Infectious Viral Disease Flashcards
(92 cards)
1
Q
period of contagiousness of Rubeola
A
3 days before up to 4-6 days onset of rash
2
Q
Pathognomonic sign of measles
A
warthin finkeldey giant cells:exanthem
3
Q
Incubation period of measles
A
8-12 days high grade fever
4
Q
Clinical features of measles
A
cough, coryza and conjuctivitis with photophobia
5
Q
In measles this sign appers 1-4 days prior to the onset of rash that can be seen at the level of the premolars
A
Koplik spot
6
Q
Mannner of appearance of rash in measles
A
cephalocaudal which starts with forehead, behind the ear, upper neck and confluence in the torso
7
Q
Describe the rash of measles
A
maculopapular rash
8
Q
most common complication of measle
A
otitis media
9
Q
Vitamin recommendation for child with measles and the dose
A
VItamin A supplementation single dose
200,000 >1y/o
100,000 6mos-1y/o
50,000 <6mos
10
Q
what is the most common cause of death in patients with measles
A
Pneumonia
11
Q
A chronic complication of measles, a delayed onset with fatal outcome, which affects the CNS
A
Subacute sclerosing Panencephalitis
12
Q
What virus causes measles?
A
paramyxovirus
13
Q
What virus affects Rubella
A
togaviridae
14
Q
This is a 3 day virus that can usually transmitted transplacentally which causes fetal damage
A
Rubella
15
Q
Viral shredding of rubella
A
nasopharynx begins at 10 days after infection and detected upto 2 weeks following the onset of rash
16
Q
What it the period of highest communicability of rubella
A
5 days before to 6 days after the appearance of rash
17
Q
what is the incubation period of rubella
A
14-21 days
18
Q
patient with low grade fever, sorethroat , red eyes with or without pain, and lymphadenopathy
A
rubella
19
Q
Characteristic of rash(Rubella)
A
non distinctive, centrifugal, no desquamation that last for 3 days
20
Q
This is a petechial hemorrhage on the soft palate which coincide with the onset of rash
A
forchheimer spots
21
Q
What are the complications of rubella
A
thrombocytopenia, arthritis, encephalitis
22
Q
Babies born with congenital rubella can shred up to how many days/months
A
1 year via respiratory secretions
23
Q
what are the timing of vaccine (MMR) for rubella
A
2 doses
1st dose:12-15mos
2nd dose:4-6 years
24
Q
What is the etiology of VZV?
A
herpes virus
25
incubation period ov VZV
10-21 days
26
what is the manner of appearance of rash in VZV?
appears first on the scalp, face the trunk( centripetal)
27
What disease has clounding and umbilication which begins at 24-48 hr
Varicella zoster virus
28
10-year-old patient calls his parents from summer camp to state that he has had fever, muscular pain in the neck, headache, and malaise. He describes the area from the back of his mandible toward the mastoid space as being full and tender and that
his earlobe on the affected side appears to be sticking upward and outward. Drinking sour liquids causes much pain in the affected area. When his father calls your office, you remind him that he had refused immunizations for his child on religious grounds. Which of the following preventable diseases has this child acquired?
a. Mumps
b. Varicella
c. Rubella
d. Measles
mumps
29
A 2-month-old child of an HIV-positive mother is followed in your pediatric practice. Which of the following therapies should be considered
for this child?
a. Monthly evaluation for Kaposi sarcoma
b. Prophylaxis against Pneumocystis jiroveci pneumonia (Pneumocystis carinii)
c. Vitamin C supplementation
d. Oral polio virus vaccine
e. Bone marrow transplantation
Prophylaxis against Pneumocystis jiroveci pneumonia (Pneumocystis carinii)
30
A 10-month-old infant on long-term aspirin therapy for Kawasaki disease develops sudden onset of high fever, chills, diarrhea, and irritability.
A rapid swab in your office identifies influenza A, adding her to the long list of influenza patients you have seen this December. Over the next few
days, she slowly improves and becomes afebrile. However, 5 days after your last encounter you hear from the hospital that she has presented to
the emergency center obtunded and posturing with evidence of liver dysfunction. Which of the following statements about her current condition
is correct?
a. With proper supportive care, the overall mortality rate is low.
b. With her progressive liver dysfunction, increased total serum bilirubin is anticipated.
c. Administration of N-acetylcysteine is first-line therapy
d. Seizures are uncommon with this condition.
e. Death is usually associated with increased intracranial pressures and herniation.
e. Death is usually associated with increased intracranial pressures and herniation.
31
an acquired mitochondrial hepatopathy results from the interaction of an influenza (or varicella) infection and aspirin use
Reye syndrome
32
An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a
temperature of 40°C (104°F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both
blood and mucus in it. Which of the following is the most likely diagnosis in this patient?
a. Salmonella
b. Enterovirus
c. Rotavirus
d. Campylobacter
e. Shigella
e. Shigella
33
A 2-year-old child is admitted to your hospital team. The child’s primary care doctor has been following the child for several days and has
noted her to have had high fever, peeling skin, abdominal pain, and a bright red throat. You are concerned because two common pediatric
problems that could explain this child’s condition have overlapping presenting signs and symptoms. Which of the following statements comparing
these two diseases in your differential is true?
a. Neither has a cardiac complication.
b. Serologic tests are helpful in diagnosing both.
c. Only one of the diseases has mucocutaneous and lymph node involvement.
d. Pharyngeal culture aids in the diagnosis of one of the conditions.
e. A specific antibiotic therapy is recommended for one of the conditions, but only supportive care is recommended for the other
d. Pharyngeal culture aids in the diagnosis of one of the conditions.
Erythrogenic toxin-producing group A ß-hemolytic streptococci is the agent responsible for scarlet fever
and rise in antistreptolysin O titer
34
A 2-year-old child is admitted to your hospital team. The child’s primary care doctor has been following the child for several days and has
noted her to have had high fever, peeling skin, abdominal pain, and a bright red throat. You are concerned because two common pediatric
problems that could explain this child’s condition have overlapping presenting signs and symptoms. What is your possible differential diagnosis
kawasaki disease
| scarlet fever
35
What is the most serious complication of kawasaki disease?
Coronary Artery aneurysm
36
A patient with hair loss complaint with the lesion does not fluoresce with a Wood lamp and has not responded well to a variety of topical
agents. The lesion is boggy, is spreading, and has tiny pinpoint black dots throughout. Which of the following courses of action is most
appropriate for this child?
a. Instruct mom to keep all hair braids loose rather than tight against the scalp
b. Initiate griseofulvin therapy
c. Ultraviolet light therapy and intradermal steroid injection
d. Supplement diet with biotin
e.Obtain thyroid function studies
b. Initiate griseofulvin therapy
37
A patient with hair loss complaint with the lesion does not fluoresce with a Wood lamp and has not responded well to a variety of topical
agents. The lesion is boggy, is spreading, and has tiny pinpoint black dots throughout. What is the etiologic agent?
Trichophyton tonsurans
38
```
An 8-year-old sickle-cell patient arrives at the emergency room (ER) in respiratory distress. Over the previous several days, the child has
become progressively tired and pale. The child’s hemoglobin concentration in the ER is 3.1 mg/dL. Which of the following viruses is likely the
cause of this clinical picture?
a. Roseola
b. Parvovirus B19
c. Coxsackie A16
d. Echovirus 11
e. Cytomegalovirus
```
```
b. Parvovirus B19
Fifth disease (erythema infectiosum),
```
39
10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, severe muscle pain, pharyngitis,
headache, sclerai injection, photophobia, and cervical adenopathy. After 7 days of symptoms, he seemed to get better, but yesterday he
developed fever, nausea, emesis, headache, and mild nuchal rigidity. Cerebrospinal fluid (CSF) shows 200 white blood cells (WBCs) per microliter
(all monocytes) and an elevated protein. Correct statements about this infection include which of the following?
a. The condition is obtained from arthropod vectors.
b. Central nervous system (CNS) involvement is uncommon.
c. Most cases are mild or subclinical.
d. Appropriate treatment includes intravenous (IV) immune globulin (IVIG) and aspirin.
e. Hepatic and renal involvement occurs in the majority of cases.
c. Most cases are mild or subclinical.
40
10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, severe muscle pain, pharyngitis,
headache, sclerai injection, photophobia, and cervical adenopathy. After 7 days of symptoms, he seemed to get better, but yesterday he
developed fever, nausea, emesis, headache, and mild nuchal rigidity. Cerebrospinal fluid (CSF) shows 200 white blood cells (WBCs) per microliter
(all monocytes) and an elevated protein. What is the possible diagnosis?
Leptospirosis
41
A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and
headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which
of the following is the most appropriate next step in the diagnosis of this child’s condition?
a. Measurement of antistreptolysin antibodies
b. Serial measurement of platelet count and initiation of aspirin therapy
c. Rapid streptococcal test
d. Obtain an echocardiogram
e. Chest radiograph and placement of a purified protein derivative (PPD)
Initial is blood culture to identify organism
d. Obtain an echocardiogram
42
A 15-month-old boy is brought to the ER because of fever and a rash. Six hours earlier he was fine, except for tugging on his ears; another
physician diagnosed otitis media and prescribed amoxicillin. During the interim period, the child has developed an erythematous rash on his face,
trunk, and extremities. Some of the lesions, which are of variable size, do not blanch on pressure. The child is now very irritable, and he does not
interact well with the examiner. Temperature is 39.5°C (103.1°F). He continues to have injected, immobile tympanic membranes, but you are
concerned about his change in mental status. Which of the following is the most appropriate next step in the management of this infant?
a. Begin administration of IV ampicillin
b. Begin diphenhydramine
c. Discontinue administration of ampicillin and begin trimethoprim with sulfamethoxazole
d. Perform bilateral myringotomies
e. Perform a lumbar puncture
e. Perform a lumbar puncture
43
The 3-year-old sister of a newborn baby develops a cough diagnosed as pertussis by nasopharyngeal culture. The mother gives a history of
having been immunized as a child. Which of the following is a correct statement regarding this clinical situation?
a. The mother has no risk of acquiring the disease because she was immunized.
b. Hyperimmune globulin is effective in protecting the infant.
c. The risk to the infant depends on the immune status of the mother.
d. Erythromycin should be administered to the infant.
e. The 3-year-old sister should be immediately immunized with an additional dose of pertussis vaccine.
d. Erythromycin should be administered to the infant.
44
A 14-year-old boy is seen in the ER because of a 3-week history of fever between 38.3°C and 38.9°C (101°F and 102°F), lethargy, and a
2.7kg (6-lb) weight loss. Physical examination reveals marked cervical and inguinal adenopathy, enlarged tonsils with exudate, small hemorrhages
on the soft palate, a WBC differential that has 50% lymphocytes (10% atypical), and a palpable spleen 2 cm below the left costal margin. Which
of the following therapies should be initiated?
a. Initiation of zidovudine
b. IV acyclovir
c. IV infusion of immunoglobulins and high-dose aspirin
d. Intramuscular penicillin
e. Avoidance of contact sports
e. Avoidance of contact sports
| - heterophil antibodies can be detected when confirming a diagnosis
45
A 14-year-old boy is seen in the ER because of a 3-week history of fever between 38.3°C and 38.9°C (101°F and 102°F), lethargy, and a
2.7kg (6-lb) weight loss. Physical examination reveals marked cervical and inguinal adenopathy, enlarged tonsils with exudate, small hemorrhages
on the soft palate, a WBC differential that has 50% lymphocytes (10% atypical), and a palpable spleen 2 cm below the left costal margin. What is the possible diagnosis
infectious mononucleosis caused by EBV
due to the presence of triad findings
1. diffuse adenopathy, tonsillar enlargement, an enlarged spleen, small hemorrhages on the soft palate, and periorbital swelling
2.hematologic changes should reveal a predominance of lymphocytes with at least 10% of these cells being atypical.
3.antibody response should be present
46
A 2-year-old child is seen in the emergency center with a 10-day complaint of fever and a limp. The child has an erythrocyte sedimentation
rate (ESR) of 60 mm/h and the radiograph is shown below. Which of the following statements about this child’s condition is correct?
a. It is most commonly caused by Streptococcus pyogenes.
b. It can arise following development of deep cellulitis.
c. It usually results in tenderness in the region of infection that is diffuse, not localized.
d. It causes diagnostic radiographic changes on plain films within 48 hours of the beginning of symptoms.
e. It requires antibiotic therapy usually for 10 to 14 days.
b. It can arise following development of deep cellulitis.
Dx: acute osteomyelitis ; begin abruptly, with fever and marked, localized bone tenderness that usually occurs at the metaphysis
Antibiotic Treatment is usually continued for at least 3 weeks.
47
how many days does a diagnostic bone changes in acute osteomyelitis be visible in a plain radiograph
12 days after the onset of the disease
48
A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanel. Spinal fluid demonstrates Gram-positive rods. Which
of the following is the most likely diagnosis?
a. Listeria monocytogenes
b. Group A streptococci
c. Group B streptococci
d. Streptococcus pneumoniae
e. Staphylococcus aureus
a. Listeria monocytogenes
Early onset listeriosis usually presents in the first day and always by day 3; fetal distress is common
49
Causes of neonatal meningitis
GBS; late onset
e. coli
listeria monocytogenes
50
Late onset of GBS in patient with meningitis is cause by
environmental exposure
51
early onset of GBS in patient with meningitis is cause by
prolonged rupture of membrane and chorioamnionitis
52
what is the clinical manifestations of meningitis in neonates
lethargy
bulging fontanel
seizures
nuchal rigidity
53
A 16-year-old boy presents to the emergency center with a 2-day history of an abscess with spreading cellulitis. While in the emergency
center, he develops a high fever, hypotension, and vomiting with diarrhea. On examination, you note the erythematous rash demonstrated in
the picture along with injected conjunctiva and oral mucosa, and a strawberry tongue. He is not as alert as when he first arrived. This rapidly
progressive symptom constellation is likely caused by which of the following disease processes?
a. Kawasaki disease
b. TSST-1-secreting S aureus
c. Shiga toxin-secreting Escherichia coli
d. α-Toxin-secreting Clostridium perfringens
e. Neurotoxin-secreting Clostridium tetani
b. TSST-1-secreting S aureus
“nonmenstrual” TSS associated with pneumonia, skin infection (as in this patient), bacteremia, or osteomyelitis.
54
What is the etiologic agent of Toxic shock syndrome
S. aureus
55
A 14-month-old infant suddenly develops a fever of 40.2°C (104.4°F). Physical examination shows an alert, active infant who drinks milk
eagerly. No physical abnormalities are noted. The WBC count is 22,000/μL with 78% polymorphonuclear leukocytes, 18% of which are band
forms. Which of the following is the most likely diagnosis?
a. Pneumococcal bacteremia
b. Roseola
c. Streptococcosis
d. Typhoid fever
e. Diphtheria
a. Pneumococcal bacteremia
infant who appears otherwise normal, the sudden onset of high fever, together with a marked elevation and shift to the left of the WBC count
56
A 21-year-old woman has just delivered a term infant. She has had only one visit to her obstetrician, and that was at about 6 weeks of
pregnancy. She provides her laboratory results from that visit. The delivered infant is microce-phalic, and has cataracts, a heart murmur, and
hepatosplenomegaly. Your further evaluation of the child demonstrates thrombocytopenia, mild hemolytic anemia, and, on the echocardiogram,
patent ductus arteriosus and peripheral pulmonary artery stenosis. Which of the following maternal laboratory tests done at 6 weeks of gestation
is likely to explain the findings in this child?
a. Positive hepatitis B surface antibody
b. Positive rapid plasma reagin (RPR) with negative Microhemagglutination Treponema pallidum test (MHATP)
c. Negative rubella titer
d. Negative triple screen
e. Positive varicella titer
c. Negative rubella titer
57
What is the most common cardiac defect caused by rubella
PDA
58
The parents of a 7-day-old infant bring her to your office for a swollen eye. Her temperature has been normal, but for the last 2 days she
has had progressive erythema and swelling over the medial aspect of the right lower lid near the punctum. Her sclera and conjunctiva are clear.
Gentle pressure extrudes a whitish material from the punctum. Which of the following ophthalmic conditions is the correct diagnosis?
a. Chalazion
b. Dacryocystitis
c. Preseptal cellulitis
d. Hyphema
e. Congenital Sjögren syndrome
b. Dacryocystitis- an inflammation in the nasolacrimal sac
59
The parents of a 3-year-old patient followed in your clinic recently took their child on a quickly planned 5-day trip to Africa to visit an ill
grandparent. Everyone did well on the trip, but since returning about 10 days ago the boy has been having intermittent, spiking fevers associated
with headache, sweating, and nausea. The parents had not been too concerned since he was relatively well, except for being tired, between
the fevers. Today, however, they feel that he looks a bit pale and his eyes appear “yellow.” Which of the following is likely to reveal the source of
his problem?
a. Hepatitis A IgG and IgM titers
b. Complete blood count (CBC) with smear
c. Hemoglobin electrophoresis
d. Tuberculosis skin test
e. Hepatitis B IgG and IgM titers
b. Complete blood count (CBC) with smear
60
The parents of a 3-year-old patient followed in your clinic recently took their child on a quickly planned 5-day trip to Africa to visit an ill
grandparent. Everyone did well on the trip, but since returning about 10 days ago the boy has been having intermittent, spiking fevers associated
with headache, sweating, and nausea. The parents had not been too concerned since he was relatively well, except for being tired, between
the fevers. Today, however, they feel that he looks a bit pale and his eyes appear “yellow.” what is the possible diagnosis?
Malaria
61
The child shown below presents with a 3-day history of malaise, fever of 41.1°C (106°F), cough, coryza, and conjunctivitis. He then
develops the erythematous, maculopapular rash pictured. He is noted to have white pinpoint lesions on a bright red buccal mucosa in the area
opposite his lower molars. Which of the following is the most likely diagnosis?
a. Parvovirus
b. Rubella
c. Herpes
d. Rubeola
e. Varicella
d. Rubeola
| high fever that reaches its peak at the height of the generalized macular rash
62
A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash as shown in the photograph. During
the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and
marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the
following is the most likely diagnosis?
a. Rubella
b. Rubeola
c. Roseola
d. Erythema infectiosum
e. Erythema multiforme
a. Rubella
63
A 4-year-old child presents in the clinic with an illness notable for swelling in front of and in back of the ear on the affected side, as well as
altered taste sensation. Correct statements about this condition include which of the following?
a. Arthritis is a common presenting complaint in children.
b. The disease could have been prevented by prior immunization with killed whole-cell vaccine.
c. Involvement of the CNS may occur 10 days after the resolution of the swelling.
d. Orchitis can occur and is almost exclusively seen in prepubertal males.
e. Subendocardial fibroelastosis is a common complication in a child of this age.
c. Involvement of the CNS may occur 10 days after the resolution of the swelling.
64
A bat is found in the bedroom of a 4-year-old patient while the boy is sleeping. The family and the patient deny close contact with or bites
from the bat. Which of the following is a correct statement regarding this situation?
a. Therapy is only required if the patient shows signs of rabies infection.
b. Bats are not a natural reservoir for rabies virus; no therapy is required.
c. The patient should be started on the rabies vaccine series.
d. The patient needs immediate treatment with acyclovir.
e. The patient needs immediate treatment with ribavirin.
The patient should be started on the rabies vaccine series.
65
An 8-year-old Cub Scout who returned from an outing 9 days ago is brought to the clinic with the rapid onset of fever, headache, muscle
pain, and rash. The maculopapular rash began on the flexor surfaces of the wrist and has become petechial as it spread inward to his trunk.
Which of the following is the most appropriate treatment for his likely condition?
a. Oral amoxicillin
b. Intravenous streptomycin
c. Infusion of IgG and supportive care
d. Intravenous vancomycin
e. Oral or intravenous doxycycline
e. Oral or intravenous doxycycline
66
An 8-year-old Cub Scout who returned from an outing 9 days ago is brought to the clinic with the rapid onset of fever, headache, muscle
pain, and rash. The maculopapular rash began on the flexor surfaces of the wrist and has become petechial as it spread inward to his trunk. what is the diagnosis?
rocky mountain spotted fever
67
Incubation period of rocky mountain spotted fever
1-14 days
68
describe the rash of RMSF
maculopapular rash starts on
| the 2nd to 4th day of illness on the flexor surfaces of the wrists and ankles before moving in a central direction
69
What is the appropriate treatment for RMSF?
Doxycycline
70
The parents of a 7-month-old boy arrive in your office with the child and a stack of medical records for a second opinion. The boy first
started having problems after his circumcision in the nursery when he had prolonged bleeding. Studies were sent at the time for hemophilia, but
factor VIII and IX activity were normal. At 2 months, he developed bloody diarrhea, which his doctor assumed was a milk protein allergy and
changed him to soy; his parents note he still has occasional bloody diarrhea. He has seen a dermatologist several times for eczema, and he has
been admitted to the hospital twice for pneumococcal bacteremia. During both admissions, the parents were told that the infant’s platelet count
was low, but they have yet to attend the hematology appointment arranged for them. The child’s WBC count and differential were normal.
Which of the following is the most likely diagnosis in this child?
a. Idiopathic thrombocytopenic purpura (ITP)
b. Wiskott-Aldrich syndrome
c. Acute lymphocytic leukemia (ALL)
d. Adenosine deaminase deficiency
e. Partial thymic hypoplasia
b. Wiskott-Aldrich syndrome
X-linked recessive combined immunodeficiency characterized by thrombocytopenia, eczema, and
increased susceptibility to infection.
71
A 10-year-old boy from the Connecticut coast is seen because of discomfort in his right knee. He had a large, annular, erythematous lesion
on his back about 1 month ago. His mother recalls that the rash, which is almost gone, appeared about 1 week after she pulled a small tick off his
back. Which of the following is the most appropriate next step in his management?
a. Aspiration of the affected knee
b. Measurement of specific IgM antibodies
c. Administration of a course of oral doxycycline
d. Electrocardiogram (EKG)
e. Biopsy of the remaining rash
c. Administration of a course of oral doxycycline
if <8 years old amoxicillin
72
A 10-year-old boy from the Connecticut coast is seen because of discomfort in his right knee. He had a large, annular, erythematous lesion
on his back about 1 month ago. His mother recalls that the rash, which is almost gone, appeared about 1 week after she pulled a small tick off his
back.What is the most likely diagnosis and the cause of the disease?
Lyme Disease, due to Borrelia Burgdorferi
73
Two weeks ago, a 5-year-old boy developed diarrhea, which has persisted to the present time despite dietary management. His stools have
been watery, pale, and frothy. He has been afebrile. Microscopic examination of his stools is likely to show which of the following?
a. Salmonella sonnei
b. Enterobius vermicularis
c. Sporothrix schenckii
d. Toxoplasma gondii
e. Cryptosporidium
e. Cryptosporidium
74
The rash and mucous membrane lesions shown in the photograph below develop in an infant 5 days into the course of an upper respiratory
infection (URI) with otitis media; the child is being treated with amoxicilin. The child’s condition is likely which of the following?
a. Urticaria
b. Rubeola
c. Stevens-Johnson syndrome
d. Kawasaki disease
e. Scarlet fever
c. Stevens-Johnson syndrome
combination of erythema multiforme and vesicular, ulcerated lesions of the mucous membranes of the eyes, mouth, anus, and urethra defines the
Stevens-Johnson syndrome (erythema multiforme major).
75
An 8-year-old immigrant from rural Central America presents with complaints of weakness, facial swelling, muscle pain, and fever. A CBC
shows his white blood count to be 8,500/mm3 with 30% eosinophils. A course of which of the following treatments is appropriate for this child’s
likely condition?
a. Supportive care alone or a course of nitazoxanide if symptoms persist
b. Saturated solution of potassium iodine (SSKI) or itraconazole
c. Metronidazole
d. Ketoconazole
e. Mebendazole or albendazole
e. Mebendazole or albendazole
76
A relatively well-appearing 6-month-old child presents with distinctive paroxysms of symptoms including machine-gun-like bursts of coughing,
eyes bulging and watering, and purple face followed by post-tussive emesis. The family reports the child had 2 weeks ago congestion, rhinorrhea,
low-grade fever, sneezing, and lacrimation, but otherwise seemed fine and had been recovering from these symptoms for a few days. They
report all in the family are well except their 15-year-old daughter who has had a cough for 3 weeks. For which of the following vaccines is the 15
year old most likely delinquent explaining the younger sibling’s symptoms?
a. Meningococcalbacteria (MCV)
b. Human papilloma virus (HPV)
c. Measles, mumps, rubella (MMR)
d. Pneumococcal 13 (PCV 13)
e. Reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed (Tdap)
e. Reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed (Tdap)
77
A 2-month-old infant comes to the emergency center with fever for 2 days, emesis, a petechial rash, and increasing lethargy. In the
ambulance, he had a 3-minute generalized tonic/clonic seizure that was aborted with lorazepam. He does not respond when blood is drawn or
when an IV is placed, but he continues to ooze blood from the skin puncture sites. On examination, his anterior fontanel is open and bulging. His
CBC shows a WBC of 30,000 cells/μ,L with 20% band forms. Which of the infant’s problems listed below is a contraindication to lumbar puncture?
a. Uncorrected bleeding diathesis
b. Bulging fontanel
c. Dehydration
d. History of recent seizure
a. Uncorrected bleeding diathesis
78
The mother of one of your regular patients calls your office. She reports that her daughter has a 3-day history of subjective fever,
hoarseness, and a “bad” barking cough. You arrange for her to be seen in your office that morning. Upon seeing this child, you would expect to
find which of the following?
a. A temperature greater than 38.9°C (102°F)
b. Expiratory stridor
c. Infection with parainfluenza virus
d. Hyperinflation on chest x-ray
e. A child between 6 and 8 years of age
c. Infection with parainfluenza virus
79
The mother of one of your regular patients calls your office. She reports that her daughter has a 3-day history of subjective fever,
hoarseness, and a “bad” barking cough. You arrange for her to be seen in your office that morning. What is the most likely diagnosis?
Croup
80
Age range of patient with croup?
age range for presentation is 6 months to 6 years
81
Symptoms of Croup
low-grade fever, barking cough, and hoarse, inspiratory stridor without
wheezing
82
Clinical feature of DiGeorge Anomaly
```
CATCH:
C for cardiac,
A for abnormal faces,
T for thymic hypoplasia,
C for cleft palate, and
H for hypocalcemia.
```
83
An 18-year-old college girl with an extremely sore throat and high fever who develops a rash upon administration of ampicillin
EBV
84
Foot puncture wound through a tennis shoe of an adolescent exploring a construction site
Pseudomonas
85
Warm, red, tender axillary lymph nodes, and red papules on the hand of a 5-year-old girl who is happily telling you of her recent adventures
at her grandmother’s farm where she enjoyed playing with Chihuahua puppies, kittens, and ducklings
Bartonella henselae
etiologic agent for cat-scratch disease
86
The appearance of an evanescent, erythematous, maculopapular rash following the rapid defervescence of several days of high fever in a 9-
month-old boy
HHV6, Roseola infantum, sixth disease
87
A 3-week-old uncircumcised boy with fever and urinary tract infection
E coli
88
Several weeks’ history of epigastric and periumbilical pain that worsens with fasting and is relieved by eating, in a 9-year-old boy with
guaiacpositive stools
H.pylori
89
A 6-week-old infant with tachypnea and history of eye discharge at 2 weeks of age.
Chlamydial pneumonia
90
A 14-year-old girl with low-grade fever, cough of 3 weeks’ duration, and interstitial infiltrate
Mycoplasma pneumonia
91
A 2-month-old boy with a 3-day history of URI who suddenly develops high fever, cough, and respiratory distress; within 48 hours, the
patient has developed a pneumatocele and a left-sided pneumothorax
Staphylococcal pneumonia
92
An 8-year-old girl with fever, tachypnea, and lobar infiltrate. She has failed outpatient therapy of amoxicillin, has developed empyema, and
has had to have chest tubes placed
Pneumococcal pneumonia
