INFECTIOUS

Question 1

Mechanisms of fever production (3)

Answer 1

1. Pyrogens (endogenous /exogenous )
2. Heat production exceeding loss (salicylate poisoning or malignant hyperthermia)
3. Defective heat loss (ectodermal dysplasia / severe heat exposure)

Question 2

4 subtypes of fever of unknown origin

Answer 2

Classic FUO
Health-care associated
Immune-deficient
HIV related

Question 3

Define Classic FUO

Answer 3

1. Fever >38 C
2. > 3 weeks
3. > 2 visits or > 1 week in hospital

Question 4

Define Health-care associated FUO

Answer 4

1. Fever > 38 C
2. > 1 week
3. Not present or incubating on admission

Question 5

Children with this defect can have a history of delayed cord separation and recurrent infections of the skin, oral mucosa, and genital tract beginning early in life.

Answer 5

Leukocyte adhesion defects

• Caused by defects in the β chain of integrin (CD18), which is required for the normal process of neutrophil aggregation and attachment to endothelial surface.
• Neutrophil count in the peripheral blood is usually extremely elevated and pus is not found at the site of infection

Question 6

Children who have congenital asplenia or splenic dysfunction due to hemoglobinopathies such as sickle cell disease or have undergone splenectomy are at risk for serious infections from these pathogens (2)

Answer 6

1. encapsulated bacteria
2. blood-borne protozoa such as Plasmodium and Babesia

> consider prophylaxis with penicillin, esp in children under 5 yo
most common causative organisms include Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella, which can cause sepsis, pneumonia, meningitis, and osteomyelitis

Question 7

Terminal complement defects (C5, C6, C7, C8, and C9) are associated with recurrent infections with this pathogen

Answer 7

Neisseria

> Vaccines for S. pneumoniae, H. influenzae type b, and Neisseria meningitidis should be administered to all children with abnormalities in opsonization or complement pathways.

Question 8

Antibody deficiency that leads to a lack of production of secretory antibody at the mucosal membranes

Answer 8

Selective IgA deficiency

• recurrent sinopulmonary infection and GI disease are the major clinical manifestations

Question 9

X-linked recessive disease associated with eczema, thrombocytopenia, a reduced number of CD3 lymphocytes, moderately suppressed mitogen responses, and impaired antibody response to polysaccharide antigens

Answer 9

Wiskott-Aldrich syndrome

> infections with S. pneumoniae or H. influenzae type b and PCP are common
W- Weeping skin lesions- eczema
A- Absent platelets- thrombocytopenia - leading to petechiae
S- Severe immunodeficiency…… (low IgM and high IgA & IgE levels)

Question 10

Triad of Botulinum

Answer 10

1. acute onsset of SYMMETRIC flaccid, descendin paralysis w clear sensorium
2. NO FEVER
3. NO PARESTHESIA

Question 11

The only bacterium known to infect Schwann cells of peripheral nerves

Answer 11

Mycobacterium leprae
> Hansen disease
> Leonin facies

Question 12

Hutchinson Triad

Seen in?

Answer 12

1. Hutchinson teeth
2. 8th Cranial nerve deafness
   3.interstitial keratitis

Congenital syphilis

Question 13

WHO criteria for diagnosis of C. trachomatis (4)

Answer 13

WHO: at least 2 of 4 criteria must be present for a diagnosis of trachoma
1. lymphoid follicles on the upper tarsal coniunctivae
2. typical conjunctival scarring
3. vascular pannus,
4. limbal follicles

Question 14

Classic triad of EBV (esp in adols and adults)

Answer 14

FPG
1. fatigue
2. Pharyngitis
3. generalized lymphadenopathy - nontender, bilateral, ant post cervical and submandibular

> may have organomegaly> splenic rupture

Question 15

MC cause of eosinophilic meningitis worldwide

Answer 15

Angiostrongylus cantonensis

Question 16

MC form of HSV reactivation

Answer 16

Herpes labialis

Question 17

MC cause of viral intrauterine infection

Answer 17

CMV

Question 18

Classic CMV presentation

Answer 18

SGA/IUGR
Microcephaly
chorioretinitis
deaf - SNHL - MC sequelae in sx children
periVentricular calcifications
hepatomegaly/jaundice

Question 19

MC cause of viral meningitis in mumps-immunized population

Answer 19

Enterovirus

Question 20

Which is the most common congenital infection that causes congenital hearing loss

Answer 20

CMV

Question 21

Classic triad of Congenital toxoplasmosis:

Answer 21

CHI
chorioretinitis, hydrocephalus, and intracranial calcifications

Question 22

Dendritic keratitis is unique to _ infection

A. CMV
B. HSV
C. Rubella
D. Measles

Answer 22

B. HSV

Question 23

1st virus associated w malignancy

Answer 23

EBV
> nasopharyngeal carcinoma
> Burkitt’s lymphoma
> Hodgkin
> Duncan sundrome (X-linked lymphoproliferative disease)

Question 24

Minor variation in influenza virus A and B causing seasonal epidemics

Answer 24

DNS

Antigenic Drift
miNor
Seasonal epidemic

SJP
antigenic Shift
maJor
Pandemics

Question 25

Gold standard diagnosis of malaria. A. Microscopy B. Culture C. PCR D. Rapid diagnostic tests

Answer 25

A. microscopy

Question 26

MC cause of osteomyelitis and suppurative arthritis in children

Answer 26

Staph aureus

Question 27

Strawberry cervix, 2nd MC STI frothy vaginal discharge

Answer 27

Trichomonas vaginalis

Question 28

MC nosocomial bacteria

Answer 28

CONS - Staph epidermidis

Question 29

DOC for CONS

Answer 29

Vancomycin

Question 30

PANDAS (Pediatric autoimmune neuropsychiastric disorder associted with strep) associated with _

Answer 30

S pyogenes

Question 31

MC cause of STI

Answer 31

N gonorrhea

Question 32

_ and _ cells are the primary defenses against TB ab

Answer 32

macrophages and T-cell lypmhocytes

Question 33

MC clinically significant form of disseminated TB A. Primary B. Primary progressive C. Miliary D. Secondary

Answer 33

Miliary TB

Question 34

MC form of extrapulmonary TB

Answer 34

TB lymphadenitis

Question 35

Most severe form of EPTB

Answer 35

TB Meningitis

Question 36

Stages of TBM (3)

Answer 36

1st stage > personality changes > fever, irritability, anorexia, listlessness 2nd stage: > signs of increased ICP > drowsiness, stiff neck, CN abn 3rd stage: convulsions

Question 37

MC Brain CT or MRI features of TBM in children

Answer 37

hydrocephalus (80%) and basal meningeal enhancement (75%) - TBIC 2016

Question 38

_ are radiologic hallmarks in reactivation TB A. caseation necrosis B. Cavitation C. Ghon complex

Answer 38

Cavitation

Question 39

Major indications for IM immunoglobulin therapy A. Replacement therapy for children with antibody deficiency disorders B. Measles exposure C. Hepatitis A exposure D. AOTA

Answer 39

D. AOTA

Question 40

Major indications for IV immunoglobulin therapy A. Replacement therapy for primary immunodeficiency disorders B. Kawasaki disease C. Replacement therapy for serious bacterial infections in children infected w HIV D. Immune-mediated thrombocytopenia E. Prevention of serious bacterial infections with hypogammaglobulinemia F. AOTA

Answer 40

F. AOTA