ENT, Eyes and Skin r/v, including viral exanthems

Question 1

features of chickenpox rash?

Answer 1

rash comes in crops for 3-5 days:
papules-vesicles-pustules-crusts
start on head and trunk, progress to peripheries
itchy
lesions may occur on palate
if new lesions appear beyond 10 days then suggests defective cellular immunity

Question 2

cause of chickenpox?

Answer 2

primary infection with VZV (human herpesvirus 3)

Question 3

complications of chickenpox?

Answer 3

in otherwise healthy children:
-secondary bacterial infection: staph, group A strep, can lead to TSS or nec fascit, consider sec bacterial infection if onset of new fever or persistent high fever after 1st few days.

• encephalitis: usually VZV-assoc. cerebellitis-usually about 1wk after rash onset, child ataxic with cerebellar signs, usually resolves within 1 mnth, can be generalised encephalitis, can be aseptic meningitis.
• purpura fulminans: result of vasculitis in skin and SC tissues. increased clotting risk in relation to VZV antiviral antibodies.

immunocompromised: -haemorrhagic lesions
- pneumonitis, viral pneumonia
- progressive and disseminated infection
- DIC
- nephritis
- arthritis
- pancreatitis

Question 4

cause of measles?

Answer 4

RNA paramyxovirus

spread by droplets

Question 5

presentation of measles?

Answer 5

prodrome: fever, irritable, conjunctivitis, cough
Koplik spots (before rash): white spots on buccal mucosa
RASH: discrete maculopapular rash starting from behind ears, spreads to involve whole body, becomes blotchy and confluent, may desquamate in 2nd week. develops 3 days after start of prodrome.

pt infective from prodrome until 4 days after rash starts

Question 6

complications of measles?

Answer 6

encephalitits-typical occurrence 1-2wks following onset of illness-headache, lethargy, irritability, proceeds to convulsions and coma.
subacute sclerosing panencephalitis-may px 5-10 yrs following initial illness
febrile convulsions
keratoconjunctivitis and corneal ulceration
giant cell pneumonia
secondary bacterial infecton and otits media
tracheitis
myocarditis
hepatitis
appendicitis
diarrhoea

Question 7

management of contacts of patient with measles?

Answer 7

if a child not immunised and comes into contact, then MMR vaccine should be given within 72hr

Question 8

complications of mumps?

Answer 8

acute pancreatitis

infertility

Question 9

complications of encephalitis that has developed as a result of measles?

Answer 9

seizures
deafness
hemiplegia
severe learning difficulties

Question 10

what is subacute sclerosing pancencephalitis?

Answer 10

rare illness that develops 5-10 years after measles infection
those affected usually had measles under the age of 2
caused by variant of measles virus that persists in CNS
px-loss of neurological function, progresses over several yrs to dementia and death
high levels of measles Ab in blood and CSF, characteristic EEG abnormalities

Question 11

measles tment?

Answer 11

symptomatic
infected children in hosptials need to be isolated
antiviral ribavirin may be use in immunocompromised children
Vit A given in developing countries to modulate immune response-children often Vit A deficient

Question 12

typical presentation of hand foot and mouth disease?

Answer 12

mouth ulcers followed by a rash classically affecting hands and feet but also face, buttocks, legs and genitals
other features=fever, anorexia, sore throat, abdo pain, cough
occurs in outbreaks e.g. at nursery

Question 13

cause of hand foot and mouth disease?

Answer 13

viral infection-pircornaviridae family-mostly coxsackie A16 and enterovirus 71

Question 14

tx hand foot and mouth disease?

Answer 14

simple tment measures-analgesia, antipyretic, hydration
keep child off school if unwell
reassure no link to disease in cattle

Question 15

likely cause of infection in an infant aged between 9 and 12 months with high fever, assoc. febrile convulsions and after a few days develops maculopapular rash on the chest?

Answer 15

herpes virus 6=roseola infantum

may be assoc. diarrhoea and cough

Question 16

viral cause of ‘slapped cheek syndrome’?

Answer 16

parvovirus B19-rash characteristically on cheeks then spreads

Question 17

most common complication of scarlet fever?

Answer 17

otitis media

Question 18

cause of scarlet fever?

Answer 18

Group A haemolytic strep

Question 19

viral cause of roseola infantum?

Answer 19

human herpesvirus 6

Question 20

features of roseola infantum?

Answer 20

high fever, followed a few days later by maculopapular rash-affects trunk and limbs, not itchy
febrile convulsions
cough
diarrhoea

Question 21

what is a port wine stain?

Answer 21

this appears as a flat purple/dark red patch on the skin, commonly on the face, from birth (although may become more noticeable with time), which is unlikely to resolve on its own (may need laser therapy)
result of malformed dilated capillaries

Question 22

features of scarlet fever?

Answer 22

• fever
• malaise
• tonsillitis
• strawberry tongue (also seen with kawasaki disease)
• rash-fine punctate erythema (pin head), generally appears 1st on torso, although children often have a flushed face and perioral pallor. desquamation occurs later in course of illness.

Question 23

scarlet fever management?

Answer 23

• throat swab normally taken but antibiotic treatment should be started immediately
• oral penicillin V (azithromycin if pen allergic)
• children can return to school 24hrs after starting antibiotics
• notifiable disease

Question 24

scarlet fever complications?

Answer 24

• otitis media
• rheumatic fever-20 days post infection
• acute glomerulonephritis-10 days after infection

Question 25

supportive management of chickenpox advised?

Answer 25

• keep cool, trim nails
• calamine lotion
• school exclusion until all vesicles have crusted over

*note immunocompromised patients should get VZIG, and if chickenpox develops IV aciclovir should be considered.

Question 26

most common type of juvenile idiopathic arthritis: joint inflammation for at least 6 wks in child under 16yrs of age, with all other causes excluded?

Answer 26

oligoarticular:
child often under the age of 6 with 1-4 joints affected-swelling, stiffness and reduced movement, limited pain
child otherwise well
commonly knee and ankle

Question 27

how is JIA diagnosis made?

Answer 27

clinical diagnosis
investigations:
FBC-normocytic anaemia, raised WCC, mild thromobcytosis
raised ESR, CRP
ANA
RF, HLA-B27
viral or bacterial serology
joint aspiration if suspect septic arthritis

Question 28

JIA drug management?

Answer 28

• NSAIDs
• intra-articular steroids
• PO steroids for quick symptom relief, but risk of growth suppression and bone demineralisation. Topical steroids for eye involvement (*risk of glaucoma, cataracts-posterior subcapsular)
• MTX-1st line if multiple affected joints
• sulfasalazine and leflunoamide
• etanercept

Question 29

complications of JIA?

Answer 29

• joint contractures and deformities
• uveitis, can cause blindness, need regular -ophthalmological r/v
• growth restriction-related to degree of inflammation
• osteoporosis
• psychosocial problems