Pediatrics CLIPP Cases UPDATED
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Appropriate antibiotics started within ___ days from the start of acute sore throat and fever, with
positive Group A Strep culture, will prevent acute rheumatic fever. - Correct answers✔✔9
Systemic onset juvenile idiopathic arthritis (JIA) - Correct answers✔✔oligoarthritis,
polyarthritis, or systemic onset (Still's disease)
Typical symptoms: Prolonged fever could suggest Still's disease, rash, arthritis (although active
arthritis in Still's disease often presents months to years after onset), or visceral involvement
(e.g., hepatosplenomegaly, lymphadenitis, serositis)
Which diseases cause rash on the palms and soles of the feet? - Correct answers✔✔Rocky
mountain spotted fever, Kawasaki disease, syphilis, and enterovirus
Kawasaki disease - Correct answers✔✔Vasculitis that presents with:
Fever > 5 days
Nonpurulent conjunctivitis (may have cleared prior to presentation)
Rash
Swelling and erythema of extremities
Infections that cause generalized LAD - Correct answers✔✔Measles (presents with a marked
generalized lymphadenopathy and splenomegaly that may last several weeks)
Infectious mononucleosis—caused by either Epstein-Barr virus or cytomegalovirus
Human immunodeficiency virus (HIV)
Histoplasmosis
,Toxoplasmosis
Mycobacteria (Mycobacteria can also present as localized lymphadenopathy)
Causes of Unilateral Cervical Lymphadenopathy - Correct answers✔✔Bacterial cervical adenitis
Cat scratch disease
Reactive node from an oral inflammatory or infectious process
Kawasaki disease
Mycobacterial infection (both tuberculosis and atypical mycobacteria) can present with unilateral
cervical lymphadenopathy
Erythematous tongue with prominent papillae is a characteristic finding in? - Correct
answers✔✔streptococcal pharyngitis, Kawasaki disease, and toxic shock syndrome
Signs and symptoms of bronchiolitis - Correct answers✔✔rhinitis and cough, which may
progress to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal flaring
Treatment failure acute otitis media - Correct answers✔✔lack of improvement in signs and
symptoms within 48-72 hrs after abx therapy inititaion
Reccurent AOM - Correct answers✔✔3 or > episodes of AOM in the past 6 months or 4 or >
episodes in the past year
Chronic AOM: symptoms >3 months
Chronic suppurative otitis media (CSOM) - Correct answers✔✔purulent otorrhea associated
with chronic tympanic membrane perforation that persists for >6 weeks despite appropriate
treatment.
Primarily affects people from Southeast Asia, the Western Pacific, and Africa, as well as ethnic
minorities. The most common pathogens isolated from chronically draining ears of older children
, who have CSOM are P aeruginosa, other enteric gram-negative bacilli, and S aureus, including
MRSA.
Risk factors for developing Acute or Chronic OM - Correct answers✔✔Age <2 years
Atopy
Bottle propping
Chronic sinusitis
Ciliary dysfunction
Cleft palate and craniofacial anomalies
Child care attendance
Down syndrome and other genetic conditions
First episode of AOM when younger than 6 months
of age
Immunocompromising conditions
How does negative pressure in the middle ear influence AOM causality? - Correct
answers✔✔The accentuated negative pressure in the middle ear space may make it possible for
nasopharyngeal contents to be aspirated or refluxed into the middle ear during transient opening
of the eustachian tube. The accentuated negative pressure also can cause increased vascular
permeability and can lead to development of an effusion. Eustachian tube dysfunction leading to
negative middle ear pressure occurs in 75% of children who have viral URIs.
Most common bacterial pathogens in AOM - Correct answers✔✔Streptococcus pneumoniae,
nontypeable Haemophilus influenzae, Moraxella catarrhalis, and S pyogenes (group A
Streptococcus). Staphylococcus aureus causes AOM less commonly.
Which serotype of S. pneumoniae is multidrug resistant and affects children with treatment
failure and recurrent AOM the most? Also it's associated with subperiosteal abscess/mastoiditis -
Correct answers✔✔Serotype 19A (very similar to 19F, found in PCV7 vaccine)
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Appropriate antibiotics started within ___ days from the start of acute sore throat and fever, with
positive Group A Strep culture, will prevent acute rheumatic fever. - Correct answers✔✔9
Systemic onset juvenile idiopathic arthritis (JIA) - Correct answers✔✔oligoarthritis,
polyarthritis, or systemic onset (Still's disease)
Typical symptoms: Prolonged fever could suggest Still's disease, rash, arthritis (although active
arthritis in Still's disease often presents months to years after onset), or visceral involvement
(e.g., hepatosplenomegaly, lymphadenitis, serositis)
Which diseases cause rash on the palms and soles of the feet? - Correct answers✔✔Rocky
mountain spotted fever, Kawasaki disease, syphilis, and enterovirus
Kawasaki disease - Correct answers✔✔Vasculitis that presents with:
Fever > 5 days
Nonpurulent conjunctivitis (may have cleared prior to presentation)
Rash
Swelling and erythema of extremities
Infections that cause generalized LAD - Correct answers✔✔Measles (presents with a marked
generalized lymphadenopathy and splenomegaly that may last several weeks)
Infectious mononucleosis—caused by either Epstein-Barr virus or cytomegalovirus
Human immunodeficiency virus (HIV)
Histoplasmosis
,Toxoplasmosis
Mycobacteria (Mycobacteria can also present as localized lymphadenopathy)
Causes of Unilateral Cervical Lymphadenopathy - Correct answers✔✔Bacterial cervical adenitis
Cat scratch disease
Reactive node from an oral inflammatory or infectious process
Kawasaki disease
Mycobacterial infection (both tuberculosis and atypical mycobacteria) can present with unilateral
cervical lymphadenopathy
Erythematous tongue with prominent papillae is a characteristic finding in? - Correct
answers✔✔streptococcal pharyngitis, Kawasaki disease, and toxic shock syndrome
Signs and symptoms of bronchiolitis - Correct answers✔✔rhinitis and cough, which may
progress to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal flaring
Treatment failure acute otitis media - Correct answers✔✔lack of improvement in signs and
symptoms within 48-72 hrs after abx therapy inititaion
Reccurent AOM - Correct answers✔✔3 or > episodes of AOM in the past 6 months or 4 or >
episodes in the past year
Chronic AOM: symptoms >3 months
Chronic suppurative otitis media (CSOM) - Correct answers✔✔purulent otorrhea associated
with chronic tympanic membrane perforation that persists for >6 weeks despite appropriate
treatment.
Primarily affects people from Southeast Asia, the Western Pacific, and Africa, as well as ethnic
minorities. The most common pathogens isolated from chronically draining ears of older children
, who have CSOM are P aeruginosa, other enteric gram-negative bacilli, and S aureus, including
MRSA.
Risk factors for developing Acute or Chronic OM - Correct answers✔✔Age <2 years
Atopy
Bottle propping
Chronic sinusitis
Ciliary dysfunction
Cleft palate and craniofacial anomalies
Child care attendance
Down syndrome and other genetic conditions
First episode of AOM when younger than 6 months
of age
Immunocompromising conditions
How does negative pressure in the middle ear influence AOM causality? - Correct
answers✔✔The accentuated negative pressure in the middle ear space may make it possible for
nasopharyngeal contents to be aspirated or refluxed into the middle ear during transient opening
of the eustachian tube. The accentuated negative pressure also can cause increased vascular
permeability and can lead to development of an effusion. Eustachian tube dysfunction leading to
negative middle ear pressure occurs in 75% of children who have viral URIs.
Most common bacterial pathogens in AOM - Correct answers✔✔Streptococcus pneumoniae,
nontypeable Haemophilus influenzae, Moraxella catarrhalis, and S pyogenes (group A
Streptococcus). Staphylococcus aureus causes AOM less commonly.
Which serotype of S. pneumoniae is multidrug resistant and affects children with treatment
failure and recurrent AOM the most? Also it's associated with subperiosteal abscess/mastoiditis -
Correct answers✔✔Serotype 19A (very similar to 19F, found in PCV7 vaccine)
