The answer is E.
EXPLANATION: Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death, especially in certain populations. Some people, such as older people, young children, and people with certain health conditions including pregnancy, are at the highest risk for serious flu complications. The best way to prevent the flu is by getting vaccinated each year. The vaccine contains three strains (two of influenza A and one of influenza B) and is derived from chicken embryos and people with severe egg allergies should not be vaccinated. However, if a person is able to eat backed goods manufactured in the United States, according to the CDC, their potential level of allergy is so low that the benefit of vaccination outweighs any reaction. Once a vaccine-eligible patient has a viral-like illness and their fever resolves, he or she should receive the annual influenza vaccine.
he answer is A.
EXPLANATION: Cytomegalovirus (CMV) is one of the congenital neonatal TORCH infections (toxoplasmosis, other [syphilis, varicella-zoster, and parvovirus in this list], rubella, cytomegalovirus, and herpes simplex/hepatitis/HIV). CMV is the most common congenital infection. The disease-specific manifestations for CMV include microcephaly with periventricular calcifications, neonatal jaundice with direct hyperbilirubinemia, and hepatosplenomegaly. Other associated manifestations include intrauterine growth retardation, thrombocytopenia, and purpura. Disease-specific manifestations for herpes simplex virus include skin/eye/mouth vesicles, encephalitis, respiratory distress, and sepsis. Disease-specific manifestations of rubella include congenital heart lesions (patent ductus arteriosus, pulmonary artery stenosis, aortic stenosis, ventricular defects), thrombocytopenic purpura characterized by purple macular lesions ("blueberry muffin" appearance), cataracts, retinopathy, and sensorineural deafness. Disease-specific manifestations of syphilis include mucocutaneous lesions (snuffles), periostitis, osteochondritis, and hemolytic anemia. Often, these babies are stillborn. Syphilis is caused by a spirochete, Treponema pallidum, not a virus.
The answer is B.
EXPLANATION: While halitosis can be caused by pharyngitis, sinusitis, and poor hygiene, the most common cause of halitosis in children is a nasal foreign body. Seeds and beads are the leading objects inserted into the nose. If not promptly removed, they can cause nasal obstruction, infection, rhinorrhea, bleeding, halitosis, or a foul smell. They are usually easy to remove, but if there is difficulty in removing the foreign body, the child should be referred to an otolaryngologist for definitive care. Tobacco use in adolescents is a common cause of halitosis. Dental disease is the most common cause of halitosis in adults.
The answer is D.
EXPLANATION: Guillain-Barré syndrome is most likely due to a delayed hypersensitivity with T-cell-mediated antibodies to mycoplasma and viral infections (CMV, EBV, hepatitis B, campylobacter jejuni). The patients may mention a nonspecific respiratory or gastrointestinal infection 1 to 2 weeks prior to symptoms. Complaints may be paresthesias, weakness in bilateral lower extremities with occasional ascension into the arms, trunk, and face, and rarely ataxia and ophthalmoplegia in the Miller-Fisher variant. Examination findings demonstrate symmetric flaccid weakness, with impairment of position, vibration, and touch in the distal portions of the extremities. If a spinal tap is performed, it may show few polymorphonuclear neutrophils with high protein and normal glucose. EMG is positive for decreased nerve conduction. Laboratory tests may show high titers of suspected infections or active infection of hepatitis/bacterial pathogens. Guillain-Barré is normally a self-limiting disorder within a few weeks, unless there are issues with respiratory depression.
The answer is C.
EXPLANATION: Generalized tetanus (lockjaw) is a neurologic disease caused by Clostridium tetani. Although any open wound is a potential source for contamination with C tetani, those with dirt, soil, feces, or saliva are at increased risk. Tetanus-prone wounds contain devitalized tissue, especially those caused by punctures, frostbite, crush injury, or burns. Recommendations for tetanus prophylaxis in a child with a laceration or abrasion depend upon the number of previous vaccinations, occurrence of last booster, type of wound (clean or tetanus-prone), and age of child. In this case, the patient is older than 7 years and had all of his previous immunizations; however, his most recent booster was greater than 10 years ago. Thus, he should receive an adult-type diphtheria and tetanus toxoid with acellular pertussis. In most cases, when tetanus toxoid is required for wound prophylaxis in a child older than 7 years, the Td instead of tetanus toxoid alone is recommended so that diphtheria immunity is maintained. If tetanus immunization is not up to date at the time of wound treatment, then the immunization series should be completed according to the primary immunization schedule. If a child is younger than 7 years, then the diphtheria, tetanus, acellular pertussis (DTaP) booster is indicated, unless there is a contraindication for pertussis, in which case the diphtheria and tetanus (DT) booster should be administered. Tetanus immune globulin (TIG) is recommended for treatment of tetanus. Under special circumstances, a patient infected with the human immunodeficiency virus (HIV) with a tetanus-prone wound should also receive TIG in addition to the prophylactic vaccine