PEDS ROSH 12/23
ASD murmur
-*systolic* ejection murmur at 2nd LICS -Early to midsystolic rumble -S2 Split
acute bacterial rhinosinusitis tx when?
1. persistent s/s and not improving >= 10 days 2. worsening or double sickening >=5-6 days 3. onset of severe s/s: fever >= 39C/102F, purulent nasal discharge >=3-4 days at beginning of illness
moderate dehydration
6-9% volume depletion tachycardia, deep respiration, dry mucous membranes, sunken anterior fontanel in infants, sunken eyes, reduced skin turgor, increased cap refill time 2-3 sec, cool skin, reduced urine output, irritability
A 5-week-old term infant presents to the clinic with his mother, who reports he cries 4 hours per day without a clear explanation. The infant is gaining weight and feeding appropriately, and physical examination is unremarkable. By which of the following ages does this condition typically resolve?
9 weeks (<3 months of age)
A 7-year-old boy presents to the urgent care clinic for evaluation of the rash over his body. On physical exam, there is blistering and large areas of peeling skin. The patient's mother states he recently began treatment for epilepsy. Physical evaluation further reveals lesions on the oral mucosa, and sloughing of the skin is noted with gentle lateral pressure. Which of the following is likely additionally noted on history and physical exam findings?
>30% of BSA involved TENS
minor jones criteria
Arthralgia Fever Elevated ESR, CRP Prolonged PR interval Strep cultures
1st gen cephalosporins
Cefazolin Cephalexin Cefadroxil
4th gen cephalosporins
Cefepime
5th gen cephalosporins
Ceftaroline
PDA murmur
Continuous machinery murmur
parvovirus b19
Erythema infectiosum (fifth disease)
influenza vaccine recommendations children age 2-8 yo
LAV or IV appropriate 6 months - 8 yo 2 doses of vaccine 4 weeks apart during their first vaccination
MCC of nephrotic syndrome in children
Minimal change disease
pertussis dx
PCR nasopharyngeal culture
milestones at 4 months
Rolls from back to side Holds head up while in a vertical position Recognizes familiar objects and faces
A 5-year-old girl presents to the clinic with a 3-day history of painful inflammation of the ankles that is now also affecting the knees. Past medical history is significant for acute tonsillitis 10 days ago. Physical exam reveals a new 3/6 blowing systolic murmur best auscultated at the apex. Which of the following additional signs and symptoms would be considered a major manifestation of the presumed diagnosis?
erythema marginatum
bacterial tracheitis
fever, barking cough, stridor (Similar to croup but toxic appearing), airway emergency, rapid progression
ortolani test
one hip at a time, flex hips and knees to 90 degrees and thigh is gently abducted
extremely high fever then rash
roseola HHV-6
rash starting on face
rubella
milestones at 7 months
sit without support
A 2-day-old infant girl is examined at the hospital for a general checkup. Her mother is concerned she has a blue mark on her buttocks that was present at birth. Upon physical exam, the child is calm and sleepy, and there is a 5 cm irregularly shaped bluish patch to the sacrococcygeal area that does not appear inflamed or irritated. Which of the following is the most likely diagnosis?
slate gray nevus aka congenital dermal melanocytosis
tx nephrotic syndrome in children
titrated dose of prednisone
A 2-year-old boy presents to the emergency department with a new-onset rash. His vital signs are within normal limits, and he is in no acute distress, though he does appear irritated. His parents report no known history of medication allergies, and there is no personal or family history of asthma, eczema, or environmental allergies. He attends daycare and has a prior history of ear infections, most recently completing a 7-day course of amoxicillin 2 days ago for a right ear infection. Otherwise, his medical history is unremarkable. On exam, he has a diffuse, morbilliform rash over his trunk and bilateral upper extremities. There are no pustules or vesicles. A few spots seem to be cropping up on his face, and his palms and soles are spared. There is no mucosal involvement, and there is no swelling or erythema over his joints. Other than the rash, he has a normal exam, is consolable, and appears well. Which of the foll
type IV hypersensitivity
androgenic alopecia MC earl hair loss location
vertex
A 9-year-old boy presents to his pediatrician's office with an intensely itchy rash. He states the rash started 2 weeks ago on his ankles and wrists. He reports no lesions on his trunk. No other family members have similar symptoms. Close examination of the ankles and wrists reveals multiple lesions with fine white lines on the surface. No other lesions are observed on the body. Which of the following findings on physical examination is most consistent with the suspected diagnosis?
violaceous lesions at sites of trauma, painless polygonal papules
A 7-year-old girl presents to the clinic with intermittent and recurrent cough and wheezing since moving to Florida 6 months ago. You suspect a reversible obstructive airway disease. Which of the following is the most appropriate patient education to reduce this patient's potential allergen exposure?
wash sheets at hot temp weekly
erythema infectiosum symptoms
-Prodrome of URI symptoms and low-grade fever -Slapped cheek rash (circumoral area spared) -Rash spreads symmetrically to full body (except palms and soles) -Lacey-Reticular pattern as lesions clear on extremities (No longer contagious once rash starts)
tetralogy of fallot components
1. Pulmonic stenosis 2. RV hypertrophy 3. VSD 4. Overriding aorta
major jones criteria
1.carditis(chest pain, muffled heart sounds, pericardial friction rub, tachy) 2.subcutaneous nodules (over bony prominences, nontender) 3. polyarthritis 4.rash (pink, non pruritis macular rash on trunk, inner surface on extremities/erythema marginatum 5. chorea (involuntary purposeless muscle movements)
A 4-year-old boy presents to his primary care provider in September for a routine visit. His medical history is unremarkable other than an allergy to eggs. He has not received the influenza vaccine before. His mother reports the patient's older brother began receiving the annual influenza vaccination at 6 months of age and was diagnosed with autism spectrum disorder 2 years later. Which of the following is the correct recommendation regarding the influenza vaccine for this patient?
2 doses of inactivated influenza vaccine
A 9-month-old boy is rescued from a burning building and presents to the ED for evaluation. On physical examination, there are superficial burns covering the anterior surface of the trunk and the entire right arm, partial-thickness burns covering the entire left arm, and a full-thickness burn covering the entire left leg. Which of the following best represents the estimated burn size?
23%
preseptal cellulitis
Fairly common infection of subcutaneous tissues anterior to the orbital septum. Not strictly an orbital disease. MC route of infection from ethmoid sinuses via staph aureus, strep pneumoniae
VSD murmur
Holosystolic, harsh-sounding murmur Loudest at tricuspid area
A 5-year-old boy presents to his primary care provider accompanied by his mother, who is concerned by right ear pain and swelling behind his right ear. His mother also notes he has had intermittent fevers the past 4 days, which she has been treating with ibuprofen. He has had no recent antibiotic use within the last 6 months. On physical exam, the patient is lethargic, and there is significant postauricular erythema, swelling, and tenderness. His right tympanic membrane is bulging and erythematous. Which of the following therapies is most appropriate for this patient?
IV antimicrobial therapy (ampicillin sulbactam if no recent abx use or recurrent otitis media, if recent abx use or recurrent otitis media then pip-tazo) and myringotomy
port wine stain
a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck
bacterial tracheitis tx
aggressive airway management in OR IV abx broad spectrum- clindamycin or vanco + 2nd gen cephalosporin IV fluids bronchoscopy
A 9-year-old girl presents with cough and nasal congestion for the last 2 weeks. She states that her symptoms have not improved during this time. On physical exam, you note erythematous and edematous nasal turbinates with clear discharge and erythematous pharynx with clear postnasal drip. What is the recommended intervention for this patient?
amoxicillin-clavulanate
when to hospitalize kids with pyelonephritis?
appear toxic, are septic, have underlying systemic disease or urinary obstruction, are unable to take fluids or meds infants younger than 2 yrs w/ febrile UTI all infants younger than 3 months
erythema toxicum neonatorum
benign pustular disorder seen in neonates, particularly term neonates and neonates with higher birth weight eruption usually in 1st 24-48 hours of life, delayed up to 10 days etiology idopathic
An 8-year-old boy presents to the clinic due to lightheadedness and chest pain during sports activities. On physical exam, a harsh crescendo-decrescendo systolic ejection murmur is auscultated, and an ejection click is auscultated at the apex. An increased left ventricular impulse is noted on chest palpation. Which of the following is the most common cause in pediatric patients for this child's presumed cardiac pathology?
bicuspid aortic valve
A 4-month-old girl is brought to her primary care provider by her mother, who has concerns of thick white plaques on the girl's tongue. A sample of the white plaque is evaluated on a potassium hydroxide smear and shows budding yeast. Which of the following physical exam findings would you expect to find in this patient?
bleeding when scraping off plaques
A 3-week-old term infant presents to the emergency department with increasing lethargy for 2 days. Vital signs include T of 101.6°F, HR of 188 bpm, RR of 65 breaths/minute, and oxygen saturation of 94% on room air. Physical exam reveals a sleepy but arousable infant with bulging fontanels and a soft and nontender abdomen. Cerebrospinal fluid analysis shows a total white blood cell count of 10,000/microL, protein of 400 mg/dL, and glucose of 5 mg/dL. Which of the following is the recommended empiric treatment?
cefotaxime and ampicillin
2nd gen cephalosporins
cefoxitin, cefaclor, cefuroxime
3rd gen cephalosporins
ceftriaxone, cefotaxime, ceftazidime
A 4-year-old girl presents to the office with abdominal pain and a painful sensation while urinating for the past 2 days. She has never had these symptoms before. On exam, she is non-toxic appearing, afebrile, and has some tenderness to palpation over the suprapubic area. A urinalysis is positive for white blood cells, and the urine culture reveals the presence of more than 100,000 CFU/mL of Escherichia coli. Which of the following medications is indicated for the treatment of uncomplicated cystitis?
cefuroxime, cefixime 1st line augmentin bactrim cipro if severe penicillin allergy and high resistance to bactrim
A 12-year-old boy presents to the clinic for evaluation of a new-onset pruritic rash that appeared in symmetric crops on his palms, soles, and the extensor aspect of his forearms. He recently recovered from a viral upper respiratory infection, for which he was treated conservatively using nonsteroidal anti-inflammatory drugs. The patient reports no current systemic symptoms, but he does have some oral discomfort with associated bullae noted in the oral cavity. Which of the following most likely describes the patient's skin findings?
central erythematous area surrounded by pale edematous skin and a sharp discrete ring of erythema erythema multiforme
oligoarticular juvenile idiopathic arthritis
children <5 years old typically, joint pain worse in morning and improves after child starts moving, joint is warm and tender to palpation
What is the most common type of psoriasis in children?
chronic plaque psoriasis
A 9-year-old boy presents to the clinic for behavioral evaluation. He was recently suspended from school for the third time following a fight with another classmate. His mother states he refuses to listen to her, and he is persistently lying to her and his father. Which of the following is the most likely diagnosis?
conduct disorder
A 7-year-old boy presents to the clinic due to abdominal pain. He reports no nausea, vomiting, changes in diet, or changes in bowel movements. Vital signs include T 100°F, HR 110 bpm, RR 22 breaths per minute, and BP 130/95 mm Hg. Upon exam, there is a large, smooth, nontender, firm mass located in the left lower quadrant. CT imaging is shown above. Which of the following is most likely to be found during history-taking based on the suspected diagnosis?
congenital abnormality wilms tumor
tetralogy of fallot murmur
crescendo-decrescendo holosystolic murmur left sternal border (LSB) radiates to back
A 4-year-old boy presents to his pediatrician with several lesions on his arms and trunk over the past 2 months. His mother states she has noticed other children at his daycare with similar lesions. She has noticed her son occasionally scratches the lesions and there seems to have been two new lesions that appeared this week. Physical examination reveals the lesion shown above. The clinician reassures the mother and patient and recommends observation with follow-up as needed. Which of the following is considered first line for the patient's condition if treatment is needed?
cryotherapy molluscum contagiosum
A 3-day-old baby girl born at 41 weeks gestation via a normal spontaneous vaginal delivery is evaluated in the labor and delivery unit for a new rash. Her mother states she noticed the small bumps for the first time today when changing her diaper. Physical examination reveals multiple erythematous macules and papules on the cheek, anterior trunk, upper arm, and thighs. The rash on the cheek is shown above. No lesions are noted anywhere else on the body. Which of the following is the most likely diagnosis, given the timing, location, and appearance of the infant's lesions?
erythema toxicum neonatorum
A 7-year-old girl presents to the clinic with unilateral ocular pain and eyelid swelling. She reports no pain with eye movement, has no visual disturbances, and has been afebrile. Which of the following is the most common route of infection?
ethmoid sinuses
A 4-year-old boy with no previous medical care presents to a pediatrician for his first medical visit. His legal guardian states the boy's birth mother was 38 years of age when she gave birth to him at a refugee clinic. The patient is noted to have mild intellectual disability, normal language comprehension, and delayed language production. Physical examination findings are significant for upslanting palpebral fissures, prominent epicanthic folds, brachycephaly, and a flat facial profile. Which of the following additional physical examination findings is most likely to be present in this patient?
excess skin at nape of neck
A 3-day-old boy born to a mother with no prenatal care is being evaluated for fever, anemia, and thrombocytopenia. Ophthalmologic evaluation is significant for chorioretinitis, and a head computed tomography scan reveals intracranial calcifications and hydrocephalus. Placental transmission from the mother to the newborn is highly suspected. Which of the following best characterizes the route of transmission associated with maternal infection of the most likely organism?
fecal- oral congenital toxoplasmosis
Kawasaki disease
fever >= 5 days + 4 out of the following: 1. bilateral bulbar conjunctival injection 2. oral mucous membrane changes: injected or fissured lips, injected pharynx, strawberry tongue 3. peripheral extremity changes: erythema of palms or soles, edema of hands or feet, periungual desquamation 4. polymorphous rash 5. cervical LAD >= 1 node 1.5 cm in diameter
viral conjunctivitis
fever, preauricular LAD
barlow test
flex and addut the hips
A 5-year-old girl presents to the clinic as a new patient for an annual checkup. Her vital signs are within normal limits, and her caretaker has no concerns. On physical exam, a harsh holosystolic murmur is auscultated at the mid-left sternal border, and a thrill is palpated at the third left intercostal space. Which of the following maneuvers is likely to increase the intensity of this child's murmur?
hand gripping VSD
A 1-month-old boy presents to the clinic because his parents notice he has occasional spells where he appears distressed, breathes rapidly, and has blue lips. On physical exam, the patient has vital signs that are within normal limits, including an oxygen saturation of 98%. He is in no apparent distress. Lung sounds are clear, and nail beds are pink. A prominent right ventricular impulse is palpated, along with a systolic thrill along the left upper sternal border. Which of the following physical exam findings would also be expected in this patient?
harsh systolic crescendo-decrescendo murmur at LSB
An 8-year-old girl presents to her pediatrician's office with multiple rashes on her palms and soles. Her father states the rash began suddenly 3 days ago, shortly after returning from a 2-day hiking trip in North Carolina. He has not seen his daughter scratching the rash, and the patient reports no pain or burning. She attends daycare, but her father is unsure whether other children have similar symptoms. Family history is significant for a mother who recently had a positive rapid plasma reagin test. Physical examination of the palms reveals the finding shown above. Similar lesions are observed on the soles of her feet. No other lesions are noted on physical examination. Which of the following is the most likely cause of the patient's symptoms?
herpes erythema multiforme
A 3-year-old boy presents to the emergency department because he started gasping and coughing after he was eating popcorn about 20 minutes ago. Upon physical exam, the patient is mildly distressed but afebrile. He has a cough that is off and on, has mild stridor, and there are decreased breath sounds in the lower left posterior lung field. Which of the following would most likely be found on a chest radiograph?
hyperinflation of the left lung
nephrotic syndrome
hypoproteinemia, edema, proteinuria, albuminuria, hyperlipidemia
A 2-year-old boy with a history of poorly controlled seizure disorder presents to the ED via EMS with rapid muscle jerking for 7 minutes. His mother reports her son fell to the ground, which was followed with the onset of the muscle jerking. Vital signs are temperature of 37.0°C, respiratory rate of 22 bpm, heart rate of 105 bpm, blood pressure of 116/75 mm Hg, and oxygen saturation of 98%. On exam, you note continued muscle jerking, tongue biting, and loss of bladder control. Laboratory studies obtained, including finger stick, are unremarkable. Which of the following medications is considered first line for his suspected diagnosis?
lorazepam
An 11-year-old girl presents to your office due to right knee swelling and stiffness for 2 months. She has not had any injury to the knee. She is able to walk but has difficulty running and playing with her friends. The pain is constant throughout the day. She reports no fevers, rashes, or other systemic symptoms at present, but her mother recalls her having a flu-like illness with fatigue and body aches a few months ago during the summer. On physical examination, she is afebrile. She has a moderate effusion in the right knee. There is mild diffuse tenderness to palpation but no warmth or erythema. She has 0° of extension to 130° of flexion of the right knee compared with +10° of hyperextension to 150° of flexion on the left. Findings on X-ray are normal. Aspiration of joint fluid reveals 20,000 white blood cells/µL. Which of the following is the most likely diagnosis?
lyme arthritis
A 2-year-old boy presents to the clinic with 2 days of vomiting and diarrhea. Vital signs include a T of 98.6°F, HR of 155 bpm, RR of 24 breaths/minute, and a blood pressure of 100/60 mm Hg. Physical exam reveals dry mucous membranes, sunken eyes, delay in capillary refill to 2.5 seconds, and a soft and nontender abdomen. Which of the following describes the severity of dehydration in this patient?
moderate
pediatric aortic stenosis murmur
moderate= loud systolic ejection murmur at R 2nd ICS radiating to neck progresses to= loud systolic ejection murmur with crescendo-decrescendo quality with ejection click visible apical hyperactivity and increased LV impulse
An 8-year-old boy presents to the pediatrician's office due to a chronic, worsening cough with recurrent hemoptysis and decreased exercise tolerance. Laboratory results indicate an elevated sweat chloride level of 72 mmol/L. Which of the following is most likely found on physical exam?
nasal polyps, increased anteroposterior chest diameter, hyperresonance to percussion
A 3-week-old term infant presents to the emergency department with increasing lethargy for 2 days. Vital signs include T of 101.6°F, HR of 188 bpm, RR of 65 breaths/minute, and oxygen saturation of 94% on room air. Physical exam reveals a sleepy but arousable infant with bulging fontanels and a soft and nontender abdomen. Cerebrospinal fluid analysis shows a total white blood cell count of 10,000/microL, protein of 400 mg/dL, and glucose of 5 mg/dL. dx
neonatal meningitis
A 3-day-old term neonate presents with a rash his mother noticed 10 hours ago. On exam, you note blotchy erythematous patches with central pustules on the trunk and extremities without the involvement of the palms or soles. The rest of the physical exam is unremarkable. Which of the following findings would be seen on a microscopic examination of a wright-stained smear of the contents of a pustule?
numerous eosinophils erythema toxicum neonatorum
A 6-year-old girl presents for a well-child check with pruritic lesions on her legs and forearms. The round, coin-shaped patches are primarily dull red with exudate and crust present. A few lesions appear dry and scaly with a central clearing. Potassium hydroxide test is negative. Which of the following is the most likely diagnosis?
nummular eczema
A 2-month-old infant presents with his mother, who states the child has been experiencing persistent tearing and debris on the eyelashes since birth. On exam, you note reflux of tears onto the eyes when the medial aspect of the eye is palpated. A fluorescein dye disappearance test is positive. Which of the following is the most appropriate treatment for this patient given the most likely diagnosis?
observation and massage, if not resolved by 6 months lacrimal duct probing
A 10-year-old boy with a history of asthma presents with bilateral eye redness for 3 days. Physical exam reveals bilateral conjunctival erythema and stringy discharge. Which of the following additional symptoms or signs would be also present given the most likely diagnosis?
ocular itching
A 2-year-old girl presents to the emergency department with vomiting and diarrhea for 2 days. Her mother reports she has vomited eight times today, and her older brother has similar symptoms. Vital signs include T of 98.6°F, HR of 140 bpm, and blood pressure of 100/60 mm Hg. Physical exam reveals a nontoxic-appearing child with mild dryness of buccal mucosa and a soft and nontender abdomen. Which of the following is the most appropriate treatment?
oral rehydration and ondansetron zofran if mild to mod dehydrdation and persistent vomiting
A 3-year-old girl who is clinically stable presents with her parents for evaluation of a nosebleed that has persisted despite pressure applied to the external nasal alae for more than 10 minutes. The source of the bleeding is identified with otoscopy at the most common point of origin. Which of the following is the best next step in treatment?
oxymetazoline application (afrin)
A 9-week-old boy who was born at 28 weeks gestation presents to the emergency department with difficulty breathing. The parents state the patient started to have some nasal congestion and drainage 3 days ago and developed a cough yesterday. Vital signs are 38.4°C (101.1°F), HR 150 bpm, RR 32 breaths per minute, and oxygen saturation 90% on room air. Physical examination reveals a crying patient with suprasternal and intercostal retractions. Lung auscultation reveals wheezing and crackles in the lower lung fields bilaterally. The patient is admitted to the hospital and improves significantly with nasal suctioning, supplemental oxygen, and fluid management. He is discharged in 2 days. Which of the following would be most useful in preventing recurrence of the condition in this patient?
palivizumab
A 13-year-old girl presents to the clinic to follow up after being diagnosed with acute pharyngitis 1 month ago. She reports new-onset joint aches that have migrated from her bilateral knees to her hips over the past week. Additionally, she reports nodules have formed over her olecranon process in her right elbow. Physical examination reveals fever, subcutaneous nodules, and mild effusion in the bilateral knees. Which of the following is the most common valvular finding during cardiac auscultation and is associated with pathologic sequelae?
pansystolic murmur- rheumatic fever mitral regurg MC mitral stenosis aortic regurg aortic stenosis mixed valvular disease
first line management of constipation
parental and patient education and initiation of oral laxatives fiber reqs, adequate water intake, avoidance of caffeine, proper positioning on toilet, toilet and food idary
A 4-year-old boy is brought to the emergency department with a history of 3 days of high fever, foul-smelling urine, persistent vomiting, and abdominal pain. On physical exam, the patient appears toxic and lethargic, with a temperature of 101.3°F. He has suprapubic tenderness and mild costovertebral angle tenderness to palpation. A urinalysis is positive for nitrites and leukocytes, and a urine culture is pending. Which of the following is the best initial IV treatment to administer in the management of this patient's condition?
parenteral= ceftriaxone, cefotaxime, cefepime 1st line or gentamicin, ampicillin (esp enterococcal infection) out pt= cefuroxime, cefixime, cefdinir (2nd or 3rd) acute pyelonephritis
A 6-year-old girl presents to her pediatrician's office with a reticular, lacy rash on her trunk and extremities. She is currently asymptomatic, but her parents report she was seen at an urgent care 1 week ago for fever, headache, sore throat, nausea, and diarrhea. The urgent care performed a rapid strep test, which came back negative, and her throat culture was also negative. Her symptoms resolved after a few days of acetaminophen. Physical examination reveals a well-developed, well-nourished girl in no acute distress. She is active and playful. In addition to the reticular rash on her trunk and extremities, a rash is noted on her face, as shown above. Which of the following organisms is most likely responsible for the patient's symptoms?
parvovirus B19
A 3-week-old girl presents to the office with her parents for a routine visit. She was born at full term through a spontaneous vaginal delivery with vertex presentation. It was her mother's first pregnancy. Her parents report no concerns. On physical examination, she moves all four extremities. Her leg lengths appear equal. She has full, equal range of motion of her hips. With adduction of the left hip, you feel the femoral head displace posteriorly with a clunk. Which of the following describes this examination finding?
positive barlow
A 6-year-old girl presents to her pediatrician's office with a sore throat and a nonpruritic, painless rash that developed suddenly 2 days ago. She was previously healthy and is up to date on all of her immunizations. Her vital signs are T of 37.9°C (100.2°F), BP of 98/74 mm Hg, HR of 85 bpm, RR of 18 breaths per minute, and oxygen saturation of 99% on room air. Physical examination reveals an alert and oriented, well-appearing child with vesicular lesions on the tongue and buccal mucosa surrounded by an erythematous rim. No tonsillar exudates or lymphadenopathy are appreciated. A maculopapular rash is present over the palms, interdigital web spaces, dorsum of the toes, soles, and heels. A rapid strep test is negative. Which of the following is the most appropriate clinical intervention at this time?
provide reassurance and supportive tx hand foot mouth disease
allergic conjunctivitis
pruritus, redness, conjunctival edema/chemosis, usually bilateral
A 5-year-old girl presents to her pediatrician's office with left ear pain, hearing loss, and otorrhea for the past 8 days. The patient developed a fever of 38.9°C (102.1°F) yesterday. Her parents state the pain has increased over the past 3 days and is worse at night. There is also pain in her left jaw when eating. She is currently under care for acute lymphocytic leukemia. The patient went swimming in a lake 10 days ago. Physical examination is significant for exquisite tenderness of the left tragus, auricle, and pinna. The left external ear canal is swollen and macerated with purulent discharge. Neurological examination reveals a left-sided facial nerve palsy. Which of the following pathogens is the most common cause of the suspected condition?
pseudomonas aeruginosa MCC of malignant otitis externa
A 1-year-old boy presents to the clinic with his father, who reports the patient has been having a fever up to 104°F oral for 3 days and a rash that appeared on the fourth day. On exam, the patient is afebrile and has a blanchable, maculopapular rash covering the body but is otherwise well-appearing and playful. Which of the following rash patterns is most consistent with the suspected diagnosis?
rash starting on the neck or trunk and spreading to the face and extremities Roseola
A 6-month-old girl presents to the clinic for a well-child check. She was born at 39 weeks gestation via uncomplicated vaginal delivery and has had no medical conditions arise since birth. She is exclusively breastfeeding and is appropriately gaining weight. Which of the following milestones is appropriate for this patient?
rolls front to back
A 9-year-old girl presents with her parents. They state that the patient has a rash that appeared yesterday. They state that the rash was initially only on her face but has since spread to her trunk and extremities. The patient is up-to-date on her vaccinations, and the family just returned from a visit to South Africa. Vital signs are within normal limits except for a temperature of 99.5°F. On physical exam, you note a well-developed, well-nourished, 9-year-old girl in no acute distress. You note a generalized maculopapular rash as well as posterior cervical and posterior auricular lymphadenopathy. When asked about sick contacts, the parents state that the friends they were staying with had a child about the same age who had a similar rash when they arrived in South Africa about 2 weeks ago. What is the most likely diagnosis?
rubella
herpes diagnostic test when lesions are crusted over
serologic PCR and viral culture negative with no vesicular fluid
A 4-year-old girl presents to the emergency department with a cough, rhinorrhea, and a fever for 5 days. The patient's father states her symptoms were initially mild, but today the patient started to have difficulty breathing and a rapidly progressive fever. Vital signs reveal HR of 125 bpm, RR of 38 breaths per minute, BP of 110/72 mm Hg, T of 103.2°F, and oxygen saturation of 94%. The patient appears toxic on the exam. A high-pitched sound with both inspiration and expiration, use of accessory respiratory muscles, and a barking cough are notable. The patient is noted to have hoarseness but is tolerating oral secretions. The father confirms she is up to date on her vaccinations. Which of the following is the most common causative agent for the suspected diagnosis?
staph aureus- bacterial tracheitis
clinical manifestations of neonatal meningitis
temperature instability (fever or hypothermia), irritability or lethargy, poor feeding, vomiting
A 12-month-old boy presents to the pediatrician for his first visit. His foster parents received him into their home 2 days ago, and they have little information on his medical, family, or social history. Since he has been in their home, he has been quite fussy, and they are concerned about what seems to be an itchy rash on both of his hands and feet. On exam, there are multiple small, erythematous papules and vesicles on both of his hands, with surrounding excoriations. Tracts that appear to be small burrows are also present and measure about 5 mm in length. Which of the following is the most appropriate treatment?
topical permethrin oral ivermectin not for children <15 yr, pregnant or lactating women
