Pediatric Infectious Diseases

8 Questions | By Liborio | Last updated: Mar 22, 2022 | Total Attempts: 1909

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Pediatric Infectious Diseases Quiz

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1.

A 7-year-old boy presents to the emergency room with fever, headache, and rash. He recently returned from a hunting trip to North Carolina with his father. His father states he and his son had several tick bites. There are no meningeal signs on examination. Labs are significant for thrombocytopenia and hyponatremia. WHICH of the following best describes the typical rash associated with most likely cause of illness in this patient?
- A.
  
  A diffuse maculopapular rash which appears symmetrically over the body
- B.
  
  A diffuse pruritic vesicular rash which appears in pinpoint lesions over the body
- C.
  
  A macular rash which begins on the head and spreads to the remainder of the body in a descending fashion
- D.
  
  A petechial rash which first appears on the extremities and moves onto the trunk in a centripetal fasion
- E.
  
  Erythema of the cheeks, followed by a lacy-reticulated rash over the trunk, especially the extremities
2.

A 9-month-old child presents to the emergency room with inconsolable crying and fever. His mother reports that he was in his usual state of health until yesterday evening. At that time, he developed cough and runny nose. He was also febrile to 101 F per his mother. Since that time he has continued to have fever, despite treatment with children s ibuprofen. Over the course of the day the child has been inconsolably crying, grabbing his head, and complaining of pain. Past medical history is unremarkable. The birth history is normal, and developmental milestones have been appropriate. The patient has no allergies, takes no medications and has never been hospitalized. On your examination, temperature is 103 F, heart rate is 156, blood pressure is 95/47, and respirations are 28. The child appears irritable and uncomfortable. Lung and cardiovascular exam are normal. There are no rashes. You note a bulging anterior fontanel. When you flex the child s neck, he whimpers and flexes his hips and knees. You perform a lumbar puncture which reveals glucose 23 mg/dl, protein 150 mg/dl, and 300 WBC/microliter (90 % PMN s). After obtaining appropriate cultures, what is the MOST APPROPRIATE empiric parenteral antibiotic regimen?
- A.
  
  Piperacillin/tazobactam (Zosyn) monotherapy
- B.
  
  Vancomycin and ceftriaxone
- C.
  
  Vancomycin and acyclovir
- D.
  
  Vancomycin and ampicillin
- E.
  
  Vancomycin and rifampin
3.

An 8-year-old girl is brought to the hospital for evaluation by her worried parents. It is summertime and their daughter has been playing outside much of the summer. She has had frequent mosquito bites. She has had no other animal bites or contact that she or her parents remember. She has previously been in good health. When she woke up this morning, she had complained to her mother of a headache which has become significantly worse throughout the day. Her mother reports low-grade fever as well. She has vomited once today and feels nauseous again while waiting to be evaluated. She denies photophobia or other symptoms. Several of her friends have had similar symptoms over the past several days. Physical examination shows an uncomfortable but non-toxic appearing child who is holding her head, but is able to converse with you. She is alert and oriented appropriately and although she is uncomfortable, she is not irritable. Vital signs are as follows: T 38.0 C, pulse 88, BP 98/52, RR 20. She has mild nuchal rigidity but otherwise has normal physical examination, including normal neurologic findings. You decide to perform a lumbar puncture with the following CSF findings:CSF leukocytes 110 cells with 92% lymphocytes CSF protein 80 mg/dl CSF glucose 90 mg /dl The child is admitted for observation and recovers without incident. What is the MOST LIKELY etiology of her infection?
- A.
  
  A gram positive bacteria
- B.
  
  An arbovirus
- C.
  
  Parvovirus B-19 infection
- D.
  
  Herpes Simplex virus
- E.
  
  An enterovirus
4.

A 14-year-old girl presents to the emergency department with her mother. She has a one-week history of pain in her left knee. She has had a low grade fever and notes that she had a round ring-like rash five months ago. She lives in the northeastern United States and frequently hikes in the woods. Recently her eightyear- old brother had an erythematous rash that was on his face and arms. His rash got worse if he took a warm bath or was out in the sun. He has been afebrile. Physical examination is essentially normal except for the patient s left knee which is moderately tender with an effusion. There are no effusions of any other joints. She has no conjunctivitis or scleral changes on examination. There are no skin lesions or rashes. WHICH of the following is the best initial treatment plan for this patient?
- A.
  
  Cefixime
- B.
  
  Ceftriaxone
- C.
  
  Ciprofloxacin
- D.
  
  Doxycycline
- E.
  
  Trimethoprim-Sulfamethoxazole
5.

You are evaluating a 4 year-old-boy in the emergency department for bloody diarrhea. He has been ill for about two days with fever and diarrhea. He has previously been well and has no underlying chronic health conditions. Evaluation shows a child who, although he indeed has frequent loose stools, some with spots of blood in them, is adequately hydrated and is not compromised either hemodynamically or neurologically. In the above scenario, infection with WHICH of the following agents would NOT require treatment with antibiotic therapy?
- A.
  
  Salmonella species
- B.
  
  Amoebic dysentery
- C.
  
  Campylobacter
- D.
  
  Clostridium dificile
- E.
  
  Yersinia
6.

A 7-year-old boy is seen in the emergency department after receiving a bite wound to his leg from a neighbor s dog. The bite was a provoked attack as the boy was teasing the dog with a water hose. The dog is up to date on its rabies vaccinations. The boy received a tetanus booster at 5 years of age. WHICH of the following is the MOST APPROPRIATE course of action for this patient?
- A.
  
  Clean the wound and start amoxicillin
- B.
  
  Clean the wound and start amoxicillin-clavulanate (Augmentin)
- C.
  
  Clean the wound and start ciprofloxacin (Cipro)
- D.
  
  Clean the wound and start cephalexin (Keflex)
- E.
  
  Clean the wound only and watch for infection before starting antibiotic therapy
7.

A 17-year-old female comes to the emergency department for evaluation of persistent vaginal discharge. She does not want to go to her pediatrician s office for this particular concern. She has had several episodes in the past two years which have been self-diagnosed as yeast infections. They have always responded to over-the-counter medications such as clotrimazole. She admits to being sexually active with a history of multiple male partners in the past. She reports all previous partners as being healthy. She admits to vaginal discharge for the past several weeks. She recently completed another over-the-counter remedy for this problem, but had no improvement in the discharge this time. She denies a history of sexually transmitted disease. She denies any vaginal lesions or vesicles. She is currently using oral contraceptives for birth control; she does not regularly use any type of barrier protection. Pelvic examination is notable for a small amount of discharge from the cervical os. There is no adnexal or cervical motion tendeness. For the patient described above, WHICH of the following is the most appropriate empiric pharmacologic therapy after obtaining specimens for culture?
- A.
  
  Azithromycin by mouth and ceftriaxone intramuscularly
- B.
  
  Azithromycin by mouth, ceftriaxone intramuscularly and penicillin-G intramuscularly
- C.
  
  Ceftriaxone intramuscularly
- D.
  
  Ceftriaxone and penicillin-G intramuscularly
- E.
  
  Penicillin-G intramuscularly
8.

An 18-year-old female is admitted to your hospital service for inpatient management of severe migraine headache. Her headache is treated and she improves. She mentions to you that she will be traveling to rural areas of Haiti following high school graduation for a summer exchange program. She expects to be spending many hours daily out in the sun. She wants to know what medications or immunizations she will need to take in order to protect herself from malaria. WHICH of the following would NOT be an appropriate choice for malaria prophylaxis in this patient?
- A.
  
  Atovaquone and proguanil (Malarone)
- B.
  
  Chloroquine
- C.
  
  Sulfadoxine and pyramethamine (Fansidar
- D.
  
  Mefloquine
- E.
  
  Praziquantel