Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2019 Bank of Goodness > ID - 2019 Updated! > Flashcards

ID - 2019 Updated! Flashcards

1
Q

Newborn who is IUGR, failed hearing screening, positive CMV PCR from urine, what do you do?

a) Reassure and follow up in 6 months
b) Ganciclovir for 2 weeks
c) Valganciclocir for 4 weeks
d) Valganciclocir for 6 months

A

d) Valganciclocir for 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A 5 year old by has had a one week history of fever and cough. He was started on amoxicillin. He develops this rash (there was a blurry photo of what looked like Erythema Multiforme). What is the most likely etiology of the rash?

Mycoplasma
HSV
Amoxicillin

A

Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pregnant woman in contact with meningococcal meningitis. Tx:

a. Cipro
b. Rifampin
c. Ceftriaxone
d. Penicillin

A

c. Ceftriaxone

  • cipro and rifampin would treat it but should not be given to pregnant women (Rifampin teratogenic, Cipro bad for cartilage)
  • close contacts should get prophylaxis regardless of immunization status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Strep throat in children aged 1 to 3 years may present with all of the following EXCEPT:

a) low grade temperature
b) prolonged fever
c) decreased appetite
d) exudative tonsillopharyngitis
e) seromucoid rhinorrhea

A

d) exudative tonsillopharyngitis

- kids under 3 rarely have strep but when they do they present atypically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

One year old child with exudative tonsillopharyngitis. Most likely?

a) viral
b) mono
c) GAS

A

a) viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pre-splenectomy immunization

a) polysacc meng A+E, polysacc pneumo and hep B
b) hep B, conjugated mening, conjugated pneumo
c) Hep A + B, mening

A

b) hep B, conjugated mening, conjugated pneumo

- at least 2 weeks prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it?
Today
1 month
6 months
11 months
A

Today

According to HamReview -
If systemic steroids 2 mg/kg/day (>20 mg/day) for >14 days, wait 1 month

In general, live vaccines may be given 1 month after discontinuation of high dose steroid therapy, 3 months or more after completion of other immunosuppressive chemotherapy, or 6 months after treatment with anti-B-cell antibodies, provided that the underlying disease is not immunosuppressive or is no longer active.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Teen can’t open mouth. Has fever. Dx?

a. Retropharyngeal abscess
b. Peritonsillar abscess

A

b. Peritonsillar abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A 13-year-old aboriginal female who lives on a reserve presents with tender erythematous induration of her shins bilaterally. What should you investigate for:

a) sarcoidosis
b) tuberculosis
c) Cat-scratch disease
d) inflammatory bowel disease
e) drug hypersensitivity

A

tuberculosis
- erythema nodosum can be caused by TB, cat scratch, sarcoid, IBD - so multiple answers could be correct but given Aboriginal on reserve has increased risk of TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Description of child with Necrotizing fasciitis lower leg- some respiratory distress. Already started IV fluids and oxygen. 5 additional things in the management.

A
  • abx: piptazo + vanco (MRSA) + clinda (antitoxin effect)
  • consult surgery - exploration and debridement
  • pain control (morphine)
  • anticipate multiorgan failure (watch U/O, BP, may need pressors)
  • blood cultures
  • consult ID, consider IVIG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the five major criteria for rheumatic fever?

A 
Joints: migratory polyarthritis
Carditis: new murmur/valve disease on echo
Subcutaneous nodules
Erythema marginatum
Sydenham's chorea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A 10-year-old who underwent recent dental surgery now presents with fever, arthralgias, splenomegaly, and lesions on the hands and feet.

a) septic emboli
b) subacute endocarditis
c) acute rheumatic fever
d) juvenile rheumatoid arthritis
e) coxsackie virus

A

b) subacute endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bite in daycare Q. What to do:

a) Reassure mom of low risk of hiv infection
b) HIV serologies for both kids
c) initiate HIV prophylaxis for both kids
d) HIV prophylaxis for kid who was bitten only

A

a) Reassure mom of low risk of hiv infection
- PEP after a bite by a child known to be infected with HIV is rarely indicated and should only be given in consult with ID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

One of your patients has mono like symptoms. Your
blood work comes back. IgM negative; IgG positive; Early D antigen negative; Nuclear capsid antigen was positive. Interpret these results.

A

This patient had a previous (remote) infection, but this is not the explanation for current symptoms
● IgM = early rise and then drop off by 1-2 mo.
● IgG = early rise and stay elevated
● Early D antigen = peak week two then decreases by 4 mo. = (+) in acute or
recent primary infection
● Nuclear capsid antigen= low then rise 6 mo. onwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pneumonia, LLL + effusion in a 10 year old, most likely bug:

a) Staph Aureus
b) strep pneumonia
c) Group A Strep
d) H.influ

A

b) strep pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Family comes to you from an area endemic for Lyme disease

What is the organism and vector causing it (2)?

What are two antibiotics that are effective against it (2)

What are three things to do for prevention if you live in an endemic area (3)

A
  1. borrelia burgdorferi; black legged tick (ixodes sp)
  2. doxycycline, amoxicillin (kids under 8), cefuroxime
  3. 20-30% deet to clothes and skin
    - shower within 2 hours of coming inside
    - full body tick check daily
    - landscape to create barriers where play areas adjoin wooded areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

influenza vaccine, 5 year old, got the shot last year, what to give this year

a) one dose 0.5 ml
b) split dose 1 month later volume 0.25 + 0.25
c) give one then second one a month later 0.5 + 0.5

A

a) one dose 0.5 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Just finishing examining baby with diarrhea. You are taking off your gloves and you get some poop on your hands. What to wash with?

a) Soap and water
b) Antibacterial Soap and Water
c) Alcohol hand sanitizers
d) Rinse with water

A

a) Soap and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of a child with asplenia:

a) pneumococcal vaccine at 6 months
b) meningococcal vaccine at 2 years
c) antibiotic prophylaxis with daily Septra
d) antibiotic prophylaxis until pneumococcal vaccine given

A

a) pneumococcal vaccine at 6 months
- PCV13 (prevnar-13) at 2, 4, 6, 12-15 months
- quadrivalent meningococcal conjugate vaccine (MCV4 - menveo) at 2, 4, 6, 12-15 months
- antibiotic prophylaxis (with pen V) until age 5 and 2 years post splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A four year child presents with pertussis. His 3 month old sibling has had her first immunization. What would you do regarding the sibling:

a. treat with erythromycin if she becomes symptomatic
b. isolate from her brother for 5 days
c. treat her with erythromycin for 2 weeks

A

c. treat her with erythromycin for 2 weeks (is one option; azithro x5d, claritho x7d, TMP-SMX x14d also options)
- continue pertussis vaccination according to routine schedule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A 3-month-old child has had tender swelling over the mandible bilaterally for 1 week, along with fever and irritability. There is hyperostosis on x-ray. Most likely diagnosis:

a) Caffey’s
b) parotitis
c) cherubism
d) osteomyelitis
e) hypervitaminosis A

A

a) Caffey’s (infantile hyperostosis of jaw, scapula, clavicles, diaphysis of long bones, can have fever and irritability)- resolves by 2y
● Cortical hyperostosis (bone thickening) with inflammation of fascia and muscle
● Avg onset 10 weeks (can be prenatal and severe- hydrops)
● Most commonly involves mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which of the following infections would not prevent a child from attending daycare:

a. Chicken pox
b. Impetigo
c. Hepatitis A
d. Hepatitis B
e. Pertussis

A

d. Hepatitis B
- impetigo exclude until 24h after treatment started
- VZV can also go if well enough

Impetigo - exclude if draining lesions can’t be covered. For GAS wait until 24hr ABx
Hep A: exclude for 1 week after onset
Pertussis - until 5 days Abx or 3 weeks if not Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

New immigrant got 4 DPT and 3 oral polio vaccines before coming to Canada. He’s 10 months. What vaccine to give him now?

A.. pneumococcus and Hib
B. pnuemococimmcul, Hib, and polio
C. DTaP-IPV-Hib and pneumococcus
D.. pneumococcus and meninogoccu

A

?b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

3 week child with suspected meningitis. Initial antibiotics?

A

Ampicillin and cefotaxime (amp for gram positive coverage, cefotax for gram negative coverage - gent does not have good CNS penetration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

2 mo baby comes in with meningitis and focal seizure. Symptoms of shock described. GCS 6. What is the FIRST step in management?

a) Culture and antibiotics
b) Intubation
c) CT
d) LP

A

b) Intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Picture of lateral neck xray (++ prevertebral soft tissue swelling), febrile with difficulty opening the mouth. Presents with neck pain, what is the dx?

a. bacterial trachieitis
b. peritonsillar abscess
c. retropharyngeal abscess
d. epiglottis

A

c. retropharyngeal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CF child admitted with pneumonia, green sputum best choice of antibiotics

a) cefixime and piperacillin/tazobactam
b) Ceftazadime and Tobra -
c) Clox and ceftazidime

A

b) ceftaz and cobra

Should do double coverage for pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A 4 year old presents to the emergency department with abdominal pain and diarrhea. On further history, you note that he went to visit his aunt a few weeks ago; she lives on a farm. Further investigations reveal a diagnosis of ileitis. What is the most likely underlying etiology?

a) Crohn’s disease
b) Yersinia
c) Mycobacterium tuberculosis
d) Lymphoma

A

b) Yersinia

- Associated with pigs, and contaminated water. Can cause pseudoappendicitis and ileitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

12 yo girl presents with >5 days of fever, unwell. Hepatomegaly. HR 85 despite the temperature of 39.5, BP normal. CBC und urine tests normal. Blood culture shows
gram negative bacilli. What is the cause?
a) pyelonephritis
b) ovarian torsion
c) typhoid fever

A

c) typhoid fever

- salmonella typhi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

An epileptic who has been on carbamazepine for the past year presents with otitis media. You prescribe Ceclor for the otitis. Two days later he returns with an urticarial rash. The otitis is still present. What would be the next drug of choice:

a) amoxicillin
b) erythromycin-sulfa
c) clarithromycin
d) TMP-sulfa
e) cefixime

A

a) amoxicillin- 1 st line for AOM; if you have a cephalosporin allergy it is usually to the side chain, not the beta lactam, so don’t tend to have penicillin allergy

cefixime is also a cephalosporin so not a good idea (though is a good choice for kids with pen allergies because does not cross react with penicillins

eryrtho, clarithro and septa all have interaction with carbamazepine (could induce toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Girl returns from mexico and begins to have vomiting, diarrhea and jaundice. Her abdomen is tender. Her LFTS are elevated. When can she return to daycare?

a) 7 days
b) When symptoms stop
c) When LFTs normal
d) Now

A

a) 7 days

- risk of transmission minimal 1 week after jaundice onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Child with history of fever 2 weeks ago with bloody stools. Now arthalgias/arthritis. What is the pathogen

a) E.coli
b) Campylobacter
c) Yersinia

A

b) Camplobacter

Campylobacter infections = reactive arthritis occurs in up to 3% of patients, though up to 13% may have joint symptoms.

Tx: NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

GBS positive mom.11 days old. On TPN from peripheral line. Three attempts at obtaining central access failed.In a tertiary care center. Now is septic. Culture shows gram positive cocci in clusters. What is the bug? What is the treatment

A
  1. staph aureus (or coagulase negative staph)

2. vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

7 month old child has recently been adopted from another country. All immunizations are up to date.

Should you vaccinate against meningitis? (1) If so, what would you use and what schedule (2 lines)

A
  1. Yes should vaccinate
  2. give Meningococcal conjugate vaccine for serotype C: 2 - 3 doses given 8 weeks apart (booster needed between 12-23 mos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Adolescent male whose partner is positive for gonorrhea. Your management would be

a. Amoxil
b. tetracycline
c. ceftriaxone
d. doxycycline
e. erythromycin

A

c. ceftriaxone 250mg IM x1
- same treatment for partners as for confirmed cases
- also give one dose of azithro 1g PO (or 7d doxy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

An 11-month-old child develops nephrotic syndrome and is going to be on prednisone. He has completed his 2, 4, and 6 month immunizations. Which is true regarding
subsequent immunizations:
a) he should continue his regular immunization schedule
b) he should not receive any further immunizations until he has been off prednisone for 2 years
c) he should not receive live-virus vaccines while on prednisone

A

c) he should not receive live-virus vaccines while on prednisone
- inactivated vaccines can be given during immunosuppressive treatment, but need to be repeated once off as will not mount sufficient immune response
- live vaccines cannot be given as are dangerous to the patient
- common live vaccines: flu, rotavirus, MMR, varicella, BCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A 13 year old boy has had a 3 week history of fever, malaise and a weight loss of ten pounds. On examination he has diffuse lymphadenopathy including a right supraclavicular node and his spleen tip is palpable. His WBCs are 10, Hgb is 120 and Plts are 150. HIV and mono testing are negative. Which of the following tests is the next step in your investigations:

a. CT abd
b. BM aspirate
c. ANA
d. CXR

A

d. CXR

- mediastinal mass for cancer; hilar adenopathy for TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Greatest risk of mortality with parvovirus B19 infection is associated with:

a) prematurity
b) sickle cell disease
c) ALL on chemotherapy
d) congenital heart disease
e) fetus of a mother infected with parvovirus B19

A

e) fetus of a mother infected with parvovirus B19 ~5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Neonate born to mom who just revealed HIV positive status.

a.) What treatment(s) would you start this baby on (1 line). How long would you treat for?

A

Zidovudine x 6 weeks + 3 doses of nevirapine during 1 st week of life (@ birth, 48h after first dose and 96h after 2nd dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Child with edema, protenuria 4 +, ascites. Presents with abdo pain and fevers. Most likely organism.

a) Strep Pneumo
b) E. Coli
c) Klebsiella

A

a) Strep pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

teen girl with sickle cell anemia with evidence of pneumonia, what do you do

a. discharge home on po antibiotic
b. treat with cefuroxime and erythro IV
c. treat with ceftriaxone IV

A

b. treat with cefuroxime and erythro IV
- need macrolide since atypicals are common cause of chest crisis

Check this - would actually treat Ceftriaxone and Azithro - are they trying to trick us with the cefuroxime??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

A 10 year old boy comes in with gradual onset of testicular pain over the last few days. On exam there is focal induration at the upper pole of the testis with a bluish hue. Testicular ultrasound with doppler shows increased blood flow and an enlarged epididymis. What is the best management?

  1. Urine cultures and antibiotics
  2. Call surgery
  3. NSAIDs and bedrest
A
  1. NSAIDS and bedrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A 7 year old boy visited a farm recently. He now presents with a cough, hepatomegaly and a slight elevation of his AST and ALT. What is the likely diagnosis? what is the treatment?

a. Psittacosis
b. Legionella
c. Q fever

A

c. Q fever
- coxsiella burnetti (rickettsial infection)

  • supportive only; can treat with doxycycline if diagnosed within 3 days of onset (otherwise abx ineffective)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

The most common bug in febrile neutropenia:

a. Pseudomonas
b. PCP
c. gram positive organisms
d. candida

A

c. gram positive organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Neutropenic child with central line site red. Which antibiotic?

A

Piptazo (for febrile neutropenia) + Vancomycin (for central line infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are 3 major criteria for staph toxic shock?

A
  • fever (T>38.8)
  • hypotension
  • eryrthroderma rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Neonate with purpura and thrombocytopenia. Diagnosed with CMV. Give six other features of congenital CMV infection.

A
  • hearing loss
  • microcephaly
  • IUGR
  • chorioretinitis
  • jaundice
  • HSM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

First line for treatment for sinusitis:

  1. Amoxicillin
  2. Azithromycin
  3. Clarithromycin
  4. TMP/SMX
A
  1. Amoxicillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

A child has bacterial meningitis. Soon after starting his vancomycin infusion, he breaks out in a red rash. Blood pressure is normal. What is your IMMEDIATE management? What are TWO things that can be done so this doesnʼt happen the next time?

A
  1. stop infusion; give benadryl and ranitidine
  2. premedicate with diphenydrydramine +/- ranitidine
    - run infusion at slower rate
    Red man syndrome - not true allergy; is a rate dependent infusion reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Teenager with Sickle cell disease presents with cough and fever. CXR shows LLL pneumonia. She looks toxic. What do you treat her with

a) Cefuroxime and eryhtromycin
b) Ceftriaxone and erythromycin
c) Amoxicillin

A

a) Cefuroxime and eryhtromycin
- cefuroxime better than ceftriaxone because ceftriaxone can increase hemolysis in sickle cell patients

CHECK THIS - NOT WHAT WE ANSWERED.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

A child is brought to ER very unwell. She has a preceding sore throat, headache and fever. She is beginning to have a purple rash that doesn’t blanche. How do you prophylaxis her family?

a. Penicillin
b. Ceftiaxone
c. Rifampin

A

c. Rifampin

- can also use ceftriaxone and cipro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Girl goes to Ghana has diarrhea then comes back hypertension

a) Schistosomiasis
b) HUS
c) coagulopathy

A

b) HUS - STEC is present everywhere and may be increased with poor sanitation
a) Schistosomiasis - Only causes in chronic infection with renal disease or portal hypertension. Acute schisto - fever + eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Child presents with pinworms. How do you treat?

A

Albendazole - single dose repeated 2 weeks later to kill any worms that have hatched from eggs in the meantime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

A mother is exposed to parvovirus B19 in her first trimester. Most common result:

a) IUGR
b) microcephaly
c) limb abnormalities
d) cardiac malformation
e) non-immune hydrops fetalis

A

e) non-immune hydrops fetalis (from fetal anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

A child has diffuse rash, oral ulcers, eye involvement. What is the most likely drug that is the cause?

  • amoxicillin
  • Septra
  • Clarithromycin
  • Cefixime
A

Septra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Baby born to HIV-positive mother discovered during pregnancy and treatment initiated. How to test the baby to confirm diagnosis:

a. ELISA
b. Western blot
c. HIV DNA PCR

A

c. HIV DNA PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

You are seeing a child with a very itchy rash. The older sibling has (or had?) a similar itchy rash. Photo shown of child’s ankle. (scabies) What is the diagnosis and how do you treat?

A
  1. scabies

2. 5% permethrin cream from neck down; leave on for 12 hours, then rinse; repeat in 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Name two organ systems and two organisms that are typically affected by granulocyte defects

A
  1. skin (abscesses, cellulitis), LNs (suppurative adenitis), internal organ abscesses, osteomyelitis
  2. staphylococcus, aspergillosis, burkholderia cepacia, serratia, nocardia, klebsiella, pseudomonas, salmonella, fungi and parasites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

11 year old girl with vague abdominal pain, vomiting, and jaundice. Her labs show ALT 1000, total bilirubin 100. What test will likely confirm the diagnosis?

a) Hep A IgM
b) CMV urine
c) Heb B serology
d) monospot

A

a) Hep A IgM
- Hep A accounts for 50% of all clinically apparent acute viral hepatitis
- clinical presentation of hep A
- fever, malaise, jaundice, anorexia, nausea, vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Contraindication to breastfeeding

e. Hep B
f. Bilateral mastitis
g. Active TB

A

g. Active TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Child with symptoms consistent with orbital cellulitis. What should be done?

a) IV Ceftriaxone
b) surgical drainage
c) PO clindamycin

A

a) IV Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Treatment of measles in child who is HIV positive

a) acyclovir
b) amantadine
c) Vit A
d) Vit E

A

c) Vitamin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What antibiotic do you give to GBS + mom who’s allergic to penicillin?

a) Clinda
b) Erythromycin

A

a) Clinda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

A 2 year old presents with a fever for 5 days and soft stools. Urine culture, urinalysis and blood tests are negative. What would be your next investigation?

a) CXR
b) ECHO
c) serology for hep A
d) stool cultures

A

d) stool cultures

- 2 year old unlikely to be symptomatic with Hep A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Winnipeg Doc..calls family concerned about west nile. 4 suggestions to help prevent west nile virus in his patients

A

o community-level mosquito control programs to reduce vector density
o personal protective measures to decrease exposure of infected mosquitoes (e.g. long sleeved shirts, limit outdoor from dusk to dawn, mosquito repellent, using air conditioning, installing window screens)
o screen of blood and organ donors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Boy with recurrent staph abscesses and serratia UTI. What investigation?

a) Nitrozolium blue
b) Oxidative Burst Test

A

b)Oxidative Burst Test

Serratia is a catalase-positive organism commonly seen in Chronic Granulomatous disease. NOBI is the recommended diagnostic test.

Other organisms:
Burkholderia cepacia, Aspergillus, Staph aureus, Serratia, Nocardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Name 4 indications for VZIG

A

PEP in high risk kids who are exposed:

  • immunocompromised without immunity (e.g. leukaemia, on steroids)
  • newborns of mom with varicella 5d before of 48h after delivery
  • pregnant women without immunity
  • hospitalized prems <28 weeks or <1000g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What antibiotic do you give for a child with pneumonia with effusion?

a) Ceftriaxone
b) Ceftriaxone + Erythromycin
c) Vancomycin

A

a) Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q 
An infant is born to a mother with a history of recurrent genital herpes which was not active at the time of vaginal delivery. For how long after delivery is it possible for
this infant to develop herpes:
a) 1-2 weeks
b) 4-6 weeks
c) 12-16 weeks
d) 20-24 weeks
e) up to 36 weeks
A

b) 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Biologics what to do?

a) TB test
b) Varicella
c) MMR
d) ?

A

a) TB Test

Do prior to starting - TST and CXR

Live vaccines contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Baby born to a Hep B positive mom. He gets immunoglobulin and vaccine at birth. At nine months he is asymptomatic. What would his blood tests show?

  1. HbeAg+, HbcAg+, HbsAg+, HbsAb+
  2. HbeAg-, HbcAg-, HbsAg+, HbsAb+
  3. HbeAg-, HbcAg-, HbsAg-, HbsAb+
  4. HbeAg+, HbcAg-, HbsAg+, HbsAb-
  5. HbeAg-, HbcAg+, HbsAg+, HbsAb
A
  1. HbeAg-, HbcAg-, HbsAg-, HbsAb+
    surface antigen should be negative (if it’s positive he has Hep B), and surface antibody should be positive (has immunity from vaccine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Needle stick injury in playgroup. No blood on needle but blood on child. After Hep B serology and vaccine, HIV serology and Hep C serology what do you do:

a) reassure low risk of HIV
b) post-exposure prophylaxis for HIV

A

a) reassure

Antiretroviral prophylaxis should be recommended only in cases of high risk, in which the source is considered likely to have HIV, the incident involved a needle and syringe with visible blood and blood may have been injected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Rotavirus question: what do you tell her regarding vaccine:

a) Protects 95 against rotavirus
b) 75% against all diarrhea
c) Significantly Decreased hospitalizations
d) Decreased virus shedding

A

c) Significantly Decreased hospitalizations
- 85% efficacy in kids under age 2 years
- decreased incidence of rotavirus hospitalization in areas with immunization programs
- 79% decrease in rota hospitalizations for kids under 1 and 73% decrease for kids 12-23 months in Ontario after vaccine introduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Baby with tachypnea, afebrile, nontoxic, has eosinophilia. CXR shows bilateral interstitial markings, areas of atelectasis. What is the likely pathogen?

a) GBS
b) Chlamydia trachomatis
c) Ureaplasma urealiticum
d) RSV

A

b) Chlamydia trachomatis
- onset of cough 1-3 months; no fever; staccato cough, eosinophilia
- treat with erythromycin (can cause pyloric stenosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

The leading cause of HIV in women in Canada is due to:

a. homosexual transmission
b. heterosexual transmission
c. IV drug use
d. blood transfusion
e. occupational exposure

A

b. heterosexual transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

18 month old child with URTI. He develops higher fever 3 days later, pulling at ear and has erythematous right tympanic membrane, not bulging. Do you treat for AOM? Explain why or why not?

A

No treatment. No bulge suggests there is no middle ear effusion, and erythematous TMs are common in viral infections. Since patient is over 6 months watchful waiting x24-48 hours is appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Child has worsening swelling around an eye. List 2 signs that would make you worried about orbital cellulitis.

A
  • proptosis
  • pain with extraoccular movements
  • decreased visual acuity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

White out of R lung CXR what antibiotics do you start

  • Ceftrixone
  • Ceftriaxone and Vanco
  • Ceftriaxone and Erythromycin
A
  • Ceftriaxone and Vanco
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Toddler, presents with fever, looking toxic. Drooling. Neck pain with lateral movement, but full ROM extension and flexion. Oropharynx – mildly erythematous, no tonsillar enlargement, no exudate. Most likely diagnosis?

a) Retropharyngeal abcess
b) Peritonsillar abcess
c) Bacterial tracheitis
d) Mastoiditis

A

a) Retropharyngeal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Infant born to mother with no prenatal care. Hepatosplenomegaly and copper rash especially on palms and soles. Rhinitis and cough. Diffuse consolidation on CXR. Appropriate investigation:

a. urine CMV
b. VDRL/FTA abs
c. blood culture

A

b. VDRL/FTA abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Mom wants to know where her 18 month old daughter acquired perineal warts. You tell her from:

a. perinatal acquisition
b. sexual abuse
c. day care
d. from bathing with her older sister
e. from dad changing diapers

A

a. perinatal acquisition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

12 month old girl is seen with fever, tachypnea and vomiting. She appears unwell but her vitals are stable. On CXR there is a lobar consolidation. What antibiotics do you start:

a. IV cefuroxime
b. IV cefuroxime and IV azythromycin
c. IV vancomycin and cefotaxime
d. IV ampicillin

A

d. IV ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q 
Child recently visited farm, presents with high fever, hepatosplenomegaly and pneumonia
a. legionella
b . Q fever 
c . cat scratch 
d. Psittacosis
A

ANSWER: b . Q fever (goat, sheep, cattle) - coxsiella burnetti (gram negative)
- treatment decreases duration and severity
a. legionella (usually contaminated water)
c . cat scratch (cat bite/scratch, kittens, HSM can occur)
d. Psittacosis (usually caged birds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

3 year old with a bite on his cheek. List 4 characteristics of the bite that would have an impact on the management of this patient.

A
  • depth
  • signs of infection
  • what bit him - animal versus human (puncture wound vs graze)
  • infective/immune status of biter if known
  • tetanus status
  • duration since bite (do not close if >24 hours)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Child with eczema and recurrent pneumonia. Hepatomegaly, petechiae, otitis media
and low platelets. What do you expect?
a. elevated IgA and IgE
b. immune response to polysaccharide vaccine
c. oral Candida
d. abnormal mitogen proliferation

A

a. elevated IgA and IgE
- poor response to polysaccharide vaccines (important they get conjugate)
- Wiscott-Aldrich

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Biting incident at daycare, breaks skin superficially, both kids are previously healthy and have all their immunizations but no HepB shots. What do you do?

a. screen them for HIV
b. start Hep B vaccinations in both kids
c. test Hep B serology only in the biter
d. tetanus immunoglobulin

A

b. start Hep B vaccinations in both kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Kid with bloody diarrhea 1 month ago which has now resolved. Now has weight loss and abdominal pain. Which was the most likely organism?

a. Yersinia
b. Campylobacter
c. E Coli
d. Shigella

A

Yersinia – can be cause of chronic abdominal pain/weight loss (not in nelsons)- crohns mimicker- can last months (Toronto notes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Kid with pain with movement both directions. Supple neck, slight red throat otherwise normal oral pharynx. Drooling.

a) Peritonsilar abcess
b) Retropharyngeal abcess
c) Mono
d) URTI

A

b) Retropharyngeal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are four clinical signs that would be considered a contraindication for a lumbar puncture?

A
  • infection of skin over intended LP site
  • spinal deformities
  • bulging fontanelle
  • focal neurologic deficit
  • cardioresp instability
  • signs of bleeding diathesis (e.g. petechiae)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

All of the following are features of HIV infection EXCEPT:

a) hypogammaglobulinemia
b) CD4 leukopenia
c) reverse CD4/CD8 ratio
d) poor response to tetanus and diptheria vaccines
e) poor response to TB skin test

A

d) poor response to tetanus and diptheria vaccines
(can have a reduced response, but this is the most correct answer)

  • 2019 - we said hypogam.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

8 year old girl with fever, nausea, vomiting, diarrhea, malaise and mild jaundice upon returning from Mexico. Labs show AST >1,000. Which of the following is true
regarding her return to school/day care?
a. she can’t return for 1 week
b. she can’t return until she’s feeling better
c. she can return if everyone is toilet trained
d. as long as they wash their hands there, she can go back immediately

A

a. she can’t return for 1 week

Hep A - out of school for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

You are called by the nursing staff in the newborn nursery that you are covering that night. A neonate had blood cultures taken in the context of deterioration earlier that day. The culture is growing gram positive rods. You will ensure that the baby is on which of the following antibiotics?

a) Ampicillin
b) Cloxacillin
c) Gentamycin
d) Septra

A

a) Ampicillin

This is Listeria (gram + bacilli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

You see a 4 year old child with a history of an enlarged left axillary lymph node for the past 14 days which is slowly enlarging in size. He has not been traveling outside the country. On examination the node is soft, mobile and mildly tender but there is no overlying redness. He is afebrile and there is no obvious skin infection over the left arm. What investigation is most likely to confirm the diagnosis:

a. Bartonella hensellae serology
b. PPD testing
c. Excisional biopsy

A

a. Bartonella hensellae serology
- self limited
- axillary lymph node common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

A pregnant women comes into contact with a child with parvovirus during her twelfth week of pregnancy. You would recommend:

a. isolate woman from child
b. perform parvovirus serology on the woman
c. IVIG
d. Abortion

A

b. perform parvovirus serology on the woman

- look for susceptibility (may have immunity) and evidence of acute infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

AOM 3 year old 39.1 degrees, red bulging tympanic membrane. Severe pain. Management plan

a) Amox 75-90mg/kg BID x 5 days
b) Amox 75-90mg/kg BID x 10 days
c) Rx for above to be filled in 24 hours if still symptomatic of rebrile
d) Reassess in 24-48 hours.

A

a) Amox 75-90mg/kg BID x 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

A child has Campylobacter cultured from his stool. He is toxic. Which antibiotic:

a) PO Erythromycin
b) PO Septra
c) PO Flagyl
d) IV Ampicillin
e) no antibiotics

A

a) PO Erythromycin
- gram negative bacilli
- leading cause of acute diarrhea worldwide
- treat if severe or risk of severe disease (pregnant, immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are two antibiotics that are effective against lyme disease (2)? When is IV and treatment indicated?

A
    • doxycycline (kids 8+ years)
      - amoxicillin
      - cefuroxime
  2. ceftriaxone/pen G for endocarditis, meningitis, encephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

A woman has recently immigrated from China to Canada and has just delivered a healthy term infant. She does not know her hepatitis B status, but the results will be available in 2 days. What will be your management:

a) await results of HBsAg before treating infant
b) give HBIG now, but await results of HBsAg before giving Hep B vaccine or allowing breastfeeding
c) give Hep B vaccine now and allow breastfeeding
d) give HBIG and Hep B vaccine now; do not allow breastfeeding
e) give HBIG and Hep B vaccine now; allow breastfeeding

A

c) give Hep B vaccine now and allow breastfeeding

  • unknown status: Hep B vaccine at birth, if mom ultimately tests positive give HBIG within 1 week of life
  • if baby <2000g give Hep B vaccine and HBIG at birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

15 year old with h. pylori. You should treat with:
A) h2 blocker
B) amox, clarithro and proton pump inhibitor
C) clarithro and h2 blocker
D) amox and proton pump inhibitor

A

B) amox, clarithro and proton pump inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

A 13 y.o. boy with HIV is diagnosed with measles. The only proven treatment is:

a) Acyclovir
b) Vitamin A
c) Inhaled amantadine
d) Vitamin E

A

b) Vitamin A (more severe disease if vit A deficient)
● WHO recommends Vit A for treatment of all children
with measles
o Daily for 2d
o 50 000 IU <6m
o 100 000 IU 6-11m
o 200 000 IU >12m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Which of the following should get Prevnar? (were they meaning Pneumovax? ie PCV23?)

a) 5 y/o with sickle cell disease who had Pneumovax already
b) 5 y/o with chronic asthma on daily inhaled fluticasone for the past year
c) 2 y/o with recurrent otitis media
d) 3 year old with well controlled type 1 DM
e) 2 y/o who stays at home

A

b) 5 YO chronic asthma on inhaled steroids

Reasons for PCV23:
Non-Immunocompromised reasons:
Chronic cerebrospinal fluid (CSF) leak
Chronic neurologic condition that may impair clearance of oral secretions
Cochlear implants, including children and adults who are to receive implants
Chronic heart disease
Diabetes mellitus
Chronic kidney disease
Chronic liver disease, including hepatic cirrhosis due to any cause
Chronic lung disease, including asthma requiring medical care in the preceding 12 months

Immunocompromising conditions
Sickle cell disease, congenital or acquired asplenia, or splenic dysfunction
Congenital immunodeficiencies
Immunocompromising therapy
1, including use of long-term corticosteroids, chemotherapy, radiation therapy, and post-organ transplant therapy
HIV infection
Hematopoietic stem cell transplant (recipient)
Malignant neoplasms including leukemia and lymphoma
Nephrotic syndrome
Solid organ or islet transplant (candidate or recipient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

A child is seen in your clinic as a follow-up post hospital discharge. She was admitted for several days with Kawasaki Disease, for which she received IVIg. Her mother mentions that she is due for her DTaP-Hib booster. When can she receive it?

a) In 11 months
b) Now
c) In 4 weeks
d) In 8 weeks

A

b) Now

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

A 6 year old boy presents to the family doctor with an eczematous rash. On exam he looks unwell and is tachypneic. He has a large rash with scaling at the edges. On eye exam he has miliary conjunctivitis. His mother says that he has joint pain in the morning and he has a knee effusion on exam. His bloodwork reveals eosinophilia, with leucopenia with normal calcium. He also has hilar nodes on his chest X-ray. What is the cause of his symptoms. (2008 MCQ)

1) Miliary TB
2) Cryptococcosis
3) Blastomycosis
4) Sarcoidosis

A

4) Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Child with CP, has a fluid-filled thing in his lung surrounded by an area of

consolidation. History of recurrent aspiration. What is this?
a. CLE (congenital lobar emphysema)
b. pulmonary abscess
c. pulmonary sequestration

A

b. pulmonary abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Wheezing toddler with URTI symptoms. Which is a proven therapy?

a. O2
b. racemic epi
c. iv steroids
d. bronchodilators

A

a. O2

assuming bronchiolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Kid with 1.5X2cm LN in the supraclavicular fossa for a few

days. NO overlying erythema. P/E otherwise normal. Most helpful test?
a. Excise LN
b. Bartonealla Henselae serology
c. Monospot/EBV serology
d. TB skin test

A

a. Excise LN

- LN biopsy is contraindicated if there is evidence of overlying infection - rule out leukemia/lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Women in labor with genital herpes, list 4 risk factors for transmission to infant.

  • If you’re going to investigate: when and what tests?
A
  • first episode of herpes for mom (primary infection)
  • prolonged rupture of membranes
  • vaginal delivery
  • use of instrumentation in delivery (forceps, vacuum, fetal scalp electrode)

Testing: If asymptomatic, at 24 hours with swabs of mucous membranes for HSV PCR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

A young boy is walking in the street. Suddenly a stray dog, unprovoked, bites him. What do you do with regard to rabies?

a. Prophylaxis
b. Prophylaxis if dog shows signs of rabies
c. No prophylaxis

A

a) treat child prophylactically

- if dog healthy and could be quarantined, could delay prophylaxis and only start if animal became symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What infection is the worst prognosis in HIV for an infant

a) Lymphoid interstitial pneumonia
b) Pneumocystis Carinii Pneumonia
c) Cardiomyopathy
d) Nephropathy
e) Candida

A

b) Pneumocystis Carinii Pneumonia

- PCP is an AIDS defining illness - if present in first 6 months of life is associated with poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

A mother has come in with her 12 month old, and is concerned by the “number of shots” that is getting today. She has read in the paper about how is it bad to expose a child to a large number of “antigens” all at once, and is worried about overwhelming his immune system. What advice can you give to help alleviate this motherʼs worries?

A
  • rigorous vaccine safety system (premarket studies and post market active and passive surveillance looking for rare complications)
  • children are exposed to many more antigens on a daily basis than they will get from the vaccines (food, bacteria, etc)
  • important for safety of child to stay on track with vaccine schedule (highest risk of severe disease when younger)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

A 3 year presents to your office with 3 days of low grade temperature, rhinorrhea, and occasional cough. On exam he looks well and has green crusted nasal discharge. A culture of his nasal secretions is growing small amounts of H. influenzae. What is your treatment:

a. no treatment
b. amoxicillin
c. trimethoprim-sulfmethoxazole
d. ENT consult

A

a. no treatment

- h flu is normal part of respiratory flora in 60-90% of children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Otitis media → complications of “watch and wait” approach

a. Bacteremia
b. Mastoiditis
c. Prolonged fever
d. Prolonged pain

A

c. Prolonged fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Child with fever, purulent nasal drainage x 14 days. What to treat him/her with?

a. amoxicillin
b. Keflex

A

a. amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

9 yo immigrated to Canada. NO previous immunizations. What 2 immunizations would you give on first visit?

A

Tdap-IPV (for sure)
and MMRV or
Men-C (kids 7-17)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

A child with marked eosinophilia is suspected of having visceral larva migrans (toxocariasis). Physical examination would likely reveal:

a) splenomegaly and lymphadenopathy
b) hepatomegaly
c) serpiginous rash
d) arthralgias
e) myalgias

A

b) hepatomegaly
Toxocariasis
o Roundworms of dogs/cats especially puppies/kittens
o Visceral
▪ Fever, leukocytosis, eosinophilia, hypergammaglobulinemia, wheezing, abdominal pain, hepatomegaly ▪ Malaise, anemia, cough, pneumonia, myocarditis, encephalitis, hemorrhagic rash, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Child admitted with known RSV bronchiolitis. On third day of his admission, develops a fever and CXR shows a small RML infiltrate. What is the most likely cause of his fever?

a. Strep pneumo
b. Chlamydia trichamotas
c. RSV
d. GBS

A

c. RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Mother who is HBsAg positive. Management of newborn should consist of:

a. Hep B vaccine only
b. Hepatitis titres and if negative, Hep B vaccine in 1 week
c. Hep Ig q monthly if breastfeeding
d. Hep Ig within 12 hours and Hep B vaccine within 12 hours
e. Hep Ig at birth and Hep B vaccine within 7 days

A

d. Hep Ig within 12 hours and Hep B vaccine within 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Adolescent with ascending leg weakness and areflexia. Which of the following infectious agents would you worry about:

  1. Campylobacter jejuni
  2. E Coli
  3. Yersinia
  4. Cryptosporidium
  5. Shigella
A
  1. Campylobacter jejuni

- GBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Mom is IVDU. Her blood work: HEB B + HepC +. Baby’s blood work at 6 mo, hep B and hep C ab negative. What to do:

a) Repeat Hepc in 6 months
b) No further investigations
c) PCR

A

b) No further investigations

- negative Hep C ab in child of any age indicates transmission did not occur

120
Q

A boy has had a 5 day history of varicella lesions, now presenting with fever, tachypnea, and increased work of breathing. On examination, there is bilateral crackles. What is the cause of his distress?

a) myocarditis
b) pneumonia
A

b) pneumonia

121
Q

2 year old fully-immunized girl fell on playground and has a deep arm laceration. After laceration has been cleaned and sutured, what further management?

  1. Tetanus toxoid
  2. Tetanus toxoid and immune globulin
  3. Antibiotics
  4. Nothing
A
  1. Nothing - fully immunized. Clean wound.
122
Q

6 mo baby of IV drug user. Mom is Hep C-positive. Baby’s anti-HepBs positive and anti-HCV positive. What do you do?

a. no further testing
b. repeat anti-HCV in 6 months
c. do HCV RNA PCR now
d. P24 antigen

A

b. repeat anti-HCV in 6 months
- HCV serology not reliable in infants because can reflect mom’s antibodies
- test at 12-18 months; if positive repeat testing in 6 months (if seropositive after 18 months, they are infected)

123
Q

Child with pulmonary findings, eosinophilia, slightly elevated calcium (2.8)

a. miliary TB
b. sarcoidosis
c. cryptococcus
d. blastomycosis

A

ANSWER: b. sarcoidosis = lung (non-caseating granulomas) + hypercalcemia + eosinophilia - non infectious

a. miliary TB lung + hypercalcemia
c. cryptococcus lung + eosinophilia + hypercalcemia? (but often in immunocompromised)
d. blastomycosis lung +eosinophilia (+ hypercalcemia in dogs)

124
Q

A newborn baby comes in for a routine care visit. In terms of the 13 valent pneumoccocal vaccine, what is the routine schedule for it? (1) - question used to be about 7 valent which is no longer used

A

Schedule across Canada is 2, 4, 12 months almost everywhere (different in territories)

125
Q

Teenage male treated for Chlamydia with azithromycin. When can he resume sexual activity?

a) once he has completed his medication
b) once his partner is treated
c) after seven days after completing treatment
d) once his symptoms appear to have resolved

A

c) after seven days after completing treatment

if same partner, then also after 7 days after partner completes treatment

126
Q

Baby born with rash, cataracts, bone lesions, big liver (photo of baby shown) most likely has:

a. Congenital syphilis
b. Congenital CMV
c. Congenital rubella

A

c. Congenital rubella

cataracts - rubella; chorioretinitis - CMV

127
Q

A child with marked eosinophilia is suspected of having visceral larva migrans (toxocariasis).
Physical examination would likely reveal:
a) splenomegaly and lymphadenopathy
b) hepatomegaly
c) serpiginous rash
d) arthralgias
e) myalgias

A

b) hepatomegaly

Classic VLM: eosinophilia, fever, hepatomegaly.

Fever, cough, wheeze, bronchopneumonia, anemia, hepatomegaly, leukocytosis, eosinophilia, +ve Toxocarai serology.
Tx: albendazole

128
Q

Complications of neonatal gonococcal eye infections include:

a. retinal hemorrhage and blindness
b. corneal perforation and blindness
c. anterior uveitis and fixed pupil
d. glaucoma

A

b. corneal perforation and blindness

129
Q

Name 4 drugs with pseudomonas coverage

A
  • pip-tazo
  • cefuroxime
  • aminoglycosides (gent, tobra)
  • cipro
130
Q

Mom has husband who lived in Brazil up to 12 months ago, babe comes out looking well with a normal head circumference, weight and length. Normal physical exam. What testing do you do on the NEWBORN?

a) Zikv PCR in blood and urine of babe and head u/s
b) MRI babe
c) ZIKV serologies
d) Do nothing

A

d) Do nothing

131
Q

Boy with unilateral eye conjunctivitis symptoms. Mom and classmate also had symptoms last week. Treatment?

a) supportive tx
b) topical Abx.
c) PO abx

A

a) supportive treatment

132
Q

A 3 year with 5 days low grade temperature, rhinorrhea, occasional cough. On exam he looks well, has green crusted nasal discharge. Mom has been giving acetaminophen 6 to 7x/day. Next test:

a) Sinus x-rays and treat if fluid level present
b) treat with amoxil
c) consult with ENT
d. counsel on Tylenol dosing and risk of too much acetaminophen

A

d. counsel on Tylenol dosing and risk of too much acetaminophen

133
Q

A 15 year old male with strep throat presents two weeks later with unusual movements of his head and shoulders. What of the following is the likely cause?

1) Rheumatic fever
2) Transient tics
3) Tourette syndrome
4) Complex partial seizures

A

1) Rheumatic Fever

134
Q 
A 6 year old presents with an erythematous lesion on the back and arthritis. He has been camping with his family recently in the U.S. You diagnose Lyme disease. What
should he be treated with?
a) PO doxycycline
b) IV ceftriaxone
c) PO amoxicillin
A

c) PO amoxicillin
- under 8 - amox, 8+ - doxycycline
- IV treatment for heart block, carditis, meningitis or encephalitis

135
Q

Description of a child who is having multiple episodes of otitis media and pneumonia. Lab results given are IgG 8 (normal), IgM normal and IgA 0.01 (decreased). What important piece of advice would you warn this child
about?

A

Selective IgA deficiency

- at risk of anaphylactic reactions to transfusion of blood products

136
Q

Newborn to a mum who has recently come from Vietnam. Her Hepatitis B status is unknown however her serology results will be back in two days. What do you do with
infant?
a) immunize with Hep B vaccine and if results from mum are positive, give Hep B IG at that time
b) Immunize with hep B vaccine and hep B IG now
c) Hep B IG now
d) HBIG now and Hep B vaccine later if mum positive

A

a) immunize with Hep B vaccine and if results from mum are positive, give Hep B IG at that time
- Hep B vaccine should be given within 12 hours of birth
- HBIG ideally within 12 hours, but within 7 days acceptable if waiting for mom’s results

137
Q

Child had a URTI a week ago. He now presents with bloody diarrhea, abdominal pain and a petechial rash . What is his diagnosis?

A

Henoch Schonlein Purpura

We has said HUS previously - but less likely with a URTI as the trigger unless they have the genetic form of HUS. Can develop it post streptococcus but more likely to have pneumonia, empyema and bacteria.
They’re also not giving you any of the acute renal stuff in this stem.

138
Q

Two siblings present to your care for influenza immunizations, ages 1 and 3. They are health, except the 3 year old, who had a moderate asthma exacerbation requiring 5 days of steroids 1 month ago.

Regarding the intranasal influenza vaccine:

a) it is indicated for both children
b) it is indicated for the 1 year old, but not for the 3 year old
c) it is indicated for the 3 year old, but not for the 1 year old
d) it is contraindicated for both children

A

c) it is indicated for the 3 year old, but not for the 1 year old

LAIV not indicated for <2 yrs
LAIV is also contraindicated for individuals with severe asthma (defined as current active wheezing or currently on oral or high-dose inhaled glucocorticosteroids, or medically attended wheezing within the previous 7 days) and during pregnancy. LAIV is also contraindicated in children and adolescents, 2 to 17 years of age, who are receiving chronic acetylsalicylic acid-containing therapy, because of the association of Reye’s syndrome with acetylsalicylic acid given during influenza infection.

139
Q

2 year old with known neisseria infection. How to treat the unvaccinated sister

a) Rifampin and immunize
b) Rifampin alone
c) MCVC alone
d) Rifampin and MCVC

A

a) Rifampin and Immunize

140
Q

It is 9 am and child is in your office, lice are detected. When can they go to school?

a) Immediately
b) After first treatment
c) After no more nits
d) After no more adult lice

A

a) Immediately

CPS - doesn’t need to be treated before going to school (but avoid rubbing heads together ;))

141
Q

Which of the following is the most common side effect of the varicella vaccine?

a. chickenpox
b. flu-like symptoms
c. herpes zoster
d. fever

A

d. fever
- pain, redness and swelling at injection site are actual most common side effects
- rash and fever may not appear until up to 2 weeks after the injection

142
Q

4 yr old with AOM treated with Amox-Clav (4:1 ratio) and develops loose watery stools. What is your dx

b) viral gastro
c) improper dosing/ratio or amox-clav
d) C.diff

A

b) improper ratio

143
Q

Pneumonia RLL non toxic, best treatment, 10 year old boy

a) Cefotaxime and Erythromycin
b) Ampicillan
c) Cefotaxime
d) PO azitro

A

b) Ampicillin

144
Q

Mother has herpes labialis. What do you advise regarding her 4 day old infant?

a) wear mask when breastfeeding
b) apply topical acyclovir to lesion
c) stop breastfeeding
d) infant needs IV acyclovir

A

a) wear mask when breastfeeding

145
Q

6 y/o boy with 2 weeks of sudden onset of OCD behaviours. Which infectious agent would you be concerned about:

  1. Strep pneumonia
  2. Group A Strep
  3. E. Coli
  4. H. Flu
  5. Echovirus
A
  1. Group A Strep

(PANDAS)

146
Q

PANDAS would be suspected in a child with

a. recurrent Sydenham’s chorea
b. new onset of tics after a group A strep infection
c. pancreatitis and depression after strep A infection

A

b. new onset of tics after a group A strep infection

147
Q

12 month old who is toxic with a lobar infiltrate. Which antibiotic do you use:

  1. IV Cefuroxime and IV Erythromycin
  2. IV Vancomycin
  3. IV Ampicillin
  4. PO Amoxicillin
  5. PO Clarithromycin
A
  1. IV Ampicillin
    - ceftriaxone for life threatening infection/shock
    - if rapidly progressing multi lobar pneumonia add vance for MRSA
148
Q

Varicella. With nec fash/or purpura fulminans. What is your management:

a) vanc cefotax
b) pen G and clinda
c) amp gent

A

b) pen G and clinda

149
Q 
8 year old presents with bilateral conjunctivitis received topical antibiotics with no improvement. Does not describe pain but a sandpaper feeling and associated photophobia and tearing. On exam he has pseudomembrane keratoconjunctivis
What is the most likely diagnosis?
1. allergic conjunctivitis
2. Uveitis
3. Bacterial conjunctivitis
4. Adenovirus keratoconjunctivitis
A
  1. Adenovirus keratoconjunctivitis
150
Q

An HIV positive mother has been compliant with triple antiretroviral therapy throughout her pregnancy. Her viral load has been undetectable for a long time. What is the risk of perinatal HIV transmission?

a) 1%
b) 10%
c) 25%
d) 75%

A

a) 1%

25% - Rate with no intervention

151
Q

2 year old child with fever for the past 2-3 weeks (up to 39 C), lymphadenopathy and mild hepatosplenomegaly presents complaining of joint pain. There is no true arthritis, but complains of pain with movement of joints. Hgb 91, WBC 9 (45% lymp, 55% PMN), platelets of 110. What is your next step in establishing diagnosis?

a. BMA
b. Blood culture
c. ANCA, ESR and RF
d. EBV serologies

A

a. BMA

152
Q

2 year old with fever and right ear pain. She was treated with clarithrymycin a few weeks ago for a respiratory infection. ON exam has an otitis media. What are three possible antibiotics for her (3)

A
  • amoxicillin
  • amoxicillin-clavulanic acid (if you think h. flu or moraxella)
  • cefuroxime-axetil
  • cefprozil
  • ceftriaxone
  • Less great: Clinda, Azithromycin
153
Q

Picture of baby with rash: told cataracts, microcephaly, hepatosplenomegaly, bony changes

a) Syphilis
b) CMV
c) Rubella
d) toxoplasmosis

A

c) Rubella

- hearing loss, cataracts, MR, IUGR, hepatitis, osseous changes, cardiac defects

154
Q

3 month old girl has an 18 month old brother who got meningococcemia. What would be your management. (2008 MCQ)

1) Provide Ciprofloxacin
2) Provide rifampin
3) provide rifampin plus menjugate
4) Provide menjugate

A

3) provide rifampin plus menjugate

155
Q

HPV vaccine what does it reduce

  • Genital warts
  • Prevents cervical cancer
  • Prevents uterine cancer
  • Transmission of warts
A
  • Genital warts
156
Q

A 4 year old child comes to your Emergency department with a history of a fever for 3 days. You do a CBC and find that the WBC count is low at 3.2.

a. What is the most common reason for this clinical scenario?
b. On a differential, which cell line, if low, increases the risk of serious infection?

A

a. viral suppression

b. neutropenia

157
Q

Child presents with ataxia and inability to sit up two weeks after having chicken pox.
A) What is the diagnosis?
B) How do you differentiate this from meningoencephalitis? List three.

A

A) acute cerebellar ataxia
B) no fever, no nuchal rigidity, no altered LOC, no seizures, CSF normal or shows mild lymphocyte pleocytosis vs meningitis which shows PMN pleocytosis

158
Q

Child develops rash on both cheeks. Then a reticulated lacy rash is seen on his body. His mother is pregnant. What infection does this child have (1) How would you manage the mother (1)?

A

Parvo B19

- serologies for mom

159
Q

6 mo baby of IV drug user. Mom is Hep C-positive. Baby’s anti-HepBs positive and anti-HCV positive. What do you do? (2009 MCQ)

a. no further testing
b. Repeat anti-HCV in 6 months
c. do HCV RNA PCR now
d. P24 antigen

A

c. do HCV RNA PCR now

160
Q

What is the most appropriate treatment for headlice when there is known resistance?

  1. Dimeticone solution
  2. Permethrin
  3. Pyrethrin
  4. Isopropyl-myristate/Cyclomethicone
A
  1. Permethrin (Nix)

Remain first line. If 2 treatments do not eradicate live lice, consider full treatment using another class

161
Q

Child appears toxic and has lobar pneumonia. What antibiotics should be used?

a) PO Amoxil
b) Cefuroxime IV
c) Cefuroxime IV and Azithromycin PO
d) Vanco and ampicillin

A

b) Cefuroxime IV - best of available; really IV amp is best

162
Q

List 3 common causes of neutropenia

A
  • transient viral suppression of bone marrow
  • drug induced marrow suppression (antipsychotics, antidepressants, some antimicrobials)
  • chronic benign neutropenia of childhood
  • primary autoimmune neutropenia
  • cyclic neutropenia
  • kostmann syndrome
  • schwachman diamond
  • secondary autoimmune (SLE, Crohn’s, RA) - destruction by autoantibodies
163
Q

A 3 year old girl with fever, arthralgia and lethargy for 10 days has lymphadenopathy, moderate hepatosplenomegaly, no obvious arthritis but screams in pain with minimal examination. WBC 9.5 Hgb 98 Plts 140, smear Normal. Next test:

a) bone marrow aspirate
b) EBV titers
c) follow

A

a) bone marrow aspirate

164
Q

A 10-year-old child has completed a 2-week course of oral erythromycin as treatment for pertussis. His mother complains that her child is still coughing. You advise:

a) chest x-ray
b) ventolin
c) oral prednisone
d) another 14 days of erythromycin
e) reassure that nothing further needs to be done

A

e) reassure that nothing further needs to be done

- 100 day cough

165
Q

A child is brought to see you with 3 days of high fever of 40.1 degrees and feeling unwell. The only thing you see on physical exam is clear rhinorrhea. A CBC shows the following : Hb 118, WBC 2.0 x 10^9 (2000/m3), platelets of 250. The differential shows neutrophils 2%, lymphocytes 70%, eosinophils 8%. What are TWO things that you will do in the management of this child?

A

Febrile Neutropenia

Blood Culture
IV ABx (Pip-Tazo)
Admit to hospital

Our previous answer…
Viral infection - ensure adequate fluid intake, analgesia and antipyretics for comfort

166
Q

Neonate born to mom who just revealed HIV positive status.

a) What treatment would you start?
b) When would you start the treatment?
c) For how long?

A

a) Start Zidovudine and nevirapine.
b) Within 12 hours of birth
c) Zidovudine x 6 weeks
Nevirapine x 3 doses in first week (2nd dose 48h after first, 3rd dose 96h later0

167
Q

What are the current recommendations regarding HPV vaccination?

a) Immunize girls only, whether sexually active or not
b) Immunize sexually active girls only
c) Immunize girls and boys, whether sexually active or not
d) Immunize sexually active girls and boys only

A

c) Immunize girls and boys, whether sexually active or not

168
Q

An 8mo old Caucasian child presents to the ER with a 24h history of fever. His temperature is 39.2 degrees. His immunizations are up to date. He has no travel history. He is otherwise asymptomatic. On exam, he is a happy, smiling child with appropriate vital signs aside from the temperature. What is the next best step?
A) Admit for IV antibiotics
B) Do a CBC and blood culture
C) Give a dose of ceftriaxone and discharge home
D) Discharge home with follow-up the next morning

A

D) Discharge home with follow-up the next morning

  • should check a urine culture
  • if not immunized need to be more conservative (CBC and culture, abs if WBC >15)
169
Q

How do you confirm the diagnosis of infective endocarditis?

A

Duke Criteria
Definite - 2 major + 1 minor, or 1 major and 3 minor, or 5 minor
Major:
- positive blood culture x2
- endocarditis - vegetation on echo, abscess or new valvular regurgitation on exam

Minor

  • fever >38
  • immunologic phenomena (GN, Osler)
  • Vascular phenomena (laneway, conjunctival hemorrhage, Roth spots)
  • Evidence of microbiologic change
  • Risk factors (eg. CHD)
170
Q

A 7 year old child has just returned to Canada from sub-Saharan Africa. She has fever and chills. List 3 common causes of her symptoms.

A
  • malaria
  • typhoid fever
  • dengue fever
  • viral illness
171
Q

Which of the following maternal infections is a contraindication to breast feeding?

a) Hep A
b) Hep B
c) CMV
d) HIV

A

d) HIV

172
Q

Child camping in New Brunswick. Had an expanding skin lesion with central clearing in axilla. Now he has fever, myalgia, malaise and chills but no other symptoms. What is the likely diagnosis. Name 3 systems involved and their specific involvement.

A
  1. lyme disease
  2. skin - erythema migrans

CNS - facial nerve palsy, meningitis, peripheral neuropathy

heart - lyme carditis, heart block

MSK - oligoarticular arthritis

173
Q

4 month old with meningitis, LP shows gram pos cocci, what drugs to use.

a) cefotaxime and vanco
b) cefotaxime and dexamethasone
c) ampicillin and gentamicin

A

a) cefotaxime and vanco

According to AAP - its all ceftriaxone and vanco above 1 month (consider + amp for listeria)

174
Q

Child presents with bloody diarrhea, anemia and thrombocytopenia. What is the diagnosis?

A

Hemolytic uremic syndrome

- triad: microangiopathic hemolytic anemia, TCP, renal insufficiency

175
Q

12 month girl is diagnosed with otitis media by her family doctor. She is started on amoxil 80 mg/kg/day and returns to you three days later still febrile. Her tympanic membrane is red and bulging. She appears well. What antibiotics should you give her:

a. Amoxil/clavulinic acid-
b. Cefuroxime
c. Ceftriaxone
d. Clarithromycin

A

a. Amoxil/clavulinic acid-

176
Q

What are THREE indications for giving the conjugated quadrivalent vaccine for meningococcus?

A
  • functional or anatomic asplenia
  • complement deficiencies
  • travel to country where meningococcal disease is hyper endemic or epidemic
  • HIV
  • Contact of IMD with serotype covered by vaccine
177
Q

Child post bone marrow transplant. Significant exposure to varicella.
A) What therapy do you give him?
B) What is the time frame for this therapy to be effective?
C) How long do you isolate this patient from other immunocompromised patients?

A

A) VZIG
B) as soon as possible - ideally within 96 hours but can give up to 10 days after exposure
C) isolate from day 8-21 days

178
Q

With respect to steroid use in bacterial meningitis:

a) little is know about its effect
b) needs to be given within 30 minutes of first dose of antibiotics
c) helps the antibiotics penetrate the brain
d) reduces incidence of hearing loss following infection

A

d) reduces incidence of hearing loss following infection
- should be given before first dose of antibiotics, at same time or within 30 minutes
- decreases hearing loss with Hib, and maybe strep pneumo
- continue if culture positive for Hib or s pneumo

179
Q

Nephrotic syndrome has peritonitis what is most likely org:

a) Strep pneumo
b) Ecoli
c) Enterococus
d) B fragilis

A

a) Strep pneumo

- increased risk of infection with encapsulated bacteria (since lose complement and immunoglobulins)

180
Q

Which of the following infections causes eosinophilia?

a. Giardia lamblia
b. Entamoeba fragilis
c. Ascaris lumbricoides
d. cryptosporidium
e. pinworms

A

c. Ascaris lumbricoides
- giardia and cryptosporidium are protozoa not helminths
- hallmark of helminths is eosinophilia

181
Q

You are trying to set up an infection control program in your hospital. Which intervention will result in the best form of infection control for RSV?

a) Hand wash with soap and water
b) Gown and glove
c) Hand wash with alcohol
d) Isolate everyone with respiratory symptoms

A

c) Hand wash with alcohol
waterless hand hygiene products save time and improve compliance and are therefore the recommended method of hand hygiene if hands are not visibly soiled

182
Q

A 6-year-old boy with acute lymphocytic leukemia completed a course of chemotherapy 1 month ago. He has a household contact with chickenpox, and he has never had it before. Management:

a) isolate the patient and observe for symptoms
b) IM VZIG
c) IM VZIG + oral acyclovir
d) Admit + IV acyclovir
e) Admit + IM VZIG + IV acyclovir

A

b) IM VZIG
- no evidence that acyclovir works for immune compromised children (is given prophylactically to immune competent children 7 days after exposure)
- vaccine within 3 days ideally but up to 5 days after exposure for immune COMPETENT people, 12+ months who do not have varicella immunity (no varicella vaccine for immune suppressed people)

183
Q

Kid with varicella, now has a deep bluish lesion to his leg, very painful, looks unwell, high fever. What antibiotics do you start?

a. penicillin, clindamycin
b. pipercillin, tazobactam
c. ampicillin, cefotaxime
d. vanco, cefotaxime

A

a. penicillin, clindamycin - good if documented GAS
- varicella gangrenosa (necrotic lesions)/necrotizing fasciitis

  • other abs regimens: vanco + pip/tazo or ceftriaxone + flagella
184
Q

You are seeing a full term newborn born to a 25 year old mother with a history of genital herpes diagnosed 5 years ago. She had no active lesions at the time of
delivery and thus was untreated. The baby was born by SVD. a. What is your management of the newborn (1 line)?

A
  • observe for signs of neonatal HSV and educate parents about what to look for. No swabs or other investigations indicated in this case
185
Q

Photo shown of antecubital fossa demonstrating Pastia’s lines. Etiology:

a) staph
b) strep
c) roseola
d) rubeola
e) rubella

A

b) strep

186
Q

Give 2 examples of patients who should get pneumovax (pneumococcal polysaccharide 23 talent vaccine)

A
  • cyanotic heart disease/CHF
  • CLD, including asthma with chronic high dose oral corticosteroids
  • DM
  • CSF leak, cochlear implant
  • functional/anatomic asplenia
  • immunocompromise: HIV, chronic renal failure, immunosupp drugs for cancer/AI disease, primary immune deficiency
187
Q

Treatment of Lyme disease in a 6 year old:

a. clarithromycin
b. amoxicillin
c. doxycycline
d. erythromycin

A

b. amoxicillin

188
Q

Premature baby. You are counseling mom about the risks of Transfusion. Which infection is the highest risk:

a) HIV
b) HEPB
c) CMV
d) HepC

A

b) HEPB
- HIV 1/8-12 million
- Hep C 1/5-7 million
- Hep B 1/1.1-1.7million
- should request CMV negative blood for premature baby

189
Q

Which vaccine is contraindicated in egg allergic patients?

a. Pertussis
b. Influenza
c. Varicella
d. Polio
e. MMR
f. Hib
g. yellow fever

A

g. yellow fever (not to egg or chicken allergic patients)

  • b. Influenza (yes egg but new CPS statement says fine)
  • trace amounts of egg protein in flu, MMR, MMRV, rabies vaccines
  • intranasal influenza vaccine should not be given to egg allergic patients because there is no safety data
190
Q

What is the best test for HSV encephalitis?

a) PCR on CSF
b) Viral culture of CSF
c) HSV IG in CSF
d) Differential on CBC

A

a) PCR on CSF

191
Q

4 y.o. with chronically draining cervical node. Most likely bug:

a. Staph Aureus
b. Atypical mycobacterium
c. Cat scratch
d. Tuberculosis

A

b. Atypical mycobacterium

192
Q

Robert is a 6 year old boy with Varicella. In the last 24 hours he has become unwell. On exam, his temperature is 40, HR 140, BP 95/60, RR 24. He has obvious lesions consistent with chicken pox. He has a red, swollen left arm that is tender.

a) Outline a prioritized differential diagnosis.
b) Outline your initial investigations.
c) Outline your management plan.

A 
a) Ddx:
● infected rash = cellulitis,
● Cellulitis ddx: abscess, osteomyelitis
● Nec Fas
b) Ix:
- CBCD, CRP, blood culture
c) mgmt: admit and IV cefazolin
193
Q

15 year old male immunocompromised in a hot tub afterwards develops folliculitis and enlarged lymph nodes. Name the organism.

A

hot tub folliculitis - pseudomonas

194
Q

Apnea and pneumonia are common complications of pertussis in infants. This is not true of adults and adolescents.

  1. List 2 presentations of pertussis in adults and adolescents.
  2. What is the main reason for instituting a generalized immunization program for pertussis in adolescents?
A
  1. Catarrhal: mild URTI symptoms followed by Paroxysmal stage: prolonged cough lasting >21 days
  2. immunity from primary series wanes in adolescents so booster protects herd immunity and infants who have not yet been vaccinated. Reduce burden of disease.
195
Q

A mother brings her 3 children to your office because she thinks they all have strep throat. The 18-month-old and 2½ -year-old both have exudative tonsillitis. The 4-year-old has a red pharynx and mild anterior cervical lymphadenopathy.
a) no treatment is necessary now; reassess in a few days
b) treat all 3 children with penicillin V tid x 10 days
c ) take throat swabs and await the results before treating
d) take throat swabs and treat empirically with penicillin V
e) take throat swabs and do CBCs; if increased WBC then start penicillin V

A

c ) take throat swabs and await the results before treating

196
Q

A 6-month old whose mother is anti-HCV+ and HCV-RNA+, baby is anti-HCV+, asymptomatic, normal exam. What is the best management of the baby?

1) Repeat anti-HCV in 6 months
2) Transaminases
3) Refer for liver biopsy
4) Obtain HCV-RNA

A

Obtain HCV-RNA (or follow up with Ab at 18 mo of age)

197
Q

Treating an eye infection with cipro drops, still not improving at 36 hours. Mom and sibling had this, plus lots of kids at school. What to do?

a. change to po cipro
b. reassess in 48 hours
c. IV antibiotics
d. Consult ophthalmology

A

Reassess in 48 hours

198
Q

Head lice - which one is least likely to increase resistance?

a. permethrin 1%
b. R&C
c. lindane
d. Resultz shampoo

A

d. Resultz shampoo (isopropyl myristate)
- R&C = pyrethrin - same resistance to permethrin and pyrethrin
- lindane - high failure rate and potentially neurotoxic
- per CPS, increasing resistance to pyrethrin, permethrin and lindane

199
Q

3 week old with RSV, day 2 of admission. Fever of 39. RML infiltrate that was new.

a) cefotax
b) amp and gent
c) supportive management

A

b) amp and gent

- because fever in <1 month

200
Q

12 m with crusty yellow discharge from Left eye and conjunctivitis. Normal visual acuity, no proptosis, no periorbital swelling, normal EOM. You prescribe cipro topical drops. At 36 h exam, unchanged. What is your next step?

a. Refer to ophto
b. Prescribe IV antibiotic
c. Continue and return in 48 h
d. Prescribe fucidic acid drops

A

c. Continue and return in 48 h

201
Q

An infant born at 31 weeks gestation is now 2 months old, but has never left the hospital. What should be done about the immunizations:

a) delay immunizations until discharge
b) start routine immunization schedule at 8 weeks corrected age
c) give DTaP, hemophilus influenza conjugate, and IPV now
d) give DtaP, hemophilus influenza conjugate, and OPV now
e) give half dose of DTaP and IVP now and repeat in one month

A

c) give DTaP, hemophilus influenza conjugate, and IPV now

202
Q

6 year old girl has recent history of gastroenteritis. She develops bilateral decreased sensation in her feet. Her respirations are normal. What is her diagnosis (1)? What test or procedure would you do and what are your expected findings? What is the likely organism that caused her gastroenteritis (1)?

A
  1. guillain-barre syndrome
  2. LP - elevated protein (>2x ULN), glucose normal, no CSF pleocytosis, cultures negative
    - can also do MRI: thickening of cauda equina and intrathecal nerve roots with gad enhancement
  3. campyobacter jejuni
203
Q

Greek 6 y/o girl with fever to 40 degrees. WBC 38. Pain in the right hypochondrium. Tender in right hypogastrium but no guarding or rebound. What is the diagnosis:

  1. Pleurodynia
  2. Bacterial pneumonia
  3. First presentation of Familial Mediterranean Fever
  4. Fitz-Hugh-Curtis
  5. Cholecystitis
A
  1. Bacterial pneumonia

FMF - episodic attacks lasting 1-3 days; accompanied by abdo pain, pleurisy, arthralgia or arhtritis. Get elevated WBC and CRP.

204
Q

An infant is delivered vaginally to a mother who has untreated gonorrhea. What do you do for the baby?
A) Give one dose of IM Ceftriaxone + conjunctival culture swab
B) Conjunctival culture and treat with erythromycin ointment
C) Conjunctival culture and wait to treat

A

A) Give one dose of IM Ceftriaxone + conjunctival culture swab

205
Q

What is the result of giving rota vaccine?

a) reduce hospitalization
b) reduce mortality
c) helps prevent other non-rota gastro

A

a) reduce hospitalization

206
Q

Asplenic child, febrile, what organisms do you need to cover with your abx?

a. staph aureus, strep pyogenes, group a strep
b. strep pneumo, h flu, n. meningitides
c. nocardia, aspergillus, etc

A

b. strep pneumo, h flu, n. meningitides

* nocardia, aspergillus, etc (cause opportunistic infections in immunocompromised patients)

207
Q

A baby is born by c-section at 6h since membranes ruptured. Mother has active HSV lesions. The baby is asymptomatic. When should cultures of the baby be done?

a. Immediately and start Acyclovir
b. After 48h
c. When the baby is symptomatic
d. Observe only

A

a. Immediately and start Acyclovir

208
Q

Mom ivdu. Early latent syphilis. Titer from 6 months ago and now. They have dropped by 8 times. Baby is born. What do you do to for the baby:

a) Observe
b) Tryponemal screen and RPR
c) CSF RPR
d) Swab baby

A

b) Tryponemal screen and RPR

209
Q

Family comes to you from an area endemic for Lyme disease – What is the organism and vector causing it (2)?

A
  • borrelia burgdoferi; from black-legged ticks
210
Q

Inuit grandmother diagnosed with active TB. His child has a TB skin test which shows 8 mm of induration. What are two possible reasons for this test result (2)

A
  • latent TB infection (in otherwise asymptomatic)
  • indicative of previous BCG vaccine
    Positive test is >5mm in a child with close contact with persons with active TB
211
Q

You diagnosed a toddler with Chicken pox a few days ago. Now he is in your office. Mother tells you he’s refusing to weight bear since this morning. Photo of his foot is shown. Area of erythema over 3 rd -4 th metatarsals and phalanges, with black necrotic looking areas. What is the diagnosis? How will you treat him (4)?

A
  1. Dx: necrotizing fasciitis
  2. mgmt:
    - admit to hospital
    - blood future, CBCD, CRP
    - start pen G and clindamycin IV
    - surgical consult for debridement
212
Q

You are planning to institute a universal vaccination program in your community. List 4 considerations in planning this program.

A
  • which diseases to target
  • effectiveness of vaccine
  • availability of supply of vaccine
  • cost of vaccine
  • ability of the community to adopt and implement a universal program given available resources
  • sufficient personnelle
  • vaccine safety storage
213
Q

15 yo male with severe retropharyngeal abscess, requiring surgical decompression. On day 3, he has new onset headache. What is the most likely cause?

a) meningitis
b) jugular thrombosis
c) migraine

A

b) jugular thrombosis

- thrombophlebitis of internal jugular vein ultimately causing central venous sinus thrombosis

214
Q

4nmo infant. Grandfather, who lives in child’s home has been diagnosed with cavitating TB. How should the infant be managed?

a) Treat with rifampin
b) give BCG
c) Treat with INH
d) Do CXR

A

d) Do CXR
- should have TST or IGRA, physical exam and CXR
- at minimum will be treated for LTBI with INH BUT need CXR to rule out active disease which will change management

215
Q

Chlid with 4+ proteinuria, distended abdo, fever. Most likely organism causing acute abdomen?

a. Ecoli
b. Strep pneumo

A

b. Strep pneumo

- nephrotic syndrome complicated by spontaneous bacterial peritonitis

216
Q

Kid with kawasaki disease. Received IVIG and ASA. Now has massive hematuria. Low haptoglobin. GN picture. High bili and LDH and liver enzymes

1) renal vein thrombosis from thrombocytosis
2) hemolysis from iVIG
3) ASA mediated platelet dysfunction
4) Kawasaki mediated Gn

A

2) hemolysis from iVIG

- passive transfer of antiA or antiB antibodies in IVIG is a known phenomenon and can cause hemolytic anemia

217
Q

What would be an indication to do radiological studies in sinusitis?
a . orbital cellulitus
b. adolescent with no fever and mucopurulent discharge

A

a. orbital cellulitus

218
Q

3yo previously healthy kid with ear pain for one day. One exam, T 37.8C and erythematous, bulging tympanic membrane. Best management?

a) Reassess in 24-48 hours
b) Amoxicillin 45-60 mg/kg/day divided BID x 5 days
c) Amoxicillin 75-90 mg/kg/day divided BID x 5 days
d) Amoxicillin 75-90 mg/kg/day divided BID x 10 days

A

a) Reassess in 24-48h

219
Q

Child sucks on finger. Lesions on finger for 10 days. Finger hurts when mom touches it – picture of a finger with vesicles but also a central area of ulceration, some diffuse erythema of finger. What is your management?

  1. po cephalexin
  2. I & D
  3. po acyclovir
  4. flamazine dressing
A
  1. po acyclovir

Herpetic whitlow - treat with acyclovir if immunocompromised or severely infected; otherwise can do nothing

*we said Cephalexin since it had been > 10 days of symptoms.

220
Q

A full term infant is born by vaginal delivery to a woman with a vaginal herpes lesion. In order to decrease infectivity you would:

a) place baby and mother in same room with no breastfeeding
b) place baby and mother in same room and allow breastfeeding
c) place baby and mother in separate rooms
d) discharge both immediately
e) contact isolation from other patients

A

ANSWER:
e) contact isolation from other patients - until lesions crusted over, 14d infectivity period passed or swabs negative
AND
b) place baby and mother in same room and allow breastfeeding

Mothers who are in hospital should be on contact precautions until their lesions have crusted.

Asymptomatic neonates whose mothers have active HSV lesions should be managed using contact precautions until the end of the incubation period (day 14) or until samples from the infant taken after the first 24 h of life are negative.

do not discharge immediately, await swabs

221
Q

Which virus is associated with transient arthropathy:

a) RSV
b) rubella
c) measles
d) Hepatitis A

A

b) rubella

Transient polyarthralgia and polyarthritis is common in adolescents (RedBook)

222
Q

What are three high risk groups for invasive pneumococcal disease (3)

A
  • functional asplenia
  • structural asplenia
  • humoral immune deficiency
  • HIV
  • DM
  • cochlear implants
  • CSF leak
  • Asthma
  • CKD
  • Hemoglobinopathy
  • Chronic Cardiac or Pulmonary
223
Q

Hep A. When can return to school?

a. 1 wk
b. when no fever
c. if washing hands well
d. when no symptoms

A

a. 1 wk (red book, CPS)

224
Q

What is the most common adverse event related to cephalosporine use?

a) Diarrhea
b) Rash
c) Neutropenia
d) Photosensitivity

A

a) Diarrhea

225
Q

A pregnant woman with syphilis and a RPA of 1:512 receives a full course of treatment and
the titer falls to 1:256. Upon delivery of the child, the next appropriate step is:
a) treat the child as the fall in the titer is inadequate
b) test child’s serum for VDRL and anti-treponemal AB and treat if positive
c) test child’s CSF for VDRL and anti-treponemal AB and treat if positive
d) no treatment is necessary for syphilis but this child should be tested for HIV

A

a) treat the child as the fall in the titer is inadequate

- full work up (blood, CSF, X-ray) and treat

226
Q

What is true regarding the spread of meningococcal disease:

a) household contacts are at greater risk than school contacts
b) penicillin is the drug of choice for prophylaxis
c) Neisseria meningitidis type B vaccine is use to prophylax against school outbreaks
d) healthcare workers should be routinely immunized against Neisseria meningitides
e) a negative NP swab will determine whether or not to treat exposed individuals

A

ANSWER: a) household contacts are at greater risk than school contacts

  • prophylaxis with rifampin, ceftriaxone or cipro
  • mening B vaccine used for lab and military personnel, not routine for school outbreaks
  • decision to treat exposed individuals is based on risk of exposure, not cultures
227
Q

Native girl, received BCG in past, PPD 13mm.

a. ) How do you interpret this?
b. ) What is your approach to treatment? (1 line)

A

a) positive test - in kids who are vaccinated, if they have been exposed to TB or are at high risk for disease the cutoffs for a positive test are the same as if they hadn’t been vaccinated
b) 9 months of isoniazid for LTBI

228
Q

Child was bitten on the hand by a cat 24 hours ago. He has been taking Clavulin, but the hand has become very erythematous and swollen. What do you do?

a) IV Ticarcillin/clavulanate
b) IV Cefuroxime
c) IV Cloxacillin
d) Call Ortho to do Surgical Debridement and irrigation

A

a) IV Ticarcillin/clavulanate (pip-tazo would also work)

2019 - we suggested call orthodox

229
Q 
What are the current recommendations for HPV Vaccine for 15 year old boy
A. 2 doses; now and 6 months later
B. 3 doses; now, then at 1, and 6 months
C. No vaccine 
D. Wait until he's sexually active
A

B. 3 doses; now, then at 1, and 6 months

230
Q

3 year old child, 2-3 day history of viral prodrome, sudden onset this morning of stridor, temperature of 40 degrees. In your ED is anxious but not drooling and very stridorous. There is no significant change with one dose of neb racemic epinephrine. What is the most likely diagnosis:

a. Croup
b. Bacterial tracheitis
c. Retropharyngeal abscess

A

b. Bacterial tracheitis

- high fever, toxic appearance, poor response to nebulized epi

231
Q

31 week GA baby, now 3 mos old. It is October. Parents are non-smokers. Mother planning to stay at home with babe.
A) What one intervention can you do to minimize risk of severe RSV bronchiolitis?
B) How does paluvizumab decrease risk and by what mechanism does it work?

A

A) this baby does not qualify for paluvizumab
- protective factors are: breastfeeding, hand hygiene and not smoking
B) decreases rate of hospitalization in some groups of prem babies (if hospitalized, does not reduce severity or mortality); confers passive immunity (immunoglobulin)

232
Q

A women is diagnosed with chicken pox 10 days prior to delivery. The baby is normal at birth. You would:

a) give VZIG immediately
b) provide normal newborn care unless the infant develops varicella
c) isolate the baby from the mother

A

ANSWER: b) provide normal newborn care unless the infant develops varicella

a) give VZIG immediately- only if rash <5d prior to or 48h after delivery or prem
c) isolate the baby from the mother (usually lesions crusted by 5d after)

233
Q 
A 6y M has always lived on a farm. For the last 3 months he has had intermittent fever, vomiting, diarrhea and weight loss. A test shows narrowing of distal ileum. Which
is the causative agent?
a. Entameoba histolytica
b. Yersinia
c. Salmonella
d. Giardia
A

b. Yersinia- ileitis
- mesenteric adenitis causes abdo pain and fever (mimics appendicitis)
- terminal ileitis and diarrhea (mimics IBD)

234
Q

A 4-month-old septic child. CSF gram stain shows GPC. Initial antibiotic therapy:

a) Ampicillin + Gentamycin
b) Ampicillin + Cefotaxime
c) Ceftriaxone
d) Ceftriaxone + Dexamethazone
e) Cefotaxime + Vancomycin

A

e) Cefotaxime + Vancomycin

- third generation cephalosporin + vanco for resistant strep pneumo (which is a gram positive coccus)

235
Q

What is the most common sequela of congenital CMV:

a) deafness
b) petechiae
c) cataracts
d) splenomegaly
e) jaundice
f) microcephaly

A

a) deafness

236
Q

Girl with sickle cell who was bitten by a dog on her leg. After appropriate cleaning of the wound and checking the (immunization status of the dog) dog for rabies what is the next step?

A) Observe and follow up in 24h
B) IM ceftriaxone
C) Amox/clav
D) Topical mupirocin

A

C) Amox/clav - Antibiotic prophylaxis indicated for immunocompromise. Higher risk of Capnocytophaga canimorsus in asplenia

237
Q

Why do you treat Salmonella bacteremia in a 2 month old child?

a) To eliminate the carrier state
b) To decrease the duration of symptoms
c) To prevent meningitis
d) To eliminate shedding from the GI tract

A

c) To prevent meningitis

238
Q

A 2 year old child sustains a laceration on the playground. She has not received any immunizations and is otherwise healthy. You clean and suture her laceration. What further
management do you offer:
a. Start tetanus immunization series
b. Tetanus immunization and tetanus immunoglobulin
c. Tetanus immunoglobulin and tetanus anti-toxin

A

b. Tetanus immunization and tetanus immunoglobulin

TIG - dirty wounds without 3 doses of TDAP

239
Q

Asymptomatic child with Giardia spores in stool. Stool sent after another child in daycare diagnosed with giardiasis. Do you treat this child and explain why yes or no? If you would treat, what would you prescribe?

A
  1. No because do not need to treat asymptomatic carriers, unless they share a household with a child with CF/ hypogammaglobulinemia.
  2. Tinidazole (first line >3years) x1dose, Nitazoxanide x1 dose, metronidazole x5-7days

Red Book Daycare: If suspect an outbreak, call public health. Treat those infected - not carriers. Daycare exclusion until symptoms resolve. Don’t test asymptomatic people.

240
Q

All are excluded from day care except:

  1. 3 y/o suspect of having scabies
  2. pertussis treatment for 2 days
  3. shigella day 2
  4. campylobacter day 2
  5. Hepatitis A after 10 days
A
  1. Hepatitis A after 10 days - exclude for 7 days after onset
    - scabies: back once treatment completed
    - pertussis: back after 5d antibiotics or 21d from cough if not treated
    - shigella: 24h after diarrhea stopped
    - campy: if in diapers, no daycare until diarrhea done
241
Q

Woman in labour with genital herpes. If you are going to do investigations, in what situation would that be and what tests would you do on the infant? (list 2)

A

If active lesions (First Primary or Unsure of Hx) and C/S after ROM or Vaginal Delivery: Mucous membrane + Blood PCR and TREAT pending results.

If active lesions (first primary) and C/S prior to ROM, well baby: Swab/Blood PCR and observe.

If active recurrent lesions, no matter delivery and baby is well. Swab/Blood and Observe.

Baby unwell - do full workup and treat.

242
Q

A 10-year-old boy has painful swelling behind his right mandible. He has torticollis on the same side and a red pharynx. Remainder of the exam is normal. Most important diagnostic test:

a) lateral neck x-ray
b) blood culture
c) monospot
d) amylase

A

a) lateral neck x-ray

- consider amylase - mumps

243
Q

A child has been receiving IV Penicillin for meningococcemia for the past 7 days. He has now developed a warm swollen right knee. What should be done:

a) provide NSAIDs
b) add a second antibiotic
c) change to a different antibiotic
d) aspirate and culture
e) bone scan

A

a) provide NSAIDs

  • allergic immune complex mediated arthritis (also vasculitis, pericarditis, episcleritis)
  • self limiting, occurs in first 10 days of disease onset
  • good response to NSAIDs
  • child with menigococcal disease who develops fever after 5 days on antibiotics - investigate for immune complex medicated disease
244
Q

Child gets a puncture wound of the foot through the sneaker. He is Limping. Bone scan confirms osteomyelitis.

What is the likely causative organism?

List 2 treatment modalities.

A
  1. pseudomonas

2. Irrigation and debridement under GA. Abx x14 days (pip-tazo, cefuroxime, cipro gent all antipseudomonal)

245
Q

Toxic child with high fever, respiratory distress. White-out on 1 side of the lung on CXR. What to do?

a. decubitus x-ray
b. chest ultrasound
c. consult surgery
d. bronch

A

b. chest ultrasound – fluid vs consolidation/atelectasis/tumor
* a. decubitus x-ray – can show shift in fluid (tells you if effusion versus consolidation

246
Q

Child with a supraclavicular lymph node 1.5 by 2 cm, firm, nontender, mobile no surrounding erythema . what is best management

a. skin testing for atypical mycobacteria
b. PPD (TB skin test)
c. excision biopsy

A

c. excision biopsy

247
Q

Teenage girl with a history of ulcerative colitis, status post
total colectomy. Had a “J- pouch” and an anal pull-through ostomy that was later removed. Did have an ileostomy, but that was closed following an end-to-end anastomosis. Now she presents with a 5-day history of bloody diarrhea 8 times per day. Stool cultures are all negative. What is the diagnosis? What 1 treatment would be the best?

A
  1. pouchitis - chronic inflammatory reaction in pouch leading to bloody diarrhea, abdo pain, and sometimes low grade fever
  2. PO metronidazole or Ciprofloxacin X 14 days
248
Q

Description of a mom who presents with her child who has otitis media. What are 4 risk factors for otitis media?

A
  • pacifier use
  • exposure to cigarette smoke
  • certain syndromes (e.g. T21 - flatter angle of ear canals)
  • orofacial abnormalities (e.g. cleft palate)
  • over crowded housing
  • shorter duration of breast feeding
  • bottle propping
  • childcare centers
  • family history
249
Q

5 year old immigrant from Pakistan. Drooling with SOB and dysphagia. Lateral Neck. (thumb sign) What organism is the likely cause? How would you manage this patient?

A
  1. hemophilus influenza B (epiglottitis)
  2. keep patient as calm as possible, call ENT and anesthesia to intubate, needs IV antibiotics but if kid is going to freak out with IV insertion wait until airway secured
    - abx: ceftriaxone and vanco (for staph coverage)
250
Q

A child diagnosed 14 days ago with Hepatitis A and is currently symptomatic. What to do with family members?

  1. Hyperimmume immune globulin against Hepatitis A
  2. Hepatitis A vaccine
  3. No treatment
  4. Antibiotic prophylaxis
A
  1. Hepatitis A vaccine
    - hep A vaccine for pre-exposure protection (e.g. travelling to endemic area)
    - hep A vaccine equal effectiveness to Ig within 2 weeks of exposure; serologic testing not recommended
251
Q

A child has fatigue for 2 weeks and was referred from the family doctor for cervical lymphadenopathy. There is left cervical lymphadenopathy with 2 palpable 5cm non-tender, mobile. He also has a papule on his left hand. Otherwise relatively well.

What is the organism?

a) ATM
b) Bartonella hensalae
c) Staphylococcus aureus

A

b) Bartonella hensalae

252
Q

3 yo with gradually increasing oxygen requirement over the past 3 hours. Had a chest tube inserted for empyeme, which drained 500ml and continues to drain well. He is tachycardic, tachypnic with decreased AE on side with empyema, He is afebrile and well perfused. Xray shows marked reduction in size of empyema. He has been given ceftriaxone, acetominophen and ibuprofen. What is your next step in management?

Clamp chest tube
Add Vancomycin
Bolus 10ml/kg
Give morphine

A

Give Morphine

253
Q

A teenage girl presents with a one week history of periumbilical pain, fever of 39.2 degrees. She has just returned from a trip to Pakistan. She looks unwell and a blood Cx shows gram negative rods.

Despite her fever and condition her HR is only 85. Which antibiotic will you treat her with:

a. Ciprofloxacin
b. Gentamicin
c. Metronidazole
d. Penicillin

A

a. Ciprofloxacin
- treat empirically with ceftriaxone or fluoroquinolone
- IV antibiotics x minimum 14 days for uncomplicated typhoid fever

254
Q

Kid with exudative pharyngitis. 1y/o. What is most likely dx

a) Viral pharyngitis
b) MONO
c) Strep

A

a) Viral pharyngitis

255
Q

Parvob19 daycare restrictions (given picture of child with facial rash)

  • Now
  • As soon as the child is well enough to go
  • After the rash resolves
  • After fever and rash resolves
A
  • As soon as the child is well enough to go
256
Q

3 yr old boy with confirmed pertussis. Lives with 3 sibs, all of whom are immunized. What treatment, if any, do you recommend?

A
  • patient should be treated

- post-exposure prophylaxis for immunized household contacts (azithro x5 days)

257
Q

Head lice – which one is least likely to increase resistance?

a. permethrin 1%
b. R&C
c. lindane
d. Resultz shampoo

A

d. results - not insecticidal

melts the exoskeleton

258
Q

Kid has had several infections. What other 4 findings would suggest immunodeficiency?

A
  • persistent thrush
  • recurrent abscesses
  • failure to thrive
  • needing prolonged courses of antibiotics (2 months with little effect)
  • family history of immune deficiency
259
Q

3 yo F with 1 wk of yellow discharge on panties. On exam inside of labia majora red and yellow secretions pooled in posterior fourchette and around urethra. Most likely diagnosis.

a. Candida
b. Foreign body
c. GAS
d. Pinworms

A

c. GAS

260
Q

Which of the following is TRUE as regards TB in children:

a) tine test and PPD are equally specific and sensitive
b) 10% of children with active disease are PPD negative
c) prior vaccination with BCG is a contraindication to PPD testing

A

b) 10% of children with active disease are PPD negative

CPS: 10-20% immune competent children with proven TB have false negative test

261
Q

Kid with diarrhea non bloody a month ago, resolved but still unwell with wt loss and abdo pain. Dx?

a) campylobacter
b) c diff
c) E. coli
d) yersinia

A

Campylobacter infection should also be considered when evaluating for inflammatory bowel disease.

262
Q

Child has Neisseria meningitidis arthritis. Prior history of Neisseria meningitidis meningitis. Which of the following tests could be positive.

a) C3, C4, CH 50
b) CBC diff
c) IgG, IgA, IgM, IgE

A

a) C3, C4, CH 50

- people with complement deficiency have 1000X increased risk of acquiring meningococcal disease

263
Q

List 4 clinical signs to distinguish orbital from periorbital cellulitis.

A
  • pain with EOM
  • rapid afferent pupillary defect
  • proptosis
  • decreased visual acuity
  • chemosis
264
Q

A 1 year old child has a cough, and mom wants to know if she can use an over-the- counter cough preparation for him/her. What do you tell her?

A

OTC cough medications are not helpful in kids and can be harmful. Not recommended in kids under 6 years.

265
Q

Child previously treated with course of Amox for otitis media. Then presents signs of meningismus irritability and lethargy. LP high protein low sugar high WBC count. No
organisms on gram stain. Gave one dose of ceftriaxone. Defervesced after dose. Doc calls you because culture has come back negative. What is the likely diagnosis. How would you tell the Doc to proceed

A
  1. culture negative bacterial meningitis
  2. will need treatment with IV antibiotics (ceftrixone empiric usage, depends on local susceptibilities, may need vanco also - strep pneumo resistance) for 2-3 weeks
  3. recommend consult ID
266
Q

Young child with periorbital edema and diarrhea. His albumin is 12. What is your differential diagnosis (4)?

A
  • infectious diarrhea (parasitic infection)
  • cow’s milk protein intolerance
  • food protein induced enterocolitis syndrome
  • IBD
  • HUS
  • Nephrotic syndrome
  • Immunodeficiency (SCID, AIDS, Agammaglobulinemia)
267
Q

Baby born to HIV-positive mother discovered during pregnancy and treatment initiated. How to test the baby to confirm diagnosis?

a) ELISA
b) Western blot
c) HIV DNA PCR
d) p24 Ag

A

c) HIV DNA PCR - preferred test for <18m

  • a) ELISA- screening in >18m
    b) Western blot - confirmatory test
    d) p24 not as sensitive - never recommended

o Testing with HIV DNA or RNA assays at 14-21d
o Repeat at 1-2m and 4-6m if negative then ELISA at 18m
o Test <48h if in utero infection suspected

268
Q

A 7 year old with CP, severe GERD and frequent choking spells while eating is admitted to the hospital with fever and increased RR. On CXR there is an air bubble in the LLL with surrounding consolidation and pleural effusion. What is the most likely organism that is causative:

a. Staphylococcus
b. Haemophilus
c. Anaerobes
d. Mycoplasma

A

a. Staphylococcus

- causes necrotizing pneumonitis - pneumatocele

269
Q

A 17 month old boy is going for elective orchidopexy today. When he shows up he has a fever of 38.2 and copious yellow nasal discharge. He has an intermittent cough but otherwise appears well. Can he have his surgery?

  1. Yes
  2. Yes, but he needs to be observed overnight
  3. No, wait until his symptoms resolve
  4. No, wait until 6 weeks after his symptoms resolve
A
  1. No, wait until his symptoms resolve
270
Q

3 year old with a history of fevers. Occur every 4 to 12 weeks for 1-4 days. Growing well. Treated for numerous otitis and pharyngitis.
A) multiple viral infections
B) familial med fever
C) CVID

A

A) multiple viral infections

271
Q

A child presents to your office with tender pre-auricular lymphadenopathy and ipsilateral conjunctivitis. There are other abnormalities noted in the same eye. On examination, you note splenomegaly. Which of the following is the most likely causative agent?

a) Toxoplasmosis
b) Adenovirus
c) Bartonella hanselae
d) Staphylococcus aureus

A

c) Bartonella hanselae - Parinaud Oculoglandular syndrome (Classic :S)

272
Q

List 4 other signs of endocarditis in a child with a fever, murmur, tachycardia and hepatospenomegaly.

How do you confirm Dx?

A
  • conjunctival hemorrhage
  • janeway lesions (non tender macules on fingers and soles)
  • osler nodes (painful lesions on hands and feet)
  • glomerulonephritis
  • splinter hemorrhages
  • clubbing
  • arthritis
  • heart failure

Confirm: BCx and ECHO

273
Q

4 year old boy presents with a pruritic rash over his chest and axilla. 2-5mm flesh coloured papules w/ central depression or umbilication. Provide most likely diagnosis.

A

Molluscum contagiosum

274
Q

8? Year old with vesicle on erythematous base on uvula, tonsils, soft palate. What is the diagnosis?

A

Herpangina (coxsackie virus)

275
Q

A child eats at a picnic and develops vomiting and diarrhea four hours later. What is the likely causative organism:

  1. E Coli
  2. S Aureus
  3. Shigella
  4. Campylobacter
  5. Salmonella
A
  1. S Aureus
    (onset 1-6 hours after exposure)
    Due to enterotoxin.
276
Q

Child with inguinal adenopathy found 1 week ago by parent while bathing. Give 4 indications for biopsy.

A
  • weight loss
  • night sweats
  • unexplained fevers
  • no decrease in size over 4-6 weeks
  • increase in size over 2 weeks
  • hard or non mobile node
277
Q

An unimmunized child has been diagnosed with Hemophilius influenza type B meningitis. His 2 siblings, ages 2 and 10, are unimmunized. What prophylaxis do you give the children?

a) none
b) give the baby rifampin
c) give the toddler rifampin
d) give all of them rifampin

A

d) give all of them rifampin

278
Q

Mom concerned about possibility of west nile in her child. What is the most common presentation of west nile in children?

a. Asymptomatic
b. Mild fever
c. Encephalitis

A

a. Asymptomatic
(70-80% of WNV infections are asymptomatic)
- if symptomatic: febrile illness with myalgia, arthralgia, headache, GI upset, maculopapular rash

279
Q

What are 3 complications of sinusitis?

A
  • orbital/periorbital cellulities
  • epidural abscess
  • meningitis
  • cerebral venosinous thrombosis
  • brain abscess
  • Pott’s puffy tumour (osteomyelitis of frontal bone)
280
Q

Which of the following is not associated with recurrent candida infection:

a. complement deficiency
b. prolonged antibiotic therapy
c. hypoparathyroidism
d. Addison’s disease

A

a. complement deficiency
- autoimmune polyendocrinopathy type I - presents with chronic mucocutaneous candidiasis, hypopara, adrenocortical insufficiency (Addison’s)
- other primary immune deficiencies that present with candida are congenital neutropenia, CGD, leukocyte adhesion deficiency

281
Q

What are three things to do for prevention if you live in a lyme endemic area (3)

A
  • use landscaping to separate play spaces from wooded areas
  • 20-30% DEET bug spray
  • full body check for ticks after coming inside and promptly remove any that are found
  • showed within 2 hours of coming inside to wash off unattached ticks
282
Q

Mom was adequately treated for syphilis during pregnancy (had greater than four-fold drop in titers). How do you manage baby?

a) Do Syphillis serology in baby
b) Monitor for symptoms only
c) Do serologies and monitor for symptoms

A

c) Do serologies and monitor for symptoms

283
Q

3 months old with seromucoid discharge from one eye, and occasional yellow crusting from the other eye. What do you do?

a. refer to an ophthalmologist
b. reassure
c. give daily antimicrobial eye drops

A

b. reassure

284
Q

3 y.o. Child with fever, headache and vomiting for last 2 days. Child has been back in the country for 1 week after visiting relatives in Nigeria for 1 month.

a) What are the 2 most important diagnostic tests?
b) List 3 vaccine preventable conditions that should be considered for this child

A

a) Malaria smear, blood culture
b) N. meningiditis, typhoid, yellow fever

High risk! Fever in child visiting family and relatives!

3 most important travel related causes of fever: Malaria(!!), Traveller’s diarrhea, Enteric fever.

285
Q

Mom with HIV, SVD, CD4 =600, on Zidovudine IV.

a) What TWO things do we test for in the infant and when?
b) What are the chances of transmission?

c) What’s the status with
breastfeeding in Canada?

A

a) HIV DNA or RNA PCR at birth within 24-48h (+14-21days, 1-2 mos and 4-6mos)
- HIV Abs at 12-18 mos (when you expect mom’s Ab are gone)

b) < 2%
(It is 25% when no interventions)

c) Breast feeding not recommended

286
Q

Kid drinking unpasteurized milk from farm.

a) What is she deficient in?
b) What are three bacteria that can be found in unpasteurized milk?

A

a) Vitamin D (pasteurized milk is fortified)

b) Brucella, Campylobacter, Salmonella, E. coli, Listeria

287
Q

Mom has been travelling to a Zika place. You are assessing the newborn and after investigations you note subcortical calcification.

1) What are 2 other clinical features of congenital zika syndrome?
2) What are two tests to diagnose congenital zika virus?

A

1) Scalp redundancy (collapsed skull), Macular scarring, congenital contractures, Microcephaly, IUGR, hypertonia, micropthalmia, cataract, SNHL
2) Zika Serology (IgM or IgG) or ZIKV RNA by PCR

In this case (symptomatic + travel Hx): Do ZIKV serology and blood and urine for AIKV PCR on mom and baby

288
Q

A 5 year old girl has a laceration after being bitten by a dog over the dorsum of her 5th digit while she was playing at the playground. Her immunizations are up to date.

What are four PRINCIPLES of her treatment? (4 points)

A
  • Assess Rabies risk and vaccination status of the dog
  • Clean the wound
  • Assess for signs of infection
  • Initiate antibiotic prophylaxis with Amoxi-Clav
  • Consider letting heal by secondary intent to reduce risk of infection
289
Q

A term infant is born to a mother with no prenatal care, and who has a history of IVDU.

List two infections that can be transmitted vertically from mom to baby. For each infection, list how you would treat the infant to prevent transmission.

A

HIV: Zidovudine ± nevirapine

HCV: No Tx

HBV: HBV vaccine ± HBIG within 12 hours

290
Q

A term infant is born to a mother with no prenatal care. The mother is diagnosed with gonorrhea, and on day 4 of life, the baby develops purulent discharge from one eye.

What are FIVE things you would do?

A
  • Single dose CTX 25-50 mg, max 125 mg
  • Swab for gonorrhoea
  • Do BCx
  • Admit
  • Optho assessment
  • Irrigate with saline
  • Treat mom
291
Q

A 2 year-old boy had an abscess on his buttocks which was drained by a walk-in clinic last week.

He had been given a 7 day course of cephalexin.

He is now presenting on day 5 of treatment. There is no more abscess, but the surrounding tissue is red and hot. His mother notes that the area of redness has spread over the past day.

1) What is the most likely infectious pathogen (be specific)?
2) How would you manage this child?

A

1) MRSA
2)
Admit
Swab
Blood cultures
IV vancomycin, step down to septra

292
Q

3 year old boy with recent diagnosis of otitis media, started on cefprozil last week. He presents to you with a two day history of fever, arthralgias and a serpiginous, very pruritic rash on the sides of his hands and feet.

1) What is the most likely cause of this rash?
2) What are two ways you would treat it?

A

1) Serum sickness like reaction

2) Discontinue antibiotic
Antihistamines
NSAIDS

293
Q

A child presents with fever, cough, tachypnea.

1) What are 2 findings on respiratory examination that would suggest a bacterial cause?

What are 2 findings on respiratory examination that would suggest a viral cause?

A

1) Bacterial Pneumonia:
- Crackles in one area
- Whispering pectoriloquy
- Dullness to percussion
- Asymmetrical decreased breath sounds

2) Viral
Wheeze
Scattered crackles

294
Q

Baby with SCID:

1) What is one thing on CBC that is specific to it
2) What are three things you are going to do next

A

1) Low lymphocyte count
2) - Strict Isolation
- Stop BF until know CMV status of mom
- Ab Replacement (IVIG)
- PJP prophylaxis after 1 mo (TMP-SMX)
- Fluconazole prophylaxis
- Work up for BMT
- No live vaccines
- All blood products IRRADIATED, leukodepleted, CMV -ve

295
Q

You diagnose a young child with measles.

a) List 3 lab tests you would do to confirm
B) List 3 acute complications of measles
C) What precautions are required in a hospitalized patient?

A

A) Measles IgM (present 3 days after exanthem, and disappears 30 days after exanthem), Measles IgG (undetectable up to 7 days after rash, but peaks around 14 days), Measles RNA (blood, NPA, throat swab or urine, present for first 3 days)

B) Diarrhea (8%), Pneumonia (6%, most common cause of death), Encephalitis (0.1%)

C) Airborne

296
Q

You are treating a 2 year old with otitis media with amoxicillin. He returns to you with a high fever, erythema behind the right ear and the right pinna appears pushed forward.

A) What is the diagnosis?
B) What are 3 complications of this condition?
C) What medications will you use to treat?

A

A) Mastoiditis
B) Subperiosteal abscess, Facial nerve palsy, hearing loss, labyrinthitis, meningitis, venous sinus thrombosis, Gradenigo syndrome (triad or periorbital pain with trigeminal nerve involvement, abducens nerve palsy (esotropia) and persistent otorrhea
C) Pip-Taxo, Vanco (cover pseudomonas + MRSA)

297
Q

HPV
A) List four disease the HPV vaccine prevent
B) The HPV is currently recommended to be given in either two or three doses, depending on the population. Who is two doses sufficient for? (1 line)

A

A) Cervical cancer, penile cancer, oropharyngeal cancer, genital warts
B) 2 doses for children aged 9-14 and 3 doses for >15 years

2019 Bank of Goodness (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions