Infection

Collected by Dr.Mahmoud Eid from pediatric board study guide book

91 Case

1. Diarrhea and turtle at home

Nontyphoid Salmonella

2.Child care center, fever, vomiting, bloody diarrhea, new onset seizure,
leukocytosis, bandemia, and rectal prolapse

Shigella

3. Diarrhea, high BUN/Creatinine, thrombocytopenia, and hemolytic anemia

Hemolytic uremic syndrome E. coli O157:H7

4. Child with his family to the Bahamas on a cruise ship, all of them have
diarrhea, and a large number of people on the ship have the same

Norovirus outbreak

5. Child had rice in a restaurant, presents with vomiting and diarrhea

Bacillus cereus

6. A child ate potato salad 3 h ago, presents with sudden onset of nausea,
vomiting, and severe abdominal cramps

Staphylococcus aureus (preformed enterotoxin)

7. Adolescent, recently had grilled “rare” pork meat, presents with severe right
lower quadrant (RLQ) abdominal pain, normal appendix on US

Yersinia enterocolitica
8. A 6-month-old infant presents with constipation, and poor feeding (mother tried
honey for the first time)

Botulism

9. Community outbreak of diarrhea, news reports that the drinking water has
been contaminated with acid-fast protozoa

Cryptosporidium

10. Travelled to Mexico, foul offensive diarrhea, burping and flatulence

Giardiasis

11. Travelled to Mexico, bloody diarrhea, tenesmus, no fever

Amebiasis

12. Travelled to Mexico, right upper quadrant pain, abdominal US showed

liver abscess

Amebiasis

13. Unimmunized and buccal cellulitis

Haemophilus influenzae b

14. Adolescent presents with, pneumonia, diarrhea, headache, and confusion

Legionella pneumophila

15. Breeds turkey, high fever, pneumonia, muscle pain, and splenomegaly

Chlamydophila psittaci

16. Adolescent presents with, cough, low-grade fever, wheezing, negative cold
agglutinins
Chlamydophila pneumoniae

17. A 3-day-old newborn, copious purulent eye discharge, and eyelid edema

Gonococcal conjunctivitis

18. Erythromycin ointment is considered the best regimen for prophylaxis against
neonatal conjunctivitis because of its efficacy against:

Gonococcal, and nongonococcal nonchlamydial pathogens (does not

prevent C trachomatis transmission from mother to baby)

19. A 6-week-old, staccato cough, eye discharge

Chlamydia trachomatis

20. A 3-month-old present with staccato cough, no fever, CXR positive for
pneumonia

Chlamydia trachomatis

21. Fever of unknown origin, lives in a farm, the most likely cause

Brucella,
blood culture is the best test and
Doxycycline is the drug of choice

22. Tick bite, fever, rash, myalgia, headache, pancytopenia, elevated liver
enzymes, and hyponatremia

Ehrlichiosis (anaplasmosis)

23. Tick bite, fever, rash on palms and soles, headache, joint pain, low platelet,
and hyponatremia

Rocky Mountain spotted fever (RMSF) Rickettsia rickettsii

24. A 4-year-old with RMSF. What is the drug of choice?

Doxycycline

25. Connecticut, target skin lesion (erythema migrans), next step:

Treat (Lyme disease), do not order serology

26. Child was camping in a park in New York, developed Bell’s palsy, no rash,
no other symptoms

Order Lyme serology, and treat if positive

27. Child visited Oklahoma with family, they hunted and skinned rabbits, the child
presented with large lymph node in the groin, and fever

Tularemia (Francisella Tularensis)

28. Neonate, peripherally inserted central catheter (PICC) line is positive for
Candida albicans

Remove the catheter and start IV antifungal

29. A child living in Ohio developed pneumonia, hilar lymphadenopathy,

splenomegaly, erythema multiforme, and oral ulcers

Histoplasmosis

30. A child spent summer vacation at his uncle’s farm in California presenting
with fever, chills, cough, shortness of breath, night sweat, bronchial breathing
sound, tender erythematous nodules on the lower extremities, ESR is elevated

Coccidioidomycosis

31. Most commonly associated electrolyte disturbance associated with

amphotericin B therapy
Hypokalemia Hypomagnesemia
Hypo K - Mg

32. Infant presents with 3 days of high fever, febrile seizure, develops rash
when fever resolves

Human herpesvirus 6 infection (roseola infantum)

33. Fever, headache, runny nose, rash on the cheeks (looks like slapped), lacy
rash on both arms

Erythema infectiosum (Parvovirus B19)

34. Very high fever, cough, coryza, conjunctivitis, bluish-grey specks on the
buccal mucosa, maculopapular rash spread from the head down,
splenomegaly, and lymphadenopathy

Measles

35. Posterior auricular and suboccipital lymphadenopathy, headache, eye

pain, sore throat, maculopapular rash, low-grade fever, and chills

German measles ( Rubella)

36. Adolescent male present with mumps (parents are asking about the possible
complications)

Epididymoorchitis, meningitis

37. Chicken pox rash is infectious for how long?

1–2 days before the rash, and until all lesions are crusted over

38. Limping, after stepping on a nail with shoe on

Pseudomonas aeruginosa
39. Kitten at home, large axillary and cervical lymph nodes

Bartonella henselae

40. Dog bite, 12 hours later presents with swelling of the hand, tenderness and
erythemas

Pasteurella species

41. Dog bite, 5 days later presents with swelling of the hand, erythema, and
tenderness

Staphylococcus aureus

42. Dog bite and allergic to penicillin

Clindamycin and TMP-SMX

43. Dog, cat, and human bite drug of choice

Amoxicillin/clavulanate

44. Dog bite with severe complications, patient is hospitalized

Ampicillin/sulbactam IV

45. Bitten by a fox

Give rabies vaccine and immunoglobulin

46. Dead bat found in same the room as the patient

Give rabies vaccine and immunoglobulin

47. Bitten by a domestic dog during aggressive play

Give amoxicillin/clavulanate

48. Most common organism that causes infection in cat bite

Pasteurella multocida

49. Cochlear implants are associated with an increased risk of which bacterial
infection?

Streptococcus pneumoniae

50. A 5-year-old, fever, headache, pharyngeal erythema, palatal petechiae,

abdominal pain, nausea

S. pharyngitis

51. A 3-year-old, fever, runny nose, cough, and pharyngeal exudates

Viral pharyngitis

52. A 12-year-old, throat pain with exudates, fever, headache, large cervical
lymph node, and splenomegaly

EBV infectious mononucleosis

53. Best screening test for suspected EBV infection

Monospot test

54. Conjunctivitis, exudative pharyngitis, rhinorrhea, and cervical adenitis, and

fever

Adenovirus (pharyngoconjunctival fever)

55. A 12-month-old, fever, gingival swelling, blisters on the lips and gingiva,
drooling, looks dehydrated
Herpetic gingivostomatitis

56. High fever, poor feeding, drooling, very small vesicles, and ulcers on both
tonsils (lips are spared) ‫عشان تفرق بينها و بين الهربس‬

Herpangina (coxsackievirus A16)

57. An 18-month-old presents with fever, vesicles and ulcers on the buccal
mucosa and the tongue, erythematous maculopapular rash all over the body, and
petechial rash on the palms and soles

Hand-foot-mouth disease (coxsackievirus)

58. Throat pain, fever, grayish-white membrane on the pharynx, the child is
not immunized, and looks toxic

Diphtheria

59. A child with persistent tooth abscess, developed multiple sinuses drainage on
the cheeks with sulfur granules seen in the exudates

Actinomycosis

60. A 12-year-old boy with history of swimming in fresh water lagoons, developed
headaches, myalgia, and fever; 7 days later he became jaundiced, with elevated
creatinine level, high bilirubin level, mild elevation of AST and ALT

Leptospirosis

61. Unimmunized, dirty wound, and fracture of femur

Tetanus vaccine and tetanus immunoglobulin (TIG)

62. Immunizations up-to-date, last tetanus vaccine was 3 years ago, dirty
wounds, and multiple compound fractures in a car accident

No tetanus vaccine nor TIG

63. A 12-year-old boy stepped on a dirty rusty nail, the last DtaP immunization
was 8 years ago (received five doses of Dtap by the age 4 years of age)

Tdap immunization

64. A 12-year-old boy stepped on a clean object at home, presents with minor,
clean wound, (received five doses of Dtap by the age 4 years of age)

No additional immunization is required for the tetanus, however he will

need the booster dose for pertussis

65. Young adolescent works in an animal farm developed skin papule on the arm
which eventually ulcerates and forms black eschar with non-pitting, painless
induration and swelling

Anthrax

66. Unimmunized, present with fever, muscle weakness and paralysis involved
the proximal muscle first

Poliomyelitis

67. A 2-month-old developed bronchiolitis and negative respiratory syncytial

virus (RSV)

Human metapneumovirus

68. Central line, methicillin-resistant S. aureus (MRSA) infection. What is the

drug of choice?

Vancomycin

69. IV vancomycin, suddenly develop rash, itchiness, flushing and tachycardia

Red man syndrome

70. Recently traveled to Africa, seizure, decreased level of consciousness,
retinal hemorrhage, and hypoglycemia. What is the most likely cause?

Plasmodium falciparum (cerebral malaria)

71. Travelling to Africa, the prophylactic antimicrobial therapy of choice for

malaria is:

Atovaquone-proguanil, or mefloquine, or doxycycline

72. A 3-year-old developed osteomyelitis, culture is negative, not responding to

vancomycin. What is the most likely cause?

Kingella Kingae (aerobic CO2 enhanced culture)

73. Neonate presents with fever, blood culture grows citrobacter. What is the
most common complication?

Brain abscess

74. The best study for neonates presenting with fever and citrobacter bacteremia

Brain CT or MRI

75. Late onset (7 days to 3 months of life) group B streptococcal infection

presents with

Bacteremia (more common), meningitis, or osteomyelitis

76. Stiff neck, fever, CSF WBC <1000, 80% neutrophil, negative CSF gram stain.
What is the best CSF study?

Enterovirus PCR

77. Empiric antibiotic therapy in newborn with presumed bacterial meningitis

Ampicillin plus aminoglycoside or ampicillin plus cefotaxime

78. Empiric antibiotic therapy in infants and children with presumed bacterial
meningitis

Vancomycin plus ceftriaxone or cefotaxime

79. What is the duration of therapy in most of the cases of meningitis?

14–21 days

80. Child with tetralogy of fallot presents with headache, seizure and brain
abscess

S. aureus

81. 17-year-old female with history of IV drug abuse, presents with fever,
dyspnea, cough, chest pain, tender subcutaneous nodules in the distal nail pads,
positive blood culture for S aureus

Endocarditis

82. Adolescent with high risk behavior and IV drug abuse presents with fever,
lymphadenopathy, pharyngitis, muscle and joint pain, mouth and genital
ulcers, skin rash including the palms and soles, rapid strep and monospot tests
are negative

Acute retroviral (HIV) syndrome

83. The best initial test for the diagnosis of acute retroviral (HIV) syndrome

HIV DNA PCR Confirm with ELISA/Western blot and HIV RNA PCR (viral
load)

84. Main side effect of zidovudine (ZDV)

Bone marrow suppression

85. Pregnant adolescent with HIV, her CD4 count is 800

Start anti-HIV therapy immediately

86. Patient with HIV infection, diarrhea for 3 weeks and not resolving

Cryptosporidium

87. A child lives with his father who was in jail, developed cough, weight loss,
night sweat, CXR shows hilar adenopathy, and pneumonia

Tuberculosis

88. Developed large matted cervical lymph node and persistent for 6 weeks and
not responding to antibiotics, you notice the overlying skin is violaceous. Most
likely diagnosis:

Mycobacterium avium

89. A child present with large anterior cervical lymph node measure 7×4 cm,
matted, painless, PPD is 9 mm induration, not responding to antibiotics for 9
weeks

Surgical removal of the node with complete excision (atypical

mycobacteria)

90. Head lice resistant after the treatment with permethrin

Give malathion (ovicidal)

91. A 1-month-old with scabies. What is the drug of choice?

Precipitated sulfur 6% in petrolatum