doc

 

You just finished a slow Peds shift during which you saw a whopping 3 patients – viral syndrome, viral syndrome, ibuprofen, PO challenge, and discharge. You feel a little underwhelmed. As you leave the hospital, you decide to call an Uber. A disheveled guy with white hair comes to pick you up in a DeLorean. Instead of taking you home, he takes you back to the future! In this future, the anti-vaxers have taken over the world, and no one vaccinates their children anymore. Autism rates haven’t changed, but your peds shifts in this future are about to become a lot more interesting…

 

Dad brings in a 7 month-old girl for multiple episodes of watery diarrhea daily for the past week, and it hasn’t been getting better. She also had a few episodes of vomiting, but there is no blood in the stool. Dad states child has been healthy and developing normally. She goes to daycare where other children have had similar symptoms. She is febrile to 101 F with dry mucus membranes. What is the most likely diagnosis?

Rotavirus

  • Major cause of infantile gastroenteritis
  • Characterized by profuse, watery diarrhea
  • Treatment: Supportive; make sure patient is well hydrated

 

10 year-old boy presents with a sore throat and fever for 1 week. It has been becoming progressively worse. He has had difficulty tolerating solids and now even liquids are hard to swallow. Upon physical exam, you notice generalized soft tissue swelling around the neck and throat. You also note a greyish membrane forming around the posterior pharyngeal wall and tonsils. What is this infectious disease?

Diphtheria

  • Characterized by pseudomembrane formation in the back of the throat

diptheria

  • Pseudomembrane is made up of dead cells, fibrin, and organisms; its formation can cause difficulty breathing or swallowing
  • Treatment: Antibiotics (penicillin or erythromycin) and antitoxin

 

5 year-old boy presents with fevers, chills, cough, and rash. His parents initially thought he just had the cold. They noticed his eyes seem red but figured it was part of the cold. They became worried when they noticed the rash appear on his face, inside his mouth, and then spread inferiorly to his trunk. His fever has not broken, and it has been about 6-7 days since the onset of symptoms. Diagnosis?

Measles: 4 “Co’s” of measles

  • Cough
  • Coryza
  • Conjunctivitis
  • Coplik spots (Koplik’s spots): Red spots with bluish centers on the buccal mucosa

koplik

  • Rash: presents last and usually spreads from head to toe

measlesrash

  • Treatment: Supportive

 

8 year-old boy presents with 3 days of low grade fever and headache. He complains of pain in his right ear. Mom says the right side of his face looks swollen. Diagnosis?

 

Mumps: Mumps make you swell like a POM-POM

  • Parotitis: Unilateral swelling of parotid gland; can make it painful to masticate

mumps

  • Orchitis: Watch out, this can cause infertility in males; swelling of the testicles usually occurs after fever breaks (around 1 week)
  • Meningitis: Aseptic
  • Treatment: Supportive

 

15 year-old girl presents with generalized “feeling unwell.” She has been experiencing fever for the past 2-3 days along with muscle aches and joint aches. Over the last day, she noted a fine rash on her face that has spread to her trunk. There is no mucosal involvement. Upon exam, you note enlarged cervical chain lymph nodes.

Rubella: AKA German measles

  • Milder than measles; shorter duration
  • Forchheimer spots: Small red lesions on soft palate that usually precede skin rash
  • Rash also spreads from head to toe, very similar to measles but usually described as more erythematous than measles

rash_of_rubella

  • Treatment: Supportive

 

References:
Chen,S. Measles. Medscape. http://emedicine.medscape.com/article/966220-overview
Dyne, P. Pediatric Rubella in the Emergency Room. Medscape.  http://emedicine.medscape.com/article/802617-overview
Lo,B. Diphtheria. Medscape. http://emedicine.medscape.com/article/782051-overview
Nguyen, D. Rotavirus. Medscape. http://emedicine.medscape.com/article/803885-overview

 

Remember, what we do in practice may not always be the right answer on the exam. Frustrating, I know, but at least you’re vaccinated against polio.

 

 

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Karen

EM Resident PGYII

Karen

EM Resident PGYII

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