Speaker 1: All right, so let's talk about some high yield pediatric
vile illnesses. There is a number of them, rosiola, measles, mumps,
among many many others. Quick thank you to all of
the support for the channel, buying a T shirt just
a nice comment in general, it really makes my day,
so thank you so much. Let's go ahead and get
started with rosiola. So rosiola also known as xanthem subitum.
Only a few things to know. The peak prevalence is
going to be between seven and thirteen months. In ninety
percent of cases are going to occur in children younger
than two years of age. Human herpes virus six B
is the most common cause of rosiola, and therefore it's
the one you need to know. It's usually spread for
asymptomatic shedding of the virus in secretions to close contacts,
clinical presentation. This is the highest heal thing you need
to know. It's a fever, then a rash on the
trunk in that order. So we start with a fever.
Fever is usually going to last around three days. It
can be over one hundred and forty degrees fahrenheit in
some cases. Most of the time, besides some fussiness, child
will otherwise be fine, alert, active, et cetera. Then after
three to five days we have our rash. And if
there is one thing I want you to remember more
than anything else for rosiola, please remember the rash starts
on the trunk really important as these findings are what
will help you differentiate from other viral exanthems. So after
the fever, a blanching macular or macula popular rash will
pop up, starting starting on the trunk, then later spreading
to the face and extremities. That is the key fever,
then rash on the trunk that later spreads elsewhere. The
rash that starts in the trunk is very specific to
rosiola and will help you get the answer right. Please
remember it all right. So for diagnosis, this is going
to be a clinical diagnosis based on the presentation we
just mentioned, meaning nothing really to know here. And then
for treatment, as this is typically a self limited disease,
treatment is supportive ctomenfin for fever, etc. So nothing really
to know for diagnosis or treatment, meaning your juicy details
are in the clinical manifestations as well as the causative agent.
I do not want you to forget that the rash
starts on the trunk. I keep saying that very important,
and I also think it's a good idea to remember
this is most commonly caused by HHV six. So when
you see rosiola rosy ola, I want you to think
of a lady named Rosie waving Ola. ROSI is waving
ola or hell with her hand. Oddly, her hand has
six fingers, which helps remember HHV six. Because her hand
have six fingers, that's all the letters in there, HHV six,
which is the most common cause. Then Rosie has a
big tattoo on her chest of a rose, of course,
which helps you remember that this is one of the
only viral examthems where the rash starts on the trunk.
And if this is mentioned in a vignette, almost certainly
they'll be talking about rosola. So again, remember rosy Ola.
Rosie is waving ola six fingers on her hand to
help you remember this is caused by HHV six, and
she has a tattoo of a rose on our chest
to help you remember this is where the rash originates. Next,
let's talk about Vericella zoster virus infection aka chicken pox.
Veraceella disaster virus causes two diseases, the primary infection, which
is chicken pox, and then later reactivation of the latent
virus known as herbiezaster or shingles. So when we're talking
about the primary ver cella infection, aka chicken pox, this
is a highly contagious disease which is spread via aerosolized
droplets or by direct contact with fluid from skin lesions.
The clinical manifestations initially fever, malaise, pharyngitis, blah blah blah.
Here's the high old part. These non specific symptoms are
followed by the development of a generalized vesticular rash, usually
within twenty four hours. So this is what you need
to know. And the phrase that I used to remember
was varying vesicles. What does this mean? So in Vericella's
auster you're going to have these vesicular lesions, So these
little fluid filled blisters and they're sitting on top of
a erythemato space, so red skin. Sometimes this is called
dew drops on a rose pedal, where the vesicles are
the dew drops and the red skin is the rose pedal. Anyways,
back to the important part. Why should you remember varying vesicles? Well,
because when you see this on an exam question or
in real life. The lesions will be presenting at multiple
stages simultaneously, so some will be vesicles, some pustules, some
crusted over. This polymorphic presentation with all stages visible at
once is what distinguishes chicken pox from a lot of
other vesticular rashes, So varying vesicles makes it very easy
for the exam. Plus, Verceela already starts with the letters var,
so it's easy to remember varying as in varying vesicles
for vericella aka lesions in all stages of development and healing.
It won't get any higher yield than that for topics,
so don't forget it. As far as complication secondary to vericella,
neurologic complications like encephalitis faracella ammonia, which occurs more often
in adults and is one of the reasons why we
more aggressively treat adult patients versus children diagnosis. Often the
diagnosis is made clinically patient with characteristic vesticular lesions in
varying stages. If confirmatory tests are needed, like in an
immunal compromised patient, PCR is usually the preferred option, then
we have treatment so if you have a healthy immunal
competent child twelve years or younger. Usually this will be
with supportive measures, as in this patient population, veraceella is
usually a self limited disease, and then impregnant immunal compromise
or immunal competent adults. Antiviral therapy will usually be recommend
it as this patient population has a higher risk of complications,
so antivirals like veal cyclovir or a cyclovier will commonly
be used. So for verara Cello's ooster virus, the highest
still thing to remember is varying vesicles, and that's faraceella.
Let's move on to measles. Diesels is spelled s L
E S, but I want you to swap out the
S and replace it with a C, as in me
ac l e S and we'll talk more about that
in a minute. So measles is a highly contagious viral illness.
How contagious, well, approximately ninety percent of susceptible individuals will
develop measles who come in contact with it. Let's first
talk about the clinical manifestations. No question, this is the
highest deal thing to know. Kind of seems like a
trend with these viral infections. For clinical manifestations, you need
to know your four seas of measles, and that's why
we spelled measles with the sea to help us remember this.
So the four seas of measles are conjunctivitis, cariiza, cough,
and copleic spots. Technically coplic is spelled with a K,
but for the sake of the demonic, we're spelling it
with a C. So during the prodrum stage of measles,
you will get fever, malais, et cetera, but most importantly
conjunctivitis cariiza aka rhinitis cough, and then the most important
pathanomonic finding called copleic spots. Pathonomonic means the presence of
this specific sign or symptom is unique to a specific disease,
and its presence essentially is diagnostic, and anytime something is
considered pathdomonic, just assume it will be tested on complex
spots are these one to three millimeters bluish or white
elevations typically seen on the bucle mucosa. So the inside
of the cheek opposite the molars doesn't appear in all
patients with measles, but when it does. Like we talked
about before, it's pathanomonic, so you can't forget it. And
you might say, okay, well, I'll definitely remember complex spots
because of the four seas, but on an exam question,
they're probably not going to call them complex spots. They'll
probably just say bluish white spots in the mouth. So
how can I remember what complex spots are? Well, that's
actually easy, coplic What happens when you lick a cop
besides getting arrested, your mouth will turn blue because of
the blue uniform of course. Okay, So again, so for
clinical metifestations for measles, remember measles is spelled with a sea.
To help you remember your four seas, conjunctivitis, kariza, cough,
complex spots. Let's talk about the rash, which is a
maculo popular blanching rash that commonly will begin on the
face and spread down to involve the neck, trunk extremities.
Notice it's the opposite of rosiola, which we just went over.
So remember these small differences. It'll help you on an exam.
All right, So complications, Diarrhea is going to be the
most common complication, but most deaths are going to be
from respiratory track complications or encephalitis diagnosis. Suspect this in
a patient with clinically compatible symptoms RASH or four c's,
and then confirm with measles IgM antibody or rtPCR. Finally,
treatment for most patients is going to be supportive antipyretics, fluids,
et cetera. Some other treatment options usually reserved for severe cases.
One is vitamin A, as a vitamin A deficiency can
contribute to delayed recovery and lead to further complications. Vitamin
A levels actually fall during acute infection, so vitamin A
supplementation is added in patients with severe cases of measles.
And then, finally, riboviron and antiviral like ribaviron can be
used in certain patient populations like immunal compromise patients or
those with measles pneumonia requiring ventilatory support. All right, so
that's measles. If you can remember all of this, great,
If not, then please just don't forget the four seas
of measles. Next is going to be handfoot mouth disease.
This is very straightforward, not very high yield, so let's
zoom through handfoot mouth disease. Most cases are going to
be seen in fins and children less than seven years old.
Transmission from person to person by the fecal oral route
is most common, and while multiple enteroviruses can cause HFMD,
Cocksaki virus A sixteen and enterovirus A seventy one are
the most common. It's probably the highest sealed thing to know,
as the rest of the disease is pretty straightforward. I
don't really have an a monicure to help you remember these,
but one of the viruses is called cocksaki, so I
suppose it could be creative anyways, clinical manifestations, it's called
handfoot mouths disease, so there should be no surprises here.
The lesions in the mouth most often show up on
the tongue, and bucle mucosa usually start as an arithmatose macule,
which progress to vesicles. The child may complain of mouth
or throw pain or refuse to eat. Now, really quickly,
I wanted to mention something called herbangina, and if you're
going to get a question on HFMD, they're probably going
to have herpangina as one of the answer choices because
they are quite similar and most exam makers are going
to probably try to trick you. So herbanjina is a
similar viral illness caused by some of the same infectious organisms,
but the lesions seen in herpanngina are related to just
the oral cavity, So an oversimplification of hermagina would be
to say that it's hand foot mouth disease of just
the mouth, So mouth disease not to be fair. In
real life, HFMD can occasionally present with only oral lesions,
which makes things a bit trickier, and that's where some
subtle clues can help. Perpagino lesions are typically more posterior,
the lesions look slightly different, and the fever can be
more abrupt and higher, But honestly, since the diagnosis and
management are essentially the same, the distinction is mostly just academic.
So for example purposes and for your own sanity, just
remember herpingina as HFMD limited to just the mouth and
move on. All right, What about the rash on the
body for handfoot mouth disease, So this can be macular, maculo, popular,
or vesicular. The lesions are usually non perritic, found on
the hands, feet, buttocks, legs, arms, and typically resolve in
three to four days. So, just like the name states,
handfoot mouth disease, clinical presentation usually lesions in the mouth,
hands and feet, diagnosis is going to be made clinically
in most cases. If eacholgic confirmation is necessary, things like
PCR testing can be used and treatment will be support
sortive in most cases, as HFMD is generally mild and
self limited unless there are some rare complication involving encephalitis, meningitis, malcroditis,
et cetera. Again, the highest seel thing to know about
hand foot mouth disease outside of the clinical presentation which
is in the name, is the causative agent. Most common
cocksacchi virus A sixteen and enterovirus A seventy one. And
if they want to be evil and throwing herpangina as
a differential in the answer is just remember herpagina as
handfoot mouth disease of just the mouth and that's HFMD.
Let's move on to epstein bar virus or EBV. So
when we think of EBV or epstein bar virus, most
of us think of mono, especially in our pediatric patients,
and it's true EBV is the primary agent of infectious mononucleosis,
but EBV has a lot of other high y findings
that want to go over so EBV, which is a
herpes virus and is also known as human herpes virus four,
is transmitted primarily through salivary secretion, so the transmission is
person to person primarily through salvary secretions. In most cases,
the infection in humans is thought to originate in the
oral farings, so the back of the mouth and throat
area where EBV initially infects the oral pharyngial epithelial cells
and then later the B cells in nearby lymphoid tissue.
Clinical manifestations. EBV can cause a number of clinical manifestations
as it can effect virtually any organ system, but the
high yield often tested on clinical manifestations are usually the
ones associated with mononucleosis, so we'll see things like pharyngitis, fatigue, fever, splenomegally,
But the one in my experience that was always in
the exam question was lymphat aopathy, more specifically posterior lymphat
andopathy involving the posterior cervical and posterior auricular nodes, as
those are the most common to be affected so remember
the posterior lymphatinopathy as this is very commonly tested on all. Right, Next,
there are some high old complications slash associated conditions, starting
with the one we already know, which is going to
be infectious mononucleosis. This is probably the most important thing
to know. Mono is an acute illness due to primary
EBV infection. You gotta know that. Next is going to
be lymphoma like Burquette Hodgkin. Now, EBV has been linked
to a number of malignancies, with lymphomas at the top
of the list, especially B cell lymphomas like Burquette lymphoma
and certain forms of Hotchkin lymphoma. So why does that happen?
While after the primary infection resolves, EBV doesn't fully go away,
it establishes lifelong latency in these B cells and insusceptible individuals,
particularly those who are immunal compromised, these EBV infected B
cells can begin to proliferate uncontrollably and over time. This
constant proliferation, combined with additional genetic mutations, can lead to
the development of lymphomas and other malignancies. Another malignancy associated
with EBV is going to be nasopharyngial and gastric carcinomas,
so both can be associated with EBV, and it's estimated
that nine to ten percent of gastric carcinomas worldwide carry
the EBV genome. Next is oral hairy leukoplakia, So what
the heck is that? So this is a white, painless plaque,
usually on the lateral surface of the tongue. Unlike candydiasis,
which presents in a similar way, it cannot be scraped off.
It's usually going to be an immunal compromised patients like
those with HIV, and this frequently comes up on exams,
so definitely know it diagnosis. Also, the diagnostic tools are
derived from what we use for diagnosis of monos So
I'm not going to dive too deep here, but just
know that heterophile antibodies, which is what's commonly known as
a monospot test, it's a good initial test, it's quick
and cheap, and it's great if it's positive, but it
can be negative early on and in some younger patients.
A more sensitive and specific test is going to be
your EBV specific antibodies, which is your gold standard test. Labs,
there are going to be some hematologic abnormalities. Transferrase levels
may be elevated your liver enzymes. But all I would
know for the exam is your lymphocytes are going to
be fed up in some way, So either too many
lymphocytes aka lymphocytosis, which is the most common finding in mono,
or atypical lymphocytes seen on peripheral smear, so the lymphocytes
are irregular in some way. Remember that for LABS treatment,
this will be supportive care in most cases. So overall
EBV seems like a lot, But there's really only five
or six things I think you should know for EBV.
You gotta know mono, you got to remember your posterial
lymphatinopathy slash abnormallyphosyites. You got to remember your associated malignancies
lymphomas and nasopharyngial carcinomas. And you got to remember oral
harry lukaplakia. How to remember that, well, you remember EBV
equals l M n op. EBV equals l M n
op L stands for lymphoma slash lymphocytosis. So don't forget.
EBV is a transforming virus and has been linked to lymphoma.
Burquette Hodgkin et cetera. And also remember your lymphocyte abnormalities
like lymphocytosis. M of course stands for mononucleosis. Of course
we know infectious mononucleosis is an acute illness due to
EBV infection. N stands for the other high old malignancy
associated with EBV, which is nasopharyngeal carcinoma. Nasofaryngeal carcinoma as
well as gastric carcinoma are also associated with EBV. O
stands for oral hairy lukoplakia. Another EBV mediated manifestation, the white,
non scrapable hacks plaques, usually on the tongue in immunal
compromised individuals. And finally the P which stands for posterior
lymphat anopathy. Remember mono infection very commonly has lymphat anopathy
and most commonly involves the posterior cervical and posterior auricular notes.
Remember again EBV equals l M n OP. Those are
the high old points to remember for EBV. Moving on
to earth Fema infectiosum Arthema infectiosum or EI for short,
is a mild, febrile illness that usually manifests in school
aged children, although we can see this in adults too.
YAI is also referred to as fifth disease, as it's
one of these six common childhood exanthems named in this
order that they were first described. But this naming system
isn't used as much anymore, so I'd really just focus
on earth them infectiosum. This illness is most commonly caused
by parvovirus B nineteen, human parvovirus B nineteen, which is
associated with a number of different syndromes, including transient aplastic crisis,
fetal infection, and of course EI. I think it's important
to know this is caused by parvovirus B nineteen because
it's often tested on. So Arithema infectiosum is caused by
parvovirus B nineteen. How do you remember that, well, Arathema
infectiosum if you count out the letters, is exactly nineteen
letters long. So remember the sentence Arithema infectiosum B nineteen
letters long. Arithema infectiosum B nineteen letters long. And yes,
it actually is exactly nineteen letters. You can count it yourself.
And now I'm not expecting you to sit there during
an exam letters on your fingers. But if you ever
get stuck on a question asking you which viral examthem
is caused by parvavirus B nineteen, this can actually save you.
So again erethemia infectioniosum is caused by parvavirus B nineteen
and erthema infectiosum B nineteen letters long. Next, clinical manifestations.
So this illness starts with some nonspecific stuff fever, headache, nausea, diarrhea,
blah blah, not important. Let's get to the good stuff.
The highest sealed thing to know for clinical manifestations is
slap cheek. What am I talking about? So with EI,
around two to five days after they get the nonspecific fever,
nause et cetera, they will develop the characteristic ARA, thematose
melar rash with circum oral polar. So this is the
classic arithmatose melar rash that appears in individuals with EI.
A melar rash is one that's across the nose and cheeks.
Circum Oral polar just means the pale area around the
mouth that we'll see. So the cheeks are usually bright
red like someone slap the patient which gave it the
nickname of slap cheek. Now, I really want you to
remember the melar slap cheek rash because it's super high yield.
So to remember this instead of ama infecttioniosum, remember erthema
infect cheek osum cheek as in c H E E case.
Remember instead of arathema infect g osum, remember it as
arithema infect cheek osume. Do remember the classic slap cheek
or mela rash which is so damn high yield. I
even have another mnemonic and I'm gonna embarrass myself here,
but I think it's worth it if maybe it helps
just one person. So if that mnemonic doesn't work for you,
it's a little embarrassing. But this is actually how I
remember it in school. So every time I would see
Ei on an exam uh arethema infectioniosum Ei, I would
think of that song by Nelly called Ei the One
that Goes and Mama Ei Ei. So yeah, that would
always help me remember the song by Nelly. And then
I would think of Nelly who always had that band
aid on his cheek, which helped me remember these slap
cheek rash. You probably don't even remember that song, so
I just embarrassed myself rapping for no reason. Anyways. After
the high old facial rash clears, it's usually followed by
many days later by this reticulated or lace like rash
on the trunk and extremities. Some patients can develop arthralgias
and other hematologic abnormality, but for most immunal competent patients,
this will only be a mild illness. But do not
forget your slap cheek rash please diagnosis this is going
to be for most individuals. Clinical diagnosis to a child
who presents with the classic melar rash. Sero Logic tests
are available for confirmation of the viral atiology, but reserved
for atypical presentationsmutal compromise patients, etc. And treatment is generally
going to be supportive as this is a mild, self
limited illness for most affected. There's no specific treatment indicated
for most cases outside of symptomatic treatment for fevers, headaches,
et cetera. So EI not allowed to know here. There's
only two main takeaways for the exam. One is that
this is caused by parvovirus B nineteen remember erathema infectioniosum
B nineteen letters long two remember the classic or melar
slap cheek rash, Remember arethema infect cheek osum or just
remember me embarrassingly wrapping and helping you to remember Nelly
with the band aid on his cheek. Anyways, let's move
on to months. This is a highly contagious viral illness
occurring most commonly among school aged children and college aged
young adults, spread via respiratory dropic oplets, direct contact, or fullmites.
Vaccination in the US has led to a significant decline
in the number of cases seen, but a few hundred
to a few thousand cases continue to occur each year
for months. There's really only a few high old things
to know for the exam. Let's run through them first,
starting with our clinical manifestations. So it usually start with
some nonspecific symptoms fever, headache, miyolgia. You know how I
feel about the nonspecific stuff by now. But then then
there is salivary gland swelling. So salivary gland swelling develops.
This is the highest deal thing you need to know
about mumps, and that is something known as paratitis. Paratitis
is the most common manifestation of the virus occurring in
over seventy percent of infections. The mumps virus actually has
an affinity for the glandular epithelium, especially of the product land,
and it's why this occurs so often. So the product lands,
which are largest salivary glands, sit below and in front
of the ear, and when these become inflamed in mumps,
the swelling can be quite traumatic, sometimes extending along the
entire side of the face and into the neck, completely
obscuring the angle of the mandible. So if clinical manifestations
do not forget para titis, there are also some other
high old complications you should know, starting with the most important,
which is going to be orchitis, specifically epididymal orchitis, which
is an inflammation of both the testes and epididymus and
is the most common complication of mumps infection. These patients
may have fever, swelling, severe testicular pain and this is
going to be unilateral in most cases sixty eight to
eighty percent. There are also a number of neurologic complications.
Meningitis which is the most common neurologic complication, specifically aseptic meningitis,
which can occur in up to ten percent of patients deafness,
so hearing loss associated with mumps is another unique complication.
Symptoms improve in many cases, although permanent deafness can occur
and then finally pancreatitis which can occur in both children
and adults with mumps. Most cases resolve with conservative management
and this is not a common complication, but it is
tested on so it's good to know and be familiar
with it. Nothing to know for diagnosis. Diagnostic tests like
reverse transcriptase PCR and serum IgM antibody testing may be
utilized to establish the diagnosis treatment. This is also not
high yield as there's no specific anti viral therapy and
this is usually a self limited condition, so supportive measures
will be the mainstay for most individuals acetomnifit, et cetera.
And then, of course the goal here is prevention through
immunization with the MMR vaccine. So the highest feel things
to know for MOMPS comes from the complications and clinical manifestations.
So since momps make you plump like plump neck and face,
et cetera, you'll remember the sentence mumps make you plump,
Mumps make you plump and plump p l U MP
has all of the hygy Olde findings for the exam.
P starts for pancreatitis, L stands for loss of hearing. Remember,
deafness can be associated with mumps. U stands for unilateral orchitis.
Remember orchitis is a common complication for males and in
sixty to eighty percent of males this will be unilateral.
TIM stands for meningitis, a septic meningitis being the most
common neurologic complication of mumps. And finally, the last P
the star of the show, paratitis, the most common manifestation
of the virus, causing significant face and next swelling. So again,
mumps make you plump, pancreatitis, loss of hearing, unilateral orchitis, meningitis, paratitis.
That's mumps. Don't forget it makes you plump. Moving on
to rubella. This is a viral illness first described by
German physicians in the seventeen fifties and was referred to
as German measles due to a similar rash as the
one seen in measles. Vaccination has resulted in a significant
decline in the number of episodes, and in two thousand
and four was actually officially eliminated from the United States,
although there are still intermittent outbreaks worldwide. So let's get
started with the clinical manifestations, which is typically comprised of
a rash, fever, and lymphat anopathy. The rash will consist
of pinpoint pink maculo papulos, first appearing on the face,
then spreading coudily or downward to the trunk, and extremities
sparing the palms and souls. The rash usually lasts for
about three days and then on the exam you may
see something called Forsheimer's spots, which are these small red
spots on the soft palate can be seen in other
conditions like scarlet fever. So unlike coplex spots and measles,
Forsheimer's spots are not pathdomonic for rubella. But if you
see this mentioned in a vignette, most likely they're going
to be talking about rubella. So important remas next important
one is going to be lymphat anopathy, which typically involves
the posterior cervical, posterior auricular, and suboccipital lymph nodes. The
posterior curricular lymphat anopathy is often mentioned in vignettes, so
it's really important to know. And if you see a
patient mentioned in a vignette that has posterior curricular lymphat
anopathy and for Shimer spots, from an exam standpoint, it's rebella.
So those are the clinical metaphestations to know, focusing on
Forsheimer spots and the posterior curricular lymphat anopathy. Infection in
children is usually going to be mild. Complications of rubella
are not common except during pregnancy, which congenital Rubella syndrome
can develop and it is the biggest concern as it
can be quite serious fetal death, premature delivery, hard and
ocular defects, et cetera. Let's move on to diagnosis. So
we diagnose with rubella IgM zerology. Usually that's going to
be the initial diagnostic test and rtPCR testing can be
used as an alternative. Treatment is going to be supportive
measures in most cases antipyretics, fluids, et cetera. So as
in most of these viral examthems, the clinical menifestations are
the high still component as there's not much to know
for diagnosis and treatment, and the key to rubella is
the post auricular lymphatinopathy and the red spots on the
soft palat the four Shamer spots. Those will both be
in the vignette. And to remember these instead of Rubella,
remember rubellaphant instead of Rubella, remember rubelephant. Rubelephant as an elephant,
because when you think of an elephant, as in rubelphant,
what do you think of those big dumbo ears and
the big trunk. So think of a rubelephant those big
dumbo ears help you remember the post auricular lymphatinopathy, these
swollenlyph notes behind the ears. Then think of the elephant
lifting its trunk up in the air and showing you
its mouth to help you remember the four Shimer spots,
the red spots on the soft palate. So remember Rubella
as instead rubellaphant to help you remember the big floppy
ears and the trunk to help remember the post auricular
lymphatinopathy and four shimer spots on the soft palate. That's Rubella.
Let's move on to the last. But I have listed
all of the key details about each individual pediatric illness,
kind of narrowing it down just to the most important
high steeled of each. So let's talk about that now,
so first is rubella, remember again orscheimer spots, posterior auricular
lymphat anopathy, and then of course rubelephant momps. Remember your
paratitis orchitis, meningitis, deafness, pancreatitis momps make you plump again,
that's the mnemonic areth them infectiosum. Remember parvovirus B nineteen
remember aratheme infectiosum B nineteen letters long. And then remember
your slap cheek crash, infect chicosum or nelly and ei
rosiola in phantom where this is human herbies virus six
b hh V six b. And then the rash of
course most importantly starts on the trunk. Remember rosiola with
the rose tattoo on her trunk and then her hand
waving hello, which has six fingers on it. Remember the
hand have six fingers. To help you remember human herpes
virus six B. Next epstein bar virus, remember the posterior lymphatnopathy, mononucleosis, lymphoma,
nasopharyngeal carcinoma or ol harry lukaplakia labs. Remember your lymphocytosis
atypical lymphocytes. And then to remember all of that, remember
EBV equals lment op handfoot mouth disease. Everything's pretty much
in the name. Just remember this is caused typically by
cox zaccu virus A sixteen. And then remember the trick
there if they mentioned herpeningin And remember that's basically HFMD
essentially of just oral lesions component measles. Remember the four
seas of measles, and remember measles is spelled with a
C instead of an S to help you remember conjunctivitis
caiza cough. And then complex spots remember complex spots blush
white spots on the buku mucosa. Remember if you look
at cop your mouth turns blue. And then finally ver
Cella's osterrovirus I. Remember they do drop on a rose
pedal to help you remember what the vesicles look like.
And then of course remember the term varying vesicles, lesions,
and varying stages of development. All right, let's do a
few quick questions and then we will wrap it up.
Question one, A ten month old, previously healthy boy is
brought to the pediatric emergency department by his parents. The
parents report that four days ago, the child developed an
abrupt onset of high fever without an obvious source. During
the febroull period, the child was fussy and irritable, but
continued to feed. There was no cough, conjunctivitis, or oral lesions.
He had no known sick contacts, and no recent travel
immunizations are up to date. He is not taking any
medications and has no known drug allergies. This morning, the
fever resolved spontaneously, and shortly after the parents notice a diffuse,
pink maculo popular rash that appeared first on the trunk
and then spread to the face and extremities. The rash
is blanching and non prourritic. The palms and souls are spared.
What is the most likely infectious organism responsible for this
child's presentation A parvovirus B nineteen, B measles virus see
human herpes virus six HHV six, D rubella virus or E.
Cocksacki virus A sixteen. So the correct answer is going
to be C human herpes virus six, as in HHV six.
All right, so there's a lot of words in this vignette,
but there's really only three that matter. Rash first trunk.
Anytime you see your viral examthum being described with a
rash that starts first on the trunk. I want you
to write away, think of which pediatric illness rosy Ola?
Remember Rosy waving Ola to us, the rose two on
our chest and the six fingers waving hello. Rosiola is
the only viral EXAMTHM we went over today that starts
on the trunk. And if you see a rash in
a vignette that starts on the trunk on an exam,
it's very very likely going to be rosiola. So then
the next question is what infectious organism causes rosiola? And
then of course we know that it's HHV six because
Rose is waving Ola with her hand with six fingers,
And even if there was some uncertainty left, it's easy
to roll out the other answers. Let's start with B
measles virus. Measles we know we spell with the sea
for the four seas, none of which are mentioned here.
In addition, the measles virus typically start on the face
a parvovirus B nineteen B nineteen, which viral exanthum be
nineteen letters long? Are them infecciosum. We do not see
mention of the classic slap cheek rash here d Rubella virus.
Rubella also typically starts on the face and is associated
with posterior lymphatnopathy and Forsheimer spots, which we remember with rubellaphant,
neither of which are mentioned. Finally, ecocksacky virus A sixteen
associated with handfoot mouth disease. Palms and souls are spared
here no orolesians. Moving on to question two, a six
year old, previously healthy girl is brought to the pediatric
clinic by her mother in early spring. The mother reports
that approximately one week ago, the child had mild illness
with low grade fever, headache, malaise that resolved after a
few days without treatment. The child has no history of
any medical conditions. Hmmanizations are up to date, and there
is no recent travel history. Today, the mother notice a striking,
bright red bilateral rash on both cheeks. The rash is
warm to the touch, slightly raised, and spares the perioral region.
The childle is a febrile and appears well. Temperature is
thirty seven degrees celsius or ninety eight point six fahrenheit,
heart rate ninety two beats per minutent, respiratory rate eighteen
breaths per minute, blood pressure in ninety eight over sixty
millimeters per mercury. A physical exam, we see arithematose plaques
on both cheeks, oral pharynx and bucle micosa are clear
ill conjunctival injection, no significantly fatinopathy. What is the most
likely diagnosis? A measles, B, handfoot mouth disease C Arethema
infectiosum D Rubella, So that is going to be see
Erythema infectiosum. So right off the bat, you can easily
eliminate handfoot mouth disease as there's no mention of oral
lesions or extremity lesions, measos. The four seas of measles,
we don't see any of them mentioned, so that's unlikely
Rubella aka rubella fin. No postterial inventopathy mentioned. Rolpharynx is
listed as normal, so no chance of Forsheimer spots. So
then we're left with earth the menfecciosum, which fits the
vignette perfectly. A mild viral prodrome followed by the hallmark
slapcheek rash. This is EI all the way. Moving on
to question three, which infectious organism is most likely responsible
for the presentation described in the previous question. So that
is going to be parvovirus B nineteen. Don't forget the
organism responsible for Earth the menfecciosum is parvovirus B nineteen,
and you'll never forget that because Earth the menfacciosum be
nineteen letters long. All right, So that was your pediatric
viral illnesses. I hope that was helpful. Thank you so much.
I really appreciate the support and bet sevluc In School