Question of the Week #485

485. A 10-year-old female presents with a 3 week history of cough.  Initially she had a runny nose and was tired with a slight cough but as the runny nose resolved the cough seemed to get worse.  She states that the cough is dry sounding and occurs during the day and night.  She describes having coughing spasms that occasionally end in vomiting but between episodes of coughing she is fine.  Her mom reports that during a coughing spasm she will gasp for air and sometimes make a “whooping” noise.  A nasopharyngeal swab confirms a diagnosis of Bordatella pertussis.  Which of the following is true?

A. Her 3-month-old brother should be treated with azithromycin as prophylaxis

B. She should be started on azithromycin for more rapid resolution of cough.

C. Her classmates should be treated with clarithromycin as prophylaxis

D. She will have lifelong natural immunity against Bordatella pertussis.

E. Her classmates should receive a Tdap booster regardless of their vaccination status

Question of the Week # 472

A 9-year-old boy is brought to the hospital with a wound to his left hand. He was in a fight with peer who bit him. His past medical history is unremarkable and he takes no medications. He has no known allergies. On examination, the child is crying. There is a 2-cm wound over the dorsum of his palm. What is the most appropriate course of action?
A. Clean the wound and prescribe amoxicillin-clavulanate.
B. Clean the wound and prescribe doxycycline.
C. Clean the wound and prescribe ciprofloxacin.
D. Clean the wound, close it with interrupted sutures and prescribe ciprofloxacin.
E. Clean the wound, close it with interrupted sutures and prescribe amoxicillin-clavulanate.

Question of the Week # 465

465) A 6-year-old boy is brought to the emergency department 2 hours after he was bitten by a peer in kindergarten in a fight. The child’s mother is frantic and wants to “sue the center for allowing such behavior!” The child is up-to-date on his vaccinations. The other child is very healthy and his vaccinations are current. On physical examination, there is puncture wound on the right hand. You gently clean the wound and consult with the hand surgeon who says that there does not appear to be any damage to the nerves, muscles, tendons, or joints of the hand. What is the most appropriate next step?

A. close the wound with a suture
B. obtain a wound culture
C. provide ampicillin-sulbactam
D. send him home with a follow-up appointment within 48 hours
E. vigorously irrigate and debride the wound

Question of the Week # 450 and #451

450) A 74 year old man with poorly controlled Diabetes Type II presents to your office with complaints of severe right ear pain since yesterday night. The Pain was particularly worse in the night and interfered with his sleep. He took some Advil but pain persisted. He also reports headache on right temporal aspect. On examination, his right external auditory canal is slightly red and swollen and extremely tender to touch. There is some white debris and granulation tissue at the junction of bone and the cartilage. Laboratory studies show normal WBC count with no left shift. Which of the following additional tests is useful in supporting the diagnosis? 

A) Comprehensive metabolic panel

B) Erythrocyte Sedimentation Rate

C) Anti-nuclear antibodies

D) Hemoglobin A1C.

E) Screening nares for MRSA ( Methicillin Resistant Staph. Aureus)

451) What is the most important next step in management?

A) Oral Cephalexin

B) Surgical resection

C) Intravenous Ciprofloxacin

D) Intravenous Ceftriaxone

E) Ciprofloxacin ear drops

Question of the Week # 393

393)  A 36 year old homeless man is evaluated in the Emergency Room for intermittent fever, cough, night sweats and weight-losss. He also reports having chronic cough with progressively increasing bloody expectoration for the past 1 month. He has lost about 10lbs weight over the past 3 months. He smokes 1 pack per day and has a history of intravenos drug abuse. On examination, he is cachectic.  He is afebrile, Pulse is 84/min, Respiratory rate 18/min, Blood pressure 120/80 mm Hg, Oxygen saturation 98%.  Reminder of the physical examination is unremarkable. Which of the following is the most appropriate initial step in managing this patient?

A) Sputum samples for Acid Fast Bacilli

B) Start Multi-drug therapy for Tuberculosis

C) Obtain a Chest X-ray

D) Tuberculin Skin test

E) Air-Borne Isolation

F) Test for HIV

Question of the Week # 322

322)  A 45 year man is evaluated in emergency department for severe cough accompanied by bloody expectoration. Cough is of 4 month duration associated with sputum production but he is worried because of the new change in the character of his sputum which is now frankly bloody. He reports a weight-loss of 10 lbs in the past two months.  He has intermittent nigh-sweats and low grade fever on a daily basis. On examination, his temperature is 100F, Pulse 98/min, RR 20/min and Blood Pressure 100/60 mm HG.  He appears cachectic and in moderate distress due to cough. On auscultation, high-pitched bronchial breath sounds are heard in the right upper chest.

A chest-x-ray is shown below:

The patient is admitted and is placed on respiratory, negative-pressure isolation. HIV rapid test is positive. Sputum smears for Acid Fast Bacilli (AFB) are positive. A CD4 count is 155/μl ( Normal = 650 to 1150/µl). Which of the following is the most appropriate next step in management at this time?

A) Bronchoscopy and send bronchial washing for clutures

B) Start Multi-Drug anti-tuberculosis Therapy alone

C) Start Highly Active Antiretroviral Therapy (HAART) plus Multi-drug Anti-TB therapy

D) Start HAART and await sputum for AFB identification and sensitivity testing

E) Start Clarithromycin for Mycobacterium Avium Intracellulare (MAC)

Question of the week # 312

312) A 73 year old man with history of Dementia and well-controlled Parkinson’s disease was admitted to the hospital 3 days ago with fever, hypotension and dysuria. He was diagnosed with sepsis secondary to urinary tract infection and has been on treatment with Ampicillin and Gentamicin. Urine cultures revealed enterococci. Over the past two days, his blood pressure improved and he has been afebrile however, he has become increasingly immobile and excessively tremulous. He is unable to rise from a chair or walk without help.  His home medications include Levodopa, Benserazide and Selegeline. On physical examination, blood pressure is 130/80 mm Hg. He is alert, awake and oriented. He has severe bilateral resting tremor, generalized rigidity and bradykinesia . Results of routine blood tests showed no abnormality and CT of the head is normal.  Which of the following is the most appropriate management at this time?

A) Increase Levodopa

B) Add Carbidopa

C) Discontinue Gentamicin

D) Add Piperacillin-Tazobactam

E) Start Bromocriptine

%d bloggers like this: