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Paediatrics > Infection and Rashes > Flashcards

Infection and Rashes Flashcards

1
Q

Define Macule

A

flat lesion ,usually a circumscribed change of colour

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2
Q

Define Papule

A

small , solid, elevated lesion

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3
Q

Define Nodule

A

a large , solid , palpable and elevated lesion

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4
Q

Define Plaque

A

Plaque – a lesion slightly raised over a larger area

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5
Q

Define Blister

A

Blister – an elevated lesion ,fluid filled

lesions

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6
Q

Define Ulcer

A

Ulcer – depressed lesion with loss of surface epithelium

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7
Q

Define Atrophy

A

Atrophy – a depressed lesion with intact surface epithelium

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8
Q

Define Crust

A

Crust – a mixture of scale and serum – yellowish accretions on the surface of a lesion

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9
Q

Define Petechiae

A

Petechiae – non raised red-brown non blanchable

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10
Q

Chicken pox virus

A

Varicella Zosta Virus

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11
Q

Stages of chicken pox

A

Virus enters upper respiratory tract
Day 4-6: Viraemia
Incubation period 10-14 days can be longer
First symptom pyrexia for up to 4 days
Headache, malaise, abdo pain
Crops of vesicles over 3-5 days on head neck and trunk (sparse on limbs)
Papule to Vesicle to Pustule to Crust

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12
Q

Management of chicken pox

A

analgesia – paracetamol for discomfort and pyrexia.
pruritis – antihistamine or calamine lotion
acyclovir only for those at risk of complications or immunocompromised.

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13
Q

Impetigo

A

Very common superficial, contagious, blistering bacterial infection

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14
Q

Types of impetigo

A

Non Bullous: Group A beta haemolytic strep pyogenes

Bullous: Fluid lesions (Staph. Aureus)

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15
Q

Presentation of non bullous impetigo

A

More common 70%
Usually aymptomatic. Occasionally pruritic
Tiny pustules or vesicles that evolve to honey coloured crusted plaques <2cm.
On face. Can be at extremeties where bites , abrasions, lacerations, burns, scratches or trauma could have occurred. Regional lymph nodes enlarged
Little or no surrounding erythema

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16
Q

Presentation of bullous impetigo

A

Occasionally pruritic. Can be painful
Usually on the face, trunk, extremities, buttocks, or perineal regions.
More common in neonates
Thin roofs and tend to rupture spontaneously

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17
Q

Diagnosis of impetigo

A

Clinical diagnosis if severe take swabs if:
?MRSA
It is severe or extensive
Recurrent or treatment is failing

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18
Q

Management of impetigo

A

Neonates: Abx, Erythromycin PO or Vancomycin IV (MRSA +)
Treatment superficial/limited: mupirocin, fusidic acid
Widespread cut. lesions: Oral Abx such as dicloxacillin or flucloxacillin, erythromycin
Deep tissue/systemic infection: Parenteral antibiotic therapy with nafcillin, oxacillin, or clindamycin

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19
Q

Erythema Multiforme

A

Hypersensitivity reaction resulting in papules forming over back of hands and feet spreading to trunk. Often involving the face. Papules then evolve to plaques and then typical target shaped lesions

Lesions have dusky red centre pale around it and then dusky red ring

Commonly associated with stevens johnson syndrome

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20
Q

Common infections associated with Erythema Multiforme

A

Herpes Simplex Virus
Mycoplasma Pneumoniae

Can also be:
Hep B, Epstein Barr virus, Cytomegalovirus and more (see BMJ)

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21
Q

Drugs associated with erythema multiforme

A

most commonly associated-Allopurinol

Recent drugs- Nevirapine, lamotrigine, sertraline, pantoprazole, tramadol
Antibiotics- Sulphonamides, including co-trimoxazole, penicillin cephalosporins, fluoroquinolones, vancomycin
NSAIDs- Piroxicam, fenbufen, ibuprofen, ketoprofen, naproxen, tenoxicam, diclofenac, sulindac
Anti-TB- Rifampicin, ethambutol, isoniazid, pyrazinamide
Anticonvulsants- Barbiturates, carbamazepine, phenytoin, valproate, lamotrigine

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22
Q

Classification of erythema multiforme

A

EM Minor: Typical targets or raised oedematous papules, with acral distribution, without involvement of mucosal sites and involving <10% total body surface area.
EM Major: Typical targets or raised oedematous papules, with acral distribution, with involvement of mucosal sites and involving <10% total body surface area.

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23
Q

Management of erythema multiforme

A

Supportive care to maintain hydration and prevent erosions from developing secondary bacterial infection

Treatment of suspected precipitating infections

Suppression therapy with antivirals if recurrent disease is caused by herpes simplex virus (HSV)

Topical or systemic corticosteroids to reduce inflammation.

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24
Q

Stevens Johnson Syndrome (SJS) and Toxic epidermal necrotitis (TEN)

A

More severe forms of eryrhema multiforme

SJS: <10% total body surface area (TBSA) involvement. Causes include Mycoplasma pneumoniae , viral infections, and vaccines, or drug-related.

TEN: >30% TBSA involvement. Drug-related

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25
Q

Clinical impression of stevens johnson syndrome and toxic epidermal necrotitis

A

Blisters or macules and flat atypical target lesions
diffuse erythema
Nikolsky’s sign (epidermal layer easily sloughs off when pressure is applied to the affected area)

Mucosal involvement presents with erosions or ulceration of the eyes, lips, mouth, pharynx, oesophagus, GI tract, kidneys, liver, anus, genital area, or urethra

One of the potential complications of SJS/TEN is mucosal involvement of the upper and lower respiratory tract, with vesicle formation, ulceration, and actual mucosal sloughing that may lead to laryngeal stridor, along with possible retractions and oedema of the nasopharynx

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26
Q

Wallace Rule of 9

A

Splits body into 9 parts allows assessment of the total body surface area an infection may cover:
Head and neck total for front and back: 9%
Each upper limb total for front and back: 9%
Thorax and abdomen front: 18%
Thorax and abdomen back: 18%
Perineum: 1%
Each lower limb total for front and back: 18%.

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27
Q

Management of SJS/TEN

A 
ABG and Oxygen sats to assess for respiratoy distress
Dressings with topical Abx
Fluid management
Analgaesia (avoid NSAIDs where possible)
Opthalmic consultation
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28
Q

Kawasaki disease

A

acute, febrile, self-limiting, systemic vasculitis of unknown origin that almost exclusively affects young children

29
Q

Presentation of Kawasaki disease

A

Fever lasting ≥5 days
Marked irritability of the child
Erythema, swelling and desquamation affecting the skin of the extremities
Bilateral conjunctivitis
Rash
Inflammation of the lips, mouth and/or tongue
Cervical lymphadenopathy

30
Q

Complications of kawasaki disease

A

development of an acute coronary artery vasculitis with dilatation or aneurysm formation.
In addition, KD may lead to myocardial infarction, sudden death, and ischaemic heart disease.

31
Q

Stages of kawasaki disease

A

Acute febrile stage: 1-2 weeks
Fever, irritability, cervical adenitis, conjunctivitis, rash, mucosal erythema, painful erythema of the hands and feet, arthralgia or arthritis, possible myocarditis, and pericarditis

Subacute: weeks 2-4

Fever, rash, and lymphadenopathy have resolved. Persistent irritability, poor appetite, and conjunctival infection, desquamation of extremities begins at this stage.

Patient may be completely asymptomatic if given intravenous immunoglobulin (IVIG)

Cardiac abnormalities develop

Convalescent weeks 4-8
All signs of inflammation have receded and acute phase markers normalise.
If present, coronary artery ectasia or aneurysms may persist and enlarge.

Chronic stage: If present, coronary artery dilation may resolve.
However, coronary artery aneurysms may persist through to adulthood. Such patients are at risk of subsequent coronary artery thrombosis, rupture, and myocardial infarction.

32
Q

Management of Kawasaki disease

A

Intravenous Immune Globulin 2g/kg x1
Aspirin 80-100 mg/kg/day until fever settled for 14 day, then
3-5mg/kg/day x ≥ 6-8 weeks
Consider corticosteroids and infliximab for second line management
Also ensure Echocardiogram is carried out and cardiology follow up where necessary

33
Q

Scabies

A

Highly contagious pruritic rash caused by parasitic mite sarcoptes scabiei. Manifests as rash usually 4-6 weeks after infection.

34
Q

Clinical presentation of scabies

A

Widespread pruritus. Usually worse at night or when the person is warm.
Skin lesions can be macules, papules, pustules or nodules. Lesions seen on the site of the burrows

Burrows may be visible as fine, wavy, greyish, dark or silvery lines, 2-15 mm long, sometimes with a minute speck (the mite) at the closed end

35
Q

Key investigations for scabies diagnosis

A

Clinical

Ink burrow test

36
Q

Scabies management

A

Clothes, towels, and bed linen should be machine-washed (at 50°C or above) to prevent re-infestation and transmission. Items that cannot be washed can be kept in plastic bags for at least 72 hours to contain the mites until they die.

-benzyl benzoate lotion ,apply for 24hours ,may be repeated in 1 week
-permethrin cream
Babies <2 months -5% sulphur ointment

37
Q

Measles

A

Highly infectious disease caused by measle virus (ssRNA Morbillivirus)

38
Q

Mode of transmission of measles

A

airborne via respiratory droplets.

39
Q

Measles symptoms

A

Prodrome - lasts 2-4 days with fever, runny nose, mild conjunctivitis and diarrhoea. Koplik spots are pathognomic and appear on the buccal mucosa opposite the second molar teeth as small, red spots each with a bluish-white speck (sometimes compared to a grain of rice) in the centre

Rash-first seen on forehead and neck and spreads, involves trunk and finally limbs over 3-4 days. It may become confluent in some areas. Rash then fades after 3-4 days in the order of its appearance. It leaves behind a brownish discoloration sometimes accompanied by fine desquamation.

40
Q

Complications of measles

A

Neuro
Acute demyelinating encephalitis
Subacute sclerosing panencephalitis
Measles inclusion body encephalitis

Gastro- Diarrhoea

Resp-Bronchopneumonia

VitA def, and blindness

Immunodeficiency

41
Q

Management of uncomplicated measles

A

paracetamol or ibuprofen and plenty of fluids. Patients should remain at home to limit disease spread.

MMR is already part of childhood immunisations

Post exposure prophylaxis of MMR vaccine to those who are susceptible (>6 months) ideally within the first 72 hours of exposure.

42
Q

Erythema infectiosum

A

AKA slapped cheek disease due to parvovirus B19

43
Q

Presentation of erythema infectiosum

A

Prodromal- week after infection. mild and may include headache, rhinitis, sore throat, low-grade fever and malaise.

Symptom free 7-10 days followed by slapped cheek rash. disappears after 2-4 days.

1-4 days after the facial rash appears, an erythematous macular/morbilliform rash develops on the extremities, mainly on the extensor surfaces.

Fades over the next 3-21 days

44
Q

types of napkin dermatitis

A

Contact:
prolonged exposure to urine and faeces, friction mild erythematous ,glazed appearance

Seborrhoeic dermatitis:
Cradle cap in babies
salmon coloured greasy lesions and a predilection for intertriginous areas

Candidiasis:
beefy red in colour with pin point pustulo-vesicular satellite lesion

45
Q

Management of napkin dermatitis

A

Frequent nappy changes
barrier cream zinc and caster oil
apply hydrocortisone 1% in aqueous cream bd
if candidiasis suspected -10% steriod and nystatin 20% in zinc cream

46
Q

Molluscum contagiosum virus (MCV)

A

Skin infection as a result of MCV of the POX family . Spread by direct contact usually through sports and by sharing towels, baths and gymnasium equipment.
MCV1 most common. MCV2 common in immunosuppressed.

47
Q

Presentation of Molluscum contagiosum

A

Firm, smooth, umbilicated papules, usually 2-5 mm in diameter
Usually it is asymptomatic but there may be tenderness, pruritus and eczema around the lesions
Usually on trunk an extremeties
No fever or malaise

48
Q

Management of molluscum contagiosum

A

Tend to heal spontaneously within 6 months – 1 year

- liquid nitrogen 2-3 weeks
- express contents with sharp curette
- benzoyl peroxide cream apply daily

49
Q

Eczema Tx

A

Emollient (Aveeno, E45)
Topical corticosteroids (1% hydrocortisone)
Occlusive bandages
Antibiotic with hydrocortisone for mildly infected eczema

50
Q

Infantile seborrhoeic dermatitis

A

Cradle cap
Mild case resolved by emollient
Scales cleared with low concentration sulfur and salycilic acid

51
Q

Urticaria

A

Hives normally due to viral infection or allergen exposure

52
Q

Haemangioma

A

Collection of small blood vessels causing lump under skin at risk of ulcerating.

53
Q

Common paediatric haemangiomas

A

Strawberry naevus: appear in first month and grow till 3-15months before reducing no need for treatment but can use topical propanol to speed process

Sturge-Webster syndrome: port wine stain facial lesions in distribution of trigeminal nerve. Can present with epilepsy, intellectual disability or contralateral hemiplagia

54
Q

Diabetes triad

A

Polydypsia
Polyurea
Weight loss

55
Q

Diagnosis of diabetes

A

Random glucose >11

Fasted glucose >7

56
Q

Complications of diabetes

A

Hypoglycaemia

Diabetic ketoacidosis

57
Q

Hypoglycaemia symptoms

A

Hunger
Tummy ache
Sweating
Feeling faint or dizzy

58
Q

Signs of diabetic ketoacidosis

A 
Acetone breath
Vomiting 
Dehydration 
Abdo pain
Hyperventilation (kussmajl breathing)
Hypovolaemic shock 
Drowsiness
Coma and death
59
Q

Diabetic ketoacidosis ranges

A 
Glucose >11.1
Ketones >3
U&amp;E, creatinine (dehydration)
Blood gas analysis (acidosis)
T wave changes in hypokalaemia
Weight loss
Evidence of precipitating cause.
60
Q

DKA management

A

Fluids: 0.9 saline 40mmol KCl 12h, 5% glucose added when <14. After 12hr id plasma stable 0.45 saline 40 mimol KCl

Insulin infusion 0.1 U/kg per Hr

Potassium as will fall when infusion starts

Avoid bicarbonate for acidosis should revolve with fluids

Restablish oral fluids

Identify cause

61
Q

Hand foot and mouth disease

A

Painful vesicular lesions on hands, feet, mouth and tongue occasionally buttocks

62
Q

Fifth disease

A

Human parovirus b19.
Slapped cheek rash, progressing to trunk
Aplastic crisis- in children with high red blood cell turnover or compromised immune system

63
Q

Erythema toxicum

A

Common benign condition in neonates usually between 2-5 days. More common in full term neonates. Combination of macule, papule and pustules.

64
Q

Hand foot and mouth disease

A

Coxsackievirus A16 virus and enterovirus 71

65
Q

Hand foot and mouth disease presentation

A

Prodrome : Low grade fever, malaise, loss of apettite. sore mouth cough abdo pain

Hand foot and mouth lesions

66
Q

Hand foot and mouth Tx

A

Supportive. No treatment
Refer if neurological symptoms occur (myoclonic jerk, severe headaches, or encephalitis -
Symptoms tend to resolve within 10 days

67
Q

Glandular fever (infectious mononucleosis)

A

Epstein Bar virus

68
Q

IM presentation

A 
Low grade fever
Malase
Sore throar
Non pruritic rash
Nausea 
Arthralgia

Paediatrics (12 decks)

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