A 10-year-old is referred to you for evaluation of hypertension. He has a history of recurrent urinary tract infections.
Which one of the following is the most likely diagnosis?
Correct Answer A:
Vesicoureteral reflux (VUR) is a cause of recurrent urinary tract infections in children. VUR predisposes children to recurrent pyelonephritis and renal scarring. Some children with renal scarring develop hypertension and renal insufficiency. Recommendations have been made to identify VUR early to stop this cascade of events, with interventions to prevent renal scarring, hypertension, and renal insufficiency.
Which one of the following is the most appropriate screening test for vesicoureteral reflux in the initial evaluation of a child with a urinary tract infection?
Correct Answer C:
The most significant anomaly associated with urinary tract infections (UTIs) in children is vesicoureteral reflux, which occurs in 30%-50% of children with UTIs. When screening a child for reflux, the initial test should be voiding cystourethrography. Although renal ultrasonography is less invasive, findings are normal in 50%-75% of patients with reflux. A DMSA renal flow scan is the best study for detecting renal scarring, but will not detect reflux in children who have not yet developed scarring. Nuclear cystography is as sensitive for detecting reflux as a standard VCUG, but grading of reflux is less precise and this test will not detect associated bladder abnormalities.
A 5-year-old girl complains of a sore throat and fever for 2 weeks. There is cervical adenopathy and a sand paper like rash on physical exam. A diagnosis of Scarlet fever is made.
What investigation will be most useful in differentiating this from a viral etiology?
Scarlet fever is an illness that brings on a rash covering most of the body, a strawberry-like appearance of the tongue and usually a high fever. The most common source of scarlet fever is one form of a common bacterial infection known as strep throat.
Common symptoms are: Red rash that looks like a sunburn and feels like sandpaper. Strawberry-like red and bumpy appearance of the tongue. Fever of 101 degrees Fahrenheit or higher, often with chills. Very sore and red throat, sometimes with white or yellowish patches. Enlarged glands in the neck (lymph nodes) that are tender.
A bacterium called Streptococcus pyogenes, or group A beta-hemolytic streptococcus causes scarlet fever. Throat culture remains the criterion standard for confirmation of group A streptococcal upper respiratory infection.
Streptococcal antibody tests are used to confirm previous group A streptococcal infection. The most commonly available streptococcal antibody test is the antistreptolysin O test (ASO). Currently, streptococcal antibody tests are not indicated during acute illness.
Possible complications include rheumatic fever, and poststreptococcal glomerulonephritis. Treatment is with antibiotics such as penicillin and amoxicillin.
A child has developed a scaling yellowish rash over scalp and face. See picture:
What is the most likely diagnosis?
Seborrhoeic dermatitis (choice C) primarily affects the scalp and intertriginous areas. It is most common in the first 6 weeks of life, but can occur in children up to 12 months of age. Involvement of the scalp is frequently termed "cradle cap", and manifests as greasy, yellow plaques on the scalp. Other commonly affected areas include the forehead and eyebrows (as in the photo), nasolabial folds, and external ears. Involvement of skin creases, such as the nappy area, can lead to secondary Candidal infection and maceration. The etiology is unknown. Treatment includes the use of a mild tar shampoo, oatmeal baths, and avoidance of soaps. Occasionally, a mild topical steroid may be indicated.
→ Atopic dermatitis, eczema (choice A and choice D) occurs in the first year of life in 60% of cases. The infantile stage may present with pruritic, red, scaly, and crusted lesions on the extensor surfaces and cheeks or scalp. There is usually sparing of the diaper area. Acute lesions can include vesicles, and there can be serous exudates and crusting in severe cases.
→ Psoriasis (choice B) is characterized by scaling erythematous macules, papules, and plaques. Typically, the macules are seen first, and these progress to maculopapules and ultimately well-demarcated, noncoherent, silvery plaques overlying a glossy homogeneous erythema.
→ Tinea versicolor (choice E) is a common, benign, superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and the back.
A 2-month-old baby presents with an erythematous, scaling, crusting eruption of the scalp, face and diaper area. It is greasy yellow in appearance.
Seborrheic dermatitis is managed using all of the following, except:
Correct Answer E:
Seborrhoeic dermatitis primarily affects the scalp and intertriginous areas. It is most common in the first 6 weeks of life, but can occur in children up to 12 months of age. Involvement of the scalp is frequently termed "cradle cap", and manifests as greasy, yellow plaques on the scalp. Other commonly affected areas include the forehead and eyebrows, nasolabial folds, and external ears. Involvement of skin creases, such as the nappy area, can lead to secondary Candidal infection and maceration.
Although this condition usually resolves without treatment, it may require treatment in some cases.
Suggestions for treatment include:
Click to expand