1
Q
Hi there 🫵 سمِّي الله
A
بسم الله الرَّحمن الرَّحيم 💡
2
Q
What are the etiologic agents and routes of transmission for Measles, Rubella, Mumps, and Roseola ⁉️
A
🦠 Measles : Measles virus – Airborne
🦠 Rubella : Rubella virus – Droplet & transplacental
🦠 Mumps : Mumps virus – Droplet
🦠 Roseola : Human herpesvirus 6 (HHV-6) – Saliva
3
Q
What are the incubation and infectivity periods for Measles, Rubella, Mumps, and Roseola ⁉️
A
🧬 Measles :
➡️ Incubation: 10–14 days
➡️ Infectious: 4 days before to 5 days after rash
🧬 Rubella :
➡️ Incubation: 14–21 days
➡️ Infectious: 7 days before to 7 days after rash
🧬 Mumps :
➡️ Incubation: 14–21 days
➡️ Infectious: 7 days before to 6 days after swelling
🧬 Roseola :
➡️ Incubation: ~9–10 days
➡️ Infectious: During febrile phase (before rash)
4
Q
What are the clinical stages and features of Measles infection ⁉️
A
🚩 Prodrome:
🔸 High-grade fever
🔸 Cough, coryza, conjunctivitis
🔸 Koplik spots (buccal mucosa)
🚩 Exanthem (Rash) :
🔸 Maculopapular, starts behind ears → face → trunk in 24h
🔸 Peels with fading
🚩 Convalescence : Resolution of symptoms
💡Mnemonic: 3 C’s & K = Cough, Coryza, Conjunctivitis, Koplik spots
5
Q
What are the distinguishing clinical features of Rubella (German measles) compared to Measles ⁉️
A
✅ Milder prodrome
✅ Low-grade fever
✅ Occipital & postauricular lymphadenopathy
✅ +/- Arthritis
✅ Rash similar to measles but:
➡️ Less prominent
➡️ Lasts 3 days
➡️ No peeling
✅ Forchheimer spots (soft palate) sometimes present
⚠️ Transplacental transmission risk
6
Q
What are the clinical stages and features of Mumps infection ⁉️
A
🚩 Prodrome :
🔸 Mild or absent symptoms
🔸 Fever, headache, malaise
🚩 Swelling :
🔸 Parotitis (starts unilateral → bilateral)
🔸 Pushes ear up & outward
🔸 Tender & painful (especially with chewing/sour)
🔸 Peaks by day 3, subsides within 5 days
🧠 Seen > felt
7
Q
What are the hallmark features of Roseola infantum (Exanthem subitum) ⁉️
A
✅ Affects children 6–36 months
✅ Abrupt high fever (3–5 days)
✅ After fever subsides ➡️ maculopapular rash appears:
➡️ Starts neck & trunk ➡️ spreads to face & limbs
✅ Mild URTI symptoms: cough, coryza, sore throat
💡Mnemonic: Fever → Rash sequence is classic
8
Q
Which of the following exanthematous diseases presents with abrupt high fever followed by a rash appearing after defervescence ⁉️
A. Measles
B. Rubella
C. Mumps
D. Roseola
A
👏
D. Roseola
## footnote
Roseola (HHV-6) presents with sudden fever for 3–5 days, then rash begins as fever subsides.
9
Q
What are the main complications of Measles infection ⁉️
A
🚨 Respiratory :
🔻 Otitis media **
🔻 Pneumonia
🔻 Laryngitis, bronchiectasis
🚨 Gastrointestinal :
🔻 Diarrhea, appendicitis
🚨 Neurologic :
🔻 Encephalitis, subacute sclerosing panencephalitis (SSPE)
🧠 Measles = multi-system danger
10
Q
What are the complications of Rubella (especially in congenital infection) ⁉️
A
🔻 Encephalitis
🔻 Neuritis
🔻 Arthritis
🔻 Myocarditis
🔻 Thrombocytopenia
🚨 Congenital Rubella Syndrome (CRS):
🔹 PDA (Patent ductus arteriosus)
🔹 Cataracts
🔹 Deafness
🔹 Microcephaly
🔹 “Blueberry muffin” rash (dermal extramedullary hematopoiesis)
## footnote
💡Mnemonic: “CRS = Cataracts, Rubella, Sensorineural deafness”
11
Q
What are the complications of Mumps ⁉️
A
🚨 Neurologic :
🔻 Meningitis, encephalitis
🚨 Endocrine/GIT :
🔻 Thyroiditis, hepatitis, pancreatitis
🚨 Reproductive :
🔻 Orchitis (testes), oophoritis (ovaries)
🚨 Other :
🔻 Arthritis
## footnote
💡Risk of infertility if orchitis is bilateral
12
Q
What is the treatment and prevention for Measles, Rubella, and Mumps ⁉️
A
💊 Treatment (All) : Supportive only
✅ Prevention :
➡️ MMR vaccine (Measles, Mumps, Rubella)
➡️ Live attenuated virus
➡️ Given at age 1 year & booster at 4–6 years
## footnote
⚠️ Not for immunocompromised or pregnancy
13
Q
What are the other names or characteristic signs of Measles, Rubella, and Mumps ⁉️
A
🧠 Measles :
➡️ “Rubeola”
➡️ 3 C’s (Cough, Coryza, Conjunctivitis)
➡️ Koplik spots
🧠 Rubella :
➡️ “German Measles”
➡️ Forchheimer spots
🧠 Mumps :
➡️ Parotitis with ear displacement
➡️ Better seen than felt
14
Q
Which childhood viral exanthem is associated with orchitis and risk of infertility in males ⁉️
A. Measles
B. Rubella
C. Mumps
D. Roseola
A
👏
C. Mumps
## footnote
Mumps can cause orchitis, particularly post-puberty males, and may lead to infertility if bilateral.
15
Q
What are the other names and etiologies of Roseola, Erythema Infectiosum, and Infectious Mononucleosis ⁉️
A
🧠 Roseola :
➡️ “6th Disease” / Exanthem Subitum
➡️ Human Herpesvirus 6 or 7 (HHV-6/7)
🧠 Erythema Infectiosum :
➡️ “5th Disease” / Slapped Cheek Syndrome
➡️ Parvovirus B19
🧠 Infectious Mononucleosis :
➡️ “Glandular Fever”
➡️ Epstein-Barr Virus (EBV)
16
Q
What are the incubation periods and routes of transmission for these viral exanthems ⁉️
A
⏳ Incubation :
🔹 Roseola: 7–15 days
🔹 Erythema infectiosum: 5–15 days
🔹 Mononucleosis: 30–60 days
🛑 Transmission :
🔸 Roseola: Droplets
🔸 Erythema infectiosum: Droplets, transplacental
🔸 Mono: Saliva, oral contact, rarely blood
17
Q
What are the key clinical features of Roseola infantum ⁉️
A
🚩 High fever (39–40°C) for 3–5 days
🚩 Then → maculopapular rash (starts on trunk ➡️ face)
🔸 Febrile seizures
🔸 Periorbital edema, bulging fontanelle
🔸 Nagayama spots (soft palate/uvula)
✅ Lymphadenopathy: cervical, occipital, postauricular
## footnote
🧠 Fever ➡️ Rash is hallmark sequence
18
Q
What are the clinical features of Erythema Infectiosum ⁉️
A
🔹 Low-grade fever, malaise, headache
🔹 “Slapped cheek” facial erythema
🔹 Lacy reticular maculopapular rash (extremities/trunk)
🔹 Circumoral pallor
✅ No peeling
🧠 May cause arthralgia/arthritis (esp. in adults)
## footnote
⚠️ Risk: aplastic crisis in hemolytic anemia, hydrops fetalis
19
Q
What are the clinical features of Infectious Mononucleosis ⁉️
A
🔸 Fever, sore throat, fatigue
🔸 Tonsillopharyngitis ➡️ may mimic strep
🔸 Petechiae on soft palate
🔸 Cervical/generalized lymphadenopathy
🔸 Splenomegaly (50%), hepatomegaly (10%)
🔸 Maculopapular rash (especially if given ampicillin)
## footnote
🧠 Avoid ampicillin/amoxicillin
20
Q
What is the diagnostic approach for Infectious Mononucleosis ⁉️
A
1️⃣ CBC: Lymphocytosis with atypical lymphocytes
2️⃣ Monospot test (heterophile Ab) – may be negative in kids
3️⃣ EBV serology:
🟣 VCA-IgM, VCA-IgG (early)
🟣 EA-IgG (early)
🟣 EBNA-IgG (late: after 3–4 months)
## footnote
⚠️ Anti-EBNA absent → recent infection
21
Q
What are the complications of each condition ⁉️
A
🚨 Roseola : Febrile seizures, encephalitis, aseptic meningitis
🚨 Erythema infectiosum :
➤ Transient aplastic crisis (e.g. in SCD)
➤ Hydrops fetalis
➤ Myocarditis
🚨 Mononucleosis :
➤ Splenic rupture
➤ Hepatitis
➤ Autoimmune hemolytic anemia
➤ Upper airway obstruction (needs steroids)
22
Q
What is the treatment and prognosis of Roseola, Erythema Infectiosum, and Infectious Mononucleosis ⁉️
A
💊 All : Supportive only
✅ Hydration, antipyretics
⚠️ Mono : Avoid ampicillin/amoxicillin
⚠️ Steroids if severe airway obstruction
🔚 Generally self-limiting
23
Q
Which of the following is most commonly associated with splenomegaly and soft palate petechiae⁉️
A. Roseola
B. Erythema Infectiosum
C. Infectious Mononucleosis
D. Scarlet Fever
A
👏
C. Infectious Mononucleosis
## footnote
24
Q
What does a completely negative EBV serology profile (VCA IgM⁻, VCA IgG⁻, EBNA-1 IgG⁻) indicate ⁉️
A
⛔ No immunity
➡️ No prior exposure to Epstein-Barr virus
25
**What does a serology profile of VCA IgM⁺, VCA IgG⁻, EBNA-1 IgG⁻ suggest** ⁉️
⚠️ **Possible acute infection or non-specific result**
💡 Further testing is required
26
**What does a serology profile of VCA IgM⁺, VCA IgG⁺, EBNA-1 IgG⁻ indicate** ⁉️
🚨 **Acute EBV infection**
27
**What does a serology profile of VCA IgM⁻, VCA IgG⁺, EBNA-1 IgG⁺ suggest** ⁉️
✅ **Past EBV infection** (immunity established)
28
**What does VCA IgM⁻, VCA IgG⁺, EBNA-1 IgG⁻ indicate in EBV serology** ⁉️
⚠️ **Indeterminate** – could be acute or past infection
💡 Further testing required
29
**What does VCA IgM⁺, VCA IgG⁺, EBNA-1 IgG⁺ indicate** ⁉️
⚠️ **Late primary infection or reactivation**
30
**What does a positive EBNA-1 IgG alone (VCA IgM⁻, VCA IgG⁻, EBNA-1 IgG⁺) suggest** ⁉️
⚠️ **Past infection or non-specific finding**
💡 Further testing required
31
**What are the etiologies of Chickenpox, Hand-Foot-Mouth Disease, and HSV infections** ⁉️
🧠 **Chickenpox** : Varicella zoster virus
🧠 **HFMD** : Coxsackievirus (Enterovirus group)
🧠 **HSV** :
🔹 HSV-1 → Lips, skin
🔹 HSV-2 → Genitalia
32
**What are the incubation periods and routes of transmission for these viral infections** ⁉️
⏳ **Incubation** :
🔸 Chickenpox: 14–21 days
🔸 HFMD: 3–6 days
🔸 HSV: Variable
🛑 **Transmission** :
🔸 Chickenpox: Droplets, contact, transplacental
🔸 HFMD: Fecal-oral, droplets
🔸 HSV:
➡️ HSV-1: Saliva, contact
➡️ HSV-2: Sexual, birth canal
33
**What are the clinical features of Chickenpox** ⁉️
✅ Fever, headache
✅ Papulovesicular rash (in crops) over 3–5 days
🔹 **Pleomorphic** : different stages at once
🔹 Starts on head/trunk ➡️ spreads to limbs
🔹 Pruritic (itchy)
✅ Heals without scarring unless secondarily infected
34
**What are the clinical features of Hand-Foot-Mouth Disease** ⁉️
🔹 Low-grade fever (usually summer)
🔹 **Vesicular lesions** on hands, feet, and mouth
🔹 Often mild or asymptomatic
🧠 Enteroviral, short course
35
**What are the clinical features of HSV infections in children**⁉️
🚩 **Gingivostomatitis** (common in 10m–3yrs):
🔸 Painful vesicles on lips, tongue, palate, mouth
🔸 High fever
🔸 Poor feeding → dehydration risk
⚠️ **Eczema herpeticum** : severe, widespread HSV in atopic skin
🧠 May persist up to 2 weeks
36
**A 2-year-old presents with high fever, painful oral ulcers, and refusal to eat. Vesicles are noted on the tongue and palate. What is the likely diagnosis** ⁉️
A. Chickenpox
B. HFMD
C. HSV-1 gingivostomatitis
D. Scarlet fever
👏
**C. HSV-1 gingivostomatitis**
HSV-1 gingivostomatitis presents with painful mouth ulcers, fever, and dehydration in toddlers.
37
**How are Chickenpox, HFMD, and HSV infections diagnosed** ⁉️
🧪 **Chickenpox** : Clinical + vesicular fluid PCR
🧪 **HFMD** : Clinical diagnosis
🧪 **HSV** :
🔹 Clinical for gingivostomatitis
🔹 Tzanck smear (multinucleated giant cells)
🔹 PCR if encephalitis suspected
38
**What are the complications of Chickenpox** ⁉️
🚨 **Skin** : Secondary bacterial infection (Staph, GAS)
🚨 **CNS** : Encephalitis (early, good prognosis), meningitis, cerebellitis
🚨 **Respiratory** : Pneumonia
🚨 **Others** : Progressive disease in immunocompromised
39
**What are the complications of HFMD** ⁉️
✅ Generally mild
⚠️ **Main risk** : Dehydration due to painful ulcers
🧠 Other enterovirus syndromes:
🔻 Herpangina
🔻 Meningoencephalitis
🔻 Myocarditis
🔻 Pleurodynia
🔻 Neonatal sepsis
40
What are the complications of HSV infection⁉️
🚨 **Skin** : Eczema herpeticum, herpetic whitlow
🚨 **Eye** : Keratoconjunctivitis
🚨 **Neonates** : Disseminated HSV, sepsis
🚨 **CNS** : HSV encephalitis → high mortality, neuro sequelae
⚠️ Recurrent HSV may cause **erythema multiforme** (target lesions)
41
**What is the treatment and prevention of Chickenpox, HFMD, and HSV infections** ⁉️
💊 **Chickenpox** :
✅ Supportive (no aspirin!)
✅ Antipyretics, antipruritics
✅ VZV vaccine (live attenuated)
✅ VZV Ig for immunocompromised
💊 **HFMD** :
✅ Supportive only (hydration, antipyretics)
❌ No vaccine
💊 **HSV** :
✅ Supportive (hydration, pain control)
✅ **Acyclovir** for severe, disseminated, or encephalitis
❌ No vaccine
42
**A 3-year-old girl who sucks her fingers presents with painful finger lesions. Which is a classic manifestation of the suspected virus** ⁉️
A. Impetigo
B. Herpetic whitlow
C. Cerebral calcifications
D. Toxic shock syndrome
👏
**B. Herpetic whitlow**
## footnote
Herpetic whitlow is a painful vesicular lesion on fingers caused by HSV, especially with finger-sucking habits.
43
**What causes shingles (herpes zoster), and how does it differ from primary varicella** ⁉️
🧠 **Cause** : Reactivation of latent **Varicella-Zoster Virus (VZV)**
🔹 Primary VZV = Chickenpox (varicella)
🔹 Reactivated VZV = Shingles (herpes zoster)
44
**What is the typical clinical presentation of shingles in children** ⁉️
🚩 **Dermatomal** vesicular rash
➡️ Localized to sensory nerve distribution (commonly thoracic)
🔸 Preceded by pain or burning
🔸 **Vesicles follow pain**
✅ Unlike adults, **neuralgia is rare** in children
45
**Which children are at higher risk for developing shingles** ⁉️
⚠️ Children who had **chickenpox in the first year of life**
⚠️ **Immunocompromised** children (e.g., HIV) →
🔻 Risk of **multidermatomal or recurrent** zoster
🔻 Risk of **disseminated severe disease**
46
**How is shingles (herpes zoster) transmitted** ⁉️
➡️ **Respiratory secretions**
➡️ **Vesicular fluid**
47
**A child with a history of neonatal chickenpox presents with a vesicular rash in a thoracic dermatome. What is the most likely diagnosis** ⁉️
A. Impetigo
B. Atopic dermatitis
C. Herpes zoster (shingles)
D. Eczema herpeticum
👏
**C. Herpes zoster (shingles)**
## footnote
Shingles in children may follow early-life chickenpox and presents as a painful vesicular rash in a dermatomal pattern.
48
**What are the 4 clinical categories of pediatric HIV/AIDS** ⁉️
🔹 **N** : Asymptomatic
🔹 **A** : Mild (lymphadenopathy, parotid enlargement)
🔹 **B** : Moderate (recurrent infections, candidiasis, LIP, chronic diarrhea)
🔹 **C** : Severe (PCP pneumonia, encephalopathy, malignancy, growth failure)
49
**How is pediatric HIV diagnosed and confirmed** ⁉️
🔬 Diagnosis:
1. **DNA PCR** (<18 months)
2. Serology (may be false +ve from maternal Ab)
3. Monitored by CD4 count, viral load
🔎 EBV serology and flow cytometry help rule out other causes
✅ **DNA PCR x2 negative in first 3 months = uninfected**
50
**What is the management and follow-up of pediatric HIV/AIDS** ⁉️
💊 **Treatment** :
1. **ART** : Zidovudine, Lamivudine, Protease inhibitors
2. **PCP prophylaxis** : Cotrimoxazole
3. Treat infections aggressively
✅ Nutritional & developmental support
✅ Multidisciplinary follow-up (growth, vaccines)
51
**How can vertical transmission of HIV be prevented in infants** ⁉️
✅ **Prevention measures** :
1. Maternal ART during pregnancy
2. Elective C-section
3. Avoid breastfeeding
4. Zidovudine to infant (6 weeks)
🚫 Avoid prolonged ROM, instrumentation
✅ Transmission risk ↓ to <1%
52
**A 9-month-old with recurrent pneumonia, FTT, and lymphopenia. Which test is most helpful to confirm the diagnosis** ⁉️
A. EBV serology
B. HIV serology
C. Lymphocyte subtype flow cytometry
D. HIV DNA PCR
👏
**D. HIV DNA PCR**
## footnote
In infants under 18 months, maternal antibodies can yield false-positive serology; DNA PCR is the most accurate.
53
**What are the etiologic agents and transmission routes for Scarlet Fever and Pertussis** ⁉️
🧠 **Scarlet Fever** :
🔸 Group A β-hemolytic Streptococcus (GAS)
🔸 Pyrogenic exotoxin
🔸 Transmission: **Droplets**
🧠 **Pertussis** :
🔸 Bordetella pertussis (Gram-negative coccobacillus)
🔸 Highly contagious
🔸 Transmission: **Droplets**
54
**What are the incubation periods of Scarlet Fever and Pertussis** ⁉️
⏳ **Scarlet Fever** : 2–7 days
⏳ **Pertussis** : 7–10 days (range 5–21 days)
55
**What are the classic clinical features of Scarlet Fever** ⁉️
1️⃣ **Fever** , sore throat, headache
2️⃣ **Strawberry tongue** :
• Day 1: White
• Day 3: Red
3️⃣ **Sandpaper rash** :
• Starts neck ➡️ trunk, extremities
• Pastia’s lines in flexures
4️⃣ **Face** : Red cheeks with **circumoral pallor**
5️⃣ Rash fades in 4–5 days with **desquamation**
56
**What are the stages of clinical presentation in Pertussis (Whooping Cough)** ⁉️
🚩 **Catarrhal stage (1–2 wks)** :
• Coryza, low-grade fever
🚩 **Paroxysmal stage (2–6 wks)** :
• Spasmodic coughing ➡️ inspiratory “whoop”
• **Post-tussive vomiting** , apnea, cyanosis
🚩 Convalescent stage (1–2 wks):
• Gradual decline in severity
🧠 Cough may last up to **3 months** = “100-day cough”
57
**How are Scarlet Fever and Pertussis diagnosed** ⁉️
🧪 **Scarlet Fever** :
• Clinical ± throat swab
• **Anti-streptolysin O (ASO)** titer
🧪 **Pertussis** :
• **PCR or ELISA** from nasopharyngeal swab
• CBC: **Absolute lymphocytosis**
• CXR if respiratory symptoms
58
**What are the complications of Scarlet Fever** ⁉️
🚨 Otitis media
🚨 Rheumatic fever
🚨 Post-streptococcal glomerulonephritis (PSGN)
🚨 Reactive arthritis
🧠 Cervical lymphadenopathy
59
**What are the complications of Pertussis** ⁉️
🚨 Apnea, pneumonia
🚨 Encephalopathy, convulsions, ICH
🚨 Retinal/subconjunctival hemorrhage
🚨 Hernia, rectal prolapse, malnutrition
🚨 OM, bronchiectasis, pneumothorax
60
**What is the treatment and prevention strategy for Scarlet Fever** ⁉️
💊 **Treatment** :
• Penicillin V x 10 days
• Antipyretics
🚫 **No vaccine**
✅ Isolation recommended
61
**What is the treatment and prevention strategy for Pertussis** ⁉️
💊 **Treatment** :
• **Macrolides** = drug of choice
• Admit if young/severe/apnea
• O₂ therapy if desaturation
✅ **Prevention** :
• **DPT vaccine**
• Macrolides to close contacts
• Vaccinate unimmunized infants
62
**A child presents with a sandpaper rash, red cheeks with perioral pallor, and a red strawberry tongue. What is the likely diagnosis** ⁉️
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Rubella
👏
**B. Scarlet fever**
## footnote
Scarlet fever has classic features of strawberry tongue, sandpaper rash, and circumoral pallor.
63
**What are the etiologies, transmission routes, and incubation periods of RMSF and Typhoid fever** ⁉️
🧠 **RMSF** :
🔸 Rickettsia rickettsii (Gram-negative, intracellular)
🔸 Vector: Tick bite (Reservoir: Dogs)
🔸 Incubation: 2–14 days
🧠 **Typhoid (Enteric) Fever** :
🔸 Salmonella typhi / paratyphi
🔸 Transmission: Feco-oral (contaminated food/water)
🔸 Incubation: 3–30 days
64
**What are the clinical features of Rocky Mountain Spotted Fever** ⁉️
🚨 Sudden high-grade fever
🚨 Severe headache, chills, myalgia
🚨 Rash (maculopapular ➡️ petechial):
• Involves **palms, soles, wrists, ankles**
🚨 GI: Diarrhea, abdominal pain
🚨 Others: Pneumonitis, myocarditis, renal failure
🧠 Tick bite history + rash + fever = classic triad
65
**What are the clinical features of Typhoid fever** ⁉️
🔸 **Fever** : Step-ladder pattern, relative bradycardia
🔸 **Abdominal pain**, diarrhea/constipation (2nd week)
🔸 **Rose spots** on trunk
🔸 **Hepatosplenomegaly**
🔸 Non-specific: headache, myalgia, anorexia
🧠 Resolves gradually in 2–4 weeks if uncomplicated
66
**How is RMSF diagnosed** ⁉️
🧪 Clinically +
🔹 CBC: Anemia, thrombocytopenia
🔹 Electrolytes: **Hyponatremia**
🔹 LFT: Elevated AST/ALT
🔹 Serology / PCR for confirmation
67
**How is Typhoid fever diagnosed** ⁉️
🧪 CBC: Variable WBC & platelets
🧪 Blood culture (1st week – 80–90% positive)
🧪 Stool & urine cultures (later weeks)
🧪 Bone marrow culture: Most sensitive
🧪 **Widal test** (limited value)
68
**What are major complications of RMSF and Typhoid** ⁉️
🚨 **RMSF** :
• Shock, DIC
• Renal failure, myocarditis
• Meningoencephalitis, ARDS
• Multiorgan failure
🚨 **Typhoid** :
• GI hemorrhage/perforation
• Osteomyelitis, GN, hepatitis
• Neurologic: Delirium, GBS, ataxia
69
**What are the treatments for RMSF and Typhoid** ⁉️
💊 **RMSF** :
• <8 yrs: Doxycycline
• >8 yrs: Tetracycline
• Macrolides (e.g. Azithromycin)
✅ Home care unless severe
💊 **Typhoid** :
• Ceftriaxone, Cefotaxime
• Azithromycin, Cefixime
• Ampicillin (if sensitive)
⚠️ Hospitalize if systemic signs
70
**Are there vaccines available for RMSF or Typhoid fever** ⁉️
🚫 **RMSF** : No vaccine
✅ **Typhoid** :
• Live attenuated & killed vaccines available
• Used in endemic areas and travelers
71
**A child presents with fever, petechial rash on palms and soles, headache, and history of tick bite. What is the likely diagnosis** ⁉️
A. Meningococcemia
B. Rocky Mountain Spotted Fever
C. Typhoid fever
D. Leptospirosis
👏
**B. Rocky Mountain Spotted Fever**
##footnote
🗝️ RMSF presents with tick exposure, high fever, and petechial rash involving palms/soles 🕵️♂️
72
**What is the cause, route of transmission, and incubation period of Lyme disease** ⁉️
🧠 **Cause** : Borrelia burgdorferi (spirochete)
➡️ **Transmission** : Tick bite (hosts: sheep, foxes, small mammals)
🗓 **Incubation** : 4–30 days
🌿 **Season** : More common in summer, rural areas
73
**What are the early clinical features of Lyme disease** ⁉️
🚩 **Erythema migrans** :
• Expanding painless macule at bite site
🚩 **Systemic** :
• Fever, headache, myalgia, arthralgia
🚩 **Lymphadenopathy** : Painful
## footnote
🧠 Early signs mimic flu but include a characteristic skin rash
74
**What are the late complications of Lyme disease** ⁉️
🧠 **Neurologic** :
• Facial nerve palsy
• Meningoencephalitis
• Peripheral neuropathy
🫀 **Cardiac** :
• Myocarditis
• Heart block (HB)
🦴 **Joint** :
• Arthralgia
• Large joint arthritis (often recurrent)
• Erosive arthritis in ~10%
75
**How is Lyme disease diagnosed** ⁉️
🔬 Primarily **clinical**
🔹 Serology (IgM/IgG) becomes positive **after 4 weeks**
## footnote
✅ Early diagnosis is clinical to avoid delay
76
**What is the treatment of Lyme disease in children**⁉️
💊 >8 yrs: **Doxycycline**
💊 <8 yrs: **Amoxicillin**
🚨 **Severe neurologic or cardiac disease** :
➡️ **IV 3rd gen cephalosporins** (e.g., ceftriaxone)
77
**What does the mnemonic FACE help remember in Lyme disease** ⁉️
💡 **F.A.C.E** =
🔸 **F** acial nerve palsy
🔸 **A** rthritis
🔸 **C** arditis
🔸 **E** rythema migrans
## footnote
👉🏼 “Remember the FACE when biting into a LIME”
78
**A child presents with fever, expanding rash at a tick bite site, facial palsy, and joint pain. What is the likely diagnosis** ⁉️
A. Leptospirosis
B. Rocky Mountain Spotted Fever
C. Lyme disease
D. Rheumatic fever
👏
**C. Lyme disease**
## footnote
Erythema migrans + joint and facial nerve involvement after tick exposure = Lyme disease.
79
**What are the causes and toxins responsible for TSS and SSSS** ⁉️
🧠 **TSS (Toxic Shock Syndrome)** :
➡️ Staphylococcus aureus (TSST-1 toxin)
➡️ Group A Streptococcus
🧠 **SSSS (Staphylococcal Scalded Skin Syndrome)** :
➡️ Staph. aureus exfoliative toxins **A & B**
80
**What are the major and minor diagnostic criteria of Toxic Shock Syndrome** ⁉️
🚨 **Major Criteria** (all required):
1. Fever > 39°C
2. Hypotension
3. Diffuse sunburn-like rash → desquamation (palms & soles)
🚨 **Minor Criteria** (3+):
🔹 Inflamed mucous membranes
🔹 GIT: Vomiting or diarrhea
🔹 Renal: ↑BUN or creatinine
🔹 Liver: ↑LFTs
🔹 Muscle: Myalgia or ↑CPK
🔹 CNS: Confusion, lethargy
🔹 Thrombocytopenia
✅ Must exclude other causes (negative cultures)
81
**What are the hallmark clinical features of TSS** ⁉️
🚩 Sudden onset high fever (102–105°F)
🚩 Hypotension → syncope/shock (within 48h)
🚩 Non-purulent conjunctivitis, sore throat
🚩 **Sunburn-like rash** + desquamation
🚩 Watery diarrhea, vomiting
⚠️ Associated with tampon use
82
**What are the complications of Toxic Shock Syndrome** ⁉️
🚨 ARDS
🚨 Renal failure
🚨 Myocardial infarction
🚨 Hair and nail loss (1–2 months later)
## footnote
⚠️ Recurrence if not adequately treated
83
**How is Toxic Shock Syndrome managed** ⁉️
💊 **Supportive** : IV fluids, inotropes
💊 **Antibiotics** : 3rd gen cephalosporin ➕ clindamycin
💊 **Severe cases** : IVIG
💉 **Surgical** : Drain abscesses or infected sites
84
**What is the cause and classic presentation of Staphylococcal Scalded Skin Syndrome (SSSS)** ⁉️
🧠 **Cause** : Staph. exfoliative toxins A & B
➡️ Neonates: **Ritter disease** – generalized skin peeling
➡️ Infants: Flaky desquamation (face/neck)
➡️ Older children: Localized bullous impetigo, tender scarlet-like rash
🧪 **Nikolsky sign** : +ve (epidermis separates on gentle pressure)
85
**What are the complications and treatment of SSSS** ⁉️
⚠️ Complications:
🔻 Dehydration
🔻 Secondary infection
💊 Treatment:
• IV **anti-staph antibiotics** (e.g., flucloxacillin)
• Pain control
• Monitor hydration + fluids
✅ Healing without scarring
86
**A child with fever, hypotension, vomiting, conjunctivitis, and sunburn-like rash followed by desquamation likely has** ⁉️
A. Scarlet fever
B. Toxic Shock Syndrome
C. Kawasaki disease
D. Measles
👏
**B. Toxic Shock Syndrome**
## footnote
TSS features rapid shock, rash with desquamation, mucous membrane involvement, and systemic signs.
87
**What are the definitions and causes of Impetigo and Periorbital Cellulitis** ⁉️
🧠 **Impetigo** :
➡️ Superficial, highly contagious skin infection
➡️ Caused by Staphylococcus aureus or Streptococcus pyogenes
🧠 **Periorbital Cellulitis** :
➡️ Inflammation **anterior to orbital septum**
➡️ Presents with fever, eyelid erythema, tenderness, edema
✅ Unilateral
88
**What is the typical clinical presentation of impetigo**⁉️
🚩 Starts as erythematous macules
➡️ Progress to **vesicular/pustular or bullous lesions**
➡️ Vesicle rupture ➡️ **honey-colored crust**
⚠️ Spreads by **autoinoculation**
📍 Sites: Face, neck, hands
89
**What is the treatment and isolation advice for impetigo** ⁉️
💊 Mild: **Topical mupirocin**
🚫 Children should not attend school/daycare **until lesions dry**
⚠️ **Complications** : Abscess, meningitis, cavernous sinus thrombosis
90
**How is periorbital (preseptal) cellulitis treated and assessed** ⁉️
💊 Treated urgently with **IV antibiotics** (e.g. ceftriaxone)
📸 **CT or MRI** if orbital cellulitis suspected
👁 Ophthalmology consult if posterior spread suspected
91
**What is the key difference between periorbital and orbital cellulitis** ⁉️
🧠 **Periorbital cellulitis:
➡️ Involves tissues **anterior to orbital septum**
➡️ No visual changes or eye movement restriction
🚨 Orbital cellulitis (posterior):
➡️ Risk of vision loss, abscess, or CNS complications
➡️ Requires imaging and urgent intervention
92
**A child presents with honey-colored crusted lesions on the face after bullous lesions ruptured. What is the most likely diagnosis** ⁉️
A. Herpes simplex
B. Erysipelas
C. Impetigo
D. Atopic dermatitis
👏
**C. Impetigo**
## footnote
Classic honey-colored crusts after vesicle rupture = hallmark of impetigo.
93
**A 4-year-old presents with fever and a “slapped cheek” rash followed by a lacy rash on the trunk. What is the most likely cause** ⁉️
A. Measles
B. Scarlet fever
C. Parvovirus B19
D. Roseola
👏
**C. Parvovirus B19**
94
**A febrile child with a petechial rash, hypotension, and neck stiffness most likely has** ⁉️
A. Rubella
B. Meningococcemia
C. HFMD
D. SJS
👏
**B. Meningococcemia**
95
**What is the most likely diagnosis in an 8-month-old with fever, drooling, and painful anterior oral ulcers** ⁉️
🧠 **Primary herpetic gingivostomatitis**
## footnote
➡️ Caused by **Herpes Simplex Virus type 1 (HSV-1)**
➡️ Common in infants aged 6 months to 5 years
➡️ Features: fever, irritability, painful vesicles/ulcers on lips, tongue, hard palate
96
**What clinical clues suggest a viral cause of pharyngitis rather than bacterial** ⁉️
✅ **Viral clues** 🕵️♂️:
🔹 Conjunctivitis
🔹 Coryza
🔹 Cough
🔹 Diarrhea
🔹 Viral exanthem
97
**What is the first-line treatment for primary HSV gingivostomatitis in infants*⁉️
💊 **Supportive care**
✅ Oral **analgesics**
✅ **Adequate hydration**
➡️ Most cases resolve spontaneously within 1–2 weeks
## footnote
⚠️ Start **oral acyclovir** only if early and severe
98
**What is the causative organism and transmission route of Enterobiasis (Pinworm infection)** ⁉️
🧠 **Cause** : Enterobius vermicularis (Pinworm) – a 1 cm threadlike nematode
➡️ **Transmission** : Feco-oral
## footnote
⚠️ **Autoinfection** common in children with finger-sucking habits
99
**What are the classic clinical features of pinworm infection** ⁉️
🔹 Often **asymptomatic**
🔸 **Anal itching** , worse at **night**
🔸 Sleep disturbances, **restlessness** , and **enuresis**
##footnote
🧠 Pruritus ani is hallmark
100
**How is Enterobiasis diagnosed** ⁉️
🔬 **Cellophane tape test** :
• Tape applied to perianal area at night
• Microscopy reveals **eggs or adult worms**
✅ Done in the **early morning**
101
**What is the treatment protocol for Enterobiasis** ⁉️
💊 **Albendazole** 400 mg PO → repeat after 2 weeks
💊 **Mebendazole** 100 mg PO → repeat after 2 weeks
➡️ Treat **entire household** simultaneously
102
**A child has nighttime anal itching and disrupted sleep. Which test confirms the diagnosis** ⁉️
A. Stool microscopy
B. Blood eosinophils
C. Cellophane tape test
D. Skin scraping
👏
**C. Cellophane tape test**
## footnote
**The perianal adhesive tape test is the gold standard for diagnosing pinworm infection** .
103
**What is the causative agent and transmission route of Amoebiasis** ⁉️
🧠 **Cause** : Entamoeba histolytica
➡️ Transmission: **Feco-oral route**
## footnote
⚠️ Common in areas with poor sanitation
104
**What are the clinical presentations of Amoebiasis** ⁉️
🔸 **Asymptomatic carriers** (majority)
🔸 **Amebic dysentery** (5–10%):
• Age: 1–5 years
• Gradual onset abdominal cramps
• Frequent stools with **tenesmus**
• **Heme-positive** stool
🧠 Fever present in only 1/3 of cases
105
**How is Amoebiasis diagnosed** ⁉️
🔬 **Stool microscopy** :
• Detects **cysts** (3 samples ⬆️ sensitivity)
🔬 **Stool antigen test** or **PCR** :
• More specific for E. histolytica
106
**What is the treatment of symptomatic vs asymptomatic Amoebiasis** ⁉️
💊 **Symptomatic** :
• **Metronidazole** (DOC)
• Tinidazole (alternative)
💊 **Asymptomatic** :
• **Paromomycin** or **Iodoquinol**
## footnote
🧠 Luminal agents needed to prevent transmission
107
**A 3-year-old has heme-positive loose stools with tenesmus but no fever. What is the most likely cause** ⁉️
A. Bacterial dysentery
B. Amebic dysentery
C. Giardia
D. Rotavirus
👏
**B. Amebic dysentery**
## footnote
Gradual-onset bloody diarrhea without fever is typical of amebic dysentery caused by E. histolytica.
108
**What is the mode of transmission and causative agent of Leishmaniasis** ⁉️
🧠 **Transmission** : Bite of **female sandfly**
🦠 **Cause** : Leishmania species (protozoan parasite)
109
**What are the key features of Cutaneous Leishmaniasis** ⁉️
🔸 Occurs on **exposed skin**
➡️ Papule ➡️ Nodule ➡️ **Painless ulcer**
✅ **Heals with scar**
## footnote
🧠 Often self-limited but disfiguring
110
**What is the classical clinical triad of Visceral Leishmaniasis (Kala-azar)** ⁉️
🚨 **High fever**
🚨 **Massive splenomegaly**
🚨 **Severe cachexia**
## footnote
🧠 Often seen in children <5 years
🧠 Reticuloendothelial hyperplasia: Liver, spleen, bone marrow, lymph nodes
111
**What are the terminal stage features of untreated Kala-azar** ⁉️
⚠️ Massive hepatosplenomegaly
⚠️ Profound **anemia**
⚠️ **Bleeding episodes** (esp. epistaxis)
⚠️ **Secondary infections**
🚨 Mortality >90% without treatment
112
**What is the treatment for Leishmaniasis** ⁉️
💊 **Sodium stibogluconate** (Pentostam)
💊 **Amphotericin B** for resistant/severe cases
## footnote
⚠️ Early treatment prevents fatal outcomes
113
**A 4-year-old from an endemic area presents with high fever, massive spleen, severe weight loss, and bleeding. What is the likely diagnosis** ⁉️
A. Typhoid fever
B. Malaria
C. Visceral Leishmaniasis (Kala-azar)
D. Acute leukemia
👏
**C. Visceral Leishmaniasis (Kala-azar)**
## footnote
**Classic triad + severe cachexia and hepatosplenomegaly point to visceral leishmaniasis** .
114
**What are the classical clinical and lab features of severe malaria caused by Plasmodium falciparum** ⁉️
🧠 **Key features** :
🔸 High fever, chills
🔸 Headache, myalgia
🔸 **Anemia**
🔸 **Thrombocytopenia**
🔸 **Metabolic acidosis**
🔸 Mild hepatosplenomegaly
## footnote
⚠️ Travel to **endemic area (e.g. Africa)** is a major clue 🕵️♂️
115
**What diagnostic test is recommended to confirm malaria in a febrile returning traveler** ⁉️
✅ **Thick blood smear + rapid diagnostic test (RDT)**
➡️ Thick smear: Detects **parasites**
➡️ RDT: Detects **antigens** from Plasmodium species
🧠 **Giemsa stain = gold standard for smear**
116
**What is the most appropriate next step to confirm the diagnosis in a patient with fever, anemia, and history of travel to Africa** ⁉️
A. Bacterial stool PCR
B. Chest X-ray + abdominal US
C. Bone marrow aspiration
D. Thick blood smear + rapid test
👏
**D. Thick blood smear + rapid test**
## footnote
**Malaria is confirmed by thick smear (parasite detection) and rapid antigen testing. All other tests are irrelevant for first-line diagnosis** .
117
**What is the purpose of the Rochester Criteria in febrile infants aged 60–90 days** ⁉️
🧠 To identify **low-risk** infants for **serious bacterial infections (SBI)**
➡️ Helps guide outpatient vs inpatient management
118
**What are the Rochester Criteria for febrile infants (60–90 days old)** ⁉️
✅ **All must be present** :
1. **Well-appearing**
2. **Full term** birth (≥37 weeks)
3. **Previously healthy**
4. No signs of skin, soft tissue, skeletal, or ear infection
5. WBC count: **5,000–15,000/mm³**
6. Bands: **<1,500/mm³**
7. UA: WBCs **<10/hpf**
8. If diarrhea: Fecal leukocytes **<5/hpf**
119
**What is the risk of serious bacterial infection in a well-appearing infant who meets all Rochester Criteria** ⁉️
✅ **<1%** risk of SBI
⚠️ If not all criteria are met ➡️ **risk increases to 7–9%**
120
**Which of the following findings disqualifies an infant from being considered low-risk under Rochester Criteria** ⁉️
A. Full-term birth
B. WBC = 13,000/mm³
C. Lumbar puncture glucose = 65 mg/dL
D. Born at 36 weeks gestation
👏
**D. Born at 36 weeks gestation**
## footnote
**Preterm birth (<37 weeks) is an exclusion criterion for low-risk classification under Rochester Criteria** .
121
**What is the most common site of TB, and what factors influence its progression** ⁉️
🫁 **Most common site** : Lung apex
✅ **Good immunity** → Ghon focus → fibrosis + calcification
⚠️ **Low immunity** → spread to lymph nodes and other organs
122
**What is a Ghon focus and Ghon complex in primary TB**⁉️
📍 **Ghon focus** : Caseating granuloma beneath pleura
📍 **Ghon complex** :
• Ghon focus
• Ipsilateral hilar lymphadenopathy
• Lymphangitis
123
**What are the typical symptoms of pulmonary TB** ⁉️
🔹 **90% asymptomatic**
🔸 Chronic cough (main symptom)
🔸 Recurrent infections unresponsive to antibiotics
🧠 Systemic:
• Weight loss
• Night sweats
• Low-grade fever
• Loss of appetite
124
**What is the pathophysiology of TB granuloma formation** ⁉️
1️⃣ Inhaled TB phagocytosed by macrophages
2️⃣ TB blocks phagolysosome fusion
3️⃣ Local infection → granuloma forms in 3 weeks
4️⃣ Central caseous necrosis → **Ghon focus**
✅ TB is held in check if immunity intact
125
**What are extrapulmonary sites of TB involvement** ⁉️
🧠 TB meningitis
🫁 Pleural TB
🦴 Spinal TB (Pott’s)
🧬 Genitourinary TB
🌿 TB lymphadenitis
🍽 TB peritonitis
💡 Disseminated TB = **Miliary TB**
126
**How is TB diagnosed** ⁉️
🧪 CBC: Lymphocytosis, ↑ESR
🧪 Tuberculin test (PPD):
• <5 mm = Negative
• ≥10 mm = Positive (infection or vaccine)
• ≥15 mm = True infection
🧪 Sputum: Ziehl-Neelsen stain, **Lowenstein-Jensen culture** (4 wks), **BACTEC** (10 days)
🧪 PCR / Quantiferon TB gold / LN biopsy
127
**What are the phases and drugs used in TB treatment** ⁉️
🩺 **Duration** : 6 months (can extend to 9 months)
➡️ **Intensive phase (0–2 months)** :
• INH + Rifampin + Pyrazinamide + Ethambutol
➡️ **Continuation phase (2–6 months)** :
• INH + Rifampin
128
**What are the side effects of TB drugs** ⁉️
💊 **INH** : Peripheral neuropathy ➡️ give Vit B6
💊 **Rifampin** : Orange-red body fluids
💊 **Pyrazinamide** : Hyperuricemia (Gout)
💊 **Ethambutol** : Optic neuritis
💊 **Streptomycin** : Ototoxicity, nephrotoxicity
129
**What is the main treatment for non-tuberculous mycobacterial (NTM) lymphadenitis in children** ⁉️
🧠 **Surgical excision** of infected lymph nodes
✅ Both **diagnostic** and **therapeutic**
130
**What are the key characteristics of Mycobacterium kansasii infection** ⁉️
🧫 **Slow-growing NTM**
🌊 Found in **tap water**
🫁 **Pulmonary disease** :
• TB-like symptoms (cough, fever, hemoptysis, cavitation)
🧪 Mimics TB radiologically and clinically
131
**What is the treatment regimen for Mycobacterium kansasii pulmonary disease** ⁉️
💊 **Rifampicin + Ethambutol**
## footnote
🧠 Similar to part of TB treatment, but without INH or PZA
132
**What is the causative organism and general characteristics of Actinomycosis** ⁉️
🧫 Actinomyces israelii
➡️ Anaerobic, **Gram-positive filamentous rod**
➡️ **Not acid-fast**
✅ Normal flora of mucosal surfaces (mouth, GI, GU)
133
**What are common risk factors for actinomycosis** ⁉️
⚠️ Poor oral hygiene
⚠️ Dental trauma or procedures
⚠️ Periodontal disease
🧠 Endogenous infection after mucosal barrier is breached
134
**What is the diagnostic appearance of Actinomyces on microscopy** ⁉️
🔬 **Gram-positive** , filamentous, **non–acid-fast** rods
🧠 Appear purple on Gram stain
🟣 Can form “sulfur granules” in pus
135
**What is the drug of choice for actinomycosis** ⁉️
💊 **Penicillin** ✅
➡️ Long-term treatment often needed (weeks to months)
## footnote
🧠 Alternatives (if allergic): Doxycycline, Clindamycin
136
**A child presents with a jaw mass and draining sinuses. Gram stain shows gram-positive filamentous, acid-fast negative organisms. What is the best treatment** ⁉️
A. Ceftriaxone
B. Clindamycin
C. Trimethoprim-sulfamethoxazole
D. Vancomycin
E. Penicillin
👏
**E. Penicillin**
## footnote
**Actinomyces is treated with long-term penicillin; it’s gram-positive, filamentous, and not acid-fast** .
137
**What are the most common bacterial causes of lymph node infections (lymphadenitis) in children** ⁉️
🦠 **Streptococcus pyogenes (Group A Strep)**
🦠 **Staphylococcus aureus**
## footnote
✅ These are the most frequent pathogens in **acute bacterial lymphadenitis**
138
**What is the recommended first-line antibiotic for bacterial lymphadenitis** ⁉️
💊 **Cephalexin**
➡️ Covers both **Streptococcus** and **Staphylococcus**
## footnote
🧠 Adjust if MRSA suspected or no response
139
**What is lymphangitis and what typically causes it** ⁉️
🧠 **Lymphangitis** = infection of **lymphatic vessels or nodes**
➡️ Usually a complication of **bacterial cellulitis**
🦠 Most common cause: **Streptococcus pyogenes (Group A Strep)**
140
**What are potential complications of untreated lymphangitis** ⁉️
🚨 **Thrombosis** of adjacent veins
🚨 **Sepsis**
## footnote
🧠 Requires prompt treatment to prevent systemic spread
141
**What is the causative agent of Cat Scratch Disease (CSD), and how is it transmitted** ⁉️
🦠 **Bartonella henselae**
🐱 Transmission: **Cat bite or scratch** (present in ~90% of cases)
## footnote
🧠 Most common cause of **chronic lymphadenitis** in children
142
**What are the key clinical features of Cat Scratch Disease** ⁉️
🔸 **Red papule** at scratch site
🔹 Regional **lymphadenopathy** (tender, erythematous, may suppurate in 10–40%)
📍 Most commonly involved nodes:
• **Axillary** (most common)
• Cervical, submandibular, preauricular
143
**How is Cat Scratch Disease diagnosed** ⁉️
🔬 **Serology** (antibody detection)
🧪 **PCR** for Bartonella DNA
## footnote
✅ Often clinical diagnosis in typical presentations
144
**What is the treatment of Cat Scratch Disease in children** ⁉️
✅ **Supportive management** in most cases
🧠 **Antibiotics** (e.g., azithromycin) may be used in **moderate/severe** or **suppurative cases**
145
**A child presents with tender axillary lymph nodes and a red papule after being scratched by a kitten. What is the most likely diagnosis** ⁉️
A. Tularemia
B. TB lymphadenitis
C. Cat Scratch Disease
D. Toxoplasmosis
👏
**C. Cat Scratch Disease**
## footnote
**Bartonella henselae from a cat scratch causes CSD, which presents with regional lymphadenopathy and a red lesion at the scratch site** .
146
**What is the causative agent and transmission route of rabies** ⁉️
🧠 **Rabies virus** = Single-stranded RNA virus
➡️ Family: **Rhabdovirus**
🐶 Transmitted via **infected animal saliva** (bite/scratch)
147
**How does rabies virus reach the brain, and which cells does it target** ⁉️
🧠 **Infects neurons**
➡️ Travels **retrograde** from peripheral nerves to the brain
⚠️ Causes fatal **encephalitis**
148
**What are the features of encephalitic (furious) rabies** ⁉️
🚨 Most common form
🔹 **Hydrophobia** (pharyngeal spasms)
🔹 **Aggressive behavior**
🔹 **Autonomic overactivation**
## footnote
⚠️ Common in dog bites (especially in developing countries)
149
**What are the features of paralytic rabies** ⁉️
🔸 Less common form
🔹 **Paresthesia**
🔹 **Ascending paralysis**
## footnote
🧠 May resemble Guillain-Barré Syndrome
150
**What is the recommended post-exposure prophylaxis for rabies** ⁉️
✅ **Wound cleaning**
✅ **Passive immunization** (Rabies Immunoglobulin)
✅ **Rabies vaccine (active immunization)**
🚨 If symptoms appear before treatment → **almost always fatal**
151
A child receives a provoked bite from a stray dog that is captured and appears healthy. What is the next best step⁉️
✅ **Confine and observe the dog for 10 days**
🧠 If the dog shows symptoms → start PEP
🧠 If the dog stays healthy → no treatment needed
152
**What is the most common cause and presentation of septic arthritis in children** ⁉️
🦠 **Staphylococcus aureus** = most common cause
🚩 **Acute monoarthritis** with:
• Fever, chills, malaise
• Red, swollen, warm joint
• Pain and restricted movement
## footnote
🧠 Hip/knee commonly affected
153
**What are key investigations for suspected septic arthritis** ⁉️
🔍 Joint **ultrasound** : detect effusion
💉 **Arthrocentesis** (aspiration): diagnostic and therapeutic
🧪 Labs:
• ↑ WBC
• ↑ ESR, CRP
• Blood cultures
154
**What is the cornerstone of management for septic arthritis in children** ⁉️
✅ **Urgent joint drainage** (aspiration or surgical)
✅ **IV antibiotics** (e.g., ceftriaxone or anti-staph agents)
💊 Pain control and supportive care
## footnote
⚠️ Delay increases risk of permanent joint damage
155
**A febrile child presents with hip pain and joint effusion. Labs show high WBC and ESR. What is the next step** ⁉️
A. Follow-up; likely post-infectious
B. Oral antibiotics
C. Joint drainage + IV antibiotics
D. Brucella serology
👏
**C. Joint drainage + IV antibiotics**
## footnote
This is classic septic arthritis; drainage and IV antibiotics are urgent to prevent joint damage.
156
**What is the causative organism and mode of transmission of brucellosis** ⁉️
🦠 Brucella spp. (intracellular Gram-negative coccobacilli)
• B. melitensis, B. suis, B. abortus, B. canis
🐄 **Transmission** :
• Ingestion of **unpasteurized dairy** (raw milk, cheese)
• Direct contact with infected animals
157
**What are the hallmark symptoms of brucellosis (Mediterranean fever)** ⁉️
🔸 **Undulant fever** (comes and goes)
🔸 Malaise, weight loss, **night sweats** , myalgia
🔸 **Arthralgia** , sacroiliitis
🔸 Hepatosplenomegaly
⚠️ Can become **chronic or relapse**
158
**What are some complications of brucellosis** ⁉️
🚨 **Endocarditis**
🚨 **Epididymo-orchitis**
🚨 **Hepatitis**
🚨 **Neurobrucellosis** (e.g., meningitis)
🚨 **Spontaneous abortion** in infected pregnant women
159
**How is brucellosis treated*** ⁉️
💊 **Doxycycline + Gentamicin**
💊 OR **Doxycycline + Rifampin**
## footnote
🧠 Treatment must be prolonged to prevent relapse
160
**A 13-year-old girl presents with weight loss, fever, arthralgia, and abdominal pain. She drank unpasteurized milk. What is the most likely clinical finding** ⁉️
A. Uveitis
B. Petechial rash
C. Oral aphthae
D. Hepatosplenomegaly
👏
**D. Hepatosplenomegaly**
## footnote
Triad of **fever, splenomegaly, and arthralgial arthritis** , points towards Brucellosis.
161
**What is erythema gangrenosum, and in whom does it typically occur** ⁉️
🧠 **Erythema gangrenosum** = necrotic skin lesions caused by **severe systemic infection**
⚠️ Typically in **critically ill or immunocompromised** patients
🧬 Common in **neutropenic** or malnourished children
162
**What is the most common pathogen responsible for erythema gangrenosum** ⁉️
🦠 **Pseudomonas aeruginosa** ✅
➡️ Other rare causes: Staph, Klebsiella, fungi, viruses
🧠 Gram-negative bacillus with a predilection for bloodstream invasion
163
**What are the classic skin findings of erythema gangrenosum** ⁉️
🔴 **Painless red patches** → blister → **black necrotic ulcer**
🟣 **Central necrosis with red halo**
📍 Often in **perineal, axillary, or extremity areas**
164
**What is the diagnostic and management approach for erythema gangrenosum** ⁉️
🔬 **Diagnosis** :
• Clinical skin exam
• **Blood cultures**
• Skin **biopsy** for confirmation
💊 **Treatment** :
• **Antipseudomonal antibiotics** (e.g., ceftazidime, meropenem)
• Surgical debridement if needed
➡️ Adjust therapy based on culture results
165
**A malnourished infant in septic shock develops necrotic skin lesions with a black center and red halo. Blood culture grows gram-negative rods. What is the most likely pathogen** ⁉️
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Klebsiella oxytoca
D. Kingella kingae
👏
**A. Pseudomonas aeruginosa**
## footnote
**Erythema gangrenosum in septic neonates is most classically due to Pseudomonas aeruginosa** .
166
**Which vaccine is routinely given at birth in the hospital** ⁉️
✅ **Hepatitis B (1st dose)**
## footnote
🧠 Protects against perinatal transmission
167
**What are the key features of live attenuated vaccines (LAV)** ⁉️
🧠 **Live attenuated vaccine = weakened form** of the actual virus/bacterium
✅ Must **replicate** in the body to be effective
✅ Mimics **natural infection**
✅ Often **1 dose is sufficient** for long-term immunity
168
**What are the key features of inactivated (killed) vaccines** ⁉️
💉 **Cannot replicate**
🛡️ Immune response is **humoral** (antibodies)
⏳ Multiple doses needed **(3–5 doses)**
🧠 Antibody levels **wane over time**
169
**Which viral vaccines are inactivated (not live attenuated)** ⁉️
❌ **NOT live** =
• Hepatitis A
• Hepatitis B
• Injectable polio (Salk)
• Injectable influenza
• Rabies
🧠 **Mnemonic** : **“Always Be RIP”**
= **A (hep A), B (hep B), R (Rabies), I (Injectable influenza), P (Polio – injectable)**
170
**Which bacterial vaccines are live attenuated** ⁉️
✅ **Live bacterial vaccines** :
• **BCG (TB)**
• **Oral Typhoid**
• **Plague vaccine** (less commonly used)
🧠 Most other bacterial vaccines are killed
171
**What are the general contraindications for immunization** ⁉️
⛔ **Anaphylaxis** to vaccine or any component (e.g., egg, gelatin, antibiotics)
⛔ **Moderate-severe illness** with or without fever
⚠️ **Immunocompromised** : Avoid LAV
✅ Exception: **Measles & BCG allowed in HIV patients** if **CD4 >15%**
172
**Which of the following is a killed viral vaccine** ⁉️
A. MMR
B. Oral polio vaccine (OPV)
C. Rabies
D. Varicella
👏
**C. Rabies**
## footnote
Rabies is a killed viral vaccine. MMR, OPV, and Varicella are all live attenuated.
173
**What is the correct management of a term neonate born to an HBsAg-positive mother** ⁉️
💉 **Administer BOTH** :
✅ **Hepatitis B vaccine (active)**
✅ **HBIG (Hepatitis B immunoglobulin)** (passive)
🧠 Must be given **within 12 hours** of birth
➡️ Prevents perinatal transmission
174
**What is the management of a neonate <2 kg born to an HBsAg-positive mother** ⁉️
⚠️ Delay **vaccine** until discharge or 1 month
✅ Still give **HBIG** at birth
➡️ Vaccine efficacy is lower in low-birth-weight neonates
175
**What does this maternal serology indicate: HBsAg (+), anti-HBc (+), anti-HCV (–), HIV (–)** ⁉️
🧠 **Current Hepatitis B infection**
➡️ Baby requires **HBIG + Hep B vaccine at birth**
176
**What does each HBV marker indicate** ⁉️
🧬 **HBsAg** = Infection (acute or chronic)
🧬 **Anti-HBs** = Immunity (from vaccine or resolved infection)
🧬 **Anti-HBc IgM** = Acute infection
🧬 **Anti-HBc IgG** = Past infection or chronic infection
🧬 **HBeAg** = High infectivity
🧬 **Anti-HBe** = Low infectivity
177
**A term neonate is born to an HBsAg-positive mother. What is the most appropriate next step** ⁉️
A. HBIG now and vaccine at 1 month
B. HBIG + Hepatitis B vaccine now
C. Tenofovir + vaccine
D. Observe and vaccinate later
👏
**B. HBIG + Hepatitis B vaccine now**
## footnote
HBIG + vaccine within 12 hours is essential to block vertical transmission.
178
**A boy has the following serology: HBsAg (–), Anti-HBs (+), Anti-HBc IgG (+), Anti-HBe (–). What does this indicate** ⁉️
A. Acute HBV infection
B. Chronic HBV infection
C. Resolved past infection
D. Vaccination only
👏
**C. Resolved past infection**
## footnote
**Anti-HBc IgG (+) indicates natural exposure, not just vaccination. Absence of HBsAg confirms resolved status** .
179
**What are the most common bacterial causes of meningitis in children** ⁉️
🦠 **Streptococcus pneumoniae** (most common overall)
🦠 **Neisseria meningitidis** (esp. with complement deficiency C5–C8)
🦠 **Haemophilus influenzae type B** (Hib, now less common with vaccination)
180
**What is the classic clinical presentation of bacterial meningitis in children** ⁉️
🚨 Sudden fever, lethargy, irritability
🧠 **Signs of meningeal irritation**:
• **Nuchal rigidity**
• **Kernig’s sign**
• **Brudzinski’s sign**
🔺 **Seizures** , altered consciousness, photophobia
⚠️ **Petechiae → purpura** in meningococcal meningitis
181
**What are signs of increased intracranial pressure (ICP) in meningitis** ⁉️
🔺 Headache, emesis, bulging fontanel
🔺 Papilledema
🔺 CN palsies (e.g., abducens)
🔺 Bradycardia + hypertension
182
**What is the diagnostic gold standard in meningitis**⁉️
🧪 **Lumbar puncture** (LP)
🔬 Confirm with CSF analysis + Gram stain + culture
🩸 Blood cultures should also be drawn
183
**When should CT scan be done before LP in suspected meningitis** ⁉️
⚠️ **Indications for CT before LP** :
• Papilledema
• Focal neurologic signs
• Coma
• History of hydrocephalus or neurosurgery
184
**What are typical CSF findings in bacterial meningitis** ⁉️
📊 CSF analysis:
• ⬆️ Opening pressure
• **WBC** : 300–10,000 (PMNs)
• ⬇️ Glucose <40 mg/dL or <50% serum
• ⬆️ Protein: 100–500 mg/dL
• Positive Gram stain/culture
185
**What is the empirical antibiotic regimen for suspected meningitis in children (non-neonatal)** ⁉️
💊 **Vancomycin + 3rd gen cephalosporin (e.g., ceftriaxone)**
➕ Add **ampicillin** if Listeria is suspected
➕ Use **cefepime/meropenem** if immunocompromised
186
**What is the specific treatment for each bacterial meningitis pathogen** ⁉️
🔹 **S. pneumoniae** : 3rd gen cephalosporin ± vancomycin
🔹 **N. meningitidis** : Penicillin or ceftriaxone
🔹 **H. influenzae type B** :
• Ampicillin (β-lactamase -)
• 3rd gen cephalosporin (β-lactamase +)
187
**What are the corticosteroid guidelines in bacterial meningitis** ⁉️
💉 **Dexamethasone** should be given **1–2 hrs before antibiotics*
✅ Reduces **hearing loss in Hib meningitis** (children >6 weeks)
188
**What is the recommended prophylaxis for contacts of bacterial meningitis cases** ⁉️
🧪 **N. meningitidis** : **Rifampin** for all close contacts
🧪 **H. influenzae B** : Rifampin if household has under-immunized <48mo or immunocompromised member
🚫 **S. pneumoniae** : No prophylaxis needed
189
**What are the long-term complications of bacterial meningitis in children** ⁉️
⚠️ **Neurologic sequelae** in 50% of cases
🔇 **Hearing loss** : most common (esp. with S. pneumoniae)
🔺 Seizures, developmental delay, hydrocephalus
💀 Mortality highest in **pneumococcal meningitis**
190
A child with fever, photophobia, purpura, and seizures. LP shows ↓glucose, ↑WBC (PMNs), ↑protein. What is the most likely diagnosis⁉️
A. Viral meningitis
B. TB meningitis
C. Bacterial meningitis (meningococcal)
D. Encephalitis
👏
**C. Bacterial meningitis (meningococcal)**
191
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Pediatrics
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