A 6-year-old male was seen in the emergency room for abdominal pain and vomiting. Major findings on physical examination were: fever (40C), no bowel sounds and abdominal rebound tenderness. The parents indicated the child had been well until 2 days previously.
Question 1 - Single Best Answer
What is the most likely cause, from the list below, for these symptoms?
A) appendicitis
B) pseudomembranous colitis
C) viral infection
D) food poisoning
E) amebic dysentery
Question 2 - Single Best Answer
What other possibilities are there?
A) obstruction
B) volvulus
C) intussusception
D) rupture of the bowel
E) all of the above
He had a WBC count of l8,000 with l0% eosinophils.
Question 3 - Single Best Answer
What is a normal WBC count and what is the normal % eosinophils?
A) 6,000 - 12,000 ; 10 - 20%
B) 0,000 - 20,000; 5 - 10%
C) 10,000 - 16,000; 2 - 5%
D) 6,000 - 8,000; 1 - 3%
E) 4500 - 11,000; 1 - 3%
Question 4 - Single Best Answer
What is the significance of the eosinophilia?
A) none, it is often spuriously high
B) it indicates an oncogenic process
C) it indicates an intracellular bacterial infection
D) it suggests an invasive helminth infection
E) it indicates a chemical poisoning
A further history from the parents indicated the family had recently moved to Gainesville from Baton Rouge, La. They stated the child had no major prior illnesses but had been treated for "worms" last year and 4 days ago had been given medicine for a skin eruption which the doctor said was "creeping eruption."
Question 5 - Single Best Answer
What causes creeping eruption?
A) Staphylococcus aureus
B) Giardia lamblia
C) dog and cat hookworm
D) Enterobius vermicularis
E) a fungus
Question 6 - Single Best Answer
The creeping eruption and previous treatment for "worms" indicate that the child could have been exposed to helminths. What helminths would most likely cause his symptoms (the intestinal symptoms)?
A) hookworms
B) whipworms
C) ringworms
D) tapeworms
E) Ascaris (large round worms)
Question 7 - Single Best Answer
The evidence up to this point indicates?
A) this case was a medical emergency and a laparotomy should be done
B) more diagnostic testing is required and laparotomy is not justified
C) this case is not really serious, only a hookworm infection from his creeping eruption
Question 8 - Single Best Answer
Laparotomy revealed that a mass of ascarid worms had blocked the intestine in the ileocecal region and these were removed. The child recovered uneventfully from the intestinal surgery. Which of the following is true?
A) Intestinal blockage is common in heavy ascaris infection of children.
B) Surgical intervention is required with partial intestinal blockage in Ascariasis.
C) Drug treatment is effective in eliminating intestinal worms but reinfection is so common in regions of high prevalence that mass treatment programs are of little public health value.
D) Ascaris infections in individuals not repeatedly exposed to infection should be treated even though asymptomatic.
Question 9 - Single Best Answer
How is ascaris transmitted?
A) ingestion of worm eggs in soil contaminated by human feces
B) direct contact with a person that is infected
C) from mosquitoes
D) from unpasteurized milk
E) from chickens
Question 10 - Single Best Answer
What could have been done to detect ascaris in the child before the problem became a medical emergency?
A) DTH test for ascaris
B) detection of eggs in the stool
C) intestinal biopsy
D) string test
E) scotch-tape test