What is the most sensitive indicator of pneumonia in a child?
Answer(s): B
Tachypnea is the most sensitive clinical parameter for diagnosing a lower respiratory tract infection. The child may have tachycardia from a fever or anxiety but, typically, not simply from pneumonia. Coughing is common in children with pneumonia but it is not specific for lower respiratory tract infections, as it can also be seen in upper and lower respiratory tract infections
A 12-month-old male child is brought to your office for a well-child examination and immunizations. You have been following the child since delivery and are aware that he has acquired immune deficiency syndrome (AIDS) and a markedly reduced T-cell count. Which of the following vaccinations should he not receive?
Answer(s): E
All of the vaccines mentioned, except varicella, are killed or synthetic vaccines. Varivax is an attenuated varicella strain (OKA) from Japan. Live virus vaccines are contraindicated in the case of AIDS with a markedly reduced T-cell count. The IPV is the inactivated version of the live polio vaccine, oral polio vaccine (OPV).
While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall.You obtain the following x-rayWhat is your interpretation of the x-ray?
Answer(s): C
The x-ray provided shows a nondisplaced spiral fracture of the distal tibia. This is also known as a toddler's fracture. This fracture can occur when the toddler begins to walk and twists on a planted leg. This torque can result in a spiral fracture of the planted tibia. There usually is no dislocation of the ankle joint and minimal displacement of the fracture. A chip fracture of the metaphysis is a common fracture seen in abused infants and is commonly termed as a "bucket-handle" or "corner" fracture. A buckle fracture is a common accidental fracture seen in falls from a height.
While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall.You obtain the following x-rayWhat is the mechanism that likely resulted in this injury?
Answer(s): A
A 16-year-old sexually active woman is being seen in the emergency department. She is complaining of vaginal discharge. She has a temperature of 99.5°F, but is otherwise well. On pelvic examination, you see a mucopurulent cervical discharge with scant blood. Samples of the discharge are sent to the laboratory for culture. There are no cervical ulcers noted. She does not have any medical allergies.Which of the following is the most common sexually transmitted infection in adolescents?
This young woman has cervicitis, but without evidence of pelvic inflammatory disease (PID). Chlamydia is the most common bacterial cause of sexually transmitted diseases in the United States and the most likely etiology of this patient's infection. Gonorrhea would be the next most likely cause and, frequently, there will be coinfection with the two pathogens. The simplest outpatient treatment for these two would be a single 1- g oral dose of azithromycin and a 125-mg IM dose of ceftriaxone. This regimen will ensure complete compliance, which is crucial. Treatment of her sexual partners would also be recommended. Another cause of cervicitis is trichomoniasis, for which metronidazole, either for 1 week of 500 mg bid or a single 2- g oral dose, would be recommended therapy. Of the suggested answers, option Ais the only one which would cover the two most common infectious agents.
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