STI's and Communicable Diseases

Question 1

What is the most common cause of the common cold?
a) Influenza virus
b) Respiratory Syncytial Virus (RSV)
c) Rhinovirus
d) Streptococcus pyogenes

Answer 1

Answer: C) Rhinovirus: Rarely causes fever. Rhinovirus is the most common cause of the common cold and typically leads to mild symptoms such as a runny nose, sore throat, and cough without significant fever

A) Influenza virus: This causes flu symptoms, which are more severe than the common cold (fever, chills, fatigue, body aches).
B) Respiratory Syncytial Virus (RSV): This virus mainly affects young children and causes more serious respiratory issues like bronchiolitis, wheezing, coughing and pneumonia. It can cause fever
D) Streptococcus pyogenes: This is the causative agent of strep throat, not the common cold. Often presents with fever.

Question 2

Which of the following is a common complication of mumps?
a) Pneumonia
b) Orchitis
c) Sinusitis
d) Conjunctivitis

Answer 2

B) Orchitis: Mumps can lead to inflammation of the testes, known as orchitis, and other complications like pancreatitis and meningoencephalitis.

A) Pneumonia: Not a typical complication of mumps.
C) Sinusitis: This is not a common complication of mumps.
D) Conjunctivitis: Not associated with mumps.

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Why Does Mumps Infect the Testes (Orchitis)?
Mumps has a strong affinity for glandular and immune-privileged tissues, such as:

Salivary glands (parotitis)
Testes (orchitis), epididymis (epididymitis), and prostate
✅ Mechanism:

Mumps virus enters via the respiratory tract, spreads through the blood (viremia), and targets glandular tissue, leading to inflammation.
The testes and prostate are immune-privileged sites, meaning they have reduced immune surveillance, making them ideal viral reservoirs.
The virus infects Sertoli cells, leading to testicular inflammation (orchitis), which can cause infertility in some cases.
✅ Why the Prostate?

The prostate is also a glandular organ and can become inflamed as part of the systemic infection.

Question 3

How is norovirus most commonly transmitted?
a) Airborne droplets
b) Contact with contaminated surfaces
c) Inhalation of infected dust
d) Direct person-to-person contact

Answer 3

B) Contact with contaminated surfaces: This is the most common route of transmission for norovirus, especially through contaminated food, surfaces, or people.

Common symptoms are vomiting and diarrhea
Treatment: take 1 -3 day to recover, oral rehydration therapy, clear fluids, plain foods like rice, bananas, apple sauce, avoid irritating foods like meats, acidic foods, dairy
i) Wash hands before and after the bathroom
ii) Wash fruits and vegetables well
iii) Cook meat thoroughly

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This answer is sufficient for norovirus management because:

Norovirus Causes Vomiting and Diarrhea – The primary risk is dehydration due to significant fluid loss. Oral hydration therapy (water, oral rehydration solutions) is the most important treatment to prevent complications.

Easily Digestible Foods Aid Recovery – Once vomiting subsides, plain foods like rice, toast, bananas, and applesauce help restore energy without irritating the gut.

No Specific Antiviral Treatment – Norovirus is self-limiting, meaning it resolves on its own. The focus is on supportive care (hydration and nutrition).

Minimizing Gut Irritation – Avoiding fatty, spicy, or dairy-heavy foods reduces the risk of prolonged symptoms.

Question 4

What is the recommended treatment for rotavirus in infants younger than 1 year?
a) Antibiotics
b) Oral hydration therapy
c) Frequent breastfeeding
d) IV fluids

Answer 4

C) Frequent breastfeeding: For infants under 1 year, breastfeeding provides hydration and nutrients that help manage rotavirus infection

A) Antibiotics: Rotavirus is viral, and antibiotics are not effective.
B) Oral hydration therapy: This is useful but for infants under 1 year, frequent breastfeeding is recommended.
D) IV fluids: Only used if there are complications like severe dehydration.

Symptoms: severe watery diarrhea in infants and
children; vaccine available by mouth at 2 mos
Transmission: virus is in fecal matter, spread by hands or in food/water
Treatment
i) younger 1yoa: frequent breastfeeding or oral hydration
therapy
ii) Over 1 yoa: oral hydration therapy, clear broth, ice pops

Question 5

Which of the following is characteristic of measles?
a) High fever with a rash that starts on the trunk
b) Koplik’s spots in the mouth
c) Low-grade fever and maculopapular rash
d) Vesicles or red papules on the face, hands, and feet

Answer 5

Answer: B) Koplik’s spots in the mouth: These are characteristic of measles and appear before the rash.

A) High fever with a rash that starts on the trunk: While measles causes a rash, it typically starts on the face and spreads downward, not on the trunk.
C) Low-grade fever and maculopapular rash: This is more characteristic of rubella.
D) Vesicles or red papules on the face, hands, and feet: This is characteristic of hand, foot, and mouth disease.

Question 6

What is a common complication of varicella zoster (chickenpox)?
a) Meningitis
b) Pneumonia
c) Sinusitis
d) Lymphadenitis

Answer 6

Answer: B) Pneumonia: Chickenpox can lead to bacterial pneumonia as a complication.

A) Meningitis: Rare for chickenpox but can occur in severe cases.
C) Sinusitis: Not typically a complication of chickenpox.
D) Lymphadenitis: Not a typical complication of chickenpox.

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Varicella-zoster virus (VZV) has an affinity for the lungs, particularly in adults. The exact reason isn’t fully understood, but it is likely due to:

VZV’s ability to spread through the bloodstream (viremia):

After initial infection in the respiratory tract, VZV spreads systemically.
The lungs, being highly vascularized, are vulnerable to viral seeding.
Tropism for epithelial and endothelial cells:

VZV targets cells lining the alveoli, causing inflammation and pneumonia.
Weakened immune response in adults:

Adults mount a stronger inflammatory response to VZV than children, leading to more severe lung damage.

Question 7

Which of the following is the best prevention for rubella?
a) Hand washing
b) Vaccination
c) Avoidance of contaminated food
d) Symptomatic therapy

Answer 7

Answer: B) Vaccination: The MMR vaccine (measles, mumps, rubella) is the best prevention for rubella.

A) Hand washing: While hand washing helps prevent infections in general, it does not specifically prevent rubella.
C) Avoidance of contaminated food: Rubella is not transmitted by food.
D) Symptomatic therapy: Treatment focuses on relieving symptoms but does not prevent the infection.

Question 8

What is the hallmark sign of hand, foot, and mouth disease?
a) Fever and cough
b) Vesicles or red papules on the hands, feet, and mouth
c) A maculopapular rash
d) Koplik’s spots in the mouth

Answer 8

Answer: B) Vesicles or red papules or putules on the hands, soles, interdigital, feet, and buttocks; and ulcers in the mouth: This is the characteristic sign of hand, foot, and mouth disease. It is cause by several enteroviruses but Coxsackievirus A is the most specific or the enterovirus

A) Fever and cough: These are more typical of respiratory infections like the common cold or flu.
C) A maculopapular rash: This is more common in diseases like rubella or measles.
D) Koplik’s spots in the mouth: These are specific to measles, not hand, foot, and mouth disease.

Question 9

What is the treatment for impetigo?
a) Oral antibiotics
b) Topical steroids
c) Antiviral therapy
d) Pain relief only

Answer 9

Answer: a) Oral antibiotics
A) Oral antibiotics: Impetigo is a bacterial infection treated with antibiotics like penicillin or amoxicillin.
B) Topical steroids: These are not used to treat impetigo; they may worsen infection.
C) Antiviral therapy: Not effective for impetigo, which is bacterial.
D) Pain relief only: Pain relief alone does not address the bacterial infection.

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Impetigo is caused by bacterial infection, primarily due to:

Staphylococcus aureus – The most common cause, responsible for both non-bullous and bullous impetigo.
Group A Streptococcus (Streptococcus pyogenes) – Can also cause non-bullous impetigo and is associated with post-streptococcal complications like glomerulonephritis.
The infection occurs when bacteria enter through broken skin, such as cuts, insect bites, eczema, or other skin conditions. It spreads easily through direct contact and is common in children.

Question 10

Which of the following is the most common cause of conjunctivitis (pink eye)?
a) Streptococcus pneumoniae
b) Adenovirus or bacteria
c) Coxsackievirus
d) Rubella virus

Answer 10

Answer: B) Adenovirus or bacteria: Adenovirus is a leading cause of viral conjunctivitis, and bacterial causes include Streptococcus pneumoniae and Staphylococcus aureus.

A) Streptococcus pneumoniae: While it can cause bacterial conjunctivitis, adenovirus is more common.

C) Coxsackievirus: Not a common cause of conjunctivitis.
D) Rubella virus: Rubella does not cause conjunctivitis; it causes a rash and other symptoms.

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E. coli is not the most common cause of conjunctivitis. The most frequent causes depend on the type of conjunctivitis (bacterial, viral, or allergic). Here’s a breakdown:

Bacterial Conjunctivitis:

The most common bacterial pathogens are Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae.
E. coli can cause conjunctivitis, but it is much less common and typically associated with contamination from fecal matter (e.g., poor hygiene or contact with contaminated water).

Viral Conjunctivitis:
Most often caused by adenoviruses. This is the most common type of conjunctivitis overall.

Allergic Conjunctivitis:
Triggered by allergens like pollen, dust mites, or pet dander, not infections.

Why E. coli is uncommon:
E. coli is primarily associated with gastrointestinal infections or urinary tract infections. Its involvement in conjunctivitis is rare and usually occurs in specific scenarios (e.g., exposure to contaminated water or in neonates during delivery if the mother has an E. coli infection).
In summary, while E. coli can cause conjunctivitis in rare cases, it is not the most common pathogen. Adenovirus is the leading cause overall, while Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae are the primary bacterial culprits.

Question 11

Which of the following is the most likely etiology of viral conjunctivitis?
A) Adenovirus
B) Staphylococcus aureus
C) Streptococcus pneumoniae
D) Chlamydia trachomatis

Answer 11

A) Adenovirus is the most common cause of viral conjunctivitis, presenting with symptoms like watery discharge, photophobia, and “pink eye.”

Why others are wrong:
B & C (Staphylococcus aureus, Streptococcus pneumoniae): These are bacterial causes, typically leading to mucopurulent discharge and “morning crustiness.”
D (Chlamydia trachomatis): While it can cause conjunctivitis, it’s typically associated with sexually transmitted infections and neonatal ophthalmia.

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Why Does Bacterial vs. Viral Conjunctivitis Have Different Discharge?
Bacterial Conjunctivitis – Mucopurulent Discharge

Caused by Staphylococcus, Streptococcus, H. influenzae, which produce pus as part of the inflammatory response.
Bacteria trigger neutrophil invasion, leading to thick, yellow-green discharge and crusting.
Viral Conjunctivitis – Watery Discharge

Caused by adenovirus or enteroviruses, which trigger a lymphocytic immune response rather than pus-forming neutrophils.
Why watery? Viral infections cause mild irritation, but not a heavy neutrophil response, so no thick pus forms.

What About Haemophilus influenzae in Conjunctivitis?
Haemophilus influenzae is a gram-negative coccobacillus that can cause bacterial conjunctivitis, especially in children.

Why Does H. influenzae Cause Mucopurulent Discharge?

It produces a strong neutrophilic response, leading to pus (mucopurulent discharge) in the eye.
Neutrophils release enzymes and dead bacteria, forming thick yellow-green discharge, which crusts overnight (“morning crustiness”).
Why Doesn’t H. influenzae Cause Watery Discharge Like Viruses?

Viral infections (e.g., adenovirus) primarily trigger lymphocytes, which don’t produce pus—leading to watery discharge instead.
H. influenzae and other bacteria, in contrast, stimulate neutrophils, which lead to thicker, pus-filled secretions

Question 12

A patient presents with mucopurulent discharge, morning crustiness, and unilateral eye redness. What is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Herpetic keratitis

Answer 12

B) Bacterial conjunctivitis

Why it’s correct: Mucopurulent discharge and “morning crustiness” are hallmarks of bacterial conjunctivitis, often caused by Staphylococcus spp., Streptococcus spp., or H. influenzae.
Why others are wrong:
A (Viral conjunctivitis): This typically presents with watery discharge and is frequently bilateral.
C (Allergic conjunctivitis): Associated with itching and bilateral symptoms, without discharge.
D (Herpetic keratitis): Often presents with photophobia, blurred vision, and dendritic ulcers seen on fluorescein staining.

Question 13

Which of the following is a potential complication of untreated Chlamydia trachomatis conjunctivitis?
A) Corneal abrasion
B) Blindness
C) Retinopathy
D) Cataracts

Answer 13

B) Blindness
Why it’s correct: Untreated C. trachomatis conjunctivitis can lead to blindness, especially in endemic areas (trachoma).

Why others are wrong:
A (Corneal abrasion): This is a complication of rubbing in viral or allergic conjunctivitis.
C (Retinopathy): Not associated with conjunctivitis.
D (Cataracts): Unrelated to conjunctivitis.

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How Does Chlamydia trachomatis Cause Blindness?
C. trachomatis causes blindness primarily through trachoma, a chronic infectious eye disease. Here’s the process:

Initial Infection:

C. trachomatis serovars A, B, and C infect the conjunctiva.
This infection often begins in childhood and is transmitted via direct contact, contaminated items, or flies.
Chronic Inflammation:

Repeated infections cause chronic conjunctival inflammation.
The body’s immune response leads to scarring of the inner eyelid (conjunctiva).

Trichiasis:
Scar tissue causes the eyelashes to turn inward (trichiasis).
The lashes scratch the cornea with each blink, leading to corneal abrasions.
Corneal Opacification:

Persistent damage to the cornea leads to ulceration, secondary infections, and ultimately, blindness due to corneal opacity.
Trachoma remains the leading infectious cause of blindness worldwide and is preventable through improved hygiene, access to clean water, and antibiotics like azithromycin.

Question 14

Which of the following is a common complication of Chlamydia trachomatis infection in women?
A) Pelvic inflammatory disease (PID)
B) Trichomoniasis
C) Cervical cancer
D) Reiter’s syndrome

Answer 14

Correct Answer: A) Pelvic inflammatory disease (PID)
Why it’s correct: PID is a well-known complication of C. trachomatis infections, often resulting from untreated cervicitis. It can lead to infertility and ectopic pregnancy.

Why others are wrong:
B) Trichomoniasis: Caused by Trichomonas vaginalis, not C. trachomatis.
C) Cervical cancer: Linked to HPV, not C. trachomatis.
D) Reiter’s syndrome: While possible, it is much rarer and presents as reactive arthritis, not a primary concern in most women.

More information
The symptoms of Pelvic Inflammatory Disease (PID) caused by Chlamydia trachomatis result from its ability to ascend from the cervix into the upper reproductive tract (uterus, fallopian tubes, and ovaries) and trigger a cascade of inflammatory damage. Here’s a detailed explanation:

Mechanism of PID Symptoms
Initial Infection (Cervicitis):

C. trachomatis infects the epithelial cells of the cervix, where it triggers a localized immune response.
Without treatment, the infection can ascend to the upper genital tract, spreading to the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries.
Tissue Inflammation and Damage:

The infection leads to an intense inflammatory response, characterized by recruitment of neutrophils, macrophages, and cytokines.
This inflammation damages the delicate tissues of the fallopian tubes and ovaries, causing scarring and adhesions.
Symptoms in PID:

Abdominal/pelvic pain: Inflammation of the reproductive organs irritates surrounding nerves.
Fever: Systemic immune activation leads to fever.
Abnormal discharge: The inflamed endometrium and cervix produce excess secretions.
Dyspareunia (painful intercourse): Inflammation in the pelvic region causes discomfort during sexual activity.
Infertility: Scarring of the fallopian tubes can block egg transport, leading to infertility.
Infertility and Ectopic Pregnancy:

Scarring and narrowing of the fallopian tubes caused by chronic inflammation can prevent fertilized eggs from traveling to the uterus.
This increases the risk of an ectopic pregnancy, where the embryo implants in the fallopian tube or another inappropriate location.
Why PID Is a Serious Complication
PID is often asymptomatic or mild at first, which delays treatment.
Chronic or recurrent PID increases the risk of irreversible damage to the reproductive organs, leading to long-term consequences like infertility, chronic pelvic pain, and increased risk of ectopic pregnancies.

Question 15

What is the gold standard diagnostic test for both Chlamydia trachomatis and Neisseria gonorrhoeae?
A) Gram stain
B) Nucleic acid amplification test (NAAT)
C) Blood culture
D) Direct fluorescence antibody test

Answer 15

Correct Answer: B) Nucleic acid amplification test (NAAT)
Why it’s correct: NAAT is highly sensitive and specific, making it the gold standard for detecting both C. trachomatis and N. gonorrhoeae in urine or swab samples.

Why others are wrong:
A) Gram stain: Useful for diagnosing N. gonorrhoeae in symptomatic males (shows diplococci) but not sensitive enough for C. trachomatis.
C) Blood culture: Used for systemic infections, not local STIs.
D) Direct fluorescence antibody test: Less sensitive and rarely used in modern clinical practice.

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How Does a Nucleic Acid Amplification Test (NAAT) Work?
NAAT is a highly sensitive and specific method for detecting pathogen DNA(Bacterial infection) or RNA (Virus). It works by amplifying small amounts of genetic material so they can be detected.

Steps of NAAT:
Sample Collection

A swab (e.g., throat, urine, vaginal, or blood sample) is collected from the patient.
Extraction of Nucleic Acids

DNA or RNA is isolated from the pathogen present in the sample.
Amplification (Copying the Genetic Material)

The test repeatedly duplicates (amplifies) a specific gene sequence using polymerase chain reaction (PCR) or similar techniques.
Even if only a tiny amount of the pathogen’s genetic material is present, amplification makes it detectable.
Detection

Fluorescent dyes, probes, or electrophoresis confirm the presence of the target DNA or RNA.
If the pathogen’s nucleic acid is present, the test is positive.
Why Is NAAT Used?
Highly accurate (better than culture or antigen tests).
Can detect low levels of bacteria or viruses (e.g., Chlamydia, Gonorrhea, COVID-19).
Works faster than traditional culture methods.

Question 16

Which of the following vaccines can prevent complications of STIs?
A) Hepatitis B vaccine
B) MMR vaccine
C) Influenza vaccine
D) Varicella vaccine

Answer 16

Correct Answer: A) Hepatitis B vaccine
Why it’s correct: Hepatitis B can be sexually transmitted, and the vaccine prevents both the infection and its complications, like chronic hepatitis or hepatocellular carcinoma.

Why others are wrong:
B) MMR vaccine: Protects against measles, mumps, and rubella, not STIs.
C) Influenza vaccine: Prevents the flu, unrelated to STIs.
D) Varicella vaccine: Protects against chickenpox and shingles, not STIs.

How the Hepatitis B Vaccine Prevents STI
Remember hepatitis B is for Blood
Complications
Hepatitis B is a sexually transmitted infection (among other transmission routes, like blood or perinatal).
The Hepatitis B vaccine works by inducing the immune system to produce antibodies against the Hepatitis B virus (HBV), preventing infection and its complications.
Complications Prevented:
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma (liver cancer)
Vertical transmission from mother to neonate during childbirth

Question 17

What is the primary method to prevent trachoma caused by Chlamydia trachomatis?
A) Antibiotic eye drops
B) Improved hygiene and sanitation
C) Routine eye exams
D) Wearing sunglasses

Answer 17

Correct Answer: B) Improved hygiene and sanitation
Why it’s correct: Trachoma spreads via contact with contaminated hands, towels, or flies, so improving hygiene and access to clean water is key to prevention.

Why others are wrong:
A) Antibiotic eye drops: Used for treatment, not prevention.
C) Routine eye exams: Important for early detection but not preventive.
D) Wearing sunglasses: Reduces UV exposure but has no role in preventing trachoma.

Question 18

What is the recommended treatment for Neisseria gonorrhoeae if co-infection with C. trachomatis cannot be ruled out?
A) Doxycycline alone
B) Ceftriaxone IM + azithromycin PO
C) Amoxicillin PO
D) Ciprofloxacin IM

Answer 18

**Correct Answer: B) Ceftriaxone IM + azithromycin PO

Why it’s correct: This combination treats both N. gonorrhoeae and C. trachomatis, covering the possibility of co-infection.**

Why others are wrong:
A) Doxycycline alone: Effective for C. trachomatis but not for N. gonorrhoeae.
C) Amoxicillin PO: Ineffective against N. gonorrhoeae.
D) Ciprofloxacin IM: No longer recommended due to widespread resistance in N. gonorrhoeae

Question 19

What complication is associated with neonatal exposure to Chlamydia trachomatis during delivery?
A) Neonatal sepsis
B) Meningitis
C) Ophthalmia neonatorum and pneumonia
D) Herpetic encephalitis

Answer 19

Correct Answer: C) Ophthalmia neonatorum and pneumonia
Why it’s correct: Neonates exposed to C. trachomatis during vaginal delivery can develop conjunctivitis (ophthalmia neonatorum) or pneumonia.

Why others are wrong:
A) Neonatal sepsis: More commonly caused by Group B Streptococcus or N. gonorrhoeae.
B) Meningitis: Typically caused by E. coli, Group B Streptococcus, or Listeria monocytogenes.
D) Herpetic encephalitis: Associated with HSV, not C. trachomatis.

Question 20

What is the most effective way to ensure compliance with STI treatment in adolescents?
A) Self-administered therapy at home
B) Directly observed therapy (DOT)
C) Providing written instructions
D) Telephone follow-ups

Answer 20

Correct Answer: B) Directly observed therapy (DOT)
Why it’s correct: DOT ensures the adolescent takes the medication correctly under supervision, improving compliance.

Why others are wrong:
A) Self-administered therapy at home: Risk of incomplete adherence.
C) Providing written instructions: Helpful but insufficient alone for ensuring compliance.
D) Telephone follow-ups: Useful for reminders but do not guarantee adherence.

Question 21

Which historical event marked the creation of the first vaccine?
A) Mass vaccination for smallpox (1967)
B) Development of the COVID-19 vaccine (2021)
C) Dr. Edward Jenner’s smallpox vaccine (1796)
D) Polio eradication initiative (1988)

Answer 21

C) Correct: Edward Jenner’s work in 1796 is widely recognized as the first successful development of a vaccine, using cowpox to create immunity against smallpox.

A) Incorrect: Mass vaccination campaigns for smallpox occurred much later, in 1967, after Jenner’s vaccine.
B) Incorrect: The COVID-19 vaccine is a modern achievement, not the first vaccine developed.
D) Incorrect: The Polio eradication initiative began in 1988, long after smallpox vaccination.

Question 22

What recommendation from the CDC aims to improve vaccine compliance in infants?
A) Avoid VIS forms during vaccination discussions.
B) Reduce missed opportunities to vaccinate.
C) Defer vaccines when parents are hesitant.
D) Schedule fewer doses by 18 months.

Answer 22

B) Correct: Reducing missed vaccination opportunities ensures that infants stay on schedule and are protected against 14 diseases by 18 months.

A) Incorrect: VIS (Vaccine Information Statements) are mandatory by law under the National Childhood Vaccine Injury Act of 1986.
C) Incorrect: Vaccines are only deferred for true medical contraindications, not vaccine hesitancy.
D) Incorrect: Infants are recommended to receive 25 doses by 18 months to ensure protection against various diseases.

Question 23

Which condition is a contraindication for live attenuated vaccines?
A) Egg allergy
B) Immunocompromised state
C) Soreness at the injection site
D) Fever following previous vaccination

Answer 23

B) Correct: Live attenuated vaccines are contraindicated in immunocompromised individuals (e.g., SCID) due to the risk of infection from the weakened virus.

A) Incorrect: Egg allergies may affect eligibility for specific vaccines but do not contraindicate all live vaccines.
C) Incorrect: Soreness is a mild, common side effect, not a contraindication.
D) Incorrect: Fever after vaccination is typically a mild, self-limiting side effect.

Question 24

What ethical consideration is critical in addressing vaccine hesitancy?
A) Restricting access to vaccines for hesitant parents
B) Avoiding discussions about vaccine safety
C) Providing evidence-based education about vaccines
D) Requiring NDs to give vaccine recommendations

Answer 24

C) Correct: Educating families about vaccine benefits, addressing myths, and building trust is key to reducing vaccine hesitancy.

A) Incorrect: Restricting access is unethical and counterproductive.
B) Incorrect: Avoiding discussions exacerbates fears and mistrust.
D) Incorrect: Naturopathic doctors (NDs) are not typically authorized to provide primary vaccine recommendations; this is usually the role of family physicians.

Question 25

What is a key benefit of the CANImmunize app? A) It administers vaccines remotely. B) Tracks vaccinations for individuals and families. C) Provides immediate treatment for adverse vaccine reactions. D) Reduces vaccine costs for low-income families.

Answer 25

**B) Correct: CANImmunize is a tool for tracking vaccination records to ensure timely immunizations.** A) Incorrect: The app does not administer vaccines. C) Incorrect: It does not provide treatments for adverse events. D) Incorrect: It does not directly reduce vaccine costs but facilitates immunization tracking.

Question 26

Which of the following diseases is vaccine-preventable and often asymptomatic in early stages? A) Influenza B) Hepatitis B C) Varicella D) HPV

Answer 26

**B) Correct: Hepatitis B is often asymptomatic initially but can lead to complications such as liver disease. It is preventable with vaccination.** A) Incorrect: Influenza is vaccine-preventable but typically presents with symptomatic respiratory illness. C) Incorrect: Varicella (chickenpox) is preventable but has a clear symptomatic presentation. D) Incorrect: HPV (human papillomavirus) can be asymptomatic but is more associated with cancer prevention through vaccines.

Question 27

Which of the following historical vaccine milestones occurred in 2016? A) Polio eradication initiative B) Measles combined with mumps and rubella C) Meningitis Vaccination Project D) Creation of the first Ebola vaccine

Answer 27

**Correct Answer: C) Meningitis Vaccination Project Why it's correct: The Meningitis Vaccination Project was a significant milestone in 2016, targeting high-risk populations.** Why others are wrong: A) Polio eradication initiative was launched in 1988. B) Measles combined with mumps and rubella occurred in 1971. D) The Ebola vaccine was developed for high-risk countries in 2019.

Question 28

Which vaccine-preventable disease is characterized by temperature instability and hypothermia in infants rather than fever? A) Hepatitis B B) HPV C) Meningococcal disease D) Varicella

Answer 28

**Correct Answer: C) Meningococcal disease Why it's correct: Meningococcal disease can cause temperature instability and hypothermia in infants, alongside severe symptoms like meningitis and encephalitis.** Why others are wrong: A) Hepatitis B primarily affects the liver and does not cause these symptoms. B) HPV leads to cervical cancer and other conditions but is asymptomatic in many cases. D) Varicella typically causes fever and a vesicular rash.

Question 29

Which of the following is a common but mild adverse effect of vaccines? A) Anaphylaxis B) Soreness at the injection site C) Cerebral edema D) Glomerulonephritis

Answer 29

**Correct Answer: B) Soreness at the injection site Why it's correct: Soreness, fever, and red raised bumps at the injection site are common and self-limiting side effects of vaccines.** Why others are wrong: A) Anaphylaxis is a rare but serious adverse effect. C) Cerebral edema is a potential complication of meningococcal disease, not a vaccine side effect. D) Glomerulonephritis is associated with certain infections, not vaccines.

Question 30

Which ethical principle is most relevant to mandatory vaccination programs? A) Health equity B) Patient autonomy C) Beneficence D) All of the above

Answer 30

**Correct Answer: D) All of the above** Why it's correct: A) Health equity ensures vaccines are accessible to all populations. B) Patient autonomy relates to informed consent for vaccination. C) Beneficence ensures actions promote public health and minimize harm. Why others are wrong: Each principle is critical, making "All of the above" the most accurate choice.

Question 31

What key information should be included in an Adverse Effect Following Immunization (AEFI) report? A) Child’s demographic details B) Vaccine specifics such as lot number C) Symptoms related to the vaccine D) All of the above

Answer 31

Correct Answer: D) All of the above Why it's correct: Comprehensive AEFI reports must include child demographics, vaccine specifics, and symptoms to identify patterns and risks. Why others are wrong: Each piece of information is essential, making "All of the above" the correct choice.

Question 32

Which group of infants is most likely to receive RSV Vaccine prophylaxis? A) Infants born at 38 weeks gestation with no chronic illness B) Infants born before 29 weeks gestation with chronic lung disease C) Infants born between 32-36 weeks with no health concerns D) Infants born at term with congenital heart disease

Answer 32

**Correct Answer: B) Infants born before 29 weeks gestation with chronic lung disease Why it's correct: RSV prophylaxis is specifically recommended for high-risk infants, including those born before 29 weeks or with chronic lung conditions. Why others are wrong:** A) Full-term infants without complications do not need RSV prophylaxis. C) Infants born slightly prematurely without other risk factors may not qualify. D) Congenital heart disease is a consideration but must be severe for RSV prophylaxis to be indicated.

Question 33

Which of the following is the most appropriate treatment for bronchiolitis caused by RSV in a hospitalized infant? A. Palivizumab B. IV fluids and oxygen therapy C. Oral antiviral therapy D. Broad-spectrum antibiotic

Answer 33

A) Palivizumab Mechanism of Action: Palivizumab binds to the F protein of the RSV virus, preventing the virus from fusing with host cell membranes. This stops the virus from entering cells and replicating, reducing viral load and preventing severe disease. Why It's Effective: RSV can cause severe respiratory distress in infants due to inflammation and airway obstruction. Preventing viral replication reduces the inflammatory response and subsequent complications like bronchiolitis or pneumonia. It doesn't cure RSV but reduces the severity and risk of hospitalization. When It’s Used: It’s administered prophylactically during RSV season to high-risk infants as monthly intramuscular injections.

Question 34

Which vaccine-preventable disease is associated with a maculopapular rash that starts on the face and spreads to the trunk and extremities? A. Varicella Zoster B. Rubella C. Mumps D. Hepatitis B

Answer 34

**B. Rubella: Correct. Rubella presents with a rash that starts on the face and spreads downward, characteristic of this disease.** Think R for Rash and Rubella and ready to spreads to trunk and extremities... I hope this helps A. Varicella Zoster: Incorrect. Varicella (chickenpox) presents as small red bumps that turn into blisters, not a maculopapular rash. C. Mumps: Incorrect. Mumps does not cause a rash; it typically presents with parotid gland swelling. D. Hepatitis B: Incorrect. Hepatitis B is a liver infection and does not involve a rash.

Question 35

What is the recommended prophylaxis for an infant <29 weeks gestation to prevent severe RSV infection? A. Acetaminophen B. Palivizumab C. Oral antiviral therapy D. Doxycycline

Answer 35

**B. Palivizumab: Correct. Palivizumab is an RSV monoclonal antibody given to high-risk infants to reduce the severity of RSV infections.** A. Acetaminophen: Incorrect. Acetaminophen is used to manage fever or pain, not RSV prevention. C. Oral antiviral therapy: Incorrect. There are no antivirals for RSV prophylaxis. D. Doxycycline: Incorrect. Doxycycline is an antibiotic, not used for RSV.

Question 36

Which of the following treatments is appropriate for norovirus infection? A. Ceftriaxone IM B. Oral hydration therapy and plain foods C. Penicillin for 10 days D. Scrotal support and analgesics

Answer 36

**B. Oral hydration therapy and plain foods: Correct. Hydration and easily digestible foods are key to recovery from norovirus.** A. Ceftriaxone IM: Incorrect. Ceftriaxone is used for bacterial infections like gonorrhea, not viral infections like norovirus. C. Penicillin for 10 days: Incorrect. Penicillin treats bacterial infections like impetigo, not norovirus. D. Scrotal support and analgesics: Incorrect. This treatment is for mumps-associated orchitis, not norovirus.

Question 37

What is the recommended treatment for Chlamydia Trachomatis in adults? A. Doxycycline for 7 days B. High-dose ceftriaxone IM C. Acetaminophen D. Nucleoside therapy

Answer 37

**A. Doxycycline for 7 days: Correct. Doxycycline is the first-line treatment for chlamydia.** There are more C's in Doxycycline for chlamydia, i hope that helps. B. High-dose ceftriaxone IM: Incorrect. Ceftriaxone is used for gonorrhea, not chlamydia. C. Acetaminophen: Incorrect. Acetaminophen only manages symptoms like fever or pain, not the infection. D. Nucleoside therapy: Incorrect. Nucleoside therapy is used for chronic Hepatitis B, not chlamydia.

Question 38

A child presents with a honey-colored crust on their face. What is the most likely diagnosis and treatment? A. Chickenpox; oral antiviral therapy B. Impetigo; Penicillin or Amoxicillin C. RSV; oxygen therapy D. Mumps; scrotal support and analgesics

Answer 38

**B. Impetigo; Penicillin or Amoxicillin: Correct. Impetigo presents with honey-colored crusts caused by bacterial infections, treated with antibiotics like Penicillin or Amoxicillin.** A. Chickenpox; oral antiviral therapy: Incorrect. Chickenpox presents as itchy blisters, not honey-colored crusts. C. RSV; oxygen therapy: Incorrect. RSV affects the respiratory system, not the skin. D. Mumps; scrotal support and analgesics: Incorrect. Mumps does not involve skin crusts.

Question 39

Which of the following diseases can be prevented with oral vaccination at 2 months of age? A. Norovirus B. Rotavirus C. Mumps D. Hepatitis B

Answer 39

**B. Rotavirus: Correct. Rotavirus vaccination is given orally at 2 months to prevent severe diarrhea in infants.** A. Norovirus: Incorrect. There is no vaccine for norovirus. C. Mumps: Incorrect. Mumps vaccination is part of the MMR (measles, mumps, rubella) vaccine, given by injection. D. Hepatitis B: Incorrect. Hepatitis B vaccine is given by injection, not orally.

Question 40

What is the appropriate treatment for gonorrhea if chlamydia has not been ruled out? A. Doxycycline for 7 days B. Palivizumab C. Ceftriaxone + Doxycycline D. Vancomycin + Cephalosporin

Answer 40

**C. Ceftriaxone + Doxycycline: Correct. Dual therapy is recommended to treat both gonorrhea (ceftriaxone) and chlamydia (doxycycline) simultaneously.** A. Doxycycline for 7 days: Incorrect. While doxycycline treats chlamydia, it is not sufficient for gonorrhea alone. B. Palivizumab: Incorrect. Palivizumab is used for RSV, not STIs. D. Vancomycin + Cephalosporin: Incorrect. This combination is used for serious bacterial infections like meningitis, not STIs.

Question 41

What should be avoided in treating children with chickenpox to prevent Reye’s syndrome? A. Oral hydration therapy B. Aspirin C. Antiviral therapy D. Acetaminophen

Answer 41

**B. Aspirin: Correct. Aspirin is associated with Reye’s syndrome in children recovering from viral illnesses like chickenpox or influenza.** A. Oral hydration therapy: Incorrect. Hydration is helpful for recovery and has no association with Reye’s syndrome. C. Antiviral therapy: Incorrect. Antivirals are sometimes used for severe chickenpox but do not cause Reye’s syndrome. D. Acetaminophen: Incorrect. Acetaminophen is safe to use for fever or pain in children.

Question 42

Which vaccine-preventable disease can cause severe complications such as meningoencephalitis and oophoritis? A. Hepatitis B B. Rubella C. Mumps D. Varicella Zoster

Answer 42

**C. Mumps: Correct. Mumps can cause complications such as meningoencephalitis, orchitis, and oophoritis.** A. Hepatitis B: Incorrect. Hepatitis B affects the liver and does not cause these complications. B. Rubella: Incorrect. Rubella causes birth defects if contracted during pregnancy but does not lead to meningoencephalitis or oophoritis. D. Varicella Zoster: Incorrect. While Varicella can lead to complications like pneumonia and bacterial superinfections, it does not cause oophoritis.

Question 43

What is Reye's syndrome and why does aspirin contribute to it?

Answer 43

Reye's syndrome is a mitochondrial dysfunction triggered by a combination of viral infection and exposure to certain drugs, particularly aspirin in children. Here's how it works: Mitochondrial Dysfunction: Aspirin metabolites impair mitochondrial function by disrupting fatty acid oxidation, a critical process in energy production. This leads to reduced ATP production and an accumulation of toxic metabolites like fatty acids and ammonia in the liver and brain. Liver Damage: Mitochondrial dysfunction in liver cells causes microvesicular steatosis (fat accumulation), which impairs normal liver function. The liver's inability to clear ammonia from the bloodstream leads to hyperammonemia, a toxic state that affects the brain. Brain Swelling (Encephalopathy): Hyperammonemia and other metabolic byproducts cause cerebral edema (swelling of the brain). This disrupts neurotransmission and can lead to confusion, lethargy, seizures, and potentially coma. Systemic Effects: The combination of liver failure and brain swelling can cause multi-organ dysfunction, potentially leading to death if untreated.

Question 44

Why is Oral Hydration Therapy and Plain Foods Ideal for Norovirus?

Answer 44

Mechanism of Norovirus: Norovirus infects the intestinal lining, causing acute gastroenteritis (vomiting, diarrhea, and abdominal cramps). The main danger is dehydration caused by rapid fluid loss through vomiting and diarrhea. Why Oral Hydration Therapy is Key: Replenishes lost fluids and electrolytes, preventing dehydration, which is the primary complication of norovirus. Oral rehydration solutions (ORS) contain the right balance of salts, sugars, and water to maximize absorption in the gut. Role of Plain Foods: Simple, bland foods (e.g., bananas, rice, applesauce, toast) are easy to digest and gentle on the irritated gastrointestinal lining. They prevent further irritation or exacerbation of diarrhea and vomiting. Plain foods also provide energy and nutrients without overwhelming the gut. Why It’s Appropriate: Norovirus is self-limiting and typically resolves in 1–3 days, so supportive care like hydration and gentle nutrition is sufficient for recovery. Avoiding heavy, greasy, or sugary foods helps prevent worsening symptoms. In both cases (Palivizumab for RSV and hydration for norovirus), the interventions address the primary pathophysiology of the conditions, ensuring effective management and prevention of complications.

Question 45

A 6-month-old infant presents with coughing, wheezing, and poor feeding. The physical exam reveals fast breathing and nasal flaring. Which of the following is the most likely diagnosis? A) Influenza B) Respiratory Syncytial Virus (RSV) C) Common Cold D) Mumps

Answer 45

**Correct Answer: B) Respiratory Syncytial Virus (RSV) Explanation: B) Correct: RSV is a common cause of bronchiolitis in infants and can present with wheezing, poor feeding, and respiratory distress.** A) Incorrect: Influenza can cause respiratory symptoms but is less likely to present with wheezing or severe respiratory distress in infants. C) Incorrect: The common cold usually presents with mild symptoms like a runny nose and sore throat, without wheezing or poor feeding. D) Incorrect: Mumps does not cause wheezing or bronchiolitis; it primarily affects the parotid glands.

Question 46

A child has watery diarrhea, fever, and dehydration after visiting a daycare center. Which of the following is the most likely causative agent? A) Rotavirus B) Norovirus C) Salmonella D) Adenovirus

Answer 46

**Correct Answer: A) Rotavirus Explanation: A) Correct: Rotavirus is the leading cause of severe watery diarrhea in infants and young children, especially in daycare settings.** B) Incorrect: Norovirus also causes diarrhea but is more common in older children and adults and is not the primary cause in daycare outbreaks. C) Incorrect: Salmonella is typically associated with undercooked food and does not present with watery diarrhea as its main symptom. D) Incorrect: Adenovirus can cause diarrhea, but it's less common and usually presents alongside respiratory symptoms.

Question 47

A 4-year-old presents with a red maculopapular rash that started on the face and spread to the trunk, fever, conjunctivitis, and white spots in the mouth. What is the most likely diagnosis? A) Measles B) Rubella C) Roseola D) Varicella

Answer 47

**Correct Answer: A) Measles Explanation: A) Correct: Measles presents with a prodrome of fever, conjunctivitis, cough, and Koplik's spots, followed by a characteristic rash spreading from the face to the trunk.** B) Incorrect: Rubella also causes a rash but is less severe and lacks Koplik's spots. C) Incorrect: Roseola presents with a high fever followed by a rash but lacks conjunctivitis or white spots in the mouth. D) Incorrect: Varicella (chickenpox) presents with vesicular lesions, not maculopapular rashes.

Question 48

A sexually active 22-year-old woman presents with vaginal discharge, dysuria, and cervical motion tenderness. A swab shows mucopurulent discharge. Which of the following is the most likely diagnosis? A) Chlamydia Trachomatis B) Nisseria Gonorrhoeae C) Trichomoniasis D) Pelvic Inflammatory Disease (PID)

Answer 48

**Correct Answer: D) Pelvic Inflammatory Disease (PID) Explanation: D) Correct: PID is a complication of STIs like chlamydia and gonorrhea and presents with lower abdominal pain, cervical motion tenderness, and vaginal discharge.** A) Incorrect: Chlamydia can cause similar symptoms, but it would not cause the extensive pelvic pain seen in PID. B) Incorrect: Gonorrhea can cause vaginal discharge and dysuria but may not explain cervical motion tenderness unless it progresses to PID. C) Incorrect: Trichomoniasis often causes frothy, greenish discharge and does not usually present with cervical tenderness.

Question 49

A 2-year-old child presents with fever, a rash on the hands, feet, and mouth, and mild sore throat. What is the most likely causative agent? A) Coxsackievirus B) Varicella-Zoster Virus C) Epstein-Barr Virus D) Rubella

Answer 49

Correct Answer: A) Coxsackievirus Explanation: A) Correct: Coxsackievirus is in the genus of enterovirus and is the cause of Hand, Foot, and Mouth Disease, which presents with fever, vesicular rashes on the hands, feet, and mouth, and mild systemic symptoms. B) Incorrect: Varicella causes vesicular rashes but does not localize to the hands, feet, and mouth. C) Incorrect: Epstein-Barr Virus (EBV) causes mononucleosis with fever, sore throat, and lymphadenopathy but no localized rash. D) Incorrect: Rubella causes a diffuse maculopapular rash, not localized vesicles.

Question 50

A child with red, itchy vesicles on the skin and a high fever on the third day is most likely suffering from which of the following? A) Varicella (Chickenpox) B) Measles C) Hand, Foot, and Mouth Disease D) Scarlet Fever

Answer 50

**Correct Answer: A) Varicella (Chickenpox) Explanation: A) Correct: Varicella presents with red bumps that develop into vesicles, which eventually crust over, accompanied by fever.** B) Incorrect: Measles causes a maculopapular rash, not vesicles. C) Incorrect: Hand, Foot, and Mouth Disease causes localized vesicles on the hands, feet, and mouth. D) Incorrect: Scarlet fever causes a sandpaper-like rash, not vesicles. ================================= 1) Varicella Zoster (Chickenpox): 2-3 week incubation Signs and symptoms: small red bumps that turn to blisters, very itchy, can turn to cloud blister or open sore that turn to dry brown crusts, appear over 4-5 days, fever highest on 3rd or 4th day Complication: secondary bacterial superinfection of the skin by strep pyogenes or staph aureus, meningeal inflammation, pneumonia DDX: not difficult, very distinct sxs, unilateral lesions in a dermatomal pattern should lead to Shingles (Herpes Zoster) dx Treatment: avoid complications, decrease pruritis, avoid aspirin (Reye’s Syndrome), oral antiviral therapy may be helpful Prevention: vaccination for 1-12 who have not had chickenpox

Question 51

What is the typical treatment for a child diagnosed with the flu within 48 hours of symptom onset? a. Antibiotics b. Antivirals (e.g., oseltamivir) c. Decongestants d. Corticosteroids

Answer 51

**(b) Correct: Antiviral medications like oseltamivir are most effective if given within 48 hours of symptom onset and can shorten the duration of the flu.** (a) Antibiotics are not indicated unless there is a secondary bacterial infection (e.g., pneumonia or otitis media). (c) Decongestants may help with nasal congestion but do not address the viral infection itself and are not recommended for young children. (d) Corticosteroids are not routinely used in the treatment of the flu unless there is an associated inflammatory complication like croup.

Question 52

What is the primary cause of the common cold (acute viral rhinitis) in pediatric patients? a. Streptococcus pneumoniae b. Rhinovirus c. Influenza virus d. Haemophilus influenzae

Answer 52

**(b) Correct: Rhinovirus is the most common viral cause of the common cold, presenting with clear to mucoid rhinorrhea, nasal congestion, sore throat, and sometimes a mild fever.** (a) Streptococcus pneumoniae is a bacterial pathogen, not the primary cause of viral rhinitis. (c) Influenza virus causes more severe symptoms, including fever, malaise, and myalgia, and is not the primary cause of the common cold. (d) Haemophilus influenzae can cause bacterial respiratory infections but is not a primary cause of viral rhinitis.

Question 53

Which of the following is a common complication of bacterial rhinosinusitis that requires immediate intervention? a. Otitis media b. Osteitis (Pott's Puffy tumor) c. Pharyngitis d. Croup

Answer 53

**(b) Correct: Osteitis, specifically Pott’s Puffy tumor, is a complication of frontal sinusitis that can lead to meningitis or brain abscesses. Immediate intervention is necessary.** (a) Otitis media is a common complication of viral and bacterial URIs but is not as urgent as other complications. (c) Pharyngitis can occur with viral infections, but it is not typically a complication of rhinosinusitis. (d) Croup is related to viral infections and is a complication more common in cases of laryngotracheobronchitis, not rhinosinusitis.

Question 54

What is the first-line treatment for bacterial rhinosinusitis in pediatric patients? a. Amoxicillin b. Amoxicillin-clavulanate c. Cefdinir d. Azithromycin

Answer 54

**(b) Correct: Amoxicillin-clavulanate is the first-line treatment for bacterial rhinosinusitis in children, particularly if symptoms do not improve after 10 days.** (a) Amoxicillin is effective for many bacterial infections, but amoxicillin-clavulanate is preferred for rhinosinusitis due to its broader spectrum of action, including against resistant strains. (c) Cefdinir is an option for children with allergies, but it’s not first-line. (d) Azithromycin is not first-line and should be reserved for specific cases, as it has limited activity against Streptococcus pneumoniae.

Question 55

6-year-old presents with nasal congestion, facial pain, headache, fever, and cough that have persisted for 12 days. What is the most likely diagnosis? a. Acute viral rhinitis b. Rhinosinusitis c. Influenza d. Allergic rhinitis

Answer 55

**(b) Correct: Rhinosinusitis is characterized by symptoms lasting 10 days or more or worsening within 10 days, with symptoms like nasal congestion, nasal drainage, postnasal drainage facial pain, headache, fever, cough, maxillary dental pain, ear pressure or fullness; resolve within 30 days** - Cause 1. Bacterial: S, pneumoniae, H. influenzae, M. catarrhalis and B- hemolytic streptococci - Complications: spreading to eye or brain from ethmoid sinuses orbital cellulitis and abcesses, eyelid edema 1. Frontal Sinus: osteitis (Pott’s Puffy tumor) meningitis and brain abcesses (a) Acute viral rhinitis has a sudden onset that typically resolves within 7-10 days, symptoms are clear or mucoid rhinorrhea thicker and purulent, nasal congestion, sore throat. Possible fever, < 5-6 yoa, hoarseness, and/or cough 3. Sxs resolve 7-10 d, cough and hoarseness can linger (Sulfur). But the symptoms described here have lasted longer than 10 days. (c) Influenza typically presents with fever, chills, myalgia, and can have gastrointestinal symptoms in children, but the timeline and symptoms here align more with rhinosinusitis. (d) Allergic rhinitis would typically present with clear nasal discharge and sneezing, without the persistent fever and facial pain.

Question 56

What is the primary cause of the common cold (acute viral rhinitis) in pediatric patients? a. Streptococcus pneumoniae b. Rhinovirus c. Influenza virus d. Haemophilus influenzae

Answer 56

**(b) Correct: Rhinovirus is the most common viral cause of the common cold, presenting with clear to mucoid rhinorrhea, nasal congestion, sore throat, and sometimes a mild fever.** (a) Streptococcus pneumoniae is a bacterial pathogen, not the primary cause of viral rhinitis. (c) Influenza virus causes more severe symptoms, including fever, malaise, and myalgia, and is not the primary cause of the common cold. (d) Haemophilus influenzae can cause bacterial respiratory infections but is not a primary cause of viral rhinitis.

Question 57

What is the typical treatment for a child diagnosed with the flu within 48 hours of symptom onset? a. Antibiotics b. Antivirals (e.g., oseltamivir) c. Decongestants d. Corticosteroids

Answer 57

**(b) Correct: Antiviral medications like oseltamivir are most effective if given within 48 hours of symptom onset and can shorten the duration of the flu.** (a) Antibiotics are not indicated unless there is a secondary bacterial infection (e.g., pneumonia or otitis media). (c) Decongestants may help with nasal congestion but do not address the viral infection itself and are not recommended for young children. (d) Corticosteroids are not routinely used in the treatment of the flu unless there is an associated inflammatory complication like croup.

Question 58

Which of the following is NOT typically a complication of influenza? a. Secondary bacterial infections (e.g., otitis media, pneumonia) b. Croup c. Post-viral encephalitis d. Myositis and rhabdomyolysis

Answer 58

**(b) Correct: Croup is typically associated with viral infections like parainfluenza, not influenza.** (a) Secondary bacterial infections like otitis media or pneumonia are common complications of the flu and are often treated with antibiotics. (c) Post-viral encephalitis can occur following influenza and is a severe complication. (d) Myositis and rhabdomyolysis have been reported as complications of severe influenza, especially in children with risk factors.

Question 59

What is a potential complication of pediatric rhinosinusitis that can occur if the infection spreads from the ethmoid sinuses? a) Otitis media b) Orbital cellulitis and abscesses c) Peritonsillar abscess d) Pott’s Puffy tumor

Answer 59

**b) Orbital cellulitis and abscesses Correct: Orbital cellulitis and abscesses are serious complications of rhinosinusitis, particularly when the infection spreads from the ethmoid sinuses. This can lead to severe symptoms like eyelid edema, vision changes, and even permanent vision loss if not treated promptly.** a) Otitis media Wrong: Otitis media is a common complication of upper respiratory tract infections (URTIs), but it is not the most likely complication when the infection spreads from the ethmoid sinuses. c) Peritonsillar abscess Wrong: Peritonsillar abscesses are associated with bacterial infections of the tonsils, not rhinosinusitis. While they can be caused by Group A Streptococcus, they are not directly related to the sinuses. d) Pott’s Puffy tumor Wrong: Pott’s Puffy tumor is a complication of frontal sinusitis, not ethmoid sinusitis. It involves osteitis and can lead to more severe complications like meningitis and brain abscesses, but it is not the complication seen with ethmoid sinus infection.

Question 60

Which of the following conditions is most likely to be the cause of exudative tonsillitis, cervical adenitis, and atypical lymphocytes in a pediatric patient? a) Bacterial pharyngitis (Group A Streptococcus) b) Infectious mononucleosis c) Pharyngoconjunctival fever d) Herpangina

Answer 60

**b) Infectious mononucleosis Correct: Infectious mononucleosis is caused by Epstein-Barr virus (EBV) and is classically associated with exudative tonsillitis, cervical adenitis, and atypical lymphocytes in the blood. The Mono Spot test is commonly positive, and patients often present with symptoms like fatigue, sore throat, and swollen lymph nodes. This is the classic viral cause for the described symptoms and lab findings, making it the correct answer here.** a) Bacterial pharyngitis (Group A Streptococcus) Wrong: Group A Streptococcus (GAS) causes bacterial pharyngitis, which often presents with exudative tonsillitis, cervical adenitis, and palatal petechiae. However, it does not cause atypical lymphocytes in the blood, which is more characteristic of viral infections like mononucleosis. In bacterial pharyngitis, you would typically find a positive culture for Group A Streptococcus, and while there may be a sore throat and fever, atypical lymphocytes are not part of the presentation. c) Pharyngoconjunctival fever Wrong: Pharyngoconjunctival fever is caused by adenovirus and typically presents with exudative tonsillitis, conjunctivitis, fever, and cervical adenopathy. However, it does not cause atypical lymphocytes in the blood, which is more characteristic of viral infections like mononucleosis. The key difference here is the conjunctivitis (eye involvement) and the absence of atypical lymphocytes. d) Herpangina Wrong: Herpangina is caused by Coxsackievirus, presenting with ulcers in the back of the mouth, particularly on the soft palate and tonsillar pillars. While it can cause a sore throat and discomfort, it does not cause exudative tonsillitis or atypical lymphocytes in the blood. The ulcers are typically small and surrounded by a red halo, and it does not have the same systemic signs like atypical lymphocytes seen in viral infections such as mononucleosis.

Question 61

In a pediatric patient with suspected bacterial pharyngitis, which of the following findings would be considered the most suggestive of Group A Streptococcal (GAS) infection? a) Rhinorrhea and hoarseness b) Tonsillar exudates, fever >38.3°C, and tender cervical lymphadenopathy c) Ulcers with a halo on the soft palate d) Conjunctivitis and lymphadenopathy

Answer 61

**b) Tonsillar exudates, fever >38.3°C, and tender cervical lymphadenopathy Correct: This is a classic presentation of Group A Streptococcal (GAS) pharyngitis, which typically involves: Tonsillar exudates (white or yellowish patches on the tonsils) Fever greater than 38.3°C (101°F) Tender cervical lymphadenopathy (swollen and painful lymph nodes in the neck) These findings are highly suggestive of GAS infection and are often used in clinical diagnostic criteria such as the Centor criteria for streptococcal pharyngitis.** a) Rhinorrhea and hoarseness Wrong: Rhinorrhea (runny nose) and hoarseness are more commonly associated with viral infections, particularly the common cold (acute viral rhinitis) or other upper respiratory viral infections. GAS pharyngitis typically presents with more specific signs such as sore throat, fever, and tonsillar exudates, but not typically with symptoms like rhinorrhea or hoarseness. GAS infection is less likely to present with these types of upper respiratory tract symptoms, making this option unlikely for bacterial pharyngitis caused by GAS. c) Ulcers with a halo on the soft palate Wrong: This presentation is more suggestive of herpangina, a condition caused by Coxsackievirus (an enterovirus). Herpangina causes ulcers on the soft palate and the back of the throat, with a characteristic halo around them. It does not typically involve the classic signs of GAS pharyngitis, such as tonsillar exudates or fever greater than 38.3°C. This would be more consistent with a viral infection rather than bacterial. d) Conjunctivitis and lymphadenopathy Wrong: Conjunctivitis (eye redness) and lymphadenopathy (swollen lymph nodes) are more commonly seen in infections like pharyngoconjunctival fever, which is caused by adenovirus. GAS pharyngitis typically does not present with conjunctivitis or significant eye involvement. While GAS can cause cervical lymphadenopathy, the absence of other hallmark symptoms like tonsillar exudates and fever makes this option less likely for a GAS infection. The presence of conjunctivitis strongly suggests a viral etiology (like adenovirus), rather than a bacterial one like Group A Streptococcus.

Question 62

Which of the following is the first-line treatment for Acute Otitis Media (AOM)? A) Tympanostomy tubes B) Garlic ear oil C) Amoxicillin D) Acetaminophen

Answer 62

**C) Amoxicillin: Correct. Amoxicillin is the first-line antibiotic for AOM, especially in children without recent antibiotic use or penicillin allergies.** A) Tympanostomy tubes: Incorrect. Tympanostomy tubes are reserved for recurrent AOM or chronic otitis media with effusion (OME) and are not first-line therapy. B) Garlic ear oil: Incorrect. While garlic ear oil may provide symptomatic relief, it is not the primary treatment for AOM. D) Acetaminophen: Incorrect. Acetaminophen is used for pain and fever management but does not treat the underlying infection.

Question 63

When should antibiotics be initiated in children with AOM? A) Immediately upon diagnosis B) If there is no improvement after 48-72 hours of observation C) Only after tympanocentesis D) Only in cases with fever >38°C

Answer 63

**B) If there is no improvement after 48-72 hours of observation: Correct. Antibiotics should be started if symptoms persist or worsen after observation, as this suggests a bacterial infection.** A) Immediately upon diagnosis: Incorrect. Observation is often recommended first, especially in mild cases or older children, to avoid unnecessary antibiotic use. C) Only after tympanocentesis: Incorrect. Tympanocentesis is not routinely required and is generally reserved for diagnostic or therapeutic purposes in complicated cases. D) Only in cases with fever >38°C: Incorrect. Fever alone does not necessitate antibiotic use unless there are other signs of bacterial infection.

Question 64

Which of the following lifestyle changes can help reduce the recurrence of AOM in children? A) Avoiding bottle propping B) Increasing pacifier use C) Switching to formula feeding D) Avoiding vaccination

Answer 64

**A) Avoiding bottle propping: Correct. Bottle propping increases the risk of fluid accumulation in the middle ear, which can lead to infections.** B) Increasing pacifier use: Incorrect. Prolonged pacifier use beyond 6 months is associated with a higher risk of AOM. C) Switching to formula feeding: Incorrect. Breastfeeding is protective against AOM due to immune factors in breast milk. D) Avoiding vaccination: Incorrect. Vaccination against pneumococcus and influenza helps prevent some of the pathogens that cause AOM. ====================== Bottle propping is when a baby’s bottle is held in place by something (like a pillow or rolled towel) instead of being held by a caregiver during feeding. It allows the baby to drink without someone holding the bottle, but it can cause several problems, including: Fluid pooling in the middle ear: When a baby lies flat while feeding, milk or formula can flow back into the eustachian tubes (which connect the middle ear to the throat). This can increase the risk of ear infections (AOM). Choking hazard: Without supervision, babies could choke if milk flows too quickly or if they spit up. Tooth decay: Prolonged exposure to milk or formula can contribute to dental issues, especially if the baby falls asleep with the bottle.

Question 65

What is the recommended management for bacterial pharyngitis in children living in high-risk communities for acute rheumatic fever? A) Only test if CENTOR score is 4 B) Treat all children with sore throat >3 years old without testing C) Observation for 48 hours before starting antibiotics D) Begin treatment only if fever exceeds 38.5°C

Answer 65

**B) Treat all children with sore throat >3 years old without testing: Correct. In high-risk populations, empirical antibiotic treatment is recommended due to the increased risk of complications.** A) Only test if CENTOR score is 4: Incorrect. High-risk communities often bypass testing due to the prevalence of acute rheumatic fever. C) Observation for 48 hours before starting antibiotics: Incorrect. Immediate treatment is prioritized in these populations to prevent rheumatic fever. D) Begin treatment only if fever exceeds 38.5°C: Incorrect. Fever is not the sole determining factor for initiating treatment in high-risk populations.

Question 66

Which of the following is a complication of untreated bacterial pharyngitis? A) Scarlet fever B) Tympanocentesis C) Eczema D) Pneumothorax

Answer 66

**A) Scarlet fever: Correct. Untreated bacterial pharyngitis, particularly Group A Streptococcus, can lead to scarlet fever, characterized by a diffuse erythematous rash.** B) Tympanocentesis: Incorrect. This is a medical procedure which is the aspiration of fluid from the middle ear , not a complication of pharyngitis. C) Eczema: Incorrect. Eczema is unrelated to bacterial pharyngitis. D) Pneumothorax: Incorrect. Pneumothorax is unrelated to bacterial pharyngitis and more commonly associated with trauma or pulmonary disease.

Question 67

Which natural remedy has antimicrobial properties and is suitable for children over 1 year old with bacterial pharyngitis? A) Sambucus cough syrup B) Organic Manuka honey C) Eucalyptus essential oil D) Peppermint tea

Answer 67

**B) Organic Manuka honey: Correct. Manuka honey has proven antimicrobial properties and is safe for children over 1 year old.** A) Sambucus cough syrup: Incorrect. Sambucus (elderberry) is antiviral and immune-supportive but not primarily antimicrobial. C) Eucalyptus essential oil: Incorrect. Eucalyptus can help with congestion but is not directly antimicrobial. D) Peppermint tea: Incorrect. Peppermint can soothe symptoms but lacks significant antimicrobial action.

Question 68

A 9-year-old child presents with fever, tender cervical lymphadenopathy, and tonsillar exudates. Using the CENTOR criteria, what is the next step? A) Start antibiotics immediately B) Perform a throat swab and culture C) Reassure the parents and advise rest D) Order a chest X-ray to rule out complications

Answer 68

**B) CENTOR score >3 suggests testing with a swab is appropriate.** A) Antibiotics should not be started without confirmation of bacterial infection. C) Reassurance without testing is inappropriate for a high-risk presentation. D) Chest X-ray is unnecessary for this case. * Communities at high risk for Acute Rheumatic Fever (northern and indigenous): test in all children >3yoa with sore throat; without testing, use antibiotics in scores 3 or more * CENTOR decision rule - 1 point for exudate or swollen tonsils, tender or swollen cervical lymph nodes, fever, no cough - Swab is score is > 3

Question 69

Which of the following is the correct dosage of acetaminophen for a child with fever? A) 5 mg/kg every 6-8 hours B) 10 mg/kg every 6 hours, maximum 50 mg/kg per day C) 15 mg/kg every 4-6 hours, maximum 80 mg/kg per day D) 20 mg/kg every 4 hours, no maximum

Answer 69

**C) 15 mg/kg every 4-6 hours, maximum 80 mg/kg per day** A) Too low to effectively manage fever. B) Incorrect dose frequency and maximum dose. C) Correct recommendation for acetaminophen in pediatric fever. D) Dose and frequency exceed safe limits.

Question 70

Intrapartum antibiotics should always be given if a pregnant person has which of the following? A) GBS bacteriuria during pregnancy B) A negative GBS culture at 35–37 weeks C) No history of GBS infection in previous pregnancies D) A fever of 99.5°F during labor

Answer 70

**A) GBS bacteriuria during pregnancy – Correct. The presence of GBS in urine indicates high bacterial load and requires intrapartum antibiotics.** B) A negative GBS culture at 35–37 weeks – Incorrect. If GBS culture is negative, antibiotics are not required, and yes 35-37 weeks is the recomended time for screeng for GBS as delivery is expected soon. C) No history of GBS infection in previous pregnancies – Incorrect. History alone does not determine current risk. D) A fever of 99.5°F during labor – Incorrect. A fever ≥100.4°F (38°C) is a criterion for antibiotic treatment, but 99.5°F is below this threshold.