Worksheets11/19 CorePendium
Total questions: 15
Worksheet time: 8mins
A 34-year-old man with HIV presents with fever, headache, and photophobia. CT head is normal. Lumbar puncture shows opening pressure of 38 cm H2O with lymphocytic pleocytosis and mildly elevated protein. What is the most critical next step?
Begin dexamethasone prior to antifungal therapy
Aggressively lower intracranial pressure with mannitol
Suspect cryptococcal meningitis and initiate antifungal therapy
Defer treatment until fungal cultures result
A 44-year-old man with HIV (CD4 42 cells/µL) has progressive dyspnea and dry cough. He is adherent to antiretrovirals but not to prophylaxis. Chest X-ray is normal. Which test most increases suspicion for Pneumocystis jirovecii pneumonia (PJP)?
Normal oxygen saturation at rest
Elevated LDH level
Negative D-dimer
Low BNP level
A patient with HIV develops acute chest pain with elevated troponin and a CD4 count of 390. Which pathophysiologic mechanism best explains the higher risk of acute coronary syndrome (ACS) in HIV?
Medication-induced hypotension leading to coronary hypoperfusion
Chronic inflammation causing accelerated atherosclerosis
Increased vasospasm from opioids
Antibody-mediated coronary vasculitis
A 47-year-old HIV-positive patient (CD4 count 400) has rapidly worsening retrosternal pain and odynophagia. Oral exam shows no thrush. Which diagnosis is most likely?
Esophageal candidiasis
HSV esophagitis
CMV esophagitis
Eosinophilic esophagitis
A patient with advanced AIDS reports visual floaters and blurred vision. Fundoscopic exam shows necrotic retinal lesions with a white halo. What is the most likely diagnosis?
HSV retinitis
CMV retinitis
Toxoplasmosis
Kaposi sarcoma of the retina
A 6-month-old has 8 days of fever with only conjunctivitis and a rash. Labs show elevated ESR and CRP plus three abnormal supplemental labs. Echocardiogram is normal. What is the best next step?
Discharge with close outpatient follow-up
Treat as incomplete Kawasaki disease
Begin empiric antibiotics for bacterial conjunctivitis
Order repeat echocardiogram in 24 hours
In incomplete Kawasaki disease, when should treatment be initiated? Choose the most accurate criterion based on standard recommendations.
Only when coronary artery aneurysm is already visible on echocardiography
When fever persists and ESR/CRP are elevated together with at least three supplemental abnormal lab findings or supportive echocardiographic findings
Immediately at first fever regardless of laboratory markers
Only after repeating labs at 48 hours to confirm persistence
A child with Kawasaki disease develops hypotension, poor perfusion, and tachycardia. Point-of-care ultrasound shows depressed ejection fraction. What is the most appropriate acute management step?
Avoid fluids because preload reduction worsens Kawasaki disease
Begin high-dose aspirin for hemodynamic stabilization
Give a 5–10 mL/kg fluid bolus and start vasoactive support (e.g., norepinephrine or epinephrine) as needed to support perfusion
Intubate immediately before any hemodynamic intervention
A 5-year-old treated with IVIG for Kawasaki disease returns 10 days later with abdominal pain and persistent irritability but no fever. Which complication must be considered first based on the disease’s natural history?
Aseptic meningitis from IVIG
Giant coronary artery aneurysm with thrombosis
Macrophage activation syndrome
Pericardial effusion causing tamponade
A child has Kawasaki disease and also tests positive for adenovirus. Fever, mucocutaneous findings, and extremity changes are present. What is the correct management implication?
Delay treatment until the viral infection resolves to avoid confounding
Treat for Kawasaki disease despite the positive adenovirus test when clinical features are consistent
Exclude Kawasaki disease because adenovirus explains all findings
Switch from IVIG to antivirals as first-line therapy
A child presents with 5 days of fever, bilateral nonexudative conjunctivitis, strawberry tongue, cervical lymphadenopathy, and a polymorphous rash. Which statement best reflects the correct diagnostic approach for complete Kawasaki disease?
Diagnosis requires at least 7 days of fever.
Diagnosis requires all 5 classic criteria plus fever.
Diagnosis can be made because fever for ≥5 days plus ≥4 clinical criteria are present.
Diagnosis cannot be made without elevated inflammatory markers.
A 7-year-old with 5 days of fever and abdominal pain has CRP 12 mg/dL, platelets 80,000/µL, D-dimer markedly elevated, BNP normal, and ferritin mildly elevated. SARS-CoV-2 serology is pending. Which feature most strongly favors MIS-C over classic Kawasaki disease?
Fever >5 days
Coronary artery aneurysm risk
Marked lymphopenia and prominent gastrointestinal symptoms (abdominal pain/diarrhea)
Mucocutaneous changes (red cracked lips, strawberry tongue)
DoK 1—Recall: In suspected MIS-C presenting as distributive shock with vasodilation and preserved systolic function, which vasoactive agent is most appropriate to initiate?
Milrinone infusion
Epinephrine infusion
Norepinephrine infusion
Dopamine infusion
DoK 3—Strategic Thinking: A child suspected of MIS-C appears clinically well but has elevated CRP (7 mg/dL), mild hyponatremia, and normal BNP and troponin. Vitals are stable after initial ED assessment. What is the most appropriate disposition plan?
Discharge home with routine follow-up and no subspecialty input
Admit for observation with serial labs, ECG (consider telemetry), and subspecialty consultation as needed
Start empiric IVIG in the ED to prevent progression
Send home on low–molecular-weight heparin for thromboprophylaxis
A 10-year-old with abdominal pain has ultrasound findings of mesenteric lymphadenopathy and small-volume ascites. Labs show leukocytosis with neutrophilia, markedly elevated CRP, lymphopenia, thrombocytopenia, and elevated D-dimer. The surgical team suspects appendicitis. Which single feature most supports MIS-C rather than isolated appendicitis?
Fever lasting 24 hours
Mesenteric lymphadenopathy
Lymphopenia with thrombocytopenia and elevated D-dimer
Right lower quadrant tenderness
