Paeds: Derm

Question 1

• High-grade fever (>5 days), resistant to antipyretics
• Strawberry tongue + white coating (mucous membranes)
• Red + swollen palms/soles/lips (peeling)
• Bilateral conjunctival injections (no discharge)
• Polymorphic blanching rash on abdo
• Cervical lymphadenopathy

Answer 1

Kawasaki Disease (Vasculitis)

Question 2

Kawasaki disease has a risk of

Answer 2

Coronary artery aneurysm

- Always do Echo

Question 3

Management of Kawasaki disease

Answer 3

Aspirin (high-dose)
IV Ig

• Risk of Reye’s syndrome

Question 4

Macular > Papular > Vesicular rash

Answer 4

Chicken pox

• caused by varicella zoster virus (VZV)
• infective 4 days before rash + 5 days after
• incubation period 10-21 days

Question 5

Complications of chicken pox

Answer 5

Shingles (dormant in dorsal root ganglion)
Impetigo
Necrotising fasciitis (by Group A Strep)

Question 6

• White grains of salt on buccal mucuosa (koplik spots)
• Proximal period (irritable, fever, conjunctivitis)
• Maculopapular rash behind ears > then whole body

Answer 6

Measles

• caused by RNA Paramyxovirus (measles morbillivirus), spread through droplets
• infectious from prodrome till 4 days after rash starts
• Incubation period 10-14 days

Question 7

Investigations for Measles

Answer 7

IgM antibodies detected within a few days of rash

Question 8

Complications of Measles

Answer 8

Otitis media
Pneumonia
Encephalitis (1-2 weeks post infection)
Subacute sclerosing pan encephalitis (Dawson Disease)

Question 9

Management of Measles

Answer 9

Supportive

Notify public health

Question 10

Fever
Malaise
Muscular pain
Parotitis (earache, pain eating)
 - unilateral > bilateral (70%)

Answer 10

Mumps

• can cause orchiditis
  deafness

Question 11

Lethargy
Fever
Headache
Erythematous rash “slapped cheeks” that spreads to proximal arms and extensors

Answer 11

Erythema Infectiosum (Fifth Disease) 
"Slapped-cheek syndrome"

• caused by Parvovirus B19
• can lead to aplastic crisis (decreased RBCs)

Question 12

Cause of chicken pox

Answer 12

varicella zoster virus (VZV)

Question 13

Cause of measles

Answer 13

RNA Paramyxovirus (measles morbillivirus)

Question 14

Cause of erythema infectiosum

Answer 14

Parvovirus B19

Question 15

2-6 years old
Nausea
Fever (2 days)
Headache
Sore throat
Strawberry tongue
"Pinhead" rash (punctate erythema) on torso with sand paper texture (palm/sole sparing)

Answer 15

Scarlet fever

• reaction to toxins produced by Group A haemolytic strep (Streptococcus pyogenes)
• incubation period 2-4 days

Can lead to rheumatic fever

Question 16

Cause of Scarlet fever

Answer 16

Group A haemolytic strep (Streptococcus pyogenes)

Question 17

Investigations for scarlet fever

Answer 17

Throat swab

Question 18

Management of scarlet fever

Answer 18

Penicillin V (oral, 10 days)
- Azithromycin (if PA)
Notify public health
Can return to school 24h after starting ABx

Question 19

Age: 6 months - 2 years
Maculopapular rash
Papular erythema on uvula + soft palate (nagayama spots)
Diarrhoea
Cough
Fever (3-5 days)

Answer 19

Roseola Infantum (Exanthem subitum)
"Sixth Disease"

• Caused by Herpes virus 6 (HHV6)
• Incubation period of 5-15 days
• Febrile convulsions in (10-15%)
• Can still go to school

Question 20

Complications of roseola infantum

Answer 20

Febrile convulsions in (10-15%)
Aseptic meningitis
Hepatitis

Question 21

Lethargy
Lesions on trunk
Herald patch presents first

Answer 21

Pityriasis rosea

Question 22

Vesicular rash (hands, feet, face, buttocks, legs, genitals)
Fever
Sore throat
Oral ulcers
Abdominal pain

Answer 22

Hand, foot + mouth disease

• caused by Coxsackie A16
  Enterovirus 71

Question 23

Cause of hand, foot and mouth disease

Answer 23

caused by Coxsackie A16

Enterovirus 71

Question 24

Cause of Roseola infantum

Answer 24

Caused by Herpes virus 6 (HHV6)

Question 25

Management of hand, foot and mouth disease

Answer 25

Self limiting

Don’t need to be kept out of school