MUST KNOW FACTS ABOUT PEDIATRIC INFECTIONS FOR YOUR USMLE / FMGE EXAM PREPARATIONS

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MUST KNOW FACTS ABOUT PEDIATRIC INFECTIONS FOR YOUR USMLE / FMGE EXAM PREPARATIONS

1) Streptococcus pharyngitis can lead to both RHEUMATIC FEVER and GLOMERULONEPHRITIS but streptococcal skin infection only leads to must know facts in pediatric infectionsGLOMERULONEPHRITIS not rheumatic fever.

2) Pharyngitis leads to rheumatic/glomerulonephritis after 2-3 weeks of primary infection but after skin infection; glomerulonephritis happens after 3-6 weeks

3) In rheumatic fever; if JOINTS are involved = heart will be minimally involved but if heart is involved Chorea would be there……….. remember: C=C (Carditis = chorea)…… but A not = C…. means arthritis not with chorea………. and remember: RHEUMATIC FEVER LICKS THE JOINTS; BUT BITES THE HEART….. so carditis is severe but arthritis is not severe……… in severe carditis = subcutaneous nodules would be there (on extensors , scapula and mastoid)

4) Signs of chorea (favorite question of Prof.Tariq Bhatti)…. i) Milkmaid sign ii) Pronator drift iii) Darting tongue

5) Chorea = Rapid, jerky, involuntary purposless movement of proximal limbs…Treated by Haloperidol Athetosis = Slow, writhing movements of distal limbs 6) In acute rheumatic fever = MITRAL REGURGITATION and AORTIC REGURGITATION……… MR = pansystolic murmur AR = early diastolic murmur…….. but sometimes due to EDEMA/Nodules of mitral valve; there happens functional mitral stenosis which gives MID-DIASTOLIC MURMUR known as CAREY COOMB MURMUR

7) Primary prophylaxis = Treatment of sore-throat by Benzathiane penicillin 2ndry prophylaxis = Prevent recurrence by continous prophylaxis

8) Acute diarrhea : < 2 weeks Persistant diarrhea: > 2 weeks (infectious) Chronic diarrhea: > 2weeks (Non-infectious)



9) Common causes of ACUTE BLOODY DIARRHEA in children = Food poisoning, Bacillary dysentry, Amebic dysentry….

10) Bacillary dysentry caused by shigella; Acute onset; Frequent stools; blood mixed with mucus; Very very very high fever (104) leading to dehydration and fits and CNS signs; pus cells in stools; confirmed by isolating organism on stool culture……Rx: Ampicillin, TMP-SMX; cipro = 5 days + FLUID AND ORS

11) Amebic dysentry caused by E.histolytica; Subacute onset; Less and small frequent stools; Just blood in feces; Fever may or may not be; Mobile trophozites in stools; detect organism in stool culture also ELISA and IHA…………..Rx: Metronidazole in 3 divided doses

12) As Shigella gives high grade fever ….leading to marked dehydration and CNS signs including fits and meningitis and TOXIC ENCEPHLOPATHY known as EKIRI SYNDROME. Eg: scenario could be: A child comes with generalized tonic clonic fits…… high grade fever….. h/o blood and mucus in stools…….. Dx: It is SHIGELLA /BACILARY DYSENTRY;……………………. never chose here amebic dysentry…

13) Most common cause of non-bloody diarrhea in chlidren is ROTAVIRUS…………. other include: Cholera; Giardia…

14) Rotavirus leads to shedding of mucosal cells causing deficiency of dissaharides leading to LACTOSE INTOLERANCE= OSMOTIC DIARRHEA.. 15) Diarrhea may be Osmotic or Secretoy…..

16) Osmotic diarrhea is more common; it stops when patient stops taking food; Calculated osmolarity of stools is > observed osmolarity….. Example include Rotavirus, lactose intolerance… acidic pH of stool

17) Secretory diarrhea is less common than osmotic; it does not stops when patient stops taking food ; calculated osmolarity of stools = observed osmolarity….example include CHOLERA..



18) Evaluate degree of dehydration by 6 signs (4 star signs and 2 non-star signs) Star signs: Consicous level, Skin pinch, Sunken-ness of eyes, Drinking ability Non-star: Eye dryness, Tongue dryness If any ONE star sign is positive = categorize dehydration by that sign………. For example if skin pinch goes back very slowly >2sec = SEVERE DEHYDRATION.

19) Example: A child with diarrhea…… Sunken eyes, and skin pinch goes back very slowely….. How will u classify this dehydration?? SEVERE DEHYDRATION…..

20) Follow PLAN C for severe dehydration…..<1 year = slowly rehydrate (5 hours)……….. >1 year = rapidly rehydrate (3 hours)

21) As ORS contains 20g glucose and 3.5 g NaCl……… it can itself cause OSMOTIC DIARRHEA…………… so to prevent its this side effect a new formulation is there = LOW OSMOLARITY O.R.S …………contains 13g Glucose and 2.7 gram NaCl 

22) Zinc is very important in treatment of DIARRHEA…………IMPORTANT: ZINC DEFICIENCY LEADS TO ACRODERMATITIS ENTEROPATHICA

23) Mumps causes painful enlargment of parotid glands; redness and swelling of stenson ducts; causes edema of soft palate, larynx and even UPPER CHEST…… Dx by Lymphocytosis, Inc . Amylase, IgM and IgG…. Complications include MENINGIOENCEPHLITIS, EPIDIDYMO-ORCHITIS, PANCREATITIS, DEAFNESS….. Meningitis can occur along with parotitis or after 10 days of parotitis…. ORCHITIS is seen in POST-PUBERTAL MALES not pre-pubertal……………….. If mumps to fetus in intra-uterine life = leads to SUBENDOCARDIAL FIBROELASTOSIS

24) In measels …. i) Prodromal phase = 3C( Cough, croyza, conjunctivitis) Koplik spots. ii) Eruptive phase: Maculopapular confluent rash from ear downwards, Complications: Giant cell pneumonia, otitis media, diarrhea, encephlitis, SSPE, Hemorrhagic meseals, Thrombocytopenia, Cancrum oris, Corneal ulcer, Myocarditis., VITAMIN A DEFICENCY

25) As measels lead to VITAMIN A DEFICENCY = So give vitamin A to MUST KNOW FACTS IN PEDIATRICSkmeasel patient to decrease morbidity and mortality

26) When rash of measels appear = fever rises abruptly, rash desends rapidly within 2-3 days and fades rapidly in same sequence as it appeared….. and severity of rash depends upon CONFLUCENCE OF RASH….rash is itching…… if severe measels = DISFIGURED AND SWOLLEN FACE…..

27) Measels vaccine given SUB.CUTANEOUSLY…………Contraindications: ANaphylactic reaction to NEOMYCIN/ GELATIN; Immunodeficency…………… S/E: Morbiliform rash, febrile fits, encephlitis

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28) Polio can occur as i) Asymptomatic (95%) ii) Abortive (febrile, sore throat) iii) Non-paralytic ASEPTIC MENINGITIS… iv) Paralytic (Assymetric paralysis)…. Spinal , bulbur, Encephlitic Confirmatory test for POLIO = STOOL CULTURE… 2 sample ; 24 hour apart….

29) A 3 year old unvaccinated child with febrile illness and lower motor neuron signs of lower limbs…………..D/D………………..gullian barrie, Paralytic polio….

30) An unvaccinated child with meningitis = D/D = Tuberculous meningitis ; Nonparalytic polio, H.Influenza

31) Infectious diseases especially ROSEOLA INFANTUM can lead to FEBRILE FITS……….

32) Febrile fits = Seizure +fever + No CNS infection

33) Febrile fits may be TYPICAL or ATYPICAL…sometimes family history is MUST KNOW FACTS IN PEDIATRICSpositive

34) Typical: >12 months of age; generalized tonic clonic; <10 mins; Brief/no postictal period; once/24 hours; no focal findings; normal CSF exam

35) Atypical: <12 months of age; focal seizure; >10 mins; Prolonged post-ictal; >1/24 hours; focal findings may be there….




36) Atypical febrile fits can transform into EPILEPSY in later life….the other risk factors for epilepsy in a patient with febrile fits include…………… i) Some neurological disease (cerebral palsy, mental retardation)….. ii) Family history of epilepsy… iii) <1 year seizure

37) When to do L.P in a patient of febrile fits? ATYPICAL febrile fits.. or IF SLOW RECOVERY, PUO, FOLLLOW UP NOT POSSIBLE…..

38) Mangemtn of febrile fits………… ABC, Tempreature regulation, seizure control by diazepam, cause of fever, …….

39) Childhood exanthems…. i) 1st disease = measels (rubeola) ii) 2nd disease = Scarlet fever iii) 3rd disease = Rubella (germen measels) iv) 5th disease = Erythema infectiousm (parvoB19) = Slapped cheek rash v) 6th disease = Roseola infantum……Leads to febrile fits

40) A child with fever, hoarsness, barking cough = LARYNGOTRACHEOBRONCHITIS/CRUOP…….. caused by PARAINFLUENZA VIRUS….

41) <2 years child with WHEEZE, DYSPNEA, COUGH = Bronchiolitis= most common cause RESPIRATORY SYNCYTIAL VIRUS ………other ADENOVIRUS, PARAINFLUENZa

42) There are just 2 contraindications of PERTUSSIS VACCINE: i) Anaphylactic reaction to previous dose of vaccine ii) Encephlopathy within 7 days of previous dose manifesting as gen/focal seizure without recovery within 24 hours…………………..NOte : FAMILY history of any thing is not contraindication...

MUST KNOW FACTS ABOUT PEDIATRIC INFECTIONS FOR YOUR USMLE / FMGE EXAM PREPARATIONS

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