A 5-year-old boy develops fever, severe sore throat, a greyish-white membrane over his tonsils that bleeds on attempted removal, and marked cervical lymphadenopathy ('bull neck'). ECG shows first-degree AV block. The immediate management includes:

• A Antitoxin alone without antibiotics
• B Surgical removal of the membrane
• C Corticosteroids to reduce edema
• D Diphtheria antitoxin (equine) + benzylpenicillin or erythromycin ✓

Explanation

Diphtheria caused by Corynebacterium diphtheriae produces exotoxin causing local pseudomembrane and systemic effects (myocarditis, neuropathy). Management requires both: (1) diphtheria antitoxin (equine) given urgently to neutralize unbound toxin — dose varies with severity; (2) antibiotics (penicillin or erythromycin) to eradicate the organism and reduce toxin production. AV block indicates myocarditis and warrants cardiac monitoring. Surgical removal of the membrane risks bleeding and toxin release. Steroids are not proven to reduce mortality in diphtheria.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.