1 00:00:00,480 --> 00:00:02,640 Speaker 1: All right, so let's talk about some high yield pediatric 2 00:00:02,720 --> 00:00:05,839 vile illnesses. There is a number of them, rosiola, measles, mumps, 3 00:00:05,879 --> 00:00:08,279 among many many others. Quick thank you to all of 4 00:00:08,279 --> 00:00:10,359 the support for the channel, buying a T shirt just 5 00:00:10,400 --> 00:00:12,400 a nice comment in general, it really makes my day, 6 00:00:12,400 --> 00:00:14,039 so thank you so much. Let's go ahead and get 7 00:00:14,039 --> 00:00:18,039 started with rosiola. So rosiola also known as xanthem subitum. 8 00:00:18,280 --> 00:00:20,239 Only a few things to know. The peak prevalence is 9 00:00:20,280 --> 00:00:23,359 going to be between seven and thirteen months. In ninety 10 00:00:23,359 --> 00:00:25,399 percent of cases are going to occur in children younger 11 00:00:25,440 --> 00:00:28,320 than two years of age. Human herpes virus six B 12 00:00:28,519 --> 00:00:31,320 is the most common cause of rosiola, and therefore it's 13 00:00:31,359 --> 00:00:33,079 the one you need to know. It's usually spread for 14 00:00:33,159 --> 00:00:37,079 asymptomatic shedding of the virus in secretions to close contacts, 15 00:00:37,119 --> 00:00:39,359 clinical presentation. This is the highest heal thing you need 16 00:00:39,399 --> 00:00:41,560 to know. It's a fever, then a rash on the 17 00:00:41,600 --> 00:00:43,479 trunk in that order. So we start with a fever. 18 00:00:44,079 --> 00:00:46,320 Fever is usually going to last around three days. It 19 00:00:46,359 --> 00:00:48,640 can be over one hundred and forty degrees fahrenheit in 20 00:00:48,679 --> 00:00:51,359 some cases. Most of the time, besides some fussiness, child 21 00:00:51,359 --> 00:00:54,320 will otherwise be fine, alert, active, et cetera. Then after 22 00:00:54,359 --> 00:00:56,759 three to five days we have our rash. And if 23 00:00:56,759 --> 00:00:58,640 there is one thing I want you to remember more 24 00:00:58,640 --> 00:01:01,960 than anything else for rosiola, please remember the rash starts 25 00:01:02,280 --> 00:01:04,560 on the trunk really important as these findings are what 26 00:01:04,599 --> 00:01:07,599 will help you differentiate from other viral exanthems. So after 27 00:01:07,640 --> 00:01:10,920 the fever, a blanching macular or macula popular rash will 28 00:01:10,920 --> 00:01:14,680 pop up, starting starting on the trunk, then later spreading 29 00:01:14,719 --> 00:01:17,239 to the face and extremities. That is the key fever, 30 00:01:17,359 --> 00:01:19,920 then rash on the trunk that later spreads elsewhere. The 31 00:01:20,000 --> 00:01:21,840 rash that starts in the trunk is very specific to 32 00:01:21,920 --> 00:01:24,159 rosiola and will help you get the answer right. Please 33 00:01:24,200 --> 00:01:26,680 remember it all right. So for diagnosis, this is going 34 00:01:26,719 --> 00:01:29,879 to be a clinical diagnosis based on the presentation we 35 00:01:30,000 --> 00:01:32,359 just mentioned, meaning nothing really to know here. And then 36 00:01:32,400 --> 00:01:35,560 for treatment, as this is typically a self limited disease, 37 00:01:35,640 --> 00:01:39,239 treatment is supportive ctomenfin for fever, etc. So nothing really 38 00:01:39,280 --> 00:01:41,959 to know for diagnosis or treatment, meaning your juicy details 39 00:01:42,000 --> 00:01:44,920 are in the clinical manifestations as well as the causative agent. 40 00:01:45,120 --> 00:01:46,640 I do not want you to forget that the rash 41 00:01:46,680 --> 00:01:49,120 starts on the trunk. I keep saying that very important, 42 00:01:49,239 --> 00:01:50,760 and I also think it's a good idea to remember 43 00:01:50,760 --> 00:01:53,439 this is most commonly caused by HHV six. So when 44 00:01:53,480 --> 00:01:56,000 you see rosiola rosy ola, I want you to think 45 00:01:56,040 --> 00:01:59,239 of a lady named Rosie waving Ola. ROSI is waving 46 00:01:59,239 --> 00:02:01,760 ola or hell with her hand. Oddly, her hand has 47 00:02:01,799 --> 00:02:04,959 six fingers, which helps remember HHV six. Because her hand 48 00:02:05,040 --> 00:02:07,640 have six fingers, that's all the letters in there, HHV six, 49 00:02:07,840 --> 00:02:10,039 which is the most common cause. Then Rosie has a 50 00:02:10,080 --> 00:02:12,080 big tattoo on her chest of a rose, of course, 51 00:02:12,120 --> 00:02:13,840 which helps you remember that this is one of the 52 00:02:13,840 --> 00:02:16,319 only viral examthems where the rash starts on the trunk. 53 00:02:16,520 --> 00:02:18,520 And if this is mentioned in a vignette, almost certainly 54 00:02:18,520 --> 00:02:21,199 they'll be talking about rosola. So again, remember rosy Ola. 55 00:02:21,479 --> 00:02:23,759 Rosie is waving ola six fingers on her hand to 56 00:02:23,800 --> 00:02:26,240 help you remember this is caused by HHV six, and 57 00:02:26,280 --> 00:02:28,039 she has a tattoo of a rose on our chest 58 00:02:28,039 --> 00:02:30,599 to help you remember this is where the rash originates. Next, 59 00:02:30,680 --> 00:02:34,360 let's talk about Vericella zoster virus infection aka chicken pox. 60 00:02:34,800 --> 00:02:38,479 Veraceella disaster virus causes two diseases, the primary infection, which 61 00:02:38,520 --> 00:02:41,199 is chicken pox, and then later reactivation of the latent 62 00:02:41,280 --> 00:02:44,159 virus known as herbiezaster or shingles. So when we're talking 63 00:02:44,159 --> 00:02:47,080 about the primary ver cella infection, aka chicken pox, this 64 00:02:47,159 --> 00:02:50,400 is a highly contagious disease which is spread via aerosolized 65 00:02:50,439 --> 00:02:53,879 droplets or by direct contact with fluid from skin lesions. 66 00:02:54,159 --> 00:02:58,680 The clinical manifestations initially fever, malaise, pharyngitis, blah blah blah. 67 00:02:58,759 --> 00:03:01,400 Here's the high old part. These non specific symptoms are 68 00:03:01,439 --> 00:03:05,360 followed by the development of a generalized vesticular rash, usually 69 00:03:05,360 --> 00:03:07,199 within twenty four hours. So this is what you need 70 00:03:07,240 --> 00:03:09,000 to know. And the phrase that I used to remember 71 00:03:09,120 --> 00:03:12,400 was varying vesicles. What does this mean? So in Vericella's 72 00:03:12,400 --> 00:03:15,240 auster you're going to have these vesicular lesions, So these 73 00:03:15,280 --> 00:03:18,039 little fluid filled blisters and they're sitting on top of 74 00:03:18,080 --> 00:03:21,800 a erythemato space, so red skin. Sometimes this is called 75 00:03:22,080 --> 00:03:24,479 dew drops on a rose pedal, where the vesicles are 76 00:03:24,520 --> 00:03:27,120 the dew drops and the red skin is the rose pedal. Anyways, 77 00:03:27,120 --> 00:03:30,360 back to the important part. Why should you remember varying vesicles? Well, 78 00:03:30,400 --> 00:03:32,479 because when you see this on an exam question or 79 00:03:32,520 --> 00:03:35,000 in real life. The lesions will be presenting at multiple 80 00:03:35,000 --> 00:03:38,719 stages simultaneously, so some will be vesicles, some pustules, some 81 00:03:38,800 --> 00:03:42,800 crusted over. This polymorphic presentation with all stages visible at 82 00:03:42,840 --> 00:03:45,280 once is what distinguishes chicken pox from a lot of 83 00:03:45,319 --> 00:03:48,560 other vesticular rashes, So varying vesicles makes it very easy 84 00:03:48,560 --> 00:03:51,520 for the exam. Plus, Verceela already starts with the letters var, 85 00:03:51,639 --> 00:03:54,520 so it's easy to remember varying as in varying vesicles 86 00:03:54,639 --> 00:03:58,159 for vericella aka lesions in all stages of development and healing. 87 00:03:58,400 --> 00:04:00,639 It won't get any higher yield than that for topics, 88 00:04:00,639 --> 00:04:04,039 so don't forget it. As far as complication secondary to vericella, 89 00:04:04,639 --> 00:04:08,879 neurologic complications like encephalitis faracella ammonia, which occurs more often 90 00:04:08,919 --> 00:04:10,960 in adults and is one of the reasons why we 91 00:04:11,000 --> 00:04:15,080 more aggressively treat adult patients versus children diagnosis. Often the 92 00:04:15,159 --> 00:04:19,079 diagnosis is made clinically patient with characteristic vesticular lesions in 93 00:04:19,120 --> 00:04:22,319 varying stages. If confirmatory tests are needed, like in an 94 00:04:22,360 --> 00:04:26,160 immunal compromised patient, PCR is usually the preferred option, then 95 00:04:26,160 --> 00:04:28,639 we have treatment so if you have a healthy immunal 96 00:04:28,680 --> 00:04:31,360 competent child twelve years or younger. Usually this will be 97 00:04:31,399 --> 00:04:34,399 with supportive measures, as in this patient population, veraceella is 98 00:04:34,439 --> 00:04:38,199 usually a self limited disease, and then impregnant immunal compromise 99 00:04:38,600 --> 00:04:42,680 or immunal competent adults. Antiviral therapy will usually be recommend 100 00:04:42,720 --> 00:04:45,639 it as this patient population has a higher risk of complications, 101 00:04:45,759 --> 00:04:48,920 so antivirals like veal cyclovir or a cyclovier will commonly 102 00:04:48,959 --> 00:04:51,639 be used. So for verara Cello's ooster virus, the highest 103 00:04:51,639 --> 00:04:54,839 still thing to remember is varying vesicles, and that's faraceella. 104 00:04:54,920 --> 00:04:58,600 Let's move on to measles. Diesels is spelled s L 105 00:04:58,680 --> 00:05:00,680 E S, but I want you to swap out the 106 00:05:00,720 --> 00:05:02,680 S and replace it with a C, as in me 107 00:05:03,279 --> 00:05:05,879 ac l e S and we'll talk more about that 108 00:05:05,879 --> 00:05:08,680 in a minute. So measles is a highly contagious viral illness. 109 00:05:08,839 --> 00:05:12,240 How contagious, well, approximately ninety percent of susceptible individuals will 110 00:05:12,279 --> 00:05:14,680 develop measles who come in contact with it. Let's first 111 00:05:14,680 --> 00:05:17,279 talk about the clinical manifestations. No question, this is the 112 00:05:17,360 --> 00:05:19,240 highest deal thing to know. Kind of seems like a 113 00:05:19,279 --> 00:05:22,560 trend with these viral infections. For clinical manifestations, you need 114 00:05:22,600 --> 00:05:25,199 to know your four seas of measles, and that's why 115 00:05:25,240 --> 00:05:27,319 we spelled measles with the sea to help us remember this. 116 00:05:27,560 --> 00:05:31,439 So the four seas of measles are conjunctivitis, cariiza, cough, 117 00:05:31,519 --> 00:05:34,560 and copleic spots. Technically coplic is spelled with a K, 118 00:05:34,759 --> 00:05:36,399 but for the sake of the demonic, we're spelling it 119 00:05:36,439 --> 00:05:39,079 with a C. So during the prodrum stage of measles, 120 00:05:39,120 --> 00:05:41,920 you will get fever, malais, et cetera, but most importantly 121 00:05:42,240 --> 00:05:46,439 conjunctivitis cariiza aka rhinitis cough, and then the most important 122 00:05:46,480 --> 00:05:50,120 pathanomonic finding called copleic spots. Pathonomonic means the presence of 123 00:05:50,120 --> 00:05:53,240 this specific sign or symptom is unique to a specific disease, 124 00:05:53,279 --> 00:05:56,879 and its presence essentially is diagnostic, and anytime something is 125 00:05:56,920 --> 00:06:00,279 considered pathdomonic, just assume it will be tested on complex 126 00:06:00,319 --> 00:06:03,079 spots are these one to three millimeters bluish or white 127 00:06:03,079 --> 00:06:06,560 elevations typically seen on the bucle mucosa. So the inside 128 00:06:06,560 --> 00:06:09,319 of the cheek opposite the molars doesn't appear in all 129 00:06:09,360 --> 00:06:11,839 patients with measles, but when it does. Like we talked 130 00:06:11,879 --> 00:06:14,199 about before, it's pathanomonic, so you can't forget it. And 131 00:06:14,240 --> 00:06:16,720 you might say, okay, well, I'll definitely remember complex spots 132 00:06:16,720 --> 00:06:19,000 because of the four seas, but on an exam question, 133 00:06:19,000 --> 00:06:21,160 they're probably not going to call them complex spots. They'll 134 00:06:21,160 --> 00:06:23,519 probably just say bluish white spots in the mouth. So 135 00:06:23,759 --> 00:06:26,120 how can I remember what complex spots are? Well, that's 136 00:06:26,160 --> 00:06:28,800 actually easy, coplic What happens when you lick a cop 137 00:06:29,000 --> 00:06:31,480 besides getting arrested, your mouth will turn blue because of 138 00:06:31,519 --> 00:06:34,160 the blue uniform of course. Okay, So again, so for 139 00:06:34,199 --> 00:06:37,240 clinical metifestations for measles, remember measles is spelled with a sea. 140 00:06:37,319 --> 00:06:40,519 To help you remember your four seas, conjunctivitis, kariza, cough, 141 00:06:40,600 --> 00:06:43,279 complex spots. Let's talk about the rash, which is a 142 00:06:43,399 --> 00:06:47,040 maculo popular blanching rash that commonly will begin on the 143 00:06:47,079 --> 00:06:50,480 face and spread down to involve the neck, trunk extremities. 144 00:06:50,720 --> 00:06:53,839 Notice it's the opposite of rosiola, which we just went over. 145 00:06:54,040 --> 00:06:56,560 So remember these small differences. It'll help you on an exam. 146 00:06:56,639 --> 00:06:59,639 All right, So complications, Diarrhea is going to be the 147 00:06:59,639 --> 00:07:02,759 most common complication, but most deaths are going to be 148 00:07:02,759 --> 00:07:06,920 from respiratory track complications or encephalitis diagnosis. Suspect this in 149 00:07:06,959 --> 00:07:10,199 a patient with clinically compatible symptoms RASH or four c's, 150 00:07:10,439 --> 00:07:14,959 and then confirm with measles IgM antibody or rtPCR. Finally, 151 00:07:15,000 --> 00:07:19,319 treatment for most patients is going to be supportive antipyretics, fluids, 152 00:07:19,319 --> 00:07:22,639 et cetera. Some other treatment options usually reserved for severe cases. 153 00:07:23,120 --> 00:07:26,160 One is vitamin A, as a vitamin A deficiency can 154 00:07:26,199 --> 00:07:30,399 contribute to delayed recovery and lead to further complications. Vitamin 155 00:07:30,439 --> 00:07:33,279 A levels actually fall during acute infection, so vitamin A 156 00:07:33,360 --> 00:07:36,399 supplementation is added in patients with severe cases of measles. 157 00:07:36,639 --> 00:07:40,360 And then, finally, riboviron and antiviral like ribaviron can be 158 00:07:40,439 --> 00:07:43,560 used in certain patient populations like immunal compromise patients or 159 00:07:43,560 --> 00:07:47,000 those with measles pneumonia requiring ventilatory support. All right, so 160 00:07:47,040 --> 00:07:49,079 that's measles. If you can remember all of this, great, 161 00:07:49,160 --> 00:07:51,600 If not, then please just don't forget the four seas 162 00:07:51,600 --> 00:07:54,040 of measles. Next is going to be handfoot mouth disease. 163 00:07:54,120 --> 00:07:56,800 This is very straightforward, not very high yield, so let's 164 00:07:56,879 --> 00:07:59,360 zoom through handfoot mouth disease. Most cases are going to 165 00:07:59,360 --> 00:08:02,120 be seen in fins and children less than seven years old. 166 00:08:02,399 --> 00:08:05,160 Transmission from person to person by the fecal oral route 167 00:08:05,199 --> 00:08:09,120 is most common, and while multiple enteroviruses can cause HFMD, 168 00:08:09,480 --> 00:08:12,720 Cocksaki virus A sixteen and enterovirus A seventy one are 169 00:08:12,720 --> 00:08:15,199 the most common. It's probably the highest sealed thing to know, 170 00:08:15,240 --> 00:08:17,480 as the rest of the disease is pretty straightforward. I 171 00:08:17,480 --> 00:08:19,360 don't really have an a monicure to help you remember these, 172 00:08:19,360 --> 00:08:21,879 but one of the viruses is called cocksaki, so I 173 00:08:21,920 --> 00:08:25,279 suppose it could be creative anyways, clinical manifestations, it's called 174 00:08:25,279 --> 00:08:27,800 handfoot mouths disease, so there should be no surprises here. 175 00:08:28,279 --> 00:08:30,560 The lesions in the mouth most often show up on 176 00:08:30,639 --> 00:08:35,240 the tongue, and bucle mucosa usually start as an arithmatose macule, 177 00:08:35,279 --> 00:08:38,600 which progress to vesicles. The child may complain of mouth 178 00:08:38,720 --> 00:08:41,360 or throw pain or refuse to eat. Now, really quickly, 179 00:08:41,360 --> 00:08:43,679 I wanted to mention something called herbangina, and if you're 180 00:08:43,720 --> 00:08:46,519 going to get a question on HFMD, they're probably going 181 00:08:46,559 --> 00:08:49,080 to have herpangina as one of the answer choices because 182 00:08:49,120 --> 00:08:52,039 they are quite similar and most exam makers are going 183 00:08:52,080 --> 00:08:54,200 to probably try to trick you. So herbanjina is a 184 00:08:54,240 --> 00:08:57,799 similar viral illness caused by some of the same infectious organisms, 185 00:08:57,799 --> 00:09:00,679 but the lesions seen in herpanngina are related to just 186 00:09:00,720 --> 00:09:04,080 the oral cavity, So an oversimplification of hermagina would be 187 00:09:04,120 --> 00:09:06,200 to say that it's hand foot mouth disease of just 188 00:09:06,279 --> 00:09:09,039 the mouth, So mouth disease not to be fair. In 189 00:09:09,080 --> 00:09:12,519 real life, HFMD can occasionally present with only oral lesions, 190 00:09:12,679 --> 00:09:15,200 which makes things a bit trickier, and that's where some 191 00:09:15,720 --> 00:09:19,000 subtle clues can help. Perpagino lesions are typically more posterior, 192 00:09:19,320 --> 00:09:21,399 the lesions look slightly different, and the fever can be 193 00:09:21,440 --> 00:09:24,200 more abrupt and higher, But honestly, since the diagnosis and 194 00:09:24,240 --> 00:09:27,240 management are essentially the same, the distinction is mostly just academic. 195 00:09:27,440 --> 00:09:29,720 So for example purposes and for your own sanity, just 196 00:09:29,759 --> 00:09:33,200 remember herpingina as HFMD limited to just the mouth and 197 00:09:33,320 --> 00:09:35,240 move on. All right, What about the rash on the 198 00:09:35,240 --> 00:09:39,399 body for handfoot mouth disease, So this can be macular, maculo, popular, 199 00:09:39,480 --> 00:09:42,440 or vesicular. The lesions are usually non perritic, found on 200 00:09:42,559 --> 00:09:45,679 the hands, feet, buttocks, legs, arms, and typically resolve in 201 00:09:45,679 --> 00:09:47,720 three to four days. So, just like the name states, 202 00:09:47,720 --> 00:09:50,840 handfoot mouth disease, clinical presentation usually lesions in the mouth, 203 00:09:50,960 --> 00:09:54,120 hands and feet, diagnosis is going to be made clinically 204 00:09:54,159 --> 00:09:57,559 in most cases. If eacholgic confirmation is necessary, things like 205 00:09:57,600 --> 00:09:59,960 PCR testing can be used and treatment will be support 206 00:10:00,000 --> 00:10:03,639 sortive in most cases, as HFMD is generally mild and 207 00:10:03,679 --> 00:10:09,279 self limited unless there are some rare complication involving encephalitis, meningitis, malcroditis, 208 00:10:09,279 --> 00:10:11,320 et cetera. Again, the highest seel thing to know about 209 00:10:11,360 --> 00:10:14,000 hand foot mouth disease outside of the clinical presentation which 210 00:10:14,039 --> 00:10:16,559 is in the name, is the causative agent. Most common 211 00:10:16,600 --> 00:10:20,000 cocksacchi virus A sixteen and enterovirus A seventy one. And 212 00:10:20,080 --> 00:10:22,000 if they want to be evil and throwing herpangina as 213 00:10:22,039 --> 00:10:24,480 a differential in the answer is just remember herpagina as 214 00:10:24,519 --> 00:10:27,240 handfoot mouth disease of just the mouth and that's HFMD. 215 00:10:27,440 --> 00:10:30,159 Let's move on to epstein bar virus or EBV. So 216 00:10:30,200 --> 00:10:32,919 when we think of EBV or epstein bar virus, most 217 00:10:32,960 --> 00:10:35,600 of us think of mono, especially in our pediatric patients, 218 00:10:35,639 --> 00:10:39,440 and it's true EBV is the primary agent of infectious mononucleosis, 219 00:10:39,639 --> 00:10:41,679 but EBV has a lot of other high y findings 220 00:10:41,720 --> 00:10:43,399 that want to go over so EBV, which is a 221 00:10:43,480 --> 00:10:46,840 herpes virus and is also known as human herpes virus four, 222 00:10:47,399 --> 00:10:51,320 is transmitted primarily through salivary secretion, so the transmission is 223 00:10:51,360 --> 00:10:54,720 person to person primarily through salvary secretions. In most cases, 224 00:10:54,759 --> 00:10:57,200 the infection in humans is thought to originate in the 225 00:10:57,399 --> 00:10:59,600 oral farings, so the back of the mouth and throat 226 00:10:59,639 --> 00:11:03,840 area where EBV initially infects the oral pharyngial epithelial cells 227 00:11:03,879 --> 00:11:06,600 and then later the B cells in nearby lymphoid tissue. 228 00:11:06,720 --> 00:11:10,600 Clinical manifestations. EBV can cause a number of clinical manifestations 229 00:11:10,679 --> 00:11:13,039 as it can effect virtually any organ system, but the 230 00:11:13,159 --> 00:11:16,240 high yield often tested on clinical manifestations are usually the 231 00:11:16,240 --> 00:11:21,480 ones associated with mononucleosis, so we'll see things like pharyngitis, fatigue, fever, splenomegally, 232 00:11:21,799 --> 00:11:24,000 But the one in my experience that was always in 233 00:11:24,120 --> 00:11:29,000 the exam question was lymphat aopathy, more specifically posterior lymphat 234 00:11:29,039 --> 00:11:33,080 andopathy involving the posterior cervical and posterior auricular nodes, as 235 00:11:33,120 --> 00:11:35,240 those are the most common to be affected so remember 236 00:11:35,279 --> 00:11:39,440 the posterior lymphatinopathy as this is very commonly tested on all. Right, Next, 237 00:11:39,480 --> 00:11:43,000 there are some high old complications slash associated conditions, starting 238 00:11:43,039 --> 00:11:44,759 with the one we already know, which is going to 239 00:11:44,840 --> 00:11:47,840 be infectious mononucleosis. This is probably the most important thing 240 00:11:47,879 --> 00:11:50,279 to know. Mono is an acute illness due to primary 241 00:11:50,320 --> 00:11:53,200 EBV infection. You gotta know that. Next is going to 242 00:11:53,279 --> 00:11:57,120 be lymphoma like Burquette Hodgkin. Now, EBV has been linked 243 00:11:57,159 --> 00:11:59,840 to a number of malignancies, with lymphomas at the top 244 00:12:00,039 --> 00:12:03,120 of the list, especially B cell lymphomas like Burquette lymphoma 245 00:12:03,440 --> 00:12:06,279 and certain forms of Hotchkin lymphoma. So why does that happen? 246 00:12:06,360 --> 00:12:10,360 While after the primary infection resolves, EBV doesn't fully go away, 247 00:12:10,480 --> 00:12:14,919 it establishes lifelong latency in these B cells and insusceptible individuals, 248 00:12:15,080 --> 00:12:18,799 particularly those who are immunal compromised, these EBV infected B 249 00:12:18,960 --> 00:12:22,080 cells can begin to proliferate uncontrollably and over time. This 250 00:12:22,279 --> 00:12:26,039 constant proliferation, combined with additional genetic mutations, can lead to 251 00:12:26,080 --> 00:12:30,440 the development of lymphomas and other malignancies. Another malignancy associated 252 00:12:30,480 --> 00:12:33,879 with EBV is going to be nasopharyngial and gastric carcinomas, 253 00:12:34,000 --> 00:12:36,720 so both can be associated with EBV, and it's estimated 254 00:12:36,759 --> 00:12:39,919 that nine to ten percent of gastric carcinomas worldwide carry 255 00:12:39,960 --> 00:12:43,600 the EBV genome. Next is oral hairy leukoplakia, So what 256 00:12:43,720 --> 00:12:46,639 the heck is that? So this is a white, painless plaque, 257 00:12:46,720 --> 00:12:50,080 usually on the lateral surface of the tongue. Unlike candydiasis, 258 00:12:50,159 --> 00:12:52,919 which presents in a similar way, it cannot be scraped off. 259 00:12:53,080 --> 00:12:55,360 It's usually going to be an immunal compromised patients like 260 00:12:55,440 --> 00:12:58,279 those with HIV, and this frequently comes up on exams, 261 00:12:58,279 --> 00:13:01,200 so definitely know it diagnosis. Also, the diagnostic tools are 262 00:13:01,240 --> 00:13:03,399 derived from what we use for diagnosis of monos So 263 00:13:03,440 --> 00:13:05,399 I'm not going to dive too deep here, but just 264 00:13:05,519 --> 00:13:08,559 know that heterophile antibodies, which is what's commonly known as 265 00:13:08,639 --> 00:13:11,360 a monospot test, it's a good initial test, it's quick 266 00:13:11,399 --> 00:13:13,200 and cheap, and it's great if it's positive, but it 267 00:13:13,279 --> 00:13:15,759 can be negative early on and in some younger patients. 268 00:13:15,840 --> 00:13:18,559 A more sensitive and specific test is going to be 269 00:13:18,679 --> 00:13:22,559 your EBV specific antibodies, which is your gold standard test. Labs, 270 00:13:22,600 --> 00:13:26,480 there are going to be some hematologic abnormalities. Transferrase levels 271 00:13:26,519 --> 00:13:29,080 may be elevated your liver enzymes. But all I would 272 00:13:29,159 --> 00:13:31,000 know for the exam is your lymphocytes are going to 273 00:13:31,039 --> 00:13:34,360 be fed up in some way, So either too many 274 00:13:34,440 --> 00:13:38,120 lymphocytes aka lymphocytosis, which is the most common finding in mono, 275 00:13:38,399 --> 00:13:41,559 or atypical lymphocytes seen on peripheral smear, so the lymphocytes 276 00:13:41,559 --> 00:13:44,440 are irregular in some way. Remember that for LABS treatment, 277 00:13:44,559 --> 00:13:47,639 this will be supportive care in most cases. So overall 278 00:13:47,720 --> 00:13:49,919 EBV seems like a lot, But there's really only five 279 00:13:50,039 --> 00:13:51,799 or six things I think you should know for EBV. 280 00:13:52,120 --> 00:13:54,120 You gotta know mono, you got to remember your posterial 281 00:13:54,159 --> 00:13:58,600 lymphatinopathy slash abnormallyphosyites. You got to remember your associated malignancies 282 00:13:58,679 --> 00:14:01,840 lymphomas and nasopharyngial carcinomas. And you got to remember oral 283 00:14:01,840 --> 00:14:04,679 harry lukaplakia. How to remember that, well, you remember EBV 284 00:14:04,840 --> 00:14:07,799 equals l M n op. EBV equals l M n 285 00:14:07,879 --> 00:14:12,159 op L stands for lymphoma slash lymphocytosis. So don't forget. 286 00:14:12,240 --> 00:14:15,440 EBV is a transforming virus and has been linked to lymphoma. 287 00:14:15,519 --> 00:14:19,000 Burquette Hodgkin et cetera. And also remember your lymphocyte abnormalities 288 00:14:19,039 --> 00:14:22,320 like lymphocytosis. M of course stands for mononucleosis. Of course 289 00:14:22,360 --> 00:14:25,159 we know infectious mononucleosis is an acute illness due to 290 00:14:25,200 --> 00:14:28,240 EBV infection. N stands for the other high old malignancy 291 00:14:28,240 --> 00:14:32,799 associated with EBV, which is nasopharyngeal carcinoma. Nasofaryngeal carcinoma as 292 00:14:32,799 --> 00:14:35,759 well as gastric carcinoma are also associated with EBV. O 293 00:14:35,960 --> 00:14:40,519 stands for oral hairy lukoplakia. Another EBV mediated manifestation, the white, 294 00:14:40,559 --> 00:14:43,759 non scrapable hacks plaques, usually on the tongue in immunal 295 00:14:43,799 --> 00:14:46,639 compromised individuals. And finally the P which stands for posterior 296 00:14:46,679 --> 00:14:50,320 lymphat anopathy. Remember mono infection very commonly has lymphat anopathy 297 00:14:50,399 --> 00:14:54,080 and most commonly involves the posterior cervical and posterior auricular notes. 298 00:14:54,279 --> 00:14:57,279 Remember again EBV equals l M n OP. Those are 299 00:14:57,279 --> 00:14:59,360 the high old points to remember for EBV. Moving on 300 00:14:59,480 --> 00:15:05,200 to earth Fema infectiosum Arthema infectiosum or EI for short, 301 00:15:05,360 --> 00:15:08,440 is a mild, febrile illness that usually manifests in school 302 00:15:08,480 --> 00:15:10,840 aged children, although we can see this in adults too. 303 00:15:11,200 --> 00:15:13,600 YAI is also referred to as fifth disease, as it's 304 00:15:13,639 --> 00:15:16,000 one of these six common childhood exanthems named in this 305 00:15:16,240 --> 00:15:18,720 order that they were first described. But this naming system 306 00:15:18,759 --> 00:15:21,120 isn't used as much anymore, so I'd really just focus 307 00:15:21,200 --> 00:15:24,519 on earth them infectiosum. This illness is most commonly caused 308 00:15:24,559 --> 00:15:28,759 by parvovirus B nineteen, human parvovirus B nineteen, which is 309 00:15:28,799 --> 00:15:32,440 associated with a number of different syndromes, including transient aplastic crisis, 310 00:15:32,519 --> 00:15:35,480 fetal infection, and of course EI. I think it's important 311 00:15:35,480 --> 00:15:37,759 to know this is caused by parvovirus B nineteen because 312 00:15:37,759 --> 00:15:40,720 it's often tested on. So Arithema infectiosum is caused by 313 00:15:40,759 --> 00:15:43,799 parvovirus B nineteen. How do you remember that, well, Arathema 314 00:15:43,840 --> 00:15:46,720 infectiosum if you count out the letters, is exactly nineteen 315 00:15:46,799 --> 00:15:50,759 letters long. So remember the sentence Arithema infectiosum B nineteen 316 00:15:50,879 --> 00:15:55,120 letters long. Arithema infectiosum B nineteen letters long. And yes, 317 00:15:55,159 --> 00:15:57,759 it actually is exactly nineteen letters. You can count it yourself. 318 00:15:57,960 --> 00:15:59,399 And now I'm not expecting you to sit there during 319 00:15:59,440 --> 00:16:01,440 an exam letters on your fingers. But if you ever 320 00:16:01,480 --> 00:16:04,080 get stuck on a question asking you which viral examthem 321 00:16:04,159 --> 00:16:07,039 is caused by parvavirus B nineteen, this can actually save you. 322 00:16:07,279 --> 00:16:10,600 So again erethemia infectioniosum is caused by parvavirus B nineteen 323 00:16:10,919 --> 00:16:14,960 and erthema infectiosum B nineteen letters long. Next, clinical manifestations. 324 00:16:15,159 --> 00:16:18,960 So this illness starts with some nonspecific stuff fever, headache, nausea, diarrhea, 325 00:16:19,039 --> 00:16:21,200 blah blah, not important. Let's get to the good stuff. 326 00:16:21,240 --> 00:16:23,759 The highest sealed thing to know for clinical manifestations is 327 00:16:24,000 --> 00:16:26,519 slap cheek. What am I talking about? So with EI, 328 00:16:26,759 --> 00:16:29,279 around two to five days after they get the nonspecific fever, 329 00:16:29,440 --> 00:16:33,080 nause et cetera, they will develop the characteristic ARA, thematose 330 00:16:33,240 --> 00:16:36,879 melar rash with circum oral polar. So this is the 331 00:16:37,039 --> 00:16:40,639 classic arithmatose melar rash that appears in individuals with EI. 332 00:16:41,000 --> 00:16:43,559 A melar rash is one that's across the nose and cheeks. 333 00:16:43,960 --> 00:16:47,360 Circum Oral polar just means the pale area around the 334 00:16:47,440 --> 00:16:49,519 mouth that we'll see. So the cheeks are usually bright 335 00:16:49,679 --> 00:16:52,600 red like someone slap the patient which gave it the 336 00:16:52,720 --> 00:16:55,120 nickname of slap cheek. Now, I really want you to 337 00:16:55,159 --> 00:16:58,440 remember the melar slap cheek rash because it's super high yield. 338 00:16:58,639 --> 00:17:02,039 So to remember this instead of ama infecttioniosum, remember erthema 339 00:17:02,200 --> 00:17:05,960 infect cheek osum cheek as in c H E E case. 340 00:17:06,079 --> 00:17:09,279 Remember instead of arathema infect g osum, remember it as 341 00:17:09,359 --> 00:17:12,880 arithema infect cheek osume. Do remember the classic slap cheek 342 00:17:12,920 --> 00:17:15,400 or mela rash which is so damn high yield. I 343 00:17:15,519 --> 00:17:17,839 even have another mnemonic and I'm gonna embarrass myself here, 344 00:17:17,880 --> 00:17:19,359 but I think it's worth it if maybe it helps 345 00:17:19,480 --> 00:17:22,039 just one person. So if that mnemonic doesn't work for you, 346 00:17:22,799 --> 00:17:24,599 it's a little embarrassing. But this is actually how I 347 00:17:24,720 --> 00:17:26,759 remember it in school. So every time I would see 348 00:17:26,799 --> 00:17:30,279 Ei on an exam uh arethema infectioniosum Ei, I would 349 00:17:30,279 --> 00:17:32,799 think of that song by Nelly called Ei the One 350 00:17:32,839 --> 00:17:37,519 that Goes and Mama Ei Ei. So yeah, that would 351 00:17:37,519 --> 00:17:39,599 always help me remember the song by Nelly. And then 352 00:17:39,599 --> 00:17:41,319 I would think of Nelly who always had that band 353 00:17:41,359 --> 00:17:43,680 aid on his cheek, which helped me remember these slap 354 00:17:43,799 --> 00:17:45,960 cheek rash. You probably don't even remember that song, so 355 00:17:46,000 --> 00:17:49,079 I just embarrassed myself rapping for no reason. Anyways. After 356 00:17:49,119 --> 00:17:52,319 the high old facial rash clears, it's usually followed by 357 00:17:52,559 --> 00:17:55,200 many days later by this reticulated or lace like rash 358 00:17:55,240 --> 00:17:58,440 on the trunk and extremities. Some patients can develop arthralgias 359 00:17:58,480 --> 00:18:02,160 and other hematologic abnormality, but for most immunal competent patients, 360 00:18:02,200 --> 00:18:04,440 this will only be a mild illness. But do not 361 00:18:04,559 --> 00:18:07,759 forget your slap cheek rash please diagnosis this is going 362 00:18:07,839 --> 00:18:11,240 to be for most individuals. Clinical diagnosis to a child 363 00:18:11,240 --> 00:18:14,200 who presents with the classic melar rash. Sero Logic tests 364 00:18:14,200 --> 00:18:17,039 are available for confirmation of the viral atiology, but reserved 365 00:18:17,079 --> 00:18:21,599 for atypical presentationsmutal compromise patients, etc. And treatment is generally 366 00:18:21,640 --> 00:18:23,799 going to be supportive as this is a mild, self 367 00:18:23,880 --> 00:18:27,079 limited illness for most affected. There's no specific treatment indicated 368 00:18:27,119 --> 00:18:29,960 for most cases outside of symptomatic treatment for fevers, headaches, 369 00:18:29,960 --> 00:18:32,279 et cetera. So EI not allowed to know here. There's 370 00:18:32,319 --> 00:18:34,480 only two main takeaways for the exam. One is that 371 00:18:34,599 --> 00:18:38,400 this is caused by parvovirus B nineteen remember erathema infectioniosum 372 00:18:38,480 --> 00:18:41,720 B nineteen letters long two remember the classic or melar 373 00:18:41,799 --> 00:18:45,240 slap cheek rash, Remember arethema infect cheek osum or just 374 00:18:45,319 --> 00:18:48,319 remember me embarrassingly wrapping and helping you to remember Nelly 375 00:18:48,400 --> 00:18:50,720 with the band aid on his cheek. Anyways, let's move 376 00:18:50,759 --> 00:18:53,960 on to months. This is a highly contagious viral illness 377 00:18:53,960 --> 00:18:57,240 occurring most commonly among school aged children and college aged 378 00:18:57,319 --> 00:19:02,240 young adults, spread via respiratory dropic oplets, direct contact, or fullmites. 379 00:19:02,440 --> 00:19:05,240 Vaccination in the US has led to a significant decline 380 00:19:05,240 --> 00:19:07,200 in the number of cases seen, but a few hundred 381 00:19:07,240 --> 00:19:09,960 to a few thousand cases continue to occur each year 382 00:19:10,319 --> 00:19:12,240 for months. There's really only a few high old things 383 00:19:12,279 --> 00:19:14,119 to know for the exam. Let's run through them first, 384 00:19:14,119 --> 00:19:16,960 starting with our clinical manifestations. So it usually start with 385 00:19:17,039 --> 00:19:20,279 some nonspecific symptoms fever, headache, miyolgia. You know how I 386 00:19:20,279 --> 00:19:23,079 feel about the nonspecific stuff by now. But then then 387 00:19:23,160 --> 00:19:27,079 there is salivary gland swelling. So salivary gland swelling develops. 388 00:19:27,119 --> 00:19:28,799 This is the highest deal thing you need to know 389 00:19:28,839 --> 00:19:32,279 about mumps, and that is something known as paratitis. Paratitis 390 00:19:32,359 --> 00:19:34,839 is the most common manifestation of the virus occurring in 391 00:19:34,880 --> 00:19:38,000 over seventy percent of infections. The mumps virus actually has 392 00:19:38,039 --> 00:19:41,480 an affinity for the glandular epithelium, especially of the product land, 393 00:19:41,680 --> 00:19:44,240 and it's why this occurs so often. So the product lands, 394 00:19:44,240 --> 00:19:47,160 which are largest salivary glands, sit below and in front 395 00:19:47,200 --> 00:19:49,799 of the ear, and when these become inflamed in mumps, 396 00:19:49,880 --> 00:19:52,680 the swelling can be quite traumatic, sometimes extending along the 397 00:19:52,880 --> 00:19:55,960 entire side of the face and into the neck, completely 398 00:19:56,039 --> 00:19:59,000 obscuring the angle of the mandible. So if clinical manifestations 399 00:19:59,119 --> 00:20:01,400 do not forget para titis, there are also some other 400 00:20:01,480 --> 00:20:04,599 high old complications you should know, starting with the most important, 401 00:20:04,599 --> 00:20:08,480 which is going to be orchitis, specifically epididymal orchitis, which 402 00:20:08,559 --> 00:20:11,400 is an inflammation of both the testes and epididymus and 403 00:20:11,559 --> 00:20:15,039 is the most common complication of mumps infection. These patients 404 00:20:15,079 --> 00:20:17,960 may have fever, swelling, severe testicular pain and this is 405 00:20:18,039 --> 00:20:20,240 going to be unilateral in most cases sixty eight to 406 00:20:20,319 --> 00:20:23,799 eighty percent. There are also a number of neurologic complications. 407 00:20:24,279 --> 00:20:29,000 Meningitis which is the most common neurologic complication, specifically aseptic meningitis, 408 00:20:29,039 --> 00:20:31,799 which can occur in up to ten percent of patients deafness, 409 00:20:31,839 --> 00:20:34,920 so hearing loss associated with mumps is another unique complication. 410 00:20:35,279 --> 00:20:38,279 Symptoms improve in many cases, although permanent deafness can occur 411 00:20:38,599 --> 00:20:41,359 and then finally pancreatitis which can occur in both children 412 00:20:41,400 --> 00:20:45,119 and adults with mumps. Most cases resolve with conservative management 413 00:20:45,200 --> 00:20:47,359 and this is not a common complication, but it is 414 00:20:47,440 --> 00:20:49,279 tested on so it's good to know and be familiar 415 00:20:49,359 --> 00:20:53,119 with it. Nothing to know for diagnosis. Diagnostic tests like 416 00:20:53,200 --> 00:20:56,720 reverse transcriptase PCR and serum IgM antibody testing may be 417 00:20:56,839 --> 00:20:59,720 utilized to establish the diagnosis treatment. This is also not 418 00:20:59,799 --> 00:21:02,880 high yield as there's no specific anti viral therapy and 419 00:21:03,039 --> 00:21:05,920 this is usually a self limited condition, so supportive measures 420 00:21:06,119 --> 00:21:09,200 will be the mainstay for most individuals acetomnifit, et cetera. 421 00:21:09,400 --> 00:21:11,119 And then, of course the goal here is prevention through 422 00:21:11,119 --> 00:21:14,119 immunization with the MMR vaccine. So the highest feel things 423 00:21:14,160 --> 00:21:17,440 to know for MOMPS comes from the complications and clinical manifestations. 424 00:21:17,759 --> 00:21:20,920 So since momps make you plump like plump neck and face, 425 00:21:20,960 --> 00:21:23,960 et cetera, you'll remember the sentence mumps make you plump, 426 00:21:24,400 --> 00:21:27,519 Mumps make you plump and plump p l U MP 427 00:21:27,920 --> 00:21:29,799 has all of the hygy Olde findings for the exam. 428 00:21:30,240 --> 00:21:33,920 P starts for pancreatitis, L stands for loss of hearing. Remember, 429 00:21:34,000 --> 00:21:37,839 deafness can be associated with mumps. U stands for unilateral orchitis. 430 00:21:37,920 --> 00:21:40,680 Remember orchitis is a common complication for males and in 431 00:21:40,759 --> 00:21:43,000 sixty to eighty percent of males this will be unilateral. 432 00:21:43,200 --> 00:21:45,960 TIM stands for meningitis, a septic meningitis being the most 433 00:21:46,000 --> 00:21:49,000 common neurologic complication of mumps. And finally, the last P 434 00:21:49,200 --> 00:21:52,000 the star of the show, paratitis, the most common manifestation 435 00:21:52,079 --> 00:21:55,279 of the virus, causing significant face and next swelling. So again, 436 00:21:55,599 --> 00:22:00,640 mumps make you plump, pancreatitis, loss of hearing, unilateral orchitis, meningitis, paratitis. 437 00:22:00,839 --> 00:22:03,279 That's mumps. Don't forget it makes you plump. Moving on 438 00:22:03,400 --> 00:22:06,240 to rubella. This is a viral illness first described by 439 00:22:06,319 --> 00:22:09,160 German physicians in the seventeen fifties and was referred to 440 00:22:09,319 --> 00:22:11,680 as German measles due to a similar rash as the 441 00:22:11,759 --> 00:22:15,079 one seen in measles. Vaccination has resulted in a significant 442 00:22:15,079 --> 00:22:17,279 decline in the number of episodes, and in two thousand 443 00:22:17,319 --> 00:22:20,480 and four was actually officially eliminated from the United States, 444 00:22:20,599 --> 00:22:23,759 although there are still intermittent outbreaks worldwide. So let's get 445 00:22:23,759 --> 00:22:26,519 started with the clinical manifestations, which is typically comprised of 446 00:22:26,640 --> 00:22:30,039 a rash, fever, and lymphat anopathy. The rash will consist 447 00:22:30,200 --> 00:22:34,319 of pinpoint pink maculo papulos, first appearing on the face, 448 00:22:34,440 --> 00:22:37,680 then spreading coudily or downward to the trunk, and extremities 449 00:22:37,920 --> 00:22:40,960 sparing the palms and souls. The rash usually lasts for 450 00:22:41,039 --> 00:22:43,200 about three days and then on the exam you may 451 00:22:43,240 --> 00:22:46,519 see something called Forsheimer's spots, which are these small red 452 00:22:46,559 --> 00:22:48,920 spots on the soft palate can be seen in other 453 00:22:48,960 --> 00:22:52,359 conditions like scarlet fever. So unlike coplex spots and measles, 454 00:22:52,640 --> 00:22:55,400 Forsheimer's spots are not pathdomonic for rubella. But if you 455 00:22:55,440 --> 00:22:57,799 see this mentioned in a vignette, most likely they're going 456 00:22:57,880 --> 00:23:01,079 to be talking about rubella. So important remas next important 457 00:23:01,079 --> 00:23:03,799 one is going to be lymphat anopathy, which typically involves 458 00:23:03,839 --> 00:23:08,559 the posterior cervical, posterior auricular, and suboccipital lymph nodes. The 459 00:23:08,640 --> 00:23:11,799 posterior curricular lymphat anopathy is often mentioned in vignettes, so 460 00:23:11,839 --> 00:23:14,079 it's really important to know. And if you see a 461 00:23:14,119 --> 00:23:16,839 patient mentioned in a vignette that has posterior curricular lymphat 462 00:23:16,880 --> 00:23:20,680 anopathy and for Shimer spots, from an exam standpoint, it's rebella. 463 00:23:20,920 --> 00:23:23,200 So those are the clinical metaphestations to know, focusing on 464 00:23:23,319 --> 00:23:26,839 Forsheimer spots and the posterior curricular lymphat anopathy. Infection in 465 00:23:26,920 --> 00:23:29,599 children is usually going to be mild. Complications of rubella 466 00:23:29,680 --> 00:23:33,799 are not common except during pregnancy, which congenital Rubella syndrome 467 00:23:33,839 --> 00:23:36,200 can develop and it is the biggest concern as it 468 00:23:36,240 --> 00:23:39,240 can be quite serious fetal death, premature delivery, hard and 469 00:23:39,240 --> 00:23:42,480 ocular defects, et cetera. Let's move on to diagnosis. So 470 00:23:42,640 --> 00:23:46,960 we diagnose with rubella IgM zerology. Usually that's going to 471 00:23:47,000 --> 00:23:50,200 be the initial diagnostic test and rtPCR testing can be 472 00:23:50,319 --> 00:23:53,400 used as an alternative. Treatment is going to be supportive 473 00:23:53,440 --> 00:23:57,160 measures in most cases antipyretics, fluids, et cetera. So as 474 00:23:57,200 --> 00:23:59,640 in most of these viral examthems, the clinical menifestations are 475 00:23:59,640 --> 00:24:01,920 the high still component as there's not much to know 476 00:24:02,000 --> 00:24:04,440 for diagnosis and treatment, and the key to rubella is 477 00:24:04,480 --> 00:24:07,279 the post auricular lymphatinopathy and the red spots on the 478 00:24:07,319 --> 00:24:09,640 soft palat the four Shamer spots. Those will both be 479 00:24:09,680 --> 00:24:12,160 in the vignette. And to remember these instead of Rubella, 480 00:24:12,559 --> 00:24:17,880 remember rubellaphant instead of Rubella, remember rubelephant. Rubelephant as an elephant, 481 00:24:17,960 --> 00:24:20,680 because when you think of an elephant, as in rubelphant, 482 00:24:21,039 --> 00:24:23,119 what do you think of those big dumbo ears and 483 00:24:23,240 --> 00:24:26,200 the big trunk. So think of a rubelephant those big 484 00:24:26,319 --> 00:24:30,119 dumbo ears help you remember the post auricular lymphatinopathy, these 485 00:24:30,160 --> 00:24:32,759 swollenlyph notes behind the ears. Then think of the elephant 486 00:24:32,839 --> 00:24:34,599 lifting its trunk up in the air and showing you 487 00:24:34,680 --> 00:24:37,200 its mouth to help you remember the four Shimer spots, 488 00:24:37,240 --> 00:24:39,839 the red spots on the soft palate. So remember Rubella 489 00:24:39,920 --> 00:24:42,799 as instead rubellaphant to help you remember the big floppy 490 00:24:42,880 --> 00:24:45,079 ears and the trunk to help remember the post auricular 491 00:24:45,160 --> 00:24:48,839 lymphatinopathy and four shimer spots on the soft palate. That's Rubella. 492 00:24:48,920 --> 00:24:50,400 Let's move on to the last. But I have listed 493 00:24:50,440 --> 00:24:53,200 all of the key details about each individual pediatric illness, 494 00:24:53,359 --> 00:24:55,440 kind of narrowing it down just to the most important 495 00:24:55,519 --> 00:24:57,759 high steeled of each. So let's talk about that now, 496 00:24:58,079 --> 00:25:01,880 so first is rubella, remember again orscheimer spots, posterior auricular 497 00:25:01,920 --> 00:25:05,559 lymphat anopathy, and then of course rubelephant momps. Remember your 498 00:25:05,640 --> 00:25:10,519 paratitis orchitis, meningitis, deafness, pancreatitis momps make you plump again, 499 00:25:10,559 --> 00:25:14,440 that's the mnemonic areth them infectiosum. Remember parvovirus B nineteen 500 00:25:14,519 --> 00:25:17,759 remember aratheme infectiosum B nineteen letters long. And then remember 501 00:25:17,799 --> 00:25:21,440 your slap cheek crash, infect chicosum or nelly and ei 502 00:25:22,240 --> 00:25:25,480 rosiola in phantom where this is human herbies virus six 503 00:25:25,559 --> 00:25:27,960 b hh V six b. And then the rash of 504 00:25:28,079 --> 00:25:31,640 course most importantly starts on the trunk. Remember rosiola with 505 00:25:31,839 --> 00:25:34,279 the rose tattoo on her trunk and then her hand 506 00:25:34,359 --> 00:25:36,720 waving hello, which has six fingers on it. Remember the 507 00:25:36,759 --> 00:25:38,839 hand have six fingers. To help you remember human herpes 508 00:25:38,920 --> 00:25:46,000 virus six B. Next epstein bar virus, remember the posterior lymphatnopathy, mononucleosis, lymphoma, 509 00:25:46,079 --> 00:25:50,599 nasopharyngeal carcinoma or ol harry lukaplakia labs. Remember your lymphocytosis 510 00:25:50,680 --> 00:25:53,480 atypical lymphocytes. And then to remember all of that, remember 511 00:25:53,559 --> 00:25:57,559 EBV equals lment op handfoot mouth disease. Everything's pretty much 512 00:25:57,559 --> 00:25:59,680 in the name. Just remember this is caused typically by 513 00:25:59,720 --> 00:26:02,559 cox zaccu virus A sixteen. And then remember the trick 514 00:26:02,640 --> 00:26:05,640 there if they mentioned herpeningin And remember that's basically HFMD 515 00:26:06,000 --> 00:26:09,599 essentially of just oral lesions component measles. Remember the four 516 00:26:09,640 --> 00:26:11,799 seas of measles, and remember measles is spelled with a 517 00:26:11,880 --> 00:26:14,559 C instead of an S to help you remember conjunctivitis 518 00:26:14,720 --> 00:26:18,240 caiza cough. And then complex spots remember complex spots blush 519 00:26:18,240 --> 00:26:20,759 white spots on the buku mucosa. Remember if you look 520 00:26:20,759 --> 00:26:23,039 at cop your mouth turns blue. And then finally ver 521 00:26:23,200 --> 00:26:26,000 Cella's osterrovirus I. Remember they do drop on a rose 522 00:26:26,039 --> 00:26:28,799 pedal to help you remember what the vesicles look like. 523 00:26:28,880 --> 00:26:31,440 And then of course remember the term varying vesicles, lesions, 524 00:26:31,480 --> 00:26:33,720 and varying stages of development. All right, let's do a 525 00:26:33,759 --> 00:26:35,839 few quick questions and then we will wrap it up. 526 00:26:36,240 --> 00:26:39,079 Question one, A ten month old, previously healthy boy is 527 00:26:39,119 --> 00:26:42,400 brought to the pediatric emergency department by his parents. The 528 00:26:42,519 --> 00:26:44,880 parents report that four days ago, the child developed an 529 00:26:44,880 --> 00:26:48,480 abrupt onset of high fever without an obvious source. During 530 00:26:48,480 --> 00:26:50,960 the febroull period, the child was fussy and irritable, but 531 00:26:51,119 --> 00:26:54,680 continued to feed. There was no cough, conjunctivitis, or oral lesions. 532 00:26:54,960 --> 00:26:58,039 He had no known sick contacts, and no recent travel 533 00:26:58,279 --> 00:27:00,799 immunizations are up to date. He is not taking any 534 00:27:00,880 --> 00:27:03,799 medications and has no known drug allergies. This morning, the 535 00:27:03,839 --> 00:27:07,839 fever resolved spontaneously, and shortly after the parents notice a diffuse, 536 00:27:08,039 --> 00:27:11,160 pink maculo popular rash that appeared first on the trunk 537 00:27:11,480 --> 00:27:13,880 and then spread to the face and extremities. The rash 538 00:27:14,000 --> 00:27:17,079 is blanching and non prourritic. The palms and souls are spared. 539 00:27:17,160 --> 00:27:19,839 What is the most likely infectious organism responsible for this 540 00:27:19,960 --> 00:27:25,680 child's presentation A parvovirus B nineteen, B measles virus see 541 00:27:25,799 --> 00:27:31,119 human herpes virus six HHV six, D rubella virus or E. 542 00:27:31,519 --> 00:27:40,039 Cocksacki virus A sixteen. So the correct answer is going 543 00:27:40,079 --> 00:27:43,559 to be C human herpes virus six, as in HHV six. 544 00:27:43,759 --> 00:27:45,680 All right, so there's a lot of words in this vignette, 545 00:27:45,680 --> 00:27:49,039 but there's really only three that matter. Rash first trunk. 546 00:27:49,400 --> 00:27:51,759 Anytime you see your viral examthum being described with a 547 00:27:51,920 --> 00:27:53,640 rash that starts first on the trunk. I want you 548 00:27:53,759 --> 00:27:57,279 to write away, think of which pediatric illness rosy Ola? 549 00:27:57,440 --> 00:28:00,359 Remember Rosy waving Ola to us, the rose two on 550 00:28:00,400 --> 00:28:03,319 our chest and the six fingers waving hello. Rosiola is 551 00:28:03,359 --> 00:28:05,400 the only viral EXAMTHM we went over today that starts 552 00:28:05,440 --> 00:28:06,880 on the trunk. And if you see a rash in 553 00:28:06,920 --> 00:28:08,920 a vignette that starts on the trunk on an exam, 554 00:28:09,240 --> 00:28:11,640 it's very very likely going to be rosiola. So then 555 00:28:11,680 --> 00:28:14,920 the next question is what infectious organism causes rosiola? And 556 00:28:15,000 --> 00:28:17,279 then of course we know that it's HHV six because 557 00:28:17,400 --> 00:28:20,000 Rose is waving Ola with her hand with six fingers, 558 00:28:20,279 --> 00:28:22,400 And even if there was some uncertainty left, it's easy 559 00:28:22,440 --> 00:28:24,200 to roll out the other answers. Let's start with B 560 00:28:24,400 --> 00:28:26,920 measles virus. Measles we know we spell with the sea 561 00:28:27,000 --> 00:28:28,960 for the four seas, none of which are mentioned here. 562 00:28:29,200 --> 00:28:31,480 In addition, the measles virus typically start on the face 563 00:28:32,160 --> 00:28:35,640 a parvovirus B nineteen B nineteen, which viral exanthum be 564 00:28:35,759 --> 00:28:38,759 nineteen letters long? Are them infecciosum. We do not see 565 00:28:38,799 --> 00:28:42,079 mention of the classic slap cheek rash here d Rubella virus. 566 00:28:42,200 --> 00:28:44,880 Rubella also typically starts on the face and is associated 567 00:28:44,920 --> 00:28:49,079 with posterior lymphatnopathy and Forsheimer spots, which we remember with rubellaphant, 568 00:28:49,319 --> 00:28:52,400 neither of which are mentioned. Finally, ecocksacky virus A sixteen 569 00:28:52,400 --> 00:28:55,440 associated with handfoot mouth disease. Palms and souls are spared 570 00:28:55,440 --> 00:28:58,559 here no orolesians. Moving on to question two, a six 571 00:28:58,720 --> 00:29:01,000 year old, previously healthy girl is brought to the pediatric 572 00:29:01,039 --> 00:29:03,559 clinic by her mother in early spring. The mother reports 573 00:29:03,599 --> 00:29:06,200 that approximately one week ago, the child had mild illness 574 00:29:06,240 --> 00:29:08,960 with low grade fever, headache, malaise that resolved after a 575 00:29:09,000 --> 00:29:11,680 few days without treatment. The child has no history of 576 00:29:11,799 --> 00:29:14,440 any medical conditions. Hmmanizations are up to date, and there 577 00:29:14,519 --> 00:29:17,799 is no recent travel history. Today, the mother notice a striking, 578 00:29:17,920 --> 00:29:21,039 bright red bilateral rash on both cheeks. The rash is 579 00:29:21,079 --> 00:29:24,359 warm to the touch, slightly raised, and spares the perioral region. 580 00:29:24,720 --> 00:29:27,599 The childle is a febrile and appears well. Temperature is 581 00:29:27,720 --> 00:29:30,599 thirty seven degrees celsius or ninety eight point six fahrenheit, 582 00:29:30,880 --> 00:29:33,680 heart rate ninety two beats per minutent, respiratory rate eighteen 583 00:29:33,720 --> 00:29:36,319 breaths per minute, blood pressure in ninety eight over sixty 584 00:29:36,400 --> 00:29:40,319 millimeters per mercury. A physical exam, we see arithematose plaques 585 00:29:40,359 --> 00:29:43,720 on both cheeks, oral pharynx and bucle micosa are clear 586 00:29:44,000 --> 00:29:48,079 ill conjunctival injection, no significantly fatinopathy. What is the most 587 00:29:48,240 --> 00:29:54,839 likely diagnosis? A measles, B, handfoot mouth disease C Arethema 588 00:29:54,920 --> 00:30:05,319 infectiosum D Rubella, So that is going to be see 589 00:30:05,559 --> 00:30:08,440 Erythema infectiosum. So right off the bat, you can easily 590 00:30:08,480 --> 00:30:11,319 eliminate handfoot mouth disease as there's no mention of oral 591 00:30:11,359 --> 00:30:14,599 lesions or extremity lesions, measos. The four seas of measles, 592 00:30:14,799 --> 00:30:17,240 we don't see any of them mentioned, so that's unlikely 593 00:30:17,599 --> 00:30:21,759 Rubella aka rubella fin. No postterial inventopathy mentioned. Rolpharynx is 594 00:30:21,839 --> 00:30:24,920 listed as normal, so no chance of Forsheimer spots. So 595 00:30:25,000 --> 00:30:27,279 then we're left with earth the menfecciosum, which fits the 596 00:30:27,359 --> 00:30:30,880 vignette perfectly. A mild viral prodrome followed by the hallmark 597 00:30:30,920 --> 00:30:33,480 slapcheek rash. This is EI all the way. Moving on 598 00:30:33,599 --> 00:30:37,440 to question three, which infectious organism is most likely responsible 599 00:30:37,480 --> 00:30:43,880 for the presentation described in the previous question. So that 600 00:30:44,000 --> 00:30:46,920 is going to be parvovirus B nineteen. Don't forget the 601 00:30:47,039 --> 00:30:50,880 organism responsible for Earth the menfecciosum is parvovirus B nineteen, 602 00:30:51,000 --> 00:30:53,880 and you'll never forget that because Earth the menfacciosum be 603 00:30:54,000 --> 00:30:56,119 nineteen letters long. All right, So that was your pediatric 604 00:30:56,200 --> 00:30:58,519 viral illnesses. I hope that was helpful. Thank you so much. 605 00:30:58,559 --> 00:31:00,799 I really appreciate the support and bet sevluc In School