Pediatric Examination and Board Review (168 page)

(E) measure HAV-specific total and IgM antibody

3.
How long should the employee be excluded from the day-care center in relation to the onset of the illness?

(A) 1 week

(B) 2 weeks

(C) 3 weeks

(D) 4 weeks

(E) 6 weeks

4.
A 3-year-old child sustains a puncture to the right hand after a bite from Flopsy, her pet cat. Within 24 hours the hand is swollen, erythematous, and tender. There is scant serous discharge at the site of the wound. The most likely etiology is

(A)
Staphylococcus aureus
(B)
Francisella tularensis
(C)
Bartonella henselae
(D) chikungunya virus

(E)
Pasteurella multocida

5.
A 9-year-old girl who has gone hiking in the woods with her father is found to have a tick attached to her neck. A number of tick-borne diseases can occur after a tick bite. These would include all of the following except

(A) Lyme disease

(B) tularemia

(C) ehrlichiosis

(D) leptospirosis

(E) Rocky Mountain spotted fever

6.
In a child-care setting, the use of prophylactic antibiotics would be most appropriate for child-care contacts of

(A) a child who has streptococcal toxic shock syndrome

(B) an infant who has pertussis

(C) an infant who has influenza A

(D) a child who has invasive
Streptococcus pneumoniae
disease

(E) a child who has shigella infection

7.
An outbreak of diarrhea has occurred in a day-care center. Important infection control measures in the setting include all but

(A) written procedures for handwashing

(B) diaper-changing areas should not be located near food preparation areas

(C) exclusion of children with diarrhea or stools that contain blood or mucus

(D) removal of all toys from rooms where children eat and play

(E) diaper-changing procedures should be posted at the changing area

8.
The mother of a 3-year-old girl with HIV infection is considering enrolling her child in a nearby daycare center. You inform her that

(A) the child should not be placed in the day-care center because of the potential risk of transmission to others

(B) the child care providers at the day-care center will need to be informed of the child’s HIV status

(C) the child should not attend the day-care center because of the risk of exposure to varicella

(D) the day-care providers should use standard precautions for handling spills of blood and blood-containing body fluids

(E) routine screening of children in day care for HIV is recommended

9.
The mother of a 14-year-old adolescent boy calls you to inform you a 16-year-old girl at her son’s high school died of meningitis. The mother’s son is a close friend of the girl’s boyfriend. You had just heard the same day from one of your colleagues about an adolescent girl who died of meningococcal meningitis. You tell the mother that her son should

(A) have a throat specimen sent for
Neisseria meningitidis
culture

(B) receive a single dose of ceftriaxone

(C) receive a single dose of ciprofloxacin

(D) be excluded from school for the next 7 days

(E) be observed closely for a febrile illness

10.
An 18-month-old boy who attends day care has diarrhea, fever, vomiting, and hematochezia. A stool culture sent grows
Salmonella
, serotype Newport. Methods recommended to limit the spread of this organism include

(A) stool cultures for all attendees and staff members

(B) frequent handwashing measures with staff training

(C) exclusion of asymptomatic children shedding
Salmonella
in the stool

(D) antibiotic therapy for all exposed children in the day care with diarrhea

(E) antibiotic therapy for the child with proven Salmonella infection

11.
A 3-year-old girl who attends child care develops fever, abdominal cramps, and mucoid stools with blood. A stool culture grows
Shigella sonnei
. Correct management would include

(A) stool cultures on all child-care attendees of the child-care facility

(B) administration of an antidiarrheal compound to shorten the duration of diarrhea

(C) treatment of children with mild symptoms with an antibiotic to prevent spread

(D) exclusion of the 3-year-old child from child care for 5 days after the onset of diarrhea

(E) stool cultures on all staff members of the child-care facility

12.
There are 3 neonates in a newborn intensive care unit (NICU) who are diagnosed with respiratory syncytial virus (RSV) infection in a span of 2 days. All of the following are important methods of preventing the further spread of RSV except

(A) cohorting infected infants

(B) excluding staff with respiratory illness from the NICU

(C) respiratory isolation of all infants positive for RSV

(D) laboratory screening of all infants in the NICU for RSV

(E) contact isolation of all infants positive for RSV

13.
A 13-year-old boy has a 2-week history of fever, cough productive of sputum, night sweats, and fatigue. A chest radiograph performed shows a right lower lobe infiltrate, and a Mantoux test is placed. The test shows a 16 mm zone of induration. Methods to prevent spread of tuberculosis in this patient in the hospital setting include

(A) droplet precautions

(B) using a mask within 3 feet of the patient

(C) providing the patient with a private room using negative air-pressure ventilation

(D) wearing a gown and gloves at each patient encounter

(E) using hand hygiene before using gloves and after glove removal

14.
A mother of one of your 13-year-old adolescent female patients calls you because she suspects one of her daughter’s classmates may have HIV infection. You counsel her that

(A) HIV is acquired through contact with tears

(B) HIV in a school-age child must be reported to school personnel

(C) the HIV status of a school-age child may only be known by the child’s parents, other guardians, and the physician

(D) HIV infection in adolescents is primarily acquired perinatally from mothers with HIV infection

(E) HIV in adolescents is acquired primarily by blood transfusion

15.
A 12-year-old boy from China with normal growth and development is known to have hepatitis B infection: hepatitis B surface antigen positive, antibody to hepatitis B core antigen positive, and antibody to hepatitis B surface antigen negative. A mother of one of your patients who is in the same classroom is concerned because her son has only received one dose of hepatitis B vaccine 1 year ago. You recommend that her child

(A) begin the 3-dose series of hepatitis B vaccine again immediately

(B) complete the 3-dose series of hepatitis B vaccine with 2 more doses

(C) receive hepatitis B immune globulin and hepatitis B vaccine

(D) have blood drawn for hepatitis B serology and be given hepatitis B vaccine, if seronegative

(E) be transferred to a different classroom in the same school

16.
A pediatric resident sustains a needlestick injury while starting a peripheral intravenous line on a 3-year-old child. The resident is concerned about possible HIV infection. You counsel the resident that

(A) postexposure prophylaxis with antiretroviral agents is recommended if the exposure occurred within 96 hours

(B) solid needles carry the highest risk of transmission of HIV

(C) antiretroviral agents should be strongly considered with a needlestick injury from an unknown occupational source

(D) HIV and HBV are the only viruses that can be transmitted by needlestick injury

(E) the transmission risk from a single percutaneous needlestick involving HIV-contaminated blood is approximately 0.3%

17.
A 15-year-old adolescent girl is diagnosed with meningococcemia. She has a 4-year-old brother and an 11-month-old sister at home. Appropriate management of her siblings includes

(A) nasopharyngeal cultures for
N meningitidis
(B) meningococcal quadrivalent vaccine

(C) single dose of azithromycin to both children

(D) rifampin given every 12 hours for 2 days

(E) close observation for a febrile illness

18.
A 2-year-old child living in a residential institution for developmentally disabled children should receive all of the following vaccinations for prevention of infection except

(A) pneumococcal conjugate vaccine

(B) hepatitis A vaccine

(C) hepatitis B vaccine

(D) meningococcal conjugate vaccine

(E) varicella vaccine

ANSWERS

1.
(A)
This child most likely has acute hepatitis A infection. Salmonella, shigella, and campylobacter most often have associated diarrhea. Giardia can present in a similar way to hepatitis A, but the patient seldom appears ill or has a fever. Diagnosis is confirmed by measuring immunoglobulin (Ig) M antibodies to hepatitis A. This antibody usually disappears within 4 months but can persist longer. The serum IgM anti-HAV antibody is usually present at the onset of clinical illness.

2.
(D)
Immune globulin (IG) is indicated if the exposure has been within the previous 2 weeks for children younger than 12 months. In this clinical situation, hepatitis A vaccine alone should be administered to the child. Hepatitis A vaccine has been shown to be as effective as IG for postexposure prophylaxis in the age groups 12 months to 40 years.

3.
(A)
Children and adults with acute hepatitis A infection who attend or work in child-care settings should be excluded for 1 week after onset of illness.

4.
(E)
This child has a wound infection occurring within 24 hours of a bite. The description is typical of an infection caused by
Pasteurella multocida
. Transmission occurs most commonly from the bite or scratch of a cat or dog. Infection can also occur after bite injuries from lions, tigers, rats, and rabbits.
Francisella, Bartonella
, and chikungunya virus do not cause acute cellulitis like this.
S aureus
is possible but much less common.

5.
(D)
Leptospirosis is caused by spirochetes of the genus
Leptospira
(see
Figure 96-1
). Humans become infected through contact of mucosal surfaces or abraded skin with contaminated soil, water, or animal tissues. In the United States, dogs and farm animals are important reservoirs in addition to rats.