An 8-year-old boy presents with a cut with swelling on his arm. His physical exam also shows swollen lymph nodes. His mother tells you that he was most likely scratched by their neighbours cat.
Which of the following organisms is most likely involved?
Correct Answer D:
Cat-scratch disease is infection caused by Bartonella henselae. Symptoms are a local papule and regional lymphadenitis. Within 3 to 10 days after a scratch, most patients develop an erythematous, crusted papule (rarely, a pustule) at the scratch site. Regional lymphadenopathy develops within 2 weeks. The nodes are initially firm and tender, later becoming fluctuant, and may drain with fistula formation. Fever, malaise, headache, and anorexia may accompany lymphadenopathy.
Treatment is local heat application and analgesics. If a lymph node is fluctuant, needle aspiration usually relieves the pain. Antibiotic treatment is not clearly beneficial and generally should not be given for localized infection.
The most common cause of apnea in infants less than 6 months is:
Correct Answer E:
The most common cause of apnea in infants is gastroesophageal reflux (GER) which is caused by immaturity of the muscle at the base of the esophagus which controls food passage into the stomach. If this muscle functions improperly, food or formula may reflux back into and up the esophagus into the back of the pharynx. This may trigger a reflex in infants which results in apnea.
A mother meets you in the emergency department with her 3-week-old infant. The infant was delivered at term, with an uneventful prenatal and postnatal course to this point. The mother reports that the infant stopped breathing for 20-25 seconds, and that his lips and tongue appeared bluish. There was no coughing, choking, or congestion, but the child seemed “limp.” The episode ended when the mother vigorously stimulated her child and he started crying. On examination, the child appears normal.
Which one of the following would be most appropriate in this situation?
Correct Answer C:
Some experts recommend inpatient observation for all children with apparent lifethreatening events such as this. It is generally advised, however, that for a short, self correcting episode associated with feeding, hospital admission is not always necessary. Otherwise, the child should be admitted for observation and evaluation.
→ If the infant is truly afebrile and appears well, laboratory results are likely to be within the reference ranges.
→ Many groups recommend home apnea monitoring after discharge for those with more severe or un-diagnosed cases.
→ Although child abuse is a concern, referral to child protective services is not mandatory.
→ Laryngoscopy would not be routine, but might be appropriate depending on the history and physical examination.
Which of the following is not a cause of apnea in infants?
Metabolic disturbances are frequent causes of apnea in preterm and term infants. However, hypoglycemia, NOT hyperglycemia, may preset as apnea in the newborn.
A. Sepsis in a newborn may frequently present as new onset apnea or as an increase in apneic events in preterm infants. It may be the only symptom.
B. Apnea of prematurity is a diagnosis of exclusion in preterm infants <37 weeks gestation who present with apnea after birth. It is centrally mediated and metabolic, infectious, and structural anomalies need to be excluded.
D. Severe hypoxemia in utero or during delivery may result in central apnea, secondary to neurologic damage.
E. Intraventricular hemorrhage may cause apnea in preterm and term infants. It may be associated with a decreasing hematocrit. Head ultrasound will reveal the hemorrhage.
Which of the following genetic diseases is incorrectly linked with its transmission pattern?
Hemophilia A (factor VIII deficiency), which affects about 80% of hemophilic patients, and hemophilia B (factor IX deficiency) have identical clinical manifestations, screening test abnormalities, and X-linked recessive genetic transmission.
Click to expand