Infectious Diseases

Question 1

Septicemia in the newborn period is most likely caused by which organism?

a) listeria monocytogenes
b) haemophilus influenzae
c) neisseria meningitidis
d) streptococcus pneumoniae

Answer 1

a) listeria monocytogenes

Question 2

Signs and symptoms of bacterial sepsis in children beyond the neonatal period include:

a) cough, fever, abdominal pain
b) vesicular rash, pruritus, fever
c) irritability, fever, lethargy
d) abdominal pain, diarrhea, vomiting

Answer 2

c) irritability, fever, lethargy

Question 3

Which of the following vaccines provides protection against a common type of sepsis/meningitis?

a) smallpox vaccination
b) hepatitis B vaccine
c) Haemophilus influenzae vaccine
d) Inactivated polio vaccine

Answer 3

c) Haemophilus influenzae vaccine

Question 4

Although relatively rare in the US, diphtheria can occur among under-immunized children. Which of the following clusters of signs, symptoms, and physical findings would suggest diphtheria in a child presenting with upper respiratory complaints?

a) Low-grade fever, sore throat, nasal discharge, and grayish-white pseudo-membrane in his/her throat
b) Abrupt onset of high fever, severe sore throat, nasal discharge, and grayish-white pseudo-membrane in the throat
c) Low-grade fever, abrupt onset of severe sore throat with difficulty swallowing and drooling
d) Abrupt onset of high fever, severe sore throat, with difficulty swallowing, and drooling

Answer 4

a) Low-grade fever, sore throat, nasal discharge, and grayish-white pseudo-membrane in his/her throat

Question 5

Infants younger than 6 months of age with pertussis frequently require hospitalization to manage:

a) fever, cough, dehydration
b) coughing paroxysms, apnea, cyanosis, feeding difficulties
c) coughing paroxysms, dehydration, renal failure
d) seizures, fever, pneumonia

Answer 5

b) coughing paroxysms, apnea, cyanosis, feeding difficulties

Question 6

One of the most appropriate agents used to treat influenza A is:

a) Acyclovir
b) Osteltamivir
c) Erythromycin
d) Tetracycline

Answer 6

b) Osteltamivir

Question 7

Which of the following symptoms are characteristic of rubella?

a) vesicular, crusted lesions and high fever
b) postauricular lymphadenopahthy and low grade fever
c) intense pruritus, usually in finger webs, buttocks, thighs, and ankles
d) rough textured maculopapular rash that blanches with pressure

Answer 7

b) postauricular lymphadenopahthy and low grade fever

Question 8

Although uncommon, a potential sequela of rubella may include:

a) pneumonia and chronic OM
b) arthritis, thrombocytopenia and encephalitis
c) oophoritis and inphertility
d) arthritis, carditis, and neurological involvement

Answer 8

b) arthritis, thrombocytopenia and encephalitis

Question 9

Rubeola is:

a) preventable by active immunization
b) caused by human herpesvirus 6
c) treated with intravenous acyclovir
d) not associated with severe complications (i.e. encephalitis, pneumonia)

Answer 9

a) preventable by active immunization

Question 10

You are examining a child who has fever, coryza, cough, conjunctivitis, malaise, and anorexia. During the oral examination you notice red eruptions with white centers on the buccal mucosa. What are these eruptions called?

a) pastia’s spots
b) rubeola spots
c) koplik’s spots
d) strawberry spots

Answer 10

c) koplik’s spots

Question 11

Which of the following best describes the treatment for roseola?

a) acetaminophen or ibuprofen for fever, parental reassurance
b) warm compresses for salivary gland swelling
c) oral acyclovir, 20mg/kg/dose, four times a day
d) bed rest, saline gargles for sore throat

Answer 11

a) acetaminophen or ibuprofen for fever, parental reassurance

Question 12

Fifth disease is usually:

a) seen in age 5-14 yo children
b) transmitted via the deer tick
c) treated with oral erythromycin
d) characterized by prolonged coughing episodes

Answer 12

a) seen in age 5-14 yo children

Question 13

Which of the following statements is not true regarding the transmission of chickenpox?

a) susceptible individuals can contract chickenpox from patients with varicella zoster (shingles)
b) children with chickenpox are infectious only during the period of time when skin lesions are present
c) children with chickenpox are no longer infectious once crusting of skin lesions has occurred
d) varicella-zoster immune globulin (VZIG) should be administered to susceptible immunocompromised individuals who are exposed to a patient with varicella zoster infection

Answer 13

b) children with chickenpox are infectious only during the period of time when skin lesions are present

Question 14

A child with chickenpox and a temperature of 102 should receive which medication for fever?

a) aspirin
b) amoxicillin
c) acetaminophen
d) acyclovir

Answer 14

c) acetaminophen

Question 15

The most appropriate agent for use in treating varicella zoster infection in an immunocompromised host is:

a) ganciclovir
b) acyclovir
c) ceftriaxone
d) chloramphenicol

Answer 15

b) acyclovir

Question 16

Varicella zoster infection is most commonly associated with which of the following skin lesions?

a) vesicle
b) comedone
c) nodule
d) macule

Answer 16

a) vesicle

Question 17

Which of the following is not a complication of mumps?

a) meningitis
b) pneumonia
c) oophoritis
d) pancreatitis

Answer 17

b) pneumonia

Question 18

What recommendation would you make to a parent whose son has been diagnosed with mumps and want to know when he can return to child-care?

a) he can return once he becomes afebrile and can tolerate eating
b) he can return 9 days after onset of symptoms
c) he can return when he is well enough to participate in activities
d) he can return after a minimum of 5 days of antibiotic therapy

Answer 18

b) he can return 9 days after onset of symptoms

Question 19

Which of the following are symptoms of cat scratch disease?

a) joint pain, conjunctivitis, mild neck stiffness
b) irritability, fever, hypotension
c) fever, malaise, lymphadenopathy
d) severe coughing, vomiting, anorexia

Answer 19

c) fever, malaise, lymphadenopathy

Question 20

The following describes a characteristic rash associated with which disease? Initially erythematous and macular, becoming maculo-papular and petechial. The rash first appears on the wrists and ankles, spreading proximally to the trunk. The palms and soles are often involved.

a) Lyme disease
b) Roseola
c) Rubeola (measles)
d) Rocky Mountain spotted fever

Answer 20

d) Rocky Mountain spotted fever

Question 21

A 10 yo child manifests symptoms of fever, sore throat, and swollen lymph nodes. Spleen tip is palpable. Throat culture and monospot test results are negative. The next logical diagnostic test would involve:

a) repeat throat culture
b) chest radiograph
c) bone marrow examination
d) epstein-barr virus titer

Answer 21

d) epstein-barr virus titer

Question 22

Which of the following factors is not associated with increased risk for infantile botulism?

a) rural environment
b) use of honey
c) use of corn syrup
d) farm families

Answer 22

c) use of corn syrup

Question 23

Which of the following interventions would not be appropriate for a 6 mo infant with a suspected diagnosis of infantile botulism?

a) stool and blood cultures
b) immediate administration of equine antitoxin
c) stool softeners
d) supportive care

Answer 23

b) immediate administration of equine antitoxin

Question 24

Which of the following are associated with paralytic poliomyelitis?

a) lacy, erythematous, pruritic rash
b) respiratory compromise, speech disturbances, urinary incontinence
c) abdominal swelling, lymphadenopathy, and jaundice
d) nonspecific abdominal pain, nausea, and vomiting

Answer 24

b) respiratory compromise, speech disturbances, urinary incontinence

Question 25

Muscle spasms associated with tetanus are aggravated by which of the following?

a) fever
b) tetanus immunoglobulin
c) external stimuli
d) NSAID

Answer 25

c) external stimuli

Question 26

Classic symptoms associated with malaria include:

a) low grade fever, upper respiratory congestion, cough
b) annular rash, conjunctivitis, headache, arthralgia
c) high fever, chills, rigors, sweats, headache
d) high fever, jaundice, lethargy, vomiting

Answer 26

c) high fever, chills, rigors, sweats, headache

Question 27

Lyme disease is most closely associated with which of the following skin lesions?

a) erythema migrans
b) nodule
c) scale
d) pustule

Answer 27

a) erythema migrans

Question 28

Many infectious diseases present with rashes along with general complaints of fever, malaise, and headaches. Which of the following clusters of symptoms would make you consider Lyme disease as a likely diagnosis?

a) fever, malaise, headache, arthralgia and well-circumscribed, erythematous, annular rash with central clearing
b) fever, malaise, headache, transient bone pain, and generalized erythematous, maculopapular rash that began on the face and spread to trunk and extremities
c) fever, malaise, anorexia, and confluent, erythematous, brownish maculopapular rash
d) fever, malaise, anorexia, and erythematous rash beginning on wrists and ankles then spreading to the trunk

Answer 28

a) fever, malaise, headache, arthralgia and well-circumscribed, erythematous, annular rash with central clearing

Question 29

Which of the following would be included in patient education regarding Lyme disease?

a) educate caretakers regarding complications, including hypertension and renal calculi due to immobility
b) avoid use of aspirin-containing products for fever control due to association with increased risk for Reye’s Syndrome
c) protective clothing and tick repellent should be worn in heavily wooded areas
d) educate caretakers regarding natural history of illness, and specific follow up needed after infection with Rickettsia rickettsii

Answer 29

c) protective clothing and tick repellent should be worn in heavily wooded areas

Question 30

A mother calls the clinic because chicken pox has been going around school and she has just noticed a few red spots along the hairline of her son’s face. She asks if there is anything that can be given to shorten the duration or severity of the illness. Which of the following is most accurate?

a) Diphenhydramine elixir has been shown to shorten the duration and severity of the rash
b) Acyclovir has been shown to shorten the duration and severity of the illness
c) Aspirin taken 4 times a day has been shown to shorten the duration and severity of the illness
d) There is no medication known to alter the course of the illness

Answer 30

b) Acyclovir has been shown to shorten the duration and severity of the illness

Acyclovir has been shown to slightly shorten the duration of fever and new lesion formation.

Question 31

A 14 yo adolescent has been diagnosed with mononucleosis. The PNP should teach the adolescent and the parents that which of the following should be avoided?

a) strenuous exercise if the spleen is palpable
b) weight bearing activities until the laboratory tests show resolution of the disease
c) unnecessary activity until lymph nodes return to normal size
d) stretching and reaching activities during the acute stage of illness

Answer 31

a) strenuous exercise if the spleen is palpable

To avoid splenic rupture, strenuous exercise and contact sports should be avoided as long as the spleen is palpable.

Question 32

A well-nourished 10 yo girl presents to the clinic with low-grade fever, sore throat, fatigue and malaise, and left upper abdominal pain. based on clinical presentation and laboratory results, a diagnosis of infectious mononucleosis is made. Which of the presenting signs and symptoms requires further investigation immediately?

a) low-grade fever
b) sore throat with lymphadenopathy
c) fatigue and malaise
d) left upper abdominal pain

Answer 32

d) left upper abdominal pain

Left upper abdominal pain should alert the practitioner to the possibility of splenic rupture.

Question 33

Initial treatment for a child with uncomplicated infectious mononucleosis should include:

a) home care with bed rest progressing to activity as tolerated
b) home care with complete bed rest until afebrile
c) hospitalization with compelte bed rest until lab values return to normal
d) hospitalization with daily, planned physical therapy

Answer 33

a) home care with bed rest progressing to activity as tolerated

Question 34

You are performing a PE on a 12 yo boy who is planning to go to summer camp in a primitive wooded area. What teaching is appropriate for the prevention of Rocky Mountain spotted fever?

a) inspect the body several times a day and remove ticks immediately
b) inspect the skin while taking a shower and apply soap to ticks before removing
c) ticks should be removed only after they have been killed with alcohol
d) tick removal should be performed by a healthcare professional

Answer 34

a) inspect the body several times a day and remove ticks immediately

Ticks must be attached for 4-6 hours or more before they can transmit Rocky Mountain spotted fever; frequent removal of ticks is valuable.

Question 35

The mother of an 8 yo phones to tell you that her son developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should tell this mother to:

a) apply topical calamine lotion
b) apply topical antibiotic to the new vesicles
c) give aspirin for fever and discomfort
d) keep him out of bright light

Answer 35

a) apply topical calamine lotion

Calamine may be applied liberally for relief of itching caused by vesicular lesions.

Question 36

The mother of an 8 yo phones to tell you that her son developed chicken pox 3 days ago. She wants to know if there is anything she can do to make him more comfortable. You should also tell this mother to:

a) avoid getting the lesions wet
b) encourage him to take a bath every day
c) have him take a bath only if he develops fever and sweats
d) encourage him to take only sponge baths until all lesions are healed

Answer 36

b) encourage him to take a bath every day

There are no restrictions on bathing and children with chicken pox should be encouraged to take daily baths to help prevent secondary bacterial infection (one of the most common complications of chicken pox).

Question 37

The mother of an 8 yo phones to tell you that her son developed chicken pox 10 days ago. He has had a severe headache since yesterday and is very irritable. Which of the following would be advised?

a) ask the mother if he has had a BM since he has been ill
b) tell his mother that these symptoms are common when chicken pox is resolving
c) ask his mother if there is a family history of severe headaches
d) ask his mother to bring him in to the office today for evaluation

Answer 37

d) ask his mother to bring him in to the office today for evaluation

Cerebellar complications or cerebral infections may occur as a complication associated with chicken pox. These complications may occur 4 days preceding the rash until 3 weeks after the appearance of the rash. Headache and irritability are signs that there may be an encephalopathy.

Question 38

A 16 yo boy has been diagnosed with measles (rubeola). He is also complaining of ear pain. His tympanic membranes are red and bulging. Appropriate management of the ear problem is to treat the ears with:

a) pain medication until the virus has run its course
b) the same medication used to treat any cause of OM
c) liquid topical antibiotics and topical steroids
d) acyclovir given by mouth

Answer 38

b) the same medication used to treat any cause of OM

OM is common with measles. It is treated the same as any other acute OM.

Question 39

The mother of a 7 yo has brought him to the clinic because he has a rash. PE reveals vesicles on the hands, feet, and in the mouth. Hand, foot, and mouth disease is diagnosed. Treatment is based on:

a) alleviating symptoms
b) eradication of causative bacteria
c) prevention of febrile convulsions
d) prevention of secondary infection

Answer 39

a) alleviating symptoms

The course of hand, foot, and mouth disease (thought to be caused by coxsackievirus) is usually benign and treatment is symptomatic. Fever is usually low grade and the throat is sore.

Question 40

The mother of a 6 yo brings her into the clinic because the family is planning a trip to a tropical area, and she wants to know how to avoid illness. Knowing that cases of malaria have been reported in the area, you should teach:

a) avoidance of contact with infected people
b) hand washing after touching contaminated fomites
c) avoidance of mosquito bites
d) cooking of all vegetables

Answer 40

c) avoidance of mosquito bites

Malaria is spread by mosquito bites.

Question 41

A 6 yo has been diagnosed with erythema infectiosum (fifth disease). His mother asks you how to prevent the spread of the disease to her other children. Your answer should be:

a) the disease is not thought to be contagious
b) the patient should eat and drink from disposable containers
c) other children should not be allowed to touch erythematous areas
d) the patient is no longer contagious by the time the rash appears

Answer 41

d) the patient is no longer contagious by the time the rash appears

Fifth disease is only contagious before the rash appears. The mode of transmission is thought to be respiratory secretions and blood.

Question 42

Considering the pathophysiology associated with fifth disease, a child with history of which of the following diseases must be monitored closely?

a) frequent respiratory infections
b) multiple skin allergies
c) malabsorption syndrome
d) hemolytic anemia

Answer 42

d) hemolytic anemia

The profound reticulocytopenia associated with fifth disease may result in a dangerous decrease of hemoglobin concentration in the child with hemolytic anemias (can cause aplastic crisis).

Question 43

The mother of a 4 do has brought her into the clinic because she has not seemed interested in her bottle since yesterday. PE reveals a lethargic infant with an axillary temp of 96 degrees F and a pulse rate of 100. Extremities are slightly cool. Appropriate management includes:

a) reassuring the mother that infants tend to regulate their own feeding habits
b) instructing the mother on proper nipple placement and feeding techniques
c) changing the infant to a soy-based formula and reevaluating in 24 hours
d) considering the possibility of sepsis with appropriate referral

Answer 43

d) considering the possibility of sepsis with appropriate referral

The neonate with sepsis often presents with hypothermia, lethargy, poor feeding, and bradycardia.

Question 44

The mother of a toddler with a typical roseola-type rash and a history of high fever asks if there is any treatment available for the condition. The PNP tells the mother that:

a) topical corticosteroids are helpful to relieve itching
b) oral diphenhydramine is helpful to decrease desquamation
c) aspirin should be used to treat the typical high fever
d) there is no medical treatment for roseola

Answer 44

d) there is no medical treatment for roseola

Febrile seizure is the most common complication of roseola, but the appearance of the diagnostic rash usually coincides with the abrupt termination of fever. There is no medical treatment indicated.

Question 45

A mother contracted rubella while pregnant with her now 1 mo son. Her son should be considered contagious for what time period?

a) between 5 & 7 days
b) until he is afebrile
c) at least the first year of life
d) he is not contagious

Answer 45

c) at least the first year of life

Infants with congenital rubella may excrete the virus from the nasopharynx and in the urine for a year.

Question 46

A 4 yo has been diagnosed with cat scratch disease. His mother asks what should be done about the cat. What should your response be?

a) the cat should be isolated until it can be treated with antibiotics
b) the cat should be isolated until it can be treated with anthelmintics
c) the cat should be evaluated by a medical lab and destroyed
d) there are no recommendations for treating or destroying the cat

Answer 46

d) there are no recommendations for treating or destroying the cat

The capacity for disease transmission by cats appears to be transient. There are no recommendations for treating or destroying the cat.

Question 47

Which of the following vaccines is contraindicated for routine use in a 3 yo child who is receiving vincristine for maintenance treatment of acute lymphocytic leukemia?

a) DPT
b) Injectable influenza
c) MMR
d) Hepatitis B

Answer 47

c) MMR

MMR contains live virus and should not be given to a child who is immunosuppressed.

Question 48

A 1 yo is infected with HIV but is asymptomatic at this time. When should her MMR immunization be given?

a) according to the usual schedule
b) after she has been asymptomatic for 1 year
c) only if she attends daycare
d) she should not receive the MMR vaccine

Answer 48

d) she should not receive the MMR vaccine

MMR contains live virus and should not be given to a child who is immunosuppressed. May receive if T cell value is within normal range.

Question 49

Premature infants should receive routine immunizations based on:

a) chronologic age
b) gestational age
c) birth weight
d) current weight

Answer 49

a) chronologic age

Premature infants may be at greater risk for vaccine-preventable disease and should be immunized according to chronologic age.

Question 50

Which of the following is recommended as the standard immunizing agent for healthy preschool children?

a) DTP
b) DTaP
c) DT
d) Td

Answer 50

b) DTaP

DTaP is the standard immunizing agent for children younger than 7 years of age. Pertussis immunization is not given routinely to children older than 7 because reaction to the immunization increases with age. DTP is an older formulation, and DT and Td both lack the important pertussis component but are used for adults and for children when pertussis is contraindicated.

Question 51

Diptheria symptoms:

Answer 51

1) sore throat
2) low grade fever
3) nasal discharge
4) bloody nose
5) hoarseness or cough
6) difficulty breathing (severe cases)
7) greyish-white pseudomembrane
8) severe complications can occur from toxins
a) severe neck swelling “bull neck”
b) myocarditis
c) Guillain-Barre
d) paralysis

Question 52

Diptheria managment:

Answer 52

1) C. diptheriae culture nose or throat
2) hospitalization (droplet precautions)
3) evaluation of sensitivity to horse toxin; if negative single dose of equine antitoxin
4) antibiotic treatment with erythromycin or penicillin G for 14 days.
5) report to health department
6) prophylaxis for all contacts for 7 days (erythromycin or penicillin G)

Question 53

Pertussis management:

Answer 53

1) nasopharyngeal culture is “gold standard”
2) erythromycin 50 mg/kg/day (max dose 2 g/day) divided four times a day for 14 days
3)

Question 54

Rubella (German measles) symptoms:

Answer 54

1) postauricular, suboccipital, and posterior cervical lymphadenopathy
2) erythematous, maculopapular discreet rash that starts on forehead and face and spreads over extremities and trunk during the 1st day; facial exanthem fades by 2nd day and disappears by 3rd day
3) petechiae on soft palate and uvula (Forchheimer’s sign)
4) may return to school 5 days after onset of rash

Question 55

Rubeola (red measles) symptoms:

Answer 55

1) acute onset of fever, runny nose, hacking cough, conjunctivitis, malaise
2) Koplik spots on buccal mucosa
3) confluent, erythematous, maculopapular rash 3-4 days after initial symptoms; rash begins at the hairline and behind the ears, and moves down the body; after 3-4 days the rash assumes a brownish appearance
4) no longer contagious 4 days after onset of rash
5) OM is the most common complication

Question 56

Roseola (human herpesvirus 6) symptoms:

Answer 56

1) abrupt onset of high fever (102-105) lasting 3-5 days (potential for febrile seizures)
2) generalized erythematous, maculopapular rash appears as fever is resolving. Rash starts on trunk and spreads to arms and neck with less involvement on face and legs
3) most common in children 6-24 months old
4) lifetime immunity following attack

Question 57

Complication of mumps:

Answer 57

1) pancreatitis
2) oophoritis
3) meningitis
4) orchitis (can cause sterility)

Question 58

Management of cat scratch disease:

Answer 58

Self-limited disease lasting 2-4 months requiring supportive treatment

a) analgesics for discomfort and fever
b) warm compresses to enlarge lymph node
c) limit activity per comfort level
d) needle aspiration/drainage are not recommended

Question 59

Rocky Mountain Spotted Fever symptoms:

Answer 59

1) fever
2) myalgia
3) severe headache
4) photophobia
5) anorexia
6) nausea and vomiting
7) Erythematous/petechial macular rash that starts on wrists and ankles and spreads to trunk; palms and soles often involved

Question 60

Management of Rocky Mountain Spotted Fever:

Answer 60

Doxycycline should be initiated within 5 days of symptoms for best outcome (regardless of age) and treatment duration is usually 7-10 days (until afebrile for 3 days and showing clinical improvement).

Question 61

Management of Lyme disease:

Answer 61

Treatment should be prescribed based on presence of characteristic rash; seroconversion is blocked by antibiotic use.
8 yr or younger: Amoxicillin 50 mg/kg/day split into 2 doses for 14-21 days
> 8 yr: doxycycline 100mg twice a day for 14-21 days

Question 62

Lyme disease stages:

Answer 62

1) Early localized: well-circumscribed erythematous annular rash with central clearing (erythema migrans) at site of tick bite. Fever, malaise, headache, conjunctivitis and mild neck stiffness may also be present.
2) Early disseminated: Multiple erythema migrans occurring several weeks after known or unknown tick bite. Accompanied by arthralgia, myalgia, headache, and fatigue; rarely carditis.
3) Late disease: Migratory joint/muscle/bone pain, transient and severe headache with stiff neck, poor memory, mood changes, somnolence, facial palsies…

Question 63

Infant botulism symptoms:

Answer 63

1) constipation most common presenting symptom
2) poor or slow feeding
3) weak cry
4) truncal weakness
5) loss of head and neck control
6) loss of facial expression
7) floppiness

Question 64

Infant botulism management:

Answer 64

1) stool specimen for toxin assay gold standard
2) stool culture for infant botulism
3) blood culture
4) human derived antitoxin (botulism immune globulin or babyBIG) is treatment of choice
5) stool softener

Question 65

Tetanus management:

Answer 65

1) cleanse and debride wounds
2) treat muscle spasms, IV fluids, respiratory support
3) minimize external stimuli to prevent muscle spasms
4) human tetanus immune globulin (TIG) to prevent toxin from binding to CNS sites