EM infectious disease

Question 1

Children with early HIV infection but without evidence of AIDS who have early mild varicella may be given a closely monitored trial of

Answer 1

oral acyclovir and switched to intravenous acyclovir if there is any sign of worsening.

Question 2

Lyme disease (LD) presenting with erythema migrans (EM) or Lyme arthritis, as described in this patient, without neurologic symptoms can be treated with

Answer 2

doxycycline, amoxicillin or cefuroxime axetil for 14 days.

Question 3

Varicella infection that occurs in the first or second trimester of pregnancy will cause approximately 2% of infants to develop congenital varicella syndrome. With current childhood vaccination recommendations this is now rare, however the most prominent manifestation seen is

Answer 3

zigzag, cicatricial skin scars reported in >60% of cases. Other manifestations include small infant size, hypoplastic limbs, chorioretinitis, microphthalmos, Horner syndrome, cataracts, nystagmus, cortical atrophy or mental retardation, zoster, and early death.

Question 4

Most common bacterial pathogens for preseptal cellulitis are

Answer 4

Haemophilus influenzae type b (H. flu), Staphylococcus aureus, Streptococcus pneumoniae (pneumococcus), Streptococcus pyogenes (group A strep), and anaerobes such as Bacteroides fragilis.

Question 5

Rare complications of orchitis include

Answer 5

oophoritis, myocarditis, nephritis, thyroiditis, nephritis, mastitis, and hearing impairment. Impairment of fertility is about 13%, though absolute infertility is rare.

Question 6

Average duration of the orchitis

Answer 6

is 4 - 6 days.

Question 7

In orchitis- approximately 30 - 40% of affected testes will become

Answer 7

atrophied.

Question 8

What are the characteristic symptoms of Ascariasis?

Answer 8

Low grade fever, abdominal pain, and intestinal blockage

Question 9

HBsAg +ve

HBeAg +ve

Answer 9

Acute or chronic infection with high risk of transmission

Question 10

HBsAg +ve

AntiHBe +ve

Answer 10

Acute or chronic infection with low risk of transmission

Question 11

HBsAg +ve

Anti HBc IgG +ve

Answer 11

Chronic infection

Question 12

HBsAg +ve

AntiHBcIgM +ve

Answer 12

Acute or recent infection

Question 13

AntiHBs +ve

AntiHBcIgG +ve

Answer 13

Resolved infection

Question 14

____ is the appropriate treatment for neonatal conjunctivitis due to Chlamydia trachomatis.

Answer 14

Erythromycin 50mg/Kg/day given orally in 4 divided doses for 14 days

Question 15

Erythromycin and penicillin both are effective in the treatment of ________

Answer 15

diphtheria. Erythromycin is superior to penicillin for eradication of nasopharyngeal carriage and thus is preferred.

Question 16

The treatment of choice for head lice in the above child is

Answer 16

malathion 0.5% in isopropanol.

Question 17

. New lesions usually do not appear after birth. The eruption consists of pigmented macules, pustules, and vesicles. There is no surrounding erythema, but a collarette of scales may be present. After a few days the pustules rupture, leaving a brownish crust that can be detached easily. The rash is commonly seen over the chin, neck, trunk, thighs, buttocks, palms, and soles. The etiology is unknown. The eruption may start resolving after 48 hours, but the macules may last for several weeks or months.

Answer 17

transient neonatal pustular melanosis (TNPM), as the skin lesions are present at birth and it is more commonly seen in African American infants with dark pigmented skin

Question 18

Concurrent with or following a tinea capitis infection, especially one caused by Trichophyton tonsurans, a red, tender, boggy swelling of the scalp with superficial pustules known as a

Answer 18

kerion may develop. Grossly purulent material may be aspirated and does not necessarily indicate ongoing infection. If cultures and stains reveal the absence of bacteria and fungi, treatment with prednisone is warranted.

Question 19

Pityriasis rosea most commonly presents at the trunk, including both the abdomen and back. Less commonly, it is seen on the extremities, although an inverse form mainly affecting the extremities but sparing the trunk is seen.

Answer 19

If the palms and soles are involved, especially in a sexually active patient, secondary syphilis must be excluded.

Question 20

boy presents with signs and symptoms consistent with Lyme meningitis which is best treated with

Answer 20

ceftriaxone IV in a single daily dose of 50mg/kg per day for 14 days. In isolated Bell’s palsy without meningitis, a 14-day oral regimen may be used.

Question 21

history of an acute febrile illness with pharyngitis and characteristic rough maculopapular erythematous skin rash which is mainly over the neck, trunk, and extremities. It is described to have a ‘sand paper’ like feel. Face is usually spared. Sometimes cheeks may be erythematous and there is circumoral pallor. most likely diagnosis is ______

Answer 21

scarlet fever

Question 22

Over the following 2 days, he develops a mildly pruritic rash on his chest and upper arms. He now has a lacy-appearing rash on his arms. According to his mother, he has been eating well and acting normally. His past medical history is unremarkable, and he takes no medications.

Answer 22

Parvovirus B19

Question 23

a syndrome characterized by chronic regional lymphadenopathy. It is also associated with bacillary angiomatosis in immunocompromised patients

Answer 23

Bartonella henselae is the organism responsible for cat-scratch disease,

Question 24

Which is found in the mouth of most cats, many dogs, and some rats. It is by far the most common cause of infected cat bites. It is found in over 50% of cat bites and in 20-30% of dog bites.

Answer 24

Pasteurella multocida. It is a small, coccobacillary, Gram-negative organism,

Question 25

Patient has symptoms include seizures, behavioral disturbances, obstructive hydrocephalus, and other neurologic symptoms.

Answer 25

neurocysticercosis, which is a cause of epilepsy. It is caused by cysts of the pork tapeworm Taenia solium in the brain. T. Solium has a high prevalence rate in Mexico, Central and South America, Philippines, and Asia. The disease is spread by fecal-oral contact by ingesting the eggs of the tapeworm.

Question 26

mild prodrome of lymphadenopathy, especially in the posterior cervical region, malaise, and low-grade fever, followed by a pink maculopapular rash that begins on the face and progresses rapidly downward. It lasts 2 to 3 days and fades in the order of appearance. Fever is slight during the rash phase, and the pharyngeal mucosa and conjunctivae are slightly inflamed. Arthritis, more common in females, may be seen after 2 to 3 days. The joints of the hands are most commonly affected.

Answer 26

Rubella, also known as German or 3-day measles, is a common contagious illness of childhood

Question 27

Prophylactic use of doxycycline PO 4 mg/kg in a single dose for suspected Lyme disease (LD) is recommended for

Answer 27

children 8 years and older who have an engorged deer tick that has been attached for a minimum of 72 hours in a hyperendemic area if it can be started within 3 days.

Question 28

The nurse screening phone calls in your office comes to tell you about a mother that just called with questions about chicken pox exposure. Her 2-year-old daughter’s day care center sent a note home telling parents that chicken pox was diagnosed in 2 other children. One child had been previously vaccinated. Her daughter was closely exposed to this child about 5 days ago and so far has no symptoms. Her daughter has also received 1 dose of vaccination herself. She wants to know if the other child is contagious, what is the risk for her child getting chicken pox, how protected is her child after 1 dose, and what should she do now.

Answer 28

About 80% of children who received 1 dose of vaccine are completely protected, however she should bring her daughter in for her second dose if it has been at least 3 months since her first dose. The Committee on Infectious Diseases has recently recommended a 2-dose varicella immunization schedule to improve the immune response, greater protect against breakthrough varicella disease, and reduce the number of outbreaks among school-aged populations.

Question 29

There is a 3.3-fold less likely chance to have breakthrough varicella in 2-dose recipients during the first 10 years after immunization. Postexposure prophylaxis vaccine may be given if it is within 5 days of exposure. Children with chickenpox should be excluded from child care or school until all their lesions have dried and crusted.

Answer 29

Of children who have been vaccinated with only 1 dose of vaccine, only 3% to 4% develop full-blown chickenpox.

All children over 12 months of age should now receive 2 doses of vaccine with at least 3 months between doses if under 13 years of age and 4 weeks if 13 years of age or older.

Question 30

At least 2/3 of HIV transmissions occur via

Answer 30

male-to-male sex.

Question 31

presence gram-negative diplococci on gram-stained smear of the purpuric lesion = Waterhouse-Friderichsen syndrome is common during fulminant meningococcemia. It occurs due to diffuse adrenal hemorrhages without vasculitis, manifesting as hypotension and circulatory collapse followed by multisystem failure and disseminated intravascular coagulation. Treatment consists of

Answer 31

Penicillin G (250,000-400,000U/kg/day divided 4-6 hourly), which is the drug of choice. However, cefotaxime 200mgm/kg/day or ceftriaxone 100mg/kg/day are equally effective alternatives. Supportive treatment consists of inotropic therapy, hydrocortisone supplementation, and mechanical ventilation (if required).

Question 32

Persons with primary deficiency of compliment components have increased risk of developing

Answer 32

meningococcal disease.

Question 33

Persons with properdin, factor D, or terminal component deficiencies develop serious

Answer 33

meningococcal disease. Recurrent meningococcal disease occurs more commonly in persons with terminal component deficiency.

Question 34

_____ is common in homes with a pet dog or a cat and can lead to increased white cell count with an eosinophilic predominance.

Answer 34

Toxocariasis

Question 35

_____ is usually associated with significant perianal itching and is less likely to cause eosinophilia.

Answer 35

Pinworm

Question 36

_____ is associated with iron deficiency and can lead to worm infestations.

Answer 36

Pica (eating non-nutritive substances)

Question 37

Infants born to mothers who have contracted chickenpox 5 days before or 2 days after delivery are at risk of severe varicella infection. Maternal viremia occurs about 48 hours prior to the onset of rash. The rash in the infant usually appears by the end of first week or the early part of second week of life. As the mother has not developed a significant antibody response, the infant receives a large dose of virus without maternal varicella-zoster virus (VZV) specific antibodies. Treatment …

Answer 37

These infants should receive 1 vial of varicella zoster immune globulin (Vari ZIG) as soon as possible after birth, ideally within 3 days and a maximum of up to 10 days. Perinatally acquired varicella can be life-threatening, so the infant should be treated with acyclovir 10 mg/kg every 8 hours intravenously, but only when the lesions develop. Treatment is continued for 10 days. Infants with neonatal varicella who receive prompt antiviral therapy have an excellent prognosis.

Question 38

Acyclovir resistant varicella-zoster virus (VZV) infection has been identified in children infected with HIV.

Answer 38

These children may be treated with intravenous foscarnet 120 mg/kg/day, divided every 8 hours for up to 3 weeks.

Question 39

Nikolsky’s sign, or desquamation of the underlying skin with gentle rubbing, often occurs. Sterile bullae are seen in more severe cases. The loss of epidermis can lead to electrolyte disturbances and secondary infection.

Answer 39

The syndrome is cause predominantly by phage group 2 staphylococci. Treatment consists of systemic antibiotics, local skin care, and fluid and electrolyte monitoring.

Question 40

14-year-old boy presents with a 1-week history of acute watery diarrhea with abdominal discomfort and vomiting. Now he has developed facial and periorbital edema and myalgias. He is also experiencing pain and swelling of the calf muscles. The patient gives history of eating some delicacies prepared from pork and game meat in a restaurant about 3-4 weeks back. Blood examination shows eosinophilia. Muscle biopsy shows that the muscle fibers are edematous and have basophilic degeneration. Muscle fibers contain a cyst containing a coiled worm. The surrounding areas show lymphocytic and eosinophilic infiltration

Answer 40

Trichinella spiralis infestation, as suggested by the clinical picture and confirmed by muscle biopsy. The recommended treatment for trichinosis is mebendazole 200-400mg TID for 3 days, then 400-500 mg TID for 10 days (for all ages) to eradicate the adult worms if the patient has ingested contaminated meat within the past 1 week. Thiabendazole 25mg/kg bid PO for 10 days and mebendazole 200 mg bid PO for 10 days are effective against muscle larvae. Mebendazole is less effective, but thiabendazole is poorly tolerated.

Question 41

_______ is effective against many protozoans and helminths. It has been approved by the US Food and Drug Administration for treatment of diarrhea due to Cryptosporidium species in children between 1-11 years of age and diarrhea due to Giardia lamblia in children over 1 year of age. It is also active against E. hystolytica, T. vaginalis, H. pylori, Ascaris, and H. nana.

Answer 41

Nitazoxanide. Common side effects are abdominal pain, diarrhea, and nausea.

Question 42

_____ is FDA approved for treatment of onchocerciasis and intestinal strongyloidiasis. It may have some effect against cutaneous larva migrans, intestinal nematodes, lymphatic filariasis, Mansonella infections, and scabies.

Answer 42

Ivermectin