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Pertussis — MCCQE Part 1 MCQ

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ModerateCoughPertussisMCCQE Part 1

9-year-old incompletely immunised child presents with paroxysmal cough with post-tussive vomiting. There is a local school outbreak and he has no pneumonia signs. Which of the following is the most appropriate next step?

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Correct answer: A — Test and treat with a macrolide, and notify public health as required

Test and treat with a macrolide, and notify public health as required is best because paroxysmal cough with post-tussive emesis and outbreak exposure suggests pertussis. Provide only reassurance without clear follow-up or safety-netting is suboptimal because children can deteriorate quickly and follow-up must be explicit; Use adult dosing or adult pathways without paediatric adjustment is suboptimal because children require age- and weight-appropriate care; Delay assessment until the next routine visit is suboptimal because developmental, infectious and neonatal red flags require timely assessment; Give antibiotics, steroids or investigations routinely despite no indication is suboptimal because over-treatment can cause harm when supportive or targeted care is indicated. Pertussis control includes case treatment, contact management and immunisation review.

Reference: Canadian Immunization Guide; provincial public health guidance