PediaMastery

.

.

.

.

.VARICELLA (Discussed later)

4-ROSEOLA INFANTUM –Golden Keys حمى عالية جدا ، يظهر الطفح"زهري اللون" بالتزامن مع نزول درجة الحرارة . الطفل غالبا يبدو بصحة جيدة ، بالرغم من الحمى العالية High fever → sudden drop → rash = Roseola 🔑 Very high fever (39–40°C) WELL-appearing despite fever 🔑 Rash after fever breaks🔑🔑🔑 Almost exclusively during infancy🔑🔑 Intro 95% of children being infected with HHV-6 by 2 yr of age. The peak age of primary HHV-6B infection is 6-9 mo of life. Presentation : -Abrupt onset of high fever. -Appears well despite high grade fever . -The fever usually resolves with the appearance of a faint pink rash on the trunk which usually lasts 1-3 days spreading from the trunk to the face and extremities. ((Roseola = Rose coloured rash )) -Associated signs are few but can include mild injection of the pharynx, eyes, or tympanic membranes and enlarged suboccipital LNs. -Convulsions are the most common complication of roseola and are recognized in up to 1/3 of patients. (Febrile) Treatment Supportive, hydration and antipyretics. Roseola is generally a self-limited illness associated with complete recovery.

3-Mumps Prodromal symptoms → Fever → Parotid swelling🔑 Tender parotid swelling 🔑 Obliterated angle of mandible🔑 Mostly 5 to 9. Years 🔑 Intro An acute self-limited infection , primarily young children between the ages of 5 and 9 yr Target organs: 1. Salivary glands, CNS, pancreas and testes. 2. Thyroid, ovaries, heart, kidneys, liver and joint (lesser extent) . Transmission: Respiratory droplets. Virus appears in the saliva from up to 7 days before to and 7 days after the onset of swelling. Presentation Incubation : 12 to 25 day A Prodrome of , fever, headache, vomiting, and achiness lasting 1-2 days Parotitis then appears, unilateral initially , become bilateral in 70% of cases. The parotid swelling : peaks in approximately 3 days gradually subsides over 7 days. Fever and the other systemic symptoms resolve in 3-5 days. Rash is rarely seen. Inv -Diagnosis mainly clinical -CBP,Leukopenia with a relative lymphocytosis. -↑ Serum amylase (due to parotitis). -Serological studies, viral isolation & culture, PCR. 1-Meningitis and Meningoencephalitis: the most common 2-Orchitis and Oophoritis: Involvement in prepubescent boys is extremely rare, but after puberty, orchitis occurs in 30-40% of males. 3-Pancreatitis may occur with or without parotid involvement. 4-Uncommon and rare Cxs of mumps include: conjunctivitis, optic neuritis, pneumonia, nephritis, myocaditis, arthritis, thyroiditis, and thrombocytopenia. Rx No specific antiviral therapy is available for mumps. Reducing the pain associated with meningitis or orchitis and maintaining adequate hydration. Antipyretics may be given for fever.

forchheimer spots

2-RUBELLA Mild fever → lymphadenopathy → rash 🔑 Lymph nodes 🔑 Posterior auricular & posterior cervical 🔑 Duration of Rash 3 days → “Three-day measles” 🔑 Forchheimer SPOTS 🔑 INTR : German Measles or Three 3️⃣ days Measles The major clinical significance of Rubella is the transplacental infection and fetal damage. Transmission : is most contagious through direct or droplet contact with nasopharyngeal secret. Presentation : The prodrome low-grade fever, sore throat, red eyes, headache, malaise, anorexia LAP (especially suboccipital, postauricular, and anterior cervical LNs) Exanthematous phase : The Rash which last about three days appears on the face first as numerous discrete rose maculopapules which rapidly spread downward . About the time of onset of the rash, an enanthem develop called "Forchheimer spots" as tiny, rose-colored lesions on oropharynx or petechial hemorrhages on soft palate. COMPLICATIONS 1-Postinfectious Thrombocytopenia and Arthritis 2-. Encephalitis is the most serious ,it occurs in 3-Other rare Cxs include Guillain-Barre syndrome, peripheral neuritis, & myocarditis. 4-Congenital Rubella Syndrome: Due to Maternal infection in the first 8 wks. Treatment: No care beyond antipyretics and analgesics. • Patients should be isolated from susceptible individuals for 7 days after the onset of rash. Prevention – MMR vaccine 💉: Dose 1: 12–15 months Dose 2: 4–6 سنوات

Never forget when Tom and Jerry got infected by Measles -First , Jerry looks sick and sad 😔 🤒 (High grade Fever prior to Rash) -Then Jerry’s rash spreads from his forehead downward Once Tom touched Jerry , he also get infected 🤧 (Measles is a highly contagious disease 🦠 ) Jerry looked at the mirror to see his mouth , he found KOPLIK SPOT . (KOPLIK SPOTS ARE pathognomonic for Measles💯💯) Wish them to get well soon

Fever and Rash 1 -Measles HIGH FEVER 39-40 🔑 FEVER IS PRIOR , THEN KOPLIK THEN RASH🔑 RASH SPREAD FROM FOREHEAD DOWNWARD TO FEET🔑 KOPLIK SPOT are the pathognomonic🔑 Intro : Measles is highly contagious , serious infection approximately one million per deaths year ⚠️ Transmission : respiratory tract or conjunctivae following contact with large- or small-droplet aerosols Presentation : Incubation period, Prodromal illness, Exanthematous phase Incubation period : 10 to 14 days Prodromal illness : fever Cough, Coryza, Conjunctivitis 😷👀🤧 (3Cs) Increasing fever 📈 could ba as high as 40 c Exanthematous phase : Koplik spots are the pathognomonic sign of measles, it is an enanthem appearing 1-4 days prior to the onset of the rash Then Symptoms increase in intensity for 2-4 days until the 1st day of the RASH. Then rash begins : On the forehead (around the hairline), behind the ears upper neck as a red maculopapular eruption Then downward to the torso and extremities and may reach to palms and soles. The rash disappears from top downward ما ننسه ابدا في الحصبة ، اول شي تبدي الصخونة ويه ال 3C بعدها تظهر الكوبلك سبوت ، الي نعتبرها علامة تشخيصية للحصبة (تكون بشكل بقعة بيضاء صغيرة محاطة بهالة حمراء غالبا على الجهة الداخلية للخد)، وتستمر وياها اشتداد المرض وارتفاع درجة الحرارة وبعدها يظهر الطفح الجلدي الي ينتشر من فوق نزولا ، ويختفي بنفس الطريقة Complications : Morbidity and mortality of measles are related to age <5 yr (especially <1 yr) and >20 yr severe malnutrition immunodeficiency low serum retinol levels (vit. A deficiency). Respiratory Cxs: Pneumonia is the most common cause of death in measles. It may manifest as giant cell pneumonia caused direct viral infection or as superimposed bacterial infection Croup, tracheitis, and bronchiolitis are common in infants and toddlers. ENT Cxs acute otitis media, mastoiditis, sinusitis. GIT Cxs: Diarrhea and vomiting with dehydration are common symptoms Neurological Cxs: Febrile seizures occur in <3%. Encephalitis is mainly occurring in adolescents and adults. It is due to postinfectious, immunologically mediated process and is not the result of a direct effect by the virus. Subacute measles encephalitis manifests 1-10 mo after measles in immunocompromised patients; it results from direct damage to the brain by the virus. Rare Cxs include: Hemorrhagic or “black” measles which is often fatal and manifests as hemorrhagic skin eruption. Other rare Management : Supportive maintenance of hydration, oxygenation, and comfort. Antipyretics are useful for comfort and fever control. Vitamin A therapy is indicated for ALL patients with measles. once daily for 2 days at doses of 200,000 IU for children >1 yr 100,000 IU for infants between 6 mo - 1 yr 50,000 IU for infants <6 mo of age. In children with signs and symptoms of vitamin A deficiency, a 3rd dose is recommended 2 - 4 wk after the 2nd dose. Prevention – MMR vaccine 💉: Dose 1: 12–15 months Dose 2: 4–6 سنوات

Section II : PediaInfex “Every silent germ in a child— Shall be unveiled, understood, and rendered powerless.” Fever and Rash 1- Measles 2-Rubella

A 7-year-old child with a know history of moderate persistent asthmapresents to the emergency department with acute shortness of breath, wheezing, and coughing. He was given short-acting beta- agonist (SABA) via nebulizer upon arrival . What is the next appropriate step in management A /The next appropriate step is to administer systemic corticosteroids (e.g., oral prednisolone 1 –2 child presents with a harsh, barking cough and inspiratory stridor What is the next best step regarding investigations? ? No further investigations are needed Croup Is a Clinical Diagnosis A child diagnosed with pneumonia has been receiving intravenous antibiotics for 7 days but continues to have persistent symptoms. A follow-up chest X-ray reveals a welldefined fluid collection adjacent to the area of lung consolidation. Next step in management? Next Step → Perform chest tube drainage : A child with poorly controlled asthma presents with sudden onset shortness of breath and chest pain. On examination, breath sounds are decreased on one side. What is the most appropriate next step? Diagnosis : Acute pneumothorax — unless the child is clinically unstable (hypotension, severe respiratory distress, hypoxaemia, tracheal deviation) — in which case immediate needle decompression is indicated without waiting for imaging. A child presents with chronic productive cough, recurrent respiratory infections and clubbing Which of the following is the most appropriate investigation TO CONFIRM the suspected diagnosis Diagnosis : Bronchiectasis. High-resolution computed tomography (HRCT) of the chest A child presents with sudden onset high fever, drooling, muffled voice, and stridor You suspect epiglottitis . What is the most appropriate immediate management ? Secure the airway immediately

A 6-year-old boy has a history of recurrent chest infections over the last 3 years. He recently presented with copious purulent sputum, mainly in the morni ng. On examination, he has finger clubbing and bilateral diffuse coarse crackles on chest auscultation. Which of the following IS THE LEAST LIKELY cause of his condition?

اسالة الدور الاول ٢٠٢٥ ما موجودة بشكل كامل موجودة بشكل نصوص حسب ذاكرة الطلاب نذكرهن للفائدة