Pediatric

28/07/2026

Neonatal cephalic pustulosis
This disorder is characterized by the development of numerous very small erythematous papulopustules over the scalp, face, and neck. Usually during the second or third week of life. it looks like neonatal acne. the cause is , Malassezia furfur or M sympodialis, topical ketoconazole is a safe and effective treatment

**البثار الرأسي لحديثي الولادة (Neonatal cephalic pustulosis)**
يتميز هذا الاضطراب بظهور العديد من البثور الحمراء الصغيرة جداً على فروة الرأس والوجه والرقبة، وعادة ما يظهر خلال الأسبوع الثاني أو الثالث من عمر المولود. و يشبه"حب الشباب لحديثي الولادة". أما السبب فيعود إلى فطر "المالاسيزيا فرفر" (Malassezia furfur) و"المالاسيزيا سيمبودياليس " (M. sympodialis).يُعد استخدام الكيتوكونازول الموضعي علاجاً آمناً وفعالاً لهذه الحالة.

23/07/2026

23/07/2026

23/02/2026

Sudden *fever* + rapidly progressive *purpuric rash* + *shock* in a child = ??

*Neisseria meningitidis with DIC* Meningococcemia causes endotoxin-mediated endothelial injury → fulminant DIC with petechiae/purpura, thrombosis, and multi-organ hemorrhage.

Toxic child + purpura → treat as *meningococcemia/DIC* until proven otherwise.

Thrombocytopenia + normal PT/PTT → *ITP* .

Thrombocytopenia + schistocytes + normal PT → *TTP/HUS.*

Thrombocytopenia + abnormal PT/aPTT → *DIC* .

Normal platelets + prolonged PT → *factor deficiency (7) or vitamin K* .

Low fibrinogen = *DIC* (not TTP, not ITP).

Normal D-dimer makes *DIC unlikely* in acute setting.

Always *rule out* leukemia before diagnosing ITP in a child.

21/02/2026

*HSP* is typically a self-limited disease and presents with a *classic tetrad:*
Palpable purpura *WITHOUT* thrombocytopenia or coagulopathy– Non-blanching rash, mainly on buttocks and lower limbs
*Arthralgia or arthritis* – Commonly knees and ankles– Non-erosive and transient
*Abdominal pain* – Colicky pain– May cause GI bleeding– Serious complication: intussusception
*Renal* involvement– Microscopic hematuria most common– May progress to nephritic or rarely nephrotic syndrome– Severe cases → rapidly progressive (crescentic) glomerulonephritis*Renal* involvement may appear *late* , even after rash resolves.
Renal involvement typically appears within the first 4–8 weeks, but may develop up to 6 months after onset.
*Recommended monitoring:*
Weekly for 1 month
Every 2 weeks until 3 months
Then at 6 and 12 months
*Check* :
Blood pressure
Urinalysis (hematuria, proteinuria)
Serum creatinine if abnormal findings*Renal disease determines prognosis* in HSP — not the rash.
Development of hypertension, ≥2+ proteinuria, macroscopic hematuria, or nephritic/nephrotic features requires urgent evaluation.
*Even if initial urinalysis is normal,* continue follow-up for at least 6 months (exam favorite).
*Recurrent HSP* episodes are monitored *as a first episode.*

22/01/2026

**5 months baby with *proteus UTI* *us done and MCUG* , received antibiotics and improved. What is *next* investigation?

a) DMSA
b) Mag3.
c) Cystoscopy.
d) Catheter.
e) KUB kidney and ureter.
A

*Simple UTI* :
responds within 48 hr
 *Atypical UTI:*
 seriously ill child
 poor urine flow
 abdominal or bladder mass
 raised creatinine
 septicaemia
 failure to respond to treatment within 48 hr
 infection with organisms other than E. coli

 *Recurrent UTI:*

 ≥2 episodes of UTI with acute pyelonephritis/upper UTI
 1 episode of UTI with acute pyelonephritis/upper UTI plus ≥1 episode or UTI with cystitis/lower UTI
 ≥3 episodes or UTI with cystitis/lower UTI

29/12/2025

12-year-old girl with Type 1 Diabetes Mellitus has poor glycemic control despite increasing insulin dose to 1.5 U/kg/day.

has weight loss, recurrent abdominal pain, and abdominal distension.
*Investigations* :
Hb: 10.8 g/dL (low)
MCV: 66 fL (low)
MCH: normal
HbA1c: 88 mmol/mol (very high)
*Question* :
investigation will most likely lead to the diagnosis?
*Correct Answer* b) Anti-tissue transglutaminase antibodies

with Type 1 DM have a high risk of associated autoimmune diseases, especially celiac disease.

Poor glycemic control despite high insulin doses + weight loss + GI symptoms *strongly suggest* malabsorption.

anemia* with GI symptoms further supports celiac disease.

-tTG antibodies* are the *best initial screening* test.⭕ *Screen* with anti-tTG antibodies ( *even* if *asymptomatic* )