Peds: ID/Pulm

Question 1

Hydrocephalus with intracranial calcifications and chorioretinitis. Dx? Test?

Answer 1

Toxoplasmosis. IgM

Question 2

Cataracts, deafness, heart defects blueberry muffin spots. Dx? Test?

Answer 2

Rubella. IgM

Question 3

Microcephaly, periventricular calcifications, petechia, thrombocytopenia. Dx? Test?

Answer 3

CMV. Urine or salive CMV culture. Serum IgM in newborn confirms congenital CMV.

Question 4

First week PNA and Shock, 2nd week skin vesicules, keratoconjunctivitis Dx? Test?

Answer 4

Herpes. Tzanck smear/culture. HSV PCR.

Question 5

Osteochrondirits, desqaumating skin rash of palms and soles. Dx? Test?

Answer 5

Syphilis VDRL. Specific FTA-ABS

Question 6

Cutaneous scars and limb hypoplasia. Dx? Rx?

Answer 6

Varicella. IgM

Question 7

Most common cause of Stridor in Children. Fever, runny nose, coryza. Barking cough, stridor on inspiration, respiratory distress. Dx Test? Rx?

Answer 7

Croup. Infection of the Subglottic space caused by parainfluenza. Test: Clinical diagnosis can see Steeple sign on CXR. Rx: Racemic nebulized epinephrine.

Question 8

Pt has fever, drooling (hurts to swallow) and refuses to lean back (hurts to lean back), speaks in muffled sounds. CXF there is thumb print sign. Dx? Next step in management? Rx?

Answer 8

Epiglottis. Ceftriaxone/Cefuroxime.

Question 9

Toddler choked on some coins. Pt is drooling and is in respiratory distress. Decreased breath sounds on the R with intercostal retractions. Dx? Test? Rx?

Answer 9

Foreign Body in airway. CXR then bronchoscopy for definiitve diagnosis. Rigid Bronchoscopy removes foreign object. Unless it’s GI then do flexible endoscope down esophagus- ingestion of foreign body.

Question 10

Rx for inpatient child pneumonia? Rx for out patient child pneumonia.

Answer 10

Inpatient - Ceftriaxone or (Azthro/Erythromycin for 1-3 month) olds Outpatient - Ampicillin, Amoxicillin or Azithro/Erythromycin

Question 11

Fever > 104, Cough, Coryza, Conjunctivityis, Kpolik spots in mouth (whitish spots on buccal mucousa) Dx? Test? Rx?

Answer 11

Rubeola (Measles). Clinical Diagnosis. Supportive.

Question 12

Fever precedes classic gland swelling with possible orchitis. Dx? Test? Rx?

Answer 12

Mumps. Clinical Diagnosis. Supportive.

Question 13

Delayed immunizations, paroxysmal cough, facial petechiae, conjunctival hemorrahages, post-tussive emesis. Dx? Test? Rx?

Answer 13

Whooping cough by Bordetella Pertussis. Test: Clinical Diagnosis and PCR can confirm. Rx: PO Erythromycin for 14 days - helps shorten the course of the illness during the infectious stage and Treat Family members (very contagious) and vaccinate anyone who has not been vaccinated yet.

Question 14

This presents in >12 year olds. Pt presents with Hot Potato Voice/Muffled Voice and the Uvula is displaced midline. Clinical diagnosis. Dx? Rx?

Answer 14

Peritonsillar Abscess. I and D and abx.

Question 15

Brassy cough, high fever, respiratory distress no drooling or dysphagia, occurs after viral URI. Dx? Test?

Answer 15

Bacterial tracheitis. CXR shows subglottic narrowing + ragged tracheal air column.

Question 16

Fever, SOB, Tacypnea, paroxysmal wheezing and cough in a child < 2 years. Dx? Test? Rx?

Answer 16

Bronchiolitis. CXR shows hyperinflation. Viral antigen testing (adenovirus, parainfluenza, RSV. ) Supportive care with nasal suctioning, nebulized hypertonic saline, supplemental 02, trial of beta agonist. Ribavirin, intubation if severe.

Question 17

Rx of CF?

Answer 17

Ivacaftor (restores mutant function of CF gene and decreases sweat chloride levels) Ibuprofen- decrease inflammation, Azithromycin slows rate of decline in FEV1, Abx delay progression of lung disease. Mild dz- give macrolide Dz w/ S. aureus or Pseudomnoas - pipercillin + tobramycin

Question 18

Fever without focus that last < 1 week and occurs in children < 36 months.

Answer 18

fever w/o focus in young child. Neonate cover group B strept , E. coli, listeria. Infant cover for strept PNA. Well appearing single dose IM ceftriaxone. Toxic: empiric IV abx

Question 19

Rx of neonatal sepsis? If meningitis what rx? If child < 28 days old what rx?

Answer 19

Amp + gentamicin. Cefotaxime. Acyclovir

Question 20

Fever, sore throat in child with vesicles and ulcers on POSTERIOR oropharynx

Answer 20

Herpangina

Question 21

Fever, vesicles & ulcers on ANTERIOR oral mucosa and around the mouth

Answer 21

Herpes gingiovostomatitis

Question 22

Tonsillar exudates, fever, anterior cervical lymphadenopathy

Answer 22

Group A strept

Question 23

Tonsillar exudates, fever DIFFUSE cervical lymphadenopathy +/- hepatosplenomegaly

Answer 23

infectious mono

Question 24

Recurrent ulcers in mouth w/ no systemic signs? Rx?

Answer 24

Apthous Stomatitis. Prednisone.