Mehl. UW bullet 5, viral 04-01 (1) Flashcards
Rubella, measles (rubeola), mumps, molluscum, VZV, perinatal HBV, HSV encephalitis
Mehl. Neonate + patent ductus arteriosus +/- deafness +/- cataracts; Dx?
Congenital rubella syndrome.
UW. 10month girl + low-grade fever for the past 3 days. A rash developed on her face 2 days ago and has since spread to her chest, abdomen, and extremities. The patient has had no cough, rhinorrhea, nasal congestion, vomiting, or diarrhea. She has otherwise been healthy. Received all routine, age-appropriate vaccinations and takes no medications. Temp. 38, BP 100/50, pulse 88, RR 18. Physical examination shows a playful infant with small, tender lymph nodes in the suboccipital, posterior auricular, and posterior cervical areas. There is patchy erythema on the soft palate. The rash is shown in the image below. A similar-appearing rash is present on the face. The remainder. Of the examination is normal. Dx?
RUBELLA
Mehl. 4F + maculopapular body rash + fever + white spots visualized on buccal mucosa, Dx?
rubeola (measles).
Mehl. 4F + maculopapular body rash + fever + suboccipital and/or post-auricular lymphadenopathy; Dx?
German measles (rubella).
UW. An 11-month-old girl + rash developed on the patient’s face yesterday and has now spread over her entire body. The parents say that she has been sick for the past 3 days with fever, cough, runny nose, and “pink eye.” The patient has no other medical conditions and has received all age-appropriate vaccinations as of age 6 months. Approximately 3 weeks ago, the family returned from a trip to Yemen for her grandfather’s funeral. Temp. 39.6 C. Other vital signs are normal for age. The patient appears tired and irritable with dry mucous membranes. The conjunctivae are injected without discharge. There is a blanching, erythematous, maculopapular rash covering the face and entire body except for the palms and soles. Which of the following is most effective in preventing nosocomial transmission in the care of this patient?
AIRBORNE PRECAUTIONS (zymejo 35 proc.)
neteisingas - droplet precautions (zymejo 53 proc.)
UW. 2-year-old boy is brought to the clinic by his parents due to fever and rash for 6 days and difficulty breathing for the past day. The rash began on the patient’s face and spread to his trunk and extremities. Prior to the onset of rash, he had a cough, tearing of eyes, a runny nose, and nasal congestion. The child has had no vaccinations. Temo. 39.5, RR 44/min. Tired-appearing boy with a diffuse, erythematous, maculopapular rash all over the body except the palms and soles. Auscultation of the chest reveals bilateral crackles. The remainder of the examination is unremarkable. The child is admitted to the hospital. Which of the following reduces morbidity and mortality in the patient’s most likely condition?
VITAMIN A.
Mehl. 4M + swollen lower face bilaterally + irritable + stiff neck; Dx?
mumps; POM = Parotitis, Orchitis, Meningitis; rash not classically associated.
UW. 17y/o boy + fever and facial pain. Two days ago, fever, myalgias, and fatigue began. This morning, pain and fullness developed in the right cheek. The patient has no chronic medical conditions and takes no daily medications. Immunizations are not up to date, but the family cannot remember which ones were missed. The patient is in high school and is on the school track team. He has a girlfriend but is not sexually active. Temp 38.3 C. Examination reveals an alert, uncomfortable-appearing adolescent. Tenderness and fullness are present in the right cheek, which obscures the angle of the mandible. Bilateral tympanic membranes are clear. The oropharynx has no erythema, exudate, or tonsillar enlargement. No cervical lymph nodes are palpable. This patient is at greatest risk for developing which of the following complications?
ORCHITIS
Mehl. 6F + attended summer camp for one month + comes home with peach-colored papules with central umbilication; Dx?
molluscum contagiosum
UW. 5-year-old boy is brought to the office for evaluation of multiple new growths on the face, as shown in the image (tipinis molluscum). The patient can open and close his eyes without pain or difficulty. Examination shows no other abnormalities. BEST MX IN KID?
OBSERVE AND PROVIDE REASSURANCE
UW. 5 y/o boy + recent exposure to chickenpox from other child from his class. His last exposure to the child was 7 days ago. The patient has had no fever, sore throat, or rash. He has no medical conditions and has not had chickenpox in the past. The patient has received no vaccinations due to parental preference. BEST NEXT STEP?
No postexposure prophylaxis indicated but recommend varicella vaccination
immunocompetent + more than 5 days past = no need to give vaccine, but still needs to recommend to prevent future infections
UW. Neonate is evaluated in the nursery an hour after vaginal delivery. The mother developed a fever 2 days ago and a vesicular rash on her face and chest yesterday. On the day of delivery, the rash spread to her abdomen and became intensely pruritic. She went into labor later that day and delivered the neonate without difficulty. Skin-to-skin contact between the mother and neonate was deferred due to the maternal rash. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The patient weighs 2.95 kg (6 lb 8 oz). Vital signs and physical examination are normal. The mother does not recall having similar symptoms previously. Which of the following is the most appropriate management of this neonate?
Administer varicella immune globulin
Postexposure prophylaxis (PEP) is recommended for neonates born to a mother with VZV infection from 5 days before to 2 days after delivery.
Mehl. 6M + crops of vesicles on the trunk at different stages of healing; Dx?
varicella (VZV) -> presumably not previously vaccinated; know this description.
UW .A 6-hour-old boy is being evaluated in the nursery. Born 39 w + vaginal delivery. The pregnancy was complicated by IV drug use, and the mother was incarcerated for 2 months during the second trimester. First trimester serologies, including RPR, HIV antibodies, and hepatitis B surface antigen (HBsAg), were negative. Due to the mother’s risk profile, follow-up testing was obtained during the third trimester and revealed the following:
HBsAg Positive
Anti-HBsAg Negative
IgM Anti-HBcAg Negative
Anti-HBcAg Positive
Liver function testing was normal. Hepatitis C and repeat HIV testing were negative. The remainder of the pregnancy was uncomplicated. The infant weighs 3.7 kg (8 lb 3 oz). Physical examination of the infant is normal. There is no jaundice or hepatomegaly. BEST NEXT STEP IN MX?
GIVE HEPATITIS B IMMUNE GLOBULIN AND VACCINE
alone - not effective any of them, neet to give both.
UW. 18 y/o + generalized tonic-clonic seizure. He developed full body jerking at home this morning, which lasted approximately 1 minute. The episode occurred just before the patient was about to visit the clinic for evaluation of a worsening headache for the past 2 days. His parents say that he has also seemed clumsy over the same period, including tripping a few times yesterday. He has no history of seizures and was previously healthy except for seasonal allergies managed with over-the-counter medications. Temp. 38.9 C, BP 130/80, pulse 92/min. The patient is awake but oriented only to person. Pupillary examination is unremarkable. The patient has bilateral hyperreflexia in the upper and lower extremities. MRI of the brain is shown below. What Dx?
HERPES SIMPLEX VIRUS ENCEPHALITIS
