4. Infectious Disease ROSH questions

An 18-month-old boy is brought in by his parents for shortness of breath. The parents woke to him coughing a low-pitched cough. They also noted other noises when he was breathing in that resolved upon walking outside. The patient is frequently coughing but has no abnormal sounds on auscultation of the neck or lungs. What is the most appropriate treatment? A. Albuterol B. Dexamethasone C. Racemic Epinephrine D. Ribavirin

B. Dexamethasone Patient has CROUP-LARYNGOTRACHEITIS TX: 1. If not severe-dexamethasone 2. IF SEVERE-RACEMIC EPINPEHIINE

A 17-month-old girl presents to the office with two days of fever, congestion, and cough. On examination, inspiratory stridor is noted when the patient becomes fussy. What is the most likely etiology of her stridor? A. Bacterial Tracheitis B. Epiglottitis C. Croup D. Laryngotracheal FB aspiration

C. Croup MCC is parainfluenza virus

A 12-month-old boy presents with a hoarse, harsh cough and inspiratory stridor following two days of mild cough and nasal congestion. He is in mild respiratory distress. Lungs are clear to auscultation. What is the most likely diagnosis? A. Bacterial Tracheitis B. Epiglottitis C. Laryngotracheitis D. Retropharyngeal Abscess

C. Laryngotracheitis

A 3-year-old boy presents with left anterior cervical lymphadenitis and fever that developed over three days. The area surrounding the node is tender, warm, and swollen. What is the most likely etiology of the lymphadenitis? A. Atypical Mycobacteria B. Bartonella Henselae C. EBV D. Staph

D. Staph aureus

A 1-year-old boy is brought to the urgent care clinic for fever, cough, and difficulty breathing. His mother tells you he had an upper respiratory tract infection 3-days ago. His temperature is 40.0°C (104°F). Auscultation of the lungs reveals expiratory wheezing and crackles on both sides. Physical examination shows suprasternal and subcostal retractions. A chest X-ray shows hyperinflation of the lungs and peribronchial thickening. Which of the following is the most likely diagnosis? A. Acute Bronchiolitis B. Acute Bronchitis C. Croup D. RSV

A. Acute Bronchiolitis <2 years old -Fever/cough/respiratory diystress -1-3 day history of URI -PE: 1. Hyperinflation 2. Peribronchilar thicening.

A boy aged 30 months presents with respiratory distress. He was diagnosed with croup one week ago and received a single dose of dexamethasone. His cough had nearly resolved until yesterday, when coughing worsened, and he developed nasal congestion. This evening, he developed inspiratory stridor, increased work of breathing, and a fever to 103°F. What is the most likely diagnosis? A. Bacterial Tracheitis B. Bronchiolitis C. FB Aspiration D. Recurrent Croup

A. Bacterial Tracheitis

A 3-year-old boy presents in severe respiratory distress. His mother informs you that he has been ill for the last 5 days, initially with a low-grade fever and "barky cough." He was seen at an urgent care facility 4 days ago and given a "breathing treatment" and discharged on steroids. He has become progressively worse despite compliance with the steroid regimen, which prompted his mother to call an ambulance this morning. He is otherwise healthy and up-to-date on his immunizations. On examination, the child is toxic in appearance and febrile. His oropharynx is clear. You hear both inspiratory and expiratory stridor. What is the most likely diagnosis? A. Bacterial Tracheitis B. Croup C. Epiglottitis D. Peritonsillar Abscess

A. Bacterial Tracheitis Bacterial tracheitis is the result of severe inflammation of the epithelial lining of the trachea leading to thick mucopurulent secretion production. This clinically manifests as viral prodrome with fever, URI symptoms, barky cough and stridor that intensifies and progresses to include a TOXIC APPEARING CHILD with signs of airway obstruction, inspiratory and expiratory stridor, cyanosis, and severe respiratory distress. Another clue is that the child has been treated with medications (aerosolized epinephrine and steroids) for croup and has not improved clinically. Bacterial tracheitis is most common in children between the ages of 3 to 5 years. Most patients require orotracheal intubation for respiratory distress and ICU admission. The patient should be started on broad-spectrum intravenous antibiotics.

A 4-week-old boy presents with a 2-week history of increasing dyspnea, cough, and poor feeding. On examination you note conjunctivitis, and a chest examination reveals tachypnea and rales. A chest X-ray shows hyperinflation and diffuse interstitial infiltrates. Which of the following is the most likely etiologic agent? A. Chlamydia Trachomatis B. Parainfluenza C. RSV D. Staph

A. Chlamydia Trachomatis Chlamydia trachomatis infections in newborns can manifest as pneumonia and conjunctivitis. -STACCATO COUGH

A 15-year-old girl presents to urgent care with a nonproductive cough and low-grade fever that developed insidiously over the previous week. Physical exam reveals diffuse rales on pulmonary auscultation, and chest X-ray shows diffuse non-focal infiltrates. Which of the following is the most accurate statement regarding this patient's condition? A. Extra pulmonary manifestations may include hemolysis and CNS involvement B. Mycoplasma Pneumoniae is the most common etiology in all age groups C. Penicillin is the most appropriate treatment D. The formation of cold Agglutinin is a positive confirmatory test

A. Extra pulmonary manifestations may include hemolysis and CNS involvement Patient shows symptoms of Community acquired pneumonia. Atypical bacterial infections are also more likely to present with extrapulmonary manifestations such as skin rashes, hemolysis (secondary to the formation of cold agglutinin antibodies), CNS involvement (aseptic meningitis, cerebellar ataxia, cranial nerve palsies), and gastrointestinal symptoms.

What is the most common causative organism of meningitis in a 1 week old child? A. Group B strep B. H. Flu C. Listeria D. Staph

A. Group B Strep

A five-year-old boy is brought into the emergency department in mild respiratory distress. His mother states that he has had a fever and sore throat since yesterday. Physical exam reveals drooling and inspiratory stridor. A soft tissue lateral X-ray of the neck is performed and shows thickened aryepiglottic folds and the "thumb" sign. Which of the following is the most likely causative pathogen? A. Adenovirus B. Group A Streptococcus C. Parainfluenza D. Staph Aureus

B. Group A Strep With the initiation of the H. influenzae type b vaccine, Group A streptococcus (GAS) is now the most common cause of acute epiglottitis in the pediatric population.

A two-year-old child is seen in the emergency room with recent onset of cough and progressive stridor. Respiratory cultures are taken, and you are concerned for bacterial tracheitis. What is the most common organism isolated on respiratory cultures in bacterial tracheitis? A. Hib B. Staph aureus C. Streptococcus Pneumoniae D. Streptococcus Pyogenes

B. Staph aureus

A 7-week-old boy born at 34 weeks gestation presents to the emergency department with a rash. Two weeks prior to presentation he was treated with mupirocin for a skin infection. One day prior to presentation he had nasal congestion. On exam, he is noted to be febrile to 38.4°C and very irritable. His skin is diffusely erythematous and tender when touched. There is a sloughing rash on the anterior folds of his neck, the diaper region, and perioral area. What is the most likely diagnosis? A. Bullous Impetigo B. Staphylococcal Scalded Skin Syndrome C. SJS D. TEN

B. Staphylococcal Scalded Skin Syndrome (SSSS)

A 2-year-old boy presents because of high-grade fever of two days and drooling of his saliva. He has been irritable as well and refuses to eat or drink. Physical examination reveals multiple vesicles and ulcers surrounded by an erythematous ring on the uvula, soft palate, anterior tonsillar pillars and posterior pharyngeal wall. Examination is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Aphthous Ulcers B. Hand, foot, mouth disease C. Herpangina D. Herpetic gingivostomatitis

C. Herpangina SX: 1. HIGH GRADE FEVER 2. SORE THROAT 3. DYSPHAGIA 4. LESIONS IN THE POSTERIOR PHARYNX or ANTERIOR TONSILS Note: herpangina has similar mouth presentation to hand, foot, mouth, but just doesn't have the hand and foot part.

Congenital Rubella Syndrome

Classic triad: congenital cataracts (white pupils), sensory-neural deafness, and patent ductus arteriosus (could be pulmonary artery stenosis as well) cCould potentially also result in microcephaly and mental retardation non-pregnant females should be vaccinated with the live MMR vaccine prior to pregnancy.

A 7-year-old boy with a history of cystic fibrosis presents with increased cough and fever. He has been doing well and has not been hospitalized for pneumonia in the last seven months. His X-ray demonstrates pneumonia and he requires supplemental oxygen. Which of the following antibiotic regimens is most appropriate? A. Ceftriaxone and Azithromycin B. Ceftriaxone and Doxy C. Moxifloxacin D. Pip Taz

D. Pip Taz Cystic fibrosis (CF) is caused by a mutation in the CF transmembrane conductance regulator gene and transmitted in an autosomal recessive pattern. Approximately 80% of patients with cystic fibrosis are colonized with PSEUDOMONAS aeruginosa by age 18. Therefore, active pneumonia infections are treated with broad-spectrum antibiotics with adequate activity against Pseudomonas, such as Piperacillin/tazobactam.

A 7-month-old girl presents to the emergency department with difficulty breathing. Her parents report two days of cough and congestion with one day of increased work of breathing. On exam, her temperature is 37.4°C, heart rate 140, blood pressure 94/65, respiratory rate 65, and oxygen saturation 90%. She has moderate suprasternal and subcostal retractions, mild intercostal retractions and slight head bobbing. On auscultation, she has diffuse polyphonic wheezing with crackles. Which of the following is the next best step? A. Discharge home with supportive care B. Initiate Bronchodilator therapy C. Obtain a chest x ray D. Suction Nares

D. Suction Nares BRONCHIOLITIS is a common lower respiratory tract infection in infants characterized by diffuse polyphonic wheezing and crackles. It is caused by VIRAL INFECTIONS, most notably RESPIRATORY SYNCITIAL VIRUS (RSV), and occurs primarily in the winter season. Clinical findings include respiratory distress, polyphonic wheezing, and rales. Infants may exhibit hypoxemia due to ventilation-perfusion mismatch from mucous plugging of respiratory units. As respiratory failure progresses, patients develop hypercapnia and respiratory acidosis and may require mechanical ventilation. Most infants develop a mild and self-limited disease that can be managed at home with supportive care. However, infants with difficulty feeding, significant respiratory distress (as seen in this patient), or need for supplemental oxygen should be admitted to a hospital for further management and close monitoring. Supportive care remains the first-line therapy while in the hospital, which includes suctioning of the nares with saline drops.

A three-year-old girl presents with headache, fatigue, anorexia, and myalgias after returning from a trip to the Dominican Republic. You notice multiple mosquito bites on physical examination. You suspect dengue fever. What is the treatment of choice for this diagnosis? A. Acyclovir B. Ceftriaxone C. Ciprofloxacin D. Supportive Care

D. Supportive Care DENGUE FEVER is an RNA virus transmitted to humans by infected MOSQUITOS in the tropical regions of Southeast Asia, Mexico, Central America, Africa, and the Caribbean. Children younger than 15 years old have increased severity and mortality. Associated morbidity and mortality is secondary to hemorrhage from thrombocytopenia, platelet dysfunction, or disseminated intravascular coagulation. Symptoms include ABRUPT ONSET HIGH FEVER, retro-orbital pain, headache, MYALGIAS, ARTHRALGIAS, mucosal bleeding, and petechiae. Associated fatigue, nausea, vomiting, and abdominal pain are common. Laboratory testing commonly reveals THROMBOCYTOPENIA, leukopenia, elevated liver transaminases, and elevated hematocrit. SUPPORTIVE CARE is the treatment of choice.

A 6-month-old infant presents to the pediatrician's office with a two-day history of increased fussiness, poor feeding, low-grade fever and rash. The family returned from a trip to India last week. The rash appears on the trunk in several stages of erythematous macules, vesicular papules and pustules. Which of the following is the most likely diagnosis? A. Herpes simplex B. Measles C. Pityriasis Rosea D. Varicella

D. Varicella The rash typically STARTS AT THE HAIRLINE, with formation of MACULES WHICH PROGRESS TO FLUID FILLED VESICLES (DEW DROPS ON A ROSE PETAL). Crops of lesions typically appear at the same time with vesicles in VARIOUS STAGES OF HEALING on the body.

What is the most common cause of acute bacterial otitis media in children?

Haemophilus Influenza according to rosh, but we were taught strep pneumo? "Haemophilus influenza is the most common etiology of acute otitis media (AOM), it has surpassed Streptococcus pneumoniae due to changes in microbiology following updated streptococcal vaccinations. H. influenzae is a gram-negative, facultatively anaerobic, non-motile rod that is transmitted via airborne droplets and direct contact with respiratory secretions. H. influenzae is exclusively found in humans. Acute otitis media (AOM) is defined as inflammation of the middle ear. AOM is the most common reason for office visits and is the most common reason for antibiotic use in children. AOM is more common in boys than in girls. Other risk factors include family history, day care attendance, lack of breastfeeding, exposure to tobacco smoke, pacifier use, and poor socioeconomic status. In children with AOM, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial pathogens isolated from middle ear aspirates. Otalgia is the most common complaint and is the best predictor of AOM in children. Other symptoms include fever, irritability, headache, vomiting, and diarrhea. A bulging and erythematous tympanic membrane is the key physical exam finding. Pneumatic otoscopy will show decreased tympanic membrane mobility in AOM. The diagnosis of AOM is based on tympanic membrane bulging and signs of acute inflammation. Immediate antibiotic use is recommended in certain populations based on age, degree of symptoms, duration of symptoms, and underlying co-morbidities. Amoxicillin is first-line therapy in most patients. Amoxicillin-clavulanate is first-line in children who have received a beta-lactam antibiotic in the previous 30 days. Cephalosporins and macrolides are first-line in patients allergic to penicillin. Oral ibuprofen or acetaminophen are recommended for pain control. Symptoms usually improve within 24 to 72 hours with appropriate antibiotic use."

Enterobiasis

Pinworms

A 3-year-old girl presents to the ED with one hour of a barking cough and inspiratory stridor at rest. On exam, she has mild retractions but is not hypoxic. Which of the following interventions has been shown to reduce hospital length of stay in moderate to severe croup? A. Dexamethasone B. Heliox C. Humidified Air D. Racemic Epinephrine

A. Dexamethasone