Human Case Studies for Final
Pediatrics Polly Pocket Newest
Exam Guide Questions |A+ Exam
At the Mount Union hospital, a 5-year old white male child in good general health and
physical condition was presented at the Saturday walk-in clinic by his mother. He was
brought in because he had a fever, was cranky and had complained of a sore throat for
about 24 hours. On physical examination by the attending resident, the patient had a
fever of 39.3C, and he had considerable swelling and drainage of the pharynx and in
the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He
had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His
chest sounded clear and he had no additional remarkable findings on routine
examination. - CORRECT ANSWERS-Disease: Streptococcal Pharyngitis (Strep
Throat)
Cause: Streptococcus pyogenes (white exudate = bacterial infection)
Diagnosis: Rapid strep test
Transmission/Portal of Entry: Upper respiratory tract via respiratory droplets
Treatment: antibiotics
Prevention: good hygiene, infectious individuals stay home for 2 days after treatment
Complications: Scarlet Fever, Rheumatic Fever
Susceptibility: Children
A lethargic 22-month old black female was presented by her mother to the emergency
room at 2:15am on a Sunday. The child had a history of a runny nose, hoarse cough
and low-grade fever (~99F) for the past 48 hours. The mother was concerned about the
forced and noisy breathing of the child. The pediatrician examined the child and found
cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection
(no significant changes in the eardrums). The throat of the child was red and coated
with mucus. The larynx was swollen and raw. The physician performed a rapid Strep
test and found it was negative. Throat swabs were taken for culture. The physician
placed the child in a room with a warm vaporizer for about 30 minutes. This dramatically
improved the breathing of the child. - CORRECT ANSWERS-Diagnosis: Croup = An
upper airway infection that blocks breathing and has a distinctive barking cough; may
begin like a cold, progress into barking cough due to swelling of vocal cords
Cause: parainfluenza virus
Transmission: Respiratory droplets
Treatment: supportive care, steroids
Prevention: good hygiene, avoiding contact with infected
Susceptibility: generally occurs in children
A 22-year old male college student was presented at the ESU health clinic. He looked
tired and pale. He presented because of high fever and chest pain. He was afraid he
,was having a heart attack (bad week of exams). He was examined immediately by the
PA and an EKG strip was run. He had no evidence of acute heart problems. The
attending physician visited the patient. He obtained the following history from the past
36 hours. The patient had a tight cough. He had significant muscle aches and pains. He
had a bad headache and had had fevers of 101-103F.
The physician ordered a chest x-ray. It did not show any significant consolidated
inflammation suggestive of pneumonia. The patient showed significant nasal drainage
and a moderately tight, but productive cough on physical exam. He had a fever of 101F
and generally inflamed mucous membranes. A rapid Strep test showed no evidence of
Streptococcal infection and his tonsils a - CORRECT ANSWERS-Diagnosis: Influenza
Cause: Influenza virus types A and B
- Enveloped RNA virus
- Hemagglutinin and neuraminidase mutations produce the ever changing array of
strains
- Mutations occur via antigenic shift and drift
Transmission: via inhalation of airborne viruses or self-inoculations
Prevention: good hygiene, vaccine
Treatment: antiviral drugs in first 48 hours and shorten duration; supportive care for
symptoms
Complications: Bacterial pneumonia - occur most often in elderly, children, and those
with chronic disease
A 68-year old patient with Alzheimer disease was brought to the emergency room by
the staff of a local nursing home. He presented as lethargic with a sallow complexion.
He had an admission temperature of 102.4F and a respiratory rate of 33/minute. During
respiration, the right side of his chest moved better than the left. He showed dense
consolidation of the lower lobe of the left lung on physical exam. A sputum sample
revealed blood and a greenish color.
A chest x-ray showed tight consolidation of the left lung with evidence of formation of
cavities in the lung tissue from cytotoxic damage. The patient complained of chills in the
exam room, combined with his fever. A smear of his sputum demonstrated no acid-fast
bacteria. - CORRECT ANSWERS-Diagnosis: Klebsiella Pneumonia (leading cause of
nosocomial death)
- Gram stain would reveal gram negative, rod shaped, with capsule
- TB ruled out because it is not acid-fast bacteria
- green sputum indicates bacterial infection
Cause: Klebsiella pneumoniae
Transmission/Portal of entry: inhalation
Treatment: antibiotic therapy and supportive care
Prevention: hygiene and ascriptive techniques by health care workers
Susceptibility: AIDS patients, very young, very old, people living in nursing homes, jails,
hospitals
A 35-year old accountant presented to his physician with a steady burning pain just right
of the mid-line of the abdominal region in an area from 1 to 4 inches above the "belly
, button." The pain usually followed meals by about 1-3 hours. He had several episodes
of vomiting, which included frank blood.
On physical examination, the patient had no fever. He appeared generally well. He had
no evidence of weight loss. He showed slight rebound tenderness in the upper
abdomen. An occult blood test revealed the presence of blood. - CORRECT
ANSWERS-Diagnosis: Peptic Ulcers
Cause: Helicobacter pylori
- blood in vomit indicates bleeding ulcer (upper respiratory)
Transmission: Fecal-oral
Susceptibility: those colonized by H. pylori
Treatment: antimicrobial and acid blocking drugs
Prevention: lifestyle changes
A 4-year old girl presents at the emergency room with bloody diarrhea, fever and
vomiting. The child's mother reports that the child has had these symptoms for about 24
hours and she has not passed any urine for about 12 hours.
The child is enrolled in a day care center and the group had recently made a field trip to
a fast food place to learn about different jobs. The children had a lunch of ground beef,
fries and cola after meeting with different workers. This field trip was 4 days earlier on
Friday. The child had a temperature of 39C and showed physical signs of dehydration.
Blood samples drawn showed evidence of greatly reduced kidney function and lysed
red blood cells. - CORRECT ANSWERS-Diagnosis: Escherichia coli 0157:H7
- Gastroenteritis
- leading cause of food borne illness
- has powerful toxin that can cause sever illness
- Shiga toxin causes lyse red blood cell
Susceptibility: children under 5 years of age and elderly, the infections can cause
hemolytic uremic syndrome
Treatment: no antibiotics, rehydration, dialysis
Complications: kidney failure, hemolytic uremic syndrome
Prevention: proper food handling and preparation
A 26-year old white female presents in her physician's office with genital itching and
sharp, severe pain on the labia. She complains of three previous episodes of pain over
the past 6 months, each of which were followed by the appearance of red sores which
crusted and healed without a scar.
On examination the physician observes a cluster of small red blisters localized in the
area of the worst pain. No significant discharge was observed from the vagina. The
patient's urine was clear and yellow. Urinalysis revealed normal specific gravity, no
sugar, no protein, no white blood cells or red blood cells and no bacteria. The patient's
temperature was 36.5C.
The patient history reveals that she is unmarried. She is moderately sexually active and
currently using an oral contraceptive which she has been taking for about 4 years. The
woman stated that she has had 5 sexual partners over the past year. She reported that
her ep - CORRECT ANSWERS-Diagnosis: Genital Herpes
- reoccurring, latent
Pediatrics Polly Pocket Newest
Exam Guide Questions |A+ Exam
At the Mount Union hospital, a 5-year old white male child in good general health and
physical condition was presented at the Saturday walk-in clinic by his mother. He was
brought in because he had a fever, was cranky and had complained of a sore throat for
about 24 hours. On physical examination by the attending resident, the patient had a
fever of 39.3C, and he had considerable swelling and drainage of the pharynx and in
the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He
had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His
chest sounded clear and he had no additional remarkable findings on routine
examination. - CORRECT ANSWERS-Disease: Streptococcal Pharyngitis (Strep
Throat)
Cause: Streptococcus pyogenes (white exudate = bacterial infection)
Diagnosis: Rapid strep test
Transmission/Portal of Entry: Upper respiratory tract via respiratory droplets
Treatment: antibiotics
Prevention: good hygiene, infectious individuals stay home for 2 days after treatment
Complications: Scarlet Fever, Rheumatic Fever
Susceptibility: Children
A lethargic 22-month old black female was presented by her mother to the emergency
room at 2:15am on a Sunday. The child had a history of a runny nose, hoarse cough
and low-grade fever (~99F) for the past 48 hours. The mother was concerned about the
forced and noisy breathing of the child. The pediatrician examined the child and found
cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection
(no significant changes in the eardrums). The throat of the child was red and coated
with mucus. The larynx was swollen and raw. The physician performed a rapid Strep
test and found it was negative. Throat swabs were taken for culture. The physician
placed the child in a room with a warm vaporizer for about 30 minutes. This dramatically
improved the breathing of the child. - CORRECT ANSWERS-Diagnosis: Croup = An
upper airway infection that blocks breathing and has a distinctive barking cough; may
begin like a cold, progress into barking cough due to swelling of vocal cords
Cause: parainfluenza virus
Transmission: Respiratory droplets
Treatment: supportive care, steroids
Prevention: good hygiene, avoiding contact with infected
Susceptibility: generally occurs in children
A 22-year old male college student was presented at the ESU health clinic. He looked
tired and pale. He presented because of high fever and chest pain. He was afraid he
,was having a heart attack (bad week of exams). He was examined immediately by the
PA and an EKG strip was run. He had no evidence of acute heart problems. The
attending physician visited the patient. He obtained the following history from the past
36 hours. The patient had a tight cough. He had significant muscle aches and pains. He
had a bad headache and had had fevers of 101-103F.
The physician ordered a chest x-ray. It did not show any significant consolidated
inflammation suggestive of pneumonia. The patient showed significant nasal drainage
and a moderately tight, but productive cough on physical exam. He had a fever of 101F
and generally inflamed mucous membranes. A rapid Strep test showed no evidence of
Streptococcal infection and his tonsils a - CORRECT ANSWERS-Diagnosis: Influenza
Cause: Influenza virus types A and B
- Enveloped RNA virus
- Hemagglutinin and neuraminidase mutations produce the ever changing array of
strains
- Mutations occur via antigenic shift and drift
Transmission: via inhalation of airborne viruses or self-inoculations
Prevention: good hygiene, vaccine
Treatment: antiviral drugs in first 48 hours and shorten duration; supportive care for
symptoms
Complications: Bacterial pneumonia - occur most often in elderly, children, and those
with chronic disease
A 68-year old patient with Alzheimer disease was brought to the emergency room by
the staff of a local nursing home. He presented as lethargic with a sallow complexion.
He had an admission temperature of 102.4F and a respiratory rate of 33/minute. During
respiration, the right side of his chest moved better than the left. He showed dense
consolidation of the lower lobe of the left lung on physical exam. A sputum sample
revealed blood and a greenish color.
A chest x-ray showed tight consolidation of the left lung with evidence of formation of
cavities in the lung tissue from cytotoxic damage. The patient complained of chills in the
exam room, combined with his fever. A smear of his sputum demonstrated no acid-fast
bacteria. - CORRECT ANSWERS-Diagnosis: Klebsiella Pneumonia (leading cause of
nosocomial death)
- Gram stain would reveal gram negative, rod shaped, with capsule
- TB ruled out because it is not acid-fast bacteria
- green sputum indicates bacterial infection
Cause: Klebsiella pneumoniae
Transmission/Portal of entry: inhalation
Treatment: antibiotic therapy and supportive care
Prevention: hygiene and ascriptive techniques by health care workers
Susceptibility: AIDS patients, very young, very old, people living in nursing homes, jails,
hospitals
A 35-year old accountant presented to his physician with a steady burning pain just right
of the mid-line of the abdominal region in an area from 1 to 4 inches above the "belly
, button." The pain usually followed meals by about 1-3 hours. He had several episodes
of vomiting, which included frank blood.
On physical examination, the patient had no fever. He appeared generally well. He had
no evidence of weight loss. He showed slight rebound tenderness in the upper
abdomen. An occult blood test revealed the presence of blood. - CORRECT
ANSWERS-Diagnosis: Peptic Ulcers
Cause: Helicobacter pylori
- blood in vomit indicates bleeding ulcer (upper respiratory)
Transmission: Fecal-oral
Susceptibility: those colonized by H. pylori
Treatment: antimicrobial and acid blocking drugs
Prevention: lifestyle changes
A 4-year old girl presents at the emergency room with bloody diarrhea, fever and
vomiting. The child's mother reports that the child has had these symptoms for about 24
hours and she has not passed any urine for about 12 hours.
The child is enrolled in a day care center and the group had recently made a field trip to
a fast food place to learn about different jobs. The children had a lunch of ground beef,
fries and cola after meeting with different workers. This field trip was 4 days earlier on
Friday. The child had a temperature of 39C and showed physical signs of dehydration.
Blood samples drawn showed evidence of greatly reduced kidney function and lysed
red blood cells. - CORRECT ANSWERS-Diagnosis: Escherichia coli 0157:H7
- Gastroenteritis
- leading cause of food borne illness
- has powerful toxin that can cause sever illness
- Shiga toxin causes lyse red blood cell
Susceptibility: children under 5 years of age and elderly, the infections can cause
hemolytic uremic syndrome
Treatment: no antibiotics, rehydration, dialysis
Complications: kidney failure, hemolytic uremic syndrome
Prevention: proper food handling and preparation
A 26-year old white female presents in her physician's office with genital itching and
sharp, severe pain on the labia. She complains of three previous episodes of pain over
the past 6 months, each of which were followed by the appearance of red sores which
crusted and healed without a scar.
On examination the physician observes a cluster of small red blisters localized in the
area of the worst pain. No significant discharge was observed from the vagina. The
patient's urine was clear and yellow. Urinalysis revealed normal specific gravity, no
sugar, no protein, no white blood cells or red blood cells and no bacteria. The patient's
temperature was 36.5C.
The patient history reveals that she is unmarried. She is moderately sexually active and
currently using an oral contraceptive which she has been taking for about 4 years. The
woman stated that she has had 5 sexual partners over the past year. She reported that
her ep - CORRECT ANSWERS-Diagnosis: Genital Herpes
- reoccurring, latent
