ID Flashcards
Women in labor with genital herpes, list 4 risk factors for transmission to infant.
- first episode of herpes for mom (primary infection)
- prolonged rupture of membranes
- vaginal delivery
- use of instrumentation in delivery (forceps, vacuum, fetal scalp electrode)
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)
Mom has active primary lesions, baby asymptomatic, born by C/S after ROM - mucous membrane swabs and start IV acyclovir on spec. If swabs positive, then do blood and CSF PCR
*if infant symptomatic, admit, treat, swab and FSWU
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
b) No further investigations
- negative Hep C ab in child of any age indicates transmission did not occur
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
b) Tryponemal screen and RPR
Neonate with purpura and thrombocytopenia. Diagnosed with CMV. Give six other features of congenital CMV infection.
- hearing loss
- microcephaly
- SGA
- chorioretinitis
- jaundice
- HSM
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)?
- observe for signs of neonatal HSV and educate parents about what to look for. No swabs or other investigations indicated in this case
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
ANSWER: b) place baby and mother in same room and allow breastfeeding
AND
e) contact isolation from other patients - until lesions crusted over, 14d infectivity period passed or swabs negative
d) discharge both immediately- no, await swabs
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
b) 4-6 weeks
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. Immediately and start Acyclovir
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
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)
What is the most common sequela of congenital CMV:
a) deafness
b) petechiae
c) cataracts
d) splenomegaly
e) jaundice
f) microcephaly
a) deafness
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
e) non-immune hydrops fetalis (from fetal anemia)
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
e) fetus of a mother infected with parvovirus B19 ~5%
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
b. perform parvovirus serology on the woman
- look for susceptibility (may have immunity) and evidence of acute infection
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
d. Hep Ig within 12 hours and Hep B vaccine within 12 hours
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?
- HbeAg+, HbcAg+, HbsAg+, HbsAb+
- HbeAg-, HbcAg-, HbsAg+, HbsAb+
- HbeAg-, HbcAg-, HbsAg-, HbsAb+
- HbeAg+, HbcAg-, HbsAg+, HbsAb-
- HbeAg-, HbcAg+, HbsAg+, HbsAb
- 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)
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
b. corneal perforation and blindness
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
b. VDRL/FTA abs
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
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
Contraindication to breastfeeding
e. Hep B
f. Bilateral mastitis
g. Active TB
g. Active TB
Picture of baby with rash: told cataracts, microcephaly, hepatosplenomegaly, bony changes
a) Syphilis
b) CMV
c) Rubella
d) toxoplasmosis
c) Rubella
- hearing loss, cataracts, MR, IUGR, hepatitis, osseous changes, cardiac defects
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
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)
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) wear mask when breastfeeding
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) treat the child as the fall in the titer is inadequate
- full work up (blood, CSF, X-ray) and treat
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
c. Congenital rubella
cataracts - rubella; chorioretinitis - CMV
Which of the following maternal infections is a contraindication to breast feeding?
a) Hep A
b) Hep B
c) CMV
d) HIV
d) HIV
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
b) Chlamydia trachomatis
- onset of cough 1-3 months; no fever; staccato cough, eosinophilia
- treat with erythromycin (can cause pyloric stenosis)
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?
Zidovudine x 6 weeks + 3 doses of nevirapine during 1 st week of life (@ birth, 48h after first dose and 96h after 2nd dose)
Neonate born to mom who just revealed HIV positive status. When would you start the treatment? (1 line)
Within 12 hours of birth
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
b) Pneumocystis Carinii Pneumonia
- PCP is an AIDS defining illness - if present in first 6 months of life is associated with poor prognosis
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
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
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
b. heterosexual transmission
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
d) poor response to tetanus and diptheria vaccines
(can have a reduced response, but this is the most correct answer)
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?
OTC cough medications are not helpful in kids and can be harmful. Not recommended in kids under 6 years.
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)?
Parvo B19
- serologies for mom
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.
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
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.
Molluscum contagiosum
8? Year old with vesicle on erythematous base on uvula, tonsils, soft palate. What is the diagnosis?
Herpangina (coxsackie virus)
Winnipeg Doc..calls family concerned about west nile. 4 suggestions to help prevent west nile virus in his patients
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
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?
Viral infection - ensure adequate fluid intake, analgesia and antipyretics for comfort
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) Ddx: ● infected rash = cellulitis, ● Cellulitis ddx: abscess, osteomyelitis ● Nec Fas b) Ix: - CBCD, CRP, blood culture c) mgmt: admit and IV cefazolin
Varicella. With nec fash/or purpura fulminans. What is your management:
a) vanc cefotax
b) pen G and clinda
c) amp gent
b) pen G and clinda
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)?
- Dx: necrotizing fasciitis
- mgmt:
- admit to hospital
- blood future, CBCD, CRP
- start pen G and clindamycin IV
- surgical consult for debridement
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) acute cerebellar ataxia
B) no fever, no nuchal rigidity, CSF normal or shows mild lymphocyte pleocytosis vs meningitis which shows PMN pleocytosis
Name 4 indications for VZIG
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
Kid with exudative pharyngitis. 1y/o. What is most likely dx
a) Viral pharyngitis
b) MONO
c) Strep
a) Viral pharyngitis
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) 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)
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. viral suppression
b. neutropenia
Hep A. When can return to school?
a. 1 wk
b. when no fever
c. if washing hands well
d. when no symptoms
a. 1 wk (red book, CPS)
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) 7 days
- risk of transmission minimal 1 week after jaundice onset
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
b. start Hep B vaccinations in both kids
Which virus is associated with transient arthropathy:
a) RSV
b) rubella
c) measles
d) Hepatitis A
b) rubella
Wheezing toddler with URTI symptoms. Which is a proven therapy?
a. O2
b. racemic epi
c. iv steroids
d. bronchodilators
a. O2
assuming bronchiolitis
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
c. RSV
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
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
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?
- po cephalexin
- I & D
- po acyclovir
- flamazine dressing
- po acyclovir
Herpetic whitlow - treat with acyclovir if immunocompromised or severely infected; otherwise can do nothing
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. perinatal acquisition
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) PCR on CSF
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. Asymptomatic
(70-80% of WNV infections are asymptomatic)
- if symptomatic: febrile illness with myalgia, arthralgia, headache, GI upset, maculopapular rash
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) multiple viral infections
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) 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
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)?
- guillain-barre syndrome
- 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 - campyobacter jejuni
Native girl, received BCG in past, PPD 13mm.
a. ) How do you interpret this?
b. ) What is your approach to treatment? (1 line)
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
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.
- pseudomonas
2. - irrigation and debridement under GA, abx x14 days (pip-tazo, cefuroxime, cipro gent all antipseudomonal)
Name 4 drugs with pseudomonas coverage
- pip-tazo
- cefuroxime
- aminoglycosides (gent, tobra)
- cipro
Child has worsening swelling around an eye. List 2 signs that would make you worried about orbital cellulitis.
- proptosis
- pain with extraoccular movements
- decreased visual acuity
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?
- stop infusion; give benadryl and ranitidine
- premedicate with diphenydrydramine +/- ranitidine
- run infusion at slower rate
Red man syndrome - not true allergy; is a rate dependent infusion reaction
Description of a mom who presents with her child who has otitis media. What are 4 risk factors for otitis media?
- 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
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
b) Retropharyngeal abscess
Teen can’t open mouth. Has fever. Dx?
a. Retropharyngeal abscess
b. Peritonsillar abscess
b. Peritonsillar abscess
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) 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
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.
- 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)
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
b) amp and gent
- because fever in <1 month
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)
- 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
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)
- amoxicillin
- amoxicillin-clavulanic acid
- cefuroxime
Family comes to you from an area endemic for Lyme disease – What is the organism and vector causing it (2)?
- borrelia burgdoferi; from black-legged ticks
What are two antibiotics that are effective
against lyme disease (2)? When is IV and treatment indicated?
- doxycycline (kids 8+ years)
- amoxicillin
- cefuroxime
- doxycycline (kids 8+ years)
- ceftriaxone/pen G for endocarditis, meningitis, encephalitis
What are three things to do for prevention if you live in a lyme endemic area (3)
- 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
List 4 clinical signs to distinguish orbital from periorbital cellulitis.
- pain with EOM
- rapid afferent pupillary defect
- proptosis
- decreased visual acuity
- chemosis
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?
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
What are the five major criteria for rheumatic fever?
Joints: migratory polyarthritis Carditis: new murmur/valve disease on echo Subcutaneous nodules Erythema marginatum Sydenham's chorea
Child presents with bloody diarrhea, anemia and thrombocytopenia. What is the diagnosis?
Hemolytic uremic syndrome
- triad: microangiopathic hemolytic anemia, TCP, renal insufficiency
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
b) 10% of children with active disease are PPD negative
4 y.o. with chronically draining cervical node. Most likely bug:
a. Staph Aureus
b. Atypical mycobacterium
c. Cat scratch
d. Tuberculosis
b. Atypical mycobacterium
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
c. excision biopsy
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:
- Pleurodynia
- Bacterial pneumonia
- First presentation of Familial Mediterranean Fever
- Fitz-Hugh-Curtis
- Cholecystitis
- Bacterial pneumonia
Adolescent male whose partner is positive for gonorrhea. Your management would be
a. Amoxil
b. tetracycline
c. ceftriaxone
d. doxycycline
e. erythromycin
c. ceftriaxone 250mg IM x1
- same treatment for partners as for confirmed cases
- also give one dose of azithro 1g PO (or 7d doxy)