Cram The Pance - S1E58 Pediatric Viral Illness

Episode Date: May 26, 2026

High Yield Pediatric Viral Exanthem / Illness Review: Roseola infantum, Varicella-zoster virus infection (Chickenpox), Measles, Hand, foot, and mouth disease, Epstein-Barr virus (EBV), Erythema infectiosum, Mumps, Rubellafor your PANCE, PANRE, Eor's, Physician Assistant exams, USMLE, NCLEX, nursing exams.►Support the channel by joining and becoming a member! (Thank you so much!)►Paypal Donation Link: https://bit.ly/3dxmTql (Thank you!)►INSTAGRAM: https://www.instagram.com/cramthepance/►YOUTUBE: https://www.youtube.com/channel/UCZCILePJ-E17txF-ObXlFKwIncluded in review: Slapped cheek rash, Koplik spots, Forchheimer spots, Posterior auricular lymphadenopathy, Circumoral pallor, Dew drops on a rose petal, Maculopapular rash, Vesicular rash, Parotitis, Orchitis, Oral hairy leukoplakia.Become a supporter of this podcast: https://www.spreaker.com/podcast/cram-the-pance--5520744/support.

All right, so let's talk about some high-yield pediatric viral illnesses. There is a number of them, roseola, measles, mumps, among many, many others. Quick thank you to all of the support for the channel, buying a T-shirt, just a nice comment in general. It really makes my day. So thank you so much. Let's go ahead and get started with Roseola. So rosiola, also known as Exanthum, Subitum, only a few things to know. The peak prevalence is going to be between seven and 13 months.

And 90% of cases are going to occur in children younger than two years of age. Human herpes virus, 6B is the most common cause of rosiolum. And therefore, it's the one you need to know. It's usually spread for asymptomatic shedding of the virus in secretions to close contacts. Clinical presentation, this is the highest yield thing you need to know. It's a fever, then a rash on the trunk in that order. So we start with a fever. Fever is usually going to last around three days.

It can be over 104 degrees Fahrenheit in some cases, most of the time besides some fussiness, child will otherwise be fine, alert, active, etc. Then after three to five days, we have our rash. And if there is one thing I want you to remember, more than anything else for Rosiola, please remember the rash starts on the trunk. Really important as these findings are what will help you differentiate from other viral exanthums. So after the fever, a blanching macular or macula papular rash will popular rash will popular rash,

starting on the trunk, then later spreading to the face and extremities. That is the key fever, then rash on the trunk that later spreads elsewhere. The rash that starts in the trunk is very specific to Rosiola and will help you get the answer right. Please remember it. All right, so for diagnosis, this is going to be a clinical diagnosis based on the presentation. just mentioned, meaning nothing really to know here. And then for treatment, as this is typically a self-limited disease, treatment is supportive, Cedomenophon for fever, et cetera. So nothing really to know for diagnosis or treatment, meaning your juicy details are in the clinical manifestations,

as well as the causative agent. I do not want you to forget that the rash starts on the trunk. I keep saying that. It's very important. And I also think it's a good idea to remember this is most commonly caused by H.HV6. So when you see Rosieola, Rosie Ola, I want you to think of a lady named Rosie waving Ola. Rosie is waving Ola or hello with her hand. Oddly her hand has six fingers, which helps you remember HHV6 because her hand have six fingers. That's all the letters in there, HV6, which is the most common cause. Then Rosie has a big tattoo on our chest of a rose, of course, which helps you remember that this is one of the only viral exanthums where the rash starts on the trunk. And if this is mentioned in a vignette, almost certainly they'll be talking about Rosieola.

So again, remember Rosie Ola. Rosie is waving Ola, six fingers are in her hand to help you remember this is caused by H.HV6, and she has a tattoo of a rose on her chis to help you remember this is where the rash originates. Next, let's talk about varicella zoster virus infection, aka chicken pox. Varicella zoster virus causes two diseases, the primary infection, which is chicken pox, and then later reactivation of the latent virus known as herpes zoster or shingles. So when we're talking about the primary varicella infection, aka chicken pox, this is a highly contagious disease, which is spread via aerosolized droplets or by direct contact with fluid from skin lesions. The clinical manifestations, initially fever, malaise, pharyngitis, blah, blah,

here's the high-yield part. These nonspecific symptoms are followed by the development of a generalized vesicular rash, usually within 24 hours. So this is what you need to know. And the phrase that I used to remember was varying vesicles. What does this mean? So in varicelizoster, you're going to have these fascicular lesions, so these little fluid-filled blisters, and they're sitting on top of a erythematos base. So red skin, sometimes, this is called dew drops on a rooster. rose pedal where the vesicles are the dew drops and the red skin is the rose pedal. Anyways, back to the important part. Why should you remember varying vesicles?

Well, because when you see this on an exam question or in real life, the lesions will be presenting at multiple stages simultaneously. So some will be vesicles, some pustules, some crusts it over. This polymorphic presentation with all stages visible at once is what distinguishes chickenpox from a lot of other vesicular rashes. So varying vesicles makes it very easy for the exam. Plus varcel already starts with the letters VAR, so it's easy to remember various. as in varying vesicles for varicella, aka lesions in all stages of development and healing.

It won't get any higher yield than that for this topic, so don't forget it. As far as complications secondary to varicella, neurologic complications like encephalitis, varicella pneumonia, which occurs more often in adults, and is one of the reasons why we more aggressively treat adult patients versus children. Diagnosis, often the diagnosis is made clinically, patient with characteristic vesicular lesions in varying stages, if confirmatory tests are needed, like in an immunocomomom. compromised patient, PCR is usually the preferred option. Then we have treatment. So if you have a

healthy, immunocompetent child 12 years or younger, usually this will be with supportive measures, as in this patient population, varicelli is usually a self-limited disease. And then in pregnant, immunocompromised or immunocompetent adults, antiviral therapy will usually be recommended as this patient population has a higher risk of complications. So antivirals like valyciclovir or acyclovir will commonly be used. So for varicellosostrovirus, the highest, you'll think to remember is varying vesicles, and that's Vercellet. Let's move on to measles. Meas is spelled M-E-A-S-L-E-S, but I want you to swap out the S and replace it with a C, as in M-E-A-C-L-E-S. And we'll talk more about that in a minute. So measles is a highly contagious viral illness. How contagious,

well, approximately 90% of susceptible individuals will develop measles who come in contact with it. Let's first talk about the clinical manifestations. No question, this is the highest you'll think to know. Kind of seems like a trend with these viral infections. For clinical manifestations, you need to know your four Cs of measles. And that's why we spelled measles with a C to help us remember this. So the four Cs of measles are conjunctivitis, cariza, cough, and coplic spots. Technically, coplic is spelled with a K, but for the sake of the mnemonic, we're spelling with a C. So during the projum stage of measles, you will get fever, malaise, etc. But most importantly, conjunctivitis, cariza, aka rhinitis, cough, and then the most important

pathonymonic finding called coplic spots. Pathenomonic means the presence of this specific sign or symptom is unique to a specific disease and its presence essentially is diagnostic, and anytime something is considered pathonomonic, just assume it will be tested on. So, Coplic spots are these one to three millimeter bluish or white elevations, typically seen on the bucumucosa. So the inside of the cheek opposite the molars. It doesn't appear in all patients with measles, but when it does, like we talked about before, it's pathonomonic.

So you can't forget it, and you might say, okay, well, I'll definitely remember coplic spots because of the four Cs, but on an exam question, they're probably not going to call them coplic spots. They'll probably just say blueish white spots in the mouth. So how can I remember what coplic spots are? Well, that's actually easy. Coplic, what happens when you lick a cop besides getting arrested, your mouth will turn blue because of the blue uniform, of course. Okay, so again, so for clinical manifestations for measles, remember measles is spelled with a C to help you remember your four Cs. Conjunctivitis, carisa, cough, coplic spots. Let's talk about the rash, which is a maculopular blanching rash that commonly will begin on the face

and spread down to involve the neck, trunk extremities. Notice it's the opposite of rosiola, which we just went over. So remember these small differences. It'll help you on an exam. All right. So complications. Diarrhea is going to be the most common complication, but most deaths are going to be from respiratory tract complications or encephalitis.

Diagnosis suspect this in a patient with clinically compatible symptoms, rash, or 4Cs, and then confirm with measles, IGM antibody or RTPCR. Finally, treatment for most patients is going to be supportive. antipyretics, fluids, etc. Some other treatment options usually reserved for severe cases. One is vitamin A as a vitamin A deficiency can contribute to delayed recovery and lead to further complications. Vitamin A levels actually fall during acute infection. So vitamin A supplementation is added in patients with severe cases of measles. And then finally, ribavirin and antiviral like ribavirin can be used in certain patient populations like immunocompromise patients or those with

measles pneumonia requiring ventilatory support. All right. So that's measles. If you can remember all of this great, if not, then please just don't forget the four Cs of measles. Next is going to be hand-foot mouth disease. This is very straightforward, not very high yield. So let's zoom through it. Hand-foot-mouth disease, most cases are going to be seen in infants and children less than seven years old. Transmission from person-to-person by the fecal oral route is most common. And while multiple interoviruses can cause HFMD,

Coxacuvirus A-16 and Intero virus A-71 are the most common. It's probably the highest yield thing to know as the rest of the disease is pretty straightforward. I don't really have a mnemonicure to help you remember these, but one of the viruses is called Coxsackie, so I suppose it could be creative. Anyways, clinical manifestations, it's called handfoot mouth disease, so there should be no surprises here. The lesions in the mouth most often show up on the tongue and bucle mucosa. Usually start as an erythematos macule, which progress to vesicles.

The child may complain of mouth or throat pain or refuse to eat. Now, really quickly, I wanted to mention something called herpingina. If you're going to get a question on HFMD, they're probably going to have herpengina. as one of the answer choices because they are quite similar and most exam makers are going to probably try to trick you. So herpingina is a similar viral illness caused by some of the same infectious organisms but the lesions seen in herpengina are isolated to just the oral cavity. So an oversimplification of hermigina would be to say that it's handfoot mouth disease of just the mouth. So mouth disease. Now to be fair in real life, HFMD can occasionally present with only oral lesions, which makes things

a bit trickier and that's where some subtle clues can help. Herpangina lesions. lesions are typically more posterior. The lesions look slightly different and the fever can be more abrupt and higher. But honestly, since the diagnosis and management are essentially the same, the distinction is mostly just academic. So for exam purposes and for your own sanity, just remember herpingina as HFMD, limited to just the mouth and move on. All right, what about the rash on the body for hand foot mouth disease? So this can be macular, maculapular, or vesicular. The lesions are usually non-parritic found on the hands, feet, buttox, legs, arms, and typically resolve in three to four days. So just like the name states, hand foot mouth disease, clinical presentation,

usually lesions in the mouth, hands, and feet. Diagnosis is going to be made clinically in most cases if etiologic confirmation is necessary. Things like PCR testing can be used and treatment will be supportive in most cases, as HFMD is generally mild and self-limited, unless there are some rare complication involving encephalitis, meningitis, myocarditis, etc. Again, the highest you'll think to know about hand foot mouth disease outside of the clinical presentation, which is in the name, is the causative agent, most common Coxsacivirus A-16 and entero virus A-71. And if they want to be evil and throw in herpingina as a differential in the answers, just remember herpengina as hand-foot mouth disease of just the mouth.

And that's HFMD. Let's move on to Epstein-Barr virus or EBV. So when we think of EBV or Epstein-Barr virus, most of us think of mono, especially in our pediatric patients. And it's true, EBV is the primary agent of infectious mononucleosis. But EBV has a lot of other high-yield findings I want to go over. So EBV, which is a herpes virus and is also known as human herpes virus four is transmitted primarily through salivary secretions. So the transmission is person and person primarily through salivary

secretions. In most cases, the infection in humans is thought to originate in the oral pharynx, so the back of the mouth and throat area where EBV initially infects the oral pharyngeal epithelial cells and then later the B cells in nearby lymphoid tissue. Clinical manifestations, EBV can cause a number of clinical manifestations as it can affect virtually any organ system. system, but the high yield often tested on clinical manifestations are usually the ones associated with mononucleosis. So we'll see things like pharyngitis, fatigue, fever, splenomagely. But the one in my experience that was always in the exam question was lymphadenopathy.

More specifically, posterior lymphadenopathy involving the posterior cervical and posterior orricular nodes, as those are the most common to be affected. So remember, the posterior lymphadenopathy, as this is very commonly tested on. All right, next there are some high-ield complications slash associated conditions. starting with one we already know, which is going to be infectious mononucleosis. This is probably the most important thing to know mono is an acute illness due to primary EBV infection. You got to know that.

Next is going to be lymphoma like Burkett, Hodgkin. Now, EBV has been linked to a number of malignancies with lymphomas at the top of the list, especially B cell lymphomas like Burkett lymphoma and certain forms of Hodgkin lymphoma. So why does that happen? Well, after the primary infection resolves, EBV doesn't fully go away. it establishes lifelong latency in these B cells and in susceptible individuals, particularly those who are immunocompromised. These EBV-infected B cells can begin to proliferate uncontrollably and over time, this constant

proliferation combined with additional genetic mutations can lead to the development of lymphomas and other malignancies. Another malignancy associated with EBV is going to be nasopharyngeal and gastricarcinomas, so both can be associated with EBV, and it's estimated that 9 to 10% of gastricarcinomas worldwide carry the EBV genome. Next is oral hairy leukoplakea. So what the heck is that? So this is a white painless plaque, usually on the lateral surface of the tongue.

Unlike candidiasis, which presents in a similar way, it cannot be scraped off. It's usually going to be an immunocompromised patients like those with HIV. And this frequently comes up on exam, so definitely know it. Diagnosis. Also, the diagnostic tools are derived from what we use for diagnosis of mono. So I'm not going to dive too deep here, but just know that heterophile antibodies, antibodies, which is what's commonly known as a monospot test. It's a good initial test. It's quick and sheep and it's great if it's positive, but it can be negative early on. And in some younger patients,

a more sensitive and specific test is going to be your EBV-specific antibodies, which is your gold standard test. Labs, there are going to be some hematologic abnormalities. Aminotransferase levels may be elevated, your liver enzymes. But all I would know for the exam is your lymphocytes are going to be effed up in some way. So either too many lymphocytes, aka lymphocytosis, which is the most common finding in mono or atypical lymphocytes seen on peripheral smear. So the lymphocytes are irregular in some way. Remember that for labs. Treatment, this will be supportive care in most cases. So overall, EBV seems like a lot, but there's really only five or six things I think you should know for EBV. You got to know

mono. You got to remember your posterior lymphadenopathy slash abnormal lymphocytes. You got to remember your associated malignancies, lymphomas, and nasalferingial carcinomas. And you got to remember oral hairy leukeplacium. How to remember that? Well, you remember, eBV equals LMNOP. EBV equals LMNOP. L stands for lymphoma slash lymphocytosis. So don't forget EBV is a transforming virus and has been linked to lymphoma, burquette, Hodgekin, et cetera.

And also remember your lymphocyte abnormalities like lymphocytosis. M, of course, stands for mononucleosis. Of course, we know infectious mononucleosis is an acute illness due to EBV infection. N stands for the other high-yield malignancy associated with EBV, which is nasopharyngeal carcinoma. nasopharyngeal carcinoma as well as gastricarcinoma are also associated with EBV. O stands for oral hairy leukoplacia, another EBV-mediated manifestation, the white non-scrapeable plaques usually on the tongue in immunocompromised individuals. And finally the P, which stands for posterior lymphadenopathy.

Remember, mono infection very commonly has lymphadenopathy and most commonly involves the posterior cervical and posterior auricular nodes. Remember again, EBV equals LMNOP. Those are the high-eal points to remember for EBV. Moving on to erythema infectiousom. Aerithema Infectiosum, or EI, for short, is a mild febrile illness that usually manifests in school-age children, although we can see this in adults too. EI is also referred to as fifth disease, as it's one of the six common childhood exanthums named in this order that they were first described, but this naming system isn't used as much anymore. So I'd really just focus on erythema infectiousom.

This illness is most commonly caused by parvovirus B-19, human parvovirus B-19, which is associated with a number of different syndromes, including transient apilastic crisis, fetal infection, and of course, EI. I think it's important to know this is caused by parvovirus B-19 because it's often tested on. So erythema infectiousom is caused by parvovirus B-19. How do you remember that? Well, erythema infectiousom, if you count out the letters, is exactly 19 letters long. So remember the sentence, erythema infectiousom B-19 letters long. Arithema infectiousom B-19 letters long. And yes, it actually is exactly 19 letters.

You can count it yourself. Now I'm not expecting you to sit there during an exam, counting letters on your fingers. But if you ever get stuck on a question, asking you which viral exantham is caused by parbovirus B19, this can actually save you. So again, erythema infectiousom is caused by parbovirus B19. And erythema infectiousom b-19 letters long. Next, clinical manifestations. So this illness starts with some nonspecific stuff, fever, headache, nausea, blah, blah,

not important. Let's get to the good stuff. The highest you'll think to know for clinical manifestations is slap cheek. What am I talking about? So with EI, around two to five days after they get the nonspecific fever, nausea, et cetera, they will develop the characteristic erythematous malar rash with circumoral pallor. So this is the classic erythematous malar rash that appears in individuals with EI. A malar rash is one that's across the nose and cheeks.

Circumoral pallor just means the pale area around the mouth that we'll see. So the cheeks are usually bright red like someone slapped the patient, which gave it the nickname of slap cheek. Now I really want you to remember the malar slap cheek rash because it's super high yield. So to remember this, instead of erythema infectiosum, remember erythema infect chikosum. Cheek as in C-H-E-E-E-E-K, remember instead of erythema infect cheeosum, remember it as erythema infect cheek osm. To remember the classic slap cheek or Melar rash, which is so damn high yield. I even have another mnemonic, and I'm going to embarrass myself here, but I think it's worth it if maybe it helps just one person. So if that mnemonic doesn't work for you, it's a little embarrassing, but this is actually how I remember it in school.

So every time I would see E.I. on an exam, eryema infectious some EI, I would think of that song by Nelly. The one that goes, Andale, Andale, Mama, E.I. E.I. So, yeah, that would always help me remember the song by Nelly. And then I would think of Nellie, who always had that band-aid on his cheek, which helped me remember the slap cheek rash. You probably don't even remember that song. So I just embarrassed myself rapping for no reason. Anyways, after the high-yield facial rash clears, it's usually followed by many days later by this reticulated or lace-like rash on the each. trunk and extremities. Some patients can develop arthralgia's and other hematologic abnormalities, but for most immunocompetent patients, this will only be a mild illness, but do not forget your slap sheet rash, please. Diagnosis, this is going to be, for most individuals, clinical diagnosis, so a child who presents with the classic malar rash. Cereologic tests are available for confirmation of the viral etiology, but reserved for atypical presentations, immunocompromised patients, etc.

And treatment is generally going to be supportive, as this is a mild self-limited illness for most affected. There's no specific treatment indicated for most cases outside of symptomatic treatment for fevers, headaches, etc. So, EI, not a lot to know here. There's only two main takeaways for the exam. One is that this is caused by parvovirus B-19. Remember, erythema infectiosum B-19 letters long. Two, remember the classic or Malar slap cheek rash. Remember erythema infect cheek osum, or just remember me embarrassingly wrapping and helping you to remember Nelly with the band-aid on his cheek. Anyways, let's move on to mumps. This is a highly contagious viral illness occurring most commonly among school-aged children and college-aged young adults spread via respiratory droplets,

direct contact, or fomites. Vaccination in the U.S. has led to a significant decline in the number of cases seen, but a few hundred to a few thousand cases continue to occur each year. For mumps, there's really only a few high-ealed things to know for the exam. Let's run through them, first starting with our clinical manifestations. So it usually start with some nonspecific symptoms, fever, headache, myalgia. You know how I feel about the nonspecific stuff by now. But then, then there is salivary gland swelling. So salivary gland swelling develops.

This is the highest deal of thing you need to know about mumps. And that is something known as paratitis. Paratitis is the most common manifestation of the virus occurring in over 70% of infections. The mumps virus actually has an affinity for the glandular epithelium, especially of the prerodic gland. That's why this occurs so often. So the prerodic glands, which are largest salivary glands, sit below and in front of the ear. And when these become inflamed in mumps, the swelling can be quite traumatic. extending along the entire side of the face and into the neck, completely obscuring the angle of

the mandible. So for clinical manifestations, do not forget parotitis. There are also some other high-ield complications you should know, starting with the most important, which is going to be orchitis, specifically epididomo orchitis, which is an inflammation of both the testes and epidemis, and is the most common complication of mumps infection. These patients may have fever, swelling, severe testicular pain, and this is going to be unilateral in most cases, 60 to 80%. There are also a number of neurologic complications, meningitis, which is the most common neurologic complication, specifically aseptic meningitis, which can occur in up to 10% of patients. Deafness, so hearing loss associated with mumps is another unique complication.

Symptoms improve in many cases, although permanent deafness can occur. And then finally, pancreatitis, which can occur in both children and adults with mumps. Most cases resolve with conservative management, and this is not a common complication, but it is tested on, so it's good to know and be familiar with it. Nothing high yield to know for diagnosis. Diagnostic tests like reverse transcriptase, PCR, and serum IGM antibody testing may be utilized to establish the diagnosis. Treatment, this is also not high yield as there's no specific antiviral therapy. And this is usually a self-limited condition.

So supportive measures will be the mainstay for most individuals, acetaminopin, et cetera. And then, of course, the goal here is prevention through immunization with the MMR vaccine. So the highest yield things to know for Mumps comes from the complications and clinical manifestations. So since mumps make you plump, like plump neck and face, etc., you'll remember the sentence, mumps make you plump. Mumps make you plump. And plump, plump, has all of the high-yield findings for the exam. P starts for pancreatitis.

L stands for loss of hearing. Remember, deafness can be associated with mumps. U stands for unilateral orchitis. Remember, orchitis is a common complication for males. And in 60 to 80% of males, this will be unilateral. M stands for meningitis, aseptic meningitis being the most common neurologic complications. of mumps. And finally, the last P, the star of the show, paratitis, the most common manifestation of the virus, causing significant face and neck swelling. So again, mumps make you plump, pancreatitis,

loss of hearing, unilateral orchitis, meningitis, paratitis. That's mumps. Don't forget, it makes you plump, moving on to Rubella. This is a viral illness first described by German physicians in the 1750s and was referred to as German measles due to a similar rash as the once seen in measles. Vaccination has resulted in a significant decline in the number of episodes, and in 2004, it was actually officially eliminated from the United States, although there are still intermittent outbreaks worldwide. So let's get started with the clinical manifestations, which is typically comprised of a rash fever and lymphadenopathy.

The rash will consist of pinpoint pink maculopulose, first appearing on the face, then spreading codily or downward to the trunk and extremities, sparing the palms and soles. The rash usually lasts for about three days. And then on the exam, you may see something called foreshimer spots, which are these small red spots on the soft palate. This can be seen in other conditions like scarlet fever. So unlike coplic spots and measles,

Forsheimer spots are not pathonomonic for Rubella, but if you see this mention in a vignette, most likely they're going to be talking about Rubella. So important to remember, next important one is going to be lymphadenopathy, which typically involves the posterior cervical, posterior orricular and suboxcipital lymph nodes. The posterior auricular lymphadenopathy is often mentioned in vignettes,

so it's really important to know. And if you see a patient mentioned in a vignopathy, that has posterior auricular lymphadenopathy and foreshymer spots. From an exam standpoint, it's Rubella. So those are the clinical manifestations to know focusing on foreshymer spots and the posterior orricular lymphadenopathy. Infection in children is usually going to be mild. Complications of Rubella are not common, except during pregnancy, which congenital

Rubella syndrome can develop, and it is the biggest concern as it can be quite serious, fetal death, premature delivery, heart and ocular defects, etc. Let's move on to diagnosis. So we diagnose with Rubella IgM. serology, usually that's going to be the initial diagnostic test, and RTPCR testing can be used as an alternative. Treatment is going to be supportive measures in most cases, antipyratics, fluids, etc. So as in most of these viral xanthums, the clinical manifestations are the highest still component, as there's not much to know for diagnosis and treatment.

And the keys to rubella is the post-orricular lymphadenopathy and the red spots on the soft palate, the foreshamor spots. Those will both be in the vignette. And to remember these, instead of rubella, remember rebella, instead of rubelphint, instead of rubella, remember rebelephant. Rebelephant as an elephant. Because when you think of an elephant, as in rebelephant, what do you think of? Those big dumber ears and the big trunk.

So think of a rebelephant, those big dumber ears, help you remember the post-arricular lymph anopathy, the swollen lymph nodes behind the ears. Then think of the elephant lifting its trunk up in the air and showing you its mouth to help you remember the foreshamber spots, the red spots on the soft palate. Just remember rebella as instead rebelephant to help you remember the big floppy ears and the trunk to help remember the post-oimber spots. orricular lymphadenopathy and four shimer spots on the soft palate. That's Rubella.

Let's move on to the last. We've listed all of the key details about each individual pediatric illness, kind of narrowing it down just to the most important highest yield of each. So let's talk about that now. So first is Rubello, remember again, foreshimer spots, posterior auricular lymphanopathy, and then, of course, rebelephant. Mumps, remember your parotitis, orchitis, meningitis, deafness, pancreatitis. Mumps make you plump again, that's the nomotic.

Errhythm infectionis, remember parvovirus B-19. Remember erythema infectiosum B-19 letters long. And then remember your slap cheek rash. In fact, cheek osum or Nelly and EI. Rosieola in Phantom, remember this is human herpes virus 6B, HHV6B. And then the rash, of course, most importantly, starts on the trunk. Remember, Rosieola with the rose tattoo on her trunk. And then her hand waving hello, which has six fingers on it.

Remember, the hand have six fingers to help you remember human herpes virus 6B. Next, Epstein-Barr virus. Remember the posterior lymphadenopathy. mononucleosis, lymphoma, nasopharyngeal carcinoma, oral hairy leukoplakea, labs, remember your lymphocytosis, atypical lymphocytes. And then to remember all of that, remember, EBV equals LMNOP, hand foot mouth disease. Everything is pretty much in the name. Just remember this is caused typically by Coxacuvirus A16. And then remember the trick there, if they mention herpingina, remember, that's basically HFMD, essentially of just oral lesions component.

Measles, remember the four Cs of measles. And remember, measles is spelled with a C instead of an S to help you remember conjunctive vitis, coriza, cough, and then coplic spots. Remember, coplice white spots on the bucomicosa. Remember, if you lick a cop, your mouth turns blue. And then finally, varicella's osteravirus. Remember, they do drop on a rose pedal to help you remember what the vesicles look like. And then, of course, remember the term varying vesicles, lesions, and varying stages of development.

All right, let's do a few quick questions, and then we will wrap it up. Question one, a 10-month-old previously healthy boy is brought to the pediatric emergency department by his parents. The parents report that four days ago, the child developed an abrupt onset of high fever without an obvious source. During the febrile period, the child was fussy and irritable, but continued to feed. There was no cough, conjunctivitis, or oral lesions. He had no known sick contacts and no recent travel. Immunizations are up to date. He is not taking any medications and has no known drug allergies.

This morning, the fever resolved spontaneously. And shortly after, the parents noticed a diffuse pink maculapular rash that appeared first on the trunk and then spread. to the face and extremities. The rash is blanching and non-pruritic. The palms and soils are spared. What is the most likely infectious organism responsible for this child's presentation? A, parvovirus B-19. B. 19. B. Measles virus. C. Human herpes virus 6, H.HV.6. D. Rubelovirus. Or E. Coxsacki virus A.16. So the correct answer is going to be C. Human Herpes Virus 6, as in H.HV.6. All right. So there's a lot of words in this vignette, but there's really only three

that matter. Rash first trunk. Anytime you see your viral examatim being described with a rash that starts first on the trunk, I want you to right away think of which pediatric illness, Rosie Ola. Remember Rosie waving Ola to us, the rose tattoo on our chest, and the six fingers waving hello. Rosie Ola is the only viral exam we went over today that starts on the trunk. And if you see a rash in a vignette that starts on the trunk on an exam, it's very, very likely

going to be Rosiola. So then the next question is what infectious organism causes Rosie Ola? And then, of course, we know that it's HHVC. because Rose is waving Ola with her hand with six fingers. And even if there was some uncertainty left, it's easy to roll out the other answers. Let's start with B, measles virus. Measles, we know we spell with a C for the four Cs,

none of which are mentioned here. In addition, the measles virus typically start on the face. A, parvovirus B-19, B-19, which viral exanthum B-19 letters long. Aretheme infectiousom. We do not see mention of the classic slap-cheek rash here. D, Rubella virus. Rubela also typically starts on the face

and is associated with posterior lymphadenopathy and Forsheimer spots, which we remember with rebelefin, neither which are mentioned. Finally, E. Coxsackivirus A-16 associated with hand-foot mouth disease. Palms and soles are spared here, no oral lesions. Moving on to question two. A six-year-old previously healthy girl is brought to the pediatric clinic by her mother in early spring. The mother reports that approximately one week ago, the child had mild illness with low-grade fever, headache, malaise, that resolved after a few days without treatment.

The child has no history of any medical conditions. Immunizations are up to date, and there is no recent travel history. Today the mother noticed a striking bright red bilateral rash on both cheeks. The rash is warm to the touch, slightly raised, and spares the peri-oral region. The child is afebrile and appears well. Temperature is 37 degrees Celsius or 98.6 Fahrenheit. Heart rate 92 beats per minute. Respiratory rate 18 breaths per minute.

Blood pressure 98 over 60 millimeters per mercury. On physical exam, we see erythematous plaques on both cheeks. Oral pharynx and bucle mucosa are clear. No conjunctival injection. no significant lymphadenopathy, what is the most likely diagnosis? A, measles, B, hand-foot mouth disease, C, erythema infectiousum, D. Rubella. So that is going to be C, erythema infectiousom. So right off the bat, you can easily eliminate hand-foot mouth disease, as there's no mention of oral lesions or extremity lesions. Measles, the four Cs of measles,

we don't see any of them mentioned, so that's unlikely. Rubela, aka. A.k.a. a rebelefin, no posterior lymphadenopathy mentioned, oral pharynx is listed as normal, so no chance of hosharesum. So then we're left with erytheme infectiousisem infectiousisem, which fits the vignette perfectly, a mild viral prodrome followed by the hallmark slap cheek rash. This is E.I. all the way. Moving on to question three. Which infectious organism is most likely responsible for the presentation described in the

previous question? So that is going to be parvovirus B-19. Don't forget, the organism responsible for erytheme infectiousom is parvovirus B-19, and you'll never forget that because erythium infectious some b-19 letters long all right so that was your pediatric viral illnesses i hope that was helpful thank you so much i really appreciate the support and best of luck in school