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1. A 2-year-old child (A) presents with a four-day history of a rash limited to the feet and ankles. The
papular rash is both pruritic and erythematous. The 3-month-old sibling of this patient (B) has
similar lesions also involving the head and neck. Appropriate treatment for this condition
includes (See Fig)
(B). Permethrin
(D). Emollients
2. A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, purple
lesion over the buttocks bilaterally, as shown in the photograph. The lesion is not palpable, and it is not
warm or tender. The mother denies trauma and reports that the lesion has been present since birth. This
otherwise well-appearing infant is growing and developing normally and appears normal upon physical
examination. The most likely diagnosis in this infant is (See Fig)
(A). Toxoplasmosis
(B). Glycogen storage disease
(C). Congenital hypothyroidism
(D). Congenital syphilis
4. Ans. (D). Congenital syphilis
The clinical presentation of congenital syphilis is varied. Many newborns appear normal at birth and continue to be
asymptomatic for the first few weeks or months of life. Most untreated infants will develop a skin lesion, the usual one
being an infiltrative, maculopapular peeling rash that is most prominent on the face, palms, and soles. Involvement of the
nasal mucous membranes causes rhinitis with a resultant serous and occasionally purulent, blood-tinged discharge
(snuffles).
This, as well as scrapings from the skin lesions, contains abundant viable treponemes. Hepatosplenomegaly and
lymphadenopathy are common, and early jaundice is a manifestation of syphilitic hepatitis. Among the later
manifestations, or stigmata, of congenital syphilis is interstitial keratitis, which is an acute inflammation of the cornea that
begins in early childhood (most commonly between 6 and 14 years of age). Interstitial keratitis represents the response of
the tissue to earlier sensitization. Findings include marked photophobia, lacrimation, corneal haziness, and eventual
scarring.
5. A 3-year-old girl is admitted with the x-ray pictured. The child lives with her parents and a 6-week-old
brother. Her grandfather stayed with the family for 2 months. The grandfather had a 3-month history of
weight loss, fever, and hemoptysis. Appropriate management of this problem includes (See Fig)
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