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Flashcards in ID Deck (32):
1

Cellulitis occurring about the face in young children (6-24 months) and associated with fever and purple skin discoloration is MOST often caused by ?

A. Group A beta hemolytic streptococci

B. Haemophilus influenzae type B

C. Streptococcus pneumoniae

D. Staphylococcus aureus

E. Pseudomonas

Answer: A or C

answer  :  c  by  pediatric  doctor (hib can lead to a violaceous or blue-purple color but it is not diagnostic).

 Note: the most common organism can cause cellulitis at 6-24-month old is streptococcus 

 

2

Breastfeeding mother with HCV treated by interferon for more than one year, what is the risk of breastfeeding on the infant? A. Cracked Nipple B. Mother with anemia C. Infant complain of oral candidiasis D. Not follow up of infant immunization

Answer: A CDC – Hepatitis C: having HCV-infection is not a contraindication to breastfeed. HCV is transmitted by infected blood, not by human breast milk. although HCV-positive mothers should consider abstaining from breastfeeding if their nipples are cracked or bleeding. Uptodate: There is no evidence that breastfeeding is a risk for infection among infants born to HCV infected women Antiviral treatment of pregnant women is not recommended. Ribavirin teratogenic in animal models. Interferon increase spontaneous abortion in animal models Is it safe for the HCV-positive mother to breastfeed if her nipples are cracked and bleeding? Data are insufficient to say yes or no. Therefore, if the HCV-positive mother's nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. Instead, she should consider expressing and discarding her breast milk until her nipples are healed. Once her breasts are no longer cracked or bleeding, the HCV-positive mother may fully resume breastfeeding. CDC .. HBV : HBV transmission through breastfeeding was not reported. All infants born to HBV-infected mothers should receive hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth. The second dose of vaccine should be given at aged 1–2 months, and the third dose at aged 6 months. The infant should be tested after completion of the vaccine series, at aged 9–18 months. However, there is no need to delay breastfeeding until the infant is fully immunized. All mothers who breastfeed should take good care of their nipples to avoid cracking and bleeding.

3

2 years old presented with fever for one month with the pic, lab shows Pancytopenia, what is the cause? A. Leishmania B. Leukemia C. Malaria D. Brucellosis

Answer: B Brucellosis, malaria and leishmanial also cause pancytopenia, but it seems the pic shows sign of leukemia.

4

10 days neonate present with lethargy , irritability , fever , signs of meningitis which organism is causative :

A. Listerea monocytogens

B. Streps pneumonia

C. Staph aureus

D. N-menningitidis

Answer: A

5

Bacterial meningitis in 14 month child I think , Gram positive cocci, what is the management?

A-amoxicillin

B-amoxicillin and gentamicin

C-ceftriaxone and vancomycin

D-vancomycin

Answer : C-ceftriaxone and vancomycin

6

child  with  rheumatic  heart  disease  allergic  to  penicillin.  What  prophylaxis  should  be  given  before  a  procedure?

A.    Iv amoxicillin

B.     Iv  vancomycin  +  iv  gentamicin

C.    Oral  vancomycin  +  gentamicin  

D.   Oral amoxicillin

 

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Answer:  b  (depends  on  the  type  of  procedure  and  the  ability  to  tolerate  oral  medications)

Most  probable,  the  answer  is  b.  Since  amoxicillin  is  type  of  penicillin  and  gentamicin  generally  not  given  po.

Medscape : Patients  with  rheumatic  heart  disease  and  valve  damage  require  a  single  dose  of  antibiotics  1  hour  before  surgical  and  dental procedures  to  help  prevent  bacterial  endocarditis.  Patients  who  had  rheumatic  fever  without  valve  damage  do  not  need endocarditis  prophylaxis.  

Do  not  use  penicillin,  ampicillin,  or  amoxicillin  for  endocarditis  prophylaxis  in  patients  already  receiving penicillin  for  secondary  rheumatic  fever  prophylaxis  (relative  resistance  of  po  streptococci  to  penicillin  and  aminopenicillins).

Alternate  drugs  recommended  by  the  american  heart  association  for  these  patients  include  po  clindamycin  (20  mg/kg  in children,  600  mg  in  adults)  and  po  azithromycin  or  clarithromycin  (15  mg/kg  in  children,  500  mg  in  adults).   

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7

boy came to your  clinic  with  yellow  discoloration  of  the  eyes  noticed  3  days  back  and  hepatomegaly.  His  liver  enzymes are  increased.  What  is  the  diagnosis?

A.  Hepatitis  a

B.  Hepatitis  b

C.  Hepatitis  c

D. Hepatitis d

Answer:  a

  Hepatitis A , the only type of hepatitis that reveal tender hepatomegaly

8

What  is  the  triple  antitoxoid?

A.  Tetanus,  diphtheria,  whooping  cough 

B.  Tetanus,  diphtheria,  tb

C.  Diphtheria,  pertussis,  colorectal  ca

D. Diphtheria, tetanus, rabies. 

Answer:  a         

9

5 years  old  girl  with  uncomplicated  cystitis.  What  is  the  management?

A.  Oral amoxicillin

B.  Iv cephalosporin

C.  Im ceftriaxone

D. Sodium … 

Answer:  a

Patients with a nontoxic appearance may be treated with oral fluids and antibiotics.
Hospitalization is necessary for the following patients with UTI:
* Patients who are toxemic or septic
* Patients with signs of urinary obstruction or significant underlying disease
* Patients who are unable to tolerate adequate oral fluids or medications
* Infants younger than 2 months with febrile UTI (presumed pyelonephritis)
* All infants younger than 1 month with suspected UTI, even if not febrile


Treat febrile UTI as pyelonephritis, and consider parenteral antibiotics and hospital admission for these patients.
Antibiotics for parenteral treatment are as follows:
* Ceftriaxone
* Cefotaxime
* Ampicillin
* Gentamicin
Patients aged 2 months to 2 years with a first febrile UTI
If clinical findings indicate that immediate antibiotic therapy is indicated, a urine specimen for urinalysis and culture should be obtained before treatment is started. Common choices for empiric oral treatment are as follows:
* A second- or third-generation cephalosporin
* Amoxicillin/clavulanate, or sulfamethoxazole-trimethoprim (SMZ-TMP)

Children with cystitis
* Antibiotic therapy is started on the basis of clinical history and urinalysis results before the diagnosis is documented
* A 4-day course of an oral antibiotic agent is recommended for the treatment of cystitis
* Nitrofurantoin can be given for 7 days or for 3 days after obtaining sterile urine
* If the clinical response is not satisfactory after 2-3 days, alter therapy on the basis of antibiotic susceptibility
* Symptomatic relief for dysuria consists of increasing fluid intake (to enhance urine dilution and output), acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs)
* If voiding symptoms are severe and persistent, add phenazopyridine hydrochloride (Pyridium) for a maximum of 48 hours

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For  an older  child  who  does  not  appear  ill  but  has  a  positive  urine  culture,  oral  antibiotic  therapy  should  be  initiated.

 For  a  child  with suspected  uti  who  appears  toxic,  appears  dehydrated,  or  is  unable  to  retain  oral  fluids,  initial  antibiotic  therapy  should  be administered  parenterally,  and  hospitalization  should  be  considered.  

Neonates  with  uti  are  treated  for  10  to  14  days  with parenteral  antibiotics  because  of  the  higher  rate  of  bacteremia.

Older  children  with  uti  are  treated  for  7  to  14  days.  

Initial treatment  with  parenteral  antibiotics  is  determined  by  clinical  status.  Parenteral  antibiotics  should  be  continued  until  there  is clinical  improvement  (typically  24  to  48  hours).                

10

11-year-old  (typical  bacterial  meningitis  case)  which  ab×  will  be  given:

A.  Ceftriaxone  and  gentamycin

B.  Ampicillin  and  gentamycin 

C.  Penicillin  and  gentamycin

D.  Vancomycin

Answer:   3rd-generation  cephalosporins  (ceftriaxone  or  cefotaxime)  for  s.  Pneumoniae  and  n.  Meningitides  and  vancomycin  for  penicillin resistant strains of s. Pneumoniae and for s. Aureus 

11

2year  old  child  got  otitis  media  after  urti.  Treatment:

A.  Observe.

B.  High dose ibuprofen.

C.  Amoxicillin  45  mg/kg/day  for  5  days.

D.  Amoxicillin  90  mg/  kg/  day  for  10  days.

Answer: d ?

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12

  13  years  old  with  enteric  fever.  Allergic  or  resistant  to  chloramphenicol  (i  forgot).  Treatment  is:

A.  Double chloramphenicol.

B.  Add ciprofloxacin.

C.  Ciprofloxacin  alone  (orally)

D.  Im ceftriaxone  

Answer:  d

Antibiotic  resistance  is  common  and  increasing,  particularly  in  endemic  areas,  so  susceptibility  testing  should  guide  drug selection.  In  general,  preferred  antibiotics  include  ceftriaxone  1  g  im  or  iv  q  12  h  (25  to  37.5  mg/kg  in  children)  for  14  days 

13

Blood  film  for  girls  came  abdominal  pain  cough  splenomegaly  dx;

A.  P.malaria

B.  P.falcifom

C.  P. Oval

D.  Mp. Something  

 

Answer: Depends  on  blood  film 

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14

Treatment  of  EBV  (in  scenario  there  patient  with  tonsillar  exudates,  lymphadenopathy,  splenomegaly)

A.  Oral acyclovir

B.  Oral antibiotic

C.  Iv acyclovir

D.  Supportive  ttt  

Answer : D

15

  Oropharyngeal  maculopapular  rash  ..  Also  rash  in  palm  and  foot  ..?

T  A.  Cmv

B.  Ebv

C.  Coxsackievirus

  D.  Vaccina  virus  

 

Answer: C

Hand, foot and mouth disease (HFMD) is a viral illness which commonly causes lesions involving the mouth, hands and feet. However, it may also affect other areas such as the buttocks and genitalia. The most common causes of HFMD are Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). It is normally a mild, self-limiting illness but occasionally has serious complications .

16

Child  with  septic  arthritis  came  to  er  with  kness  pain  ,  swelling  .  Management:  

A.  Oral antibiotic  for  14  days  

B.  Broad spectrum  iv antibiotic  

C.  Surgical  drainage  and  iv  antibiotic  

D.  Antipyretic  till  the  result  of  aspiration  culture  

 

Answer:  c   

According  to  illustrated  textbook  of  pediatrics:  a  prolonged  course  of  antibiotics  is  required,  initially  intravenously.  Washing  out of  the  joint  or  surgical  drainage  may  be  required  if  resolution  does  not  occur  rapidly  or  if  the  joint  is  deep-seated,  such  as  the hip. However joint aspiration is indicated prior to starting antibiotics and repeated until joint aspirate is clear. 

17

Baby  with  recurrent  infection  tb,  aspergillosis  all  type  of  infection  with  history  o  brothers  death  at  3  year  with  same  pr give?  Repeated

A.  Influenza  

B.  Bcg  

C.  Varicella  

D.  Polio 

Answer: im influenza 

18

child  with  hepatosplenomegaly,  current  infection.  Brother  died  at  3  years  with  septic  shock.  How  to  give  vaccination?  

A.  Give all.

B.  Don’t  give  until  3  years.

C.  Don’t  give  live  vaccines.

D.  Don’t  give  killed  vaccines.

 

Answer: c 

19

Which vaccine is contraindicated in hiv patient ?

 A. Opv

B. Varicella  

C. Mmr  

D. Hbv 

Answer : A

HIV-infected individuals who are on ART with well-controlled HIV RNA levels and CD4 counts of >200 cells/µL (or ≥15%) may receive indicated live-virus vaccines such as (MMR) and varicella if lacking immunity ( but these vaccines should be avoided in patients with CD4 counts of <200 cells/µL. )

the varicella vaccine should be given at least 28 days after MMR

Live-virus vaccination should be avoided during and 3 months after intravenous immunoglobulin (IVIG) treatment, if possible, because passive antibodies in IVIG may impair response to live-virus vaccination with MMR or varicella for up to 3 months after IVIG infusion.

most patients who have acquired HIV infection are at risk of HBV infection and could benefit from effective HBV vaccination

HAV vaccination currently is recommended for HAV-susceptible, HIV-infected individuals who are MSM or have chronic liver disease,

use of LAIV generally has been avoided in HIV-infected patients because of concern about prolonged shedding caused by immunocompromise. In a study of asymptomatic, HIV-infected adults with CD4 counts of >200 cells/µL and HIV RNA levels of <10,000 copies/mL, LAIV appeared safe and did not result in prolonged shedding or increases in HIV RNA.However, LAIV may lead to a less-effective antibody response in adults,regardless of HIV status, and trivalent inactivated vaccine 

HIV-infected persons appear to achieve adequate antibody responses to HiB vaccination

BCG should not be given to those with severe immunocompromise owing to HIV, and it is not recommended routinely in the United States.

Administration of the HPV vaccine is not contraindicated in HIV infection in persons aged 9-26

The live, attenuated oral polio vaccine (OPV) is not recommended for persons with HIV infection outside resource-limited settings if the inactivated polio vaccine (IPV) is available.

 Diphtheria, pertussis, and tetanus: Clinicians should administer these vaccines in the same regimens as for HIV-uninfected patients.

20

What  is  the  effect  of  polio  (ipv&  opv)  on  body? 

A.  All  lead  to  the  formation  ag  in  the  anterior  horn 

B.  All  lead  to  the  formation  of  the  ab  in  the  serum  which  fight  the  virus 

C.  They all  enter  the  intestinal  mucosa  where  the  entry  of  the  virus  is 

  D.  They all  lead  to  the  formation  of  interferon  gamma 

 

Both b&c can be correct answer 

21

Young  ,  vesilce  ,pastule  on  back  like  a  band  :

A.  Shingles  

B.  Chicken  box

C.  Herpes

D.  Coxsackievirus

 

Answer:a

Http://emedicine.medscape.com/article/1132465-overview 

22

What  is  the  most  common site  for  mump?

 

Answer:  Parotid gland 

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23

child  was  on  clindamycin  developed  abdominal  pain  and  watery  diarrhea.

 

 Clostridium  difficile   

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24

Child came with Rt abdominal pain , jaundice, palpable tender liver, Dx ?  

Answer: Hepatitis A 

(HAV) spread via the fecal-oral route.

●The incubation period for HAV is 15 to 50 days. HAV RNA can be detected in stools at least one week before the onset of histological and biochemical evidence of hepatitis, and it can be detected for at least 33 days after the onset of disease. In neonates and younger children, HAV RNA can be detected in stools for several months.

●HAV infection in children is typically an acute, self-limited illness Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, and jaundice. Common examination findings are hepatomegaly and clinical jaundice with marked elevation of serum trans-aminases (usually >1000 units/L). IgM anti-hepatitis A virus serology is the test of choice for diagnosis.

●The diagnosis of acute HAV infection is made by the detection of anti-HAV IgM in a patient with the typical clinical presentation. Serum IgM anti-HAV is the gold standard for the detection of acute illness. This antibody is positive at the onset of symptoms, peaks during the acute or early convalescent phase of the disease, and remains positive for approximately four to six months

●Hepatitis A vaccine is part of the recommended childhood and adolescent immunization schedule in the United States. It is recommended for all children at one year of age (ie, 12 to 23 months), and also for specific high-risk groups, including international travelers and patients with chronic liver disease

●Post-exposure prophylaxis for individuals with recent exposure to HAV may be accomplished with the HAV vaccine or immune globulin.

●HAV infection in children is usually self-limited infection requiring no specific therapy. The usual supportive measures for fever and diarrhea may be undertaken. Patients rarely require hospitalization except for those who develop fulminant hepatic failure. Children with HAV-related hepatic failure are candidates for liver transplantation. 

25

Child  with  fever,  malaise,  LNs  enlargement  &  mouth  ulcers.  What  is  the  diagnosis? 

Herpes  simplex  virus  infection  type  1  (HSV  1)   

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26

child  presented  with  fever  and  coryza,  then  watery  diarrhea.  

A. Adenovirus

   B. Rotavirus

 

  Answer:  A 

27

Bilateral  parotid  swelling. 

Answer : ? 

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28

20  days  infant  diagnosis  as  meningitis,  his  culture  show  gram  negative  bacilli.  Which  of  following could  be  the  organism?

A.hemophiles influenza

B. E.coli  

C. neisseria  meningitides

 

Answer:  B.  E.coli

Note:  group  B  streptococci  (GBS)  are  the  most  commonly  identified  causes  of  bacterial  meningitis,  implicated  in  roughly 50% of all cases.

Escherichia  coli  accounts  for another 20%.  Thus, identification  and treatment of maternal genitourinary infections is an important prevention strategy.

Listeria monocytogenes is  the  third  most  common  pathogen,  accounting  for  5-10%  of  cases;  it  is  unique  in  that  it  exhibits  transplacental  transmission.

 N .  Meningitides  it  is  gram  negative  diplococcus  

 H .  Influenza  it  is  gram  negative  coccobacili  

 Reference : nelson p381 

29

Cat bite child .. he develop infection .. what is the causative organism ? 

Answer : posturella multicedia 

30

child  with  high  fever  2  wk  and  abdominal  distention  and  wt  loss

    

Answer: ??? 

31

Recived  antibiotics  and  went  home  .  Now  improving  but  The  culture  then  was  .......  اعتقد N.meningitdis What  you will  do  ?

A. rifambicin  for  7  days

B. one  dose  ceftriaxone  IM  .

C. Tell  family  to  come  to  hospital

 

Answer: B

Ceftriaxone  is  one  of  the  most  commonly  used  antibiotics  for  meningococcal  meningitis.  Penicillin  in  high  doses  is  almost  always  effective,  too.

If  the  patient  is  allergic  to  penicillin,  chloramphenicol  may  be  used.  Sometimes  corticosteroids  may  be used, ciprofloxacin especially in children.

People  in  close  contact  with  someone  who  has  meningococcal  meningitis    should  be  given  oral  rifampcin or ciprofloxacin is an alternative drug to prevent infection.

32

Newborn with meningitis , organism gram  + cocci?? 

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Group B streptococcus 

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