86

b. start Hep B vaccinations in both kids

Question 87

Kid with bloody diarrhea 1 month ago which has now resolved. Now has weight loss and abdominal pain. Which was the most likely organism? a. Yersinia b. Campylobacter c. E Coli d. Shigella

Answer 87

Yersinia – can be cause of chronic abdominal pain/weight loss (not in nelsons)- crohns mimicker- can last months (Toronto notes)

Question 88

Kid with pain with movement both directions. Supple neck, slight red throat otherwise normal oral pharynx. Drooling. a) Peritonsilar abcess b) Retropharyngeal abcess c) Mono d) URTI

Answer 88

b) Retropharyngeal abscess

Question 89

What are four clinical signs that would be considered a contraindication for a lumbar puncture?

Answer 89

- infection of skin over intended LP site - spinal deformities - bulging fontanelle - focal neurologic deficit - cardioresp instability - signs of bleeding diathesis (e.g. petechiae)

Question 90

All of the following are features of HIV infection EXCEPT: a) hypogammaglobulinemia b) CD4 leukopenia c) reverse CD4/CD8 ratio d) poor response to tetanus and diptheria vaccines e) poor response to TB skin test

Answer 90

d) poor response to tetanus and diptheria vaccines (can have a reduced response, but this is the most correct answer) - 2019 - we said hypogam.

Question 91

8 year old girl with fever, nausea, vomiting, diarrhea, malaise and mild jaundice upon returning from Mexico. Labs show AST >1,000. Which of the following is true regarding her return to school/day care? a. she can’t return for 1 week b. she can’t return until she’s feeling better c. she can return if everyone is toilet trained d. as long as they wash their hands there, she can go back immediately

Answer 91

a. she can’t return for 1 week | Hep A - out of school for 7 days

Question 92

You are called by the nursing staff in the newborn nursery that you are covering that night. A neonate had blood cultures taken in the context of deterioration earlier that day. The culture is growing gram positive rods. You will ensure that the baby is on which of the following antibiotics? a) Ampicillin b) Cloxacillin c) Gentamycin d) Septra

Answer 92

a) Ampicillin This is Listeria (gram + bacilli)

Question 93

You see a 4 year old child with a history of an enlarged left axillary lymph node for the past 14 days which is slowly enlarging in size. He has not been traveling outside the country. On examination the node is soft, mobile and mildly tender but there is no overlying redness. He is afebrile and there is no obvious skin infection over the left arm. What investigation is most likely to confirm the diagnosis: a. Bartonella hensellae serology b. PPD testing c. Excisional biopsy

Answer 93

a. Bartonella hensellae serology - self limited - axillary lymph node common

Question 94

A pregnant women comes into contact with a child with parvovirus during her twelfth week of pregnancy. You would recommend: a. isolate woman from child b. perform parvovirus serology on the woman c. IVIG d. Abortion

Answer 94

b. perform parvovirus serology on the woman | - look for susceptibility (may have immunity) and evidence of acute infection

Question 95

AOM 3 year old 39.1 degrees, red bulging tympanic membrane. Severe pain. Management plan a) Amox 75-90mg/kg BID x 5 days b) Amox 75-90mg/kg BID x 10 days c) Rx for above to be filled in 24 hours if still symptomatic of rebrile d) Reassess in 24-48 hours.

Answer 95

a) Amox 75-90mg/kg BID x 5 days

Question 96

A child has Campylobacter cultured from his stool. He is toxic. Which antibiotic: a) PO Erythromycin b) PO Septra c) PO Flagyl d) IV Ampicillin e) no antibiotics

Answer 96

a) PO Erythromycin - gram negative bacilli - leading cause of acute diarrhea worldwide - treat if severe or risk of severe disease (pregnant, immunocompromised)

Question 97

What are two antibiotics that are effective against lyme disease (2)? When is IV and treatment indicated?

Answer 97

1. - doxycycline (kids 8+ years) - amoxicillin - cefuroxime 2. ceftriaxone/pen G for endocarditis, meningitis, encephalitis

Question 98

A woman has recently immigrated from China to Canada and has just delivered a healthy term infant. She does not know her hepatitis B status, but the results will be available in 2 days. What will be your management: a) await results of HBsAg before treating infant b) give HBIG now, but await results of HBsAg before giving Hep B vaccine or allowing breastfeeding c) give Hep B vaccine now and allow breastfeeding d) give HBIG and Hep B vaccine now; do not allow breastfeeding e) give HBIG and Hep B vaccine now; allow breastfeeding

Answer 98

c) give Hep B vaccine now and allow breastfeeding - unknown status: Hep B vaccine at birth, if mom ultimately tests positive give HBIG within 1 week of life * if baby <2000g give Hep B vaccine and HBIG at birth

Question 99

15 year old with h. pylori. You should treat with: A) h2 blocker B) amox, clarithro and proton pump inhibitor C) clarithro and h2 blocker D) amox and proton pump inhibitor

Answer 99

B) amox, clarithro and proton pump inhibitor

Question 100

A 13 y.o. boy with HIV is diagnosed with measles. The only proven treatment is: a) Acyclovir b) Vitamin A c) Inhaled amantadine d) Vitamin E

Answer 100

b) Vitamin A (more severe disease if vit A deficient) ● WHO recommends Vit A for treatment of all children with measles o Daily for 2d o 50 000 IU <6m o 100 000 IU 6-11m o 200 000 IU >12m

Question 101

Which of the following should get Prevnar? (were they meaning Pneumovax? ie PCV23?) a) 5 y/o with sickle cell disease who had Pneumovax already b) 5 y/o with chronic asthma on daily inhaled fluticasone for the past year c) 2 y/o with recurrent otitis media d) 3 year old with well controlled type 1 DM e) 2 y/o who stays at home

Answer 101

b) 5 YO chronic asthma on inhaled steroids Reasons for PCV23: Non-Immunocompromised reasons: Chronic cerebrospinal fluid (CSF) leak Chronic neurologic condition that may impair clearance of oral secretions Cochlear implants, including children and adults who are to receive implants Chronic heart disease Diabetes mellitus Chronic kidney disease Chronic liver disease, including hepatic cirrhosis due to any cause Chronic lung disease, including asthma requiring medical care in the preceding 12 months Immunocompromising conditions Sickle cell disease, congenital or acquired asplenia, or splenic dysfunction Congenital immunodeficiencies Immunocompromising therapy 1, including use of long-term corticosteroids, chemotherapy, radiation therapy, and post-organ transplant therapy HIV infection Hematopoietic stem cell transplant (recipient) Malignant neoplasms including leukemia and lymphoma Nephrotic syndrome Solid organ or islet transplant (candidate or recipient)

Question 102

A child is seen in your clinic as a follow-up post hospital discharge. She was admitted for several days with Kawasaki Disease, for which she received IVIg. Her mother mentions that she is due for her DTaP-Hib booster. When can she receive it? a) In 11 months b) Now c) In 4 weeks d) In 8 weeks

Answer 102

b) Now

Question 103

A 6 year old boy presents to the family doctor with an eczematous rash. On exam he looks unwell and is tachypneic. He has a large rash with scaling at the edges. On eye exam he has miliary conjunctivitis. His mother says that he has joint pain in the morning and he has a knee effusion on exam. His bloodwork reveals eosinophilia, with leucopenia with normal calcium. He also has hilar nodes on his chest X-ray. What is the cause of his symptoms. (2008 MCQ) 1) Miliary TB 2) Cryptococcosis 3) Blastomycosis 4) Sarcoidosis

Answer 103

4) Sarcoidosis

Question 104

Child with CP, has a fluid-filled thing in his lung surrounded by an area of consolidation. History of recurrent aspiration. What is this? a. CLE (congenital lobar emphysema) b. pulmonary abscess c. pulmonary sequestration

Answer 104

b. pulmonary abscess

Question 105

Wheezing toddler with URTI symptoms. Which is a proven therapy? a. O2 b. racemic epi c. iv steroids d. bronchodilators

Answer 105

a. O2 | assuming bronchiolitis

Question 106

Kid with 1.5X2cm LN in the supraclavicular fossa for a few days. NO overlying erythema. P/E otherwise normal. Most helpful test? a. Excise LN b. Bartonealla Henselae serology c. Monospot/EBV serology d. TB skin test

Answer 106

a. Excise LN | - LN biopsy is contraindicated if there is evidence of overlying infection - rule out leukemia/lymphoma

Question 107

Women in labor with genital herpes, list 4 risk factors for transmission to infant. - If you're going to investigate: when and what tests?

Answer 107

- first episode of herpes for mom (primary infection) - prolonged rupture of membranes - vaginal delivery - use of instrumentation in delivery (forceps, vacuum, fetal scalp electrode) Testing: If asymptomatic, at 24 hours with swabs of mucous membranes for HSV PCR.

Question 108

A young boy is walking in the street. Suddenly a stray dog, unprovoked, bites him. What do you do with regard to rabies? a. Prophylaxis b. Prophylaxis if dog shows signs of rabies c. No prophylaxis

Answer 108

a) treat child prophylactically | - if dog healthy and could be quarantined, could delay prophylaxis and only start if animal became symptomatic

Question 109

What infection is the worst prognosis in HIV for an infant a) Lymphoid interstitial pneumonia b) Pneumocystis Carinii Pneumonia c) Cardiomyopathy d) Nephropathy e) Candida

Answer 109

b) Pneumocystis Carinii Pneumonia | - PCP is an AIDS defining illness - if present in first 6 months of life is associated with poor prognosis

Question 110

A mother has come in with her 12 month old, and is concerned by the “number of shots” that is getting today. She has read in the paper about how is it bad to expose a child to a large number of “antigens” all at once, and is worried about overwhelming his immune system. What advice can you give to help alleviate this motherʼs worries?

Answer 110

- rigorous vaccine safety system (premarket studies and post market active and passive surveillance looking for rare complications) - children are exposed to many more antigens on a daily basis than they will get from the vaccines (food, bacteria, etc) - important for safety of child to stay on track with vaccine schedule (highest risk of severe disease when younger)

Question 111

A 3 year presents to your office with 3 days of low grade temperature, rhinorrhea, and occasional cough. On exam he looks well and has green crusted nasal discharge. A culture of his nasal secretions is growing small amounts of H. influenzae. What is your treatment: a. no treatment b. amoxicillin c. trimethoprim-sulfmethoxazole d. ENT consult

Answer 111

a. no treatment | - h flu is normal part of respiratory flora in 60-90% of children

Question 112

Otitis media → complications of “watch and wait” approach a. Bacteremia b. Mastoiditis c. Prolonged fever d. Prolonged pain

Answer 112

c. Prolonged fever

Question 113

Child with fever, purulent nasal drainage x 14 days. What to treat him/her with? a. amoxicillin b. Keflex

Answer 113

a. amoxicillin

Question 114

9 yo immigrated to Canada. NO previous immunizations. What 2 immunizations would you give on first visit?

Answer 114

Tdap-IPV (for sure) and MMRV or Men-C (kids 7-17)

Question 115

A child with marked eosinophilia is suspected of having visceral larva migrans (toxocariasis). Physical examination would likely reveal: a) splenomegaly and lymphadenopathy b) hepatomegaly c) serpiginous rash d) arthralgias e) myalgias

Answer 115

b) hepatomegaly Toxocariasis o Roundworms of dogs/cats especially puppies/kittens o Visceral ▪ Fever, leukocytosis, eosinophilia, hypergammaglobulinemia, wheezing, abdominal pain, hepatomegaly ▪ Malaise, anemia, cough, pneumonia, myocarditis, encephalitis, hemorrhagic rash, seizures

Question 116

Child admitted with known RSV bronchiolitis. On third day of his admission, develops a fever and CXR shows a small RML infiltrate. What is the most likely cause of his fever? a. Strep pneumo b. Chlamydia trichamotas c. RSV d. GBS

Answer 116

c. RSV

Question 117

Mother who is HBsAg positive. Management of newborn should consist of: a. Hep B vaccine only b. Hepatitis titres and if negative, Hep B vaccine in 1 week c. Hep Ig q monthly if breastfeeding d. Hep Ig within 12 hours and Hep B vaccine within 12 hours e. Hep Ig at birth and Hep B vaccine within 7 days

Answer 117

d. Hep Ig within 12 hours and Hep B vaccine within 12 hours

Question 118

Adolescent with ascending leg weakness and areflexia. Which of the following infectious agents would you worry about: 1. Campylobacter jejuni 2. E Coli 3. Yersinia 4. Cryptosporidium 5. Shigella

Answer 118

1. Campylobacter jejuni | - GBS

Question 119

Mom is IVDU. Her blood work: HEB B + HepC +. Baby’s blood work at 6 mo, hep B and hep C ab negative. What to do: a) Repeat Hepc in 6 months b) No further investigations c) PCR

Answer 119

b) No further investigations | - negative Hep C ab in child of any age indicates transmission did not occur

Question 120

A boy has had a 5 day history of varicella lesions, now presenting with fever, tachypnea, and increased work of breathing. On examination, there is bilateral crackles. What is the cause of his distress? a) myocarditis b) pneumonia

Answer 120

b) pneumonia

Question 121

2 year old fully-immunized girl fell on playground and has a deep arm laceration. After laceration has been cleaned and sutured, what further management? 1. Tetanus toxoid 2. Tetanus toxoid and immune globulin 3. Antibiotics 4. Nothing

Answer 121

4. Nothing - fully immunized. Clean wound.

Question 122

6 mo baby of IV drug user. Mom is Hep C-positive. Baby’s anti-HepBs positive and anti-HCV positive. What do you do? a. no further testing b. repeat anti-HCV in 6 months c. do HCV RNA PCR now d. P24 antigen

Answer 122

b. repeat anti-HCV in 6 months - HCV serology not reliable in infants because can reflect mom's antibodies - test at 12-18 months; if positive repeat testing in 6 months (if seropositive after 18 months, they are infected)

Question 123

Child with pulmonary findings, eosinophilia, slightly elevated calcium (2.8) a. miliary TB b. sarcoidosis c. cryptococcus d. blastomycosis

Answer 123

ANSWER: b. sarcoidosis = lung (non-caseating granulomas) + hypercalcemia + eosinophilia - non infectious a. miliary TB lung + hypercalcemia c. cryptococcus lung + eosinophilia + hypercalcemia? (but often in immunocompromised) d. blastomycosis lung +eosinophilia (+ hypercalcemia in dogs)

Question 124

A newborn baby comes in for a routine care visit. In terms of the 13 valent pneumoccocal vaccine, what is the routine schedule for it? (1) - question used to be about 7 valent which is no longer used

Answer 124

Schedule across Canada is 2, 4, 12 months almost everywhere (different in territories)

Question 125

Teenage male treated for Chlamydia with azithromycin. When can he resume sexual activity? a) once he has completed his medication b) once his partner is treated c) after seven days after completing treatment d) once his symptoms appear to have resolved

Answer 125

c) after seven days after completing treatment | if same partner, then also after 7 days after partner completes treatment

Question 126

Baby born with rash, cataracts, bone lesions, big liver (photo of baby shown) most likely has: a. Congenital syphilis b. Congenital CMV c. Congenital rubella

Answer 126

c. Congenital rubella | cataracts - rubella; chorioretinitis - CMV

Question 127

A child with marked eosinophilia is suspected of having visceral larva migrans (toxocariasis). Physical examination would likely reveal: a) splenomegaly and lymphadenopathy b) hepatomegaly c) serpiginous rash d) arthralgias e) myalgias

Answer 127

b) hepatomegaly Classic VLM: eosinophilia, fever, hepatomegaly. Fever, cough, wheeze, bronchopneumonia, anemia, hepatomegaly, leukocytosis, eosinophilia, +ve Toxocarai serology. Tx: albendazole

Question 128

Complications of neonatal gonococcal eye infections include: a. retinal hemorrhage and blindness b. corneal perforation and blindness c. anterior uveitis and fixed pupil d. glaucoma

Answer 128

b. corneal perforation and blindness

Question 129

Name 4 drugs with pseudomonas coverage

Answer 129

- pip-tazo - cefuroxime - aminoglycosides (gent, tobra) - cipro

Question 130

Mom has husband who lived in Brazil up to 12 months ago, babe comes out looking well with a normal head circumference, weight and length. Normal physical exam. What testing do you do on the NEWBORN? a) Zikv PCR in blood and urine of babe and head u/s b) MRI babe c) ZIKV serologies d) Do nothing

Answer 130

d) Do nothing

Question 131

Boy with unilateral eye conjunctivitis symptoms. Mom and classmate also had symptoms last week. Treatment? a) supportive tx b) topical Abx. c) PO abx

Answer 131

a) supportive treatment

Question 132

A 3 year with 5 days low grade temperature, rhinorrhea, occasional cough. On exam he looks well, has green crusted nasal discharge. Mom has been giving acetaminophen 6 to 7x/day. Next test: a) Sinus x-rays and treat if fluid level present b) treat with amoxil c) consult with ENT d. counsel on Tylenol dosing and risk of too much acetaminophen

Answer 132

d. counsel on Tylenol dosing and risk of too much acetaminophen

Question 133

A 15 year old male with strep throat presents two weeks later with unusual movements of his head and shoulders. What of the following is the likely cause? 1) Rheumatic fever 2) Transient tics 3) Tourette syndrome 4) Complex partial seizures

Answer 133

1) Rheumatic Fever

Question 134

``` A 6 year old presents with an erythematous lesion on the back and arthritis. He has been camping with his family recently in the U.S. You diagnose Lyme disease. What should he be treated with? a) PO doxycycline b) IV ceftriaxone c) PO amoxicillin ```

Answer 134

c) PO amoxicillin - under 8 - amox, 8+ - doxycycline - IV treatment for heart block, carditis, meningitis or encephalitis

Question 135

Description of a child who is having multiple episodes of otitis media and pneumonia. Lab results given are IgG 8 (normal), IgM normal and IgA 0.01 (decreased). What important piece of advice would you warn this child about?

Answer 135

Selective IgA deficiency | - at risk of anaphylactic reactions to transfusion of blood products

Question 136

Newborn to a mum who has recently come from Vietnam. Her Hepatitis B status is unknown however her serology results will be back in two days. What do you do with infant? a) immunize with Hep B vaccine and if results from mum are positive, give Hep B IG at that time b) Immunize with hep B vaccine and hep B IG now c) Hep B IG now d) HBIG now and Hep B vaccine later if mum positive

Answer 136

a) immunize with Hep B vaccine and if results from mum are positive, give Hep B IG at that time - Hep B vaccine should be given within 12 hours of birth - HBIG ideally within 12 hours, but within 7 days acceptable if waiting for mom's results

Question 137

Child had a URTI a week ago. He now presents with bloody diarrhea, abdominal pain and a petechial rash . What is his diagnosis?

Answer 137

Henoch Schonlein Purpura We has said HUS previously - but less likely with a URTI as the trigger unless they have the genetic form of HUS. Can develop it post streptococcus but more likely to have pneumonia, empyema and bacteria. They're also not giving you any of the acute renal stuff in this stem.

Question 138

Two siblings present to your care for influenza immunizations, ages 1 and 3. They are health, except the 3 year old, who had a moderate asthma exacerbation requiring 5 days of steroids 1 month ago. Regarding the intranasal influenza vaccine: a) it is indicated for both children b) it is indicated for the 1 year old, but not for the 3 year old c) it is indicated for the 3 year old, but not for the 1 year old d) it is contraindicated for both children

Answer 138

c) it is indicated for the 3 year old, but not for the 1 year old LAIV not indicated for <2 yrs LAIV is also contraindicated for individuals with severe asthma (defined as current active wheezing or currently on oral or high-dose inhaled glucocorticosteroids, or medically attended wheezing within the previous 7 days) and during pregnancy. LAIV is also contraindicated in children and adolescents, 2 to 17 years of age, who are receiving chronic acetylsalicylic acid-containing therapy, because of the association of Reye’s syndrome with acetylsalicylic acid given during influenza infection.

Question 139

2 year old with known neisseria infection. How to treat the unvaccinated sister a) Rifampin and immunize b) Rifampin alone c) MCVC alone d) Rifampin and MCVC

Answer 139

a) Rifampin and Immunize

Question 140

It is 9 am and child is in your office, lice are detected. When can they go to school? a) Immediately b) After first treatment c) After no more nits d) After no more adult lice

Answer 140

a) Immediately CPS - doesn't need to be treated before going to school (but avoid rubbing heads together ;))

Question 141

Which of the following is the most common side effect of the varicella vaccine? a. chickenpox b. flu-like symptoms c. herpes zoster d. fever

Answer 141

d. fever - pain, redness and swelling at injection site are actual most common side effects - rash and fever may not appear until up to 2 weeks after the injection

Question 142

4 yr old with AOM treated with Amox-Clav (4:1 ratio) and develops loose watery stools. What is your dx b) viral gastro c) improper dosing/ratio or amox-clav d) C.diff

Answer 142

b) improper ratio

Question 143

Pneumonia RLL non toxic, best treatment, 10 year old boy a) Cefotaxime and Erythromycin b) Ampicillan c) Cefotaxime d) PO azitro

Answer 143

b) Ampicillin

Question 144

Mother has herpes labialis. What do you advise regarding her 4 day old infant? a) wear mask when breastfeeding b) apply topical acyclovir to lesion c) stop breastfeeding d) infant needs IV acyclovir

Answer 144

a) wear mask when breastfeeding

Question 145

6 y/o boy with 2 weeks of sudden onset of OCD behaviours. Which infectious agent would you be concerned about: 1. Strep pneumonia 2. Group A Strep 3. E. Coli 4. H. Flu 5. Echovirus

Answer 145

2. Group A Strep | (PANDAS)

Question 146

PANDAS would be suspected in a child with a. recurrent Sydenham’s chorea b. new onset of tics after a group A strep infection c. pancreatitis and depression after strep A infection

Answer 146

b. new onset of tics after a group A strep infection

Question 147

12 month old who is toxic with a lobar infiltrate. Which antibiotic do you use: 1. IV Cefuroxime and IV Erythromycin 2. IV Vancomycin 3. IV Ampicillin 4. PO Amoxicillin 5. PO Clarithromycin

Answer 147

3. IV Ampicillin - ceftriaxone for life threatening infection/shock - if rapidly progressing multi lobar pneumonia add vance for MRSA

Question 148

Varicella. With nec fash/or purpura fulminans. What is your management: a) vanc cefotax b) pen G and clinda c) amp gent

Answer 148

b) pen G and clinda

Question 149

``` 8 year old presents with bilateral conjunctivitis received topical antibiotics with no improvement. Does not describe pain but a sandpaper feeling and associated photophobia and tearing. On exam he has pseudomembrane keratoconjunctivis What is the most likely diagnosis? 1. allergic conjunctivitis 2. Uveitis 3. Bacterial conjunctivitis 4. Adenovirus keratoconjunctivitis ```

Answer 149

4. Adenovirus keratoconjunctivitis

Question 150

An HIV positive mother has been compliant with triple antiretroviral therapy throughout her pregnancy. Her viral load has been undetectable for a long time. What is the risk of perinatal HIV transmission? a) 1% b) 10% c) 25% d) 75%

Answer 150

a) 1% 25% - Rate with no intervention

Question 151

2 year old child with fever for the past 2-3 weeks (up to 39 C), lymphadenopathy and mild hepatosplenomegaly presents complaining of joint pain. There is no true arthritis, but complains of pain with movement of joints. Hgb 91, WBC 9 (45% lymp, 55% PMN), platelets of 110. What is your next step in establishing diagnosis? a. BMA b. Blood culture c. ANCA, ESR and RF d. EBV serologies

Answer 151

a. BMA

Question 152

2 year old with fever and right ear pain. She was treated with clarithrymycin a few weeks ago for a respiratory infection. ON exam has an otitis media. What are three possible antibiotics for her (3)

Answer 152

- amoxicillin - amoxicillin-clavulanic acid (if you think h. flu or moraxella) - cefuroxime-axetil - cefprozil - ceftriaxone - Less great: Clinda, Azithromycin

Question 153

Picture of baby with rash: told cataracts, microcephaly, hepatosplenomegaly, bony changes a) Syphilis b) CMV c) Rubella d) toxoplasmosis

Answer 153

c) Rubella | - hearing loss, cataracts, MR, IUGR, hepatitis, osseous changes, cardiac defects

Question 154

3 month old girl has an 18 month old brother who got meningococcemia. What would be your management. (2008 MCQ) 1) Provide Ciprofloxacin 2) Provide rifampin 3) provide rifampin plus menjugate 4) Provide menjugate

Answer 154

3) provide rifampin plus menjugate

Question 155

HPV vaccine what does it reduce - Genital warts - Prevents cervical cancer - Prevents uterine cancer - Transmission of warts

Answer 155

- Genital warts

Question 156

A 4 year old child comes to your Emergency department with a history of a fever for 3 days. You do a CBC and find that the WBC count is low at 3.2. a. What is the most common reason for this clinical scenario? b. On a differential, which cell line, if low, increases the risk of serious infection?

Answer 156

a. viral suppression | b. neutropenia

Question 157

Child presents with ataxia and inability to sit up two weeks after having chicken pox. A) What is the diagnosis? B) How do you differentiate this from meningoencephalitis? List three.

Answer 157

A) acute cerebellar ataxia B) no fever, no nuchal rigidity, no altered LOC, no seizures, CSF normal or shows mild lymphocyte pleocytosis vs meningitis which shows PMN pleocytosis

Question 158

Child develops rash on both cheeks. Then a reticulated lacy rash is seen on his body. His mother is pregnant. What infection does this child have (1) How would you manage the mother (1)?

Answer 158

Parvo B19 | - serologies for mom

Question 159

6 mo baby of IV drug user. Mom is Hep C-positive. Baby’s anti-HepBs positive and anti-HCV positive. What do you do? (2009 MCQ) a. no further testing b. Repeat anti-HCV in 6 months c. do HCV RNA PCR now d. P24 antigen

Answer 159

c. do HCV RNA PCR now

Question 160

What is the most appropriate treatment for headlice when there is known resistance? 1. Dimeticone solution 2. Permethrin 3. Pyrethrin 4. Isopropyl-myristate/Cyclomethicone

Answer 160

2. Permethrin (Nix) Remain first line. If 2 treatments do not eradicate live lice, consider full treatment using another class

Question 161

Child appears toxic and has lobar pneumonia. What antibiotics should be used? a) PO Amoxil b) Cefuroxime IV c) Cefuroxime IV and Azithromycin PO d) Vanco and ampicillin

Answer 161

b) Cefuroxime IV - best of available; really IV amp is best

Question 162

List 3 common causes of neutropenia

Answer 162

- transient viral suppression of bone marrow - drug induced marrow suppression (antipsychotics, antidepressants, some antimicrobials) - chronic benign neutropenia of childhood - primary autoimmune neutropenia - cyclic neutropenia - kostmann syndrome - schwachman diamond - - secondary autoimmune (SLE, Crohn's, RA) - destruction by autoantibodies

Question 163

A 3 year old girl with fever, arthralgia and lethargy for 10 days has lymphadenopathy, moderate hepatosplenomegaly, no obvious arthritis but screams in pain with minimal examination. WBC 9.5 Hgb 98 Plts 140, smear Normal. Next test: a) bone marrow aspirate b) EBV titers c) follow

Answer 163

a) bone marrow aspirate

Question 164

A 10-year-old child has completed a 2-week course of oral erythromycin as treatment for pertussis. His mother complains that her child is still coughing. You advise: a) chest x-ray b) ventolin c) oral prednisone d) another 14 days of erythromycin e) reassure that nothing further needs to be done

Answer 164

e) reassure that nothing further needs to be done | - 100 day cough

Question 165

A child is brought to see you with 3 days of high fever of 40.1 degrees and feeling unwell. The only thing you see on physical exam is clear rhinorrhea. A CBC shows the following : Hb 118, WBC 2.0 x 10^9 (2000/m3), platelets of 250. The differential shows neutrophils 2%, lymphocytes 70%, eosinophils 8%. What are TWO things that you will do in the management of this child?

Answer 165

Febrile Neutropenia Blood Culture IV ABx (Pip-Tazo) Admit to hospital Our previous answer... Viral infection - ensure adequate fluid intake, analgesia and antipyretics for comfort

Question 166

Neonate born to mom who just revealed HIV positive status. a) What treatment would you start? b) When would you start the treatment? c) For how long?

Answer 166

a) Start Zidovudine and nevirapine. b) Within 12 hours of birth c) Zidovudine x 6 weeks Nevirapine x 3 doses in first week (2nd dose 48h after first, 3rd dose 96h later0

Question 167

What are the current recommendations regarding HPV vaccination? a) Immunize girls only, whether sexually active or not b) Immunize sexually active girls only c) Immunize girls and boys, whether sexually active or not d) Immunize sexually active girls and boys only

Answer 167

c) Immunize girls and boys, whether sexually active or not

Question 168

An 8mo old Caucasian child presents to the ER with a 24h history of fever. His temperature is 39.2 degrees. His immunizations are up to date. He has no travel history. He is otherwise asymptomatic. On exam, he is a happy, smiling child with appropriate vital signs aside from the temperature. What is the next best step? A) Admit for IV antibiotics B) Do a CBC and blood culture C) Give a dose of ceftriaxone and discharge home D) Discharge home with follow-up the next morning

Answer 168

D) Discharge home with follow-up the next morning - should check a urine culture - if not immunized need to be more conservative (CBC and culture, abs if WBC >15)

Question 169

How do you confirm the diagnosis of infective endocarditis?

Answer 169

Duke Criteria Definite - 2 major + 1 minor, or 1 major and 3 minor, or 5 minor Major: - positive blood culture x2 - endocarditis - vegetation on echo, abscess or new valvular regurgitation on exam Minor - fever >38 - immunologic phenomena (GN, Osler) - Vascular phenomena (laneway, conjunctival hemorrhage, Roth spots) - Evidence of microbiologic change - Risk factors (eg. CHD)

Question 170

A 7 year old child has just returned to Canada from sub-Saharan Africa. She has fever and chills. List 3 common causes of her symptoms.

Answer 170

- malaria - typhoid fever - dengue fever - viral illness

Question 171

Which of the following maternal infections is a contraindication to breast feeding? a) Hep A b) Hep B c) CMV d) HIV

Answer 171

d) HIV

Question 172

Child camping in New Brunswick. Had an expanding skin lesion with central clearing in axilla. Now he has fever, myalgia, malaise and chills but no other symptoms. What is the likely diagnosis. Name 3 systems involved and their specific involvement.

Answer 172

1. lyme disease 2. skin - erythema migrans CNS - facial nerve palsy, meningitis, peripheral neuropathy heart - lyme carditis, heart block MSK - oligoarticular arthritis

Question 173

4 month old with meningitis, LP shows gram pos cocci, what drugs to use. a) cefotaxime and vanco b) cefotaxime and dexamethasone c) ampicillin and gentamicin

Answer 173

a) cefotaxime and vanco According to AAP - its all ceftriaxone and vanco above 1 month (consider + amp for listeria)

Question 174

Child presents with bloody diarrhea, anemia and thrombocytopenia. What is the diagnosis?

Answer 174

Hemolytic uremic syndrome | - triad: microangiopathic hemolytic anemia, TCP, renal insufficiency

Question 175

12 month girl is diagnosed with otitis media by her family doctor. She is started on amoxil 80 mg/kg/day and returns to you three days later still febrile. Her tympanic membrane is red and bulging. She appears well. What antibiotics should you give her: a. Amoxil/clavulinic acid- b. Cefuroxime c. Ceftriaxone d. Clarithromycin

Answer 175

a. Amoxil/clavulinic acid-

Question 176

What are THREE indications for giving the conjugated quadrivalent vaccine for meningococcus?

Answer 176

- functional or anatomic asplenia - complement deficiencies - travel to country where meningococcal disease is hyper endemic or epidemic - HIV - Contact of IMD with serotype covered by vaccine

Question 177

Child post bone marrow transplant. Significant exposure to varicella. A) What therapy do you give him? B) What is the time frame for this therapy to be effective? C) How long do you isolate this patient from other immunocompromised patients?

Answer 177

A) VZIG B) as soon as possible - ideally within 96 hours but can give up to 10 days after exposure C) isolate from day 8-21 days

Question 178

With respect to steroid use in bacterial meningitis: a) little is know about its effect b) needs to be given within 30 minutes of first dose of antibiotics c) helps the antibiotics penetrate the brain d) reduces incidence of hearing loss following infection

Answer 178

d) reduces incidence of hearing loss following infection - should be given before first dose of antibiotics, at same time or within 30 minutes - decreases hearing loss with Hib, and maybe strep pneumo - continue if culture positive for Hib or s pneumo

Question 179

Nephrotic syndrome has peritonitis what is most likely org: a) Strep pneumo b) Ecoli c) Enterococus d) B fragilis

Answer 179

a) Strep pneumo | - increased risk of infection with encapsulated bacteria (since lose complement and immunoglobulins)

Question 180

Which of the following infections causes eosinophilia? a. Giardia lamblia b. Entamoeba fragilis c. Ascaris lumbricoides d. cryptosporidium e. pinworms

Answer 180

c. Ascaris lumbricoides - giardia and cryptosporidium are protozoa not helminths - hallmark of helminths is eosinophilia

Question 181

You are trying to set up an infection control program in your hospital. Which intervention will result in the best form of infection control for RSV? a) Hand wash with soap and water b) Gown and glove c) Hand wash with alcohol d) Isolate everyone with respiratory symptoms

Answer 181

c) Hand wash with alcohol waterless hand hygiene products save time and improve compliance and are therefore the recommended method of hand hygiene if hands are not visibly soiled

Question 182

A 6-year-old boy with acute lymphocytic leukemia completed a course of chemotherapy 1 month ago. He has a household contact with chickenpox, and he has never had it before. Management: a) isolate the patient and observe for symptoms b) IM VZIG c) IM VZIG + oral acyclovir d) Admit + IV acyclovir e) Admit + IM VZIG + IV acyclovir

Answer 182

b) IM VZIG - no evidence that acyclovir works for immune compromised children (is given prophylactically to immune competent children 7 days after exposure) - vaccine within 3 days ideally but up to 5 days after exposure for immune COMPETENT people, 12+ months who do not have varicella immunity (no varicella vaccine for immune suppressed people)

Question 183

Kid with varicella, now has a deep bluish lesion to his leg, very painful, looks unwell, high fever. What antibiotics do you start? a. penicillin, clindamycin b. pipercillin, tazobactam c. ampicillin, cefotaxime d. vanco, cefotaxime

Answer 183

a. penicillin, clindamycin - good if documented GAS - varicella gangrenosa (necrotic lesions)/necrotizing fasciitis - other abs regimens: vanco + pip/tazo or ceftriaxone + flagella

Question 184

You are seeing a full term newborn born to a 25 year old mother with a history of genital herpes diagnosed 5 years ago. She had no active lesions at the time of delivery and thus was untreated. The baby was born by SVD. a. What is your management of the newborn (1 line)?

Answer 184

- observe for signs of neonatal HSV and educate parents about what to look for. No swabs or other investigations indicated in this case

Question 185

Photo shown of antecubital fossa demonstrating Pastia’s lines. Etiology: a) staph b) strep c) roseola d) rubeola e) rubella

Answer 185

b) strep

Question 186

Give 2 examples of patients who should get pneumovax (pneumococcal polysaccharide 23 talent vaccine)

Answer 186

- cyanotic heart disease/CHF - CLD, including asthma with chronic high dose oral corticosteroids - DM - CSF leak, cochlear implant - functional/anatomic asplenia - immunocompromise: HIV, chronic renal failure, immunosupp drugs for cancer/AI disease, primary immune deficiency

Question 187

Treatment of Lyme disease in a 6 year old: a. clarithromycin b. amoxicillin c. doxycycline d. erythromycin

Answer 187

b. amoxicillin

Question 188

Premature baby. You are counseling mom about the risks of Transfusion. Which infection is the highest risk: a) HIV b) HEPB c) CMV d) HepC

Answer 188

b) HEPB - HIV 1/8-12 million - Hep C 1/5-7 million - Hep B 1/1.1-1.7million - should request CMV negative blood for premature baby

Question 189

Which vaccine is contraindicated in egg allergic patients? a. Pertussis b. Influenza c. Varicella d. Polio e. MMR f. Hib g. yellow fever

Answer 189

g. yellow fever (not to egg or chicken allergic patients) * b. Influenza (yes egg but new CPS statement says fine) - trace amounts of egg protein in flu, MMR, MMRV, rabies vaccines - intranasal influenza vaccine should not be given to egg allergic patients because there is no safety data

Question 190

What is the best test for HSV encephalitis? a) PCR on CSF b) Viral culture of CSF c) HSV IG in CSF d) Differential on CBC

Answer 190

a) PCR on CSF

Question 191

4 y.o. with chronically draining cervical node. Most likely bug: a. Staph Aureus b. Atypical mycobacterium c. Cat scratch d. Tuberculosis

Answer 191

b. Atypical mycobacterium

Question 192

Robert is a 6 year old boy with Varicella. In the last 24 hours he has become unwell. On exam, his temperature is 40, HR 140, BP 95/60, RR 24. He has obvious lesions consistent with chicken pox. He has a red, swollen left arm that is tender. a) Outline a prioritized differential diagnosis. b) Outline your initial investigations. c) Outline your management plan.

Answer 192

``` a) Ddx: ● infected rash = cellulitis, ● Cellulitis ddx: abscess, osteomyelitis ● Nec Fas b) Ix: - CBCD, CRP, blood culture c) mgmt: admit and IV cefazolin ```

Question 193

15 year old male immunocompromised in a hot tub afterwards develops folliculitis and enlarged lymph nodes. Name the organism.

Answer 193

hot tub folliculitis - pseudomonas

Question 194

Apnea and pneumonia are common complications of pertussis in infants. This is not true of adults and adolescents. 1. List 2 presentations of pertussis in adults and adolescents. 2. What is the main reason for instituting a generalized immunization program for pertussis in adolescents?

Answer 194

1. Catarrhal: mild URTI symptoms followed by Paroxysmal stage: prolonged cough lasting >21 days 2. immunity from primary series wanes in adolescents so booster protects herd immunity and infants who have not yet been vaccinated. Reduce burden of disease.

Question 195

A mother brings her 3 children to your office because she thinks they all have strep throat. The 18-month-old and 2½ -year-old both have exudative tonsillitis. The 4-year-old has a red pharynx and mild anterior cervical lymphadenopathy. a) no treatment is necessary now; reassess in a few days b) treat all 3 children with penicillin V tid x 10 days c ) take throat swabs and await the results before treating d) take throat swabs and treat empirically with penicillin V e) take throat swabs and do CBCs; if increased WBC then start penicillin V

Answer 195

c ) take throat swabs and await the results before treating

Question 196

A 6-month old whose mother is anti-HCV+ and HCV-RNA+, baby is anti-HCV+, asymptomatic, normal exam. What is the best management of the baby? 1) Repeat anti-HCV in 6 months 2) Transaminases 3) Refer for liver biopsy 4) Obtain HCV-RNA

Answer 196

Obtain HCV-RNA (or follow up with Ab at 18 mo of age)

Question 197

Treating an eye infection with cipro drops, still not improving at 36 hours. Mom and sibling had this, plus lots of kids at school. What to do? a. change to po cipro b. reassess in 48 hours c. IV antibiotics d. Consult ophthalmology

Answer 197

Reassess in 48 hours

Question 198

Head lice - which one is least likely to increase resistance? a. permethrin 1% b. R&C c. lindane d. Resultz shampoo

Answer 198

d. Resultz shampoo (isopropyl myristate) - R&C = pyrethrin - same resistance to permethrin and pyrethrin - lindane - high failure rate and potentially neurotoxic - per CPS, increasing resistance to pyrethrin, permethrin and lindane

Question 199

3 week old with RSV, day 2 of admission. Fever of 39. RML infiltrate that was new. a) cefotax b) amp and gent c) supportive management

Answer 199

b) amp and gent | - because fever in <1 month

Question 200

12 m with crusty yellow discharge from Left eye and conjunctivitis. Normal visual acuity, no proptosis, no periorbital swelling, normal EOM. You prescribe cipro topical drops. At 36 h exam, unchanged. What is your next step? a. Refer to ophto b. Prescribe IV antibiotic c. Continue and return in 48 h d. Prescribe fucidic acid drops

Answer 200

c. Continue and return in 48 h

Question 201

An infant born at 31 weeks gestation is now 2 months old, but has never left the hospital. What should be done about the immunizations: a) delay immunizations until discharge b) start routine immunization schedule at 8 weeks corrected age c) give DTaP, hemophilus influenza conjugate, and IPV now d) give DtaP, hemophilus influenza conjugate, and OPV now e) give half dose of DTaP and IVP now and repeat in one month

Answer 201

c) give DTaP, hemophilus influenza conjugate, and IPV now

Question 202

6 year old girl has recent history of gastroenteritis. She develops bilateral decreased sensation in her feet. Her respirations are normal. What is her diagnosis (1)? What test or procedure would you do and what are your expected findings? What is the likely organism that caused her gastroenteritis (1)?

Answer 202

1. guillain-barre syndrome 2. LP - elevated protein (>2x ULN), glucose normal, no CSF pleocytosis, cultures negative - can also do MRI: thickening of cauda equina and intrathecal nerve roots with gad enhancement 3. campyobacter jejuni

Question 203

Greek 6 y/o girl with fever to 40 degrees. WBC 38. Pain in the right hypochondrium. Tender in right hypogastrium but no guarding or rebound. What is the diagnosis: 1. Pleurodynia 2. Bacterial pneumonia 3. First presentation of Familial Mediterranean Fever 4. Fitz-Hugh-Curtis 5. Cholecystitis

Answer 203

2. Bacterial pneumonia FMF - episodic attacks lasting 1-3 days; accompanied by abdo pain, pleurisy, arthralgia or arhtritis. Get elevated WBC and CRP.

Question 204

An infant is delivered vaginally to a mother who has untreated gonorrhea. What do you do for the baby? A) Give one dose of IM Ceftriaxone + conjunctival culture swab B) Conjunctival culture and treat with erythromycin ointment C) Conjunctival culture and wait to treat

Answer 204

A) Give one dose of IM Ceftriaxone + conjunctival culture swab

Question 205

What is the result of giving rota vaccine? a) reduce hospitalization b) reduce mortality c) helps prevent other non-rota gastro

Answer 205

a) reduce hospitalization

Question 206

Asplenic child, febrile, what organisms do you need to cover with your abx? a. staph aureus, strep pyogenes, group a strep b. strep pneumo, h flu, n. meningitides c. nocardia, aspergillus, etc

Answer 206

b. strep pneumo, h flu, n. meningitides | * nocardia, aspergillus, etc (cause opportunistic infections in immunocompromised patients)

Question 207

A baby is born by c-section at 6h since membranes ruptured. Mother has active HSV lesions. The baby is asymptomatic. When should cultures of the baby be done? a. Immediately and start Acyclovir b. After 48h c. When the baby is symptomatic d. Observe only

Answer 207

a. Immediately and start Acyclovir

Question 208

Mom ivdu. Early latent syphilis. Titer from 6 months ago and now. They have dropped by 8 times. Baby is born. What do you do to for the baby: a) Observe b) Tryponemal screen and RPR c) CSF RPR d) Swab baby

Answer 208

b) Tryponemal screen and RPR

Question 209

Family comes to you from an area endemic for Lyme disease – What is the organism and vector causing it (2)?

Answer 209

- borrelia burgdoferi; from black-legged ticks

Question 210

Inuit grandmother diagnosed with active TB. His child has a TB skin test which shows 8 mm of induration. What are two possible reasons for this test result (2)

Answer 210

- latent TB infection (in otherwise asymptomatic) - indicative of previous BCG vaccine Positive test is >5mm in a child with close contact with persons with active TB

Question 211

You diagnosed a toddler with Chicken pox a few days ago. Now he is in your office. Mother tells you he’s refusing to weight bear since this morning. Photo of his foot is shown. Area of erythema over 3 rd -4 th metatarsals and phalanges, with black necrotic looking areas. What is the diagnosis? How will you treat him (4)?

Answer 211

1. Dx: necrotizing fasciitis 2. mgmt: - admit to hospital - blood future, CBCD, CRP - start pen G and clindamycin IV - surgical consult for debridement

Question 212

You are planning to institute a universal vaccination program in your community. List 4 considerations in planning this program.

Answer 212

- which diseases to target - effectiveness of vaccine - availability of supply of vaccine - cost of vaccine - ability of the community to adopt and implement a universal program given available resources - sufficient personnelle - vaccine safety storage

Question 213

15 yo male with severe retropharyngeal abscess, requiring surgical decompression. On day 3, he has new onset headache. What is the most likely cause? a) meningitis b) jugular thrombosis c) migraine

Answer 213

b) jugular thrombosis | - thrombophlebitis of internal jugular vein ultimately causing central venous sinus thrombosis

Question 214

4nmo infant. Grandfather, who lives in child’s home has been diagnosed with cavitating TB. How should the infant be managed? a) Treat with rifampin b) give BCG c) Treat with INH d) Do CXR

Answer 214

d) Do CXR - should have TST or IGRA, physical exam and CXR - at minimum will be treated for LTBI with INH BUT need CXR to rule out active disease which will change management

Question 215

Chlid with 4+ proteinuria, distended abdo, fever. Most likely organism causing acute abdomen? a. Ecoli b. Strep pneumo

Answer 215

b. Strep pneumo | - nephrotic syndrome complicated by spontaneous bacterial peritonitis

Question 216

Kid with kawasaki disease. Received IVIG and ASA. Now has massive hematuria. Low haptoglobin. GN picture. High bili and LDH and liver enzymes 1) renal vein thrombosis from thrombocytosis 2) hemolysis from iVIG 3) ASA mediated platelet dysfunction 4) Kawasaki mediated Gn

Answer 216

2) hemolysis from iVIG | - passive transfer of antiA or antiB antibodies in IVIG is a known phenomenon and can cause hemolytic anemia

Question 217

What would be an indication to do radiological studies in sinusitis? a . orbital cellulitus b. adolescent with no fever and mucopurulent discharge

Answer 217

a. orbital cellulitus

Question 218

3yo previously healthy kid with ear pain for one day. One exam, T 37.8C and erythematous, bulging tympanic membrane. Best management? a) Reassess in 24-48 hours b) Amoxicillin 45-60 mg/kg/day divided BID x 5 days c) Amoxicillin 75-90 mg/kg/day divided BID x 5 days d) Amoxicillin 75-90 mg/kg/day divided BID x 10 days

Answer 218

a) Reassess in 24-48h

Question 219

Child sucks on finger. Lesions on finger for 10 days. Finger hurts when mom touches it – picture of a finger with vesicles but also a central area of ulceration, some diffuse erythema of finger. What is your management? 1. po cephalexin 2. I & D 3. po acyclovir 4. flamazine dressing

Answer 219

3. po acyclovir Herpetic whitlow - treat with acyclovir if immunocompromised or severely infected; otherwise can do nothing *we said Cephalexin since it had been > 10 days of symptoms.

Question 220

A full term infant is born by vaginal delivery to a woman with a vaginal herpes lesion. In order to decrease infectivity you would: a) place baby and mother in same room with no breastfeeding b) place baby and mother in same room and allow breastfeeding c) place baby and mother in separate rooms d) discharge both immediately e) contact isolation from other patients

Answer 220

ANSWER: e) contact isolation from other patients - until lesions crusted over, 14d infectivity period passed or swabs negative AND b) place baby and mother in same room and allow breastfeeding Mothers who are in hospital should be on contact precautions until their lesions have crusted. Asymptomatic neonates whose mothers have active HSV lesions should be managed using contact precautions until the end of the incubation period (day 14) or until samples from the infant taken after the first 24 h of life are negative. do not discharge immediately, await swabs

Question 221

Which virus is associated with transient arthropathy: a) RSV b) rubella c) measles d) Hepatitis A

Answer 221

b) rubella Transient polyarthralgia and polyarthritis is common in adolescents (RedBook)

Question 222

What are three high risk groups for invasive pneumococcal disease (3)

Answer 222

- functional asplenia - structural asplenia - humoral immune deficiency - HIV - DM - cochlear implants - CSF leak - Asthma - CKD - Hemoglobinopathy - Chronic Cardiac or Pulmonary

Question 223

Hep A. When can return to school? a. 1 wk b. when no fever c. if washing hands well d. when no symptoms

Answer 223

a. 1 wk (red book, CPS)

Question 224

What is the most common adverse event related to cephalosporine use? a) Diarrhea b) Rash c) Neutropenia d) Photosensitivity

Answer 224

a) Diarrhea

Question 225

A pregnant woman with syphilis and a RPA of 1:512 receives a full course of treatment and the titer falls to 1:256. Upon delivery of the child, the next appropriate step is: a) treat the child as the fall in the titer is inadequate b) test child’s serum for VDRL and anti-treponemal AB and treat if positive c) test child’s CSF for VDRL and anti-treponemal AB and treat if positive d) no treatment is necessary for syphilis but this child should be tested for HIV

Answer 225

a) treat the child as the fall in the titer is inadequate | - full work up (blood, CSF, X-ray) and treat

Question 226

What is true regarding the spread of meningococcal disease: a) household contacts are at greater risk than school contacts b) penicillin is the drug of choice for prophylaxis c) Neisseria meningitidis type B vaccine is use to prophylax against school outbreaks d) healthcare workers should be routinely immunized against Neisseria meningitides e) a negative NP swab will determine whether or not to treat exposed individuals

Answer 226

ANSWER: a) household contacts are at greater risk than school contacts - prophylaxis with rifampin, ceftriaxone or cipro - mening B vaccine used for lab and military personnel, not routine for school outbreaks - decision to treat exposed individuals is based on risk of exposure, not cultures

Question 227

Native girl, received BCG in past, PPD 13mm. a. ) How do you interpret this? b. ) What is your approach to treatment? (1 line)

Answer 227

a) positive test - in kids who are vaccinated, if they have been exposed to TB or are at high risk for disease the cutoffs for a positive test are the same as if they hadn't been vaccinated b) 9 months of isoniazid for LTBI

Question 228

Child was bitten on the hand by a cat 24 hours ago. He has been taking Clavulin, but the hand has become very erythematous and swollen. What do you do? a) IV Ticarcillin/clavulanate b) IV Cefuroxime c) IV Cloxacillin d) Call Ortho to do Surgical Debridement and irrigation

Answer 228

a) IV Ticarcillin/clavulanate (pip-tazo would also work) 2019 - we suggested call orthodox

Question 229

``` What are the current recommendations for HPV Vaccine for 15 year old boy A. 2 doses; now and 6 months later B. 3 doses; now, then at 1, and 6 months C. No vaccine D. Wait until he's sexually active ```

Answer 229

B. 3 doses; now, then at 1, and 6 months

Question 230

3 year old child, 2-3 day history of viral prodrome, sudden onset this morning of stridor, temperature of 40 degrees. In your ED is anxious but not drooling and very stridorous. There is no significant change with one dose of neb racemic epinephrine. What is the most likely diagnosis: a. Croup b. Bacterial tracheitis c. Retropharyngeal abscess

Answer 230

b. Bacterial tracheitis | - high fever, toxic appearance, poor response to nebulized epi

Question 231

31 week GA baby, now 3 mos old. It is October. Parents are non-smokers. Mother planning to stay at home with babe. A) What one intervention can you do to minimize risk of severe RSV bronchiolitis? B) How does paluvizumab decrease risk and by what mechanism does it work?

Answer 231

A) this baby does not qualify for paluvizumab - protective factors are: breastfeeding, hand hygiene and not smoking B) decreases rate of hospitalization in some groups of prem babies (if hospitalized, does not reduce severity or mortality); confers passive immunity (immunoglobulin)

Question 232

A women is diagnosed with chicken pox 10 days prior to delivery. The baby is normal at birth. You would: a) give VZIG immediately b) provide normal newborn care unless the infant develops varicella c) isolate the baby from the mother

Answer 232

ANSWER: b) provide normal newborn care unless the infant develops varicella a) give VZIG immediately- only if rash <5d prior to or 48h after delivery or prem c) isolate the baby from the mother (usually lesions crusted by 5d after)

Question 233

``` A 6y M has always lived on a farm. For the last 3 months he has had intermittent fever, vomiting, diarrhea and weight loss. A test shows narrowing of distal ileum. Which is the causative agent? a. Entameoba histolytica b. Yersinia c. Salmonella d. Giardia ```

Answer 233

b. Yersinia- ileitis - mesenteric adenitis causes abdo pain and fever (mimics appendicitis) - terminal ileitis and diarrhea (mimics IBD)

Question 234

A 4-month-old septic child. CSF gram stain shows GPC. Initial antibiotic therapy: a) Ampicillin + Gentamycin b) Ampicillin + Cefotaxime c) Ceftriaxone d) Ceftriaxone + Dexamethazone e) Cefotaxime + Vancomycin

Answer 234

e) Cefotaxime + Vancomycin | - third generation cephalosporin + vanco for resistant strep pneumo (which is a gram positive coccus)

Question 235

What is the most common sequela of congenital CMV: a) deafness b) petechiae c) cataracts d) splenomegaly e) jaundice f) microcephaly

Answer 235

a) deafness

Question 236

Girl with sickle cell who was bitten by a dog on her leg. After appropriate cleaning of the wound and checking the (immunization status of the dog) dog for rabies what is the next step? A) Observe and follow up in 24h B) IM ceftriaxone C) Amox/clav D) Topical mupirocin

Answer 236

C) Amox/clav - Antibiotic prophylaxis indicated for immunocompromise. Higher risk of Capnocytophaga canimorsus in asplenia

Question 237

Why do you treat Salmonella bacteremia in a 2 month old child? a) To eliminate the carrier state b) To decrease the duration of symptoms c) To prevent meningitis d) To eliminate shedding from the GI tract

Answer 237

c) To prevent meningitis

Question 238

A 2 year old child sustains a laceration on the playground. She has not received any immunizations and is otherwise healthy. You clean and suture her laceration. What further management do you offer: a. Start tetanus immunization series b. Tetanus immunization and tetanus immunoglobulin c. Tetanus immunoglobulin and tetanus anti-toxin

Answer 238

b. Tetanus immunization and tetanus immunoglobulin TIG - dirty wounds without 3 doses of TDAP

Question 239

Asymptomatic child with Giardia spores in stool. Stool sent after another child in daycare diagnosed with giardiasis. Do you treat this child and explain why yes or no? If you would treat, what would you prescribe?

Answer 239

1. No because do not need to treat asymptomatic carriers, unless they share a household with a child with CF/ hypogammaglobulinemia. 2. Tinidazole (first line >3years) x1dose, Nitazoxanide x1 dose, metronidazole x5-7days Red Book Daycare: If suspect an outbreak, call public health. Treat those infected - not carriers. Daycare exclusion until symptoms resolve. Don't test asymptomatic people.

Question 240

All are excluded from day care except: 1. 3 y/o suspect of having scabies 2. pertussis treatment for 2 days 3. shigella day 2 4. campylobacter day 2 5. Hepatitis A after 10 days

Answer 240

5. Hepatitis A after 10 days - exclude for 7 days after onset - scabies: back once treatment completed - pertussis: back after 5d antibiotics or 21d from cough if not treated - shigella: 24h after diarrhea stopped - campy: if in diapers, no daycare until diarrhea done

Question 241

Woman in labour with genital herpes. If you are going to do investigations, in what situation would that be and what tests would you do on the infant? (list 2)

Answer 241

If active lesions (First Primary or Unsure of Hx) and C/S after ROM or Vaginal Delivery: Mucous membrane + Blood PCR and TREAT pending results. If active lesions (first primary) and C/S prior to ROM, well baby: Swab/Blood PCR and observe. If active recurrent lesions, no matter delivery and baby is well. Swab/Blood and Observe. Baby unwell - do full workup and treat.

Question 242

A 10-year-old boy has painful swelling behind his right mandible. He has torticollis on the same side and a red pharynx. Remainder of the exam is normal. Most important diagnostic test: a) lateral neck x-ray b) blood culture c) monospot d) amylase

Answer 242

a) lateral neck x-ray | - consider amylase - mumps

Question 243

A child has been receiving IV Penicillin for meningococcemia for the past 7 days. He has now developed a warm swollen right knee. What should be done: a) provide NSAIDs b) add a second antibiotic c) change to a different antibiotic d) aspirate and culture e) bone scan

Answer 243

a) provide NSAIDs - allergic immune complex mediated arthritis (also vasculitis, pericarditis, episcleritis) - self limiting, occurs in first 10 days of disease onset - good response to NSAIDs - child with menigococcal disease who develops fever after 5 days on antibiotics - investigate for immune complex medicated disease

Question 244

Child gets a puncture wound of the foot through the sneaker. He is Limping. Bone scan confirms osteomyelitis. What is the likely causative organism? List 2 treatment modalities.

Answer 244

1. pseudomonas | 2. Irrigation and debridement under GA. Abx x14 days (pip-tazo, cefuroxime, cipro gent all antipseudomonal)

Question 245

Toxic child with high fever, respiratory distress. White-out on 1 side of the lung on CXR. What to do? a. decubitus x-ray b. chest ultrasound c. consult surgery d. bronch

Answer 245

b. chest ultrasound – fluid vs consolidation/atelectasis/tumor * a. decubitus x-ray – can show shift in fluid (tells you if effusion versus consolidation

Question 246

Child with a supraclavicular lymph node 1.5 by 2 cm, firm, nontender, mobile no surrounding erythema . what is best management a. skin testing for atypical mycobacteria b. PPD (TB skin test) c. excision biopsy

Answer 246

c. excision biopsy

Question 247

Teenage girl with a history of ulcerative colitis, status post total colectomy. Had a “J- pouch” and an anal pull-through ostomy that was later removed. Did have an ileostomy, but that was closed following an end-to-end anastomosis. Now she presents with a 5-day history of bloody diarrhea 8 times per day. Stool cultures are all negative. What is the diagnosis? What 1 treatment would be the best?

Answer 247

1. pouchitis - chronic inflammatory reaction in pouch leading to bloody diarrhea, abdo pain, and sometimes low grade fever 2. PO metronidazole or Ciprofloxacin X 14 days

Question 248

Description of a mom who presents with her child who has otitis media. What are 4 risk factors for otitis media?

Answer 248

- pacifier use - exposure to cigarette smoke - certain syndromes (e.g. T21 - flatter angle of ear canals) - orofacial abnormalities (e.g. cleft palate) - over crowded housing - shorter duration of breast feeding - bottle propping - childcare centers - family history

Question 249

5 year old immigrant from Pakistan. Drooling with SOB and dysphagia. Lateral Neck. (thumb sign) What organism is the likely cause? How would you manage this patient?

Answer 249

1. hemophilus influenza B (epiglottitis) 2. keep patient as calm as possible, call ENT and anesthesia to intubate, needs IV antibiotics but if kid is going to freak out with IV insertion wait until airway secured - abx: ceftriaxone and vanco (for staph coverage)

Question 250

A child diagnosed 14 days ago with Hepatitis A and is currently symptomatic. What to do with family members? 1. Hyperimmume immune globulin against Hepatitis A 2. Hepatitis A vaccine 3. No treatment 4. Antibiotic prophylaxis

Answer 250

2. Hepatitis A vaccine - hep A vaccine for pre-exposure protection (e.g. travelling to endemic area) - hep A vaccine equal effectiveness to Ig within 2 weeks of exposure; serologic testing not recommended

Question 251

A child has fatigue for 2 weeks and was referred from the family doctor for cervical lymphadenopathy. There is left cervical lymphadenopathy with 2 palpable 5cm non-tender, mobile. He also has a papule on his left hand. Otherwise relatively well. What is the organism? a) ATM b) Bartonella hensalae c) Staphylococcus aureus

Answer 251

b) Bartonella hensalae

Question 252

3 yo with gradually increasing oxygen requirement over the past 3 hours. Had a chest tube inserted for empyeme, which drained 500ml and continues to drain well. He is tachycardic, tachypnic with decreased AE on side with empyema, He is afebrile and well perfused. Xray shows marked reduction in size of empyema. He has been given ceftriaxone, acetominophen and ibuprofen. What is your next step in management? Clamp chest tube Add Vancomycin Bolus 10ml/kg Give morphine

Answer 252

Give Morphine

Question 253

A teenage girl presents with a one week history of periumbilical pain, fever of 39.2 degrees. She has just returned from a trip to Pakistan. She looks unwell and a blood Cx shows gram negative rods. Despite her fever and condition her HR is only 85. Which antibiotic will you treat her with: a. Ciprofloxacin b. Gentamicin c. Metronidazole d. Penicillin

Answer 253

a. Ciprofloxacin - treat empirically with ceftriaxone or fluoroquinolone - IV antibiotics x minimum 14 days for uncomplicated typhoid fever

Question 254

Kid with exudative pharyngitis. 1y/o. What is most likely dx a) Viral pharyngitis b) MONO c) Strep

Answer 254

a) Viral pharyngitis

Question 255

Parvob19 daycare restrictions (given picture of child with facial rash) - Now - As soon as the child is well enough to go - After the rash resolves - After fever and rash resolves

Answer 255

- As soon as the child is well enough to go

Question 256

3 yr old boy with confirmed pertussis. Lives with 3 sibs, all of whom are immunized. What treatment, if any, do you recommend?

Answer 256

- patient should be treated | - post-exposure prophylaxis for immunized household contacts (azithro x5 days)

Question 257

Head lice – which one is least likely to increase resistance? a. permethrin 1% b. R&C c. lindane d. Resultz shampoo

Answer 257

d. results - not insecticidal melts the exoskeleton

Question 258

Kid has had several infections. What other 4 findings would suggest immunodeficiency?

Answer 258

- persistent thrush - recurrent abscesses - failure to thrive - needing prolonged courses of antibiotics (2 months with little effect) - family history of immune deficiency

Question 259

3 yo F with 1 wk of yellow discharge on panties. On exam inside of labia majora red and yellow secretions pooled in posterior fourchette and around urethra. Most likely diagnosis. a. Candida b. Foreign body c. GAS d. Pinworms

Answer 259

c. GAS

Question 260

Which of the following is TRUE as regards TB in children: a) tine test and PPD are equally specific and sensitive b) 10% of children with active disease are PPD negative c) prior vaccination with BCG is a contraindication to PPD testing

Answer 260

b) 10% of children with active disease are PPD negative CPS: 10-20% immune competent children with proven TB have false negative test

Question 261

Kid with diarrhea non bloody a month ago, resolved but still unwell with wt loss and abdo pain. Dx? a) campylobacter b) c diff c) E. coli d) yersinia

Answer 261

Campylobacter infection should also be considered when evaluating for inflammatory bowel disease.

Question 262

Child has Neisseria meningitidis arthritis. Prior history of Neisseria meningitidis meningitis. Which of the following tests could be positive. a) C3, C4, CH 50 b) CBC diff c) IgG, IgA, IgM, IgE

Answer 262

a) C3, C4, CH 50 | - people with complement deficiency have 1000X increased risk of acquiring meningococcal disease

Question 263

List 4 clinical signs to distinguish orbital from periorbital cellulitis.

Answer 263

- pain with EOM - rapid afferent pupillary defect - proptosis - decreased visual acuity - chemosis

Question 264

A 1 year old child has a cough, and mom wants to know if she can use an over-the- counter cough preparation for him/her. What do you tell her?

Answer 264

OTC cough medications are not helpful in kids and can be harmful. Not recommended in kids under 6 years.

Question 265

Child previously treated with course of Amox for otitis media. Then presents signs of meningismus irritability and lethargy. LP high protein low sugar high WBC count. No organisms on gram stain. Gave one dose of ceftriaxone. Defervesced after dose. Doc calls you because culture has come back negative. What is the likely diagnosis. How would you tell the Doc to proceed

Answer 265

1. culture negative bacterial meningitis 2. will need treatment with IV antibiotics (ceftrixone empiric usage, depends on local susceptibilities, may need vanco also - strep pneumo resistance) for 2-3 weeks 3. recommend consult ID

Question 266

Young child with periorbital edema and diarrhea. His albumin is 12. What is your differential diagnosis (4)?

Answer 266

- infectious diarrhea (parasitic infection) - cow's milk protein intolerance - food protein induced enterocolitis syndrome - IBD - HUS - Nephrotic syndrome - Immunodeficiency (SCID, AIDS, Agammaglobulinemia)

Question 267

Baby born to HIV-positive mother discovered during pregnancy and treatment initiated. How to test the baby to confirm diagnosis? a) ELISA b) Western blot c) HIV DNA PCR d) p24 Ag

Answer 267

c) HIV DNA PCR - preferred test for <18m * a) ELISA- screening in >18m b) Western blot - confirmatory test d) p24 not as sensitive - never recommended o Testing with HIV DNA or RNA assays at 14-21d o Repeat at 1-2m and 4-6m if negative then ELISA at 18m o Test <48h if in utero infection suspected

Question 268

A 7 year old with CP, severe GERD and frequent choking spells while eating is admitted to the hospital with fever and increased RR. On CXR there is an air bubble in the LLL with surrounding consolidation and pleural effusion. What is the most likely organism that is causative: a. Staphylococcus b. Haemophilus c. Anaerobes d. Mycoplasma

Answer 268

a. Staphylococcus | - causes necrotizing pneumonitis - pneumatocele

Question 269

A 17 month old boy is going for elective orchidopexy today. When he shows up he has a fever of 38.2 and copious yellow nasal discharge. He has an intermittent cough but otherwise appears well. Can he have his surgery? 1. Yes 2. Yes, but he needs to be observed overnight 3. No, wait until his symptoms resolve 4. No, wait until 6 weeks after his symptoms resolve

Answer 269

3. No, wait until his symptoms resolve

Question 270

3 year old with a history of fevers. Occur every 4 to 12 weeks for 1-4 days. Growing well. Treated for numerous otitis and pharyngitis. A) multiple viral infections B) familial med fever C) CVID

Answer 270

A) multiple viral infections

Question 271

A child presents to your office with tender pre-auricular lymphadenopathy and ipsilateral conjunctivitis. There are other abnormalities noted in the same eye. On examination, you note splenomegaly. Which of the following is the most likely causative agent? a) Toxoplasmosis b) Adenovirus c) Bartonella hanselae d) Staphylococcus aureus

Answer 271

c) Bartonella hanselae - Parinaud Oculoglandular syndrome (Classic :S)

Question 272

List 4 other signs of endocarditis in a child with a fever, murmur, tachycardia and hepatospenomegaly. How do you confirm Dx?

Answer 272

- conjunctival hemorrhage - janeway lesions (non tender macules on fingers and soles) - osler nodes (painful lesions on hands and feet) - glomerulonephritis - splinter hemorrhages - clubbing - arthritis - heart failure Confirm: BCx and ECHO

Question 273

4 year old boy presents with a pruritic rash over his chest and axilla. 2-5mm flesh coloured papules w/ central depression or umbilication. Provide most likely diagnosis.

Answer 273

Molluscum contagiosum

Question 274

8? Year old with vesicle on erythematous base on uvula, tonsils, soft palate. What is the diagnosis?

Answer 274

Herpangina (coxsackie virus)

Question 275

A child eats at a picnic and develops vomiting and diarrhea four hours later. What is the likely causative organism: 1. E Coli 2. S Aureus 3. Shigella 4. Campylobacter 5. Salmonella

Answer 275

2. S Aureus (onset 1-6 hours after exposure) Due to enterotoxin.

Question 276

Child with inguinal adenopathy found 1 week ago by parent while bathing. Give 4 indications for biopsy.

Answer 276

- weight loss - night sweats - unexplained fevers - no decrease in size over 4-6 weeks - increase in size over 2 weeks - hard or non mobile node

Question 277

An unimmunized child has been diagnosed with Hemophilius influenza type B meningitis. His 2 siblings, ages 2 and 10, are unimmunized. What prophylaxis do you give the children? a) none b) give the baby rifampin c) give the toddler rifampin d) give all of them rifampin

Answer 277

d) give all of them rifampin

Question 278

Mom concerned about possibility of west nile in her child. What is the most common presentation of west nile in children? a. Asymptomatic b. Mild fever c. Encephalitis

Answer 278

a. Asymptomatic (70-80% of WNV infections are asymptomatic) - if symptomatic: febrile illness with myalgia, arthralgia, headache, GI upset, maculopapular rash

Question 279

What are 3 complications of sinusitis?

Answer 279

- orbital/periorbital cellulities - epidural abscess - meningitis - cerebral venosinous thrombosis - brain abscess - Pott's puffy tumour (osteomyelitis of frontal bone)

Question 280

Which of the following is not associated with recurrent candida infection: a. complement deficiency b. prolonged antibiotic therapy c. hypoparathyroidism d. Addison’s disease

Answer 280

a. complement deficiency - autoimmune polyendocrinopathy type I - presents with chronic mucocutaneous candidiasis, hypopara, adrenocortical insufficiency (Addison's) - other primary immune deficiencies that present with candida are congenital neutropenia, CGD, leukocyte adhesion deficiency

Question 281

What are three things to do for prevention if you live in a lyme endemic area (3)

Answer 281

- use landscaping to separate play spaces from wooded areas - 20-30% DEET bug spray - full body check for ticks after coming inside and promptly remove any that are found - showed within 2 hours of coming inside to wash off unattached ticks

Question 282

Mom was adequately treated for syphilis during pregnancy (had greater than four-fold drop in titers). How do you manage baby? a) Do Syphillis serology in baby b) Monitor for symptoms only c) Do serologies and monitor for symptoms

Answer 282

c) Do serologies and monitor for symptoms

Question 283

3 months old with seromucoid discharge from one eye, and occasional yellow crusting from the other eye. What do you do? a. refer to an ophthalmologist b. reassure c. give daily antimicrobial eye drops

Answer 283

b. reassure

Question 284

3 y.o. Child with fever, headache and vomiting for last 2 days. Child has been back in the country for 1 week after visiting relatives in Nigeria for 1 month. a) What are the 2 most important diagnostic tests? b) List 3 vaccine preventable conditions that should be considered for this child

Answer 284

a) Malaria smear, blood culture b) N. meningiditis, typhoid, yellow fever High risk! Fever in child visiting family and relatives! 3 most important travel related causes of fever: Malaria(!!), Traveller's diarrhea, Enteric fever.

Question 285

Mom with HIV, SVD, CD4 =600, on Zidovudine IV. a) What TWO things do we test for in the infant and when? b) What are the chances of transmission? c) What’s the status with breastfeeding in Canada?

Answer 285

a) HIV DNA or RNA PCR at birth within 24-48h (+14-21days, 1-2 mos and 4-6mos) - HIV Abs at 12-18 mos (when you expect mom's Ab are gone) b) < 2% (It is 25% when no interventions) c) Breast feeding not recommended

Question 286

Kid drinking unpasteurized milk from farm. a) What is she deficient in? b) What are three bacteria that can be found in unpasteurized milk?

Answer 286

a) Vitamin D (pasteurized milk is fortified) | b) Brucella, Campylobacter, Salmonella, E. coli, Listeria

Question 287

Mom has been travelling to a Zika place. You are assessing the newborn and after investigations you note subcortical calcification. 1) What are 2 other clinical features of congenital zika syndrome? 2) What are two tests to diagnose congenital zika virus?

Answer 287

1) Scalp redundancy (collapsed skull), Macular scarring, congenital contractures, Microcephaly, IUGR, hypertonia, micropthalmia, cataract, SNHL 2) Zika Serology (IgM or IgG) or ZIKV RNA by PCR In this case (symptomatic + travel Hx): Do ZIKV serology and blood and urine for AIKV PCR on mom and baby

Question 288

A 5 year old girl has a laceration after being bitten by a dog over the dorsum of her 5th digit while she was playing at the playground. Her immunizations are up to date. What are four PRINCIPLES of her treatment? (4 points)

Answer 288

- Assess Rabies risk and vaccination status of the dog - Clean the wound - Assess for signs of infection - Initiate antibiotic prophylaxis with Amoxi-Clav - Consider letting heal by secondary intent to reduce risk of infection

Question 289

A term infant is born to a mother with no prenatal care, and who has a history of IVDU. List two infections that can be transmitted vertically from mom to baby. For each infection, list how you would treat the infant to prevent transmission.

Answer 289

HIV: Zidovudine ± nevirapine HCV: No Tx HBV: HBV vaccine ± HBIG within 12 hours

Question 290

A term infant is born to a mother with no prenatal care. The mother is diagnosed with gonorrhea, and on day 4 of life, the baby develops purulent discharge from one eye. What are FIVE things you would do?

Answer 290

- Single dose CTX 25-50 mg, max 125 mg - Swab for gonorrhoea - Do BCx - Admit - Optho assessment - Irrigate with saline - Treat mom

Question 291

A 2 year-old boy had an abscess on his buttocks which was drained by a walk-in clinic last week. He had been given a 7 day course of cephalexin. He is now presenting on day 5 of treatment. There is no more abscess, but the surrounding tissue is red and hot. His mother notes that the area of redness has spread over the past day. 1) What is the most likely infectious pathogen (be specific)? 2) How would you manage this child?

Answer 291

1) MRSA 2) Admit Swab Blood cultures IV vancomycin, step down to septra

Question 292

3 year old boy with recent diagnosis of otitis media, started on cefprozil last week. He presents to you with a two day history of fever, arthralgias and a serpiginous, very pruritic rash on the sides of his hands and feet. 1) What is the most likely cause of this rash? 2) What are two ways you would treat it?

Answer 292

1) Serum sickness like reaction 2) Discontinue antibiotic Antihistamines NSAIDS

Question 293

A child presents with fever, cough, tachypnea. 1) What are 2 findings on respiratory examination that would suggest a bacterial cause? What are 2 findings on respiratory examination that would suggest a viral cause?

Answer 293

1) Bacterial Pneumonia: - Crackles in one area - Whispering pectoriloquy - Dullness to percussion - Asymmetrical decreased breath sounds 2) Viral Wheeze Scattered crackles

Question 294

Baby with SCID: 1) What is one thing on CBC that is specific to it 2) What are three things you are going to do next

Answer 294

1) Low lymphocyte count 2) - Strict Isolation - Stop BF until know CMV status of mom - Ab Replacement (IVIG) - PJP prophylaxis after 1 mo (TMP-SMX) - Fluconazole prophylaxis - Work up for BMT - No live vaccines - All blood products IRRADIATED, leukodepleted, CMV -ve

Question 295

You diagnose a young child with measles. a) List 3 lab tests you would do to confirm B) List 3 acute complications of measles C) What precautions are required in a hospitalized patient?

Answer 295

A) Measles IgM (present 3 days after exanthem, and disappears 30 days after exanthem), Measles IgG (undetectable up to 7 days after rash, but peaks around 14 days), Measles RNA (blood, NPA, throat swab or urine, present for first 3 days) B) Diarrhea (8%), Pneumonia (6%, most common cause of death), Encephalitis (0.1%) C) Airborne

Question 296

You are treating a 2 year old with otitis media with amoxicillin. He returns to you with a high fever, erythema behind the right ear and the right pinna appears pushed forward. A) What is the diagnosis? B) What are 3 complications of this condition? C) What medications will you use to treat?

Answer 296

A) Mastoiditis B) Subperiosteal abscess, Facial nerve palsy, hearing loss, labyrinthitis, meningitis, venous sinus thrombosis, Gradenigo syndrome (triad or periorbital pain with trigeminal nerve involvement, abducens nerve palsy (esotropia) and persistent otorrhea C) Pip-Taxo, Vanco (cover pseudomonas + MRSA)

Question 297

HPV A) List four disease the HPV vaccine prevent B) The HPV is currently recommended to be given in either two or three doses, depending on the population. Who is two doses sufficient for? (1 line)

Answer 297

A) Cervical cancer, penile cancer, oropharyngeal cancer, genital warts B) 2 doses for children aged 9-14 and 3 doses for >15 years