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A2-year-old girl has severe dental caries of the upper and lower incisors. Her teeth are brushed twice daily with a small amount of fluoride-containing toothpaste. What is the feeding practice most likely to result in this pattern of dental caries?

  1. drinking juice from a cup at snack time
  2. drinking juice from a bottle at snack time
  3. drinking milk from a bottle at meal time
  4. prolonged breast-feeding beyond the first year
  5. drinking a bottle of juice in bed

Answer(s): E

Explanation:

Organic acids produced by bacterial fermentation lower the pH of dental plaque causing demineralization and caries of the adjacent tooth. Nursing bottle caries is a pattern of caries involving the upper and lower incisors. It occurs because of prolonged contact of the tooth to a sugar-containing liquid (juice or milk). This is more likely to occur with overnight exposure or with use of a bottle. Asimilar pattern of caries may rarely occur with breast-fed babies who feed through the night. Cup feeding or drinks given during mealtimes are less likely to cause prolonged contact to the teeth.



An 8-year-old African American boy is brought in for evaluation of a mass on the scalp. On examination, he is afebrile and nontoxic. There is a boggy mass on his scalp with alopecia. His posterior cervical lymph nodes are enlarged but nontender. Which of the following is the most appropriate treatment?

  1. incision and drainage
  2. oral amoxicillin
  3. IV naficillin
  4. selenium sulfide shampoo twice a week
  5. oral griseofulvin and selenium sulfide shampoo twice weekly

Answer(s): E

Explanation:

A tender, boggy mass on the scalp is most likely to be a kerion. This is an inflammatory form of tinea capitis. Tinea capitis is more common in African American children and is the most common cause of alopecia in children. In the United States, a majority of cases are caused by Trichophyton tonsurans; Microsporum canis may also be involved. Tinea capitis may present with diffuse scaling, a black dot form, and as the inflammatory form--kerion. The recommended treatment is 812 weeks of oral griseofulvin.
Shampooing with selenium sulfide shampoo is a helpful adjunctive therapy which decreases spore shedding. Topical therapy alone is ineffective. Incision and drainage or antibiotic therapy are not recommended in treatment of tinea capitis.



A 4-year-old child presents to your office in July with a history of a low-grade fever (38.1°C) and "s ores" in his mouth for 2 days. He has been refusing to eat but has been drinking an adequate amount of liquids. On examination, he is afebrile and seems well hydrated. He has ulcers on his tongue and posterior pharynx, which are 4 mm in diameter. You also note a few vesicles on his hands and feet, which are 34 mm in size and mildly tender.
Which of the following is the most likely diagnosis?

  1. herpes simplex virus (HSV)
  2. coxsackie virus
  3. aphthous ulcers
  4. Behçet syndrome
  5. traumatic ulcers

Answer(s): B

Explanation:

Coxsackie A16 is the major cause of hand, foot, and mouth disease. This is a summer enteroviral illness presenting with classic lesions of the hand, feet, and mouth. Herpetic gingivostomatitis is the most common cause of stomatitis in children aged 13 years. There is often a high fever, fetor oris, refusal to eat, and irritability. The lesions are initially vesicular, and soon form ulcers ranging from 2 to 10 mm in diameter. The tongue, cheek, and gums are usually involved, and there may be submaxillary lymphadenitis. Aphthous ulcerations (canker sores) are painful ulcerations, which present as erythematous, indurated papules that erode to form circumscribed necrotic ulcers with gray fibrinous exudates and erythematous halo. They are 210 mm in diameter, heal spontaneously, and often recur. Behçet syndrome is a multisystem disorder characterized by recurrent oral and genital ulceration, iritis or uveitis, as well as other cutaneous, arthritic, neurologic, vascular, and gastrointestinal (GI) manifestations. It is rare in children. Traumatic oral ulcers may be seen in chronic cheek biters but do not involve extremities.



A10-year-old boy comes to the office with fever and chills for 5 days and myalgia. He has recently returned from a 2-week vacation to New England with his family. On physical examination he has mild splenomegaly. Which of the following is the most likely cause of his symptoms?

  1. Kawasaki disease
  2. pneumococcus
  3. babesiosis
  4. leptospirosis
  5. psittacosis

Answer(s): C

Explanation:

Kawasaki disease is an acute vasculitis of unknown etiology. Humans contract brucellosis by direct contact with infected animals or by drinking unpasteurized milk. Babesiosis is transmitted by ticks. Leptospirosis is obtained from exposure to the urine of infected animals. Psittacosis is obtained from exposure to bird feces.






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