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Question 1General Pediatric Pharmacotherapy Principles, Growth, and Development

A 2-day-old term neonate is given an oral weak-acid medication. Compared with an older child, gastric pH in this neonate is best described as:

  1. Equal to that of older children
  2. Lower than in older children
  3. Neutral regardless of age
  4. Higher than in older children Correct answer.

Explanation

Acid secretion is immature at birth, so neonatal gastric pH is relatively high (less acidic), particularly in the first days of life. Weak acids remain more ionized at higher pH and therefore cross the gastric mucosa poorly. This pattern reverses as gastric acid output matures over the first months of life.

Question 2General Pediatric Pharmacotherapy Principles, Growth, and Development

Which pediatric dose is conventionally calculated from body surface area rather than from body weight alone?

  1. Amoxicillin
  2. Acetaminophen
  3. Albuterol
  4. Mercaptopurine Correct answer.

Explanation

Antineoplastic agents such as mercaptopurine are dosed by body surface area because BSA correlates better with marrow tolerance and toxicity for narrow-therapeutic-index cytotoxic drugs. Most routine pediatric anti-infective and analgesic doses are weight-based in mg/kg.

Question 3General Pediatric Pharmacotherapy Principles, Growth, and Development

Benzyl alcohol–containing intravenous flush solutions are avoided in neonates because benzyl alcohol has been associated with which adverse effect?

  1. Gray baby syndrome with shock
  2. Hyperkalemia with arrhythmia
  3. Kernicterus with hearing loss
  4. Gasping syndrome Correct answer.

Explanation

Neonates have limited capacity to oxidize benzyl alcohol to benzoic acid and conjugate it with glycine, so the preservative accumulates. This has produced a fatal neonatal gasping syndrome with metabolic acidosis. Preservative-free flushes are therefore used in newborns.

Question 4General Pediatric Pharmacotherapy Principles, Growth, and Development

Which vaccine is contraindicated in a child receiving high-dose systemic corticosteroids?

  1. Varicella vaccine Correct answer.
  2. Diphtheria-tetanus-acellular pertussis
  3. Hepatitis B vaccine
  4. Inactivated influenza vaccine

Explanation

High-dose systemic corticosteroids cause clinically significant immunosuppression, and live attenuated vaccines such as varicella can cause disseminated infection in that setting. Inactivated vaccines remain appropriate and are in fact recommended for these children. Live vaccines are generally deferred until immunosuppression has resolved.

Question 5General Pediatric Pharmacotherapy Principles, Growth, and Development

At approximately what age does a healthy term infant typically double the birth weight?

  1. 18 months
  2. 4 to 5 months Correct answer.
  3. 12 months
  4. 8 to 9 months

Explanation

Term infants usually double their birth weight by about 4 to 5 months and triple it by about 12 months. These landmarks are used to screen for adequate growth and nutrition. Deviations should prompt evaluation of intake and underlying disease.

Question 6General Pediatric Pharmacotherapy Principles, Growth, and Development

Most children develop the ability to reliably swallow small tablets whole at approximately which age?

  1. 2 years
  2. 13 years
  3. 6 years Correct answer.
  4. 10 years

Explanation

Coordination for swallowing solid dosage forms generally matures around 6 years of age, although individual variation is wide. Younger children usually require liquids, chewables, or dispersible formulations. Age alone does not guarantee ability, so the first dose should be observed.

Question 7General Pediatric Pharmacotherapy Principles, Growth, and Development

Neonates often need larger weight-based doses of water-soluble drugs than adults mainly because neonates have:

  1. More total body water per kilogram Correct answer.
  2. Higher plasma protein binding
  3. Faster hepatic blood flow
  4. More adipose tissue per kilogram

Explanation

Total body water is about 75% to 80% of body weight in neonates versus roughly 60% in adults, enlarging the apparent volume of distribution of hydrophilic drugs. A larger volume of distribution lowers plasma concentrations for a given mg/kg dose. This is one reason loading doses of water-soluble drugs may be relatively larger in newborns.

Question 8General Pediatric Pharmacotherapy Principles, Growth, and Development

Morphine is eliminated mainly by glucuronidation. In a 1-week-old term neonate, the elimination half-life compared with an older child is:

  1. Longer, so intervals are extended Correct answer.
  2. Similar, so doses are unchanged
  3. Shorter, so larger doses are needed
  4. Shorter, but with higher peaks

Explanation

UDP-glucuronosyltransferase activity is markedly reduced in the first weeks of life, so glucuronidated drugs such as morphine clear slowly. The resulting longer half-life requires extended dosing intervals and careful monitoring for respiratory depression. Activity increases over the first months of life.

Question 9General Pediatric Pharmacotherapy Principles, Growth, and Development

Which statement best describes hepatic CYP3A4 activity during the first year of life?

  1. Low at birth, rising to above adult levels Correct answer.
  2. Absent until puberty
  3. Highest at birth, then declining
  4. Fully mature at birth

Explanation

CYP3A4 activity is low in the newborn period and increases rapidly during the first year, often exceeding adult weight-normalized values in infancy. Clearance of CYP3A4 substrates therefore changes substantially over the first 12 months. This ontogeny is a major reason dosing must be reassessed as infants grow.

Question 10General Pediatric Pharmacotherapy Principles, Growth, and Development

A healthy term neonate's glomerular filtration rate, expressed per 1.73 m², is approximately what fraction of the adult value?

  1. 30% to 40% Correct answer.
  2. 5% to 10%
  3. 70% to 80%
  4. 100%

Explanation

GFR is low at birth, roughly 30% to 40% of adult values per body surface area in a term neonate, and rises rapidly over the first weeks. Adult values per 1.73 m² are generally reached by about 1 to 2 years of age. Drugs cleared renally therefore need extended intervals early in life.

Question 11General Pediatric Pharmacotherapy Principles, Growth, and Development

Which maternal drug property most favors low infant exposure during breastfeeding?

  1. High maternal protein binding Correct answer.
  2. Low molecular weight
  3. High lipid solubility
  4. Long maternal half-life

Explanation

Only unbound maternal drug is available to diffuse into milk, so extensive maternal protein binding limits transfer. High lipid solubility, low molecular weight, and long half-life all tend to increase milk transfer or infant accumulation. Infant oral bioavailability and dose per kilogram are also considered when estimating risk.

Question 12General Pediatric Pharmacotherapy Principles, Growth, and Development

Ceftriaxone should be avoided in a jaundiced neonate primarily because it:

  1. Inhibits hepatic glucuronidation
  2. Precipitates in renal tubules
  3. Displaces bilirubin from albumin Correct answer.
  4. Causes dose-related hemolysis

Explanation

Ceftriaxone is highly protein bound and competes with bilirubin for albumin binding sites, raising free bilirubin and the risk of kernicterus in hyperbilirubinemic neonates. It is also avoided with calcium-containing intravenous solutions because of precipitation. Alternative agents are preferred in this population.

Question 13General Pediatric Pharmacotherapy Principles, Growth, and Development

Which equation is used to estimate creatinine clearance in children from height and serum creatinine?

  1. MDRD equation
  2. Schwartz equation Correct answer.
  3. Friedewald equation
  4. Cockcroft-Gault equation

Explanation

The Schwartz equation estimates creatinine clearance in children using height, serum creatinine, and a proportionality constant that varies with the assay and age. Cockcroft-Gault and MDRD were derived in adults and are unreliable in children. Friedewald estimates LDL cholesterol.

Question 14General Pediatric Pharmacotherapy Principles, Growth, and Development

Which excipient found in oral liquid formulations can accumulate in neonates and cause hyperosmolar metabolic acidosis?

  1. Sorbitol
  2. Tartrazine
  3. Sodium saccharin
  4. Propylene glycol Correct answer.

Explanation

Propylene glycol is metabolized by alcohol dehydrogenase to lactic acid and pyruvate and is renally eliminated; immature neonatal pathways permit accumulation with hyperosmolarity, metabolic acidosis, and seizures. Sorbitol can cause osmotic diarrhea, and dyes such as tartrazine cause hypersensitivity but not this syndrome.

Question 15General Pediatric Pharmacotherapy Principles, Growth, and Development

A hypoalbuminemic neonate receives a highly protein-bound drug. Compared with a child who has normal albumin, the free drug fraction in this neonate is:

  1. Unchanged
  2. Eliminated
  3. Increased Correct answer.
  4. Decreased

Explanation

Less albumin means fewer binding sites, so a larger proportion of drug circulates unbound. Because only free drug is pharmacologically active and available for hepatic and renal clearance, both effect and toxicity may be enhanced. Highly bound drugs such as phenytoin are especially affected.

Question 16General Pediatric Pharmacotherapy Principles, Growth, and Development

Compared with adults, the elimination half-life of caffeine in a preterm neonate is:

  1. Slightly shorter
  2. Essentially the same
  3. Much longer Correct answer.
  4. Much shorter

Explanation

Caffeine is metabolized by hepatic CYP1A2, which is essentially inactive in the preterm infant, so half-life may be 40 to 100 hours versus a few hours in adults. This permits less frequent dosing for apnea of prematurity. Clearance accelerates as the infant matures and reaches term-equivalent age.

Question 17General Pediatric Pharmacotherapy Principles, Growth, and Development

Under US pediatric research regulations, children generally begin providing written assent to participate in research at approximately which age?

  1. 12 years
  2. 2 years
  3. 7 years Correct answer.
  4. 16 years

Explanation

Assent is typically sought once a child can understand the study at a developmentally appropriate level, generally around 7 years, alongside parental permission. The exact age threshold is set locally, and dissent should be respected. Assent does not replace legally authorized representative consent.

Question 18General Pediatric Pharmacotherapy Principles, Growth, and Development

A child weighing 16 kg is prescribed 15 mg/kg/day of a medication divided into doses given every 8 hours. How much is given with each dose?

  1. 120 mg
  2. 40 mg
  3. 240 mg
  4. 80 mg Correct answer.

Explanation

Multiplying 15 mg/kg/day by 16 kg gives 240 mg per day, and dividing by three doses (every 8 hours) yields 80 mg per dose. Checking that the daily total and interval match the order guards against tenfold errors. Weight-based pediatric calculations should always be double-checked against a maximum dose.

Question 19General Pediatric Pharmacotherapy Principles, Growth, and Development

Codeine is contraindicated after tonsillectomy in children younger than 12 years because some children:

  1. Have reduced renal clearance of codeine
  2. Convert codeine to morphine too rapidly Correct answer.
  3. Develop histamine-mediated hypotension
  4. Lack CYP3A4 activity

Explanation

Codeine is a prodrug activated by CYP2D6 to morphine; ultrarapid metabolizers generate unexpectedly high morphine concentrations and have died of respiratory depression after tonsillectomy. Genotype is usually unknown at the time of prescribing, so the contraindication applies broadly. Alternative analgesics are recommended.

Question 20General Pediatric Pharmacotherapy Principles, Growth, and Development

A child with low thiopurine methyltransferase activity is at highest risk of severe myelosuppression from which drug?

  1. Azathioprine Correct answer.
  2. Methotrexate
  3. Cyclophosphamide
  4. Vincristine

Explanation

Azathioprine is converted to mercaptopurine, which is inactivated by thiopurine methyltransferase; deficient patients shunt the drug toward thioguanine nucleotide accumulation and profound marrow suppression. Genotype or phenotype testing guides substantial dose reduction. The same principle applies to mercaptopurine itself.

Question 21General Pediatric Pharmacotherapy Principles, Growth, and Development

Which anthropometric index is most sensitive to acute malnutrition in a young child?

  1. Mid-thigh circumference
  2. Weight-for-length Correct answer.
  3. Length-for-age
  4. Head circumference-for-age

Explanation

Acute undernutrition causes weight loss or failure to gain while linear growth is preserved, so weight-for-length (wasting) falls first. Length-for-age declines only with chronic or prolonged deprivation, producing stunting. Head circumference tracks brain growth and is relatively spared in acute malnutrition.

Question 22General Pediatric Pharmacotherapy Principles, Growth, and Development

A 20-month-old born at 28 weeks' gestation is being assessed for growth and development. The most appropriate approach is to:

  1. Use adult reference standards
  2. Use chronological age for all plotting
  3. Use corrected age for plotting Correct answer.
  4. Add 15% to all measurements

Explanation

Corrected age subtracts the weeks of prematurity from chronological age and is used for growth and developmental assessment until roughly 2 to 3 years. This avoids falsely labeling a preterm child as delayed or growth-impaired. Chronological age alone underestimates expected performance in this group.

Question 23General Pediatric Pharmacotherapy Principles, Growth, and Development

Screening for which HLA allele is recommended before starting carbamazepine in patients of Han Chinese ancestry?

  1. HLA-B*15:02 Correct answer.
  2. HLA-DQ2.5
  3. HLA-B*27
  4. HLA-B*57:01

Explanation

HLA-B*15:02 carriers of Asian ancestry have a markedly increased risk of carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis, so genotyping is recommended before therapy. Carriers should receive an alternative anticonvulsant. HLA-B*57:01 predicts abacavir hypersensitivity instead.

Question 24General Pediatric Pharmacotherapy Principles, Growth, and Development

A 15-month-old clears a drug more rapidly per kilogram than an adult does, while the volume of distribution per kilogram is similar. The child's elimination half-life is therefore:

  1. Shorter than the adult's Correct answer.
  2. Identical to the adult's
  3. Longer than the adult's
  4. Variable and unrelated

Explanation

Half-life is proportional to volume of distribution divided by clearance, so higher weight-normalized clearance with a comparable volume of distribution yields a shorter half-life. This pattern is typical of toddlers for many hepatically eliminated drugs and can require shorter dosing intervals or higher mg/kg doses. Half-life lengthens again as clearance matures toward adult values.

Question 25Neonatal and Premature Infant Care

Which caffeine citrate maintenance regimen is appropriate for a 1.2 kg preterm infant with apnea of prematurity?

  1. 15 mg/kg every 8 hours
  2. 20-40 mg/kg once daily
  3. 1 mg/kg every 12 hours
  4. 5-10 mg/kg once daily Correct answer.

Explanation

Caffeine citrate is typically loaded at 20-40 mg/kg and then maintained at 5-10 mg/kg once daily, started about 24 hours after the loading dose. Maintenance dosing is adjusted for persistent apnea or signs of toxicity.

Question 26Neonatal and Premature Infant Care

What is the recommended initial intratracheal dose of beractant for a premature infant with respiratory distress syndrome?

  1. 100 mg/kg (4 mL/kg) Correct answer.
  2. 200 mg/kg (8 mL/kg)
  3. 25 mg/kg (1 mL/kg)
  4. 50 mg/kg (2 mL/kg)

Explanation

Beractant is given initially at 100 mg/kg, which corresponds to 4 mL/kg of the 25 mg/mL suspension. Repeat doses of 100 mg/kg may be given at intervals if respiratory distress persists.

Question 27Neonatal and Premature Infant Care

Apnea of prematurity is best defined as cessation of breathing for more than 20 seconds or for a shorter period accompanied by which finding?

  1. Bradycardia or oxygen desaturation Correct answer.
  2. A rise in blood pressure
  3. Metabolic alkalosis
  4. Isolated cyanosis

Explanation

The definition requires a pause longer than 20 seconds, or a shorter pause associated with bradycardia or desaturation. This distinguishes pathologic apnea from brief respiratory pauses.

Question 28Neonatal and Premature Infant Care

Which condition is a contraindication to using indomethacin for closure of a patent ductus arteriosus in a preterm infant?

  1. Necrotizing enterocolitis Correct answer.
  2. Hypocalcemia
  3. Hyperbilirubinemia
  4. Apnea of prematurity

Explanation

Indomethacin reduces mesenteric and renal blood flow, so it is avoided in necrotizing enterocolitis, renal impairment, and active bleeding. In those settings, conservative management or an alternative agent may be considered.

Question 29Neonatal and Premature Infant Care

What is the standard empiric antibiotic regimen for early-onset sepsis in a term newborn?

  1. Ampicillin plus gentamicin Correct answer.
  2. Nafcillin plus rifampin
  3. Ceftriaxone plus vancomycin
  4. Meropenem plus amikacin

Explanation

Early-onset neonatal sepsis is usually caused by group B streptococci, Escherichia coli, and Listeria monocytogenes. Ampicillin plus gentamicin provides appropriate coverage for these organisms.

Question 30Neonatal and Premature Infant Care

When monitoring gentamicin in a neonate receiving extended-interval dosing, when should the trough concentration be drawn?

  1. 30 minutes after the end of the infusion
  2. Immediately after birth
  3. Within 30 minutes before the next dose Correct answer.
  4. At the midpoint of the dosing interval

Explanation

For extended-interval aminoglycoside dosing, the trough is drawn within 30 minutes before the next scheduled dose to confirm adequate drug clearance. Peak concentrations, when measured, are typically drawn about 30 minutes after an intravenous infusion ends.

Question 31Neonatal and Premature Infant Care

Phototherapy reduces unconjugated bilirubin primarily by which mechanism?

  1. Binding bilirubin to albumin in the plasma
  2. Increasing hepatic glucuronidation directly
  3. Stimulating renal tubular secretion of bilirubin
  4. Converting bilirubin to water-soluble isomers and oxidation products Correct answer.

Explanation

Light energy converts unconjugated bilirubin into configurational isomers and oxidation products that can be excreted without hepatic conjugation. Lumirubin formation is a key pathway because it is excreted readily in bile and urine.

Question 32Neonatal and Premature Infant Care

Which radiographic finding is most characteristic of necrotizing enterocolitis?

  1. Ground-glass opacification
  2. Double-bubble sign
  3. Pneumatosis intestinalis Correct answer.
  4. Air bronchograms

Explanation

Pneumatosis intestinalis, which represents intramural gas from gas-forming organisms, is the hallmark radiographic sign of necrotizing enterocolitis. Portal venous gas and pneumoperitoneum may also appear in advanced disease.

Question 33Neonatal and Premature Infant Care

Which infant meets the criteria for retinopathy of prematurity screening?

  1. A 38-week infant weighing 3200 g
  2. A 36-week infant weighing 2500 g
  3. A 29-week infant weighing 1200 g Correct answer.
  4. A 34-week infant weighing 1800 g

Explanation

Retinopathy of prematurity screening is recommended for infants born at 30 weeks' gestation or earlier or weighing 1500 g or less at birth. Some larger or more mature infants with an unstable clinical course are also screened.

Question 34Neonatal and Premature Infant Care

A preterm infant has a cranial ultrasound showing blood filling the lateral ventricle without ventricular dilation. What grade of intraventricular hemorrhage is this?

  1. Grade II Correct answer.
  2. Grade I
  3. Grade III
  4. Grade IV

Explanation

In the Papile grading system, grade I is hemorrhage confined to the germinal matrix, grade II extends into the ventricle without dilation, grade III includes ventricular dilation, and grade IV includes intraparenchymal hemorrhage. The described findings therefore represent grade II.

Question 35Neonatal and Premature Infant Care

Therapeutic hypothermia for hypoxic-ischemic encephalopathy should be initiated within what time after birth?

  1. 12 hours
  2. 24 hours
  3. 1 hour
  4. 6 hours Correct answer.

Explanation

Cooling is most effective when started within 6 hours of birth in eligible infants with moderate to severe hypoxic-ischemic encephalopathy. Starting later reduces the likelihood of neuroprotection.

Question 36Neonatal and Premature Infant Care

Which medication is first-line pharmacologic therapy for neonatal opioid withdrawal syndrome when nonpharmacologic measures fail?

  1. Clonidine
  2. Morphine Correct answer.
  3. Naloxone
  4. Fentanyl

Explanation

Morphine or methadone is used as first-line pharmacologic treatment for opioid withdrawal in neonates after nonpharmacologic measures are optimized. Therapy is titrated to symptom scores and then gradually tapered.

Question 37Neonatal and Premature Infant Care

What initial glucose infusion rate is appropriate when starting parenteral nutrition in a premature infant?

  1. 4-6 mg/kg/min Correct answer.
  2. 10-12 mg/kg/min
  3. 1-2 mg/kg/min
  4. 15-20 mg/kg/min

Explanation

Parenteral nutrition in premature infants is typically started at a glucose infusion rate of about 4-6 mg/kg/min and advanced gradually with glucose monitoring. This range supports glucose homeostasis while limiting hyperglycemia and osmotic complications.

Question 38Neonatal and Premature Infant Care

A symptomatic term newborn has a blood glucose of 25 mg/dL. Which intravenous treatment is appropriate?

  1. D10W 2 mL/kg bolus Correct answer.
  2. D5W 10 mL/kg bolus
  3. D50W 1 mL/kg bolus
  4. D25W 4 mL/kg bolus

Explanation

Symptomatic neonatal hypoglycemia is treated with an intravenous bolus of 10% dextrose, usually 2 mL/kg, followed by a continuous dextrose infusion and glucose recheck. More concentrated dextrose can cause hyperosmolar injury and is avoided.

Question 39Neonatal and Premature Infant Care

What vitamin K prophylaxis is recommended for a healthy term newborn?

  1. 5 mg IM once at birth
  2. 1 mg PO daily for 3 months
  3. 1 mg IM once at birth Correct answer.
  4. 0.1 mg IM once at birth

Explanation

A single intramuscular dose of 1 mg vitamin K is recommended for healthy term newborns to prevent vitamin K deficiency bleeding. Preterm infants often receive a reduced dose such as 0.5 mg IM.

Question 40Neonatal and Premature Infant Care

What is the recommended dose of palivizumab for RSV prophylaxis in a premature infant?

  1. 50 mg/kg IV once
  2. 15 mg/kg IM monthly Correct answer.
  3. 100 mg/kg IM once
  4. 5 mg/kg IM monthly

Explanation

Palivizumab is given intramuscularly at 15 mg/kg once monthly during the RSV season for eligible high-risk infants. Prophylaxis is continued through the season rather than given as a single dose.

Question 41Neonatal and Premature Infant Care

A preterm infant receiving caffeine citrate develops a heart rate of 190/min and jitteriness. Which action is most appropriate?

  1. Add theophylline
  2. Hold the caffeine dose Correct answer.
  3. Give a repeat loading dose
  4. Increase the caffeine dose

Explanation

Tachycardia and jitteriness are recognized signs of methylxanthine toxicity, so the caffeine dose should be held or reduced and the infant evaluated for other contributors. The dose can be restarted at a lower dose after symptoms resolve.

Question 42Neonatal and Premature Infant Care

Which statement best describes the renal effects of ibuprofen compared with indomethacin for PDA closure?

  1. Ibuprofen causes more renal vasoconstriction
  2. Ibuprofen increases glomerular filtration rate
  3. Ibuprofen reduces renal blood flow less Correct answer.
  4. Both agents have identical renal effects

Explanation

Ibuprofen is associated with less reduction in renal blood flow and less oliguria than indomethacin, although both are nonselective cyclooxygenase inhibitors. Renal function still requires monitoring during either therapy.

Question 43Neonatal and Premature Infant Care

An extremely low birth weight infant has a potassium of 7.8 mEq/L with ECG changes. Which is the most appropriate immediate treatment?

  1. Sodium bicarbonate infusion
  2. Intravenous calcium gluconate Correct answer.
  3. Oral potassium binder
  4. Subcutaneous insulin alone

Explanation

Intravenous calcium stabilizes the myocardial membrane and is the immediate priority when hyperkalemia causes ECG changes. Insulin with glucose, albuterol, and potassium binders are used afterward to shift or remove potassium.

Question 44Neonatal and Premature Infant Care

What oxygen saturation target is recommended for a preterm infant receiving supplemental oxygen?

  1. 90-95% Correct answer.
  2. 85-89%
  3. 80-85%
  4. 98-100%

Explanation

Preterm infants receiving supplemental oxygen are generally targeted to an SpO2 of 90-95% to balance oxygen delivery against retinopathy of prematurity and oxidative lung injury. Alarm limits are set around this range.

Question 45Infectious Diseases and Immunization

A 2-year-old with no antibiotic allergies has acute otitis media with a temperature of 39°C and moderate otalgia. Which oral regimen is the most appropriate initial therapy?

  1. Azithromycin 10 mg/kg on day 1, then 5 mg/kg daily for 4 days
  2. Amoxicillin 90 mg/kg/day divided twice daily Correct answer.
  3. Cefdinir 14 mg/kg/day as a single daily dose
  4. Trimethoprim-sulfamethoxazole 8 mg/kg/day of the trimethoprim component divided twice daily

Explanation

High-dose amoxicillin provides reliable coverage of Streptococcus pneumoniae, including many penicillin-nonsusceptible strains, as well as Haemophilus influenzae and Moraxella catarrhalis. It is the recommended first-line agent for uncomplicated acute otitis media in children without recent antibiotic exposure or penicillin allergy.

Question 46Infectious Diseases and Immunization

A 7-year-old with confirmed group A streptococcal pharyngitis has no drug allergies. Which antibiotic is the first-line choice?

  1. Trimethoprim-sulfamethoxazole
  2. Penicillin V Correct answer.
  3. Doxycycline
  4. Azithromycin

Explanation

Penicillin V (or amoxicillin) remains the drug of choice for group A streptococcal pharyngitis because Streptococcus pyogenes has never developed confirmed penicillin resistance. A 10-day course is needed to prevent acute rheumatic fever.

Question 47Infectious Diseases and Immunization

Which finding is a contraindication to administration of rotavirus vaccine in an infant?

  1. A history of intussusception Correct answer.
  2. Birth at 34 weeks' gestation
  3. Mild acute gastroenteritis with low-grade fever
  4. A household contact receiving chemotherapy

Explanation

A previous episode of intussusception is an absolute contraindication to rotavirus vaccination because the vaccine is associated with a small increased risk of intussusception. Minor illness and prematurity are not contraindications, and a household contact with immunosuppression is not a contraindication to rotavirus vaccination.

Question 48Infectious Diseases and Immunization

Which of the following is a live attenuated vaccine?

  1. Diphtheria-tetanus-acellular pertussis vaccine
  2. Hepatitis B vaccine
  3. Inactivated poliovirus vaccine
  4. Measles-mumps-rubella vaccine Correct answer.

Explanation

Measles-mumps-rubella is a live attenuated viral vaccine and is contraindicated in pregnancy and in severely immunocompromised patients. DTaP, hepatitis B, and inactivated poliovirus vaccines are all non-live products.

Question 49Infectious Diseases and Immunization

A 10-day-old neonate with HSV-2 encephalitis is beginning intravenous acyclovir. Which dose is recommended?

  1. Acyclovir 20 mg/kg IV every 8 hours Correct answer.
  2. Acyclovir 5 mg/kg IV every 8 hours
  3. Acyclovir 30 mg/kg IV every 8 hours
  4. Acyclovir 15 mg/kg IV every 8 hours

Explanation

Neonatal HSV disease is treated with high-dose acyclovir 20 mg/kg IV every 8 hours, which improves mortality compared with older lower-dose regimens. Central nervous system and disseminated disease are treated for 21 days, while skin-eye-mouth disease is treated for 14 days.

Question 50Infectious Diseases and Immunization

A 6-month-old presents with fever, lethargy, and nuchal rigidity. Which empiric intravenous regimen is appropriate while cerebrospinal fluid results are pending?

  1. Vancomycin plus ceftriaxone Correct answer.
  2. Ampicillin alone
  3. Azithromycin plus ceftriaxone
  4. Ceftriaxone alone

Explanation

Empiric therapy for bacterial meningitis beyond the neonatal period combines vancomycin, for penicillin-nonsusceptible pneumococcus, with a third-generation cephalosporin for meningococcus and Haemophilus influenzae. Ampicillin is added for infants younger than 3 months to cover Listeria monocytogenes.