Q 1:
A
15-year-old boy from Missouri develops prolonged low-grade fever, cough, chest
pain, and fatigue. Chest radiography reveals hilar adenopathy and scattered
pulmonary infiltrates. Results of a skin test with purified protein derivative
are negative.
Of
the following, the MOST likely diagnosis is:
A. allergic
bronchopulmonary aspergillosis
B. atypical
mycobacterial infection
C. histoplasmosis
D. sporotrichosis
E. tuberculosis
Answer
C
Histoplasmosis
Clinical manifestations may be classified
according to site (pulmonary, extrapulmonary, or disseminated), duration of
infection (acute, chronic), and pattern of infection (primary versus
reactivation). Acute pulmonary histoplasmosis is an influenza-like illness that
is characterized by nonpleuritic chest pain, pulmonary infiltrates, and hilar
adenopathy, as described for the boy in the vignette. Symptoms persist for 2 or
3 days to 2 weeks. Erythema nodosum (Figure 189A) can occur in adolescents, but
erythema nodosum and chronic pulmonary histoplasmosis are uncommon in children.
Primary cutaneous infections can occur after trauma.
Acute disseminated histoplasmosis is most common
in children whose cell-mediated immunity is impaired, including patients who
have human immunodeficiency virus (HIV) infection, solid-organ transplant
recipients, and infants younger than 1 year of age. Features include prolonged
fever, failure to thrive, cough, hepatosplenomegaly, adenopathy, pneumonia,
skin lesions, and pancytopenia. Central nervous system involvement is common. Chronic
disseminated infection is rare. Histoplasmosis may reactivate years after
primary infection in isolated tissues, particularly in the central nervous
system, adrenal glands, and mucocutaneous surfaces, as well as in other sites.
Disseminated or extrapulmonary histoplasmosis is an acquired immunodeficiency
syndrome–defining condition in an HIV-infected person. Histoplasmosis may be
diagnosed by culture, antigen detection in body fluids, or serology. T
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Q 2:
Q 2:
A
12-year-old girl complains of pain in a 3 cm linear distribution along the
course of a vein in the dorsum of her right forearm. She was recently
hospitalized because of cellulitis of her left hand, which was treated with
intravenous nafcillin.
Of
the following, the MOST likely cause for her symptom is:
A. an
allergic reaction
B. ascending
lymphangitis
C. carpal
tunnel syndrome
D. deep
vein thrombosis
E. thrombophlebitis
Answer
E
E
Penicillinase-resistant
penicillins can cause thrombophlebitis and an acute interstitial nephritis.
Intravenous infusion, particularly of nafcillin, has been associated with
thrombophlebitis of the infused vein, which is the most likely diagnosis for
the girl described in the vignette.
---------------
Q 3:
---------------
Q 3:
A
child is being treated with intravenous antibiotics for culture-proven
Staphylococcus aureus osteomyelitis.
Of
the following, the MOST important factor in determining the likelihood of
success of oral antibiotic therapy in the management of this child is:
A. absence
of bacteremia at diagnosis
B. age
of the child
C. location
of osteomyelitis
D. need
for surgical drainage
E. patient
compliance
Answer
E
Answer
E
The
steps in managing patients who have osteomyelitis are to: 1) identify the
location, 2) isolate the organism, 3) select the appropriate antibiotic, 4)
deliver the antibiotic to the bacterial organisms, and 5) prevent further
tissue destruction.
Absence of bacteremia at diagnosis, the age of the child, the location of the osteomyelitis, and the need for surgical drainage are not important factors in determining the likelihood of success of oral antibiotic therapy in culture-proven osteomyelitis.
-----------------
Q 4:
A 5-year-old boy has been ill for 2 days with fever, decreased appetite, and a rash. On physical
examination, you note ulcers on the tongue and soft palate, but the gingivae are
spared. You also see oval vesicles with surrounding erythema on the hands
Of the following, the MOST likely diagnosis is
A. aphthae
B. hand-foot-and-mouth disease
C. herpangina
D. herpetic gingivostomatitis
E. thrush
Answer
B
Hand-foot-and-mouth disease is a distinctive syndrome usually caused by infection with Coxsackievirus A16 or enterovirus 71, although other Coxsackievirus types and echoviruses have been implicated. Hand-foot-and-mouth disease typically occurs during the summer and fall and is characterized by fever, sore throat, and rash. Oral involvement precedes the appearance of skin lesions. Shallow ulcers, measuring 1 to 5 mm, surrounded by a red border, are observed on the soft palate, uvula, tonsillar pillars, and tongue, as described for the boy in the vignette.
Cutaneous lesions are erythematous papules or vesicles that typically are oval and surrounded by a rim of erythema. They are located acrally, involving the palms soles, and digits, particularly the lateral aspects. The thighs and buttocks also may be affected, but the trunk and face generally are spared. Approximately two thirds of patients exhibit this typical presentation, 20% have only oral lesions, and 11% have acral lesions without mucosal involvement. Hand-foot-and-mouth disease generally is a mild illness and is self-limited, resolving in about 1 week.
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Q 5
A mother brings in her child because she found a tick on the girl’s shoulder yesterday and is
worried about Lyme disease. The mother found a site on the Internet that suggests her daughter
needs an antibiotic called ceftriaxone. You assure the mother that only very few children who
suffer tick bites actually develop a tick-associated disease.
Of the following, the manifestation of Lyme disease for which ceftriaxone administration is MOST
appropriate is
A. acute arthritis
B. carditis
C. disseminated erythema migrans
D. isolated facial palsy
E. peripheral neuropathy
Q 5
A mother brings in her child because she found a tick on the girl’s shoulder yesterday and is
worried about Lyme disease. The mother found a site on the Internet that suggests her daughter
needs an antibiotic called ceftriaxone. You assure the mother that only very few children who
suffer tick bites actually develop a tick-associated disease.
Of the following, the manifestation of Lyme disease for which ceftriaxone administration is MOST
appropriate is
A. acute arthritis
B. carditis
C. disseminated erythema migrans
D. isolated facial palsy
E. peripheral neuropathy
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