Children under 1 year of age should not be given honey because of possible contamination with which one of the following?
Correct Answer B:
The most common cause of infant botulism is ingestion of Clostridium botulinum spores in honey.
A pediatrician's office gets a phone call from a frantic mother. Her 6-year-old daughter was playing under the sink and accidentally spilled a drain cleaner all over her arms and legs. The nurse on the phone can hear the girl screaming in the background.
Which of the following are the most appropriate instructions to give the mother?
By far the most important thing that can be done for caustic chemical burns is to wash away the caustic agent as soon as possible, and the best way to do that is with massive irrigation. Any answer that allows the chemical agent to stay in touch with the skin, whether mixed with antibiotic ointment, wrapped in bandages, or with no specific additional instructions will result in continued burning for the time that it will take to get to the emergency department or physicians' office.
A 10-year-old female presents with a mildly itchy rash of 10 days’ duration. She had streptococcal pharyngitis 2 weeks ago. A red, papular rash with scaling is present on the trunk and proximal extremities. The lesions are 5-10 mm in diameter.
This presentation is most consistent with:
Guttate psoriasis occurs predominantly in children and is characterized by a distinctive, acute eruption of small, drop like, 1-10 mm in diameter, salmon-pink papules, usually with a fine scale on the trunk and proximal extremities. The onset frequently follows a streptococcal respiratory infection.
→ Scarlet fever (choice A) usually accompanies streptococcal pharyngitis and the rash is red, punctate, and often felt more readily than seen.
→ Atopic dermatitis (choice C) is characterized by chronic dry skin which is pruritic.
→ Scabies (choice D) is not related to streptococcal infection and is a papular, itchy rash seen on the finger webs, axillae, belt line, and genital areas.
→ Erythema marginatum (choice E) is a manifestation of rheumatic fever and is a nonspecific macular lesion of the trunk with central blanching that appears serpiginous.
In a day-care center for which you are the medical consultant, two children develop systemic Haemophilus influenzae type b infections within the same month.
You recommend prophylaxis with which one of the following for all children and staff in the classroom?
Correct Answer E:
Whereas many antibiotics temporarily suppress nasopharyngeal colonization by Haemophilus influenzae type b, only rifampin is effective in eradicating the organism. It should therefore be administered to all attendees and staff of a day-care facility in which two or more children have been diagnosed with disease caused by H. influenzae, regardless of previous immunization status. The patients should also receive rifampin before returning to the center. Prophylaxis after a single case is controversial.
Nontypeable Haemophilus influenzae is frequently responsible for:
Correct Answer A:
Nontypeable (une-ncapsulated strains) Haemophilus influenzae is a significant pathogen in children, causing otitis media, sinusitis, conjunctivitis, pneumonia, and occasionally invasive infections. H. influenzae type b conjugate vaccines have no effect on infections caused by non-typeable strains because non-typeable strains are nonencapsulated. Approximately, one-third of episodes of otitis media are caused by non-typeable H. influenzae, which is the most common cause of recurrent otitis media.
Epiglottitis is classically associated with Haemophilus influenzae type b (Hib) infection.
→ Bacterial meningitis in college students is typically caused by Neisseria meningitides.
→ The most common bacterial causes of cellulitis include: Group A beta-hemolytic streptococcus, Streptococcus pneumoniae, Staphylococcus aureus, and Methicillin-resistant staphylococcus aureus (MRSA).
→ Children with septic arthritis are more likely than adults to be infected with Group B streptococcus or Haemophilus influenza, if they have not been vaccinated.
Note: In infants and young children, H. influenzae type b (Hib) causes bacteremia, pneumonia, epiglottitis and acute bacterial meningitis. Un-encapsulated H. influenzae strains are unaffected by the Hib vaccine and cause otitis media, conjunctivitis, and sinusitis in children, and are associated with pneumonia.
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