pediatric final

الاوسكي ٦ محطات -كاونسلنك -فوكس هستري -اكزامينيشن (كارديو ، رسبايرتري ، جي اي تي ، نيورو ) -نيونيتولوجي (اكزام ، روسيستيشن) -گراوث جارت -لوك بوك

خلنتجاوز الكوزات اليومية اللي ما نجاوب بيها و نبدي نتحضر للاوسكي

Remember always That any infection targets the RES (reticuloendothelial system) Like Enteric fever , Kala Azar , Brucellosis Mostly presents with 1-Leukopenia rather than leukocytosis 2-Hepatospleenomegaly 3-Prolong fever 4-In severe cases :➡️➡️ pancytopenia

دفرنشيل لكل البلو

## 1) Tuberculosis (TB) Key Differentiators * Chronic symptoms: prolonged cough (>2–3 wk), weight loss, fever, night sweats * Exposure history to adult with TB * Pulmonary ± extrapulmonary (lymph nodes, bone, CNS) 🩺 Exam clues * Firm, non-tender lymphadenopathy (esp. cervical) * Signs of chronic illness, failure to thrive 📊 Investigations * Positive TST/IGRA * Chest X-ray: hilar lymphadenopathy, segmental/lobar disease 💡 Pearl: TB is indolent, not acute; think TB with persistent symptoms + exposure history (Nelson22e, Infectious Diseases – Tuberculosis) --- ## 2) Exanthematous Diseases ### a) Scarlet Fever * Cause: Group A Streptococcus (toxin mediated) * Rash: sandpaper-like, starts on trunk * Other clues: strawberry tongue, circumoral pallor 💡 Follows streptococcal pharyngitis (Nelson22e, Streptococcal infections) --- ### b) Measles (Rubeola) * Prodrome: 3 C’s – cough, coryza, conjunctivitis * Pathognomonic: Koplik spots * Rash: starts at hairline → spreads downward 💡 Severe illness, high fever (Nelson22e, Measles) --- ### c) Mumps * Parotitis (painful, bilateral or unilateral) * Fever, malaise * Complications: orchitis, meningitis 💡 No rash (Nelson22e, Mumps) --- ### d) Rubella * Mild illness * Postauricular & occipital lymphadenopathy * Rash spreads rapidly, fades quickly 💡 Congenital rubella risk (Nelson22e, Rubella) --- ### e) Erythema Infectiosum (Parvovirus B19) * Slapped cheek rash * Lacy rash on body * Mild or no fever 💡 Can cause aplastic crisis (Nelson22e, Parvovirus infections) --- ### f) Roseola Infantum (HHV-6) * High fever → sudden defervescence → rash * Age: 6–18 months 💡 Febrile seizures common (Nelson22e, HHV-6 infections) --- ## 3) Diphtheria * Gray pseudomembrane on tonsils/pharynx * Bleeds on removal * Bull neck (cervical adenopathy) * Low-grade fever 💡 Toxin causes myocarditis & neuropathy (Nelson22e, Diphtheria) --- ## 4) Pertussis (Whooping Cough) Stages * Catarrhal → Paroxysmal → Convalescent * Inspiratory “whoop” * Post-tussive vomiting 💡 Apnea common in infants (Nelson22e, Bordetella pertussis) --- ## 5) Tetanus * Trismus (lockjaw) * Generalized muscle rigidity * Painful spasms triggered by stimuli 💡 No fever, sensorium intact (Nelson22e, Tetanus) --- ## 6) Kala-azar (Visceral Leishmaniasis) * Prolonged fever * Massive splenomegaly * Pancytopenia * Dark skin pigmentation 💡 Endemic areas + chronic fever (Nelson22e, Leishmaniasis) --- ## 7) Varicella (Chickenpox) * Pruritic vesicles * Lesions in different stages simultaneously * Starts on trunk → spreads 💡 “Dew drops on rose petals” (Nelson22e, Varicella-Zoster virus) --- ## 8) Infectious Mononucleosis (Children) * EBV most common * Fever, sore throat, fatigue * Posterior cervical lymphadenopathy * Hepatosplenomegaly 📊 Atypical lymphocytes, positive heterophile test (older children) 💡 Avoid amoxicillin → rash (Nelson22e, Epstein-Barr virus)

أول مرة نفروتك + طفل → Steroid trial • Steroid-resistant → Biopsy • Frequent relapse → Cyclophosphamide • نفروتك + ألم مفاجئ → Thrombosis

خريطة ذهنية سريعة: • طفل + يستجيب للستيرويد → MCD • ما يستجيب + ضغط عالي → FSGS • رضيع + تشوهات جنسية → Denys-Drash • Complement واطي → MPGN / Lupus

4️⃣ أكو تشوهات خلقية أو مشاكل جنسية؟ هاي تودّي مباشرة لتشخيصات نادرة 👀 🚨 Ambiguous genitalia 👉 Denys-Drash syndrome 🚨 Large placenta + edema at birth 👉 Congenital nephrotic syndrome (Finnish type)

2️⃣ يستجيب للستيرويد لو لا؟ هاي أهم نقطة بالتمييز 👑 ✔️ Steroid-sensitive 👉 غالباً: • Minimal Change Disease • بول: foamy • ضغط طبيعي • Complement طبيعي ⸻ ❌ Steroid-resistant فكّري فوراً بـ: • FSGS • Denys-Drash • Congenital nephrotic syndrome