CAT SCRATCH DISEASE

Q.6) A6-year-old girl presents with unilateral nonpainful, nonsuppurative conjunctivitis and preauricular lymphadenitis. What is the most likely causative organism?
(A) Mycobacterium avium
(B) Bartonella henselae
(C) Adenovirus
(D) Staphylococcus aureus
(E) Chlamydia trachomati

Ans: (B) Bartonella henselae
This patient presents with Parinaud oculoglandular syndrome. This syndrome is the

most common atypical presentation of cat scratch disease (CSD) but can also occur with

tularemia, tuberculosis, and syphilis. CSD is one of the most common causes of subacute

lymphadenitis in children. Bartonella henselae is the organism that has been associated with the

clinical syndrome of CSD. Bartonella henselae is transmitted among cats by fleas and bacteremic cats transmit the disease to humans through saliva. Human-to-human transmission does not occur. The conjunctiva is the site of inoculation in oculoglandular syndrome and the conjunctivitis is typically painless and nonsuppurative. A conjunctival granuloma may be present at the inoculation site. 

Lymphadenopathy most often occurs in the preauricular nodes and less commonly submandibular.

REFEEDING SYNDROME

Q.5) A 23-month-old female is hospitalized for severe malnutrition. Which of the following problems is most likely to be the result of inappropriately rapid treatment of the severely malnourished child?
(A) hyperkalemia
(B) hyponatremia
(C) hyperglycemia
(D) congestive heart failure
(E) renal failure

Ans:  (D)

 Congestive heart failure is very easy to precipitate in a severly malnourished child particulary if colloid (blood) or crystalloid (sodium) is infused aggressively. Because the heart is malnourished, contractility and therefore cardiac output is already impaired. By increasing plasma volume which would occur by infusing either of the above substances, the preload to the heart would increase in the face of animpaired pump, resulting in congestive heart failure.

MECONIUM ASPIRATION

Q.3) A term infant requires intubation in the delivery room after aspiration of thick meconium and is brought to the neonatal intensive care unit. Which of the following is the most likely risk factor for meconium aspiration syndrome in this infant?

(A) chromosomal anamoly

(B) congenital heart disease

(C) cystic fibrosis

(D) fetal distress

(E) tracheoesophageal fistula

Ans: D.

 Fetal distress is the major risk factor for meconium aspiration. The mechanism involves the loss of anal sphincter tone, passage of meconium into the amniotic fluid, and aspiration by the distressed, gasping infant during the process of birth. The thick meconium obstructs the airways, causing tachypnea, retractions, and grunting.

This is the type of question in which a little common sense is required. If you knew that meconium aspiration was a relatively common problem in the delivery room, you could eliminate (C) cystic fibrosis (a relatively uncommon disease) as its cause. 
(Meconium ileus, which is associated with cystic fibrosis, has nothing to do with meconium aspiration.) If you realized that aspiration of meconium can only occur before or during delivery, you also could eliminate (B) congenital heart disease and (A) neonatal meningitis, as neither of these generally cause distress during delivery. 
Finally, you should be able to figure out that a tracheoesophageal fistula with or without associated esophageal atresia, would lead to aspiration of saliva, milk, or gastric contents after birth but would not predispose to aspiration of meconium.

A severe pneumonia following meconium aspiration occurs as an in utero response to significant hypoxic or ischemic stress. Infants who have fetal distress, thick meconium, and APGAR scores of less than 7 at 1 and 5 minutes are at increased risk for meconium aspiration syndrome.

When meconium staining of amniotic fluid is noted, the appropriate approach to care of the infant according to The Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics and American Heart Association include intubation when the infant is not vigorous (defined as having poor respiratory efforts, poor muscle tone, and a heart rate less than 100 beats/minute).

EB- VIRUS

Q). with a 5-day history of fever, sore throat, and fatigue. Physical examination reveals an

exudative tonsillitis and bilateral enlarged and slightly tender posterior cervical lymph nodes. The spleen is palpable 3 cm below the rib cage. Which agent is most likely responsible for this patient’s illness?

(A) Group A β-hemolytic streptococcus

(B) Adenovirus

(C) Toxoplasma gondii

(D) Epstein-Barr virus

(E) Corynebacterium diphtheriae

Ans: (D).

The agent most likely responsible for this child’s illness is the Epstein-Barr virus (EBV). The clinical picture is strongly suggestive of mononucleosis.

Although this patient could be infected with group A streptococcus or adenovirus, several

features are much more characteristic of EBV infection than either of these. They include the

fact that the child is a college student, the presence of splenomegaly, and the fact that

the adenopathy is posterior rather than anterior and is only slightly tender. While these

findings also could be explained by toxoplasmosis, this diagnosis is rarely confirmed as a

cause of acute exudative tonsillitis and cervical adenitis. Although it is appropriate to think of diphtheria in patients with acute exudative tonsillitis, there is nothing specific in this case to suggest that diagnosis. Infectious mononucleosis is clearly the most likely diagnosis.

COCAINE

Q.Aterm infant is born to a mother who has been using crack cocaine. This infant is at increased risk for which of the following?

(A) anemia

(B) intrauterine growth retardation

(C) hypercalcemia

(D) macrosomia

(E) postmaturity

Ans: B.

 Infants born to women using cocaine, especially crack cocaine, have an increased incidence of prematurity (not postmaturity) and low birth weight (not macrosomia). Intrauterine growth retardation with disproportionate decrease in head size is noted in infants exposed prenatally to cocaine.