Question & Answer ID

  Mohammad H. Soltanzadeh , MD,ID

        Professor of Pediatrics,  Shaheed  Beheshti  University

         Of Medical Sciences  , Tehran , IRAN

Question 1

What medications are used for the treatment of influenza in children ?


  Older agents include

  Amantadine & Rimantadine

   Both of which block the entry of influenza into  host cells and inhibit a viral assembly protein called M2

   Because the M2 protein of influenza B strains is unaffected by these agents

   The drugs are effective only against influenza A strains



Newer agents

  Inhibit viral neuraminidase

Oseltamivir ( Tamiflu )

   Useful for the prophylaxis or treatment of both influenza A & B infection

  Zanamivir ( Relenza ) for influenza A&B

Question 2?

In which patients should TMP – SMX be avoided or used with caution ?



   Fragile X syndrome

   Known sensitivity to any sulfonamide

   Age of < 2 months

   History of skin Rash while receiving TMP-SMX

   G6PD deficiency

Question 3?

 Which Antibiotic is associated with the Red Man  Syndrome?


 The red mn syndrome is a frequent occurrence with the rapid infusion of Vancomycin

Characterized by flushing of the Neck, Face and Thorax

The Histamine release underlying this reaction


   It is not mediated by IgE

  Does not true Hypersensitivity

  The reaction can be avoided by slowing the rate of drug infusion

   H1 receptore antagonist  e.g. :

   Diphenhydramine  before Vancomycin

   Effective for preventing this reaction

Question 4?

Name of 3 stages of Pertussis

 Whooping cough


Catarrhal 1-2 wks low grade fever , URI symptoms

Paroxysmal 2-4 wks sever cough

Convalescent 1-2 wks resolution of symptom

Question 5?

What is the most common cause of Death in children with whooping cough ?


 90% of deaths are attributed to:


  Which develops as a secondary bacterial infection

   These cases can be missed during the paroxysmal phase

   A new spiking fever prompt a careful for pneumonia

Question 6?

  Is the Erythromycin of value in pertussis infection?


If used the first 14 days of illness or

Before the paroxysmal stage

Erythromycin can decrease the severity of symptoms during the paroxysmal stage


If the diagnosis is later should be administered to eliminate the N.F. carriage of Bor. Pertussis

50 mg /k/d  14 days


Recent suggest :

Azithromycin 10/mg/k/d in one dose

Clarithromycin 10-20 mg/k/d divided in 2 dose for 5-7 d

Question 7?

 Do antibiotic prevent the development of pneumonia after a URI ?


 Over 90% of URI are used by Viruses

   Children < 5 yrs can experience 6-8 URI episodes per yr

 Antibiotic does not shorten their course or prevent the development of Pneumonia

    Pediatrics ID j 12;115-120,1993

Question 8?

 Sternal edema is classically the sign of  what infection?



Question 9?

 How does Hatchcocks sign help distinguish swelling as a result : Mumps from caused by Adenitis ?


Upward pressure applied to the angle of the mandible produces tenderness with mumps ( Hatchcocks sign )

This maneuver produces no tenderness with  Adenitis

Question 10 ?

 What is the best approach to diagnosing HSV Encephalitis in children ?


    In the past :

   Definitive diagnosis relied on Brain Biopsy

    In recent yrs :

    Have demonstrated that analysis of CSF using the PCR > 98%of cases 

    May be more sensitive than Brain Biopsy

    Clin. ID 20;414-420,1995

Question 11?

 Can Acyclovir be used to prevent or treat oral HSV infections ?


In immunocompetent host :

Oral Acyclovir benefit in primary HSV gingivostomatitis

Limited efficacy for the treatment of recurrent herpes labialis


 Topical Acyc. Has not shown benefit in this setting .

 Prophylaxis with oral Acyc. Can reduce the numbers of recurrence in Adults with Herpes Labialis

 But it has not been studied in children.

Question 12 ?

 Does Teething cause fever ?


Long a Doctrine of Grandmothers The suggested association between teething and temperature

  Elevation may have some bases in fact.


In one study of 46 healthy infants with rectal T. recorder before the eruption the 1st tooth

Nearly half had a new temperature  elevation of > 37.5  on the day of eruption


       Other study:

Have shown some slight temperature increase

 In any event elevated fever should not be ascribed simply to teething

 Listen to the Grandmothers , but verify


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