Common pediatric skin infections

Question 1

Description of Impetigo?

Answer 1

discrete purulent lesions, usually multiple coleascing lesions on face (perioral and perinasal) and extremities. initially are small vesicles r pustules that rupture and become honey colored crusts with moist erythematous base. regional lymphadenopathy present.

two typs:bullous or nonbullous.

bullous will rupture and then lacquer like crust forms.
nonbullous begin as papules and and evolve into vessibles w/erythema. pusutules break down, form crusts. usually self limiting in 2 weeks.

high incidence 2-5 years old.

Question 2

cause of impetigo?

Answer 2

gram positive group A streptococci, staphylococcus aureus (usually bullous), strept pyrogenes or mix

Question 3

what is ecythma?

Answer 3

deep ulcers associated with impetigo

Question 4

Treatment of localized impetigo?

Answer 4

mupirocin topically (bactroban or centany)

alt: retapamulin (altabax)

less effective: bacitracin and neomycin and NOT recommended

Question 5

Tx of impetigo w/numerous lesions or not responding to topical?

Answer 5

Need: stability against beta lactamase and against gram positive S aureus and streptococcus

options: dicloxacillin, cephalosporin (first or second generation)

Question 6

MRSA impetigo tx?

Answer 6

TMP- SMX or clindamycin

alt: doxycycline and minocycline but not in children

Question 7

How long after antibiotic tx before can go back to school?

Answer 7

24 hours

Question 8

Tx mild acne?

Answer 8

benzoyl peroxide or topical retinoid.

alt: BP + antibiotics or all three

Question 9

mild acne definition?

Answer 9

fewer than 20 comedones or

Question 10

moderate acne definitions?

Answer 10

total lesion count 30-125, 20 -100 comedones or 15-50 inflamm lesions

Question 11

severe acne definition?

Answer 11

more than 5 nodules or total inflamm lesion count > 50 or total lesion count > 125

Question 12

SE of accutane?

Answer 12

idiopathic intracranial hypertesion, hypertrigluceridemia, elevated hepatic enzymes, cheilitis , altered mood

Question 13

oral antibiotics used for acne?

Answer 13

doxycycline, minocycline, clindamycin, erythromycin, azithromycin

Question 14

topical antibiotics used for acne?

Answer 14

clindamycin, erythromycin, tetracycline

Question 15

tx moderate acne?

Answer 15

topical combo: BP, retinoid, antibiotic in various arrangements

alter: oral antibiotic with topical combo

Question 16

tx severe acne?

Answer 16

combination therapy = oral antibiotics + topical retonioid + BP +- oral isoretinoin

Question 17

Rabies risk in what type of bites?

Answer 17

bat, raccoon, skunk,

Question 18

tx of bat, racoon, or skunk bite?

Answer 18

amoxicillin with clavulante, 875 mg/125 mg BID or 500 mg/125 mg TID

alter: doxycycline 100 mg BID

rabies immunoglobulin and vaccine

Question 19

tx cat bite?

Answer 19

amoxicillin with clavulante, 875 mg/125 mg BID or 500 mg/125 mg TID

alter: cefurozime, 0.5 g BID, doxycycline 100 mg BID

culture and tx empirically –>
switch to penicillin if P multicoda present

Question 20

tx dog bite?

Answer 20

amoxicillin with clavulante, 875 mg/125 mg BID

altern: clindamycin 300 mg QID + flouroquinolone
or
clindamycin with TMP-SMX

tx only if high risk

Question 21

tx human bite?

Answer 21

amoxicillin with clavulante, 875 mg/125 mg BID for 5 days

if later after bite or signs of infection - parental therapy with ampicillin with sulbactam, cefixutub

PCN alergy: clindamycin wit cpirofloxacin or TMP SMX

Question 22

tx rat bite?

Answer 22

amoxicillin with clavulante, 875 mg/125 mg BID

alt: doxycycline, rabies not indicated!

Question 23

pig or swine bite tx?

Answer 23

amoxicillin with clavulante, 875 mg/125 mg BID

alter: parenteral third-generation cephalosporin

Question 24

tx nonhuman primate?

Answer 24

acyclovir

Question 25

What type f burns can be treated in outpatient setting?

Answer 25

10% BSA or less, second-degree or lower, ad not involving foot or hand

Question 26

What bacteria can colonize burns and cause infections?

Answer 26

staphylococcus aurea or CNS, enterococci or pseudominea aureg, E coli, klebsiella pneumoniae

Question 27

mafenide acetate or silver sulfadiazine are used for what?

Answer 27

infection prevention

Question 28

first and second degree burns defined as?

Answer 28

erythema, hyperemia, and pain

first degree- skin blanches easily
second degree - blisters and raw moist surface
third - pain may be minimal and white nd leathery

Question 29

rubella description?

Answer 29

mild viral illness involving skin, lymphadenopathy (suboccipital, postauricular, anterior and posterior cervical nodes) and joints at times. droplet based.

incubation 14-19 days and onset rash on 15 day. appearance of exanthem rash.discrete macules on face. spreads to neck, trunk, and extremities. macules coalesce on trunk. rash lasts 1-3 days. desquamation occurs.

adults can have fever, sore thraot, rhinitis.

Question 30

diagnostics for rubella?

Answer 30

Not necessary. no clinical basis. but could do CBC, culture from pharynx. OgM antibody.

Question 31

tx rubella?

Answer 31

self limitiing. rest and fluids. contagious 7 days post rash onset. tylenol.

Question 32

measles description?

Answer 32

incubation 7-14 days. first sign is high fever (> 104), prodrome - maliase, anorexia, and triad of 3 C’s (conjuctivitis, cough and coryza.)

enanthem - appears 2-4 days after onset of prodrome. koplik spots, lasts 5-7 days before fade into coperry brownhyperpigementation that desquamate.

rash - 14 days after exposure, blanching macules and papules on face. within 48 hours coalesce into patches and plaques and spread to trunk and extremitieies, palms, ans soles.

total time - 7-10 days!

Question 33

diagnostics for measles?

Answer 33

clinical pciture. can do IgM and IgG. PCR. viral swab.

Question 34

tx measles?

Answer 34

vitamin A, support of fluids.

Question 35

what are koplik spots?

Answer 35

bluish grey specks or grains of sand with red base spots inside cheeks during measles.

Question 36

scarlet fever description?

Answer 36

caused by GABHS complication. onset of fever, sore throat, HA, n/v, abdominal pain, mayalgias. rash appears 12-48 hours after fever on neck and travels. feels like sand paper

day 1 -5 white strawberry tongue, red strawberry tongue next.

edaematous exudative tonsils.

desquamation occurs 7-10 days after rash resolution.

Question 37

scarlet fever diagnostics?

Answer 37

throat culture. titer!

Question 38

tx scarlet fever?

Answer 38

PCN VK or erythromycin x 10 days.

or cingle PCN GB IM.

can consider first generation cephalosporin.

Question 39

Kawasakis disease description?

Answer 39

acute febrile vasculitis syndrome of early childhood, could lead to CAA. most often starts with prolonged fever. irritability,

THEN! 3 stages - acute, subacute, and convalescent.

acute - abrupt fever for 7-14 days, 102 -104. Non responsive to antipyretics. nonexudative bilateral conjunctivitis, anterior uveitis, erythema and edema on hands and feet. strawberry togue. lymphadenopathy.

subacute stage - fever abated. week 406. desquamation of digits, thromboyctosis, and CA develop.

convalescent phase - 3 mo. all normal except nails might have grooves.

Question 40

Diagnostic of Kawasakis dx?

Answer 40

4 of the five clinical features.

1. peripheral extremity changes (redenneing edema or desqaumation)
2. polymorphous rash
3. oropharyngeal changes - erythema, fissuring, crusting of lips, strawberry otngue, diffuse mucosal injection
4. bilateral nonexudative painless bulbar cinjuctivitis
5. acute nonpurulet cervical lymphadenopathy. usually unilaeral.

FEBRILE!!! (fever, enanthem, bulbar conjcutivits, rash, internal organ involvement, lymphaden, extremitiy changes)

labs: ESR, CRP, alpha 1 antitrypsin.

Question 41

manage kawasakis?

Answer 41

ecg! at time, 2 weeks, and 6-8 weeks. on presentation.

Question 42

tx kawasakis?

Answer 42

full dose IVIG. high dose ASA.

resistent to IVIG - methtrexate or cyclophophamide,

risk of Coronary aneurysm - infliximab, antiplatet, anticoag

Question 43

erythema infectiosum description.

Answer 43

slapped cheek appearance and lacy exanthem r/t human parovirus B19 and erythrovirus.

Question 44

symptoms od erythema infectiosum?

Answer 44

HA, fever, sore throat, pruritis, coryza, abdominal pain, arthralgias.

phase 1 - exanthem and slapped cheek fades over 2-4 days. nasal and perioral and periorbital sparing.

phase 2 - erythematous maculopapular rash on extremitis and trunk and that fades to lacelike reticular pattern

phase 3- freq clearing and recurrences for weeks or months due to stimulus. can have polyarthropathy.

Question 45

diagnostics of erythema infectio?

Answer 45

clinical presenation alone. IgM, dot blot, PCR,

Question 46

tx of erythema infectio?

Answer 46

self limiting. NSAIDS for symptoms. topical antipruritics and oral anithistamines. fluids and rest.

Question 47

roseola description?

Answer 47

common 9-12 month old infant. HHV - 6 causing agent.

onset with fever. 3 days later, defervescence and morbilliform rash. rose -pink macules and maculopapules.

nonspecific complaints. common febrile seizure.

Question 48

daignostics roseola infantum?

Answer 48

IgM, immunoblot. work up for seizures if indicated.

Question 49

tx for roseola?

Answer 49

self limiting. antipyretics.