c h i l d h o o d x a n t h e m s

Question 1

features to assess

Answer 1

Distribution
Central or peripheral
Dermatomal
Extensor surfaces
Mucosal involvement
Colour
Size
Blanching or non-blanching
Palpability
Presence of petechiae

Question 2

what is a macule

Answer 2

flat area, normal skin colour

Question 3

what is a papule

Answer 3

raised lesion, solid

0.5cm greatest diameter

Question 4

what is a nodule

Answer 4

papule but deeper in dermis or sub cut tissue

Question 5

what is a plaque

Answer 5

elevation of skin occuping large area in relation to its height

Question 6

what is a pustule

Answer 6

confluence of papule with purulent fluid

Question 7

vesicle

Answer 7

pustule but smaller

Question 8

bullar = vesicle but larger

Question 9

features of measles

Answer 9

> 38.3°C or ‘felt hot’ if not measured, a generalised maculopapular rash lasting in excess of 3 days and at least one of: cough, conjunctivitis or coryza.

Question 10

management

Answer 10

1. a notifiable illness and notification is required based on clinical suspicion
2. symptomatic

Question 11

when is the mmr vaccine given

Answer 11

indicated in healthy unimmunised or partially immunised children if used within 72 hours of exposure to measles

Question 12

complications of measles

Answer 12

Otitis media
Bronchopneumonia
Laryngotracheobronchitis (croup)

Question 13

what is chicken pox

Answer 13

caused by the varicella zoster virus and is spread via respiratory droplets.

Question 14

management of chicken pox

Answer 14

1. oral acyclovir
2. Varicella zoster immunoglobulin (VZIG) should be given to neonates whose mothers develop the rash 7 days before or 7 days after the delivery, to reduce the risk of severe neonatal varicella.
3. paracetamol if pain or fever causing distress
4. topical calamine to alleviate itch

Question 15

timeline of chicken pox

Answer 15

coryzal-type illness with itchy fluid filled vesicles, which progress over the trunk around 3-5 days.

It is possible to be infected with no symptoms. Fever tends to resolve by day 4.

Question 16

advice to adult with chickenpox

Answer 16

Encourage adequate fluid intake to avoid dehydration.

Dress appropriately to avoid overheating or shivering.

Wear smooth, cotton fabrics.

Keep nails short to minimize damage from scratching and secondary bacterial infection from scratching.

Question 17

sx of croup

Answer 17

sudden onset of a seal-like barking cough. Hoarse voice is also common

worse at night and increase with agitation.

Question 18

ddx for croup

Answer 18

epiglottis

upper airway foreign body

Question 19

management of croup

Answer 19

1. consider the need for hospital admission
2. give oxygen whilst awaiting hospital admission
3. severe fever or pain - paracetamol or ibuprofen
4. advise regular fluids regularly

Question 20

how are lice detected

Answer 20

detection combing with fine toothed head lice detection comb

can be done on wet or dry hair

live louse must be found in order to confirm active head lice infestation

Question 21

management of lice

Answer 21

all members of the household and close contacts should also be checked for head lice.

treat with wet combing via bug buster kit

physical pesticide

chemical or traditional insecticide

Question 22

general advice about headline

Answer 22

1. children being treated for headlice can still attend school
2. there is no evidence headline prefer dirty or clean hair
3. provide information via NHS leaflets

Question 23

bronchiolitis

Answer 23

if child does not require hospital admission (give oxygen, whilst waiting)

assure parents it is usually self limiting

paracetamol or ibuprofen to treat sx

regular and good oral fluid intake, continue breast feeding ifd= doing so

safety net - becomes unresponsive, central cyanosis, increase resp effect - chest recession