infectious disease/infection

See Explanation

[]

Question 1 / 4

686463876c78b8d82816dc56

Pediatrics

infectious disease

infection

Case History

An 8-year-old girl, previously healthy and fully immunized, initially presented to an outpatient clinic with a 3-day history of headache, myalgia, and a persistent cough, accompanied by a low-grade fever. Her parents administered over-the-counter medications, including an aspirin-containing product, for symptomatic relief. Four days later, her condition acutely worsened at home; she developed intractable vomiting, became progressively lethargic, and then disoriented, leading to her emergency presentation at a tertiary care facility. On arrival, she is semicomatose, exhibiting periods of combativeness and decorticate posturing. Her liver span is mildly enlarged on palpation, and deep tendon reflexes are brisk. Which of the following is the most likely diagnosis and the critical initial management step for this patient?

Lab Parameter	Value	Reference Range
Blood Glucose	2.8 mmol/L	3.9-6.1 mmol/L
Ammonia	250 µmol/L	11-32 µmol/L
Alanine Aminotransferase (ALT)	350 U/L	7-56 U/L
Aspartate Aminotransferase (AST)	420 U/L	10-40 U/L
Prothrombin Time (PT)	18 seconds	11-13.5 seconds
International Normalized Ratio (INR)	1.6	0.8-1.2
White Blood Cell Count (WBC)	11.2 x 10^9/L	4.5-13.5 x 10^9/L
Cerebrospinal Fluid (CSF) Protein	0.25 g/L	0.15-0.45 g/L
Cerebrospinal Fluid (CSF) Glucose	3.5 mmol/L	2.2-3.9 mmol/L

A ) Bacterial Meningitis and immediate broad-spectrum intravenous antibiotics.

B ) Viral Encephalitis and intravenous acyclovir with supportive care.

C ) Diabetic Ketoacidosis and initiation of an insulin infusion with aggressive fluid resuscitation.

D ) Reye Syndrome and prompt intravenous dextrose infusion with intracranial pressure monitoring and management.

E ) Acute Liver Failure secondary to acetaminophen toxicity and N-acetylcysteine administration.

Edit question

See Explanation

[]

Question 2 / 4

686463876c78b8d82816dc60

Pediatrics

infectious disease

infection

Case History

A 3.5-year-old girl presents to the pediatric outpatient clinic for a follow-up visit after experiencing her third febrile urinary tract infection within the past 18 months. Her recent episode, which resolved with oral antibiotics, was characterized by high-grade fever peaking at 39.5°C, lethargy, poor appetite, and suprapubic pain, accompanied by the following lab findings. Her parents express concern about the recurrent nature of these infections and potential long-term implications. They report her growth and development have otherwise been normal. On physical examination today, her vital signs are stable, and abdominal examination reveals no acute tenderness, although mild suprapubic discomfort is noted on deep palpation. There is no costovertebral angle tenderness. Given her history, what is the most appropriate next step in her diagnostic evaluation and initial management strategy?

Lab Parameter	Value	Reference Range
White Blood Cell Count	13.5 x 10^9/L	4.0-11.0 x 10^9/L
Neutrophils	75%	40-70%
C-reactive protein (CRP)	45 mg/L	<5 mg/L
Urinalysis: Leukocyte Esterase	Positive	Negative
Urinalysis: Nitrites	Positive	Negative
Urinalysis: Red Blood Cells	0-2 /hpf	<3 /hpf
Urinalysis: White Blood Cells	>50 /hpf	<5 /hpf
Urine Culture	Escherichia coli >10^5 CFU/mL	No growth

A ) Initiate continuous low-dose antibiotic prophylaxis and schedule a cystoscopy to investigate bladder anomalies.

B ) Obtain a baseline renal ultrasound to evaluate for structural abnormalities and recommend regular urine dipstick testing.

C ) Schedule a DMSA renal scan to assess for pyelonephritic scarring and consider an IV pyelogram if scarring is present.

D ) Recommend close observation and prompt treatment of future febrile UTIs, reserving further imaging for more severe or complicated cases.

E ) Perform a voiding cystourethrogram (VCUG) to evaluate for vesicoureteral reflux (VUR) and, if positive, consider daily low-dose antibiotic prophylaxis or surgical consultation depending on VUR grade.

Edit question

See Explanation

[]

Question 3 / 4

686463876c78b8d82816dc86

Pediatrics

infectious disease

infection

Case History

A 7-year-old boy presents to his pediatrician with a two-year history of intermittent fever, flank pain, and dysuria, despite several courses of broad-spectrum antibiotics for presumed urinary tract infections. On examination, his blood pressure is 115/75 mmHg (95th percentile for age and height), and he shows signs of poor growth velocity compared to previous visits. Imaging studies, including a renal ultrasound, showed bilateral renal scarring, and a subsequent voiding cystourethrogram confirmed grade 3 bilateral vesicoureteral reflux. His parents are concerned about the persistent nature of his symptoms and the potential long-term health implications. What is the most appropriate definitive management strategy for this patient, and what serious long-term complications might occur if the condition remains unaddressed?

Lab Parameter	Value	Reference Range
White Blood Cell Count	11.2 x 10^9/L	4.0-10.0 x 10^9/L
Hemoglobin	118 g/L	120-160 g/L
Serum Creatinine	78 µmol/L	20-60 µmol/L
Urinalysis: Protein	2+	Negative
Urinalysis: Leukocyte Esterase	Positive	Negative

A ) Increased dose of prophylactic antibiotics and monitoring for blood pressure changes, with a long-term risk of developing drug-resistant infections.

B ) Regular surveillance with serial renal ultrasounds and urine cultures, primarily to detect early signs of bladder dysfunction and urinary incontinence.

C ) Endoscopic dextranomer/hyaluronic acid injection or ureteral reimplantation, aiming to prevent recurrent pyelonephritis, hypertension, and progressive renal scarring leading to chronic kidney disease.

D ) Immediate nephrectomy of the more severely affected kidney and lifelong antihypertensive medication, to prevent a systemic inflammatory response.

E ) Cystoscopy with bladder augmentation and prophylactic anti-rejection medication, to prepare for future renal transplantation.

Edit question

See Explanation

[]

Question 4 / 4

686463876c78b8d82816dd16

Pediatrics

infectious disease

infection

Case History

A 6-week-old female presents to an outpatient clinic with a 10-day history of progressive cough and mild nasal congestion. Her mother reports the cough has become more frequent and sounds like a series of short bursts. The infant has no reported fever, but her breathing seems faster at times. Her mother, who did not receive consistent prenatal care, indicates a history of prior sexually transmitted infections. On physical examination, the infant is afebrile with clear rhinorrhea. Auscultation of the chest reveals mild bilateral crackles and a staccato cough is noted. Her respiratory rate is 48 breaths/min with occasional nasal flaring. A chest radiograph demonstrates diffuse hyperinflation and symmetrical interstitial prominence. Based on these findings, what is the most likely diagnosis and the cornerstone of the initial management strategy?

Lab Parameter	Value	Reference Range
White Blood Cell Count	10.5 x 10^9/L	5.0-15.0 x 10^9/L
Hemoglobin	125 g/L	110-140 g/L
Platelets	350 x 10^9/L	150-450 x 10^9/L
Absolute Eosinophil Count	0.8 x 10^9/L	< 0.5 x 10^9/L
C-reactive protein	3 mg/L	< 5 mg/L

A ) Respiratory Syncytial Virus Bronchiolitis and supportive care with nebulized hypertonic saline.

B ) Bacterial Pneumonia (e.g., Streptococcus pneumoniae) and oral amoxicillin-clavulanate.

C ) Chlamydia trachomatis Pneumonia and oral azithromycin or erythromycin for 14 days.

D ) Pertussis and macrolide therapy along with respiratory isolation.

Edit question