Paediatrics (2)

Question 1

What is eczema?

Answer 1

chronic inflammatory skin condition which causes dry, scaly + itchy red skin, flares manage with topical CCS + antihistamines. Uncommon < 2YO (consider seborrheic dermatitis)

Question 2

Common eczema triggers

Answer 2

Irritant allergens/ clothing, skin infections (Staph. aureus), contact allergens (e.g. perfume), inhalant allergens, climate, teething, stress

Question 3

Clinical presentation of eczema

Answer 3

Dry scaly itchy red skin. Episodic (2-3 x a month). Pattern varies w/ age:
Infant: scalp/ face/ flexures +/- hair loss
Child: flexural, around mouth/ chin, excessive scratching → lichenification
Atopic comorbidities (asthma/ allergic rhinitis)

Question 4

What is the atopic triad?

Answer 4

Asthma, atopic eczema, allergic rhinitis

Question 5

Infant vs. child pattern of eczema

Answer 5

Infant: scalp/ face/ flexures +/- hair loss

Child: flexural, around mouth/ chin, excessive scratching → lichenification

Question 6

Diagnosis of eczema

Answer 6

Clinical

Question 7

Complications of eczema

Answer 7

Infection - w/ Staph. aureus (Tx = oral abx) OR HSV (Tx = oral acyclvoir)

Question 8

Management of eczema

Answer 8

Maintenance - advice (avoid hot water/ scratching/ harsh soaps + triggers), emollients (thin = E45, thick = 50:50 hydro emollient)

Flares - thicker emollients + topical steroids (caution around face/ eyes)
Mild = hydrocortisone
Moderate = eumovate
Potent = betnovate
V. potent = dermovate

Question 9

Different medications used in the management of eczema flares?

Answer 9

Mild = hydrocortisone
Moderate = eumovate
Potent = betnovate
V. potent = dermovate

Question 10

What is Stephen-Johnson syndrome?

Answer 10

immune-mediated hypersensitivity reaction to foreign antigens (most common = medication), affect the skin + mucous membrane → painful rash + mucosal ulceration (Nikolsky sign)

Question 11

Medications that can cause Stephens-Johnson syndrome

Answer 11

lamotrigine, carbamazepine, allopurinol, NSAIDs, sulfonamides

Question 12

Triggers of Stephen-Johnson syndrome

Answer 12

Medications: lamotrigine, carbamazepine, allopurinol, NSAIDs, sulfonamides
Infections: mycoplasma pneumoniae, HSV

Question 13

Clinical presentation of Steven-Johnson syndrome

Answer 13

Prodrome (flu-like symptoms for 1-3 days before rash)
Rash (erythematous macules → blisters → skin detachment, Nikolsky’s sign)
Mucosal involvement (painful erosions affecting mouth/ eyes/ genitals)

Question 14

Management of Stephen-Johnson syndrome

Answer 14

Discontinue offending drugs + supportive care (fluid Mx, wound care) + hospitalisation

Question 15

Complications of Stephen-Johnson syndrome

Answer 15

Sepsis, pneumonia, dehydration, long-term eye problems

Question 16

A 6-year-old boy is brought to the GP by his mother due to a persistent, itchy rash that has been present for several months. The mother reports that the rash worsens at night, and the child frequently scratches his skin, sometimes to the point of causing bleeding. The rash started on his cheeks but has now spread to his elbows, knees, and behind his ears. The mother mentions that the child also has asthma, and there is a family history of hay fever and eczema. She notes that the rash tends to flare up more in the winter months and when the boy wears certain fabrics, such as wool. On examination, you observe dry, red patches of skin on the flexural areas (inside the elbows and behind the knees), with signs of excoriation due to scratching. There are areas of lichenification (thickened skin) on his elbows, and the skin feels rough and dry to the touch.

What is the most likely diagnosis?

Answer 16

Eczema

Question 17

A 10-year-old boy presents to the emergency department with a high fever, flu-like symptoms (fatigue, malaise, and body aches), and a rapidly worsening painful rash that began 2 days ago. The rash started as red macules on his trunk but has spread to his face, arms, and legs. He also complains of a burning sensation in his eyes and difficulty swallowing.
On examination, he is found to have: Multiple erythematous macules with some forming target-like lesions. Blistering and erosions of the oral mucosa and crusting on the lips. Involvement of the conjunctiva with redness and swelling. Skin peeling over large areas when rubbed lightly (positive Nikolsky’s sign).
The parents report that he was started on lamotrigine 10 days ago for epilepsy.

What is the most likely diagnosis?

Answer 17

Stephen-Johnson syndrome

Question 18

What is allergic rhinitis?

Answer 18

inflammation of the nasal epithelium lining

IgE associated response to allergens (pollen, dust mites, mould, smoke, animal dander)

Question 19

Common allergens that trigger allergic rhinitis

Answer 19

pollen, dust mites, mould, smoke, animal dander

Question 20

Clinical presentation of allergic rhinitis

Answer 20

Nasal - sneezing, itching, rhinorrhoea, congestion
Eye - itching, redness
Chronic congestion - snoring, mouth breathing

Question 21

Management of allergic rhinitis

Answer 21

Avoid allergens, nasal irrigation

Medical - first-line = oral antihistamines (e.g. loratidine/ cetirizine)
Second-line = intranasal CCS (e.g. beclomethasone/ mometasone)

Question 22

What is urticaria?

Answer 22

skin condition w/ itchy raised wheals lasting minutes to 24hr

Question 23

Define angioedema

Answer 23

deeper swelling involving periocular skin + lips + genitalia lasting up to 72hrs

Question 24

Common triggers for hives

Answer 24

Water, warmth/ exercise, cold, pressure, UV, vibratory stimuli, contact w/ allergens, strong emotion

Question 25

Management of hives

Answer 25

Lifestyle - avoid triggers, cool skin

Medical - first-line = oral antihistamines (cetirizine, fexofenadine)
Severe flares = oral prednisolone

n.b. second gen antihistamines only

Question 26

What is anaphylaxis?

Answer 26

severe, life-threatening, generalised/ systemic hypersensitivity reaction characterised by rapidly developing airway/ breathing/ circulation problems, usually associated with skin + mucosal changes

Question 27

Aetiology of anaphylaxis

Answer 27

Food (85%)

Others: insect strings, drugs, latex, exercise, inhalant allergens

Question 28

Clinical presentation of anaphylaxis

Answer 28

Rapid onset of shock.

Most common in children < 5YO (fatality most common in adolescents w/ allergy to nuts)

Question 29

Management of anaphylaxis

Answer 29

ABCDE approach - established airway, high flow oxygen, IV fluid (20ml/kg), chlorpheniramine, hydrocortisone

Adrenaline (epinephrine) - repeat every 5 mins
<6YO = 150 micrograms, 6-12YO = 300 micrograms, >12YO = 500 micrograms (0.15ml 1:1000, 0.3ml, 0.5ml)

Question 30

Doses of adrenaline based on age

Answer 30

<6YO = 150 micrograms (0.15ml 1:1000)

6-12YO - 300 micrograms (0.3ml 1:1000)

> 12YO = 500 micrograms (0.5 1:1000)

Question 31

Birth mark that is red/ purple. Present at birth and grows with infant

Answer 31

Port-wine stain

Question 32

Birth mark that is a red raised lump that appears in the first month of life, increases until 3-15 months, then disappears by 7YO.

Answer 32

Strawberry nevus

Question 33

Birthmark that is blue, present at birth, and disappears by 305YO. It can be mistaken for a bruise.

Answer 33

Slate-grey nevus

Question 34

What is roseola infantum

Answer 34

common disease of infancy caused by human herpes virus 6 (HHV 6). (3 day fever). Child < 2YO.

Question 35

Clinical presentation of roseola infantum

Answer 35

Children < 2YO
High fever
Rose-coloured rash on trunk → spread peripherally
Nagayama spots: enanthems on uvula + soft palate
May have febrile convulsions prior to rash

Question 36

What are nagayama spots? what condition might you find them in?

Answer 36

enanthems on uvula + soft palate
Roseola infantum

Question 37

Management of Roseola infantum

Answer 37

Supportive - self-resolving within 2-5 days

No need to exclude from school.

Question 38

1YO boy. High fever last week of 41 degrees, lasted for three days. Fever ended and rash began, started on trunk and spread peripherally. Vomiting + diarrhoea before rash. Spots on uvula + soft palate.

What is the most likely diagnosis?

Answer 38

Roseola infantum