A pediatric patient presented with fever and a rash, which can indicate various illnesses ranging from minor to life-threatening. The differential diagnosis for febrile patients with a rash is extensive, including viral, bacterial, and other infectious etiologies. Proper evaluation and management of these patients is important as the severity of illness can vary greatly.
A simplified guide to the most common diseases with fever & rash especially in pediatrics. The data have been trimmed as much as possible and focused on spot visual diagnosis of the disease.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
A simplified guide to the most common diseases with fever & rash especially in pediatrics. The data have been trimmed as much as possible and focused on spot visual diagnosis of the disease.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
2 y/o boy. Taken to Pediatrician with history of sudden onset of fever, vomiting and lethargy for 4 hours.
Referred to walk-in clinic at hospital.
Presentation
Drowsy and pale, dark rings around eyes
Temperature 38.7o C
OMICS Publishing Group, Journal of Emergency Medicine is an Open Access, peer-reviewed online journal which aims to publish the original research, reviews and short articles in the field of emergency medicine which are easy to access and freely available.
Chickenpox -symptoms |tests |management ( medical information ) martinshaji
Chickenpox is a highly contagious viral infection that causes an acute fever and blistered rash, mainly in children.
The name may be derived from the French term for chick pea, chiche pois. Another theory is that the word 'chicken' was derived from a slang term for 'child'. Chickenpox is also known as varicella.
please comment
thank you ...
It's that time of year. The little ones are heading to school and inevitably exposed to much larger groups of children. With this also comes a higher risk of catching...
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Hot Selling Organic intermediates
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
4. Rashes can be categorized as:
- maculopapular
-petechial
- diffusely erythematous with desquamation
-vesicular
-bullous
-pustular
-nodular
5. Because the severity of these illnesses can
vary from minor (roseola) to life-threatening
(meningococcemia), the physician must
make prompt management decisions regarding
imperical theraby.
6.
Evaluating the patient who presents with
fever and a rash can be challenging
because the differential diagnosis is
extensive and includes minor and lifethreatening illnesses
7.
Ringworm
Worms don't cause ringworm.
It's caused by a fungus that
lives off dead skin, hair, and
nail tissue. It starts as a
red, scaly patch or bump. Then
comes the telltale itchy red ring.
The ring has raised, blistery, or
scaly borders. Ringworm is
passed on by skin-to-skin
contact with a person or animal.
Kids can also get it by sharing
things like towels or sports
gear. You may treat it with
antifungal creams.
8.
Fifth Disease
This contagious and usually mild
illness passes in a couple of
weeks. Fifth disease starts with
flu-like symptoms. A bright face
and body rash follow. It’s spread
by coughing and sneezing and
most contagious the week before
the rash appears. It's treated with
rest, fluids, and pain relievers (do
not give aspirin to children). If
your child has fifth disease and
you are pregnant, call your doctor.
9.
Chickenpox
This once-common rash isn't seen
as much in today's kids thanks to
the chickenpox vaccine. It’s very
contagious, spreads easily, and
leaves an itchy rash and red spots
or blisters all over the body. The
spots go through stages. They
blister, burst, dry, and crust over.
Chickenpox can be very serious.
All young kids should get a
chickenpox vaccine. So should
teens and adults who never had it
or the shot.
10.
Impetigo
Impetigo, caused by
bacteria, creates red sores or
blisters. These can break
open, ooze, and develop a yellowbrown crust. Sores can show up
all over the body but mostly
around the mouth and nose.
Impetigo can be spread through
close contact or by sharing things
like towels and toys. Scratching
can spread it to other parts of the
body. It's treated with antibiotic
ointment or pills.
11.
Warts
A virus causes these funky but
mostly harmless, painless skin
growths. Warts can spread easily
from person to person. They also
spread by touching an object used
by a person with the virus. They're
most often found on fingers and
hands. To prevent warts from
spreading, tell your child not to
pick them or bite nails. Cover
warts with bandages. Most warts
go away on their own.
12.
Contact Dermatitis
Some kids' skin reacts after
touching foods, soaps, or plants
like poison ivy, sumac, or oak. The
rash usually starts within 48 hours
after skin contact. Minor cases
may cause mild redness or a rash
of small red bumps. In severe
cases you may see
swelling, redness, and larger
blisters. This rash goes away after
a week or two or when contact
ends.
13.
Hand-Foot-Mouth Disease
(Coxsackie)
Despite its scary name, this is a
common childhood illness. It starts
with a fever, followed by painful
mouth sores and a non-itchy rash.
The rash blisters on hands, feet,
and sometimes buttocks and legs.
It spreads through coughing,
sneezing, and used diapers. So
wash hands often. Coxsackie isn’t
serious and usually goes away on
its own in about a week.
14.
Eczema
Kids prone to eczema may have
other allergies and asthma. The
exact cause isn't clear. But kids
who get it tend to have a sensitive
immune system. Watch for a
raised rash with dry skin and
intense itching. Atopic dermatitis is
the most common type of eczema.
Some children outgrow it or have
milder cases as they get older.
15.
Hives
Many things can trigger these itchy or
burning welts. Medicines such as
aspirin (which kids should never take)
and penicillin can set off hives. Food
triggers include
eggs, nuts, shellfish, and food
additives. Heat or cold and strep throat
can also cause hives. Welts can show
up anywhere on the body and last
minutes or days. Sometimes an
antihistamine can help. Hives can be a
sign of serious problems, especially
when they come with breathing
troubles or swelling in the face. In
those cases or if hives don't go
away, see your doctor.
16.
Scarlet Fever
Scarlet fever is strep throat with a
rash. Symptoms include sore
throat, fever, headache, belly pain,
and swollen neck glands. After 1-2
days, a red rash with a sandpaper
texture shows up. After 7-14 days,
the rash rubs off. Scarlet fever is
very contagious, so wash hands
often to keep it from spreading.
Call your child's doctor if you think
your child has it. He'll probably be
treated with with antibiotics.
17.
Roseola (Sixth Disease)
Roseola, a mild illness, gets its
nickname from a list of six
common childhood rashes. Young
kids 6 months to 2 years are most
likely to get it. It's rare after age 4.
It starts with a cold, followed by a
few days of high fever (which can
trigger seizures). Then the fevers
end suddenly. They're followed by
a rash of small, pink, flat, or
slightly raised bumps. It shows up
first on the chest and back, then
hands and feet.
18.
Rubella (German Measles)
Rubella, also called German
measles, is a mild virus that
usually causes no serious
problems. However, it can harm
the fetus if a pregnant woman
becomes infected. The symptoms
are a low fever and rash that
spreads from the face to the rest
of the body. A standard childhood
vaccine called MMR protects
against measles, mumps, and
rubella.
19.
Lyme Disease
The hallmark of Lyme disease is a
target-shaped rash that appears
1-2 weeks after a tick bite, though
not everyone will develop the
distinctive rash. The rash may be
accompanied by a
fever, chills, and body aches. The
culprit is a type of bacterium
carried by tiny deer ticks. Without
treatment, Lyme disease can
affect the joints, nervous
system, and heart.
20.
Molluscum Contagiosum
Signs: This contagious rash
shows up as one or more
flesh-colored, raised bumps
that are about the size of a
pimple. The center of each
bump has a tiny dimple. The
rash usually shows up on the
face, arms, and legs
21.
Diaper Rash With Yeast
Infection
Signs: This red, raised rash
shows up in the groin, around
the genitals, in the creases of
the hips, or on the buttocks. It
itches or irritates. Signs of an
accompanying yeast infection
are round, red spots separate
from but near the main rash.
22.
Kawasaki Disease
Kawasaki disease is a very rare
and mysterious ailment that
strikes children under age 5. The
symptoms include a high
fever, patchy rash, swelling and
redness of the hands and
feet, bloodshot eyes, and
chapped, red lips. Without
treatment, the illness can damage
the heart and may be fatal.
Doctors have yet to discover what
causes Kawasaki disease.
23. •
•
•
•
•
•
A child is brought into his pediatrician's
office after developing a diffuse rash.
His parents do not believe in
vaccinations. You suspect that the
child has developed measles. All of the
following are true about measles
EXCEPT:
A. Measles is a leading cause of death
in young children worldwide
B. The classic triad is
cough, coryza, and conjunctivitis
C. Koplik spots are pathognomonic
white spots that appear on the buccal
cheeks
D. A major early complication is acute
sclerosing panencephalitis
E. Since the introduction of the
measles vaccine, the annual incidence
dramatically decreased.
24.
Measles is one of the most contagious
infectious diseases, with a secondary
infection rate of 90% in susceptible
individuals
it remains one of the leading causes of
death in young children
worldwide, with an estimated 197,000
deaths yearly. After exposure, the
incubation period lasts for 7-14 days.
Patients then develop a prodrome of
high fevers, often > 104 F, with the
classic triad of cough, coryza, and
conjunctivitis. A couple of days
later, Koplik spots develop on the
buccal mucosa, appearing as white
spots on an erythematous base, as
shown.
25. o
o
o
o
o
o
A 4-month-old girl presents to the
ED in extremis with rapidly
developing gangrene of the
extremities. All of the following are
true of meningococcemia
EXCEPT:
A. The mortality rate is 5%-10%
B. Meningitis is present in all
cases of septicemia
C. Empiric antibiotic treatment
should be initiated immediately
D. Transmission is person-toperson by direct contact via
respiratory droplets
E. Gangrene is caused by arterial
occlusion
26.
The correct answer is B
Meningococcemia is caused by the
gram-negative diplococcusNeisseria
meningitides. Transmission is personto-person via respiratory
droplets, often from an asymptomatic
carrier. Up to 30% of teenagers and
10% of adults carry meningococci in
the upper respiratory tract. The clinical
presentation is variable, with 50% of
patients developing meningitis
only, 10% developing septicemia
only, and 40% developing both.
Children with meningitis are usually
febrile and ill-appearing, with
symptoms of lethargy, vomiting, or
nuchal rigidity. Septicemia leads to
capillary leak, coagulopathy, profound
acidosis, and myocardial failure. Septic
emboli cause arterial occlusion in the
distal extremities, as shown in this
infant.
27.
An 11-year-old girl presents with
raised violaceous plaques on her legs
and arms that developed over the last
few days. She has had a temperature
of 100-101 F at home but no other
complaints. Her current temperature is
100.2 F. The rest of her exam is
normal. You conclude that she has
Henoch-Schonlein purpura (HSP).
Which of the following tests are most
appropriate to perform at this point?
A. CBC, lumbar puncture
B. CBC, electrolytes, stool for occult
blood, urinalysis
C. CBC, electrolytes, stool for occult
blood, renal ultrasound
D. CBC, head CT, lumbar
puncture, abdominal ultrasound
E. CBC, abdominal ultrasound
28.
The correct answer is B. The images
shown are purpuric lesions. In this
case of a healthy-appearing child with
this history and physical
examination, HSP is a reasonable
diagnosis. HSP is a vasculitis that can
affect the skin, joints, gastrointestinal
tract, and kidneys. In a well-appearing
child, HSP can be managed on an
outpatient basis. It is helpful to check
blood pressure, urine, and electrolytes
to look for a glomerulonephritis.
Urinalysis and blood pressure may be
followed for several months to monitor
kidney function. A fecal occult blood
test can help rule out significant gut
involvement, especially in children with
pain. Intussusception is the most
serious complication of HSP; if it is
suspected, the child should be
admitted and monitored.
29. A 3-year-old girl presents with a blistering
rash on her face and body. Her mouth is
pictured above. All of the following are true
statements regarding Stevens-Johnson
syndrome (SJS) EXCEPT:
A. Medications, including nonsteroidal
anti-inflammatory medications (NSAIDs),
sulfonamides, antiepileptics, and
allopurinol, are commonly accepted
triggers
B. Viruses, such as herpes simplex virus,
Epstein-Barr virus, enteroviruses, and
influenza, are accepted triggers
C. Malignancy can be associated with SJS
D. Bacterial etiologies include
mycoplasma and group A beta-hemolytic
streptococcus, among others
E. Idiopathic causes are unlikely
30.
The correct answer is E.
SJS may involve the mucous
membranes, including the eyes and
gastrointestinal tract. When more than
30% of the body surface area is
involved, cases are generally referred
to as toxic epidermal necrolysis.
Treatment is symptomatic, including
treatment of superinfection and pain
control. Patients with severe cases
should immediately be fluidresuscitated and treated as burn
victims. Offending agents should be
removed or treated. Use of steroids is
controversial. Involvement of
specialists, including
ophthalmologists, immunologists, and
burn specialists, may be indicated.
Morbidity and mortality are correlated
with the percentage of body surface
area involved
31.
Staphylococcal scalded skin
syndrome (SSSS) is a disease
that usually affects infants and
young children who lack the
antibodies to Staphylococcus
aureus toxins that adults have. It
is caused by bacterial infection by
group II S. aureus that produces
toxins that cause
exfoliation, bullae (blister)
formation and redness of skin. In
children mortality is low, but can
be high in adults, who will usually
have a serious underlying disease
that makes them susceptible to
infection