A 10-year-old boy comes to your office in the winter with a sore throat he has had for 2 days. In addition, he has had fever, headache, and abdominal pain. He does not have any allergies to medications. On examination, he has a temperature of 38.6°C, an ery thematous pharynx, and tender cervical adenopathy. Arapid screening test for group Astreptococcus is performed and is positive. Which of the following would be the most appropriate antimicrobial agent?
Answer(s): B
Penicillin remains the drug of choice for treatment of streptococcal pharyngitis. Amoxicillin, macrolides, and cephalosporins are acceptable alternatives.
A 10-year-old boy comes to your office in the winter with a sore throat he has had for 2 days. In addition, he has had fever, headache, and abdominal pain. He does not have any allergies to medications. On examination, he has a temperature of 38.6°C, an ery thematous pharynx, and tender cervical adenopathy. Arapid screening test for group Astreptococcus is performed and is positive. Which of the following would be the most appropriate antimicrobial agent?The same child returns to your office the next day. He has taken the medication you prescribed. He is feeling a little better. His fever has resolved, but he has developed a rash. His examination is unchanged, except that he is afebrile and has a fine, papular rash over his body, which is accentuated in his axilla and groin.Which of the following is the most likely cause of his rash?
Answer(s): C
Scarlet fever is caused by toxins made by group A Streptococci. It is usually seen in patients with strep throat. The rash is popular and described as sandpaper like. Sometimes it is easier to feel it than to see it.An allergic rash would be urticarial. More than 80% of patients with EBV infection develop a maculopapular rash if given amoxicillin. This patient's clinical course is not typical for EBV which presents more gradually, and patients often have posterior cervical adenopathy and splenomegaly. Patients with serum sickness often have urticarial rashes, sometimes progressing to angioedema. They may also have arthritis, myalgias, and lymphadenopathy. The rash in enteroviral infections is typically macular.
An 8-year-old girl presents for a checkup. She is new to your practice. The mother states that she has always been small for her age; otherwise, she has been well. She is short and has a height age of 4 years, 4 months. You note some abnormalities in her general appearance as shown in the figure.Which of the following is the most likely diagnosis?
Answer(s): D
Patients with Turner syndrome have a 45,X karyotype. The classic physical features are illustrated in this case. Patients have short stature, a webbed neck, ptosis, triangular faces, prominent brow, hypertelorism, low-set ears, and pectus excavatum
A 12-year-old boy comes to the clinic for a sports physical. He is new to your practice. He comes with his foster mother, who states that he was recently placed in her care because of his mother's problems with drug abuse. Although a complete medical history is not available, she knows that he has not received regular care. He does not have any chronic medical problems. She also knows that his father died of heart disease when he was 35. On physical examination, the boy's height is greater than the 95th percentile. His arm span exceeds his height.Which of the following is the most likely cause of his tall stature?
Marfan syndrome is a genetic disorder of connective tissue. It is transmitted in an autosomal dominant manner. Patients have tall stature and skeletal disproportion, where the arm span exceeds the height.Other important clinical features include subluxation of the ocular lens which occurs in 5080% of patients.Progressive dilatation of the aortic root and ascending aorta can lead to dissection or rupture.
A 12-year-old boy comes to the clinic for a sports physical. He is new to your practice. He comes with his foster mother, who states that he was recently placed in her care because of his mother's problems with drug abuse. Although a complete medical history is not available, she knows that he has not received regular care. He does not have any chronic medical problems. She also knows that his father died of heart disease when he was 35. On physical examination, the boy's height is greater than the 95th percentile. His arm span exceeds his height.As you continue your physical examination, you remember that congenital heart disease is common in this particular syndrome. Which of the following is the most likely congenital heart defect in patients with this syndrome?
Answer(s): E
Marfan syndrome is associated with mitralvalve prolapse and aortic root dilatation.
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