ID

Question 1

Cellulitis occurring about the face in young children (6-24 months) and associated with fever and purple skin discoloration is MOST often caused by ?

A. Group A beta hemolytic streptococci

B. Haemophilus influenzae type B

C. Streptococcus pneumoniae

D. Staphylococcus aureus

E. Pseudomonas

Answer 1

Answer: A or C

answer : c by pediatric doctor (hib can lead to a violaceous or blue-purple color but it is not diagnostic).

Note: the most common organism can cause cellulitis at 6-24-month old is streptococcus

Question 2

Breastfeeding mother with HCV treated by interferon for more than one year, what is the risk of breastfeeding on the infant? A. Cracked Nipple B. Mother with anemia C. Infant complain of oral candidiasis D. Not follow up of infant immunization

Answer 2

Answer: A CDC – Hepatitis C: having HCV-infection is not a contraindication to breastfeed. HCV is transmitted by infected blood, not by human breast milk. although HCV-positive mothers should consider abstaining from breastfeeding if their nipples are cracked or bleeding. Uptodate: There is no evidence that breastfeeding is a risk for infection among infants born to HCV infected women Antiviral treatment of pregnant women is not recommended. Ribavirin teratogenic in animal models. Interferon increase spontaneous abortion in animal models Is it safe for the HCV-positive mother to breastfeed if her nipples are cracked and bleeding? Data are insufficient to say yes or no. Therefore, if the HCV-positive mother’s nipples and/or surrounding areola are cracked and bleeding, she should stop nursing temporarily. Instead, she should consider expressing and discarding her breast milk until her nipples are healed. Once her breasts are no longer cracked or bleeding, the HCV-positive mother may fully resume breastfeeding. CDC .. HBV : HBV transmission through breastfeeding was not reported. All infants born to HBV-infected mothers should receive hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth. The second dose of vaccine should be given at aged 1–2 months, and the third dose at aged 6 months. The infant should be tested after completion of the vaccine series, at aged 9–18 months. However, there is no need to delay breastfeeding until the infant is fully immunized. All mothers who breastfeed should take good care of their nipples to avoid cracking and bleeding.

Question 3

2 years old presented with fever for one month with the pic, lab shows Pancytopenia, what is the cause? A. Leishmania B. Leukemia C. Malaria D. Brucellosis

Answer 3

Answer: B Brucellosis, malaria and leishmanial also cause pancytopenia, but it seems the pic shows sign of leukemia.

Question 4

10 days neonate present with lethargy , irritability , fever , signs of meningitis which organism is causative :

A. Listerea monocytogens

B. Streps pneumonia

C. Staph aureus

D. N-menningitidis

Answer 4

Answer: A

Question 5

Bacterial meningitis in 14 month child I think , Gram positive cocci, what is the management?

A-amoxicillin

B-amoxicillin and gentamicin

C-ceftriaxone and vancomycin

D-vancomycin

Answer 5

Answer : C-ceftriaxone and vancomycin

Question 6

child with rheumatic heart disease allergic to penicillin. What prophylaxis should be given before a procedure?

A. Iv amoxicillin

B. Iv vancomycin + iv gentamicin

C. Oral vancomycin + gentamicin

D. Oral amoxicillin

Answer 6

Answer: b (depends on the type of procedure and the ability to tolerate oral medications)

Most probable, the answer is b. Since amoxicillin is type of penicillin and gentamicin generally not given po.

Medscape : Patients with rheumatic heart disease and valve damage require a single dose of antibiotics 1 hour before surgical and dental procedures to help prevent bacterial endocarditis. Patients who had rheumatic fever without valve damage do not need endocarditis prophylaxis.

Do not use penicillin, ampicillin, or amoxicillin for endocarditis prophylaxis in patients already receiving penicillin for secondary rheumatic fever prophylaxis (relative resistance of po streptococci to penicillin and aminopenicillins).

Alternate drugs recommended by the american heart association for these patients include po clindamycin (20 mg/kg in children, 600 mg in adults) and po azithromycin or clarithromycin (15 mg/kg in children, 500 mg in adults).

Question 7

boy came to your clinic with yellow discoloration of the eyes noticed 3 days back and hepatomegaly. His liver enzymes are increased. What is the diagnosis?

A. Hepatitis a

B. Hepatitis b

C. Hepatitis c

D. Hepatitis d

Answer 7

Answer: a

Hepatitis A , the only type of hepatitis that reveal tender hepatomegaly

Question 8

What is the triple antitoxoid?

A. Tetanus, diphtheria, whooping cough

B. Tetanus, diphtheria, tb

C. Diphtheria, pertussis, colorectal ca

D. Diphtheria, tetanus, rabies.

Answer 8

Answer: a

Question 9

5 years old girl with uncomplicated cystitis. What is the management?

A. Oral amoxicillin

B. Iv cephalosporin

C. Im ceftriaxone

D. Sodium …

Answer 9

Answer: a

Patients with a nontoxic appearance may be treated with oral fluids and antibiotics.
Hospitalization is necessary for the following patients with UTI:
* Patients who are toxemic or septic
* Patients with signs of urinary obstruction or significant underlying disease
* Patients who are unable to tolerate adequate oral fluids or medications
* Infants younger than 2 months with febrile UTI (presumed pyelonephritis)
* All infants younger than 1 month with suspected UTI, even if not febrile

Treat febrile UTI as pyelonephritis, and consider parenteral antibiotics and hospital admission for these patients.
Antibiotics for parenteral treatment are as follows:
* Ceftriaxone
* Cefotaxime
* Ampicillin
* Gentamicin
Patients aged 2 months to 2 years with a first febrile UTI
If clinical findings indicate that immediate antibiotic therapy is indicated, a urine specimen for urinalysis and culture should be obtained before treatment is started. Common choices for empiric oral treatment are as follows:
* A second- or third-generation cephalosporin
* Amoxicillin/clavulanate, or sulfamethoxazole-trimethoprim (SMZ-TMP)

Children with cystitis
* Antibiotic therapy is started on the basis of clinical history and urinalysis results before the diagnosis is documented
* A 4-day course of an oral antibiotic agent is recommended for the treatment of cystitis
* Nitrofurantoin can be given for 7 days or for 3 days after obtaining sterile urine
* If the clinical response is not satisfactory after 2-3 days, alter therapy on the basis of antibiotic susceptibility
* Symptomatic relief for dysuria consists of increasing fluid intake (to enhance urine dilution and output), acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs)
* If voiding symptoms are severe and persistent, add phenazopyridine hydrochloride (Pyridium) for a maximum of 48 hours

—————––————

For an older child who does not appear ill but has a positive urine culture, oral antibiotic therapy should be initiated.

For a child with suspected uti who appears toxic, appears dehydrated, or is unable to retain oral fluids, initial antibiotic therapy should be administered parenterally, and hospitalization should be considered.

Neonates with uti are treated for 10 to 14 days with parenteral antibiotics because of the higher rate of bacteremia.

Older children with uti are treated for 7 to 14 days.

Initial treatment with parenteral antibiotics is determined by clinical status. Parenteral antibiotics should be continued until there is clinical improvement (typically 24 to 48 hours).

Question 10

11-year-old (typical bacterial meningitis case) which ab× will be given:

A. Ceftriaxone and gentamycin

B. Ampicillin and gentamycin

C. Penicillin and gentamycin

D. Vancomycin

Answer 10

Answer: 3rd-generation cephalosporins (ceftriaxone or cefotaxime) for s. Pneumoniae and n. Meningitides and vancomycin for penicillin resistant strains of s. Pneumoniae and for s. Aureus

Question 11

2year old child got otitis media after urti. Treatment:

A. Observe.

B. High dose ibuprofen.

C. Amoxicillin 45 mg/kg/day for 5 days.

D. Amoxicillin 90 mg/ kg/ day for 10 days.

Answer 11

Answer: d ?

Question 12

13 years old with enteric fever. Allergic or resistant to chloramphenicol (i forgot). Treatment is:

A. Double chloramphenicol.

B. Add ciprofloxacin.

C. Ciprofloxacin alone (orally)

D. Im ceftriaxone

Answer 12

Answer: d

Antibiotic resistance is common and increasing, particularly in endemic areas, so susceptibility testing should guide drug selection. In general, preferred antibiotics include ceftriaxone 1 g im or iv q 12 h (25 to 37.5 mg/kg in children) for 14 days

Question 13

Blood film for girls came abdominal pain cough splenomegaly dx;

A. P.malaria

B. P.falcifom

C. P. Oval

D. Mp. Something

Answer 13

Answer: Depends on blood film

Question 14

Treatment of EBV (in scenario there patient with tonsillar exudates, lymphadenopathy, splenomegaly)

A. Oral acyclovir

B. Oral antibiotic

C. Iv acyclovir

D. Supportive ttt

Answer 14

Answer : D

Question 15

Oropharyngeal maculopapular rash .. Also rash in palm and foot ..?

T A. Cmv

B. Ebv

C. Coxsackievirus

D. Vaccina virus

Answer 15

Answer: C

Hand, foot and mouth disease (HFMD) is a viral illness which commonly causes lesions involving the mouth, hands and feet. However, it may also affect other areas such as the buttocks and genitalia. The most common causes of HFMD are Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). It is normally a mild, self-limiting illness but occasionally has serious complications .

Question 16

Child with septic arthritis came to er with kness pain , swelling . Management:

A. Oral antibiotic for 14 days

B. Broad spectrum iv antibiotic

C. Surgical drainage and iv antibiotic

D. Antipyretic till the result of aspiration culture

Answer 16

Answer: c

According to illustrated textbook of pediatrics: a prolonged course of antibiotics is required, initially intravenously. Washing out of the joint or surgical drainage may be required if resolution does not occur rapidly or if the joint is deep-seated, such as the hip. However joint aspiration is indicated prior to starting antibiotics and repeated until joint aspirate is clear.

Question 17

Baby with recurrent infection tb, aspergillosis all type of infection with history o brothers death at 3 year with same pr give? Repeated

A. Influenza

B. Bcg

C. Varicella

D. Polio

Answer 17

Answer: im influenza

Question 18

child with hepatosplenomegaly, current infection. Brother died at 3 years with septic shock. How to give vaccination?

A. Give all.

B. Don’t give until 3 years.

C. Don’t give live vaccines.

D. Don’t give killed vaccines.

Answer 18

Answer: c

Question 19

Which vaccine is contraindicated in hiv patient ?

A. Opv

B. Varicella

C. Mmr

D. Hbv

Answer 19

Answer : A

HIV-infected individuals who are on ART with well-controlled HIV RNA levels and CD4 counts of >200 cells/µL (or ≥15%) may receive indicated live-virus vaccines such as (MMR) and varicella if lacking immunity ( but these vaccines should be avoided in patients with CD4 counts of <200 cells/µL. )

the varicella vaccine should be given at least 28 days after MMR

Live-virus vaccination should be avoided during and 3 months after intravenous immunoglobulin (IVIG) treatment, if possible, because passive antibodies in IVIG may impair response to live-virus vaccination with MMR or varicella for up to 3 months after IVIG infusion.

most patients who have acquired HIV infection are at risk of HBV infection and could benefit from effective HBV vaccination

HAV vaccination currently is recommended for HAV-susceptible, HIV-infected individuals who are MSM or have chronic liver disease,

use of LAIV generally has been avoided in HIV-infected patients because of concern about prolonged shedding caused by immunocompromise. In a study of asymptomatic, HIV-infected adults with CD4 counts of >200 cells/µL and HIV RNA levels of <10,000 copies/mL, LAIV appeared safe and did not result in prolonged shedding or increases in HIV RNA.However, LAIV may lead to a less-effective antibody response in adults,regardless of HIV status, and trivalent inactivated vaccine

HIV-infected persons appear to achieve adequate antibody responses to HiB vaccination

BCG should not be given to those with severe immunocompromise owing to HIV, and it is not recommended routinely in the United States.

Administration of the HPV vaccine is not contraindicated in HIV infection in persons aged 9-26

The live, attenuated oral polio vaccine (OPV) is not recommended for persons with HIV infection outside resource-limited settings if the inactivated polio vaccine (IPV) is available.

Diphtheria, pertussis, and tetanus: Clinicians should administer these vaccines in the same regimens as for HIV-uninfected patients.

Question 20

What is the effect of polio (ipv& opv) on body?

A. All lead to the formation ag in the anterior horn

B. All lead to the formation of the ab in the serum which fight the virus

C. They all enter the intestinal mucosa where the entry of the virus is

D. They all lead to the formation of interferon gamma

Answer 20

Both b&c can be correct answer

Question 21

Young , vesilce ,pastule on back like a band :

A. Shingles

B. Chicken box

C. Herpes

D. Coxsackievirus

Answer 21

Answer:a

Http://emedicine.medscape.com/article/1132465-overview

Question 22

What is the most common site for mump?

Answer 22

Answer: Parotid gland

Question 23

child was on clindamycin developed abdominal pain and watery diarrhea.

Answer 23

Clostridium difficile

Question 24

Child came with Rt abdominal pain , jaundice, palpable tender liver, Dx ?

Answer 24

Answer: Hepatitis A

(HAV) spread via the fecal-oral route.

●The incubation period for HAV is 15 to 50 days. HAV RNA can be detected in stools at least one week before the onset of histological and biochemical evidence of hepatitis, and it can be detected for at least 33 days after the onset of disease. In neonates and younger children, HAV RNA can be detected in stools for several months.

●HAV infection in children is typically an acute, self-limited illness Symptomatic patients may present with abrupt-onset fever, abdominal pain, malaise, and jaundice. Common examination findings are hepatomegaly and clinical jaundice with marked elevation of serum trans-aminases (usually >1000 units/L). IgM anti-hepatitis A virus serology is the test of choice for diagnosis.

●The diagnosis of acute HAV infection is made by the detection of anti-HAV IgM in a patient with the typical clinical presentation. Serum IgM anti-HAV is the gold standard for the detection of acute illness. This antibody is positive at the onset of symptoms, peaks during the acute or early convalescent phase of the disease, and remains positive for approximately four to six months

●Hepatitis A vaccine is part of the recommended childhood and adolescent immunization schedule in the United States. It is recommended for all children at one year of age (ie, 12 to 23 months), and also for specific high-risk groups, including international travelers and patients with chronic liver disease

●Post-exposure prophylaxis for individuals with recent exposure to HAV may be accomplished with the HAV vaccine or immune globulin.

●HAV infection in children is usually self-limited infection requiring no specific therapy. The usual supportive measures for fever and diarrhea may be undertaken. Patients rarely require hospitalization except for those who develop fulminant hepatic failure. Children with HAV-related hepatic failure are candidates for liver transplantation.

Question 25

Child with fever, malaise, LNs enlargement & mouth ulcers. What is the diagnosis?

Answer 25

Herpes simplex virus infection type 1 (HSV 1)

Question 26

child presented with fever and coryza, then watery diarrhea.

A. Adenovirus

B. Rotavirus

Answer 26

Answer: A

Question 27

Bilateral parotid swelling.

Answer 27

Answer : ?

Question 28

20 days infant diagnosis as meningitis, his culture show gram negative bacilli. Which of following could be the organism?

A.hemophiles influenza

B. E.coli

C. neisseria meningitides

Answer 28

Answer: B. E.coli

Note: group B streptococci (GBS) are the most commonly identified causes of bacterial meningitis, implicated in roughly 50% of all cases.

Escherichia coli accounts for another 20%. Thus, identification and treatment of maternal genitourinary infections is an important prevention strategy.

Listeria monocytogenes is the third most common pathogen, accounting for 5-10% of cases; it is unique in that it exhibits transplacental transmission.

N . Meningitides it is gram negative diplococcus

H . Influenza it is gram negative coccobacili

Reference : nelson p381

Question 29

Cat bite child .. he develop infection .. what is the causative organism ?

Answer 29

Answer : posturella multicedia

Question 30

child with high fever 2 wk and abdominal distention and wt loss

Answer 30

Answer: ???

Question 31

Recived antibiotics and went home . Now improving but The culture then was ……. اعتقد N.meningitdis What you will do ?

A. rifambicin for 7 days

B. one dose ceftriaxone IM .

C. Tell family to come to hospital

Answer 31

Answer: B

Ceftriaxone is one of the most commonly used antibiotics for meningococcal meningitis. Penicillin in high doses is almost always effective, too.

If the patient is allergic to penicillin, chloramphenicol may be used. Sometimes corticosteroids may be used, ciprofloxacin especially in children.

People in close contact with someone who has meningococcal meningitis should be given oral rifampcin or ciprofloxacin is an alternative drug to prevent infection.

Question 32

Newborn with meningitis , organism gram + cocci??

Answer 32

Group B streptococcus