 |  A 16 yo girl with fever,rash,vomiting...
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| Author | 15 Posts |
smitha
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A 16 yo girl has had fever , vomiting, and watery diarrhea for the past 24 hrs. She also complains of intermittent abdominal pain and generalized myalgia.OE…slightly lethargic, T—103 F, BP—75/50mm Hg, P—150/min. Her conjunctivae and pharynx are hyperemic.She has a generalized erythematous maculopapular rash that spares the wrists. Which of the following will be the most appropriate treatment?
a. Amanatidine
b. Gentamicin
c. Ketoconazole
d. Nafcillin
e. Prednisone.
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| shirish_sss
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SEEMS TO BE VIRAL IN ORIGIN....?
MAY BE AMANTIDINE IS THE ANSWER.... :roll: :roll:
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| shirish_sss
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I HAVE A THOUGHT ABOUT SCARLET FEVER TOO.....
THEN IT WOULD BE NAFCILLIN.....
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to me its bacterial origin.......very high grade fever............ ummmm i will go with scarlet fever....... and Neficillin
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| Yulia
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I think it looks more like Toxic Shock Syndrome, and Nafcilline would be the best choice then...
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| dr_perfect_stranger
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:roll: Scarlet fever......... ummm okay ........ but why naficillin.... Penicillin G IV must be drug of choice and if patient is allergic then Erythromycin.....
High grade fever,,, low bp. macular rash........ i think Yulia is very right....its Toxic Shock Syndrom ..... but i have not read that rash of TSS spares wrists.......but still neficillin is the best choice
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| Nubie
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Nafcillin (for TSS)
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| shirish_sss
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there r only two rashes that spares palms and soles...
ONE IS SCARLET FEVER AND OTHER IS EPIDEMIC TYPHUS.....
TSS RASH DOES INVOLVE PALM AND SOLE...
I THINK IT MAY BE SCARLET FEVER AND ANSWER MAY BE NAFCILLIN..... :roll: :roll:
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| smitha
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CORRRRRRRECT YULIA & NUBIE!!!!!!!!!! 
The clinical presentation is consistent with TSS and IT DOES SPARE wrists.......
It is caused by Staph. aureus and ususally occurs in women using highly absorbent tampons. The pt.s systemic and other symptoms r due to it's toxic nature.
In a YOUNG GIRL, TOXIC, RASH SPARING WRISTS, ALWAYS THINK OF TSS FIRST!!!!!!!!!!!
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| smitha
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And this q, with no clue of any tampon usage, makes it a little confusing for us to go for an answer and that is the reason y i posted, coz these smaaaaaall things can take away big points from us while answering,though we all know our theory/subject............. 
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| bakpity
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Hi Guys,
I found this case in the archieve. Would any of you explain or give me resources regarding the derm. presentation of TSS stating that it spares palm and soles>
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| BellKicker
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TSS doesn't spare the wrists, hands or palms.
Still, I think the case was pointing heavily toward TSS.
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| bakpity
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I agree with u the case seems pretty obvious I am just trying understand the reasoning.
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| prity
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| scorpion
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hi...
i think that toxic shock syndrome is the best choice in this case.....
TSS is caused by the strains of staphylococci wich produce toxins..
it occurrs in men in most cases (90% or more) . . although it occurrs in women of child bearing age.
symptoms begin in nearly all patients withen 5 days of the onset of a menstrual period in women who have used tampon.
nonmenstrual cases are now about as common as menstrual cases.
blood cultures are negative because symptoms are due to the effects of the toxin.
treatment: rapid rehydration , nafcillin , management of renal or cardiac failure( if happened) ,
removal of sources of toxin , intravenous immune globulin .
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