Topic
Review Topic
0
0
Questions
1
0
0
Evidence
1
0
0
Snapshot
  • A 6-month old boy born at full term to a 26-year-old mother is brought to the emergency room for high fevers and seizure lasting less than 1 minute. The mother reports that he has been healthy without any medical problems and has met all 6-month milestones. Two days ago, he began having high fevers and some irritability, and today, he had a seizure. He was admitted for infectious workup. The next day, his fever resolved and he developed a morbilliform blanching rash on his trunk.
Introduction
  • Classification
    • human herpesvirus-6 (HHV-6)
      • an enveloped, linear, double-stranded DNA virus
      • transmission via respiratory secretions
      • causes roseola infantum (exanthem subitum)
  • Epidemiology
    • demographics
      • infants > children > adults
    • location
      • skin
    • risk factors
      • immunosuppression
      • transplant recipients
  • Pathogenesis
    • the virus replicates in salivary glands
    • the virus is latent in lymphocytes and monocytes
    • may contribute to tumor progression in Kaposi sarcoma and lymphoma
  • Associated conditions
    • may be associated with human herpesvirus-7
  • Prevention
    • no vaccines are available
  • Prognosis
    • does not commonly recur
    • disease is self-limited
Presentation
  • Symptoms
    • high fever for 3 days
    • may have febrile seizures
    • no upper respiratory symptoms
  • Physical exam 
    • light pink morbilliform rash that develops after the fever resolves
      • blanching 
      • discrete and irregular macules and papules
      • lasts 2 days
    • Nagayama spots
      •  erythematous papules on the mucosa of soft palate and uvula
Studies
  • Making the diagnosis
    • based on clinical presentation
Differential
  • Measles
    • distinguishing factor
      • cough, conjunctivitis, coryza, Koplik spots, and confluent rash excluding palms and soles
  • Rubella
    • distinguishing factor
      • post-auricular lymphadenopathy with non-confluent rash that desquamates
Treatment
  • Management approach
    • mainstay of treatment is supportive care
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • antipyretics
        • hydration
Complications
  • Seizures
 

Please rate topic.

Average 5.0 of 2 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

You have 100% on this question.
Just skip this one for now.

(M1.MC.1) A 2-year-old male is brought to the emergency department by his mother following a seizure. The mother reports that he has had a fever for 3 days prior to convulsing while watching TV. You admit the patient to the hospital for further workup and observation. Three days later, you note the appearance of a papular, non-confluent rash on the patients back, extending superiorly towards the nape of the patient's neck. The abdomen and chest are shown in Figure A. What is the most likely diagnosis? Review Topic

QID: 103790
FIGURES:
1

Roseola

42%

(42/101)

2

Variola

3%

(3/101)

3

Rubeola

23%

(23/101)

4

Rubella

27%

(27/101)

5

Mumps

5%

(5/101)

M1

Select Answer to see Preferred Response

SUBMIT RESPONSE 1
ARTICLES (1)
Topic COMMENTS (2)
Private Note