Question

Please Write Succinct: fever with rash on five year old child

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Exa
• Five Differential Diagnosis

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

Ans. Fever with rash on 5 year old child

Associated symptoms: chills, shivering, headache, loss of appetite, muscle aches, chance of febrile seizures, general weakness, dehydration, nausea, vomiting, rashes may develop into blisters or bumps,itching, irritability.

Risk factors: Viral infections like cold, flu chicken pox, bacterial infections like pneumonia, ear or sinus infections, respiratory or gastronintestinal infections kawaski disease, slapped cheek syndrome, trave, sick contacts.

Red flags: New onset of headache with or without any neurological symptoms, seizures, abdominal pain, sore throat, cough, chest pain.

Physical Examination: Meningococcemia- signs of shock, headache, mylagias. Erythema infectiosum- fever, rhinorrhea, vomiting and diarrhoea, lacey reticular rash. Varicella zooster virus- encephalitis, pneumonitis, bacterial superinfection. Rocky mountain spotted fever- tick borne, rashes spread from ankles to trunk.

Differential diagnosis: Roseola, erythema infectiosum, scarlet fever, pruritis sometimes occur with atopic dermatitis, pityriasis rosea, molluscum contagiosum and tinea infection, eczema herpeticum, viral exanthema.