Which of the following organisms would you be worried about if the question referred to ingestion of “goat cheese” or “uncooked hot dogs”?
A: Listeria
B: Pseudomonas
C: GBS
D: E. coli
E: enterococcus

A 4-year-old, previously well boy presents with a 6-day history of subjective fever, crampy abdominal pain, frequent episodes of watery diarrhea, and malaise. He is afebrile on physical examination. He looks fatigued, but no abnormal focal findings are identified. A stool culture is obtained, which is positive for Salmonella serotype enteritidis.



What is the most appropriate next step in the patient’s treatment?
A: Administer a single dose of IM ceftriaxone
B: Treat with oral ampicillin for 7 days
C: Treat with Bactrim for 7 days
D: No antimicrobial treatment is indicated
E: Administer a single dose of penicillin G IM

A 17-month-old girl presents with a 2-day history of increased temperature, poor feeding, and irritability. On physical examination, she is noted to have a rash and oral lesions. Which of the following describes the findings associated with coxsackievirus?
A: Widespread punctuate papular erythematous lesions associated with oral ulcerations covering the soft and hard palates
B: Maculopapules and vesicular lesions on the palms and soles with ulcerations of the soft palate and anterior tonsillar pillars
C: Multiple light reddish-pink macular lesions on the anterior and posterior trunk associated with gingival erythema and ulcerations
D: A “sunburn-like” malar flush associated with multiple well-demarcated ulcerations on the tongue and buccal mucosa
E: Blistering and crusting of the lips associated with marginated wheals with central vesicles on the anterior and posterior trunk

Following clinical evaluation for a febrile illness, an 11-year-old girl is thought to likely have an infection caused by adenovirus.



Which of the following findings is most likely to be associated with this patient’s illness?
A: Enlargement of the liver and spleen
B: Ulcerative lesions covering the soft palate
C: Swelling of one or more large joints
D: Inflammation of the bulbar and palpebral conjunctiva
E: Petechiae covering the extensor surfaces of the hands and feet

A 3-week-old infant presents with a history of worsening cough. Her mother reports difficulty with feeding and episodes of post-tussive vomiting. Paroxysms of cough are observed during physical examination, and the patient is admitted for additional evaluation. The patient is subsequently diagnosed with pertussis.


Which of the following represents a potential complication of treatment in this patient?
A: Achalasia
B: Intussussception
C: Volvulus
D: Toxic megacolon
E: Infantile hypertrophic pyloric stenosis

A 12-year-old boy is seen in follow-up 3 days after beginning treatment with amoxicillin/clavulanate for axillary lymphadenopathy. His parents state that his pain has worsened, the nodes have enlarged, and he has experienced shaking chills over the last 24 hours. On physical examination, his temperature is 103.2° F (39.6° C). An irregular, erythematous, painful ulceration is noted on the left forearm associated with several fluctuant clustered left axillary nodes; hepatosplenomegaly is noted on abdominal examination. These findings are most consistent with infection associated with close contact with...
A: Turtle
B: Ferret
C: Rabbit
D: Dog
E: Snake

A 3-year-old boy presents to the emergency department after 2 episodes of bloody diarrhea. His parents report that he has become increasingly lethargic and pale over the last several days. Laboratory findings include a hemoglobin of 6 g/dL; helmet cells, burr cells, and fragmented red blood cells are evident on examination of the peripheral blood smear. These clinical and lab findings are most associated with which of the following?
A: Ingestion of undercooked hamburger meat
B: Recent travel to the southern New England area
C: Ingestion of fried rice
D: Ingestion of contaminated soil
E: A pet turtle in the home

An 11-year-old girl presents with a history of subjective fever, myalgia, headache, and a rash that she first noticed the day prior to presentation. On physical examination, her temperature is 100.6° F (38.1° C). A 3 x 5-cm circular erythematous lesion with central clearing is present on the left upper thigh. A similar but smaller lesion is located just below her left knee. Which complication often occurs if appropriate treatment is not given?
A: Lower back pain with paresthesias and urinary retention
B: Unilateral facial nerve palsy
C: Symmetric proximal lower extremity weakness
D: Temporary loss of vision with hemiparesis
E: Miosis, ptosis, and anhidrosis

A 12-year-old boy presents with a red eye. He had been swimming at the local pool 3 days ago. Initially, his mother thought it was just the chlorine, but he woke up with “crust” in his eyes. She has called around, and 4 other children from that day at the pool now have the same red-eye symptoms.
A: H. flu
B: Neisseria
C: Streptococcus pneumonia
D: HSV
E: Adenovirus

A 6-year-old comes into the emergency department because of dysphagia and respiratory distress. This morning he had acute onset of fever and a severe sore throat. He is now drooling, his voice is raspy, and he has stridor. He is in obvious respiratory distress and leaning forward with the “I am going to die” look. What should you do next?
A: Call for immediate ENT or anesthesia and start erythromycin
B: Call for immediate ENT or anesthesia and start linezolid
C: Call for immediate ENT or anesthesia and start vancomycin and ceftriaxone
D: Culture the back of the throat; call for immediate ENT/anesthesia and start ceftriaxone and vancomycin
E: Call for immediate ENT or anesthesia and start penicillin

A 7-year-old boy presents with an uncomfortable and pruritic rash that began several days earlier during a family vacation at the beach. On physical examination, several erythematous papules are noted on the dorsal surface of the left foot and lateral malleolus. Brownish-red, palpable, well-demarcated, serpiginous plaques extend from each papule; these plaques have continuously lengthened since first observed.


Which of the following is the most appropriate treatment in this patient?
A: oral itraconazole
B: topical acyclovir cream
C: Oral albendazole
D: Oral clindamycin
E: Topical nystatin cream

A 7-year-old boy presents with a 2-day history of anorexia, malaise, watery, nonbloody, profuse diarrhea, and vomiting. His parents report that he recently returned from a trip to a local water park. Examination of the stool reveals small rounded oocysts.



Which of the following is the most appropriate treatment for this patient?
A: Paramomycin
B: Doxycycline
C: Nitazoxanide
D: Sulfadiazine
E: Mebendazole

An 11-year-old boy is transported to the emergency department after his mother found him to be unresponsive when she attempted to awaken him. He is febrile and difficult to arouse. Multiple petechial, purpuric, and ecchymotic lesions are noted on the trunk and extremities. Following stabilization, a lumbar puncture is performed. Gram stain of a CSF sample reveals numerous gram-negative diplococci.Which of the following is often identified in patients at increased risk for infection with this organism?
A: Glomerular hypercellularity with crescent formation on renal biopsy
B: Reed-Sternberg cells on bone marrow biopsy
C: Reducing substances in the urine
D: Elevated serum ammonia levels
E: Terminal complement component deficiency

The parents of a 7-year-old girl present with the concern that their daughter has had a rash for several days. By history, the rash is nonpruritic. In addition, they state that she has been “sleeping with her left eye partially opened.” She had been well until 4–6 weeks ago, when she complained of fatigue, headache, and arthralgia. She was diagnosed with “a virus” and treated symptomatically at that time.

On physical exam, she has multiple annular erythematous lesions on the trunk and upper extremities. She is unable to close her left eye, and the left corner of her mouth droops.


Which of the following is the most likely cause of this patient’s symptoms?
A: borrelia burgdorferi
B: Bartonella henselae
C: HSV
D: Ehrlichia chaffeensis
E: Rickettsia rickettsii


The patient has facial nerve palsy (Bell’s palsy) and a rash consistent with multiple erythema migrans, the most common manifestation of early disseminated Lyme disease.

A 3-month-old boy is hospitalized because of continued worsening of upper respiratory symptoms, including a prominent cough associated with post-tussive vomiting. During evaluation, a polymerase chain reaction (PCR) assay for Bordetella pertussis is positive. Which lab finding is most likely?
A: Elevated WBC with increased segmented neutrophils
B: Elevated WBC with increased eosinophils
C: Elevated WBC with increased lymphocytes
D: Depressed WBC with increased lymphocytes
E: Depressed WBC with increased segmented neutrophils

A 15-year-old boy complains of increased temperature, headache, chills, and generalized malaise. On physical examination, an ulcerated lesion is noted on the left leg associated with 3 tender, distinct, 2 x 4-cm left inguinal lymph nodes. Upon further history, it is learned that the patient removed several ticks from his legs during a recent camping trip with the Boy Scouts. What is the most likely etiology:
A: Francisella tularensis
B: Bartonella henselae
C: Ehrlichia chaffeensis
D: Rickettsia rickettsia
E: Borrelia burgdorferi

A 1-year-old boy presents for his first visit after arriving in the United States following his adoption from an orphanage in Guatemala. According to his adoptive parents, he appears well and is free of any systemic symptoms. Which screening test is routinely recommended for international adoptees?
A: Urine CMV
B: Serologic testing for N. meningitides
C: Stool for Giardia
D: CXR for TB
E: Stool for E. coli O157:H7

During a prenatal ultrasound at 24 weeks of gestation, significant fetal edema is identified in the subcutaneous tissue, pleura, liver, and abdomen. There is also evidence of an increase in the amount of amniotic fluid.
Which of the following rashes is caused by the same infectious agent that accounts for the ultrasound findings in this patient?
A: A vesicular rash following a thoracic dermatome
B: Grouped tender vesicles around the mouth and nose
C: A diffuse macular rash with fine raised punctate lesions giving the skin a rough texture
D: Bright red erythema of the cheeks, which spares the perioral, nasal, periorbital areas, associated with a fine erythematous macular rash on upper extremities
E: Numerous papules and vesicles on an erythematous base in addition to other lesions that have crusted

During initial evaluation of a 4-pound, 1-ounce female born at 36 weeks of gestation, she is noted to have a head circumference of < 3rd percentile. Additional abnormalities include bilateral cataracts; multiple areas of scarring, some of which appear to follow along a dermatome; and a shortened hypoplastic left leg.


Which of the following is the most likely cause of the clinical findings in this patient?
A: An amniotic band
B: toxoplasmosis
C: CMV
D: Varicella virus
E: HSV

A 7-week-old female presents with a 48-hour history of cough. She is afebrile with a respiratory rate of 66 breaths/minute. Rales in the absence of wheezing are noted on auscultation. Hyperinflation with minimal interstitial and alveolar infiltrates is noted on chest x-ray.


Which of the following additional findings increases the likelihood that this patient’s clinical and radiographic findings are due to Chlamydia trachomatis?
A: Elevated titers of cold antibodies
B: Eosinophilia
C: Large inclusion bodies in all nucleated RBC
D: Leukocytosis with an absolute lymphocytosis
E: Leukopenia with an ANC of 1,000-1,500 cells/uL

An 8-year-old boy living in Arkansas presents complaining of a “swollen, infected, and tender neck gland” associated with fever, nausea, and vomiting. On physical examination, his temperature is 103° F. Positive findings include a tender, fluctuant, and warm 2 x 1.5-cm anterior cervical lymph node and an ulcerative lesion with associated eschar formation located several inches below the node. Upon further questioning, the patient and his father report that they recently have been caring for a rabbit after it was bit by their family dog.



Which of the following is the most appropriate choice of treatment for this patient?
A: Imipenem/cilastatin
B: Gentamicin
C: Itraconazole
D: Famiciclovir
E: Cefotaxime

A 13-year-old female is transported to the emergency department by her parents because she “started talking out of her head after vomiting 5 times in an hour.” The patient appears confused and disoriented, recognizing none of her family members. There is no significant past medical history, recent travel, or sick contacts. Her temperature is 104.0° F (40° C), heart rate is 160 beats/minute, and blood pressure is 75/30. On physical exam, she has conjunctival hyperemia, a “strawberry” tongue, and a diffuse intensely erythematous rash without associated petechiae or purpura. Laboratory results include marked elevation of serum transaminases, a BUN of 44 mg/dL, and a serum creatinine of 3.6 mg/dL.

Which of the following is the most likely cause of this patient’s clinical and laboratory findings?
A: Scarlatina
B: Toxic shock syndrome
C: Reye syndrome
D: Rocky Mountain Spotted Fever
E: HUS

A 4-year-old unvaccinated boy presents with a 2-day history of fever and rash. Findings on physical examination include retroauricular, posterior cervical, and posterior occipital lymphadenopathy. Which of the following best describes the most likely findings upon further evaluation of this patient?
A: Painful tender popular and vesicular lesions in a dermatomal distribution
B: Scattered vesicles on an erythematous base that is intensely pruritic
C: A discrete erythematous macular rash associated with reddish-pink spots on the soft palate
D: Prominently erythematous cheeks associated with circumoral pallor and a reticulated rash on the upper extremities
E: A diffuse, fine, macular popular erythematous rash especially prominent in the axilla, groin, and antecubital areas associated with circumoral pallor

A 6-year-old girl presents with a 2-day history of a “red eye.” She describes only minimal pain and denies associated trauma. The conjunctiva of her right eye is very erythematous. No discharge is present. The upper lid is swollen without associated tenderness or warmth. A prominent ipsilateral preauricular node is palpated. Referral to an ophthalmologist reveals unilateral conjunctival granuloma in the right eye. What is the most likely cause?
A: Bartonella henselae
B: HSV
C: Histoplasma capsulatum
D: Toxoplasma gondii
E: Adenivirus

A 5-year-old girl recently adopted from the Ukraine presents for a physical examination. She is asymptomatic and has a normal examination and growth parameters. By report, she received a bacillus Calmette-Guérin (BCG) vaccine at an earlier age. A tuberculin skin test (PPD) measures 10 mm of induration after 48 hours. A chest radiograph is unremarkable.


Which of the following helps in the evaluation of this patient?
A: culture of early morning gastric aspirate
B: Acid fast smear of early morning gastric aspirate
C: Interferon gamma release assay
D: Culture of sputum following induction with aerolisized hypertonic saline
E: Culture of bronchial washings