A 7-month-old patient presents with a history of 3 days of fever to 104°F, which resolved the same day that an exanthem erupted. The exanthema is prominent on the neck and trunk. It is macular, with discrete lesions 35 mm in diameter.Which of the following is the most likely diagnosis?
Answer(s): C
Roseola infantum, or sixth disease, is a common acute illness of young children. Human herpesvirus 6 is the most common etiologic agent. The rash of erythema infectiosum presents initially on the face. It is intensely red with a "slapped-cheek" appearance. Rubella and measles are not commonly seen because of routine vaccination. The rash of scarlet fever is on the trunk and is described as sandpaper like.
A3-year-old male presents after having a tonicclonic seizure lasting about 1 minute. On examination, the child now has no nuerologic abnormalities. He has a temperature of 40.3°C and has an obvious otitis media on the left but no other abnormalities on physical examination. You correctly counsel the family with which one of the following statements?
Answer(s): D
Simple febrile seizures are common in children between ages 6 months and 5 years. They are usually brief, with bilateral clonic or tonicclonic movement. They have a 30% likelihood of recurrence. The investigation should include a search for the cause of the fever, usually a viral infection, UTI, or following immunization. A lumbar puncture must be performed if there is suspicion of an intracranial infection and when features of the seizure suggest a focal or lateralized seizure. In these situations, EEG and imaging may also be considered. However, in most children with uncomplicated febrile seizures, these procedures are unnecessary. There is an increased risk for developing epilepsy in later life, as high as 7% in a study with mean followup of 18 years. When risk factors are present, the incidence of epilepsy rises to 49%. Risk factors include prior neurologic abnormality, prolonged seizures (>30 minutes), focal or lateralized seizure, and repeated seizure within 24 hours.
Children with sickle cell disease are at risk for certain conditions with characteristic presentation.Match the clinical scenario with the syndrome.A 12-month old patient presents with a 3-day history of lethargy and fever. He has also had rhinorrhea and a cough. On physical examination, he is pale, tachycardic, and has a left upper quadrant mass. His hemoglobin is 4 g/dL, platelet count is 100,000, and WBC is 15,000 with 50% segmented neutrophils.His reticulocyte count is 15%.
Answer(s): B
This is the classic presentation of splenic sequestration which occurs in these patients in the first few years of life, before the spleen autoinfarcts. This often occurs following an acute febrile illness. Blood pools in the spleen, which becomes enlarged; signs of circulatory collapse may develop. In an aplastic crisis, a very low reticulocyte count would be expected, and there is no such splenic enlargement.
Children with sickle cell disease are at risk for certain conditions with characteristic presentation.Match the clinical scenario with the syndrome.An 8-month-old patient with sickle cell disease presents with a 2-day history of painful, swollen fingers and toes.
Acute sickle dactylitis or hand-foot syndrome is often the earliest clinical syndrome seen in children with sickle cell anemia. There is painful, symmetrical swelling of the hands and feet. Roentgenograms usually reveal bony destruction only in the later phase, 12 weeks later.
Children with sickle cell disease are at risk for certain conditions with characteristic presentation.Match the clinical scenario with the syndrome.A 5-year-old boy with sickle cell anemia presents with a 2-day history of increasing pain in both legs. He has had multiple admissions for similar episodes of pain. On examination, he has no swelling of the legs. There is diffuse tenderness along both legs. There is no joint involvement, and there is full range of movement.
Answer(s): F
Acute painful episodes are the most common manifestation of sickle cell disease. Most patients experience some pain nearly daily. In younger children, this usually involves the extremities. In older children, head, chest, abdomen, and back pain may occur.
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