Paediatrics - orthopaedics, rheumatology and dermatology Flashcards

Question

what is the management of transient synovitis

Answer 1

normally a self limiting disorder and so management is symptomatic with simple analgesia to help the discomfort - children 3-9 may be managed in primary care if the limp is present for less than 48hrs and they are otherwise well - SAFTEY NET - follow up at 48hrs and 1 weeks to ensure symptoms are improving and resolve

Answer 2

this is infection within a joint

Answer 3

in children under the age of 4

Answer 4

affects one joint - knee or hip mc rapid onset of: hot, red, swollen and painful joint refusing to weight bear stiffness and reduction in the range of movement systemic symptoms such as fever, lethargy and sepsis

Answer 5

staphylococcus aureus is most common neisseria gonorrhoea group A strep (pyogenes) haemophilus influenza e. coli

Answer 6

transient synovitis perthes disease slipped upper femoral epiphysis juvenile idiopathic arthritis

Answer 7

Bloods: full screen + cultures imaging: X-ray, ultrasound joint aspiration and culture

Answer 8

Empirical antibiotics IV given until sensitivities are known, choice of which depends on local guidelines (normally ceftriaxone and vancomycin) antibiotics are given for 30-6 weeks patients may require surgical drainage and washout to clear the joint of infection

Answer 9

it is an infection in the bone and bone marrow which typically occurs in the metaphysis of the long bones

Answer 10

directly - open fracture travelled through the blood after entering through another route such as skin or gums

Answer 11

more common in boys more common in children under 10 open bone fracture orthopaedic surgery immunocompromised sickle cell anaemia HIV tuberculosis

Answer 12

acutely with an unwell child/chronically with subtly features refusing to use the limb or weight bear pain swelling tenderness may be afebrile or have a low grade fever

Answer 13

X ray is first line imaging, MRI is the best bloods: inflammatory markers and wbc blood culture bone marrow aspiration/biopsy with histology and culture

Answer 14

extensive and prolonged antibiotic therapy - flucloxacillin, clindamycin if penicillin allergy, vancomycin if staph. aureus suspected surgical drainage and debridement of infected bone

Answer 15

involves the disruption of blood flow to the femoral head causing avascular necrosis of the bone, affecting the epiphysis of the femur

Answer 16

children aged 4-12 mostly between the ages of 5-8 and most commonly in boys

Answer 17

idiopathic - theory suggests that repeated mechanical stress to the epiphysis may interrupt the blood supply

Answer 18

slow onset of: pain in the hip or groin limp restricted hip movements and stiffness with loss of internal rotation and abduction may be referred pain to the knee muscle spasms leg length discrepancy (late finding)

Answer 19

initial investigation - X ray bloods: inflammatory markers technetium bone scan MRI scan

Answer 20

soft and deformed femoral head which leads to early hip osteoarthritis

Answer 21

around 5% of patients

Answer 22

initial management in younger and less severe disease is conservative help maintain a healthy position and alignment in the joint and reduce the risk of damage or deformity to the femoral head with: bed rest, traction, crutches, analgesia physiotherapy regular X rays surgery to help with alignment and function

Answer 23

asymmetrical femoral epiphyseal size increased density of femoral head epiphysis radiolucency coxa plana: femoral head widening and flattening coxa magna: proximal femoral neck deformity sagging rope sign: thin sclerotic line running across the femoral neck crescent sign is a specific finding in late stage disease and represents a subchondral fracture

Answer 24

age over 8 years old more than 50% of the femoral head is damaged nonsurgical management has been unsuccessful

Answer 25

osteoarthritis general join stiffness and immobility premature physeal arrest, degenerative arthritis acetabular dysplasia unequal, shortened limb length

Answer 26

A discoid meniscus is thicker than normal, and often oval or disc-shaped. It is more prone to injury than a normally shaped meniscus.

Answer 27

frequently asymptomatic but discoid menisci are prone to cystic degeneration with subsequent tearing if this happens it presents as: pain, locking or a clunk sensations stiffness or swelling pain feeling as if the knee is giving way inability to fully extend the knee

Answer 28

there is decreased collagen fibres and loss of normal collagen orientation which predisposes them to intradiscal/meniscal mucoid degeneration

Answer 29

complete vs incomplete stable vs unstable

Answer 30

80% coverage of the tibial plateau is often used as the cut off between incomplete and complete

Answer 31

stable: normal peripheral attachments with an intact posterior meniscofemoral ligament unstable: lack or tear of a posterior meniscocapsular ligaments with an attachment only from the meniscofemoral ligament of Wrisberg

Answer 32

plain radiograph: widening of the lateral joint space and cupping of the lateral tibial plateau MRI: meniscal body width of 15mm or more is typically considered diagnostic (coronal)

Answer 33

conservative management may need meniscal repair with partial or total resection

Answer 34

meniscal tears intrasubstance mucoid degeneration early bony degenerative change

Answer 35

it acts as a shock absorber between the femur and the tibia. it protects the thin articular cartilage that covers the ends of the bones and helps the knee to easily bend and straighten

Answer 36

the meniscus is slightly thicker and wider than normal

Answer 37

when the meniscus completely covers the tibia

Answer 38

this occurs when the ligaments that attach the meniscus to the femur and tibia are not there. Without these ligaments even a fairly normal shaped meniscus can move around the joint and cause pain, as well as licking and popping of the knee

Answer 39

due to the thick, abnormal shape f a discoid meniscus makes it more likely to get stuck in the knee or to tear

Answer 40

because the meniscus lacks a strong blood supple and the nutrients that are essential to healing cant reach the injured tissue

Answer 41

it is a congenital defect that is present from birth

Answer 42

knee arthroscopy is the most common - few small incisions and meniscus is cut and reshaped

Answer 43

it is where the head of the femur is displaced (slips) along the growth plate

Answer 44

it is most common around the ages of 8-15 most common in boys around 12 rarer in girls, and presents around 11 it is more common in obese children

Answer 45

typical presentation is an adolescent , obese male undergoing a growth spurt. There may be history of minor trauma pain is disproportionate to the severity of the trauma hip, groin, thigh or knee pain restricted range of movement in the hip painful limp

Answer 46

the patient will prefer to keep the hip in external rotation they will have limited movement of the hip, particularly restricted internal rotation

Answer 47

initial investigation is Xray bloods: normal technetium bone scan Ct and MRI

Answer 48

surgery is required to return the femoral head to the correct position and fix it in place to prevent it slipping further

Answer 49

inflammation at the tibial tuberosity where the patella ligament inserts and is common cause of anterior knee pain in adolescents

Answer 50

at around 10-15 years more common in males

Answer 51

the patella tendon inserts into the tibial tuberosity which is at the epiphyseal plate. stress from running, jumping and other movements at the same time as growth can result in inflammation on the tibial epiphysial plate. there are multiple small avulsion fractures where the patella ligament pulls away pieces if the bone. this leads to growth of the tibial tuberosity causing a visible lump below the knee initially this is tender due to inflammation but as the bone heals it becomes hard and non tender

Answer 52

gradual onset of symptoms visible or palpable hard and tender lump at the tibial tuberosity pain in the anterior aspect of the knee pain exacerbated by physical activity, kneeling and on knee extension

Answer 53

reducing pain and inflammation - reduction of physical activity - ice - NSAIDs for symptomatic relief once symptoms settle, stretching and physiotherapy can be used to strengthen the joint and improve function

Answer 54

symptoms should fully resolve over time patient is usually left with a hard bony lump on their knee

Answer 55

full avulsion fracture where the tibial tuberosity is separated from the rest of the tibia

Answer 56

this usually requires a surgical intervention

Answer 57

it is a disorder of abnormal development resulting in dysplasia and potential subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors

Answer 58

most common abnormality in newborn infants.

Answer 59

due to the nature of how the baby sits in the womb the left hip is more commonly affected

Answer 60

family history of DDH breeched baby female sex fixed root deformity torticollis

Answer 61

leg length discrepancy limitations in hip abduction on one side significant bilateral restriction in abduction in children older than 1 a Trendelenburg gait and toe walking may also be seen asymmetrical buttock creases hip locking/clicking pain

Answer 62

Ortolani and Barlow tests

Answer 63

performed by adducting the hip (bringing the thigh towards the midline) whilst applying light pressure on the knee with your thumb, directing the force posteriorly. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, producing a palpable sensation of subluxation or dislocation. If the hip is dislocatable the test is considered positive.

Answer 64

Ortolani test is done with the baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh. Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.

Answer 65

when it is suspected an ultrasound of the hips will be investigation of choice and establish the diagnosis all children with risk factors or examination findings should have an ultrasound Xray can also be used in older infants (greater than 4-6 months)

Answer 66

under 6 months: Pavlik harness 6-8 months or failure of Pavlik harness: closed reduction and spica casting greater than 18 months (or failure of closed reduction): operative management (open reduction and hip reconstruction)

Answer 67

it is used in Developmental dysplasia of the hip when the baby is under 6 months. it is fitted and kept on permanently and adjusted for growth. it holds the femoral head in the correct position to allow the acetabulum to develop a normal shape. The harness keeps the babies hips flexed and abducted

Answer 68

recurrence transient femoral nerve palsy with excessive flexion during Pavlik bracing avascular necrosis due to retrograde femoral head blood flow (mc affected is the median circumflex femoral artery)

Answer 69

it is a condition affecting children and adolescents where autoimmune inflammation occurs in the joints

Answer 70

when the arthritis is without any other cause when it lasts more than 6 weeks when it is in a patient under 16

Answer 71

five key ones: systemic JIA polyarticular JIA oligoarticular JIA enthesitis related arthritis juvenile psoriatic arthritis

Answer 72

this is a systemic illness that can occur throughout childhood it is an idiopathic inflammatory condition

Answer 73

subtle salmon pink rash high swinging fevers enlarged lymph nodes weight loss joint inflammation and pain splenomegaly muscle pain pleuritis and pericarditis

Answer 74

usually negative however there will be raised inflammatory markers with raised CRP, ESR, platelets and ferritin

Answer 75

macrophage activation syndrome

Answer 76

it is where there is a severe activation of the immune system with a massive inflammatory response

Answer 77

It presents with an acutely unwell child with disseminated intravascular coagulation (DIC), anaemia, thrombocytopenia, bleeding and a non-blanching rash. It is life threatening

Answer 78

it involves idiopathic inflammatory arthritis in 5 joints or more

Answer 79

it tends to be symmetrical can affect small joints of the hands and feet as well as larger ones minimal systemic symptoms but there can be mild fever, anaemia and reduced growth

Answer 80

rheumatoid arthritis

Answer 81

most are negative - seronegative if rheumatoid factor is positive they tend to be older children and adolescents and the disease pattern is much more similar to rheumatoid arthritis in adults

Answer 82

it involves 4 joints or less, usually affecting only a single joint

Answer 83

the larger joints - often the knee or ankle

Answer 84

in girls under the age of 6

Answer 85

anterior uveitis

Answer 86

4 or less joints affected associated with anterior uveitis patients tend to have no systemic symptoms antinuclear antibodies are often positive, rheumatoid factor is usually negative

Answer 87

this is thought of as a paediatric version of seronegative spondyloarthropathy it is inflammation of the point where a tendon of a muscle inserts into a bone. Patients have inflammatory arthritis in the joints as well as enthesitis

Answer 88

traumatic stress such as repetitive strain during sport autoimmune inflammatory process

Answer 89

an MRI scan (cant differentiate between what it is due to)

Answer 90

signs and symptoms of psoriasis signs and symptoms of IBD signs and symptoms of anterior uveitis

Answer 91

patients will have tenderness to localised palpation of the entheses may have signs of psoriasis, IBD or anterior uveitis

Answer 92

interphalangeal joints in the hand wrist over the greater trochanter on the lateral aspect of the hip quadriceps insertion at the anterior superior iliac spine quadriceps and patella tendon insertion around the patella base of achilles at the calcaneus metatarsal heads on the base of the foot

Answer 93

this is a seronegative inflammatory arthritis when associated with psoriasis

Answer 94

plaques of psoriasis on the skin pitting of the nails onycholysis - separation of the nail from nail bed dactylitis - inflammation of full finger enthesitis - inflammation of the entheses

Answer 95

MDT approach NSAIDs such as ibuprofen steroids either oral, IM or intra articular in oligoarthritis DMARDs such as methotrexate, sulfasalazine and leflunomide biologic therapy such as TNF inhibitors etanercept, infliximab and adalimumab

Answer 96

it is an abnormal side to side curve of your spine - can range from mild to severe

Answer 97

infantile - younger than 3 juvenile - age 4-10 adolescent - 11-18 adult - any time after 18

Answer 98

idiopathic - most common congenital - when vertebrae dont form as they should during development neuromuscular - abnormalities in the muscles and nerves that support the spine causes this, usually occurs alongside neurological or muscular conditions like injury, cerebral palsy, spina bifida or muscular dystrophy

Answer 99

affects an estimated 2% of people around the world

Answer 100

back pain difficulty standing upright core muscle weakness leg pain, numbness or weakness

Answer 101

uneven shoulders shoulder blades that stick out head that doesnt centre around the pelvis uneven waist elevated hip constant leading to one side uneven leg length changes in skin appearance or texture (dimples, hair patches, discolouration)

Answer 102

adolescents - most occur in the thoracic spine adults - mainly lumbar or the lower spine

Answer 103

vertebrae malformation during development genetic mutation spinal injury tumour muscle/nerve condition

Answer 104

biological family history of scoliosis underlying nerve/muscle condition

Answer 105

long lasting pain physical deformity organ damage nerve damage arthritis spinal fluid leakage difficulty breathing

Answer 106

scoliosis screening - remove shirt and stand up straight and bend forward. physical examination X-rays (from front and side) CT/MRI

Answer 107

measure the curve of the spine in degrees no scoliosis diagnosis: less than 10 degrees Mild: between 10-24 degrees moderate: between 25-39 degrees severe: more than 40 degrees

Answer 108

dependent on type and severity - conservative: regular monitoring, analgesia, exercise/physio, back brace - surgery: stabilise spine and relieve pressure on nerves

Answer 109

spinal fusion: fuse vertebrae to stabilise spine, and use metal braces to hold spine in place expandable rod: insertion of an expandable rod along vertebrae to support a child's growing spine

Answer 110

it is when the babies neck muscles cause their head to turn and rotate to one side due to a short, tight sternocleidomastoid muscle

Answer 111

congenital - mc acquired

Answer 112

in the first four to six months of a babies life

Answer 113

babies head tilts to one side and the chin tilts to the other limited movement of the babies head and neck one shoulder will be higher than the other swollen neck muscles small pea sized limp in one of the babies neck muscles uneven facial features

Answer 114

severe neck pain head tremors headache

Answer 115

it is due to shortening of the sternocleidomastoid muscle. It is unsure why it shortens but may be due to positioning in the womb, abnormal development, haemotoma, fibrosis or Klippel-Feil syndrome

Answer 116

a rare birth defect that causes the vertebrae in the neck to fuse

Answer 117

because of swelling around the throat. This swelling causes the tissues surrounding the upper spine to loosen, allowing vertebrae to move out of the normal position. this causes neck muscles to spasm and causing the head to tilt to one side can also be due to GORD, vision problems, reaction to medications, scar tissue, cervical spondylarthritis, sandifer syndrome, grisel syndrome

Answer 118

rare condition which combines GORD with neck spasms

Answer 119

rare complication of head and neck infections or ENT surgeries

Answer 120

physical examination neck X ray head and neck CT/MRI

Answer 121

stretching exercised and position changes can help congenital torticollis may need surgery to lengthen SCM muscle in acquired need to focus on the underlying cause: antibiotics, botox injections, heat therapy, massage, neck braces/collars, physical therapy

Answer 122

they are found in the bones of children, but not adults. they are the area at the ends of long bones that allow the bones to grow in length

Answer 123

hyaline cartilage

Answer 124

1. children have growth plates 2. children have more cancellous bone which is spongy and highly vascular making them more flexible but less strong

Answer 125

1. the younger the child the faster and better the healing of fractures 2. when bones break in children they are much more likely to break clean in two 3. children are more likely to get greenstick fractures where one side of the bone breaks while the other stays intact 4. children are more likely to have a buckle fracture

Answer 126

Buckle transverse oblique spiral segmental salter-harris (growth plate fracture) comminuted greenstick

Answer 127

they can cause issues with growth of the bone

Answer 128

the Salter harris classification - the higher the grade the more likely it will affect growth

Answer 129

SALTR pneumonic type 1: Straight across type 2: Above type 3: BeLow type 4: Through type 5: CRush

Answer 130

think safeguarding - is it a reasonable fracture? mechanical alignment via closed reduction via manipulation of the joint, or open reduction via surgery then provide stability with fixing the bone

Answer 131

external casts K wires intramedullary wires intramedullary nails screws plate and screws

Answer 132

WHO have a pain ladder for children with two steps 1. paracetamol or ibuprofen 2. morphine

Answer 133

limp refusal to weight bare refusal to use affected leg inability to walk pain swollen or tender joint

Answer 134

septic arthritis developmental dysplasia of the hip transient arthritis

Answer 135

septic arthritis transient arthritis perthes disease

Answer 136

septic arthritis slipped upper femoral epiphysis juvenile idiopathic arthritis

Answer 137

Child under 3 years Fever Waking at night with pain Weight loss Anorexia Night sweats Fatigue Persistent pain Stiffness in the morning Swollen or red joint

Answer 138

Child under 3 years Child older than 9 with a restricted or painful hip Not able to weight bear Evidence of neurovascular compromise Severe pain or agitation Red flags for serious pathology Suspicion of abuse

Answer 139

bloods: inflammatory markers, anaemia C-rays ultrasound joint aspiration MRI

Answer 140

it is a fixed abnormal ankle position that presents at birth

Answer 141

this is when the ankle is in plantar flexion and supination

Answer 142

this is when the ankle is in dorsiflexion and pronated

Answer 143

this is a way of treated talipes without surgery where the foot is manipulated towards a normal position and a cast is applied to hold it in position. this is repeated over and over until the foot is in the correct position at some point an achilles tenotomy is perfroed to release tension in the achilles tendon after treatment with casts, a brace is used to hold the feet in correct position when not walking until the child is around 4

Answer 144

this is a common condition where the resting position of the ankle is in plantar flexion and supination, however it is not fixed and there is no structural boney issue in the ankle - muscles are slightly tight but bones unaffected - foot can be moved into a normal position - physiotherapist provide exercises to help move foot back into a normal position

Answer 145

it is the most common cause of disproportionate short stature (dwarfism) - type of skeletal dysplasia

Answer 146

the achondroplasia gene (fibroblast growth factor receptor 3) is on chromosome 4, and achondroplasia results from either a sporadic mutation or inheritance of an abnormal copy - causes abnormal function of the epiphyseal plates and restricts bone growth

Answer 147

autosomal dominant

Answer 148

disproportionate short stature - average height is around 4ft short digits bow legs disproportionate skull foramen magnum stenosis

Answer 149

limbs are more affected, with the femur and humerus being affected more than the bones in the forearm and lower leg spine is less affected and patients have a normal trunk

Answer 150

there is disproportionate skull as different areas of the skull grow by different methods 1. skull base grows and fuses via endochondral ossification and is affected, leading to a flattened mid face, nasal bridge, and foramen magnum stenosis 2. cranial vault grows and fuses via membranous ossification and is unaffected leading to a normal sized vault and frontal bossing

Answer 151

recurrent otitis media kyphoscoliosis spinal stenosis obstructive sleep apnoea obesity foramen magnum stenosis can lead to cervical cord compression and hydrocephalus

Answer 152

no cure - MDT approach pediatricians specialist nurses physiotherapists occupational therapists dieticians orthopaedic surgeons - leg length durgery can add height but requires extensive surgery and recovery ENT surgeons genetics

Answer 153

leg lengthening surgery - involves cutting the bone and separating the two parts creating a gap between them. Over a long time bone will form between the two parts, creating a longer bone

Answer 154

group of genetic conditions involving defects in collagen, causing hypermobility in the joints and abnormalities in the connective tissue of the skin, bones, blood vessels and organs

Answer 155

Hypermobile classical vascular kyphoscoliotic

Answer 156

it is the most common and least severe type joint hypermobility soft and stretchy skin inherited in an autosomal dominant pattern

Answer 157

very stretchy skin that feels smooth and velvety severe joint hypermobility joint pain abnormal wound healing lumps often develop over pressure points prone to hernias, prolapses prone to mitral regurgitation and aortic root dilation inheritance is autosomal dominant

Answer 158

most severe and dangerous blood vessels particularly fragile and prone to rupture patients have thin translucent skin gastrointestinal perforation and spontaneous pneumothorax patients monitored for vascular abnormalities autosomal dominant inheritance pattern

Answer 159

it is characterised initially by poor muscle tone as a neonate and infant, followed by kyphoscoliosis as they grow significant hypermobility joint dislocation is common inheritance is autosomal dominant

Answer 160

joint hypermobility and pain joint dislocations soft and stretchy skin easy bruising poor wound healing bleeding chronic pain and fatigue headaches POTS/autonomic dysfunction GORD abdominal pain and IBS menorrhagia and dysmenorrhoea premature rupture of membranes in pregnancy urinary incontinence pelvic organ prolapse temporomandibular joint dysfunction

Answer 161

assess hypermobility in children and adults one point is scored for each side of the body with a maximum score of 9

Answer 162

1. if they can place their palms flat on the floor with their legs straight (scores only 1) 2. hyperextended elbows 3. hyperextended knees 4. ability to bend their thumb to touch their forearm 5. hyperextended their little finger past 90 degrees

Answer 163

no cure - manage symptoms regular follow up physiotherapy to strengthen and stabilise joints occupational therapy moderating activity

Answer 164

it is an IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children

Answer 165

the skin, kidneys and gastrointestinal tract

Answer 166

upper airway infection or gastroenteritis

Answer 167

purpura joint pain abdominal pain renal involvement

Answer 168

inflammation and leaking of blood from small blood vessels under the skin forming purpura

Answer 169

start on the legs and spread to the buttocks they can also affect the trunk and arms

Answer 170

arthralgia/arthritis typically affect the knees and ankles in Henoch-schonlein purpura

Answer 171

abdominal pain gastrointestinal haemorrhage intussusception bowel infarction

Answer 172

via IgA nephritis which can lead to microscopic or macroscopic haematuria and proteinuria

Answer 173

exclude other causes of non-blanching rash FBC and blood film renal profile serum albumin CRP blood cultures urine dipstick urine protein: creatinine ratio blood pressure

Answer 174

palpable purpura + at least one of: diffuse abdominal pain arthritis or arthralgia IgA deposits on histology proteinuria or haematuria

Answer 175

supportive with simple analgesia, rest and hydration steroids is debatable monitored closely via urine dip and blood pressure

Answer 176

abdo pain usually settles within a few days patients without kidney involvement can recover within 4-6 weeks 1/3 of patients will have recurrence within 6 months

Answer 177

Acute phase: unwell with fever, rash and lymphadenopathy subacute: desquamation and arthralgia occur and risk of aneurysms convalescent stage: remaining symptoms settle, blood tests return to normal, aneurysms may regress (lasts 2-4 weeks)

Answer 178

it is an autoimmune condition triggered by streptococcus bacteria it causes antibodies created to fight streptococcus bacteria to target tissues in the body

Answer 179

caused by group A beta haemolytic streptococcus (pyogenes) which typically causes tonsillitis antibodies created to fight this infection not only target the bacteria, but also match antigens on cells in the body resulting in a type 2 hypersensitivity reaction where the immune system attacks its own cells

Answer 180

type 2 hypersensitivity

Answer 181

2-4 weeks after the initial infection

Answer 182

fever joint pain rash shortness of breath chorea nodules

Answer 183

migratory arthritis affecting the large joints, with hot swollen painful joints. - different joints become inflamed and improve at different times

Answer 184

carditis, inflammation throughout the heart, with pericarditis, myocarditis and endocarditis - tachycardia or bradycardia - murmurs (typically through mitral valve disease) - pericardial rub on auscultation - heart failure

Answer 185

subcutaneous nodules - firm painless nodules over extensor surfaces of joints erythema marginatum rash - pink rings of varying sizes affecting the torso and proximal limbs

Answer 186

chorea - uncontrolled irregular rapid movements of the limbs

Answer 187

throat swab for culture ASO antibody titres ECHO, ECG and chest Xray diagnosis is made using the jones criteria

Answer 188

they indicate recent infection and can support a diagnosis of rheumatic fever. they rise over 2-4 weeks after initial infection. they peak around 3-6 weeks and then gradually fall over 3-12 months

Answer 189

evidence of recent streptococcal infection plus: two major criteria OR one major plus two minor criteria

Answer 190

joint arthritis organ inflammation, such as carditis nodules erythema marginatum rash sydenham chorea

Answer 191

fever ECG changes (prolonged PR interval) without carditis arthralgia without arthritis raised inflammatory markers

Answer 192

treatment of infections with antibiotics helps prevent rheumatic fever - Phenoxymethylpenicillin (V) for 10 days patients with rheumatic fever - MDT - NSAIDS - Aspirin and steroids to treat carditis - prophylactic antibiotics to prevent further infections and recurrence of rheumatic fever - monitoring and management of complications

Answer 193

recurrence valvular heart disease (mitral stenosis) chronic heart failure

Answer 194

chronic atopic condition caused by defects in the normal continuity of the skin barrier leading to inflammation in the skin

Answer 195

presents in infancy with dry, itchy and sore patches of skin over the flexor surfaces and on the face and neck

Answer 196

eczema is caused by defects in the barrier that the skin provides. Gaps in the skin barrier provide and entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation and the associated symptoms

Answer 197

atopic dermatitis contact dermatitis dyshidrotic eczema neurodermatitis nummular eczema seborrheic dermatitis

Answer 198

dry skin itchy skin skin rash bumps on your skin thick, leathery patches of skin flaky, scaly or crusty skin swelling

Answer 199

hands neck elbows ankles knees feet face, especially cheeks in and around the ears lips

Answer 200

maintenance and management of flairs

Answer 201

create an artificial barrier over the skin - done using emollients that are thick and greasy patients should avoid activities that can break down the skin barrier - bathing in hot water, scratching or scrubbing their skin, using soaps and body washes that remove natural oils

Answer 202

thicker emollients, topical steroids, wet wraps (covering affected areas in a thick emollient and applying a wrap to keep moisture in) treating complications such as bacterial or viral infections

Answer 203

zinc impregnated bandages topical tacrolimus phototherapy systemic immunosuppressants such as oral corticosteroids, methotrexate and azathioprine

Answer 204

E45 diprobase cream oilatum cream aveeno cream cetraben cream epaderm cream

Answer 205

50:50 ointment (5% liquid paraffin) hydromol ointment diprobase ointment cetraben ointment epaderm ointment

Answer 206

general rule is to use the weakest steroid for the shortest period of time to get the skin under control - thicker the skin the stronger the steroid required

Answer 207

can lead to thinning of the skin makes the skin more prone to flares, bruising, tearing, stretch marks and enlarged blood vessels (telangiectasia)

Answer 208

Mild: hydrocortisone 0.5, 1 and 2.5 % moderate: Eumovate (clobetasone butyrate 0.05%) potent: Betnovate (betamethasone 0.1%) very potent: Dermovate (clobetasol propionate 0.05%)

Answer 209

most common is staph. aureus

Answer 210

oral antibiotics - flucloxacillin more severe cases may need admission and IV antibiotics

Answer 211

this is a viral skin infection in patients with eczema caused by HSV or VZV

Answer 212

Herpes simplex virus 1 may be associated with a coldsore

Answer 213

patient that suffers with eczema that has developed a widespread, painful, vesicular rash systemic symptoms such as fever, lethargy, irritability, and reduced oral intake there will usually be lymphadenopathy

Answer 214

widespread - can affect any area of the body erythematous painful can be itchy vesicles containing pus which burst and leave small punched out ulcers with a red base

Answer 215

viral swabs can confirm the diagnosis treatment is with aciclovir - in milder cases use oral and in severe cases use IV

Answer 216

life threatening when not treated correctly, particularly in those immunocompromised bacterial superinfection can occur

Answer 217

disproportional immune response causes epidermal necrosis, resulting in blistering and shedding of the top layer of the skin

Answer 218

they are a spectrum of the same pathology SJS affects less than 10% of the body surface TEN affects more than 10% of the body surface

Answer 219

medications: anti-epileptics, antibiotics, allopurinol, NSAIDS infections: herpes simplex, mycoplasma pneumonia, cytomegalovirus, HIV

Answer 220

dependent on severity starts nonspecific such as fever, cough, sore throat, sore mouth, sore eyes, itchy skin then develop a purple or red rash that spreads across the skin and starts to blister few days after blistering starts the skin starts to break away and shed eyes can become inflamed and ulcerated can affect urinary tract, lungs and internal organs

Answer 221

medical emergency nutritional care, antiseptics, analgesia steroids immunoglobulins immunosuppressants

Answer 222

secondary infection: breaks in skin can lead to bacterial infection, cellulitis and sepsis permanent skin damage visual complications: sore eyes, scarring or blindness

Answer 223

also known as hives - small itchy lumps that appear on the skin can be localised or widespread

Answer 224

acute chronic

Answer 225

urticaria is caused by release of histamine and other pro-inflammatory chemicals by mast cells in the skin - can be part of an allergic reaction in acute - can be due to autoimmune reaction in chronic

Answer 226

allergies to food, medications or animals contact with chemicals, latex or stinging nettles medications viral infections insect bites dermatographism (rubbing of skin)

Answer 227

autoimmune condition where autoantibodies target mast cells, and can be sub-classified into: chronic idiopathic chronic inducible autoimmune

Answer 228

it is recurrent episodes of chronic urticaria without a clear underlying cause or trigger

Answer 229

episodes of urticaria that can be induced by certain triggers such as: sunlight temperature change exercise strong emotions hot or cold weather pressure (dermatographism)

Answer 230

it is chronic urticaria which is associated with an underlying autoimmune condition such as SLE

Answer 231

antihistamines are the main treatment - fexofenadine oral steroids can be used in severe flares in very problematic cases referral is needed and specialised treatment may be given: anti-leukotrienes (montelukast) ,omalizumab and cyclosporin

Answer 232

they are marks on the skin that are present at birth or can show up soon after, which cosmetically change the appearance of the skin

Answer 233

vascular birthmarks: made of blood vessels pigmented birthmarks: cluster of melanocyte cells

Answer 234

hemangiomas port wine stains salmon patches/stork bites

Answer 235

they consist of small closely packed blood vessels which develop after several weeks and are often rapidly growing

Answer 236

face, scalp. back or chest

Answer 237

it is similar to a strawberry hemangioma but extends deeper below the surface of the skin

Answer 238

flat, purple to red birthmarks made of dilated blood capillaries, which most often appear on the face port wine stains are permanent and may darken over time

Answer 239

these marks are capillaries which are visible through the childs skin they are most common on the forehead, eyelids, upper lip, between the eyebrows and back of the neck

Answer 240

dermal melanocytosis (mongolian spots) pigmented nevi congenital nevi cafe-au-lait spots

Answer 241

this is a bluish birthmark which can look like a bruise they often appear on the buttocks and the lower back

Answer 242

these are raised growths on the skin that are the same colour as you natural skin tone/brown/black moles can appear anywhere on the skin

Answer 243

these are moles which are present at birth and have a slightly higher chance of becoming skin cancer, depending on the size

Answer 244

they are light tan or light brown spots that are usually oval in shape they appear at birth but bight develop in the first few years of a childs life multiple spots might be a sign of an underlying condition called neurofibromatosis

Answer 245

blood vessels not forming as expected melanocyte cells growing in clusters genetic predisposition underlying medical condition

Answer 246

physical examination if its deep in the skin may image it - MRI, ultrasound or CT skin biopsy may be necessary

Answer 247

cryotherapy laser removal surgical removal injections of cortisone

Answer 248

it is a chronic autoimmune condition that causes recurrent symptoms of psoriatic skin lesions

Answer 249

patches of psoriasis are dry, flaky, scaly and faintly erythematous skin lesions can appear in raised and rough plaques commonly over extensor surfaces of the elbows, knees and scalp

Answer 250

plaque psoriasis guttate psoriasis pustular psoriasis erythematous psoriasis

Answer 251

thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp plaques are 1cm-10cm most common in adults

Answer 252

it is the second most common commonly occurs in children presents with small raised papules across he trunk and limb mildly erythematous scaly over time the papules can become plaques

Answer 253

streptococcal throat infection stress medications

Answer 254

severe form where pustules form around areas of erythematous skin patients can be systemically unwell treated as medical emergency

Answer 255

rare severe form extensive erythematous inflamed areas covering most of the surface area of the skin skin comes away in large patches medical emergency

Answer 256

in children the distribution and presentation may differ than in adults plaques are likely to be smaller, soften and less prominent

Answer 257

Auspitz sign: small points of bleeding where plaques are scraped off Koebner phenomenon: development of psoriatic lesions to areas of skin affected by trauma residual pigmentation of skin after lesions resolve

Answer 258

topical steroids topical vitamin D analogues (calcipotriol) topical dithranol topical calcineurin inhibitors (tacrolimus) are usually only used in adults phototherapy with narrow band UV B light in extensive guttate psoriasis where topical treatments fail children may be started on unlicensed systemic treatment under specialist guidance: methotrexate, cyclosporin, retinoids, biologics

Answer 259

Dovobet Enstilar These not licensed in children and will be guided by a specialist.

Answer 260

nail psoriasis: nail pitting, thickening, discolouration, ridging and onycholysis psoriatic arthritis psychosocial issues obesity, hyperlipidaemia, hypertension, T2DM

Answer 261

caused by chronic inflammation with or without localised infection, in pockets within the skin known as pilosebaceous unit. Acne results from increased production of sebum, trapping of keratin and blockage of the pilosebaceous unit leading to swelling and inflammation

Answer 262

these are tiny dimples in the skin that contain the hair follicles and sebaceous glands. The sebaceous glands produce the natural skin oils and a waxy substance known as sebum

Answer 263

because androgenic hormones increased the production of sebum

Answer 264

these are swollen and inflamed units in acne

Answer 265

red, inflamed and sore spots on the skin, typically distributed across the face, upper chest and back has macules, papules and pustules comedomes - skin coloured papules blackheads ice pick scars - small indentations in the skin that remain after acne lesions heal hypertrophic scars - small lumps in the skin that remain after acne lesions heal rolling scars - irregular wave like irregularities of the skin that remain after acne lesions heal

Answer 266

reduce symptoms of acne, reduce risk of scarring - topical benzoly peroxide: reduces inflammation and helps unblock skin, toxic to P.acnes bacteria - topical retinoids: slow production of sebum - topical antibiotics such as clindamycin - oral antibiotics such as lymecycline - oral contraceptive pill

Answer 267

oral retinoids - need careful follow up and monitoring and reliable contraception in females

Answer 268

Co-cyprindiol (dianette) - it has higher risk of thromboembolism so treatment is usually discontinued once acne is controlled and is not prescribed long term

Answer 269

it is a retinoid which is very effective at clearing the skin

Answer 270

it reduces the production of sebum reduces inflammation reduces bacterial growth

Answer 271

dry skin and lips photosensitivity of the skin to sunlight depression, anxiety, aggression and suicidal ideation - screen for mental health issues prior rarely stephens-johnson syndrome and toxic epidermal necrolysis

Answer 272

first disease: measles second disease: scarlet fever third disease: Rubella fourth disease: Dukes' disease fifth disease: Parvovirus B19 sixth disease: roseola infantum

Answer 273

measles virus

Answer 274

10-12 days after exposure

Answer 275

these are greyish white spots on the buccal mucosa, and appear 2 days after fever in measles

Answer 276

the rash starts on the face, classically behind the ears 3-5 days after the fever it then spreads to the rest of the body

Answer 277

it is self resolving after 7-10 days of symptoms

Answer 278

children should be isolated until 4 days after their symptoms resolve

Answer 279

pneumonia diarrhoea dehydration encephalitis meningitis hearing loss vision loss death

Answer 280

group A streptococcus infection, usually tonsilitis

Answer 281

it is caused by an exotoxin produced by the streptococcus pyogenes bacteria

Answer 282

red-pink, blotchy macular rash with rough sandpaper skin starts on the trunk and spreads outward

Answer 283

rash flushed red cheeks fever lethargy sore throat strawberry tongue cervical lymphadenopathy

Answer 284

phenoxymethylpenicillin for 10 days

Answer 285

until 24 hours after starting antibiotics

Answer 286

the rubella virus

Answer 287

2 weeks after exposure

Answer 288

milder erythematous rash than measles rash starts on face and spreads to the rest of the body, lasting 3 days mild fever joint pain sore throat lymphadenopathy behind ears and back of neck

Answer 289

for at least 5 days after the rash appears

Answer 290

thrombocytopenia encephalitis in pregnancy can be dangerous and lead to congenital rubella which causes deafness, blindness and congenital heart disease

Answer 291

parvovirus B 19

Answer 292

starts with mild fever, coryza and non specific viral symptoms then 2-5 days in a rash appears as a diffuse bright red rash on both cheeks few days later a mildly erythematous lace like rash appears on the trunk and limbs

Answer 293

infectious prior to the rash forming but once the rash has formed they are no longer infectious and dont need to stay off school

Answer 294

immunocompromised pregnant patients sickle cell anaemia thalassemia hereditary spherocytosis haemolytic anaemia

Answer 295

aplastic anaemia encephalitis or meningitis pregnancy complications including fetal death rarely hepatitis, myocarditis or nephritis

Answer 296

HHV 6 and less frequently HHV7

Answer 297

presents 1-2 weeks after infection with a high fever (up to 40o) lasting 3-5 days coryzal symptoms when the fever settles the rash appears for 1-2 days consisting of a mild erythematous rash across the arms, legs, trunk and face. It is not itchy

Answer 298

febrile convulsions

Answer 299

slapped cheek syndrome or erythema infectiosum

Answer 300

it is a erythematous rash caused by a hypersensitivity reaction

Answer 301

viral infections and medications associated with herpes simplex virus and mycoplasma pneumonia

Answer 302

it produces a widespread, itchy, erythematous rash produces characteristic target lesions - red rings within larger rings doesnt usually affect mucous membraned but can cause a sore mouth may be associated with mild fever, stomatitis, muscle and joint aches, headaches and flu like illness

Answer 303

need to identify the underlying cause and treat that when there is no clear cause - chest x ray (look for cause) usually it is mild and will resolve spontaneously without further treatment in severe cases it may need hospital admission for treatment with IV fluids, analgesia, steroids

Answer 304

Varicella zoster virus

Answer 305

widespread, erythematous, raised, vesicular blistering lesions rash normally starts on the face or trunk and spreads outward affecting the whole body over 2-5 days eventually lesions scab over

Answer 306

after all the lesions have crusted over

Answer 307

bacterial superinfection dehydration conjunctival lesions pneumonia encephalitis

Answer 308

if the woman is not immune, and catches it before 28 weeks it can cause developmental issues in the fetus chickenpox around the time of delivery can lead to life threatening neonatal infection treated with VZ immunoglobulins and aciclovir

Answer 309

normally self limiting aciclovir can be used in immunocompromised patients, adults and adolescents over 14 presenting within 24 hours, neonates and those at risk of complications symptoms of itching can be treated with calcamine lotion and chlorphenamine (antihistamine)

Answer 310

coxsackie A virus

Answer 311

illness typically starts with viral respiratory tract symptoms after 1-2 days small mouth ulcers appear followed by blistering red spots across the body, notably on the hands, feet and mouth painful mouth ulcers on tongue are also present

Answer 312

no treatment - management is supportive with adequate fluid intake and simple analgesia such as paracetamol if required the rash and illness resolve spontaneously without treatment after a week to 10 days

Answer 313

dehydration bacterial superinfection encephalitis

Answer 314

as its highly contagious advise should be given such as: avoiding sharing towels and bedding washing hands careful handling dirty nappies

Answer 315

it is a viral skin infection caused by the molluscum contagiosum virus which it a type of poxvirus

Answer 316

small flesh coloured papules that characteristically have a central dimple they typically appear in crops of multiple lesions in a local area it spreads through direct contact or by sharing items like towels or bedsheets

Answer 317

by themselves without treatment however this can take up to 18 months

Answer 318

no treatment or change in lifestyle is required avoid sharing towels or other close contact with lesions to minimise the risk of spreading rarely bacterial superinfection occurs in the lesions due to scratching and this may need antibiotics such as fuscidic acid or flucloxacillin

Answer 319

topical potassium hydroxide, benozyl peroxide, podophyllotoxin imiquimod or tretinoin surgical removal and cryotherapy

Answer 320

it is a generalised self limiting rash that has an unknown cause. it may be caused by a virus such as HHV6 or 7 but no definitive cause has been established

Answer 321

there may be prodromal symptoms prior to the rash such as headache tiredness, LOA and flu like symptoms the rash then starts with a herald patch (faint red or pink scaly oval lesion 2cm or more) which normally presents on the torso then the rash appears which is a widespread faint red/pink slightly scaly oval shaped lesions. seen as christmas tree rash on the torso may have a generalised itch, pyrexia, headache and lethargy

Answer 322

resolves without treatment within 3 months can leave a discolouration of the skin where the lesions were but this will resolve within another few months

Answer 323

no treatment for the rash patient education and reassurance can have symptomatic treatment if bothered by itching such as emollients, topical steroids or sedating antihistamines at night (chlorphenamine)

Answer 324

this is an inflammatory skin condition that affects the sebaceous glands, affecting skin where there are a lot of these glands such as the scalp, nasolabial folds and the eyebrows

Answer 325

erythema dermatitis crusted dry skin in infants it causes a crusted cry flaky scalp often called cradle cap

Answer 326

Malassezia yeast colonisation is thought to have a role and the condition improves with antifungal treatment

Answer 327

it is a self limiting condition which causes a crusted flaky scalp

Answer 328

applying baby oil, vegetable oil or olive oil, and gently brushing the scalp and then washing off when this isnt effective white petroleum jelly can be used overnight to soften crusted areas

Answer 329

topical anti-fungal cream such as clotrimazole or miconazole used for up to 4 weeks

Answer 330

this is a condition which presents with faky itchy skin on the scalp, with more severe cases causing more dense oily scaly brown crusting - commonly in adolescents and adults rather than children

Answer 331

ketoconazole shampoo, left on for 5 minutes before washing off topical steroids may be sued if there is severe itching

Answer 332

this is a condition which presents with red, flaky, crusted itching skin, commonly affecting the eyelids, nasolabial folds, ears, upper chest and back

Answer 333

anti-fungal cream such as clotrimazole or miconazole used for up to 4 weeks localised areas may benefit from topical steroids such as hydrocortisone 1%

Answer 334

this is a fungal infection of the skin also known as tinea and dermatophytosis

Answer 335

tinea capitis - ringworm affecting the scalp tinea pedis - ringworm affecting the feet tinea cruris - ringworm of the groin tinea corporis - ringworm on the body onychomycosis - fungal nail infection

Answer 336

itchy rash that is erythematous, scaly and well demarcated often one or several rings or circular shaped areas that spread outward, with a well demarcated edge edge is more prominent and red

Answer 337

normal ringworm presentation plus well demarcated hair less also be itching, dryness and erythema of the scalp

Answer 338

white or red flaky, cracked, itchy patches between the toes skin may split and bleed

Answer 339

thickened, discoloured and deformed nails

Answer 340

antifungal medications - creams: clotrimazole or miconazole - shampoo: ketoconazole - oral medications: fluconazole, griseofulvin and itraconazole

Answer 341

with amoroline nail lacquer for 6 -12 months Resistant cases may need oral terbinafine, however the patient will need their LFTs monitoring before and whilst taking this.

Answer 342

mild topical steroids: hydrocortisone 1% (often combined with miconazole 2%)

Answer 343

Wear loose breathable clothing Keep the affected area clean and dry Avoid sharing towels, clothes and bedding Use a separate towel for the feet with tinea pedis Avoid scratching and spreading to other areas Wear clean dry socks every day

Answer 344

it is a more extensive and less well recognised fungal skin infection that results from the use of steroids to treat an initial fungal infection This often occurs when the initial presentation of ringworm was misdiagnosed as dermatitis and a topical steroid was prescribed. The steroid improves the itching and inflammation but accelerates the growth of the fungal infection by dampening the immune response in the local area

Answer 345

less recognisable as ringworm as there is a less demarcated boarder and fewer scales

Answer 346

it is a contact dermatitis in the nappy area usually caused by friction between the skin and the nappy and contact with urine and faeces in a dirty nappy

Answer 347

delayed changing of nappies irritant soap products and vigorous cleaning certain types of nappies (poorly absorbent ones) diarrhoea oral antibiotics predispose to candida infection pre-term infants

Answer 348

sore, red, inflamed skin in the nappy area rash appears in individual patches on exposure areas of the skin tends to spare the skin creases skin may be uncomfortable, itchy and infant may be in distress longstanding rash may lead to erosions and ulceration

Answer 349

candida (thrush) in the nappy area is a common finding, signs that would point to candida rather than nappy rash are: - rash extending into the skin folds - larger red macules - well demarcated scaly border - circular pattern to the rash spreading outward - satellite lesions which are smaller patches of rash or pustules near to the main rash - may have oral thrush as well

Answer 350

simple measures to improve skin health: Switching to highly absorbent nappies (disposable gel matrix nappies) Change the nappy and clean the skin as soon as possible after wetting or soiling Use water or gentle alcohol free products for cleaning the nappy area Ensure the nappy area is dry before replacing the nappy Maximise time not wearing a nappy infection with candida or bacteria warrants treatment with antifungal or antibiotic (fusidic acid cream or flucloxacillin)

Answer 351

Candida infection Cellulitis Jacquet’s erosive diaper dermatitis Perianal pseudoverrucous papules and nodules

Answer 352

scabies is tiny mites called sarcoptes scabiei that burrow under the skin causing infection and intense itching. They lay eggs in the skin, leading to further infection and symptoms

Answer 353

can take up to 8 weeks for any symptoms to appear after the initial infection incredibly itchy small red spots, possibly with track marks where the mites have burrows classic location of the rash is between the finger webs but can spread to the whole body

Answer 354

permethrin cream - applied to the shole body, completely covering the skin. the cream should be left on for 8-12 hours and then washed off. this should be repeated a week later to catch all the eggs that survived the first treatment and have now hatched oral ivermectin as a sngle dose can be repeated a week later for difficult to treat/crusted scabies

Answer 355

All clothes, bedclothes, towels and other materials in contact with scabies need to be washed on a hot wash to destroy the mites. Thorough hoovering of carpets and furniture is also essential.

Answer 356

Crotamiton cream and chlorphenamine at night

Answer 357

it is a serious infestation with scabies in patients that are immunocompromised it is extremely contagious rather than individual spots and burrows they have patches of red skin that turn into scaly plaques

Answer 358

they are the pediculus humanus capitis parasite which causes infestations of the scalp

Answer 359

head to head contact or by sharing equipment like combs or towels

Answer 360

itchy scalp can see visible eggs and lice on examination

Answer 361

dimeticone 4% applied to hair and left to dry - left on for 8 hrs and then washed off. this is then repeated 7 days later to catch any like that have hatched since the treatment fine combs can be used

Answer 362

these are rashes caused by bleeding under the skin, and can be described as petechiae (<3mm) and purpura (3-10mm)

Answer 363

meningococcal septicaemia or other bacterial sepsis Henoch-schonlein purpura idiopathic thrombocytopenic purpura acute leukaemias haemolytic uraemic syndrome mechanical: strong coughing, vomiting or breath holding traumatic: non accidental injury, occlusion of blood in an area viral illness: influenza and enterovirus

Answer 364

FBC, U+E, CRP, ESR coagulation screen blood culture meningococcal PCR lumbar puncture blood pressure urine dipstick

Answer 365

this is a condition where red lumps appear across the patients shins, caused by inflammation of the subcutaneous fat on the shins

Answer 366

a hypersensitivity reaction and is associated with a number of triggers and underlying conditions

Answer 367

streptococcal throat infections gastroenteritis mycoplasma pneumoniae tuberculosis pregnancy medications such as the OCP and NSAIDS

Answer 368

inflammatory bowel disease sarcoidosis lymphoma leukaemia

Answer 369

red, inflamed, subcutaneous nodules across both shins nodules are raised and can be painful and tender often will settle over time and appear as bruises

Answer 370

diagnosis is based on clinical presentation Inflammatory markers (CRP and ESR) Throat swab for streptococcal infection Chest xray can help identify mycoplasma, tuberculosis, sarcoidosis and lymphoma Stool microscopy and culture for campylobacter and salmonella Faecal calprotectin for inflammatory bowel disease

Answer 371

conservatively with rest and analgesia steroids can be used to settle the inflammation

Answer 372

it is a superficial bacterial infection usually caused by staphylococcus aureus bacteria (can also be caused by streptococcus pyogenes)

Answer 373

when bacteria enters via a break in the skin - healthy skin or can be related to eczema or dermatitis

Answer 374

typically occurs around the nose and mouth, and has exudate from lesions that dries to form a golden crust

Answer 375

topical fusidic acid can be used antiseptic cream (hydrogen peroxide 1%) can be used in localised non bullous impetigo oral flucloxacillin can be used in more widespread or severe impetigo

Answer 376

Patients should be given advice about not touching or scratching the lesions, hand hygiene and avoiding sharing face towels and cutlery. They need to be off school until all the lesions have healed or they have been treated with antibiotics for at least 48 hours.

Answer 377

it is aways caused by staphylococcus aureus bacteria, and causes 1-2cm fluid filled vesicles to form on the skin which grow and then burst causing a golden crust

Answer 378

bullous impetigo

Answer 379

lesions - golden crust, painful, itchy feverish malaise can cause staphylococcus scalded skin syndrome

Answer 380

antibiotics - flucloxacillin

Answer 381

Cellulitis if the infection gets deeper in the skin Sepsis Scarring Post streptococcal glomerulonephritis Staphylococcus scalded skin syndrome Scarlet fever

Answer 382

this is a condition caused by a type of staphylococcus aureus bacteria that produces epidermolysis toxins. These break down proteins that holds skin together

Answer 383

generalised patches of erythema on the skin then the skin looks thin and wrinkles then there is formation of bullae which burst and leave very sore erythematous skin below gentle rubbing of the skin causes it to peel away will have generalised symptoms: fever, irritability, lethargy, dehydration

Answer 384

where very gentle rubbing of the skin causes it to peel away. This is positive in SSSS.

Answer 385

IV antibiotics fluid and electrolyte balance is key

Answer 386

it is a yeast infection of the skin which causes flaky discoloured patches on the chest and back

Answer 387

commonly affects young adults slightly more common in men than women can also affect children, adolescents and older adults

Answer 388

it is more common in hot humid climates it affects those who heavily perspire may be clear in winter months and recur in the summer

Answer 389

fungi in the genus Malassezia which are a part of the normal microbiota most common are M. globosa, M. restricta and M. sympodialis

Answer 390

One theory implicates a tryptophan-dependent metabolic pathway. The yeasts induce enlarged melanosomes (pigment granules) within basal melanocytes in the brown type of pityriasis versicolor. The white or hypopigmented type of pityriasis versicolor is thought to be due to a chemical produced by malassezia that diffuses into the epidermis and impairs the function of the melanocytes. The pink type of pityriasis versicolor is mildly inflamed, due to dermatiits induced by malassezia or its metabolites.

Answer 391

affects the neck, trunk and/or arms patches may be coppery brown, paler than surrounding skin or pink pale patches are more common in darker skin normally asymptomatic but may have mild itching

Answer 392

wood lamp (black light) examination - yellow-green fluorescence may be seen dermoscopy of the patches - pallor, background faint pigment network and scale microscopy of skin scraping fungal culture skin biopsy

Answer 393

mild - topical antifungals: selenium sulfide shampoo, topical azole cream/shampoo, terbinafine gel applied to skin for 5-15 minutes and then washed off - daily for for one week and then weekly for one month systemic measures - oral: fluconazole prevention - selenium sulfide shampoo every month once the rash has cleared

Answer 394

it is a long term skin condition that mainly affects the face - redness

Answer 395

redness across the nose, cheeks, forehead, chin, neck and chest that comes and goes usually lasts minutes each time face may also feel warm, hot and painful burning or stinging feeling when using water or skincare products may cause tiny broken blood vessels on face dry skin and swelling around the eyes yellow-orange patches on the skin sore eyelids or crusts around the roots of the eyelashes thickened skin mainly around the nose

Answer 396

It's not known what causes rosacea, but some things can make symptoms worse. Common triggers for rosacea include: alcohol spicy foods hot drinks sunlight hot or cold temperatures aerobic exercise, like running being stressed

Answer 397

cant be cured but can control symptoms creams: brimonidine gel to reduce redness, creams such as azelaic acid or metronidazole antibiotics for 6-16 weeks: doxycycline dermatology referral

Answer 398

wear a high SPF sunscreen of at least SPF 30 every day try to avoid heat, sunlight or humid conditions if possible try to cover your face in cold weather use gentle skincare products for sensitive skin clean your eyelids at least once a day if you have blepharitis take steps to manage stress

Answer 399

they need to be referred for same day assessment even if transient synovitis is suspected