A 10-year-old girl has had a “cold” for 14 days

A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C (102.2°F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?

a. Brain abscess

b. Maxillary sinusitis

c. Streptococcal throat infection

d. Sphenoid sinusitis

e. Middle-ear infection

the answer is below…

A 38-year-old man who is immunocompromised because of HIV presents with 1 month of worsening right headache, ear pain, and fever

A 38-year-old man who is immunocompromised because of HIV presents with 1 month of worsening right headache, ear pain, and fever. He is determined to have malignant external otitis and osteomyelitis of the base of the skull. The etiology is fungal. Fungal malignant external otitis and osteomyelitis of the base of the skull in HIV patients is most commonly caused by which of the following?

a. Nocardia

b. Cryptococcus neoformans

c. Actinomyces

d. Aspergillus

e. Candida

the answer is below…

A 4-year-old boy and the complaint of “difficulty breathing”

A 4-year-old boy was admitted to the hospital last night with the complaint of “difficulty breathing.” He has no past history of lung infection, no recent travel, and no day-care exposure; he does, however, have an annoying tendency to eat dirt. In the emergency center he was noted to be wheezing and to have hepatomegaly. He is able to talk, relaying his concern about his 6-week-old Chihuahua being left alone at home. Laboratory studies revealed marked eosinophilia (60% eosinophils). Which of the following tests is most likely to produce a specific diagnosis?

a. Tuberculin skin test

b. Histoplasmin test

c. ELISA for Toxocara

d. Silver stain of gastric aspirate

e. Stool examination for ova and parasites

the answer is below…

A 10-year-old girl has had a “cold” for 14 days

A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C (102.2°F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?

a. Brain abscess

b. Maxillary sinusitis

c. Streptococcal throat infection

d. Sphenoid sinusitis

e. Middle-ear infection

the answer is below…

A fully immunized 2-year-old with several days of low-grade fever, barking cough, and noisy breathing

A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?

a. Intubation and intravenous antibiotics

b. Inhaled epinephrine and oral steroids

c. Inhaled steroids

d. Observation in a cool mist tent

e. Oral antibiotics and outpatient follow-up

the answer is below…