Quiz1

Question 1

Chlamydial Pneumonia

Answer 1

Correct.
Chlamydial pneumonia is usually seen in infants 3–16 weeks of age, and these patients frequently have
been sick for several weeks. The infant appears nontoxic and is afebrile, but is tachypneic with a prominent
cough.

The physical examination will reveal diffuse crackles with few wheezes, and conjunctivitis is
present in about 50% of cases. A chest film will show hyperinflation and diffuse interstitial or patchy
infiltrates.

Question 2

Staph pneumonia

Answer 2

Staphylococcal pneumonia has a sudden onset. The infant appears very ill and has a fever, and initially
may have an expiratory wheeze simulating bronchiolitis. Signs of abdominal distress, tachypnea, dyspnea,
and localized or diffuse bronchopneumonia or lobar disease may be present. The WBC count will show
a prominent leukocytosis.

Question 3

RSV

Answer 3

Respiratory syncytial virus infections start with rhinorrhea and pharyngitis, followed in 1–3 days by a
cough and wheezing. Auscultation of the lungs will reveal diffuse rhonchi, fine crackles, and wheezes, but
the chest film is often normal. If the illness progresses, coughing and wheezing increase, air hunger and
intercostal retractions develop, and evidence of hyperexpansion of the chest is seen. In some infants the
course of the illness may be similar to that of pneumonia. Rash or conjunctivitis may occur occasionally,
and fever is an inconsistent sign. The WBC count will be normal or elevated, and the differential may be
normal or shifted either to the right or left. Chlamydial infections can be differentiated from respiratory
syncytial virus infections by a history of conjunctivitis, the subacute onset and absence of fever, and the
mild wheezing. There may also be eosinophilia.

Question 4

Parainfluenza

Answer 4

Parainfluenza virus infection presents with typical cold symptoms. Eight percent of infections affect the
upper respiratory tract. In children hospitalized for severe respiratory illness, parainfluenza viruses account
for about 50% of the cases of laryngotracheitis and about 15% each of the cases of bronchitis,
bronchiolitis, and pneumonia.

Question 5

Over diagnosis

Answer 5

Overdiagnosis is the diagnosis of a disease that will not produce symptoms during a
patient’s lifetime.

Question 6

Mallet fracture tx

Answer 6

The recommended treatment for a mallet fracture is splinting the distal interphalangeal (DIP) joint in
extension (SOR B). The usual duration of splinting is 8 weeks

Question 7

Drugs for Bipolar

Answer 7

Lithium, valproate, lamotrigine, and some antipsychotics (including quetiapine) are effective treatments
for both acute depression and maintenance therapy of bipolar disorders. Haloperidol is an effective
treatment for acute mania in bipolar disorders, but not for maintenance therapy or acute depression.

Question 8

Necrotizing fasciitis

Answer 8

Severe pain and skin changes outside the realm of cellulitis, including bullae and deeper
discoloration, are strong indications of necrotizing fasciitis

Question 9

Amiodarone

Answer 9

Patients on amiodarone can develop either hyperthyroidism or hypothyroidism.

Question 10

Subluxation of the Radial head

Answer 10

holding the left arm slightly pronated, flexed, and close to her body.

Tx: With the child’s elbow in 90° of flexion,
the hand is fully supinated by the examiner and the elbow is then brought into full flexion.

Question 11

Asthma management Chart

Answer 11

Look it up

Question 12

The first-line treatment for primary dysmenorrhea

Answer 12

NSAIDs (SOR A). They should be started
at the onset of menses and continued for the first 1–2 days of the menstrual cycle. Combined oral
contraceptives may be effective for primary dysmenorrhea, but there is a lack of high-quality randomized,
controlled trials demonstrating pain improvement (SOR B).

Question 13

Thyroid nodule one centimeter

Answer 13

Thyroid nodules >1 cm that are discovered incidentally on examination or imaging studies merit further
evaluation. Nodules <1 cm should also be fully evaluated when found in patients with a family history
of thyroid cancer, a personal history of head and neck irradiation, or a finding of cervical node
enlargement. Reasonable first steps include measurement of TSH or ultrasound examination. The American
Thyroid Association’s guidelines recommend that TSH be the initial evaluation (SOR A) and that this be
followed by a radionuclide thyroid scan if results are abnormal.