PEDIATRICS SMLE COURSE
Dr. Osama Safder
A child came with cough with deep inspiration
between cough , conjunctivitis , and diarrhea
unvaccinated
Most likely cause
A-Adenovirus
B-Pertusis
C-Chalymedia
A child came with cough with deep inspiration
between cough , conjunctivitis , and diarrhea
unvaccinated
Most likely cause
A-Adenovirus
B-Pertusis
C-Chalaymedia
Whooping cough : no fever , no concjucutivis , no
SOB , paroxysmal cough with whooping and post
tussive vomiting
Chlamydia: no fever , pneumonia (afebrile
pneumonia , conjutivirs
common cold or flu-like symptoms
fever
sore throat
acute bronchitis
pneumonia
pink eye
acute gastroenteritis (inflammation of the
stomach or intestines causing diarrhea, vomiting,
nausea and stomach pain)
Child presented with ulcers on mouth and
gingiva erythematous based and pale in the
center.
A. Coxaci
[Link]
[Link]
Influnza
Child presented with ulcers on mouth and
gingiva erythematous based and pale in the
center.
A. Coxaci
[Link]
[Link]
D-Infunza
Herpes caused by hepes virus type 1
Multiple ulcers in the mouth , tongue , lips
Hepangina caused by coxackie virus
Similar to herpes but affect oropharynix more
than oral cavity
6 years old presented with macupaular rash Rash
on the face and inner cheeck there’s white spots ,
most lkely cause
Rubella
Measles
Roseola
Scarlet fever
6 years old presented with macupaular rash Rash
on the face and inner cheeck there’s white spots ,
most likely cause
Rubella
Measles
Roseola
Scarlet fever
Measles
Koplik spot (usually comes with fever and
disappear before rash)
High fever then f followed by Macupaulpar rash
Rash will start from the face and spread
downward
Koplik spot
Non-purlent conjunctivitis
Usually in older children (above 5 years)
No hands and foot changes
No strawberry tongue
Child with sore throat and coryza 2 days ago
came with difficulty swallow food what is
investigation you will order?
A. Chest x ray
B. Ct scan
C. Lateral neck x ray
D-Echo
Child with sore throat and coryza 2 days ago
came with difficulty swallow food what is
investigation you will order?
A. Chest x ray
B. Ct scan
C. Lateral neck x ray
D-Echo
A child with tympanostomy tube and has ear
discharge and fever , he likes to swim
Most likely cause
A-Staphy aurues
B-Psumonal argunoise
C-Sterpptococus pneumonia
D=Moraxella catarils
A child with tympanostomy tube and has ear
discharge and fever , he likes to swim
Most likely cause
A-Staphy aurues
B-Psumonal argunoise
C-Sterpptococus pneumonia
D=Moraxella catarils
In children
Tympanostomy tube with otorhea (TTO):
Early: within 2 weeks after tube insertion
Late : after 2 weeks of insertion
Most common casue:
In children below 2 yeears:
-Streptococcus pneumonia
-Hemophils influnza
-Moraxella catarhails
In children above 2 years ususayll causes by
water ppenetration and most causes:
-Psudomona arguinosa
-Staphy aurues
SIGNS AND SYMPTOMS OF PERITONILAR
ABSSESS (QUINSY)
Fever and chills.
Severe throat pain that is usually on one side.
Ear pain on the side of the abscess.
Difficulty opening the mouth, and pain with
opening the mouth.
Swallowing problems.
Drooling or inability to swallow saliva.
Facial or neck swelling.
Fever.
Peritonilar abscces best diagnosed by CT
Treatment : sugery and antibiotic
7 y/o unvacclnated boy presents with red
erythematous irregular patches of rash that is
around his neck and spreads down his back.
What does he have?
A. measles
B. Chickenpox
C. Rubell
D. Pertussis
7 y/o unvacclnated boy presents with red
erythematous irregular patches of rash that is
around his neck and spreads down his back.
What does he have?
A. measles
B. Chickenpox
C. Rubella
D. Pertussis
Chicken pox
Incubation period 10-21 days
Transmitted by droplet
Self limited disease
Ploymorph rash
Both macupapular and vesicular
Self limited disease
Can be fatal in immunocpmromized patients
Reactivation cause (shingles)
Secondary bacterial infections of the skin, soft
tissues, bones, joints or bloodstream (sepsis)
Dehydration.
Pneumonia (most common cause of death).
CNS: Acute cerbellar ataxia (common and diffuse
encephailits (rare )
Toxic shock syndrome.
Reye's syndrome for people who take aspirin
during chickenpox.
Which of the following organs most commonly
affected in chicken pox
A-Eye
B-Ear
C-Lungs
D-Liver
Which of the following organs most commonly
affected in chicken pox
A-Eye
B-Ear
C-Lungs
D-Liver
Although pneumonia is not common in
imunocompetent children , it is the most
common cause for morbidity and mortality in
imminocpmromized children and in adults
A child with runny nose and fever which subsides
and then rash appear allover his body starting
from the face
Most likey cause
A-Rubella
B-Measles
C-Roseola
D-Chicken pox
A child with runny nose and fever which subsides
and then rash appear allover his body starting
from the face
Most likey cause
A-Rubella
B-Measles
C-Roseola
D-Chicken pox
Roseloa infantum
Cause: human herpes virus 6
High fever but patient will looks happy
Rash comes after fever subsided completely
(rainbow after rain)
In all other rash disease : fever comes with
rash or before rash for 2-3 days and fever
continues with rash
Rosela can cause febrile seizures
Ususally no treatment
ROSEOLA
Baby with white eye reflex (Leukocoria) and
murmur. Mother mentioned viral infection
during pregnancy:
A. Rubella
B. CMV
C. Toxoplasmosis
D-Measles
Baby with white eye reflex (Leukocoria) and
murmur. Mother mentioned viral infection
during pregnancy:
A. Rubella
B. CMV
C. Toxoplasmosis
D-Measles
Congenial rubella cause cataract in newborn
Cataract cause absent red reflex
Cause of white or absent red reflex
Retinoblasrome
Cataract
Coats disease Metabolic disease
BLUBERRY RASH IN CONGENTIAL RUBELLA
SYNDROME
Measles:
1-High fever
2-Rash more severe and disappear in 5-6 days
3-Infectivit period (4-5 days days before the rash and 4-5
days after rash )
4-Conjucitivits
5-Koplik spots
Rubella
1-Mild or no fever
2-rash milder and disappears in 3 days
3-Longer infectivity period ( days before and days after the
rash
4-Teratogenic
5- forcheimer spot
Rubella is tertogenic
Cause congenital rubllea syndrome
Deadness
Cataract
Congenital heart disease (PDA or TOF)
Blueberry muffin rash
4 years old with fever for 6 days , rash , you
suspetct Kawaski disease following is one of the
criteria:
A. anterior uveitis
B. myocarditis
C. conjunctivitis with no exudate
D. arthritis
4 years old with fever for 6 days , rach , you
suspetct Kawaski disease following is one of the
criteria:
A. anterior uveitis
B. myocarditis
C. conjunctivitis with no exudate
D. arthritis
KAWASKI DISEASE
Burn
Fever > 5days
CRASH
Conjunctivitis (non-purelent)
Rash
Adenopathy (cervical above 1.5 cm)
Strawberry tongue
Hands and foot swelling
S: strawberry tongue
A: adenopathy
F: fever for > 5days
D:Dry conjuticvitis
E: erthymema in hands or foot
R: rash
A patient with kawasaki features,what is the
best indicator as poor response to IVIG?
A. Neutropenia
B. High CRP
C. Albumin
D-Hypernatermia
A patient with kawasaki features,what is the
best indicator as poor response to IVIG?
A. Neutropenia
B. High CRP
C. Albumin
D-Hypernatermia
A child presented with 5 days of fever, oral
mucosal lesions, cervical lymph node
enlargement and limb edema. Lab results
essentially normal. Drug of treatment?
A. Acyclovir
B. Cefotaxime
C. Ampicilin
D. Aspirin
A child presented with 5 days of fever, oral
mucosal lesions, cervical lymph node
enlargement and limb edema. Lab results
essentially normal. Drug of treatment?
A. Acyclovir
B. Cefotaxime
C. Ampicilin
D. Aspirin
Treatment of Kawaski disease
High dose of IVIG
Asprin started with high ant inflammatory dose
dose (6-80 mg per kg per day) then decrease to
antiplateltes dose for 6-8 weeks
Pt with pharyngitis for 2 days , what’s the
possible complication and on examination there
exudates
Which of the following is a lkeiy complicatin
A-Scarlet fever
B-Glomerulonephritis
C-Rhuematic fever
D-Meninigits
Pt with pharyngitis for 2 days , what’s the
possible complication and on examination there
exudates
Which of the following is a lkeiy complicatin
A-Scarlet fever
B-Glomerulonephritis
C-Rhuematic fever
D-Meninigits
Scarlett fever
Group A streptococcus
High fever
Sore throat
Strawberry tongue
Peeling of skin
In comparison to Kawasaki
No conjunctivitis
No lympandopathy
Rash is milder
SACRTELT FEVER : SAND PAPER RASH
SCARLET FEVER: GOOSEPUMP
RASH
SCARLET FEVER: PASTIAL INES
(ELBOW)
SCALRTET FEVER: CIRCUMORAL
PALLOR
الوزة القرمزية ماشية على الرملة و منقارها ابيض ولسانها فراولة وتاكل
باستا
Patient came with pharyngitis, rash begins in the
groin, axillae, neck, antecubital fossa; Pastia’s
lines + may be accentuated in flexural areas 24 h,
sandpaper rash becomes generalized with
perioral sparing, non-pruritic, non- painful,
blanchable treatment is
A-Supportive
B- penicillin
C-IVIG
D- steroid
Patient came with pharyngitis, rash begins in the
groin, axillae, neck, antecubital fossa; Pastia’s
lines + may be accentuated in flexural areas 24 h,
sandpaper rash becomes generalized with
perioral sparing, non-pruritic, non- painful,
blanchable treatment is
A-Supportive
B- penicillin
C-IVIG
D- steroid
Treatment for scarlet fever
A short course of penicillin for 10 days
If allergic to penicillin then consider macrolide or
sulpha drugs
4 months old with proven pertussis infection on
macrolide. His 3 and 5 years old siblings are
vaccinated up to date. What is the proper action
to prevent the siblings from getting the infection
A. prophylactic macrolide.
B. booster vaccination against pertussis
C. observe them for the possibility of developing
the infection.
D-Immunogloblin
4 months old with proven pertussis infection on
macrolide. His 3 and 5 years old siblings are
vaccinated up to date. What is the proper action
to prevent the siblings from getting the infection
A. prophylactic macrolide.
B. booster vaccination against pertussis
C. observe them for the possibility of developing
the infection.
D-Immunogloblin
Prophylaxis for pertusis showld be considered in
Close contacts person:
Living int eh same household
Face to face exposure with symptomatic patients
(within 3 feet distance)
Direct contact with repository secretion of the
patients
Sharing the same confined space for more than 1
hour with symptomatic patient
Also pertusis prohylaxis should be considered for
high risk patients
Infants younger than 1 year
Pregnant women
Persons with immundefeciency
Persons with underlying medical condition
Perso taking care of infants
Prophylaxis foe pertusis
Azithromycin for 5 days
Erythromycin for 14 days
Clarithromycin for 7 dyas
Pertussis case “whooping cough”Ask about
diagnosis and Investigation:
A. Nasopharyngeal swab
B. Blood culture
C-Neck X ray
D-ECHO
Pertussis case “whooping cough”Ask about
diagnosis and Investigation:
A. Nasopharyngeal swab
B. Blood culture
C-Neck X ray
D-ECHO
Best diagnostic test for pertussis is
nasophayngeal swab
Serology is not very useful and nit available in
many labs
Neonatal lumbar puncture + diplococci
Management
A-Marolide
[Link] + gentamicin
C-cefitraxone
D-Ciprofluxoacilin
Neonatal lumbar puncture + diplococci
Management
A-Marolide
[Link] + gentamicin
C-cefitraxone
D-Ciprofluxoacilin
Tretment for neonatal menigits
Emprically: ampicllin + gentamycin and
cefotaxime
Ampiclin for Group B Sterptococcus and listeria
Gentamycin and cefotaxime to cover E coli and
other gram negative
3 day neonate with B hemolytic and catalse +ve
what antibiotic give: I
A-ampicillin
2-gentamicin
3-ceftriaxone
D-Macrlide
3 day neonate with B hemolytic and catalse +ve
what antibiotic give: I
A-ampicillin
2-gentamicin
3-ceftriaxone
D-Macrlide
Group B streptococcus
Common cause of neonatal sepsis
Vaginal swab is a routine at 35-37 weeks
Gram positive
Catalase positve
7 y/o with meningeal irritation, headache, and
fever. CSF (normal protein and normal glucose
and lymphocytosis). What you will give the child?
[Link] and vancomycin and steroids
[Link] and steroid
C-Antiviral
D-Steroid
7 y/o with meningeal irritation, headache, and
fever. CSF (normal protein and normal glucose
and lymphocytosis). What you will give the child?
[Link] and vancomycin and steroids
[Link] and steroid
C-Antiviral
D-Steroid
7 y/o with meningeal signs, headache, and fever.
He and his family came from Africa recently. He
also has sore throat and lymphadenopathy. CSF
(normal protein and normal glucose and
lymphocytosis). What you will give the child
[Link]
[Link]
C. EBV
D-Hantavirus
7 y/o with meningeal signs, headache, and fever.
He and his family came from Africa recently. He
also has sore throat and lymphadenopathy. CSF
(normal protein and normal glucose and
lymphocytosis). What you will give the child
[Link]
[Link]
C. EBV
D-Hantavirus
Asetpic meningitis is the most most common
cause of meningitis
Enteroviruses like coxackie . Polio , echo virus
Other virtues include herpes and arbo virus
Fever for 6days and tender splenomegaly, which
culture is most importantly needed?
urine and stool culture –
B-repeated blood cultures
C-bone marrow smear culture
D-Chest X ray
Fever for 6days and tender splenomegaly, which
culture is most importantly needed?
urine and stool culture –
B-repeated blood cultures
C-bone marrow smear culture
D-Chest X ray
Patients with fever and splenomgaly sfor less
than 7 days should be suspected for infectious
cause like Typhoid fever , infective endocarditis ,
TB , brucellosis and repated blood clutire shoud
be rpeated several times
Chime with meningitis came with his parents
and has papilldema , parents are afarid of
A-Hearing loss
B-Vision loss
C-Cerberal palsy
D-Heart failure
Chime with meningitis came with his parents
and has papilldema , parents are afarid of
A-Hearing loss
B-Vision loss
C-Cerberal palsy
D-Heart failure
B 3 mo old boy with pic of bacterial meningitis
What’s most common pathogen?
A. Moraxella catarrhalis.
B. Streptococcus pneumonia.
C. Streptococcus pyogen
D-Nesseria
B 3 mo old boy with pic of bacterial meningitis
What’s most common pathogen? A. Moraxella
catarrhalis.
B. Streptococcus pneumonia.
C. Streptococcus pyogen
D-Nesseria
Causes of meningitis
In babies below 3 month: GBS , E coli , lieteria
Above 3 motnhs : Sterptococcus pneumonia ,
Hemophilus influnza , nesseria
In children with basilar skull fractures:
sterptococcus pneumonia
In children with VP shunt: staph epidermis
Treatment of bacteral meningits
For neonates :Ampiclin , gentamcin , cefotaxime
For older than 3 months
Cefitraxone , vancomycin and dexamehtasoe
Duration of treatment
7 days for nesseria
10 days for hemohplilus influnza
14 das for streptococcus pneumonia
A child diagnosed with meningitis and treated
Which of the following is the likey most long term
complication
A-Cerberal palsy
B-Vision loss
C-Hearing loss
D-Mental retardation
A child diagnosed with meningitis and treated
Which of the following is the likey most long term
complication
A-Cerberal palsy
B-Vision loss
C-Hearing loss
D-Mental retardation
pediatric patient have meningitis, with close
contact to his brother recently, Asking for what
to give to his brother:
A. Rifampicin
B. IVIG
C-Steroid
D-Pencilini
pediatric patient have meningitis, with close
contact to his brother recently, Asking for what
to give to his brother:
A. Rifampicin
B. IVIG
C-Steroid
D-Pencilini
Rifampicin once per day for 4 days
Should be given for house hold contact if
1-they are younger than 4 years and did not
receive the immunizations against hemophlis
influenza
2-If known immunodeficiency regardless history
of immunizations
Household contact defined as spending more
than 4 hours with index patients for at least 5-7
days
For nesseria menitingits
For close contact and should started within 10
days after exposure
Rifampicin twice per day for 2 days
For sterpococcus pneumonia no evieince for
antibioti prophylaxis
Child came from africa. complaining of weakness,
he couldn’t move his head and legs especially
when he is prone. What is the dx?
A. Polio
B. CMV
C-EBV
D-Influnza
Child came from africa. complaining of weakness,
he couldn’t move his head and legs especially
when he is prone. What is the dx?
A. Polio
B. CMV
C-EBV
D-Influnza
Polio virus can case weakness in both legs and
the weakness is asymmetry
Most common virus cause of acute otitis media in
pedia
Rhinovirus
RSV
Influnza
Chicken POX
Most common virus cause of acute otitis media in
pedia
Rhinovirus
RSV
Influnza
Chicken POX
Most common cause of acute otitis media in
pedia is bacterial cause
Streptococcus pneumonia
Hemophilus influnza
Moraxella catarhails
Most common viral cause for otitis media
RSV most common
Rhinovirus: 2nd most common
Other virsuses
Adenovirus
Echo virus
child with fever and left knee pain and swelling.
Most important single investigation? A. Blood
culture.
B. CBC.
C. Joint aspirate
. D. Xray
child with fever and left knee pain and swelling.
Most important single investigation? A. Blood
culture.
B. CBC.
C. Joint aspirate
. D. Xray
Septic arthritis
Best diagnosed with joint aspiration
Most common cause: staph aurues
13 months old girl present with fever 38 ,
bilateral lung infiltrate , she looks mildly ill ,
what is the likely organism
A. Moraxella catarrhalis
B. Strep pneumoniae
C. Hib influenza
D-Nesseria
13 months old girl present with fever 38 ,
bilateral lung infiltrate , she looks mildly ill ,
what is the likely organism
A. Moraxella catarrhalis
B. Strep pneumoniae
C. Hib influenza
D-Nesseria
Most coomon causes of pneumonia
In neonate : Group B sterptocoocs ,E coli
In childen less than 5 years: viral followed by
bacteria like sterptococcus pneumonia .
Hemophilis and staphy aurues
3 years child came with fever and and tachepneia
30 per minutes , O2 saturatin is 92 %
, not known to have any medical condition
You should
A-Disharg e him on amoxicoin
V-Disharge him on augementin
C-Admit him for IV Cefitraxone
D-Admit him for IV fluid
3 years child came with fever and and tachepneia
30 per minutes , O2 saturatin is 92 %
, not known to have any medical condition
You should
A-Discharge him on amoxicoin
V-Discharge him on augementin
C-Admit him for IV Cefitraxone
D-Admit him for IV fluid
Most children with pneumonia can be managed
as an outpatients
Treatment of choice amoxicillin
Alternative if patients has non type 1
hypersensitivity reations (2nd or thrid generation
cephaosprin
Alternative if patients has type hypersnstitiy
reation: macrlide or clindamycin
In patients management indicated
Not tolerate oral antibiotic
Severe hypoxia less than 90 %
Severe tachypenia more than 50 per minutis in
infants and more than 70 per minutes per
minutes in children older than1 year
Toxic apperance
Patients with underlying medical conditions
Pnemonoa complicated by effusion or embymea
Children with cough, fatigue, 2 time bloody
vomiting, low grade fever, with dullness in
percussion dx?
A. parapneumonic effusion
B. pleural effusion
C. TB
D-Viral
Children with cough, fatigue, 2 time bloody
vomiting, low grade fever, with dullness in
percussion dx?
A. parapneumonic effusion
B. pleural effusion
C. TB
D-Viral
An infant came with oral thrush , he does not
look sick
Treatment
A-Oral antifungal
B-Topical antifungal
C-Systetic antifungal
An infant came with oral thrush , he does not
look sick
Treatment
A-Oral antifungal
B-Topical antifungal
C-Systetic antifungal
Topical antifungal as nystatin suspension is the
treatment if choice or oral Candidiasis
Systemic oral fluconazole used in
Infants with immnuocompromized
Infants with severe oseaphageal lesion a (more
than 50%)
Child c/o fever, bloody stool, and tenesmus,
abdominal exam showed abdominal distention,
A. Ascaris.
B. Amebiasis✅.
C. Giardiasis ( watry diarrhia )
D. Rotavirus
Child c/o fever, bloody stool, and tenesmus,
abdominal exam showed abdominal distention,
A. Ascaris.
B. Amebiasi.
C. Giardiasis ( watry diarrhia )
D. Rotavirus
Amebiasis
Cause blood diarrhea
Complicated by liver abscess
Diagnosis by stool antigen test or PCR for serum
and stool
Can distinguishe entameoba histolytic from other
ameba species like entameba dispar
Treatment of invasive intestinal aembiasis
Metronadzole and Tindiazole followed by
paramoycin to eliminate luminal cysts
Treatment for amebic liver absess is the same as
above and rareyl need aspitation or surgery
Child with chronic diarrhea and labs indicative of
macrocytic anemia asks which of the following is
important in past
giardiasis infection
Amebiasis
C-Rota
D-Salmonella
Child with chronic diarrhea and labs indicative of
macrocytic anemia asks which of the following is
important in past
giardiasis infection
Amebiasis
C-Rota
D-Salmonella
Giardiasis
Can cause
Watery diahrrea
Chronic diarhea
Malabpotion
Treatment
For patients above 3 years : tinidazole
Between 1 to 3 year Nitazoxanide
For chidren below 1 year meronidazole
Child aged 3 years old brought by his mother
with episodes of crying, fever, productive cough
and drooling of saliva. 1-2 weeks ago mother
reported that her child was complaining of
bilateral conjunctivitis. Which of the following is
the most causative organism?
A- Mycoplasmapneumonia
B- Adenovirus
C-Chlamydia
D-Infflunza
Child aged 3 years old brought by his mother
with episodes of crying, fever, productive cough
and drooling of saliva. 1-2 weeks ago mother
reported that her child was complaining of
bilateral conjunctivitis. Which of the following is
the most causative organism?
A- Mycoplasmapneumonia
B- Adenovirus
C-Chlamydia
D-Infflunza
Adenovirus cause
Conjucitivits: phayngioconjuctival fever
Upper airway : pertusis like
Pneumonia
Gastroenetritits
Hemorhagic cysitits
Child is treated for eczema with topical steroid,
comes to clinic with itching and pastular lesions
on top of his eczema, arrranged in grape like
pattern. What is the most likley organism that
causes his superimposed infection?
A-Herpes simplex
B-Staphylococcus aureus
C-Group A streptococcus
D-Nesseria
Child is treated for eczema with topical steroid,
comes to clinic with itching and pastular lesions
on top of his eczema, arrranged in grape like
pattern. What is the most likley organism that
causes his superimposed infection?
A-Herpes simplex
B-Staphylococcus aureus
C-Group A streptococcus
D-Nesseial
Eczema patients can get seconary seocnat
psultalr infection due to staphy aurues or other
bacteria
Staph can cause impetigo as well (honey crust
lesion)
Applications of muprocin tical is enoughb
BULLOUS IMPETIGO
NON BULLOS IMPETIGO
What is the safe for baby?
A. mother HIV and direct breast feeding
B. mother HIV with expressed breast milk
C. mother TB direct breast feed.
D. mother TB with expressed breast milk
What is the safe for baby?
A. mother HIV and direct breast feeding
B. mother HIV with expressed breast milk
C. mother TB direct breast feed.
D. mother TB with expressed breast milk
HIV patients should not breastfeed her children
and should give formula feeding
TB mother can express her breast milk but
should not give breast milk directly unless she is
treated for 2 weeks
Mumps complication in child ,?
A. Meningitis...
B. Enephalitis
C. Orchitis
D-Thyoriditis
Mumps complication in child ,?
A. Meningitis...
B. Enephalitis
C. Orchitis
D-Thyroditis
The most common comlication of mumps Orcitits
(15-30 % of post pubertal males and oophritis in 5
% of post pubertal females
CNS is the 2nd most common affected and usually
is mild
A 7-year-old boy presents to the pediatric clinic
complaining of painless swelling of the left knee joint
for the past three days. He reports that bright light
has also been bothering him lately. The synovial fluid
is found to be sterile, and a diagnosis of synovitis is
recorded. On physical exam, the child is noted to have
a saddle nose, peg-shaped upper central incisors, and
a maculopapular rash. Eye exam reveals interstitial
keratitis. It is noted during the exam that the child
has difficulty hearing:
A. Syphilis
B-Nesseria
C-Toxoplasmosis
D-Rubella
A 7-year-old boy presents to the pediatric clinic
complaining of painless swelling of the left knee joint
for the past three days. He reports that bright light
has also been bothering him lately. The synovial fluid
is found to be sterile, and a diagnosis of synovitis is
recorded.
On physical exam, the child is noted to have a saddle
nose, peg-shaped upper central incisors, and a
maculopapular rash. Eye exam reveals interstitial
keratitis. It is noted during the exam that the child
has difficulty hearing:
A. Syphilis
B-Nesseria
C-Toxoplasmosis
D-Rubella
SADDLE NOSE
PIG SHAPE INCISOR
child miss his vaccine for 4 and 6 months develop
eye proptosis with painful addiction?
A. orbital myositis
B. orbital cellulitis
C. Per orbital cellulitis
D- Eye candida
child miss his vaccine for 4 and 6 months develop
eye proptosis with painful addiction?
A. orbital myositis
B. orbital cellulitis
C. Per orbital cellulitis
D-Eye candida
12 month old boy with orbital celluitis
Most common cause
A-Sterpococcus milleri
B-Sterptococcus pygens
C-Group B sterptoccis
D-Hemopluis
D-Staphy aueus
12 month old boy with orbital celluitis
Most common cause
A-Sterpococcus milleri
B-Sterptococcus pygens
C-Group B sterptoccis
D-Hemopluis
D-Staphy aueus
Most common casue of orbital cellutits
Sterptococcal milleri
followed by stertpcoccal pyrogenes (group A0 and
staph aures
Orbital cellulites is dangerous
Can affect vision
Can extend and cause
Sinusitis
Meningitis
Cavernous sinus thrombosis
Epidural abscess or subdural embeyma
Treatment of orbital cellutits
Cefitraxone and vanomycin for 2-3 weeks
Might add metronidazole if we susect
intracranian extensiom
12 month baby on otoscope exam there’s no
mobility of TM, he is breast feeding,no fever, no
pacifier, it’s unilateral what will you give?
A. amoxicillin
B. amoxicillin-clav
C. refer to ENT for tympanic tube
D. ask him to come back again in 48 hours"
12 month baby on otoscope exam there’s no
mobility of TM, he is breast feeding,no fever, no
pacifier, it’s unilateral what will you give?
A. amoxicillin
B. amoxicillin-clav
C. refer to ENT for tympanic tube
D. ask him to come back again in 48 hours"
This is most likely ototis media with effusion
Needs observations only
If there is redness of tympanic membrane or
systemic symptoms then this likely bacterai
lotitis media
Common casue for otitis media
Bacteria
Streptococcus pneumonia
Hemophilus
Moraxella
Otitis media
Indications for antibiotic treatment
Any children less than 2 years
Children above 2 year with
Bilateral otitis media
High fever
Severe ear pain for 2 days
No good follow up
Known for craniofacail anomalies
Child presented with erythematous pharynx,
with cervical lymph nodes and rapid strplysin
test negative and low grade fever with positive
EBV . It next step ?
A. Give antibiotics and anti-pyretic
B. Give antipyretic and fluids
C. Do culture and sensitivity
D. Give Acyclovir
Child presented with erythematous pharynx,
with cervical lymph nodes and rapid strplysin
test negative and low grade fever with positive
EBV . It next step ?
A. Give antibiotics and anti-pyretic
B. Give antipyretic and fluids
C. Do culture and sensitivity
D. Give Acyclovir
EBV cause fever , hepatosplenomegally
(infectious mononucluesosi loke)
Rash usually increase by ampicillin
Upper air way obstruction
Meningitis
Alice in wonderland syndrome
Hemlyitc anemia , thombcytpenia
Management is supportive
Fluid and antypyrics
Steroid in:
Upper airway
CNS
Aplastic aemia
Liver failure
EBV associate aith number of malignancies like
Nasopharyngeal carcinoma
Hodgkin lymphoma
T cell lymphoma
Post transplant lymphoprolifertive disorder
● A child with gum bleeding, erythema papules
in mouth. Swab showed ( multinucleated giant
cell ) on Tzanck smear , Which organism ?
A. Coxsackie virus
B. Staphylococcus
C. EBV
D. Herpes simplex
● A child with gum bleeding, erythema papules
in mouth. Swab showed ( multinucleated giant
cell ) on Tzanck smear , Which organism ?
A. Coxsackie virus
B. Staphylococcus
C. EBV
D. Herpes simplex
Tznak smear is uausllay posive in
Herpes
Varicella
Pemphigus vulgaris
Cytomegalovirus
Good test for screening but not diagnostic
2 weeks old with conjunctivitis bilaterally , 2
weeks later chest x ray show lung interstitial
lung infiltration:
A. Chalymedia trancumnus
B. streptococcus
C-Adenivirsu
D-Pertussis
2 weeks old with conjunctivitis bilaterally , 2
weeks later chest x ray show lung interstitial
lung infiltration:
A. Chalymedia trancumnus
B. streptococcus
C-Adenivirsu
D-Pertussis
Chaymedia trachomatis
Usually case conjuctivits in 1st 2 weeks of life
Pneumonia at 3 month of likde (ususally mild
with low grade or absent fever and uusally cause
afebrile pneumonia
Treatment: Macrolide (eye drops and oral)
Child has PPD of 10 mm
A- negative
B- Postive
C- This test is not reliable anymore
D-Borderline
Child has PPD of 10 mm
A- negative
B- Postive
C- This test is not reliable anymore
D-Borderline
Pedia pt have tachypnea, runny nose,
cough,slightly elevated fever, audible wheezing
sound whats is the definitive diagnosis:
A-Chest X ray
B-Nasopharyngeal swab
C-Sputum culture
D-CBC
Pedia pt have tachypnea, runny nose,
cough,slightly elevated fever, audible wheezing
sound whats is the definitive diagnosis:
A-Chest X ray
B-Nasopharyngeal swab
C-Sputum culture
D-CBC
Respiratory synctial virus
Common cause for broncholotitis
Treatment
Hydration and oxygen
Child came with maculpapular rash and rash
disappeared after 3 days , large occipital lymph
node
A-Mumps
B-Measles
C-Kawaski
D-Rubella
Child came with maculpapular rash and rash
disappeared after 3 days , large occipital lymph
node
A-Mumps
B-Measles
C-Kawaski
D-Rubella
Child came with maculpapular rash and rash
disappeared after 3 days , large occipital lymph
node
A-Mumps
B-Measles
C-Kawaski
D-Rubella
Rubella
Days rash disease
3 typical lymph nodes (occiptal , post auricular ,
posterior cervical )
Teratogenic
Patient with JIA and on methotroxate ans
Adalimummab and develped serios infections
Best action
A-Stop Adalimumamb
B-Stop methotroxate
C-Stop both drugs and give antubiotic
D-Continue current treatment and give antibiotic
Patient with JIA and on methotroxate ans
Adalimummab and develped serios infections
Best action
A-Stop Adalimumamb
B-Stop methotroxate
C-Stop both drugs and give antibiotic
D-Continue current treatment and give antibiotic
According to British and American rehmatology
guidelines
If patients on DMARD and has serious infection
then you should stop DMARD and start antibiotic
A child came with fever and pahyngitis ,
lympandeopathy and develoed a rash after
amoxicin
A-EBV
B-Diphetria
C-Scarlet fever
D-Adenivrrus
A child came with fever and pahyngitis ,
lympandeopathy and develoed a rash after
amoxicin
A-EBV
B-Diphetria
C-Scarlet fever
D-Adenivrrus
Rash after using beta lactam in patient with
pharyngitis is typical in EBV
This rash is related to virus immune mediation
and not hypersensitivity reaction
So patient take beta lactam safely
Definition of fever of unknown origins
A-8 days
B-14 days
C-21 dyas
D-28 days
Definition of fever of unknown origins
A-8 days
B-14 days
C-21 dyas
D-28 days
Fever of unknown origin : fever 38..3 lasting 8
days in whom no diagnosis after initial
outpatient or inpatient assessment including
history and physical examination and basic
laboratory test
Causes if fever of unknown origin
1-Infectios
2-Connective tissue disease
3-Maligancy
4-Drugs
5-Central
6-factitious
A child with vesicular lesion in chest and upper
trucnk
Which antibody will be positive
A-VZV IgM
B-HSV1 IgM
C-HSV 2 IgM
D-HIV IgM
A child with vesicular lesion in chest and upper
trucnk
Which antibody will be positive
A-VZV IgM
B-HSV1 IgM
C-HSV 2 IgM
D-HIV IgM
Varicella: vesicular lesion in the face , upper
trucnk
Herpes virus type 1: vesicular lesion in the
mouth
Herpes virus Type 2: genilial herpes or neonatal
infection
A child with rashin the hand and mouth. What
you would expect in examination
A-Spots on the foot
B-Lymph node
C-Scratch mark
A child with rashin the hand and mouth. What
you would expect in examination
A-Spots on the foot
B-Lymph node
C-Scratch mark
12 years and wants to go for hajj, He is not
vaccinated
Patents asked for nesseria prophylaxis
A-Oral azithromycin for 2 doses
B-Oral Ciprofluxaocilin for 2 doses
C-IM Cefitraxone for 3 dises
12 years and wants to go for hajj, He is not
vaccinated
Patents asked for nesseria prophylaxis
A-Oral azithromycin for 2 doses
B-Oral Ciprofluxaocilin for 2 doses
C-IM Cefitraxone for 3 dises
Agents for neseearia Prophylaxis
Oral Rifampicin for 4 doses (best(
Oral ciprofluxacilin single dose
IM cefitraone for single dose
A child came with symptoms of acute sinusitis
and found to have hemopluis infiunzza
Treatment
A-Supportive
B-Steroid and decogenstant
C-Antibiotic
A child came with symptoms of acute sinusitis
and found to have hemopluis infiunzza
Treatment
A-Supportive
B-Steroid and decogenstant
C-Antibiotic
Acute bacterial sinusitis
Causes
Sterptococcus pneumiia
Hemophilus infunza
Moraxella catahrails
Risk factors
Viral URTI (most common)
Anatomical obstruction (nasal polyps)
Change in the weather
Mucosal irritants (loe tobacco)
Treatment : Amoxixilin and clauvaenic acid for 1
days Plus normal saline nasal drops
Nasal steroid and antihistamine only in if there
is allergic rhinitis
A child diagnosed with impetigo. When he should
retuned to school
A-Immediately
B-After 3 days of antibiotic
C-After 1 week of antibtiotic
D-After 2 weeks of antibiotic
A child diagnosed with impetigo. When he should
retuned to school
A-Immediately
B-After 3 days of antibiotic
C-After 1 week of antibtiotic
D-After 2 weeks of antibiotic
Impetigo
Caused by Group A streptococcus and staphy
aiures
Treatment : toical antibiotic like fuscidin
Children can return to school after 1-2 dyas of
starting treatment
