Pediatric Infectious Diseases Pre-Test

1. The cephalosporin that is metabolized through the liver in appreciable amounts is

  1. Cefazolin
  2. Cefuroxime
  3. Cefotaxime
  4. Ceftriaxone

E.Ceftazidime

2. Of the following, the most likely to cause diarrhea is

  1. Rhinovirus
  2. HSV
  3. Enterovirus
  4. Astrovirus
  5. Parvovirus B19

3. Of the following causes of bacterial meningitis, which has the highest complication rate?

A. Haemophilus influenzae type b

B. Neisseria meningitidis type y

C. Streptococcus pneumoniae

D. Moraxella catarrhalis

E. Neisseria meningitidis type a

4. A child has acute otitis media and conjunctivitis. Of the following, the best choice of oral antibiotic is

  1. Cefuroxime axetil
  2. Ciprofloxacin
  3. Amoxicillin
  4. Cephalexin
  5. Erythromycin

5. A 5 month old boy is admitted to the hospital with 7 days of fever (daily to 39C), a truncal blanching erythematous rash, and conjunctivitis, but no adenopathy, oral mucous membrane changes or extremity changes. Which lab studies should be done to evaluate for “incomplete” Kawasaki disease?

  1. AST/ALT, albumin, creatinine, urinalysis
  2. AST/ALT, albumin, CBC, urinalysis
  3. AST/ALT, alk Phos, creatinine, urinalysis
  4. AST/ALT, CBC, creatinine, urinalysis
  5. CBC, albumin, creatinine, alk Phos

6. You are called from a family practitioner from Ft.Bragg. He wants to transfer a 4-year old boy with fever, HA, stiff neck and a petechial rash on the lower extremities. You accept the patient and suggest that he begin antibiotic therapy. The best choice would be

  1. Oxacillin and clindamycin
  2. Ceftriaxone and vancomycin
  3. Ceftriaxone and doxycycline
  4. Vancomycin and ceftazidime
  5. Ampicillin, gentamicin and metronidazole

7. A 13-month old child is admitted with dehydration from Rotavirus, however you discover that the child has had diarrhea since age 6 months, with failure-to-thrive. You suspect CF and order a sweat test. The lab calls to tell you that insufficient sweat was collected. What do you do next?

  1. Reorder the sweat test with the child adequately hydrated.
  2. Cross CF off the list: all children with CF sweat a lot.
  3. Ask the lab to re-sweat using a smaller electrode; smaller arms require smaller equipment
  4. Order a sweat tests on the mother: if she is a carrier her test will be abnormal

8. The most common arboviral encephalitis in children in the USA is

A. West Nile Fever

B. LaCrosse Virus

C. Eastern Equine Encephalitis

D. St. Louis Encephalitis

E. Western Equine Encephalitis

9. A 23 y/o housekeeper is found in the kitchen seizing, left-sided clonic activity greater than on the right side. She emigrated from Central America 3 years ago. She has a negative family history and has been previously well. The most likely cause of her seizures is

A. Toxoplasmosis

B. Cryptococcus

C. Tuberculosis

D. Angiostrongyliasis

E. Cysticercosis

10. A patient’s mother has read about CF and wonders if she could be a carrier. How common is the carrier rate in the general U.S. population?

  1. 1 in 50-75
  2. 1 in 1000
  3. 1 in 3500
  4. 1 in 16-20
  5. 1 in 200

11. A 12 month old child has vomited twice and had 8 watery diarrhea stools since last evening. You are concerned about dehydration. What do you do next?

  1. Obtain a stool specimen for bacterial culture; observe the child drinking 8 oz. apple juice; check urine specific gravity
  2. Weigh the child; examine mucous membranes, skin, anterior fontanel for fluid status; administer IV fluids if >10 % dehydrated
  3. Obtain stool specimen for Rotazyme; place an nasogastic tube for administration of oral rehydration solution (ORS); consider lumbar puncture if still vomiting
  4. Count the number of wet diapers in the last 24 hours; observe the child drinking 10 cc/ kg water; obtain an abdominal x-ray

12. A patient had hives and wheezing when given ampicillin. Of the following, the safest drug that could be used in the future is

  1. Pipericillin/tazobactam
  2. Imipenem-cilastin
  3. Cefaclor
  4. Ceftazidime
  5. Aztreonam

13a. A man and his wife recently returned from a cruise in the Caribbean. He has a mild headache, but hers is much more significant and is accompanied by a stiff neck. An LP is done on the wife with the following findings: WBC 234 (24% pmn 17 lymph 59 eos) Prot 87 Glu 53 RBC 9. The most likely cause is:

A. Arboviral meningitis

B. Neisseria meningitidis

  1. Dengue fever
  2. Angiostrongyliasis
  3. Cysticercosis

13b. The causative organism was probably acquired from

  1. Mosquitos
  2. Cercariae found in sea water
  3. Contact with a colonized person
  4. Shellfish
  5. Eating milk-based sauces on foods from a buffet

14.A fussy, febrile 10 month old female is admitted to r/o meningitis. A lumbar puncture is performed, CSF sent to the lab and the patient is started on Ceftriaxone. As part of your orders you order isolation precautions. The most appropriate orders are:

  1. Airborne precautions until RSV and flu are ruled out
  2. Droplet and Contact precautions until discharged
  3. Universal precautions
  4. Contact precautions until all cultures are negative
  5. Droplet precautions x 24 hours

15. Of the following, the most likely to cause a hoarse voice:

  1. Rotavirus
  2. Parainfluenzavirus
  3. Measles
  4. RSV
  5. Coronavirus

16. In the month of April, a 4 month old infant was hospitalized for 2 weeks for a staged procedure to correct Tetrology of Fallot. Her surgery went well and she was discharged two days ago. The mother calls the clinic to report that the infant vomited 4 times through the night, and this morning had 6 watery, non bloody diarrhea stools. The most likely etiology of the gastroenteritis is:

  1. Clostridium difficile (Pseudomembranous colitis)
  2. Calicivirus (Norwalk-like agent)
  3. Rotavirus
  4. Salmonella typhimurium
  5. Astrovirus

17a. A 3 y/o boy comes to clinic for a pre-school physical. He has a normal exam and negative review of systems. A PPD is required for day care attendance. The nurse tells you that the PPD is “positive”. Which of the following would require the child to take preventive therapy (INH for 9 months)

A. Erythema 12 mm, induration 3 mm within 1 hour of placement

  1. Erythema 3 mm, induration 3 mm read at 48-72 hrs
  2. Erythema 19 mm, induration 9 mm read at 48-72 hrs
  3. Erythema 11 mm, induration 11 mm read at 48-72 hrs
  4. None of the above

17b. Same scenario, but child is 9 y/o?

  1. Erythema 12 mm, induration 3 mm within 1 hour of placement
  2. Erythema 3 mm, induration 3 mm read at 48-72 hrs
  3. Erythema 19 mm, induration 9 mm read at 48-72 hrs
  4. Erythema 11 mm, induration 11 mm read at 48-72 hrs
  5. None of the above

17c If the child acquired TB from a source with a high likelihood of INH resistance, the recommended therapy is

  1. INH 10-15 mg/kg/d
  2. Rifampin + Ethambutol
  3. INH + Rifampin
  4. Rifampin + PZA
  5. INH + PZA

  1. A 20-month old child from Northern Virginia is seen in a walk in clinic due to fever. There is a no focus on exam. BC and UC are sent, and CBC shows 16.3> 10.9/32.0< 454k.

Diff: 23 P, 32 L, 37 eos, 8 M

Two days later, the child is afebrile and well. Repeat CBC shows

14.7> 11.0/33.0< 356k. Diff: 17 P, 42 L, 39 eos, 2 M

What test would be most useful for diagnosis?

  1. Stool O&P
  2. IgE level.
  3. Allergy skin test panel (molds, environmentals).
  4. Toxocara titers.
  5. CT chest/abdomen.

19. An 18 month old child comes to the ED with fever, stiff neck and irritability. The CSF appears cloudy. Optimal antibiotic therapy at this time is

  1. ampicillin and gentamicin
  2. ceftriaxone and vancomycin
  3. cefotaxime and oxacillin
  4. ceftriaxone and rifampin
  5. ceftriaxone

20. A 3 year old male has abdominal cramps and bloody diarrhea. Shigella flexneri is isolated on stool culture. The most likely mode of transmission occurred from:

  1. Day care attendance
  2. Pet iguana
  3. Well water
  4. Eating undercooked chicken

21. A patient presents with pharyngitis and cervical lymphadenopathy. Of the following causes, the one for which there is no specific antiviral therapy:

  1. Influenza A
  2. HSV
  3. EBV
  4. CMV
  5. HIV

22. The recommended primary prevention of Acute Rheumatic Fever is:

A. 10 days treatment with Trimethoprim-Sulfamethoxazole or Penicillin V

B. Penicillin, NSAIDS, and steroids for severe symptoms

C. Penicillin V orally for 10 days

D. Clindamycin plus a beta-lactam antibiotic for 10 days

E. Penicillin G 1.2 million U IM q 3-4 weeks

23. The Jones Criteria for diagnosis of Rheumatic Fever

A. Include serositis as a major criterion

B. Require 1 Major or 2 Minor criteria for diagnosis

C. Heart-related Major Criteria include acute valvulitis or abnormal ECG (prolonged PR interval)

D. Minor criteria include elevated ESR or CRP, leukocytosis, arthralgia and fever.

E. Define the need for lifelong prophylaxis.

24. The most likely/frequent evidence of strep infection in a patient with ARF is

A. Anti-Hyaluronidase

B. Positive Rapid strep

C. Positive Urine antigen for strep

D. Anti- Streptolysin O

E. Positive throat culture for Gp A strep

1