Question 2

2.  A 13 year old female presents with a fever 103, sore throat, arthralgias, and headache for 3 days.  Physical exam reveals exudative pharyngitis and cervical lymphadenopathy. Liver Transaminases are elevated.  CBC shows a WBC of 12,600.  Given this information, what is the most likely diagnosis?

A.  Kawasaki's

B.  Infectious Mononucleosis 

C.  CMV infection

D.  Rubella

Answer and Explanation 1

1.  Choice D is the correct answer.  Phototherapy is indicated for indirect bilirubin levels between 16-18 mg/dl.  Exchange transfusions are usually not indicated until the indirect bilirubin levels are over 20.  This child should not be discharged and needs to be treated because if levels reach above 20 kenicterus can develop and can be neurotoxic.

Question 1

1.  Your patient is a 1 day old infant born to a group B strep negative mother at 39 weeks via vaginal delivery.  He presents with jaundice.  Peripheral indirect bilrubin was measured and came back at 17 mg/dl.  He is currently being breast fed.  Given this information, what is the best management option?

A.  Discharge the patient home.  This should resolve itself in a couple days.

B.  Admit the patient to the hospital, start normal saline infusion at maintenance and repeat labs in the morning.

C.  Start the patient on exchange transfusions.

D.  Start the patient on phototherapy