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Paeds: Acute Presentation > Acute presentations with rash > Flashcards

Acute presentations with rash Flashcards

1
Q

What is the cause of chickenpox?

A

varicella zoster virus

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2
Q

What is shingles?

A

reactivation of the dormant varicella zoster virus in the dorsal root ganglion

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3
Q

How is chickenpox spread?

A

spread via the respiratory route

can be caught from someone with shingles

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4
Q

When are you infective if you have chickenpo?

A

4 days before the rash until 5 days after the rash first appeared

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5
Q

What is the incubation period of chickenpox?

A

10-21 days

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6
Q

When are the features of chickenpox more severe?

A

older children/ adults

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7
Q

What are 3 clinical features of chickenpox?

A
  1. Fever initially
  2. Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular (all 3 on child at once)
  3. Systemic upset is usually mild
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8
Q

What are 4 aspects of the managemen to chickenpox?

A
  1. Keep cool, trim nails
  2. Calamine lotion
  3. School exclusion: most infectious period is 1-2 days before the rash appears, but infectivity continues until all lesions are dry and have crusted over (usually about 5 days after onset of rash) - can return when vesicles have crusted
  4. Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG)
  5. If chickenpox develops in immunocompromised and newborns with peripartum exposure - should give IV aciclovir
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9
Q

What is a common complication of chickenpox?

A

secondary bacterial infection of the lesions

either single infected lesion/ small area of cellulitis or invasive group A streptococcal soft tissue infections, which can result in necrotising fasciitis

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10
Q

What can increase the risk of secondary bacterial infection of chickenpox lesions?

A

NSAIDs

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11
Q

What are 6 rare complications of chickenpox?

A
  1. Pnemonia
  2. Encephalitis (cerebellar involvement may be seen)
  3. Disseminated haemorrhagic chickenpox
  4. Arthritis
  5. Nephritis
  6. Pancreatitis
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12
Q

What are the rules about school exclusion in chickenpox?

A

can go back when all vesicles have crusted over

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13
Q

What are 3 features of the prodrome of measles?

A
  1. Irritable
  2. Conjunctivitis
  3. Fever
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14
Q

What pathogen causes measles?

A

RNA paramyxovirus

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15
Q

How is measles spread?

A

droplet spread

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16
Q

When are you infective with measles?

A

from prodrome until 4 days after rash starts

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17
Q

What is the incubation period of measles?

A

10-14 days

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18
Q

What are 3 clinical features of measles?

A
  1. Koplik spots (before rash): white spots (grains of salt) on buccal mucosa
  2. Rash: stars behind ears then to whole body, discrete maculopapular rash becoming blotch and confluent (morbilliform rash)
  3. Diarrhoea occurs in around 10% patients
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19
Q

What investigation can be performed in suspected measles?

A

IgM antibodies can be detected within a few days of rash onset

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20
Q

What are 3 aspects of the management of measles?

A
  1. Mainly supportive
  2. Admission may be considered in immunosuppressed or pregnant patients
  3. Notifiable disease - inform public health
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21
Q

What are 10 complications of measles?

A
  1. Otitis media
  2. Pneumonia
  3. Encephalitis
  4. Subacute sclerosing panencephalitis (very rare, 5-10 years later)
  5. Febrile convulsions
  6. Keratoconjunctivitis, corneal ulceration
  7. Diarrhoea
  8. Increased incidence of appendicitis
  9. Myocarditis
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22
Q

What is the most common complication of measles?

A

otitis media

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23
Q

What is the most common cause of death from measles?

A

pneumonia

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24
Q

When does encephalitis typically occur following measles?

A

1-2 weeks following onset

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25
Q

When might subacute sclerosing panencephalitis occur following measles?

A

5-10 years following illness

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26
Q

What should you offer to a child who is not immunised and comes into contact with measles?

A

MMR vaccine within 72 hours: vaccine-induced measles antibody develops more rapidly than that following natural infection

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27
Q

What is another name for rubella?

A

German measles

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28
Q

What pathogen causes rubella?

A

the togavirus

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29
Q

At what time of year are outbreaks of rubella more common?

A

winter and spring

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30
Q

What is the incubation period of rubella?

A

14-21 days

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31
Q

When are patients with rubella most infectious?

A

from 7 days before symptoms appear to 4 day days after the onset of the rash

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32
Q

What is the prodrome of rubella?

A

low grade fever

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33
Q

What are 2 clinical features of rubella?

A
  1. Rash: maculopapular, initially on face before spreading to the whole body, usually fades by the 3-5 day
  2. Lymphadenopathy: suboccipital and postauricular
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34
Q

What are 4 complications of rubella?

A
  1. Arthritis
  2. Thrombocytopaenia
  3. encephalitis
  4. Myocarditis
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35
Q

What causes hand, foot and mouth disease?

A

Intestinal viruses of the Picornaviridae family, most commonly coxsackie A16 and enterovirus 71

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36
Q

In which setting does hand, foot and mouth most commonly occur?

A

always in children, typically in outbreaks at nursery

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37
Q

What are 3 clinical features of hand, foot and mouth disease?

A
  1. Mild systemic upset, sore throat, fever
  2. Oral ulcers
  3. Followed later by vesicles on the palms and soles of the feet
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38
Q

What are 3 aspects of the management for hand, foot and mouth disease?

A
  1. Symptomatic treatment only: general advice about hydration and analgesia
  2. Reassurance no link to disease in cattle
  3. Children do not need to be excluded from school
    • HPA recommends children who are unwell be kept off until feel better
    • contact if you suspect there may be a large outbreak
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39
Q

What are the school exclusion rules for hand, foot and mouth disease?

A

don’t need to be excluded from school

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40
Q

What causes roseola infantum?

A

human herpes virus 6 (HHV6)

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41
Q

What are 2 alternative names for roseola infatum?

A
  1. exanthem subitum
  2. sixth disease
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42
Q

What is the incubation period of roseola infantum?

A

5-15 days

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43
Q

What age is typically affected by roseola infantum?

A

6 months to 2 yrs

44
Q

What are 5 features of roseola infantum?

A
  1. high fever: lasting a few days, followed later by a
  2. maculopapular rash
  3. Nagayama spots: papular enanthem on the uvula and soft palate
  4. febrile convulsions occur in around 10-15%
  5. diarrhoea and cough are also commonly seen
45
Q

In addition to Roseola infantum what are 2 Other possible consequences of HHV6 infection?

A
  1. aseptic meningitis
  2. hepatitis
46
Q

What are the school exclusion rules for roseola infantum?

A

school exclusion not needed

47
Q

What is Kawasaki disease?

A

type of vasculitis that is predominantly seen in children

48
Q

What is one of the key complications of Kawasaki disease?

A

coronary artery aneurysm

49
Q

What are 6 features of Kawasaki disease?

A
  1. High grade fever which lasts for >5 days. Resistant to antipyretics
  2. Conjunctival injection
  3. Bright red, cracked lips
  4. Strawberry tongue
  5. Cervical lymphadenopathy
  6. Red palms of the hands and soles of the feet which later peel
50
Q

How is a diagnosis of Kawasaki disease made?

A

clinical diagnosis, no specific diagnostic test

51
Q

What are 3 aspects of the management of Kawasaki disease?

A
  1. High dose aspirin
  2. IV immunoglobulin
  3. Echocardiogram (rather than angiography) initial screening test for coronary artery aneurysms
52
Q

Why is aspirin usually contraindicated in children?

A

Risk of Reye’s syndrome

53
Q

What causes molluscum contagiosum?

A

molluscum contagiosum virus (MCV), member of Poxviridae family

54
Q

How does transmission of molluscum contagiosum occur?

A

direct transmission by close person contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels

55
Q

What is the age of children with the maximum incidence of molluscum contagiosum?

A

1-4 years

56
Q

What is the appearance of mollscum contagiosum?

A

characteristic pinkish or pearly white papules with central umbilication, which are up to 5mm in diameter

lesions appear in clusters in areas anywhere on body (Except palms of hands and soles of feet)

57
Q

Where is molluscum contagiosum most commonly seen in children?

A

on trunk and in flexures, also in anogenital region

58
Q

What are 5 pieces of self-care advice to give in molluscum contagiosum?

A
  1. Reassure that molluscum contagiosum is self-limiting condition
  2. Spontaneous resolution usually occurs within 18 months
  3. Explain lesions are contagious, sensible to avoid sharing towels, clothing, baths with uninfected people (e.g. siblings)
  4. Encourage people not to scratch the lesions. If problematic, consider treatment to alleviate itch
  5. Exclusion from school, gym, swimming is not necessary
59
Q

What is the treatment offered for molluscum contagiosum?

A

not usually recommended. if troublesome or considered unsightly, can use simple trauma or cryotherapy, depending on parents’ wishes and child’s age

60
Q

What are the 2 ways that molluscum contagiosum lesions can be removed?

A
  1. Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Should be limited to a few lesions at one time
  2. Cryotherapy may be used in older children or adults, if healthcare professional experienced in the procedure
61
Q

How can eczema affect molluscum contagiosum?

A

eczema or inflammation can develop around lesions prior to resolution

may require treatment if itching is problematic - prescribe emolient and mild topical steroid e.g. hydrocortisone 1%

62
Q

What are 2 situations when you should apply topical treatment to molluscum contagiosum?

A
  1. Itching is problematic; prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%)
  2. Skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%)
63
Q

What are 3 situations when a referral should be made for molluscum contagiosum?

A
  1. For people who are HIV-positive with extensive legions - urgent referral to HIV specialist
  2. For people with eyelid-margin or ocular lesions and associated red eye urgent referral to ophthalmologist
  3. Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
64
Q

What causes scarlet fever?

A

reaction to erythrogenic toxins produced by group A haemolytic streptococci (usually Steptococcus pyogenes)

65
Q

At what age is scarlet fever most common?

A

aged 2-6 years, peak incidence 4 years

66
Q

How is scarlet fever spread?

A

via respiratory route by inhaling or ingesting respiratory droplets or by direct contact with nose and throat discharges (especially during sneezing and coughing)

67
Q

What is the incubation period of scarlet fever?

A

2-4 days

68
Q

What are 5 presenting features of scarlet fever?

A
  1. Fever, usually lasting 24-48 hours
  2. Malaise, headache, nausea/vomiting
  3. Sore throat
  4. ‘Strawberry’ tongue
  5. Rash
    1. fine puncturate erythema (pinhead) which appears on torso and spares palms and soles
    2. flushed appearance, circumoral pallor
    3. rough sandpaper texture
69
Q

What are 6 features of the rash of scarlet fever?

A
  1. Fine punctate erythema (‘pinhead’)
  2. Generally appears first on the torso and spares palms and soles
  3. Flushed appearant of child with circumoral pallor
  4. Rash more obvious in the flexures
  5. Often described as having a rough, sandpaper texture
  6. Desquamination occurs later in course of illness, particularly around fingers and toes
70
Q

How is a diagnosis of scarlet fever made and how much is this prioritised for its management?

A

throat swab normally taken, but antibiotic treatment should be commenced immediately rather than waiting for the results

71
Q

What is the management of scarlet fever?

A
  • oral penicillin V for 10 days
    • azithromycin if penicillin allergy
  • notifiable disease
72
Q

What are the rules about school exclusion for scarlet fever?

A

children can return to school 24h after commencing antibiotics

73
Q

What are 4 possible complications of scarlet fever?

A
  1. Otitis media
  2. Rheumatic fever: typically occurs 20 days after infection
  3. Acute glomerulonephirits: 10 days after infection
  4. Invasive complications e.g. bacteraemia, meningitis, necrotising fasciitis - rare but may be life-threatening
74
Q

When does rheumatic typically occur following scarlet fever?

A

20 days after infection

75
Q

When does acute glomerulonephritis usually occur following scarlet fever?

A

10 days after infection

76
Q

What is the typical distribution of seborrhoeic dermatitis in children?

A

typically affects the scalp (‘Cradle cap’), nappy area, face and limb flexures

77
Q

What does cradle cap due to seborrhoeic dermatitis usually look like?

A

erythematous rash with coarse yellow scales

78
Q

When does cradle cap in seborrhoeic dermatitis usually develop?

A

may develop in the first few weeks of life

79
Q

What is the management of seborrhoeic dermatitis dependent on?

A

the severity

80
Q

What is the management of mild-moderate seborrhoeic dermatitis?

A

baby shampoo and baby oils

81
Q

What is the management of severe seborrhoeic dermatitis?

A

mild topical steroids e.g. 1% hydrocortisone

82
Q

What is usually the natural course of seborrhoeic dermatitis in children?

A

tends to resolve spontaneously by around 8 months of age

83
Q

What is seborrhoeic dermatitis?

A

chronic dermatitis thought to be caused by inflammatory reaction to a proliferation of a normal skin inhabitant, a fungus called Malasezie furfur (formerly konwn as Pityrosporum ovale)

84
Q

What are 2 other names for erythema infectiosum?

A

fifth disease, or slapped cheek syndrome

85
Q

What is the cause of erythema infectiosum aka slapped cheek syndrome?

A

Parvovirus B19

86
Q

What is the typical course of features in slapped cheek syndrome/ erythema infectiosum? 2 features

A
  1. Mild feverish illness - hardly noticeable
  2. Noticeable rash after a few days - rose red ceeks, may spread to rest of body
    1. child usually begins to feel better as the rash appears
87
Q

Where is the rash present in erythema infectiosum (slapped cheek)?

A
  • bright red cheeks
  • may spread to rest of body
  • rarely involves palms and soles
88
Q

What is the course of the rash following infection with erythema infectiosum?

A

usually peaks after a week then fades

for some months afterwards, warm bath/sunlight/heat/fever will trigger recurrence of bright red cheeks and rash itself

89
Q

What is the management of slapped cheek/ erythema infectiosum?

A

most children recover and need no treatment

school exclusion unnecessary

90
Q

What is the advice regarding school exclusion in slapped cheek/ erythema infectiosum and why?

A

unnecessary as child not infectious once rash emerges

91
Q

What acute presentation can parvovirus B19 cause in adults?

A

acute arthritis

92
Q

When is parvovirus B19 a risk in pregnancy?

A

can affect unborn baby in first 20 weeks of pregnancy

93
Q

What is the management if a pregnant lady is exposed to slapped cheek syndrome in pregnancy before 20 weeks?

A

she should seek prompt advice from whoever is giving her antenatal care

maternal IgM and IgG will need to be checked

94
Q

How is parvovirus B19 spread?

A

by the respiratory route

95
Q

When is a person infectious with parvovirus B19?

A

3-5 days before appearance of the rash

96
Q

What are 3 presentations of parvovirus B19 infection in addition to slapped cheek/ erythema infectiosum?

A
  1. Asymptomatic
  2. Pancytopaenia in immunosuppressed patients
  3. Aplastic crises e.g. in sickle cell disease (parvovirus B19 suppresses erythropoiesis for about a week so aplastic anaemia is rare unless there is a chronic haemolytic anaemia)
97
Q

What is purpura?

A

bleeding into the skin from small blood vessels that produces a non-blanching rash

98
Q

What are 6 differentials for causes of purpura in children?

A
  1. Meningococcal sepsis
  2. Acute lymphoblastic leukaemia
  3. Congenital bleeding disorders
  4. Immune thrombocytopenic purpura
  5. Henoch-Schonlein purpura
  6. Non-accidental injury
99
Q

What are 5 different causes of ‘napkin’ (nappy) rash?

A
  1. Irritant dermatitis - from urinary ammonia and faeces
  2. Candida dermatitis
  3. Seborrhoeic dermatitis
  4. Psoriasis
  5. Atopic eczema
100
Q

What is the characteristic distribution of irritant dermatitis as a cause of nappy rash?

A

creases are characteristically spared

101
Q

What is the most common cause of nappy rash?

A

irritant dermatitis

102
Q

What is the appearance of Candida dermatitis as a cause of nappy rash?

A

typically an erythematous rash which involves the flexures and has characteristic satellite lesions

103
Q

What is the appearance of seborrhoeic dermatitis as a cause of nappy rash?

A

erythematous rash with flakes

may be coexistent scalp rash

104
Q

What is the appearance of psoriasis as a cause of nappy rash?

A

erythematous scaly rash also present elsewhere on the skin

105
Q

What is a clue as to atopic eczema as a cause of nappy rash?

A

other areas of skin will also be affected

106
Q

What are 5 general management points for nappy rash?

A
  1. Disposable nappies preferable to towel nappies
  2. Expose napkin area to air when possible
  3. Apply barrier cream (e.g. zinc and castor oil)
  4. Mild steroid cream (e.g. 1% hydrocortisone) in severe cases
  5. Management of suspected candidal nappy rash is with a topical imidazole. Cease the use of a barrier cream until the candida has settled

Paeds: Acute Presentation (14 decks)

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