Rosh Review family med Questions And Answers Rated A+

A 10-year-old boy presents with a two day history of sore throat, fever and headache. He denies cough, significant rhinnorhea or head congestion. Physical exam is remarkable for enlarged, erythematous tonsils with a pharyngeal whitish exudate. He has marked lymphadenopathy over his anterior cervical lymphoid chain. What is the most likely diagnosis? A. Mononucleosis B. Sinusitis C. Strep throat D. Tonsillolithiasis - Correct Answer ( C ) Explanation: "Strep throat" caused by Group A Beta-hemolytic streptococcus (Streptococcus pyogenes or GAS) is a common etiology of acute pharyngitis especially in children ages 5 to 15. It is characterized by inflammation of the pharynx or tonsils (tonsillar exudates) associated with symptoms of fever, malaise and sore throat, as well as the absence of other URI symptoms such as nasal congestion and cough. Cervical lymphadenopathy is often found on exam, as is a whitish exudate over the pharynx and tonsils. A rapid streptococcal antigen test is recommended in order to determine if treatment with antibiotics is warranted, as other conditions which do not require antibiotic treatment may mimic streptococcal pharyngitis. A throat culture to rule-out GAS infection is recommended in children if rapid antigen testing is negative (90% sensitivity), in order to limit transmission and prevent complications such as rheumatic fever. Other complications of strep throat may include acute glomerulonephritis, peritonsillar abscess, bacteremia, sinusitis and pneumonia. Penicillin-based antibiotics (benzathine penicillin IM or oral penicillin VK) are the treatment of choices. For penicillin allergic patients, azithromycin is an alternative. Mononucleosis (A) is an infection caused by Epstein-Barr virus and is most common in 15 to 24 year-olds. Patients usually experience a several day prodrome of fever, chills, malaise and anorexia followed by the onset of throat pain, fever and lymphadenopathy. The diagnosis is supported by heterophile (Monospot) antibody testing. Treatment is supportive and the illness is generally self-limited, though some patients may experience residual symptoms of malaise and fatigue for months following initial diagnosis. Sinusitis (B) refers to inflammation of the mucous membranes lining A 12-year-old girl presents to the clinic with one day of cough, fever to 102°F, and extreme fatigue. She is awake and alert but appears tired. Her oxygen saturation is 95 percent, and respiratory rate is 15 breaths per minute. Lung auscultation reveals fine crackles in the left upper lobe. Which of the following is treatment of choice?A.Ampicillin B.Azithromycin C.Cefotaxime D.Clindamycin - Correct Answer ( B ) Explanation: The above patient's constellation of fever, cough, and focal lung findings are concerning for communityacquired pneumonia. The onset of symptoms was acute and severe, and the lung findings are focal, which is suggestive of a typical bacterial etiology. S. pneumoniae is the most frequent cause of "typical" bacterial pneumonia in children of all ages. However, in otherwise healthy children five years and older with CAP who are not ill enough to require hospitalization, M. pneumoniae and C. pneumoniae are the most likely pathogens. A macrolide is the empirical treatment of choice for typical bacterial pneumonia in otherwise healthy children 5 years old being treated in outpatient setting. Among the macrolide antibiotics, clarithromycin and azithromycin have a more convenient dosing schedule and fewer side effects than erythromycin, but erythromycin is less expensive. Macrolide antibiotics may provide coverage for S. pneumoniae, which is the most frequent typical bacterial pathogen for all age groups. However, approximately 40 to 50 percent of S. pneumoniae isolates are resistant to macrolides. Failure to respond to macrolide therapy may indicate the development of a complication, a macrolide-resistant pathogen, or the need to alter therapy to provide better pneumococcal coverage. Given the significant resistance of S. pneumoniae to macrolides, fluoroquinolones (e.g., levofloxacin, moxifloxacin) are another reasonable alternative for the outpatient treatment of CAP. In addition to their excellent Gramnegative spectrum, the fluoroquinolones are active against a number of the pathogens responsible for CAP, including beta-lactam-susceptible and non-susceptible S. pneumoniae, M. pneumoniae, and C. pneumoniae. However, S. pneumoniae resistant to levofloxacin has been identified. Ampic A 12-year-old uncircumcised boy presents to the emergency department with a complaint of inability to retract his foreskin to its normal position. While he was showering, he retracted his foreskin to clean his penis. He called his mother for help when he could not get his foreskin back into place. Which of the following is the most likely diagnosis? A.Balanitis B.Paraphimosis C.PhimosisD.Priapism - Correct Answer ( B ) Explanation: Paraphimosis occurs in uncircumcised males when entrapment of the foreskin behind the glans penis causes venous and lymphatic congestion, resulting in inability to retract the foreskin to its normal position. Risk factors include genitourinary procedures, sexual activity, penile trauma, and males who forget to replace the foreskin after cleaning or urination. Paraphimosis typically causes significant pain and is a true urologic emergency. Treatment includes the timely reduction of the foreskin back over the glans penis. Urology consultation should be ordered for any signs of arterial compromise of the glans penis. Balanitis (A) is an inflammation of the glans penis often caused by poor hygiene. Phimosis (C) occurs when the foreskin cannot be retracted over the glans penis. Priapism (D) is a prolonged erection of the penis. A 13-year-old boy on chemotherapy for acute lymphoblastic leukemia presents with progressive lower back pain for 2 weeks. Per mom, he has had subjective fevers and a "bulge in his lower back" that is warm to touch. He is currently afebrile and has no focal neurologic deficits. An MRI is obtained as seen in the image above. Which of the following regarding this patient's condition is true? A.An appropriate antibiotic regimen is cefepime and metronidazole B.Direct extension of skin and soft tissue infections is the most common cause C.Erythrocyte sedimentation rate is a sensitive screening tool D.Most patients present with back pain, fever, and a focal neurologic deficit - Correct Answer ( C ) Explanation: