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An 8-year-old girl is brought by her mother who states the child has had a mild fever of 99.9°F and has been lethargic for the past few days and has now developed a rash. She has not received her childhood vaccinations. The rash began yesterday on her trunk and has spread to her extremities. The patient states it is really itchy in spots. Physical exam reveals a diffuse maculopapular rash, intermixed with vesicles and ruptured vesicles that have crusted over. Which of the following is the most likely causative pathogen?
A. Coxsackie virus
B. Group A Streptococcus
C. Rubeola virus
D. Varicella zoster virus
D!
A 2-year-old boy is brought in by his mother with a rash that appeared one day ago. The rash began on his abdomen but has now spread over his entire body. Five days ago, the patient had a high fever. An image is attached of the maculopapular, blanching rash. He also has mild rhinorrhea. His physical examination is otherwise negative. Which of the following is the most likely based on this patient's history and physical exam findings?
A. Fifth Disease
B. Hand-Foot-Mouth Disease
C. Roseola Infantum
D. Rubeola
C!
Follow up question: which of the following pathogen is causing this 2-year-old’s illness?
A. Coxsackie A16 virus
B. Human herpes virus type 6
C. Parvovirus B19
D. Rubella virus
B!
A 6-year-old girl is brought to the emergency department by her parents because she has had severe swelling of her right cheek for the past day. She was evaluated by her pediatrician three days ago because of fever, headache, and anorexia, and a nonspecific viral illness was diagnosed. Physical examination shows a very tender right parotid gland with swelling severe enough to obscure the angle of the mandible. Which of the following viral illnesses is most commonly associated with this disorder?
A. Varicella Zoster Virus
B. Coxsackie Virus
C. Rubeola
D. Mumps
D!
What pathogen is responsible for mumps infection?
A. Adenovirus
B. Parainfluenza virus
C. Paramyxovirus
D. Togavirus
C!
A 4-year-old girl who has recently immigrated to the United States is brought to the ED by her mother. The child has not been immunized and has been sick for seven days. The patient's mother states that she has had a cough, congestion, and red, crusty eyes in the mornings. Temperature is 40.0°C (104°F), pulse rate is 85/min, respirations are 17/min, and blood pressure is 130/80 mmHg. Physical examination reveals mild rhinorrhea. Both of the patient's eyes are mildly injected with scant, clear discharge present. Image of the oropharynx is attached. She also has a fine, erythematous maculopapular rash on the trunk and upper extremities. Which of the following is the most likely based on the patient's symptoms, history, and physical exam findings?
A. Erythema infectiosum
B. Roseola infantum
C. Rubella
D. Rubeola
C! Kocklick spots (?)
A patient presents to the emergency department requesting a rabies vaccine. He states several hours earlier he was bitten on the arm by a rat while cleaning out his garage. Which of the following is the best step in management?
A. Administer rabies vaccine and inject immunoglobulin to the bite site
B. Administer rabies vaccine
C. Antiviral medication
D. Local Wound care + education
D! (rats don’t carry rabies)
Which of the following statements regarding influenza is true?
A. Influenza A is more virulent than influenza B
B. Symptoms typically have gradual onset
C. The diagnosis must be confirmed with laboratory findings during outbreaks
D. The influenza vaccine is contraindicated in pregnancy
A!
A. A 24 year old female 2 months postpartum
B. A 3 year old male with no past medical problems and symptoms for 36 hours
C. A 55 year old female with no other medical problems and three days of symptoms
D. A 72 year old male with diabetes and symptoms for 24 hours
D!
A 33-year-old male with a history of HIV presents to the emergency department with a fever and generalized weakness. He is not compliant with his medications and his last CD4 count was less than 50 cells/µL. Laboratory analysis is significant for pancytopenia. What is the most likely etiology of this patient’s presentation?
A. Cryptosporidium
B. Mycobacterium avium complex
C. Pneumocystis jirovecii (pneumocystis pneumonia)
D. Toxoplasma gondii
B!
A 50 year old man presents to the ER with a fever and headache for the past two days. Vital signs are T 102.4F, HR 122, BP 90/55 mmHg, RR 20, and O2 sat of 96% RA. Initial laboratory testing shows a WBC of 11,400. How many systemic inflammatory response criteria does this patient have?
A. 1
B. 2
C. 3
D. 4
B!
A 67-year-old woman is brought to the emergency department by her family because she has had fever, chills, dysuria, and flank pain for the past three days. Temperature is 39.0°C (102.2°F), heart rate is 133/min, respirations are 22/min, and blood pressure is 88/64 mmHg. Oxygen saturation is 93%. Results of laboratory studies are pending. Which of the following next steps is associated with the greatest mortality benefit in this patient?
A. Early initiation of antibiotics
B. Intravenous hydrocortisone therapy
C. Rapid fluid resuscitation with at least 30 ml/kg of crystalloids
D. Vasopressor support to maintain a mean arterial pressure (MAP) of 65mmHg
A!
