UW pediatrics

Question 1

Preseptal vs orbital cellulitis regarding clinical features

Answer 1

preseptal: eylid erythema + swelling + chemosis (edema of conjuctiva)
orbital: same symptoms PLUS proptosis +/or opthaloplegia with diplopia

Question 2

preseptal vs orbital cellulitis regarding treatment

Answer 2

preseptal: oral antibiotics
orbital: IV antibiotics +/- surgery

Question 3

Herpangina vs herpetic gingivostomatitis regarding etiology / age / season

Answer 3

herpangina: Cox A, 3-10 years, summer/early fall
Herpetic: HSV1, 6months - 5 years, no season

Question 4

herpangina vs herpetiv gingivostomatitis regarding clinical features / treatment

Answer 4

1. herpangina: fever, pharyngitis, GRAY vesivles/ulcers on POSTERIOR oropharynx –> supportive management
2. Herpetic: fever pharyngitis, erythematous gingiva, Clusters of small vesicles on ANTERIOR oropharynx and LIPS –> oral acyclovir

Question 5

perinatal transmission of HCV - ways of transmission

Answer 5

1. perinatal exposure to genital secretion (MC)
2. transplacental (rare)
   NOT FROM BREASTFEEDING

Question 6

impetigo - types and microbiology / treatment

Answer 6

• non-bullous: S. aureus, S. pyogenes
• boullou: S. aureus
  treatment: limited skin: topical antibiotics (mucirocin)
  extensive skin involvemnt: oral antibiotics (cephalexin, dicloxacillin, clindamycin)

Question 7

rubella immunization during pregnancy

Answer 7

contraindicated

Question 8

nonbulous impetigo - treatment

Answer 8

topical antibiotics (eg. mupirocin)

Question 9

Rubella - clinical manifestations

Answer 9

children: fever, cephalocaudal spread of maculopapular rash (SPREADS IN 24 HOURS)
adolsescents/adults: same + arhtralgias/arthritis

Question 10

how to diagnose measles instead of rubella

Answer 10

higher fever more than 40), rash ospread over multiple days, cervical lymphadenopathy rather than posterior auricular or suboccipital
NOT ARTHRITIS

Question 11

congenital varicella is characterised by

Answer 11

limb hypoplasia, cataracts, distintive skin lesion (eg. scarring)

Question 12

maternal - fetal transmission is more teratogenic during (time)

Answer 12

1st trimester

Question 13

pertusis prophylaxis

Answer 13

all close contacts should be given a macrolide antibiotic REGARDLESS OF AGE, IMMUNISATION STATUS, OR SYMPTOMS

Question 14

MCC of viral meningitis

Answer 14

non-polio enterovirus such as exchovirus and cox

Question 15

Measles virus (rubeola) - clinical manifestation and treatment

Answer 15

prodrome (cough, coryza, conjunctivitis, fever (more than 40), koplik spots)
maculopapular exanthem: cephalocaudal + centrifugal spread, spares palms and soles
treatmetn: supportive, vit A for hospitalized patients

Question 16

retropharyngeal abcess - presentation

Answer 16

fever, dysphagua, inability to extend neck, muffled voic,

LATERAL X-RAY showing widened prevertbral space

Question 17

suspect of retropharyngeal abcess - next step

Answer 17

if no resp compromise –> CT scan

polymicrobial

Question 18

FIRST step in treatmetn of septic athrtitis

Answer 18

atrhocentesis

Question 19

complications of malaria in children vs adults

Answer 19

children: seizure, coma, hypoglycemia, met acidosis
adults: jaundice, acute renal failure, acute pulm edema

Question 20

protective factors for severe malaria

Answer 20

1. SC trait

2. past history of malaria partial immunity

Question 21

Mump virus - etiology / presenation

Answer 21

paramyxovirus

presentation: fever and parotitis
complications: orchitis, aseptic meningitis, pancreatitis (can cause sterility esp after puberty

Question 22

sore throat - evidence for strep - evaluation

Answer 22

rapid strep test –> if positive treat it –> if negative make a throat culture –> if positive treat it, if negative is viral
unlike adults, in children must be confirm the strep before treat it
(MAKE ALWAYS TESTS BEFORE TREATMENT)

Question 23

Varicella infection - treatmetn / prognosis

Answer 23

prodrome (fever malaise)
maculopapular rash follwed by successive crops of vesicles
self limited

Question 24

varicella - prevention

Answer 24

2 doses of VZV (age 1 + 4 years old)

breakthrough are still possible, esp if only 1 dose

Question 25

eczema hepreticum

Answer 25

HSV on atopic dermatitis --> vesicular rash, fever, possible dissaminated virus

Question 26

Varicella post exposure prophylaxis

Answer 26

received 2 doses (1 + 4)? yes --> observation no --> vaccine if immunocompoment, IVIG if low immune IF YOUNGER THAN 1 --> NOTHING

Question 27

MC source of rabies in US vs developing world

Answer 27

USA: bat Developing: dogs

Question 28

exposure to rabies -->

Answer 28

vaccination + IVIG

Question 29

Scarlet fever - etiology clinical

Answer 29

S. pyogenes | Clinical: fever + pharyngitis, STRABERRY TONGUE, anterior cervical nodes, sanpaper rash

Question 30

IM --> acute airway obstruction ?

Answer 30

rare complication --> give corticosteroids

Question 31

pertusis in infnats under 6 months

Answer 31

life threatening death and apnea

Question 32

foodborne disease with vomiting predominant

Answer 32

Vomiting predominant: B. cereus, S. aureus, Norwalk

Question 33

empiric treatment for suscpetect meningitis

Answer 33

3rd generation ceph (eg. ceftriaxone) + vancomycin

Question 34

infectious complications of atopic dermatitis - types (and pathogens)

Answer 34

1. impetigo (S. aureus, S pyogenes) 2. Eczema herpeticum (HSV1) 3. Molluscum contagiosum (Poxvirus) 4. Tinea corporis (Trichphyton)

Question 35

HBV transmission to neonatal - ways

Answer 35

perinatal exposure to genital secretions (MC) 2. Transplacental (rare) 3. not by breastfeefing)

Question 36

prevention of early onset GBS infection inclide maternal screening - prevent sepsis?

Answer 36

NO

Question 37

difference in gonoc vs chlamydial conjuctiva exvcept the days

Answer 37

- gonoco: marked eyelid swelling, profuse purulent discharge, corneal edema/ulceration - chlamydial: mild eyelid swelling watery serosanguineous or mucopurulent eye discharge

Question 38

pediatric septic arthritis - organisms and treatment

Answer 38

- 0-3 momths:staph, agalacte, gram (-) bacilli): antistaphylococcal + GEentamicin or cefotamice - older than 33 months: staph, Strep pyogenus, strep pneumoneia: nafcillin, clindamycin, cefazolin or vancom

Question 39

clinical features of rabies

Answer 39

1. encephalitic: hydrophobia, aerophobia, spastic paralysis of pharynx, agitation 2. paralytic: ascending flaccid paralysis