Infections/Rash

Question 1

Important differentials for a fever + rash in a child

Answer 1

Scarlet fever - blanching sandpaper like rash on chest/abdo.
Kawaski ideas - red rash and strawberry tongue.
Scalded skin/Staph aureus - blisters, rupture, skin peeling.
Measles - erthymatous maculopapular rash
Rubella - maculopapular rash from behind ears

Question 2

Clinical features of scarlet fever, treatment and causative organism

Answer 2

10 days of penicillin e.g Phenoxymethylpenicillin
Notify PHE!
Sore throat
Fever
Heachache
Sandpaper texture rash on abdo/chest and skin folds
Strawberry tongue
Flushed face
Swollen cervical lymph nodes
Group A strep e.g. Strep pyogenes.

Question 3

Criteria for Kawaski disease diagnosis

Answer 3

MY HEART
Fever for 5 days and 4 out of 5 of MY HEART
M(y) - Mucosal involvement (dry lips, strawberry tongue)
H - Hands and feet reddening, oedema, peeling.
E - Eyes non-purulent bilateral conjunctivitis.
A - Adenopathy/lymphadenopathy and cervical swelling.
R - rash usually on trunk, erthymatous.
T - Temperature of persistent high fever.

Question 4

Pathophysiology of Kawaski disease

Answer 4

Vasculitis
6months-4yrs old
More common in Japanese and Afro-carribean
immune hyperactivity due to trigger e.g. genetic.

Question 5

Complications fo Kawaski disease

Answer 5

Coronary artery aneurysm - echocardiogram patients!

Question 6

Investigations of Kawaski’s

Answer 6

High CRP and ESR
High WCC
Unremitting high temperature
Platelets increase in second week

Question 7

Treatment of Kawaski disease and side effects

Answer 7

IV immunoglobulins (SE = anaphylaxis, headache, n+v)
Aspirin (increase bleeding and bruising)

Question 8

Other form of Kawaski Disease

Answer 8

Incomplete/Atypical - not all clinical symptoms present.

Question 9

Encephalitis pathophys

Answer 9

inflammation of the brain parenchyma

Question 10

Causes of encephalitis

Answer 10

HSV (acute viral), mumps varicella zoster, parovirus.
Post-infective
Post measles

Question 11

Rx of encephalitis

Answer 11

Acyclovir for HSV

Question 12

Organism for toxic shock syndrome

Answer 12

S.aureus

Question 13

Organism for impetigo

Answer 13

Staph or strep e.g. S.aureus

Question 14

Is impetigo contagious?

Answer 14

HELL YES don’t go to school until lesions dry over

Question 15

Organism and features of scalded skin

Answer 15

S.aureus
Fever
Malaise
Crusting skin blisters
Erythema
Tender skin
Skin peeling

Question 16

Rx for whooping cough

Answer 16

notify phe and azithromycin

Question 17

Pathognomonic of Measles and rash description

Answer 17

Koplik’s spots in buccal mucosa.

macular rash starting behind ears, blotchy becoming confluent.

Question 18

Pathognomonic of rheumatic fever

Answer 18

Aschoff bodies

Question 19

Organism in Measles

Answer 19

Paramyxovirus

Question 20

Organism in slapped-cheek

Answer 20

Parvrovirus B19, erythema

Question 21

Organism in scalded skin and rash

Answer 21

S.aureus.

Pustular, blistering rash with skin peeling.

Question 22

Organism in hand foot and mouth disease

Answer 22

Coxsackie A16 virus