Dermatology

Question 1

describe this and what is it?
How do you treat it?

Answer 1

Swelling right occipital region
Erythematous
Loss of hair

Kerion - fungal infection

Treat - Supportive: Simple analgesia e.g. paracetamol 1g PO Q6H PRN
Specific: 6-8 weeks ORAL antifungal (itraconazole, terbinafine, griseofulvin)

Question 2

Describe this rash
What could it be?
Management

Answer 2

• *multiple vesicles with erythematous base
• crusted
• lower lip and eyelid involvement
• coalescing around cheek

Dx:
Impetigo
eczema herpticum
chicken pox
SJS
HFM with secondary infection

Mx
Analgesia plus dose
treat condition - abx, antiviral eg fluclox 50mg/kg IV
look for complications - shock, dehydration, meningism, systemc infection

Question 3

describe rash
differentials

Answer 3

widespread erythematous rash, bullae, scolded skin, covers majority of body

Dx
Toxic epidermal necrolysis, SJS, staph scolded skin syndrome, erythematous drug reaction, erythroderma

Question 4

how do you differentiate TEN and SJS

How do you manage them?

What are the complications?

Answer 4

●SJS – skin detachment of <10 percent of BSA
●TEN – skin detachment of >30 percent of BSA
●SJS/TEN overlap – skin detachment of 10 to 30 percent of BSA

Management:
Supportive:
wound care, analgesia, hydration (electrolyte and nutrition), ocular care, monitor for infections and strict infection control measures
may beed ICU if severe

Complications
* massive fluid loss and hypovolemia and electrolyte imbalnce
* renal failure
* bacteramia
* multi organ failure
* insulin resistance
* * s.aureus infection plus aeriginosa - pneumonia common

Question 5

What are the common causes of SJS/TEN

Answer 5

Medications:
Allupurinol
Abx - beta lactams
Anticonvulsants - lamotrigine, phenytoin, carbamazepine
analgesics - padanol and oxicam NSAIDS
Omeprazole

Infections
mycoplasma pneumonia
CMV

Question 6

What are two risk factors for TEN/SJS/Staph scolded skin?

Answer 6

HIV/Aids
Lupus
Lymphoma/leukemia

Question 7

Describe rash
What is it?

Answer 7

involves palms, macular, target lesions, erythematous - discrete and miultiple sites

Erythema multiforme

Question 8

What are the causes of erythema multiforme?

Answer 8

malignancy
infections - Mycoplasma, HSV
Cephalasporins
Carbamazepine

Question 9

What are some other differentials for erythema multiforme and what makes you think that?

Answer 9

Syphillis - serology, primary chancre
Gonoccoameia - sexual history, urine PCR, PID
HFM - Age, lesion elsewhere, source eg daycare

Question 10

What is this rash?
What features support it?
What are complications?
What would suggest the need for admission?

Answer 10

Facial Herpes Zoster
clusters of vesicles, unilateral, confined to one dermatome, surrounding erythema

Complications
* * Added bacterial infections
* * keratitis, uveitis, acute angle glaucoma, optin neuritis, ramsay hunt, cranial nerve palses, meningoencephalitis, post herpetic neuralgia

Admission
severe ocular involvement affecting globe
suspicions of disseminated infection eg cranial
high analgesia requirement eg iv opiates
immunocompromised

Question 11

Differentials
What things do you need to assess for?

Answer 11

SJS/TEN/Staph scolded skin, erythema multiforme

Assess for:
degree of skin involvement
involvement of mucosal surfaces (oral, genital, GI, optic)
blisters and vesicles
nikolskys sign - mechanical pressure causes shedding
target lesions

Question 12

Describe and what is it?

Answer 12

Erythema multiforme:
mutiple lesions of difference sizes
target lesions with central clearing
discrete lesions
mention where the leisons are

Question 13

What else could TEN/SJS be?

Answer 13

staph scolded skin
bullous pemphigoid
pempigus vulgaris
sunburn
herpes simplex
herpes zoster
mustard gas
insect bites
kawasaki disease

Question 14

Describe, diagnosis, management

Answer 14

location - swelling right occiput, loss of hair, large, erythema
Kerion - fungal infection (fungal abscess)

management
Analgesia - paracetamol and ibuprofen
6-8 weeks of oral anti fungal eg terbinifine

Question 15

Describe

Answer 15

on both legs, upper things - petichial, multiple discrete erythematous lesions, bruises, purpura

Question 16

differentials

Answer 16

WIDE

Question 17

What is the main indication to consider transfusion in ITP

Answer 17

significant bleeding/intercranial haemorrhage
platelets under 10

Question 18

describe clinical features
What pathogens can cause this?
Other differentials

Answer 18

child looks unwell - location (arms face torso) petichial and purpuric

n.meningitidis, strep pneumonaie, staph aureus, haemophilus influenzae

SJS/TEN/viral/ lupus/DiC from malignancy

Question 19

Important investigations and why
initial treatment
complications of meningitis

Answer 19

IV abx ceftriaxone 50mg/kg and vanc 30mg/kg
20ml/kg fluid bolus

complications
DIC
death
brain injury
amputations
ischaemic heptatitis

Question 20

What can cause petichiae with fever

Answer 20

meningitis/septicaemia
ITP
HSP’
viral infection eg flu
leukemia
any illness causing coughing or vomiting

Question 21

With petichial rash what would suggest serious bacterial infection?

Answer 21

drowsiness, decreased LOC
abnormal vitals
poor perfusion
rapidly progessive symptoms

Question 22

describe
differentials

Answer 22

state of child - alert
location - face and shoulders, erythematous, papular, areas of confluence
negatives - not affecting mucous membranes, no conjunctivitis

Differentials;
measles
viral rash
urticaria
scarlet fever
erythema multiforme
kawasaki

Question 23

list and justify four investigations

Answer 23

measles PCR - nasopharyngeal swab
CRP/ESR for kawasaki
strep- throat cultures