Fever/rash Flashcards
causes of maculopapular rash
- measles
- rubella
- glandular fever
- kawasaki disease
- scarlet fever
3 features of scarlet fever
- strawberry tongue
- fever
- sore throat
features of kawasaki disease
- Conjunctivitis
- Rash (non vesicular, non bullae)
- Adenopathy: cervical + unilateral
- Stawberry tongue (redness of oral mucosa/lips/dry peeling lips)
- Hands/feet red
- Burn = fever 5 days
describe features of strawberry tongue
Redness of oral mucosa/lips/dry peeling lips
Describe the rash in kawasaki disease
non vesicular, non bullae
2 conditions with strawberry tongue
- kawasaki disease
- scarlet fever
2 conditions that present with a vesicular rash
- chickenpox
- eczema herpeticum
describe the course of the rash in chicken pox
Papulovesicles on erythematous base –> vesicles become encrusted, mucous membranes are involved
what are haemorrhagic rashes classified as (3)
- petechiae
- purpura
- ecchymoses
causes of haemorrhagic rashes
- immune thrombocytopenic purpura
- meningococcal septicaemia
- acute leukaemia
- henoch scholein purpura
- bleeding disorders
- non accidental injury
typical location of rash in HSP
thighs and buttocks
type of rash in meningococcal septicaemia
non blanching petechiael/purpuric rash
features of fever in kawasaki disease
high fever lasting > 5 days
and
unresponsive to antibiotics and antipyretics
4 out of the following 5 features for diagnoses of kawasaki disease
- cervical lymphadenopathy
- conjunctivitis: bilateral + non purulent
- rash (mucosal, polymorphous)
- strawberry tongue with red cracked lips
- peripheral skin changes (hands and feet red)
what may happen in 2-3 weeks following kawasaki disease
peeling of hands and feet
HSP type of vasculitis
IgA mediated small vessel vasculitis
features of HSP
- abdo pain
- polyarthritis
- rash
type of rash in HSP
raised red/purple spots/ palpable purpuric rash
buttocks, extensor surfaces of arms/legs
treatment for HSP
- analgesia
- supportive trx
pathophysiology of staphylococcal scalded skin syndrome
staph aureus –> infects skin –> releases toxin –> toxin damages outside layer of skin causing it to be shed/detached + peel and crust
small blisters appear at the site of the infection which easily burst and form blistering
treatment of staph scalded skin syndrome
- IV abx followed by oral for 5-8 days
- skin cleansing with soap substitute
- burns dressing
- pain killers
what is toxic shock syndrome
severe reaction to staphylococcal exotoxins
what are Koplik spots
tiny white spots seen early in measles; before the rash starts, and seen on the inside of the cheek
rash in measles
dark reddish/brown
features of measles
- koplik spots
- prodrome: irritable, conjunctivitis, fever
- rash
contraindications to live vaccine
- pregnancy
- immunosuppression
what is sepsis
a clinical syndrome caused by an overwhelming and dysregulated immune response to infection
renal abnormalities that predispose to infection
- renal pelvis dilatation
- cysts
- oligohydramnios
causes of proteinuria
- tubular disease
- glomerular disease
nephrotic range for PCR
> 200 mg/mmol
benefits of ACR
useful to differentiate between glomerular and tubular cause as albumin can be lost from glomerulus but not tubules
> 30 mg/mmol
triad of nephrotic syndrome
- massive proteinuria
- hypoalbuminaemia
- oedema
75% cause of nephrotic syndrome in children
minimal change nephrotic syndrome
pathophysiology of minimal change nephrotic syndrome
- inflammatory cell mediated damage to glomerular basement membrane resulting in increase in glomerular permeability
renal biopsy in minimal change disease
podocyte fusion
treatment of minimal change disease
1st line = steroids
2nd line = cyclophosphamide
complication of nephrotic syndrome and what can be given as prophylaxis to prevent this?
Spontaneous peritonitis
penicillin prophylaxis
3 congenital kidney malformations and their grading of severity
1) renal hypoplasia - fewer nephrons and glomeruli develop
2) renal dysplasia - undifferentiated tissue with little function
3) renal agenesis - kidney never forms
when do kidneys begin to form
5 weeks
most common renal anomaly
renal hypoplasia
upper uti symptoms
bacteriuria
fever
loin tenderness
under 3 months
lower uti symptoms
bacteruria
no systemic features
age greater than 3 months
investigations to consider in children with UTI
- renal USS: look at size, shape and location of kidneys; can identify hydronephrosis
- micturating cystogram: to identify VUR, bladder abnormalities, posterior urethral valves within a few weeks after treatment
what does renal agenesis cause in utero
oligohydramnios
what does oligohydramnios result in
- poor lung development
- potter sequence
what is potter sequence
oligohydramnios –> foetus compressed in the amniotic sac –> developmental abnormalities
- flattened face
- widely separated eyes
- low set ears
- clubbed feet
when do majority of children achieve day and night time continence
3-4 years of age
what is aneuresis
involuntary discharge of urine by day or night or both in a child greater than 5 years… in the absence of congenital or acquired defects of the nervous system or urinary tract
what is primary and secondary eneuresis
primary: child has never achieved eneuresis
secondary: child has been dry for at least 6 months before
causes of nocturnal eneuresis
- defective sleep arousal
- nocturnal polyuria
- lack of inhibition of bladder emptying during sleep and reduced bladder capacity
treatment of nocturnal enuresis if above and below 7 years
< 7 years –> eneuresis alarm
> 7 years –> desmopreasin
underlying causes of bedwetting
diabetes
constipation
uTI
what is VUR
abnormal backflow of urine from the bladder into the ureter and kidney
what is primary and secondary VUR
primary = dysfunction of valve at ureterovesical junction resulting in backflow of urine when the pressure in the bladder builds up
secondary = obstruction; caused by; recurrent uti, posterior urethral valve disorder, flaccid neurogenic bladder
AKI is
acute reversible rise in serum and creatinine and nitrogenous waste products coupled with inability of kidneys to appropriately regulate fluid and electrolytes
what is polycystic kidney disease
genetic condition where the kidneys become filled with cysts and enlarge
what can polycystic kidneys result in before birth
potter sequence
signs and symptoms of polycystic kidneys
- flank pain
- haematuria
- recurrent UTI
treatment for polycystic kidneys
- HTN with ACEi/ARB
- tolvaptan
cause of lyme disease
tick bite carrying borrelia burgdorfeli
symptoms in early disease of lyme disease
- erythema, non painful bite, arthralgia, malaise, fever
fever & sore throat. Tonsillitis, furred tongue, enlarged papillae, blanched punctate rash sparing face
Scarlet fever
describe rash in scarlet fever
Blanching punctate rash, sparing face
describe progression of rash in chicken pox
macular –> papular –> vesicular
prodrome in measles
irritable, conjunctivits, fever
describe rash in measles & the course
rash starts behind ears then to whole body then discrete maculopapular rash becoming blotchy & confluent
infection there child has Parotitis
mumps
symptoms of parotitis
ear ache, pain on eating
describe rash in rubella
pink maculopapular, initially on face before spreading to whole body, usually fades by day 3-5
slapped cheek syndrome/5th disease caused by?
Parovirus B19
cause of scarlet fever
Group A haemolytic streptococci
describe rash in scarlet fever
fine punctate erythema, sparing around the mouth
cause fo hand, foot & mouth disease
Coxsackie A16
viral cause of Croup
Parainfluenza viruses
