Diarrhea
Tick-Borne
Rash
TORCH
Respiratory
100
A 36 day old female presents to ER for watery diarrhea and fever to 100.6 F taken rectally at home. Mother reports family has a pet snake at home, and bottle washer is located next to sink where she cleans raw chicken prior to cooking. What is most likely diagnosis and treatment?
Salmonella enteritis (but must rule out systemic disease)
Treatment= rehydration oral vs IV, IV CTX --> azithromycin since high risk (once systemic disease ruled out)
100
An 11 yo F develops fever, headache, and this rash after hiking on vacation in Connecticut. What is the diagnosis?
Lyme Disease
100
An unvaccinated 3 yo M presents with fever and these exam findings. What is the diagnosis?
Measles
Koplik spots, measles rash, conjunctivitis
100
You are evaluating a newborn in the nursery and hear a machine-like murmur on auscultation. Later, the patient fails hearing screen and you note this on physical exam. What infection is classically associated?
Rubella
100
3 mo M presents with rhinorrhea, cough, wheezing, crackles, tachypnea, and increased WOB. What is most likely infectious cause and treatment?
RSV, treatment= supportive care
No routine bronchodilators or corticosteroids
200
6 year old M is brought to ED by mother for fever to 101 F, bloody diarrhea, and RLQ abdominal pain. Mother reports family lives on farm and uses unpasteurized milk. What is most likely pathogen?
Campylobacter jejuni (mimics appendicitis)
200
An 8 yo child presents with fever to 103 F, headache, and this rash that began on the wrists/ ankles and spread centrally after white water rafting trip in North Carolina. What is the diagnosis?
Rocky Mountain spotted fever
200
A 5 yo F was sent home from kindergarten due to rash over her arms and legs. Mother reports pt had "red cheeks" last week she attributed to viral illness since pt also had fever. What is the diagnosis?
Last week:
Today:
Parvovirus B19
200
You are evaluating a 3 yo M in clinic who recently immigrated from sub-saharan Africa. Mother recalls at birth pt had complications including rash over palms/ soles and jaundice requiring phototherapy. On exam today you note these findings- what is diagnosis?
Syphilis (treponema pallidum)
Hutchinson teeth and saber shins
200
6 yo M is brought to ED by mother. She reports pt had cough, runny nose about 2 weeks ago and diagnosed with viral infection. However, for the past 2 days pt has developed coughing fits that can cause him significant distress, difficulty breathing, and are often followed by vomiting. What is most likely infectious cause and treatment?
Bordatela pertussis "whooping cough"
Treatment= azithromycin
300
11 yo F with pre-B ALL currently undergoing chemo develops severe abdominal cramping and bloody diarrhea after potential undercooked ground beef exposure. What is concerning pathogen and treatment?
STEC- shiga toxin producing E.coli
Treatment= NO antibiotics or anti motility agents due to HUS risk
300
A 7 yo F presents with fever and headache after visiting Florida. Labs show leukopenia, thrombocytopenia, and transaminitis. What infection is this?
Ehrlichiosis
Mulberry-shaped clusters of intracellular bacterial inclusions called morulae inside the cytoplasm of host white blood cells (monocytes/ lymphocytes/ macrophages)
300
This 8 yo M is admitted to CHPA for daily fever x 5 days of unknown origin to 101F. Fever curve has finally improved and today on exam you notice this rash on his trunk. What is the diagnosis?
Roseola (HHV-6)
300
3 day old neonate admitted to NICU for prematurity currently requiring phototherapy develops these skin findings and head imaging reveals this. What is diagnosis?
Cytomegalovirus
Blueberry muffin rash
Periventricular calcification and ventriculomegaly
300
13 yo F presents to clinic with 2 weeks of mild dry cough, headache. Well appearing on exam. CXR findings as below. What is most likely diagnosis and treatment?
Mycoplasma pneumonia
Treatment= macrolide like azithromycin, lacks a cell wall so beta-lactams like penicillin/ amoxicillin do not work against it
400
3 yo F who attends daycare presents to clinic by mother due to fever to 100.8 F, abdominal cramping, tenesmus, frequent small-volume bloody/ mucoid stools. Stool culture confirms shigella enteritis, what is feared complication?
Toxic megacolon (other acceptable answers= intestinal perforation/ rectal prolapse, HUS is possible but MUCH more rare compared to STEC)
400
An 11 yo M presents with high fever, fatigue, headache, weight loss after hiking in rural upstate New York. Labs show anemia, thrombocytopenia. What organism is responsible?
Babesia microti "Babesiosis"
Hemolytic anemia + thrombocytopenia
400
Mother brings her 2 yo M to your office for fever. On exam you note these findings:
Group A strep
Tonsillar hypertrophy with pustular exudate, Erythematous papular sandpaper rash
400
4 day old neonate admitted to NICU for prematurity and phototherapy develops seizures. Further workup shows this- what is treatment?
Toxoplasma gondii
Chorioretinitis, diffuse intracranial calcification
Treatment= pyrimethamine, sulfadiazine, leucovorin (protects from bone marrow suppression)
400
Unvaccinated child with fever, drooping, dysphagia, muffled voice, tripod positioning, respiratory distress. What is treatment?
Epiglottis 2/2 haemophilus influenzane type B
Treatment= secure airway, CTX, adjunctive steroids
500
13 yo M went to Boy Scout hiking trip over the summer and since returning has had prolonged, foul-smelling, greasy stools with bloating, flatulence, and weight loss. What is causative microbe and treatment?
Giardia lamblia
Treatment= tinidazole, metronidazole, or nitazoxanide
500
16 yo M who lives in Wisconsin presents with fever, headache, myalgias, malaise after hiking trip. Labs show leukopenia, thrombocytopenia, elevated transaminases. What is causative microbe?
Human granulocytic anaplasmosis
Dark blue-to-purple, mulberry-like clusters of bacteria called morulae inside the cytoplasm of neutrophils (neutrophils as opposed to monocytes/ lymphocytes/ macrophages for erlichiosis)
500
7 yo M presents with an intensely pruritic rash and low grade fever. (rash below)- name 2 complications that can occur with this infection.
Varicella zoster virus
Reye syndrome (not just flu!), bacterial superinfection of skin, cerebellar ataxia, encephalitis, aseptic meningitis, viral pneumonia
500
7 day old neonate is brought to ED by mother for sleepiness. Shortly after presentation pt has multiple seizures and respiratory failure requiring intubation and mechanical ventilation. Initial lab workup shows transaminitis, coagulopathy. Despite prompt treatment, pt dies within the next 24h. What is most likely infectious causative agent?
Herpes simplex virus
500
Afebrile 3 week old brought to ED with staccato cough and eye drainage. XR as follows. What is treatment?
Chlamydia trachomatis
Tx= erythromycin