ID and Immunology

Question 1

Days of malaise w/ fever and cough, conjuctivitis with widespread maculopapular rash

Answer 1

Measels

Also has Koplik spots

Question 2

Diffuse maculopapullar rash for 3 days w/ enlarged POSTERIOR CERVICAL and OCCIPITAL LN. May have sore throat w/ occasional conjuctivitis, arthralgias

Answer 2

Rubella in child

Question 3

Mild sore throat + malaise and +/- fever. Quick progression to adherent membrane on oropharynx and hypopharnx and glottic area. Lymphadenopathy with ‘bull neck’

Answer 3

Diptheria

Question 4

What can we provide child with HIV + mom with while awaiting his HIV status?

Answer 4

PCP prophy as well as TMSX at 6 weeks

Question 5

What should the vaccine schedule be for infant w/ HIV

Answer 5

Get the primary and booster DPT, the MMR (unless severly compromised) Hep B vaccine, Hib vaccine and the inactivatd polio vaccine (IPV) in place of active oral polio vaccine

Question 6

What is the cause of death in patients w/ Reye syndrome

Answer 6

Cerebral edema and hernation; towards end of disease kiddos have seizure, coma, hypervent, respiratory arrest and loss of DTR
DONT use ASA in kids with varicella or influenza

Question 7

What are the manifestations of Shigellossis?

Tx?

Answer 7

watery stools, high fever and abdominal pain. Some have bloody stool and often present with fever (for 3 days). Dx w/ stool culture adn provide supportive care

Question 8

Two illnesses that cause scarlatiniform rash, desquamating rash, erythema of mucous mmb with injected pharynx and strawberry tongue and cervical lymphadenopathy

Answer 8

Kawasaki dx or Scarlet fever (Group A beta-hemolytic strep)

Question 9

What causes scarlet fever?

Answer 9

erythrogenic toxin-producing group A B-hemolytic strep; see rise in antistreptolysin titer

Question 10

What causes Rheumatic heart dx

Answer 10

Strep. Pharyngitis; prevent w/ PCN

Question 11

Kiddo with bald spot on head with black dots, dx and tx

Answer 11

Trichophytan tonsurans; tinea capitus and need to use long term griseofulvan or other PO antibx. will NOT see flouresence on Wood lamp but dx w/ KOH prep
-if bad you devo a kerion (boggy area) w/ occipital lympahdenopathy

Question 12

10yo w/ 7 day course of fever, chills, severe msl pain, pharyngtitis, headache and scleral injection w photophobia and cervical adenopathy–> got a little better then devo fever, n/v, headache w/ nuchal rigiditiy. CSF 200 WBC, all monocytes adn elevated protein

Answer 12

Cause is leptospirosis; often mild or subclinical course. Exposure to dogs, cats, livestock. Anicteris lept and icteric start with septecemic phase that resolves then have ‘immune’ phase w/ meningitic symptoms.
PCN and tetracyline are appropriate therapy

Question 13

What is the preferred antibx to start on neonate with meningitis?

Answer 13

Ampicillin (listeria) and cefotaxime (gram -)

can use gentamycin instead but has more risk for hearing complications later on

Question 14

14 mo infant with sudden onset high grade fever 104; with WBC 22 and left shift. BAby is otherwise normal

Answer 14

pneumococcal bacterimia; may present similar to roseola but roseola doesn’t have a left shift. less common bc of pneumococcal vaccine

Question 15

3 day hx malaise, fever to 106, cough, corzya and conjuctivitis with white pinpoint spots on buccal mucosa. Dx

Answer 15

Rubeola or german measels

Complications: pneumonia, laryngitis, myocarditis, encephalitis

Question 16

low grade fever, headache mild URI and red cheeks

Answer 16

Parvo B19, erythema infectiousum or 5ths disease

Question 17

How would rubella present in a 4 yo

Answer 17

mild URI, retoauritular and posterior cervical and postoccipital lymphadenopathy with diffuse erythematous maculopapular rash clears w/in 72 hrs

Question 18

Patient has severe cough, photophobia, conjuctiviys and high fever that peaks at height of generalized rash.

Answer 18

Rubeola (measels)

Question 19

3 yo girls with viral exanthem all over body and disappears with onset of high fever.

Answer 19

Roseola

Question 20

Target like lesions on skin and mucous associated with infection or drugs

Answer 20

ERythema multiforme

Question 21

What sequela can we see with mumps

Answer 21

orchitis in post pubertal males, parotitis, and also have meningitis, pancreatitis and renal involvement can occur; need live attenuated vaccine to prevent.

Question 22

What tx is recommended for anyone in contact w/ animal that may have rabies?

Answer 22

wound cleansing (if present) rabies immune globulin adn 5 injections of rabies vaccine series

Question 23

Kid was out hiking a few days ago now has headache, malaise w/ fever. Next day has maculopapular rash on extensor surface of wrist and ankles move in central direction
Dx and Tx?

Answer 23

Rocky moutain spotted fever; need doxycycline

Question 24

How does tularemia present

Answer 24

abrupt fever, chills, malaise and variety of rashes. also hae pharyngitis, hepatospelno

Question 25

Family goes to barbeque, one week later have abdominal pain, nausea/vomitting and malaise. Second week see muscle invasion, fever, eosinophilia

Answer 25

T. Spirali from improper pork cooking; cyst can stay encased for years

Question 26

Complications of meningococcemia

Answer 26

meningitis, purulent pericarditis, endocarditis, pneumonai, otits media, arthritis.
-Potent endotoxin–> induce shock and disseminated invtravascular coagulation w/ hemorrhage and get Waterhorse Friderichsen

Question 27

Recommended tx for close contacts of people infected with menigoccocal

Answer 27

Rifampin or sulfadiazine

Question 28

Contraindication to LP

Answer 28

increased ICP in pt w/out open fontanelle severe cardiorespiratory distress, skin infection at puncture site or severe thrombocytopenia

Question 29

How does Brutons present? What doe’s patients Ig’s, lymphocytes and T cell look like?

Answer 29

Has low Ig of all classes and low B cells with normal T cells; will have pneumonia, diarrhea, sinusitis but can protect self from fungal and viral infectoin

Question 30

What does MacConkey culture help dx?

Answer 30

E.coli 0157 from stool sample

Question 31

What do you use Thayer-Martin culture for?

Answer 31

helps to culture sites like cervix and rectum

Question 32

9 mo child w/ abrupt onset of fever and respiratory distress following several days of URI sxs. May cuase pleural effusion, empyema adn can see elevated WBC w/ left shift

Answer 32

Pneumonia by Staph Aureus

CXR: nonspecific–> more dense and homogenous may involved entire lobe

Question 33

Kiddo with sudden onset fever, cough and chest pain and recently tx for bacterial infection

Answer 33

Pneumococcal pneumonia

Tx: high dose penicillin, cefuroxime, augmentin