Rita's Infectious Disease Questions

Question 1

When should you draw titer seroconversion after hepatitis B series is complete?

a) 2-3 weeks
b) 1-2 months
c) 3-4 months
d) 4-5 months

Answer 1

b) 1-2 months

- -> impt. in babies whose moms are +…

Question 2

What is a contraindication for MMR vaccine?

a) received immunoglobulin 1 month ago
b) has a URI
c) has otitis media
d) had PPD placed 3 weeks ago

Answer 2

a) received immunoglobulin 1 month ago

Question 3

What is a contraindication for MMR vaccine?

a) pregnancy
b) HIV individual w/no viral load and near normal T cells
c) A child who lives in a household with a pregnant woman
d) A child who lives in a house of a person who is on chemotherapy

Answer 3

a) pregnancy

Question 4

Which of the following vaccines is given twice in the second year of life?

a) MMR
b) Varivax
c) Hep B
d) Hep A

Answer 4

d) Hep A

Question 5

Which of the following are contraindicated for giving MMR?

a) fever of 99.8
b) pregnancy
c) egg allergy
d) hx of previous fever and rash with MMR

Answer 5

b) pregnancy

Question 6

What is an example of an immunization precaution?

a) Fever 3 hrs
c) encephalopathy
d) redness at the site

Answer 6

b) crying > 3 hrs

Question 7

A healthy 4yo comes into the clinic for a well-child check. He has had 4 DTaPs, 3 IPVs, 1 MMR, 1 Varicella, 2 hepatitis A vaccines, 2 Hepatitis B vaccines, 4 Prevnar 13s, and 4 HIBs. What would you order today?

a) PCV13, IPV, Varicella, DTaP
b) Tdap, MMR, Hepatitis B, IPV
c) DTaP, Hepatitis B, MMR, IPV, hepatitis A, varicella
d) PCV13, DTaP, IPV, MMR

Answer 7

c) DTaP, Hepatitis B, MMR, IPV, hepatitis A, varicella

Question 8

A 4 month old had her RotaTeq, DTaP, Hib, Hep B, PCV13, and IPV immunizations at 2 months. She has had a viral URI, but has been afebrile. Her older sister, who has cancer, is receiving chemotherapy. Her PE is unremarkable. What immunizations would you give?

a) DT, Hib, IPV
b) same immunizations she received at 2 months of age
c) DTaP, PCV13, Hep A
d) None, immunizations are contraindicated d/t the current circumstances

Answer 8

b) same immunizations she received at 2 months of age

- -> all are inactivated, so none CI’d

Question 9

A healthy 18 month old whose mother has brought her to the office for immunizations. Her record states that at her 12 month PE visit she received DTaP (3rd dose), Hepatitis B (2nd dose), MMR (1st dose), IPV (2nd dose), PCV13 (4th dose) and HIB (4th dose). What do you need to give her today to get her up to date with her immunizations?

a) MMR, DTaP
b) DT, IPV, Varicella, PCV13, & Hep B
c) HIB, PCV13, IPV
d) DTaP, IPV, Varicella, Hep A, Hep B

Answer 9

d) DTaP, IPV, Varicella, Hep A, Hep B

Question 10

Baby Joey returns for his 2 month PE. He is healthy, being breast fed every 3-4 hours, sleeps in naps during the day, and has one 7 hour sleep stretch at night. Joey has had no immunizations since his Hep B at birth. What immunizations will you give today?

a) DTaP, IPV, Hep B, HIB, PCV13, Rotateq
b) HIB, Hep B, MMR
c) DPT, IPV, HIB, Hep A, PCV13
d) DPT, HIB, Hep B

Answer 10

a) DTaP, IPV, Hep B, HIB, PCV13, Rotateq

Question 11

In a given population, why don’t we need 100% of people immunized to stop disease transmission?

a) Virulence theory
b) Secular immunity
c) Diffusion theory
d) Herd Immunity

Answer 11

d) Herd Immunity

Question 12

An unvaccinated 8yo child steps on a rusty nail. What is the next best step?

a) Dtap
b) Tdap
c) Td
d) Td and tetanus immunoglobulin

Answer 12

• -if there is a clear, minor wound, and the hx of vaccination is 3 immunizations or less, Tdap or Td can be used
  
  • -> if there are >3 immunizations with Dtap or Tdap and Td, no TIG is needed

–For all other wound, Td or Tdap along with TIG is recommended

Question 13

What side effect of DTaP would be a precaution for a future dose?

a) crying for 1 hour
b) temperature of 104.5
c) indurated red mark for a week
d) limpness for one week following shot

Answer 13

precautions for dtap=
fever > 105F
crying > 3 hrs
seizure w/in 3 days
collapse or shock-like state

Question 14

When can a child return to school after having mumps?

a) children are excluded for school for 5 days after parotid swelling
b) children are excluded for school for 9 days after parotid swelling
c) children are excluded for school for 12 days after parotid swelling
d) children are excluded for school for 14 days after parotid swelling

Answer 14

a) children are excluded for school for 5 days after parotid swelling

–if 5 is not an answer, pick 9! used to be 9

Question 15

Which is the best tx for a healthy child with varicella?

a) Benadryl
b) anti-vitals
c) immunoglobulin

Answer 15

a) Benadryl

+ b) anti-vitals (if immunocompromised)

Question 16

Which one of the following is not a characteristic of varicella?

a) papules, vesicles, and pustules with crust in varying stages
b) erupts over 3-4 days
c) transmitted by direct contact
d) incubation is 1 week

Answer 16

d) incubation is 1 week
- -> incubation = 10-21 days!

b) erupts over 3-4 days
- -> erupts over 5-6 days

Question 17

An 8 month old with vomiting, diarrhea, and fever in winter. What is the likely organism?

a) Enterovirus
b) Adenovirus
c) Rotavirus
d) Shigella

Answer 17

c) Rotavirus

Enterovirus = May - Oct.

Adenovirus = sore throat, no seasonality

Question 18

Which of the following is a symptom of otitis externa?

a) Red TM
b) Pain on movement of auricle
c) Redness of the auricle

Answer 18

b) Pain on movement of auricle

Question 19

A 1yo presents with pink eye. Which of the following would lead the PNP to consider another dx?

a) hyperemic conjunctiva
b) foreign body sensation
c) decreased corneal clarity
d) copious tearing

Answer 19

c) decreased corneal clarity

Question 20

A 13yo presents with sore throat and fever. Exam reveals edematous pharynx w/a deviated uvula and a bulging left tonsil. What is the most appropriate next step?

a) Refer to ENT
b) Provide supportive care
c) Order a lateral neck
d) Order a mono spot

Answer 20

a) Refer to ENT
- -> tonsillar abscess…requires drainage, but no lateral neck

for epiglottitis: + thumb sign! (do lateral neck)

Question 21

A 3yo presents with URI for 3 days and ear pain. The left TM is normal and the right TM has a fluid level with erythema. What is the most appropriate step?

a) Amoxicillin at 40mg/kg/day
b) Augmentin 45 mg/kg/day
c) Amoxicillin at 90 mg/kg/day
d) Motrin at 10mg/kg/day

Answer 21

d) Motrin at 10mg/kg/day

Question 22

An 11 month old presents with a history of fever, crankiness, and refusing to drink. On exam, there are vesicular lesions at the posterior pharynx. What is the most likely dx?

a) Streptococcal pharyngitis
b) Herpetic gingivostomatitis
c) Herpangina
d) Aphthous stomatitis

Answer 22

c) Herpangina

Question 23

The most appropriate management for this child is to:

a) prescribe PCN
b) Prescribe viscous lidocaine
c) Prescribe motrin
d) Prescribe prednisone

Answer 23

c) Prescribe motrin

Question 24

What drug is used in individuals who have been closely exposed to someone w/neisseria meningitides?

a) rifampin
b) cephalexin
c) Amoxil
d) azithromycin

Answer 24

a) rifampin
- -> or Cipro if older
- -fyi: turns urine orange; stains contacts

Question 25

You are seeing a 3yo with a 5-day hx of diarrhea, abdominal pain, and anorexia, who is in daycare. What organism is likely to cause this?

a) Enterovirus
b) Giardia
c) Amoeba
d) Adenovirus

Answer 25

a) enterovirus
- -> live on surface x 2 weeks

Giardia: risk factor w/daycare

Question 26

A sexually active 17yo teen presents with a flat erythematous macular rash on both hands and feet. There are no other complaints. What is the most likely dx?

a) hand foot and mouth disease
b) pityriasis rosea
c) syphilis
d) gonorrhea

Answer 26

c) syphilis

- -> acral distribution!

Question 27

A child presents with vesicles on an erythematous base in different stages of healing on the third day of illness. He has a temperature of 102 with mild malaise. What is the most likely dx?

a) Rocky Mountain spotted fever
b) Varicella
c) Small pox
d) Measles

Answer 27

b) Varicella

Question 28

A mother calls to report that her 8yo had a deer tick on him. What is the next step?

a) send the tick off to the lab
b) order a lyme ELISA test
c) Treat him with an antibiotic
d) tell mom about the signs of Lyme disease

Answer 28

d) tell mom about the signs of Lyme disease

Question 29

When can a well child who has slapped cheeks of fifth disease return to school?

a) after the facial rash has disappeared
b) when the child has no rash for 24 hours
c) he can go the next day

Answer 29

c) he can go the next day
- -> contagious w/prodrome
- -> w/slapped cheek/mottled skin –> no longer contagious

Question 30

A 7yo has been camping in the NE and now was a low-grade fever and a red macule on his arm. What is the name of the lesion?

a) erythema migrans
b) erythema infectiosa
c) erythema toxicum
d) Erythema marginatum

Answer 30

a) erythema migrans

- -> = lyme disease!

Question 31

A 16 month old presents with swollen red gums, and several ulcerative lesions in the front of his mouth with some vesicles around the lips. The most likely dx is:

a) herpangina
b) gingivostomatitis
c) corona virus infection

Answer 31

b) gingivostomatitis

Question 32

A 9 month old presents with a hx of 104 for 3 days and now has a flat, macular mildly erythematous rash on the trunk. The most likely dx is:

a) Roseola
b) Measles
c) Coxsackie virus
d) Lyme disease

Answer 32

a) Roseola

…#1 cause of febrile seizures!

Question 33

A one month old presents with a fever of 102 and poor feeding. The most likely organism is:

a) Listeria
b) Late onset Group B Strep
c) Strep pneumonia
d) H influenza

Answer 33

b) Late onset Group B Strep

***1st month of life –> CHOOSE GBS!

Question 34

A child presents with a hx of rhinitis and malaise. She now has bilateral red slapped cheeks. What is her likely dx?

a) Fifth’s disease
b) Enterovirus
c) Adenovirus
d) Measles

Answer 34

a) Fifth’s disease

Question 35

Who is at risk for adverse outcomes if they are infected with fifth’s disease?

a) 18yo adolescent
b) an HIV infected child
c) A child with Turner’s syndrome
d) A baby with Down syndrome

Answer 35

b) an HIV infected child

Question 36

What does the PCP need to screen for after a pt has meningitis?

a) Vision
b) TB
c) hearing
d) urinalysis

Answer 36

c) hearing

Question 37

A 3yo Chinese infant presents with a 4 day hx of fever, lymphadenopathy, conjunctivitis, erythematous oral mucosa, and a polymorphous erythematous rash. What is the most likely dx?

a) Scarlet fever
b) Kawasaki disease
c) Measles
d) Rubella

Answer 37

c) Measles

- -> Morbilliform rash…

Question 38

What is a clinical presentation of malaria?

a) rash
b) hepatosplenomegaly
c) sore throat
d) cyclic fever

Answer 38

d) cyclic fever

Question 39

What is the tx for ascariasis?

a) mebendazole
b) flagyl
c) amoxil

Answer 39

a) mebendazole
ascariasis = an infection of the small intestine caused by Ascaris lumbricoides (A. lumbricoides), which is a species of roundworm

Question 40

What drug would you treat scabies with?

a) Permethrin
b) Lindane
c) Cetaphil lotion

Answer 40

a) Permethrin

Question 41

What is most likely to cause a pneumothorax?

a) viral pneumonia
b) bacterial pneumonia

Answer 41

b) bacterial pneumonia

Question 42

If a child with a negative medical hx comes from Africa to US school and had BCG, what do you do about the TB screen?

a) Give PPD
b) Do nothing
c) Chest xray

Answer 42

a) Give PPD

Question 43

What screening test should pregnant woman have for Hep B?

a) no testing is indicated
b) check serum for hep B surface antigen (HBsAg)
c) Check her serum for antibody to hepatitis B e antigen (anti-HBe)

Answer 43

b) check serum for hep B surface antigen (HBsAg)
- -> all women should have this! regardless of risk factors, immunization hx
- -> woman’s HBsAg status determines what prophylaxis should be given to her newborn and the level of f/u that both mother and child should receive

Question 44

What do you recommend to a male patient who was exposed to Hep A via a male sexual partner?

a) administer gamma globulin
b) administer lamivudine
c) administer hepA vaccine
d) do nothing as it’s been too long

Answer 44

c) administer hepA vaccine
- -> recent guidelines are to administer Hep A vaccine for hep A post-exposure prophylaxis in healthy persons 12 months to 40 yrs of age
- -> for some pt populations, such as immunocompromised, use of IG (immune globulin) is still preferred for prophylaxis
- -> in this case, HAV should be given asap and not more than 2 weeks after exposure; pt also needs to complete Hep A series to provide long-term protection against future infection

Question 45

Which of the following statements regarding latent TB infections (LTBI) in the US is correct?

a) Placing a TST on all new students to a school is a case effective screening method
b) Using targeted screening with TST is estimated to prevent 85 cases per 100 persons tested
c) All foreign-born students should have TST placed to evaluate for LTBI
d) The size of the reaction to TST in child who had BCG does not correlate w/the TB disease risk

Answer 45

b) Using targeted screening with TST is estimated to prevent 85 cases per 100 persons tested

• -the new guidelines discourage screen-all strategies
• -should use risk questionnaire; only test if 1 or more risk factors is present

Question 46

Which of the following about tuberculin skin testing (TST) is correct?

a) A wheal and flare reaction occurring after administration indicates a positive TST.
b) A well child with 8mm of induration 96 hrs after TST placement has a positive TST.
c) In reading the TST result, the recorder can put down negative if there is no induration.
d) Erythema around the TST is not considered significant unless there is induration.

Answer 46

d) Erythema around the TST is not considered significant unless there is induration.

Question 47

A well 10yo from Venezuela has had BCG immunization shortly after birth. During his well visit, he receives a booster MMR vaccine and TST. Which of the following statements is true regarding his 15mm TST reaction read at 70 hours?

a) It is more likely related to his BCG vaccine.
b) It is most likely the result of MMR vaccine.
c) He needs to have it repeated to make sure it is accurate.
d) He needs a chest X-ray for further evaluation.

Answer 47

d) He needs a chest X-ray for further evaluation.
- -> 79% of world’s population has had BCG!
- -> BCG vaccination should be ignored in interpreting the results of TST
- -> MMR can be administered the same time as a TST but if an MMR has been given earlier, there needs to be a six-week interval between the TST and the BCG
- -> there is no need to repeat a positive PPD
- -> a chest x-ray should be done in children and adolescents with a positive TST before starting tx for LTB

Question 48

A 15yo San Salvadorian female has an 18mm TST and a negative chest x-ray. Her Quantiferon Gold is positive. There are no known household contacts with TB. What is the best course of tx?

a) INH at 10-15mg/kg with a max of 300mg po od for 6 months
b) INH at 10-15mg/kg with max of 300 po od for 9 months
c) Rifampin at 10mg/kg-20mg/kg with a max of 600mg od for 6 months
d) Rifampin at 10mg/kg-20mg/kg with a max of 600mg od for 9 months

Answer 48

b) INH at 10-15mg/kg with max of 300 po od for 9 months

• -INH remains standard tx for LTBI w/out any exposure to a household contact w/INH resistant TB
• -dosage for INH = 10-15mg/kg, which can be administered daily for 9 months or with directly observed therapy (DOT) at 20-30mg/kg with a max dose of 900mg
• -side effects of INH include: hepatitis, peripheral neuropathy, and hypersensitivity reactions

Question 49

An 8 month old presents with a high fever as well as diffuse erythematous rash which is tender and denudes on touch. What is the most likely organism causing this?

a) Staphylococcus aureus
b) Streptococcus pyrogenes
c) H. influenza
d) Coxsackie B

Answer 49

a) Staphylococcus aureus

- -> staph scalded skin syndrome