infectious disease/fever

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Question 1 / 3

686463876c78b8d82816dc92

Pediatrics

infectious disease

fever

Case History

A 10-month-old boy is brought to the pediatric urgent care clinic by his parents due to a 3-day history of increasing vomiting and frequent watery diarrhea. The vomiting has been nonbloody and nonbilious, occurring 5-6 times daily, and the diarrhea is described as "profuse, pure water" occurring up to 15 times daily. He had a mild upper respiratory infection last week. His immunizations are reportedly up-to-date, though the parents are unsure about specific dates. He has been exclusively formula-fed since 6 months of age, and recently started on solids including pureed chicken, rice cereal, and strained vegetables. Over the past 12 hours, he has appeared lethargic, has had significantly reduced urine output, and refuses oral intake. On examination, his temperature is 38.7 C, pulse is 170/min, respirations are 40/min, and blood pressure is 85/50 mmHg. He is irritable but consolable, has sunken eyes, dry mucous membranes, and a depressed anterior fontanelle. Capillary refill time is prolonged at 4 seconds. Abdominal examination reveals a soft, non-distended abdomen with hyperactive bowel sounds; no masses or tenderness are appreciated. Considering the clinical presentation, what is the most likely diagnosis and the immediate priority in this patient's management?

Lab Parameter	Value	Reference Range
White Blood Cells (WBC)	18.2 x 10^9/L	6.0-17.0 x 10^9/L
Sodium	130 mmol/L	135-145 mmol/L
Potassium	3.2 mmol/L	3.5-5.0 mmol/L
Bicarbonate	16 mmol/L	22-29 mmol/L
Creatinine	58 micromol/L	27-62 micromol/L
Urinalysis Specific Gravity	1.030	1.003-1.030

A ) Diagnosis: Bacterial dysentery; Management: Initiate empiric oral azithromycin

B ) Diagnosis: Acute lactose intolerance; Management: Recommend a lactose-free formula

C ) Diagnosis: Viral gastroenteritis; Management: Initiate oral rehydration therapy with close monitoring

D ) Diagnosis: Viral gastroenteritis; Management: Begin intravenous fluid resuscitation with isotonic crystalloids

E ) Diagnosis: Giardiasis; Management: Prescribe oral metronidazole after stool ova and parasites confirmation

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Question 2 / 3

686463876c78b8d82816dce0

Pediatrics

infectious disease

fever

Case History

A 12-year-old girl presents to her pediatrician's office with a 3-day history of gradually worsening sore throat, low-grade fever, general malaise, and a persistent cough. Her mother notes she has also been rubbing her eyes frequently, which appear red, and has had some clear nasal discharge. She denies difficulty breathing or rash. Her past medical history is unremarkable, and she is up-to-date on immunizations. On examination, her temperature is 37.9 C, heart rate 88 bpm, respiratory rate 16 breaths/min, and blood pressure 105/65 mmHg. Oropharyngeal examination reveals diffuse erythema and moderate tonsillar enlargement (2+), with scant, clear mucous but no frank exudates or vesicles. Bilateral conjunctival injection without purulent discharge is noted. The neck is supple with a few small (0.8 cm), non-tender, mobile anterior cervical lymph nodes. Lung fields are clear to auscultation, and no skin lesions are observed. Given these findings, what is the most likely diagnosis and the initial management plan?

Lab Parameter	Value	Reference Range
White Blood Cell Count	9.5 x 10^9/L	4.0-11.0 x 10^9/L
Neutrophils	50%	40-75%
Lymphocytes	40%	20-50%
C-reactive protein (CRP)	8 mg/L	<5 mg/L

A ) Diagnosis: Infectious mononucleosis; Treatment: Oral corticosteroids and activity restriction.

B ) Diagnosis: Group A Streptococcal pharyngitis; Treatment: Prescribe a 10-day course of oral amoxicillin after rapid antigen detection test.

C ) Diagnosis: Viral pharyngitis, likely Adenoviral; Treatment: Symptomatic management including analgesics and hydration.

D ) Diagnosis: Group A Streptococcal pharyngitis; Treatment: Initiate oral azithromycin empirically without further testing.

E ) Diagnosis: Peritonsillar abscess; Treatment: Immediate incision and drainage with intravenous antibiotics.

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Question 3 / 3

686463876c78b8d82816dd20

Pediatrics

infectious disease

fever

Case History

An 8-year-old girl is brought to her pediatrician's office by her parents due to a persistent fever, sore throat, and a new rash. Her symptoms began three days ago with a temperature of 39.2 °C and difficulty swallowing. The rash, which started on her neck and chest, has since spread diffusely across her body, feeling rough to the touch. Her parents recall she had a throat swab performed at a local clinic two days prior, which subsequently returned positive for Streptococcus pyogenes. On examination, she appears fatigued but alert. Her pharynx is erythematous with mild exudates, and her tongue has a prominent, papular, reddish appearance. Mild anterior cervical lymphadenopathy is noted. Given these findings, what is the most likely diagnosis and the most appropriate initial management strategy to prevent long-term complications?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	14.5 x 10^9/L	4.0-11.0 x 10^9/L
C-reactive Protein (CRP)	85 mg/L	<5 mg/L

A ) Viral Exanthem and symptomatic care with antipyretics

B ) Scarlet Fever and oral Amoxicillin 50 mg/kg/day once daily for 10 days

C ) Kawasaki Disease and intravenous immunoglobulin (IVIG) with high-dose Aspirin

D ) Acute Rheumatic Fever and penicillin G benzathine intramuscularly with corticosteroids

E ) Staphylococcal Scalded Skin Syndrome and intravenous Nafcillin with aggressive fluid resuscitation

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