A 9-year-old girl who recently immigrated from Brazil is evaluated for a single, large, pale skin patch on her back. The pediatrician is assessing her for the cardinal signs of Hansen disease. Which of the following findings would represent one of these three cardinal signs?
A 4-month-old infant, not previously in care, presents with a one-week history of fever, tachypnea, and significant respiratory distress. A chest x-ray reveals diffuse bilateral interstitial infiltrates, and oxygen saturation is 85% on room air. A rapid HIV test on the mother is positive. What is the most common opportunistic infection responsible for this clinical picture in an infant with undiagnosed perinatal HIV?
A 2-year-old with a barking cough, hoarseness, and inspiratory stridor is diagnosed with croup. Despite receiving a single dose of oral dexamethasone, his condition worsens over the next hour. He now has severe substernal retractions, stridor at rest, and appears lethargic. What is the most appropriate next therapeutic intervention?
A 2-year-old child who is not fully immunized against Streptococcus pneumoniae is hospitalized with a life-threatening pneumonia and a large empyema. What is the most appropriate empirical parenteral therapy for this severe presentation?
A 7-year-old girl presents with a sore throat, fever of 38.9°C (102°F), and tonsillar exudates. A rapid antigen detection test for Group A Streptococcus is positive. What is the primary reason for initiating a 10-day course of antibiotic therapy?
A 7-year-old child is brought to the emergency department in June with a 3-day history of fever up to 39.4°C (103°F), severe headache, and myalgias. Today, a maculopapular rash appeared on his wrists and ankles. The family recently returned from a camping trip in North Carolina. What is the most appropriate first-line treatment for this child’s suspected condition?
A healthy 4-month-old infant is found to have cytomegalovirus in her urine during a well-child check. The mother reports exclusively breastfeeding. What is the most common route of cytomegalovirus infection in infancy?
A 4-year-old boy in a childcare center presents with a 1-week history of foul-smelling, greasy stools, abdominal distention, and flatulence. A stool enzyme immunoassay is positive for Giardia duodenalis. What is the preferred treatment for this child?
A 4-year-old child hospitalized for a complex medical condition develops a new fever and worsening clinical status. A urine culture grows Klebsiella pneumoniae that is noted to be resistant to ceftriaxone but susceptible to meropenem. Which mechanism of resistance is most likely responsible for this specific susceptibility pattern?
A term infant is born to a mother who had a positive Group B Streptococcus (GBS) screen at 36 weeks gestation and received adequate intrapartum antibiotic prophylaxis (IAP) more than 4 hours before delivery. The infant is well-appearing with no signs of sepsis. What is the most appropriate management for this newborn?
