USMLE Forum Archives - USMLE Step 2 CK - Peds 18
Peds 18
TheOne - 06-25-07 15:28
A 2 years old boy is brought to the emergency department by his grandmother because of a high fever for 4 days. Despite repeated use of acetaminophen and ibuprofen syrup, she has not been able to get his body temperature below 39 C (102.2 F). That morning the fever had finally broken, but he developed a rash that is getting worse with every passing hour. The grandmother states that he is otherwise in good health and has no medical problems. He goes to day care regularly since he was 18 months old and has only had the usual colds and sore throats on occasion. On physical examination, the child is quiet but playful and in no distress. His body temperature is 37 C (98.6 F) and the vital signs are within normal limits. There is moderate enlargement of the tonsils with no visible exudate and a moderate cervical lymphadenopathy. On his neck, trunk, and buttocks numerous discrete, morbilliform, erythematous macules are noted. The skin turgor is normal. Which of the following is the most appropriate next step in the management?
A. Administer intravenous rehydration
B. Administer oral acyclovir
C. Administer oral ampicillin
D. Keep him for overnight observation in the emergency room
E. Provide reassurance
TheOne - 06-25-07 15:28
A 2 years old boy is brought to the emergency department by his grandmother because of a high fever for 4 days. Despite repeated use of acetaminophen and ibuprofen syrup, she has not been able to get his body temperature below 39 C (102.2 F). That morning the fever had finally broken, but he developed a rash that is getting worse with every passing hour. The grandmother states that he is otherwise in good health and has no medical problems. He goes to day care regularly since he was 18 months old and has only had the usual colds and sore throats on occasion. On physical examination, the child is quiet but playful and in no distress. His body temperature is 37 C (98.6 F) and the vital signs are within normal limits. There is moderate enlargement of the tonsils with no visible exudate and a moderate cervical lymphadenopathy. On his neck, trunk, and buttocks numerous discrete, morbilliform, erythematous macules are noted. The skin turgor is normal. Which of the following is the most appropriate next step in the management?
A. Administer intravenous rehydration
B. Administer oral acyclovir
C. Administer oral ampicillin
D. Keep him for overnight observation in the emergency room
E. Provide reassurance
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#2
Re: Peds 18 jwang - 06-26-07 02:14 Sounds like the kid has Roseola. The rash will go away on its own in a day or so. Because the fever broke and he appears otherwise healthy I'd provide reassurance and tell the parents that if the rash doesn't go away within 3 days or if he develops other symptoms then to call the pediatrician or bring him to the emergency room. So I'd pick E.
#3
Re: Peds 18
TheOne - 07-08-07 15:31 The correct answer is E. This is the typical clinical picture of exanthema subitum (roseola infantum) caused by human herpesvirus type 6. Roseola infantum is a common cause of sudden, unexplained high fever in children between 6 and 36 months of age. A prodrome of high fever usually lasts for 72 to 96 hours and may be accompanied by convulsions and lymphadenopathy. On about the fourth day, the fever abruptly drops and rose-colored discrete macules appear most commonly on the neck, trunk, buttocks, and Mucous membranes are typically spared. Complete resolution of the rash occurs in 1 to 2 days. Typical cases are mild and without complications, so reassurance is all that is needed at the time of diagnosis. The child should be adequately hydrated and may resume normal activities as soon as the rash subsides.
Intravenous rehydration (choice A) would be indicated if the child were dehydrated. The examination of our patient revealed normal mucous membranes and skin turgor. In addition, vital signs were within normal limits. These findings point against the need for intensive rehydration. Oral acyclovir (choice B) is an antiviral agent used in the treatment of primary and recurrent herpes simplex and in herpes zoster. It is not indicated for the treatment of roseola infantum. Oral ampicillin (choice C) is not indicated because this is not a bacterial infection nor is there signs of bacterial superinfection.
#4
Re: Peds 18 bingousmle - 06-20-10 08:24 fever giving way to a rash that is present on neck, trunk, and buttocks and has numerous discrete, morbilliform, erythematous macules...reassure
#5
Re: Peds 18 babbu5508 - 06-20-10 13:48 E. Provide reassurance..On his neck, trunk, and buttocks numerous discrete, morbilliform, erythematous macules are noted. The skin turgor is normal.
#7
Re: Peds 18 babbu5508 - 06-21-10 14:18 Morbilliform rash, or "measles-like" maculopapular skin eruption, is commonly caused by certain drug reactions or viral diseases.
#9
Re: Peds 18 bingousmle - 06-30-10 17:46 the child has roseola which has a similar appearance like rubeolla.. in rubella there will be post auricular lymphadenopathy.. since the child has none of these its best to reassure
#10
Re: Peds 18 babbu5508 - 07-10-10 03:39 two common strains of herpes viruses cause roseola. The condition typically causes several days of fever, followed by a rash....
#11
Re: Peds 18 bingousmle - 07-15-10 01:36 roseola infantum is caused by human herpesvirus type 6 and it is a cause of high fever in children between 6 and 36 months of age
#12
Re: Peds 18 ktkmelody - 07-21-10 01:47 The answer is E. It is roseola infantum caused by Herpes virus 6. It is commom in children
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