Liferocks
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A 3-month-old girl presents to her general pediatrician’s office with a rash. She is the product of a normal uncomplicated pregnancy, and was born at 40 weeks’ gestation. Her mother reports that she was well until this morning, when she suddenly developed a fever to 41°C (105.8°F) with no other symptoms. In the pediatrician’s office, the patient begins to seize and is rushed to a nearby hospital. She is hospitalized and continues to have seizures whenever her temperature spikes above 40°C (104°F). After 3 days, her fever breaks and she develops a maculopapular rash on her trunk that then spreads to her face and extremities. Which of the following is the most likely pathogen?
(A) Human herpesvirus-6
(B) Measles virus
(C) Parvovirus B19
(D) Rubella virus
(E) Varicella-zoster virus
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| docnit
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HHV-6.
fever followed by rash.
seizures sare febrile seizures.
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| kpmle2
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Classic presentation.
Roseola HHV-6
Prodrome: Acute onset of high fever (> 40°C); no other symptoms for 3–4 days.
Rash: Maculopapular rash appears as fever
breaks (begins on the trunk and quickly
spreads to the face and extremities) and
often lasts < 24 hours.
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| docnit
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let's finis off the discussion of rashes here.
where they begin and how they progress..very imp and a bit confusing.
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| Liferocks
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Measles ----Maculopapular rash starts from head,then to neck and torso and then to feet. (imagine a bucket of red paint being poured over patient's head. The paint is thicker over the head and shoulders and drips completely off in 6 days.)
Varicella --- Pruritic Rash in the form of vesicles first erupt on trunk and face and then spread to involve entire body. Vesicles erupt in crops, so one crop forms as another crop scabs.
Parvovirus--- Specific 'slapped cheek' rash, then to trunk,then central clearing--lacey.
Rubella --- Rash similar to measles, begin on face and spreads to rest of body...lasts approx. 3 days.
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| docnit
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Thanks liferocks !
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| kpmle2
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cont....
Measles
Prodrome: Low-grade fever with cough, coryza,
and conjunctivitis (the “three C’s&rdquo ; Koplik’s
spots (small irregular red spots with central
gray specks) appear on the buccal mucosa
after 1–2 days.
Rash: Erythematous, maculopapular rash spreads
from the head toward the feet.
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| docnit
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mother brings her 12 yr old child with CNS symptoms..
somewhere in the q it might be mentioned she recollects her child having some rash when her child was 2 yrs of age..
to look for SSPE in the options. ( subacute sclerosing panencephalitis) ( very rare complication but usmle likes rare stuff too!)
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| docnit
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Measles causes vitamin A deficiency...so always supplement vit A as a part of treatment.
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| docnit
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Rubella causes postauricular, suboccipital and posterior cervical lymphadenopathy
german measles...its very similar to measles but appears and disappers soon..within 3 days called 3 day measles.
mother recived vaccine and got pregnant within 1 month of vaccine administration: reassurance...no need to abort ( no cases have been reported)
if mother aquires rubella frm day care centre during first 10 weeks of pregnancy: then therapeutic abortion cos 90% transmission risk.
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| docnit
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Parvovirus: case scenario
pregant mother contacts a child with slapped cheek appearance....few weeks later her baby is dx with erythroblastosis fetalis: aplastic anemia secondary to parvovirus B19.
other way parvovirus can be asked: B/L symmetrical polyarthropathy in an adult where all other serology including RF, lymes's, SLE , hepatitis B panel are all negative.
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| ngaybinhyen
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Thanks, docnit
Your are so sweet, ma'am 
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| docnit
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u didnt put across ur interesting qs today?
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