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

 B.EBV

 C.Herpes

 Influnza
 Child presented with ulcers on mouth and
gingiva erythematous based and pale in the
center.
 A. Coxaci

 B.EBV

 C.Herpes

 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

 B.ampicillin + gentamicin

 C-cefitraxone

 D-Ciprofluxoacilin
 Neonatal lumbar puncture + diplococci
Management
 A-Marolide

 B.ampicillin + 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?
 A.Ceftriaxone and vancomycin and steroids
B.ceftriaxone 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?
 A.Ceftriaxone and vancomycin and steroids
B.ceftriaxone 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
 A.Coronavirus

 B.CMV

 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
 A.Coronavirus

 B.CMV

 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