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A 13-month-old boy presents with a rash. The mother tells you that the child has had high fevers
over the past 4 days, although he has not had a fever for the past 24 hours. The rash began 6
hours ago; it started on his chest and back, and it spread to his neck, face, and arms. The child
doesn't appear to be itchy, and he has been acting normally since the fever subsided. The mother
denies cough, runny nose, vomiting, and diarrhea. The only medication that the child has taken is
acetaminophen. On examination, the child is happy and playful. The only physical finding is the
rash that is shown in the image. What is the most likely diagnosis?
Rubella
Roseola
Measles
Drug hypersensitivity
Varicella - Answer>>> Roseola
This child exhibits the typical rash of roseola. Roseola infantum (also called exanthem subitum)
is caused by Human Herpesvirus-6 and occurs almost exclusively during infancy. There is
usually no prodromal period. The illness begins with high temperatures (averaging 103 F) for 3
to 5 days; the fever typically resolves rather abruptly. The rash appears within 12 to 24 hours of
the fever resolution. The rash of roseola is rose-colored and begins as discrete, small, slightly
raised pink lesions on the trunk and spreads to the neck, face and proximal extremities. The rash
is not pruritic and no vesicles or pustules develop. The lesions may become confluent. Roseola is
self-limited and the treatment is supportive only (e.g., antipyretics during the febrile phase).
,An 8-month-old male infant presents with rashes over the scalp and eyebrows. Physical
examination shows a dry, scaly, and crusting lesion over the scalp, eyebrows, and nape area. He
is comfortable, so his mother presumed that it was not itchy at all. He has been breastfed up to
the present, and he started solid food at about 5 months old. There are no other signs and
symptoms noted. Bowel movement and urination are normal. Developmental milestones are
consistent with age. What is the most likely diagnosis?
Atopic dermatitis
Seborrheic dermatitis
Psoriasis
Candidiosis
Lichen simplex chronicus - Answer>>> Seborrheic dermatitis
The clinical picture is suggestive of seborrheic dermatitis, which is a chronic inflammatory
disease common in the pediatric age group especially during infancy and adolescent. The
etiology is unknown, but it has been attributed to stressful situations, poor hygiene, and
excessive perspiration.
A 3-year-old, HIV-positive boy has contracted varicella infection. He has not shown a
satisfactory response to treatment with acyclovir. He is suspected of having an acyclovir resistant
varicella zoster infection.
What is the alternate drug appropriate for treatment of varicella in this child?
Zidovudine
Ribavirin
, Oseltamivir
Foscarnet
Nevirapine - Answer>>> Foscarnet
Foscarnet is the appropriate drug for treatment of varicella in the above child. Acyclovir resistant
varicella-zoster virus (VZV) infection has been identified in children infected with HIV. These
children may be treated with intravenous foscarnet 120 mg/kg/day, divided every 8 hours for up
to 3 weeks. The dose needs to be modified in the presence of renal insufficiency. When foscarnet
is used to treat VZV infection in acquired immunodeficiency syndrome (AIDS) patients, it also
decreases HIV viral load, but it is not used primarily for HIV infection.
You are evaluating a 3-year-old African-American boy at a well-child visit. Prenatal and past
medical histories are unremarkable. Growth and developmental are normal. Immunizations are
up to date. Examination is normal. When inquiring about living arrangements, the child's mother
tells you that they live in a 3rd story apartment of an older building that has exterior fire escapes
accessible by the windows.
What should you advise regarding the windows?
She should have window bars spaced 8 inches part installed
Operable window guards should be installed on all windows
All windows should be screened.
She should have all windows bricked over
Fixed window guards should be installed on all windows - Answer>>> Operable window guards
should be installed on all windows