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Table of Contents
                            Contents
Contributors
Student Reviewers
Preface
Acknowledgements
1. Warm-Up Questions and Exam-Taking Skills
	Questions
	Answers and Explanations
2. General Pediatrics
	Questions
	Answers and Explanations
3. The Neonate
	Questions
	Answers and Explanations
4. Growth and Development
	Questions
	Answers and Explanations
5. Feeding and Nutrition
	Questions
	Answers and Explanations
6. Fluids, Electrolytes, and Metabolic Disorders
	Questions
	Answers and Explanations
7. Infectious Diseases
	Questions
	Answers and Explanations
8. Injuries, Poisoning, and Substance Abuse
	Questions
	Answers and Explanations
9. Pediatric Therapeutics
	Questions
	Answers and Explanations
10. Case Diagnosis and Management
	Questions
	Answers and Explanations
11. Practice Test
	Questions
	Answers and Explanations
Bibliography
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
	X
	Y
	Z
                        
Document Text Contents
Page 2

Mary Anne Jackson, MD
Chief, Section of Pediatric Infectious Diseases

Children’s Mercy Hospital & Clinics
Professor of Pediatrics

University of Missouri, Kansas City School of Medicine
Kansas City, Missouri

Sara S. Viessman, MD
Former Director, Pediatric Residency Program and Associate Professor

Former Director, Med-Peds Residency Program
University of Missouri-Columbia School of Medicine

Columbia, Missouri
Former Associate Dean for Medical Education at Lehigh Valley Hospital

Penn State College of Medicine
Allentown, Pennsylvania

PEDIATRICS

LANGE Q&A™
SEVENTH EDITION

New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto

Page 168

158 7: Infectious Diseases

66. A 7-year-old unimmunized child presents with
fever and vesicular rash. You notice about 300
lesions, some of which were crusted. You sus-
pect varicella infection. Which of the following
is a TRUE statement about varicella?

(A) It has an incubation period of 5–7 days.
(B) The rash is confluent, centrifugal, and

pustular.
(C) It is associated with Koplik spots.
(D) There is a high risk of shingles.
(E) It can cause visceral dissemination in

the immunocompromised host.

67. You are counseling a primigravid woman who
has been found to be rubella nonimmune on
prenatal laboratory evaluation. She asks you if
her fetus is at risk for malformations. When is
maternal infection with rubella virus most
commonly associated with congenital defects?

(A) in the first 4 weeks of gestation
(B) in the second month
(C) in the third or fourth month
(D) in the last trimester
(E) anytime during pregnancy

68. A 15-year-old has exudative tonsillitis, cervical
adenitis, and splenomegaly. His monospot test
is positive. Which of the following is the most
common complication encountered?

(A) chronic fatigue lasting greater than
6 months

(B) hemorrhage
(C) pneumonia
(D) encephalitis
(E) airway obstruction

69. An 8-year-old male presents to the emergency
department with an erythematous, swollen
hand. He sustained a dog bite to the hand the
day prior which broke the skin and was treated
with irrigation. Purulent material drains from
the bite site with palpation. What is the most
likely organism causing this infection?

(A) Pasteurella multocida
(B) Eikenella corrodens

(C) Streptobacillus moniliformis
(D) group A streptococcus
(E) Staphylococcus aureus

70. A 15-year-old presents with fever, acute pharyn-
gitis, and rash. Rapid streptococcal antigen test-
ing is negative. Three days later the laboratory
informs you that A haemolyticum is growing on
culture. Which of the following is the most
accurate description of the rash associated with
this infection?

(A) It has a rough, sandpaper-like texture.
(B) It has a tendency to involve the palms

and soles.
(C) It has a tendency to become vesicular

within 24 hours.
(D) It is pustular.
(E) It has a predilection for the face.

71. A 3-year-old child travels with his family to
Mexico, where he dines on the local cuisine. One
month after return, he develops fever, anorexia,
myalgias, and abdominal pain. Serologic testing
is positive for Brucella infection. Which of the
following is a common manifestation of bru-
cellosis in children?

(A) hepatosplenomegaly
(B) glaucoma
(C) meningitis
(D) endocarditis
(E) osteomyelitis

72. A 3-year-old child in day care develops abdom-
inal pain with diarrhea and malaise. His class
recently had a field trip to the local petting zoo.
Stool culture subsequently grows Campylobacter
jejuni. Which of the following is the most common
clinical manifestation that follows infection with
Campylobacter?

(A) Guillain-Barré syndrome
(B) polyarticular arthritis
(C) encephalitis
(D) inguinal lymphadenitis
(E) anterior uveitis

Page 169

Questions: 66–78 159

73. You see a 5-year-old child in your office with a
palpable lymph node in her right axilla that is
progressing in size over the last 3 days. It has
become erythematous and warm. On exami-
nation, the node is indurated. You also note
many scratches on the child’s arms. On further
questioning, you discover that the family has
recently adopted a new kitten. What is the most
likely etiology of the child’s adenopathy?

(A) Coxiella burnetii
(B) Streptobacillus moniliformis
(C) Bartonella henselae
(D) Mycobacterium avium complex
(E) Mycobacterium tuberculosis

74. A 3-month-old infant is admitted to the hospital
with respiratory distress. He has had cough and
congestion for the last 2 days and is now breath-
ing too fast to eat effectively. You suspect bron-
chiolitis and respiratory syncytial virus (RSV)
antigen testing is positive. Which of the following
roentgenographic findings is most commonly
seen in infants with bronchiolitis caused by RSV?

(A) hyperinflation
(B) hilar adenopathy
(C) multilobar infiltrate
(D) lower lobe infiltrates
(E) pleural effusion

75. An 8-year-old was hiking with his Boy Scout
troop a few days ago. He now presents to your
office with 2 days of abdominal pain. On further
history, you realize he drank from the stream
on his hike. You suspect Giardia intestinalis infec-
tion. What additional symptom would you see
most commonly in a child with giardiasis?

(A) fever
(B) watery diarrhea
(C) bloody diarrhea
(D) failure to thrive
(E) vomiting

76. After confirmation of giardiasis by antigen test-
ing on the stool, you initiate therapy on the
child in the previous question. What is the most
appropriate therapy for giardiasis?

(A) trimethoprim-sulfamethoxazole
(B) ketoconazole
(C) mebendazole
(D) nitrofurantoin
(E) metronidazole

77. A 3-year-old child from Somalia presents to the
emergency department with a 2-week history
of low-grade fever, headache, and irritability.
This morning he was difficult to arouse and
subsequently had a seizure. On examination,
he has a temperature of 102.2°F (39°C), nuchal
rigidity, and somnolence. You discover that he
and his parents had positive tuberculin skin
tests on arrival to the United States and suspect
tuberculous meningitis. Which of the following
is characteristic of the cerebrospinal fluid in
tuberculous meningitis?

(A) The color is usually blood tinged.
(B) Protein is normal.
(C) Culture reveals tuberculous organisms

within 1 week.
(D) Glucose is low.
(E) Neutrophils predominate.

78. A3-month-old African American infant presents
to the emergency department on Thanksgiving
weekend with fever and hematochezia. From
the history, you discover that the family pre-
pared chitterlings for the Thanksgiving meal.
Fecal leukocytes are present. Stool cultures are
positive. What is the most likely etiology of
this infant’s infection?

(A) Salmonella enteritidis
(B) Salmonella typhi
(C) Escherichia coli
(D) Shigella flexneri
(E) Yersinia enterocolitica

Page 335

Pyridoxine dependency, 55, 71
Pyruvate dehydrogenase complex

deficiency, 130, 140
Pyruvate kinase deficiency, 129, 139

R
Rabies, 161, 177
Radial head subluxation, 185, 192
Ranitidine, 203
Rash

“blueberry muffin,” 61, 78
incubation of, 158, 174

Rat bite fever, 295, 314
RDS. See Respiratory distress syndrome
RDW. See Red cell distribution width
von Recklinghausen disease. See

Neurofibromatosis type 1
Rectal prolapse, 23, 39
Rectal suction biopsies, 18, 32
Red blood cell transfusions, 20, 34
Red cell distribution width (RDW), 252
Red tide, 191
Reflexes, 85, 98
Renal tubular acidosis (RTA), 141
Resilience, childhood, 90, 103
Respiratory acidosis, 62–63, 79
Respiratory distress syndrome (RDS)

pathophysiology of, 50, 67
pulmonary surfactant and, 51, 68
radiographic findings of, 52, 68–69
symptoms of, 60, 75

Respiratory rate, normal, 92, 104
Respiratory syncytial virus (RSV), 150, 159,

166, 175, 252
Resuscitation, newborn, 49, 56, 62,

65, 72, 78
Retinal hemorrhage, 311
Retinoblastoma, 4, 9, 26, 42, 288, 307
Retinopathy of prematurity (ROP),

52–53, 69
Rh hemolytic disease, 49, 66
Rheumatic fever, acute

arthritis of, 16, 30
Group A streptococcal infection and,

152, 168
streptococcal infection and, 21, 35

RhoGAM. See Anti-D gamma globulin
Rickets, vitamin D refractory type 1,

130, 140
Rocky Mountain spotted fever, 152–153,

153f, 169, 294, 313
Rocuronium, 199, 214
Rodent poison, 202, 218
ROP. See Retinopathy of prematurity
Roseola, 294, 314
Rotavirus, 152, 169, 289, 308
RSV. See Respiratory syncytial virus
RTA. See Renal tubular acidosis
Rubella, 149, 165

complications of, 158, 174
Rumack-Matthew nomogram, 250, 272

S
Salicylate poisoning, 133, 144–145, 185, 187,

192, 195
absorption prevention and, 207, 222

Salmonella infection, symptoms of, 150,
166–167

Scabies infestation, clinical feature of,
150–151, 167

Scaphocephaly, 54, 70
School readiness, 91, 104
Sciatic nerve injury, 206, 221
SCID. See Severe combined

immunodeficiency
Scoliosis, 283, 303
Secondary syphilis

symptoms of, 162, 178
treatment of, 162, 178

Seizures
absence, 202, 218
case study on, 238, 258–259
complex partial, 18, 32
febrile, 280, 301
management plan for, 238, 258–259
neonatal

first 36 hours of life and, 56, 72
hypopigmented patches and, 54, 70
pyridoxine dependency and, 55, 71

phenytoin for, 200, 216
Selective serotonin reuptake inhibitor

(SSRI), 216
Self-feeding, 95, 108, 113, 120–121
Separation anxiety, 87, 100–101
Sepsis, 203, 218–219
Septic arthritis, 233, 253
Serum concentration

continuous intravenous infusion, 211,
211f, 229

intermittent intravenous dosing, 211,
211f, 229

single intravenous bolus dose, 211, 211f,
229

Serum creatinine kinase, 19, 33
Serum glucose, 127, 137
Severe combined immunodeficiency

(SCID), 36, 162, 177–178, 292–293,
310–311

Sexual abuse, 187, 194
Sexual maturity rating (SMR), 84, 97
Shaken baby syndrome, symptoms of, 22,

36, 185, 192
Shellfish poisoning, 184, 191
Shock, hypovolemic, case study on,

246–247, 268–269
SIADH. See Syndrome of inappropriate

antidiuretic hormone secretion
Sickle cell disease, 20, 27–28, 34–35, 44,

157, 174
case study on, 248, 270
complication of, 279, 299

SIDS. See Sudden infant death syndrome
Single intravenous bolus dose, serum

concentration and, 211, 211f, 229
Skim milk, 114, 116, 121, 123
“Slapped cheek” appearance, 38, 155,

171–172
Sleep apnea, 22, 37
Sleep requirements, newborn, 84, 98
Sleeping positions, 3, 9, 300
Small bowel biopsy, 111, 119
Snoring, 280, 300
Sodium bicarbonate, 209, 225, 293, 312
Sodium nitroprusside, cyanide from, 202,

217–218
Sodium requirements, 128–129, 138–139

Soy-protein formula, 112, 119–120
Speech, 279, 299

language v., 92, 105
Spirillum minus, 295, 314
Splenectomy, 240–241, 261
Splenic sequestration, 279, 299–300
Splenic trauma, 185, 192–193
SSRI. See Selective serotonin reuptake

inhibitor
Staphylococcal food poisoning, 151, 168
Staphylococcal scalded skin syndrome, 152,

168–169
Staphylococcal toxic shock syndrome. See

Toxic shock syndrome
Staphylococcus aureus, 57, 72–73, 148, 164
Steroids. See Anabolic steroids
Stimulant drugs, for ADHD, 203, 218
Stools, bloody, case study on, 246, 268
Stranger anxiety, 95, 108
“Strawberry tongue,” 215
Streptococcal infection. See also Group A

streptococcal infection; Group B
streptococcal infection

pharyngitis v., 158, 174
Streptococcus pneumoniae, 157, 160, 174, 176

penicillin resistance of, 162–163, 178
Stridor, 24, 40, 284, 303
Sturge-Weber disease, 5, 12, 295, 314
Subarachnoid hemorrhage, 290, 309
Subcutaneous fat necrosis, 58, 74
Subdural hematoma, 292–293, 311
Subdural hemorrhage, 60, 76
Succinylcholine, 201, 216–217
Sucrose, 114, 121
Sudden death, 184, 192
Sudden infant death syndrome (SIDS),

3, 9, 101
modifiable risk factors for, 280, 300

Suicide, adolescent, 187, 195, 245, 266–267
Supravalvular aortic stenosis, 27, 44,

294, 313
Supraventricular tachycardia (SVT), 62, 78

case study on, 236–237, 257
SVT. See Supraventricular tachycardia
Sweat chloride test, 23, 39, 115, 122, 131,

142, 287, 306
Syndrome of inappropriate antidiuretic

hormone secretion (SIADH), 127,
136–137, 289, 308–309

diagnosis of, 290, 309
therapy for, 290, 309

Synovitis, transient, 26, 42
Syphilis. See Congenital syphilis; Secondary

syphilis

T
Treponema pallidum, 155, 167
TAR. See Thrombocytopenia absent radius

syndrome
Tay-Sachs disease, 19, 33, 134, 145
TCA. See Tricyclic antidepressants
TEC. See Transient erythroblastopenia of

childhood
Teeth, 82, 85, 96, 99
Television, 88, 93, 101, 106
Temper tantrums, 86, 100
Temperament, child, 95, 107
Tension pneumothorax, 60, 76

Index 325

Page 336

Terminal complement deficiency, 162, 178
Testes, undescended, 25, 42
Testicular torsion, 23, 38, 283, 303
Tetanus immune globulin (TIG), 177
Tetanus prophylaxis, case study on, 236,

256, 256t
Tetralogy of Fallot, 134, 146
TGA. See Transposition of the great arteries
Theophylline, 210, 227, 228
Thiazide diuretic therapy, 201, 217
Thrombocytopenia, 59, 75, 279

maternal, 286, 305
Thrombocytopenia absent radius (TAR)

syndrome, 21, 36, 75
Thyroid dysgenesis, 287, 306

case study on, 233, 253
treatment for, 233, 253

Thyrotoxicosis, 57, 73
TIG. See Tetanus immune globulin
Tinea capitis, 198–199, 213–214

treatment for, 161, 177
Tinea corporis, 198–199, 213–214
Tobacco/cigarette smoking, adolescent,

188, 195
Tobramycin, 198, 213
Toddler fracture, 188, 195

case study on, 239, 260
Toddlerhood, 90–91, 103
Toilet training, 90, 95, 103, 108
Tonic neck reflex, 88, 101
Total anomalous pulmonary venous return,

16–17, 30
Total parenteral nutrition (TPN), 111
Total serum osmolality, 126, 136
Tourette syndrome, 5, 11–12
Toxic shock syndrome, 148, 164
Toxic shock syndrome toxin-1 (TSST-1), 164
Toxocara canis, 155, 171, 291, 310
Toxoplasmosis, 70

from cats, 61, 77
TPN. See Total parenteral nutrition
Transient erythroblastopenia of childhood

(TEC), 20, 34
Transient neonatal pustular melanosis, 54, 70
Transient synovitis of the hip, 289, 308
Transposition of the great arteries (TGA),

case study on, 242–243, 264–265
Trichophyton tonsurans, 161, 177
Tricyclic antidepressants (TCA), 188, 195

poisoning, 209, 225
toxic effect of, 225

Trisomy 13, 61, 77
Trisomy 18, 61, 77

Trisomy 21. See Down syndrome
TSST-1. See Toxic shock syndrome toxin-1
TST. See Tuberculin skin test
TU. See Tuberculin units
Tuberculin skin test (TST), 149, 165

TU reaction and, 150, 166
Tuberculin units (TU), 150, 166
Tuberculosis infection, 150, 166
Tuberculosis meningitis, 159, 175
Tularemia, 160–161, 176
Tumor lysis syndrome, 209, 225–226, 267
Turner syndrome, 294, 313

case study on, 238–239, 259
karyotyping for, 21, 36
symptoms of, 25, 27, 41, 44, 61, 77–78,

259, 276, 296
22q11 deletion syndrome, 21, 33, 36
Typhoid fever, 153, 169, 169f
Tyrosinemia, 128, 138

hereditary, 56–57, 73

U
Umbilical hernias, 282, 302
Underweight, 118, 123
Unintentional injuries, 185, 193

child abuse v., 187, 194–195, 195f
Urethral valves, posterior, 25, 41
Urethritis, 208, 224
Urinary tract infections, 151, 167

circumcision and, 27, 43
infants and, 4, 9

Urine analysis, 20, 34
for edema, 233, 253

Uveitis, 17, 31, 285, 304

V
Vaccine

DTaP, 149, 165
for HBV, 19, 32
infant/childhood schedule of, 162, 178
influenza, 160, 176
measles, 149, 155, 165, 171
pertussis, 3, 9
TIG, 177

Vaginitis, 151, 167
Valproic acid (Depakene/Depakote), 208,

218, 224, 267
Vancomycin, 203, 218
Vanderbilt Assessment Scale, 108
Vanillyl mandelic acid (VMA), 234, 254
Varicella infections, 149, 165

in newborns, 62, 78
rash incubation of, 158, 174

Vegan diet, 112, 119, 277, 297
Vein of Galen aneurysm, 63, 79
Ventricular septal defects (VSD), 287, 306
Very long chain fatty acids (VLCFAs), 130,

140
Vincristine, 206, 221
Vision

acuity, 82, 96
milestones, 87, 100

Vitamin A deficiency, 110, 117
Vitamin B

12, 112, 119, 277, 297
Vitamin D, 111, 118

refractory rickets type I, 130, 140
Vitamin K, 202, 218
VLCFAs. See Very long chain fatty acids
VMA. See Vanillyl mandelic acid
Vocabulary, 83, 97
VSD. See Ventricular septal defects

W
Warfarin, 218
WAS. See Wiskott-Aldrich syndrome
“Washing machine” murmur, 201, 216
Weight gain, normal, 51, 68, 94, 106, 107,

281, 301
Weight loss, newborn, 50, 66, 83, 96
Werdnig-Hoffmann disease, 294, 313

symptoms of, 16, 29
White blood cell count, 153, 169
von Willebrand disease, 286–287, 305–306
Williams syndrome, 294, 313

anomalies, 27, 44
Wilms tumor (nephroblastoma), 276, 296
Wilson disease, 134, 145

symptoms of, 19, 33, 129, 139
Wiskott-Aldrich syndrome (WAS), 36, 283,

303
inheritance pattern of, 19, 33

Wound management, tetanus prophylaxis
and, 236, 256, 256t

X
X-linked agammaglobulinemia, enterovirus

and, 22, 37
XO karyotype, 36
XX karyotype, 133, 143
XXY karyotype, 286, 305

Y
Yersinia enterocolitica, 159, 175

Z
Zinc deficiency, 111, 118, 295, 304

326 Index

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