Fever and a Rash

Question 1

What do papular and macular rashes have in common? What is different?

Answer 1

Both are blanching

Papular is raised, macular is flat

Question 2

DDx for fever and petechiae and purpura?

Answer 2

Infection

• Viral - enterovirus
• Bacteria - meningococcal, pneumococcal, Hib

Non-infectious

• HSP
• ITP & disorders of platelet function
• HUS
• Leukaemia, bone marrow infiltration
• Traumatic/mechanical
  
  • Cough, torniquet

Question 3

What are some factors that indicate a fever + petechiae is bacterial sepsis?

Answer 3

Unwell
Abnormal white cell count
Purpura

Question 4

What are some other presenting features of meningococcal?

Answer 4

Leg or muscle pain
Rigors
Cold hands and feet
Purpura

Question 5

How is meningococcal Ix?

Answer 5

Blood cultures
CSF
PCR
?Skin biopsy

Question 6

How is meningococcal Mx?

Answer 6

Abx: 3rd gen cephalosporins
Intensive supportive management
Notifiable disease
Chemoprophylaxis less than 24 hours - rifampicin, ceftriaxone (pregnancy) - for household contacts

Question 7

What is the role of rifampicin in meningococcal?

Answer 7

Decolonisation

Question 8

What are the complications of meningococcal?

Answer 8

Shock
DIC
Adrenal haemorrhage
Gangrene
Developmental delay
Hearing loss

Question 9

What is the organism in roseola?

Answer 9

Human herpes virus 6

Question 10

What is the rash in roseola?

Answer 10

Non-pruritic, painless
Maculopapular
Typically confined to the trunk

Question 11

What is roseola associated with?

Answer 11

Febrile convulsions

Question 12

When does the rash appear in slapped cheek?

Answer 12

At the end

Question 13

What is the course of slapped cheek?

Answer 13

Prodrome: fever, diarrhoea, coryza

Rash once well

Question 14

What is a complication of slapped cheek?

Answer 14

Arthritis
Myocarditis
Transient Aplastic crisis

Hydrous fetalis

Question 15

What are the 3 C’s of measles? And other symptoms?

Answer 15

Conjunctivitis
Coryza
Cough

Fever
Koplik’s spot
Rash

Question 16

What is the natural history of measles?

Answer 16

10 days of asymptomatic period
4 days of infectious prodrome
Rash up to 10 days

Question 17

What are the complications of measles?

Answer 17

Pneumonitis and pneumonia - 55% (staph usually)
Encephalitis - 1/1000
Subacute sclerosing panencephalitis
Death in 1/300
Foetal death

Question 18

How do you protect susceptible measles contacts?

Answer 18

MMR vaccination if within 72 hour
Ig if between 72 and 7 days
- If less than six months, no Ig unless mother is case or has no immunity

Question 19

How does rubella present?

Answer 19

Prodrome: fever, sore throat, red eyes, headache, malaise, lymphadenopathy (peri-auricular)

Erythematous, fine maculopapular rash
Face > body > limbs

Mild illness

Question 20

What do you worry about with rubella?

Answer 20

Congenital rubella

Question 21

How does scarlet fever present?

Answer 21

Acute pharyngitis

Widespread sandpaper like rash with peri-oral sparing

Question 22

What causes scarlet fever?

Answer 22

Strep pyogenes

Question 23

How does toxic shock present? What causes it?

Answer 23

Toxin mediated rash

Toxins from Staph aureus, Group A strep
Tampon use

Question 24

How is toxic shock Mx?

Answer 24

Circulatory support

Abx
- IV penicillin, fluc, clindamycin, Ig

Question 25

What are the features of kawaski’s?

Answer 25

Desquamation of finger tips and genitals
Rash hands and feet
Conjunctivitis 
Cervical lymphadenopathy
Strawberry tongue
Dry cracked lips

Question 26

What the mnemonic for KD?

Answer 26

C - Conjunctivitis
O - Oedema
L - Lymphadenopathy
D - Dry cracked lip, desquamation

S - Strawberry tongue
O - Ongoing fever
R - Rash
E - Erythema

A - Aspirin
E - Echocardiogram
I - Ig
O - anti-steptolysin O
U - Up to date with vaccinations

Question 27

What are some complications of KD?

Answer 27

Coronary aneurysms

Question 28

How does chicken pox present?

Answer 28

Prodrome: fever, malaise, anorexia
Rash: pruritic macules, papules, chest

Question 29

How is chickenpox treated?

Answer 29

Aciclovir

- Only if neonate, immunocompromised, pneumonia, older kids

Question 30

When get secondary prophylaxis?

Answer 30

Pregnant women

Neonates whose mother develops peri-delivery

Question 31

What is erysipelas?

Answer 31

Infection of upper dermis and superficial lymphatics

Question 32

What is the classic sign of necrotising fasciitis?

Answer 32

Pain out of keeping with clinical signs