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New cases in Pous 2064, HIV = 175, AIDS = 26, Death = 2. HIV rate is very high in Housewives than sex workers in Nepal ! ! ! HIV status in Nepal till 2005: Total Adult=70000, Adult Prevalence (15-49)=0.55%, Number of Women (15-49) LWHA=15,310 (22%), HIV Prevalence rate in IDUs=32.7%, HIV prevalence rate in sex worker=3.8%, HIV prevalence rate in client of SW=2.1%. The latest U.N. report shows that 65 million people have been infected with HIV since it was first identified 25 years ago. Twenty five million people have died of AIDS.

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Clinical Vignette A clinical vignette is a concise presentation of an interesting or challenging patient encounter that stimulated an interesting learning issue.

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Four yr old child with multiple isolated lesions on his face & neck - 16-09-2006, 09:38 AM

A 4 year old child is seen by a pediatrician because he has developed multiple isolated lesions on his face and neck. Physical examination reveals many lesions up to 4 cm in diameter with golden crusts, while in other sites small blisters and weeping areas are seen. Which of the following is the most likely diagnosis?
A. Aphthous ulcers
B. Erysipelas
C. Herpes simplex I
D. Impetigo
E. Measles


I Love Clinical Vignette a concise presentation of an interesting & challenging patient encounter that stimulates an inquisitive learning session.
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Re: Four yr old child with multiple isolated lesions on his face & neck - 17-09-2006, 07:46 AM

hi bro how are u? iam still busy after few days i will try to be regular.
well this seems to be the case of Staphylococcus aureus or Group A streptococci so it is impetigo option D.
can u tell me how to attach pic. in the reply, i have nice pic. of a child with impetigo but i dont know how to attach it since it is not the url....
see u later,bye
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The correct answer is D - 17-09-2006, 08:25 AM

Thats right bharat, the correct answer is D. This is impetigo, which is typically seen in preschool children with poor hygiene, particularly in the summer in warm climates. The characteristic lesion has a large golden crust. Most cases are caused by Staphylococcus aureus; Streptococcus pyogenes is occasionally implicated. Impetigo is highly infectious, and mini-epidemics can occur in daycare settings. The initial treatment is typically with penicillins and topical preparations. Methicillin-resistant strains are presently rare in this setting, but can occur.

Aphthous ulcers (choice A), commonly known as "canker sores," are painful, shallow ulcers of the oral cavity.

Erysipelas (choice B) is a different type of skin infection, often caused by Streptococcus pyogenes (also sometimes others including Staphylococcus), and is characterized by large erythematous patches.

Herpes simplex I (choice C) causes tiny oral and perioral vesicles, but not large golden crusts.

Measles (choice E) causes a blotchy erythematous rash.

I know your busy with exams and I also know that you will get through with flying scores ... anyway best of luck bharat.

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Originally Posted by bharat
how to attach pic. in the reply
Do the following:

1. Click on the New Reply (or New Thread if you are starting new one)
2. Look for the Manage Attachment

then a separate window will open through which you can upload the pictures.

Best of luck once again for your exams.


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