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Phase 3a > Paeds - Skin > Flashcards

Paeds - Skin Flashcards

1
Q

Purpuric non-blanching rash on buttocks and legs; abdo and joint pain

A

Henoch-Schonlein purpura

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2
Q

What is Henoch-Schonlein purpura caused by?

A

IgA small vessel vasculitis triggered by upper airway infection or gastroenteritis

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3
Q

Typical presentation of Henoch-Schonlein

A

Kids 3-10 years old

Previously ill: now arthralgia, skin rash, abdo pain, local oedema

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4
Q

Complications of Henoch-Schonlein

A

Intussusception, renal failure (nephrotic syndrome), arthritis

Usually self limiting tho

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5
Q

Young child with high fever not responding to paracetamol, bilateral red eyes and cracked lips

A

Kawasaki disease

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6
Q

What is Kawasaki disease

A

Medium vessel vasculitis

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7
Q

Kawasaki disease main presentation

A

Persistent high fever for over 5 days AND AT LEAST 4 Of the following:

  • Red tongue and cracked lips
  • red rash on trunk
  • Skin peeling on palms and soles (desquamation)
  • cervical lymphadenopathy

(CRASH and burn: conjunctivitis, rash, adenopathy, strawberry tongue, hands - erythem, swelling, desquamation + Fever)

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8
Q

Kawasaki Management

A

HIGH DOSE ASPIRIN AND IV IMMUNOGLOBULIN within 10 DAYS of presentation

Do ECHO to check for CORONARY ANEURYSM

NOTIFY HEALTH COUNCIL

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9
Q

Treatment for meningococcal septicemia

A
  • BLOOD CULTURE AND LUMBAR PUNCTURE before starting antibiotics

If at GP: IM BENZYLPENICILLIN AND CALL 999

< 3 months: CEFOTAXIME AND AMOXICILLIN

> 3 months: Ceftriaxone or CEFOTAXIME

+ Dexamethasone to reduce swelling and neuro/hearing damage

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10
Q

What is Erythema marginatum

A

Type 2 hypersensitivity reaction (autoantibodies) triggered by rheumatic fever

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11
Q

Kid with malaise, fever and generalised itchy vesicular rash

A

Varicella zoster (chicken pox)
- can be caught via shingles contact

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12
Q

Spread of chicken pox rash

A

Red raised and blistering

Starts on trunk/face and spread across whole body

Once it scabs over it stops being Infectious

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13
Q

Mx of chicken pox

A

Mainly conservative: keep cool, trim nails, calamine lotion

If IMMUNOCOMPROMISED/ Neonate - give VARICELLA ZOSTER IMMUNOGLOBULIN

DO NOT USE NSAIDS - risk of secondary infection

DON’T go to school for 5 days after vesicles form

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14
Q

Complications of VARICELLA ZOSTER

A
  • Pneumonia
  • Encephalitis
  • Strep pyogènes skin infection
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15
Q

Treatment for shingles

A

Oral aciclovir

Also used for pregnant people with chicken pox (otherwise can get congenital varicella syndrome)

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16
Q

Kid with gold-ish crusty rash around mouth or nose

A

Impétigo - staph aureus or less commonly strep pyogenes

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17
Q

What causes classic appearance of impetigo

A

Staph aureus makes EXFOLIATIVE TOXINS which break down proteins holding cells together

Get fluid filled vesicles (1-2 cm) and crust

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18
Q

Management for impétigo

A

Swab vesicles to confirm and get bacteria and antibiotic sensitivities

TOPICAL FUSIDIC ACID

Flucloxacillin if systemic features

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19
Q

Kid with flu-like symptoms, cheeks very red, lips look pale

A

Parvovirus B19 (erythema infectiosum)
- slapped cheek disease

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20
Q

Complications of parvovirus

A

If transmitted from mum to baby - hydrops fetalis

In people with sickle cell or thalessaemial - APLASTIC CRISIS

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21
Q

Baby with high fever and maculopapular rash on chest, spreading to limbs. Now getting convulsions.

A

Sixth disease - HUMAN HERPES VIRUS 6 (6-24 month olds)

Also causes:

  • palpable posterior lymph nodes
  • vomiting and diarrhoea
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22
Q

Treatment for sixth disease

A

Resolves by itself, just support

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23
Q

Kid with rash on chest but NOT FACE. Feels rough (like sandpaper). Fever, malaise, nausea, headache.

A

SCARLET FEVER from GROUP A BETA HAEMOLYTIC STREP (pyogenes)

Also get desquamation on fingers and toes
CLASSIC STRAWBERRY TONGUE

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24
Q

Complications of scarlet fever

A

Otitis media, rheumatic fever, glomerulonephritis (all linked to strep pyogenes)

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25
Q

Management of scarlet fever

A

Swab throat

ANTIBIOTICS PRONTO:

  • PO PENICILLIN V or Azithromycin for 10 days

DON’T go to school till 24hrs after starting Abx

Notifiy local infectious diseases centre

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26
Q

Hand foot mouth rash

A

COXSACKIE A16 Virus and enterovirus 71

Fever, sore throat, cough, tiredness
- then the rash, starting from mouth ulcers

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27
Q

Management of hand foot mouth

A

Conservative but VERY CONTAGIOUS

Resolves in 10 days ish

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28
Q

Young child with fever and sore throat. Widespread Erythematous rash with peeling skin

A

Staphylococcal Scalded Skin Syndrome (same method of action as impetigo but more severe)

Skin is thin and wrinkled, bullae form which burst and look like scalds

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29
Q

Nikolsky’s sign

A

Skin separates on gentle pressure

(Staphylococcal Scalded Skin Syndrome)

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30
Q

Mangement of staphylococcal Scalded Skin Syndrome

A
  1. IV ANTIBIOTICS
  2. Topical FUSIDIC ACID
  3. Fluid and Electrolyte management
  4. Analgésia and paracetamol
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31
Q

Teen girl with high fever, hypotension, tachycardia and diffuse desquamating erythematous rash

A

Toxic shock syndrome
- severe systemic reaction to STAPHYLOCOCCAL EXOTOXIN

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32
Q

Causes of toxic shock syndrome

A

TAMPONS for too long
Female barrier contraception
Nasal packing for nose bleeds
Any break in skin

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33
Q

Présentation of toxic shock

A

Multi organ:
- D and V
- Confusion
- Renal failure
- Thrombocytopenia
- Hepatitis
- Rash
- FEVER AND SIGNS OF SHOCK

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34
Q

Management of Toxic shock

A

ABCDE

Oxygen

IV broad spectrum ANTIBIOTICS AND IV IG

IV fluids

Surgical debridement

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35
Q

Common presentation of measles

A
  1. Prodrome phase: fever, coryza, conjunctivitis, cough, irritable
  2. Koplik spots - white spots in mouth mucosa
  3. Maculopapular rash - starts behind ears and spreads to whole body
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36
Q

Cause of measles

A

Single strand negative sense RNA PARAMYXOVIRUS

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37
Q

Complications of measles

A
  • Otitis media
  • Pneumonia (most common killer)
  • Encephalitis (1-2 weeks after)
  • Sub acute sclerosing pan encephalitis (5-10 years later)
  • Febrile convulsions
  • Myocarditis
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38
Q

Management of measles

A
  • LIVE MMR VACCINE (1, 3 and 4 years)
    • immunity from mum till 9 months

When active just supportive management

NOTIFY HEALTH COUNCIL + DON’T go to school till 5 days after rash

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39
Q

Scarlet fever aet + epid

A

Caused by reaction to ERYTHROGENIC TOXINS made by STREP PYOGENES

TYpically between 2-6 years

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40
Q

Investigations for measles

A

Bloods:

  • IgM Ab
  • LFTs (raised)
    Measles RNA PCR on ORAL FLUID
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41
Q

Slapped cheek presentation

A

Any age

  • Fever, coryza, headache
  • Slapped cheek + glove + stocking rash
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42
Q

Slapped cheek Mx

A

Ix: clinical diagnosis +/- serology

Tx: Supportive
- rash means it’s no longer infective

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43
Q

Roseola infantum Px

A
  • HIGH FEVER typically lasting around 3 days
  • Potentially:
    • vomiting, diarrhoea, febrile convulsions
  • Rose-coloured rash starting from trunk, spreading peripherally
  • Nagayama spots: on soft palate + uvula
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44
Q

Roseola Infantum cause

A

Human Herpes Virus - 6

45
Q

Roseola Infantum epid

A

Kids < 2 y/o

46
Q

Roseola Infantum Mx

A

Self-resolving within 2-5 days - supportive treatment

Clinically diagnosised

47
Q

Kawasaki epid

A

More common in JAPANESE/KOREAN or AFROCARRIBEAN kids < 4 y/o

48
Q

Eczema

A

Chronic inflammation of dermis leading to SPONGIOTIC epidermal changes on histology

49
Q

RFx for Eczema

A
  • FHx of atopy
  • Urbanisation/industrialisation
50
Q

Eczema pathophys

A
  • High number of immune cells in skin -> dermatitis
  • Keratinocytes separate + become rounder -> spongy look under microscope
  • If chronic: HYPERPLASIA + impaired differentiation (leading to retained nuclei in stratum corneum)
  • Oft associated with + exacerbated by IgE sensitivity to environmental allergans

N/b: can get dermatitis without eczematous change

51
Q

DDx for atopic dermatitis

A
  • Atopic eczema
  • Contact dermatitis (allergic or irritant)
  • Seborrheic dermatitis (basically inflammed dandruff)
  • Venous/stasis eczema
  • Asteatotic dermatitis/eczema craquele (caused by dry skin)
  • Erythrodremic eczema
  • Pompholyx eczema (hands + feet)
52
Q

Atopic eczema Px

A
  • Typically in kids -> less severe with age
  • Rash on face + flexors (face more common in infants)
    - Itchy, ERYTHEMATOUS + OOZING - may have vesicles
    - Dry + flaky
    - Lichienification from scratching (thick + leathery)
  • Atopic PHx/FHx
53
Q

Eczema Dx

A

Clinical diagnosis - additional investigations are done for the following:

  • Prior to starting systemic DMARDs if severe
  • Bloods:
    • if concerned about infection
    • IgE + RAISED EOSINOPHILS = atopic
  • RAST IgE or Skin-prick test for allergies
  • Patch test (48hr skin contact to allergen) - for allergic contact dermatitis (type 4 delayed allergic reaction)
  • Swabs if infection concern
  • Skin biopsy if Dx very uncertain
54
Q

Severity of eczema presentation

A
  • Mild: some dryness + infrequent itching
  • Mod: some dryness, frequent itching + ERYTHEMA
  • Severe: Widespread dryness + erythema; incesent itching
  • Infected if weeping, crusted, pustules +/- fever/malaise

Can also get excoriation, skin thickening, bleeding, oozing, cracking + altered pigment

55
Q

What are the 3 key signs of chronic eczema inflam

A
  • Epidermal acanthosis (thickening epidermis)
  • Hyperkeratosis (Thick stratum corneum)
  • Parakeratosis (retained nuclei in stratum corneum)
56
Q

Eczema Tx

A

Conservative:

  • Avoid triggers + allergens
  • Keep affected area cool + dry
  • Sedating antihistamine can reduce itching (esp if affecting sleep)
  • Liberal amounts of emollient
  • Psych support as needed

Medical:

  • Mild: Emollient + mild topical hydrocortisone 1%
  • Moderate: emollient + moderate corticoseteroid (clobetasone butyrate 0.5%) - only put hydrocortisone on face + flexures
  • Severe: emollient + BETAMETHASONE valerate 0.1% (clobetasone butyrate for face + flexures)
  • Consider oral corticosteroid if severe, extensive + causing psych distress
  • DEMARDs
  • Biologics (Dubilumab, Barcitinib) - only if not responding
  • 2nd line: Topical calcineurin inhibitors (Tacrolimus) - need specialist prescribing

Narrow band UV-B light therapy

If nothing working on severe after 1 wk refer to derm (urget if not responding after 2 wks)

57
Q

Complications of eczema

A

Scratching:

  • Poor sleep
  • Poor mood
  • Skin breakdown -> risk of infection

Psycho-social:

  • Insecurities
  • Having to avoid activites e.g. swimming

ECZEMA HERPETICUM (emergancy)

  • Disseminated Herpes simplex infaection
  • Vesicles + punched out errosions
  • Multi organ involvement
58
Q

Mx of Eczema hherpeticum

A

Dx with SWAB + Tzanck test (large round keratinocyte with hypertrophic nucleus, hazy/absent nucleoli + basophilic cytoplasm present)

IV ACICLOVIR + concommitant Abx

59
Q

Stevens-Jhonson syndrome (SJS)

A

Immune-COMPLEX (type 3) mediated hypersensitivity disorder

Can be mild - most severe = Toxic Epidermal Necrolysis

60
Q

Cause of SJS

A
  • Most commonly ADVERSE DRUG REACTIONS
  • Also VIRAL pathogens (bacteria/fungal less common)
61
Q

Which drugs are most likely to cause SJS

A
  • SULFONAMIDES (e.g. co-trimoxazole)
  • BETA-LACTAMS
  • ANtiepileptics
  • ALLOPURINOL
  • NSAIDs
62
Q

SJS Px

A
  • URTI like Sx within 1 week of meds/infection
  • Erythematous macules within a few days
    - Become TARGET SHAPED
  • Flaccid blisters + Nikolskey sign (skin separates when rubbed)
  • Mucosal ulceration:
    - Conjunctiva
    - Mouth
    - Pharynx
    - GI tract
    - Urethra

N/B: SJS only covers <10% of body surface
- if it covers > 30% it is Toxic Epidermal Necrolysis (TEN)

63
Q

SJS prognosis

A

10% mortality rate due to:

  • Dehydration
  • Infection
  • DISSEMINATED INTRAVASCULAR COAGULATION
64
Q

DDx for SJS Px

A
  • Erythema multiforme (target lesions typically tend to be on hands/feet; less mucosal involvement)
  • Drug Rash with Eosinophilia + Sytemic Symptoms (2-6 wks after drug exposure)
  • Acute Generalised Exanthematous Pustulosis (rapid + small non-follicular pustules)
65
Q

SJS Dx

A

Clinical +/- skin biopsy

On histology:

  • Necrotic keratinocytes
  • Sparse lymphocytic infiltrate
66
Q

SJS Mx

A

Supportive:

  • prevent occular complication (refer to ophthal)
  • Fluid + electrolyte balance (hosp admission)
  • ANALGESIA
  • Tx any 2ndry infections
67
Q

Allergic rhinitis

A

Inflammation of nasal mucosa in response to environmental allergens. Often associated with allergic conjunctivitis. May have seasonal variation.

More common in people with other immune disorders e.g. atopy/asthma

68
Q

Allergic rhinitis aet

A

IgE-mediated response to environmental allergens

69
Q

Allergic rhinitis Sx

A
  • Nasal pruritis + sneezing
  • Rhinorrhoea
  • Nasal congestion

Congunctivitis:

  • Eye redness
  • Puffiness
  • Watery eye discharge
70
Q

DDx for rhinitis

A
  • Sinusitis (facial pain/pressure; anosmia)
  • Nasal polyps (nosebleeds; chronic sinusitis)
  • Deviated Nasal septum (bleeds, pain, headache, postnasal drip)
  • Common cold (body aches + fatigue)
71
Q

Allergic rhinitis Dx

A

Clinical usually

Ix: Skin prick test; Bloods for specific IgE Ab
- to identify allergen

72
Q

Allergic rhinitis Mx

A
  • Avoid trigger
  • NASAL IRRIGATION (saline)
  • Intra-nasal/oral ANTI-HISTAMINES
  • Intranasal steroids if not responding
  • Oral steroids if severe + affecting QoL
  • Refer to ENT if:
    - Red flags for serious diagnosis
    - Refractory
    - Allergen testing needed
73
Q

Urticaria

A

Hives - small, itchy lumps

Oft associated with patchy erythematous rash (localised or widespread)

Can be associated with Angioedema + flushing

74
Q

Urticaria pathophys

A

Caused by HISTAMINE + other PRO-INFLAM chemicals - released from MAST CELLS in SKIN

Acute = part of allergic reaction

Chronic = Autoimmune

75
Q

Causes of Acute urticaria

A
  • Allergies
  • Contact with chemical, latex, stinging nettles
  • MEDICATIONS
  • Viral infections
  • Insect bites
  • Dermatographism (rubbing of skin)
76
Q

Causes of Chronic urticaria

A

Autoimmune reaction where Autoantibodies cause mast cells to release pro-inflam.

Can be:

  • Chronic idioptahic urticaria
  • Chronic inducible urticaria
    - Triggeres include:
    - Sunlight, Temp change, Exercise, Strong emotions, Heat/cold, Pressure
  • Autoimmune urticaria (associated with underlying condition e.g. SLE)
77
Q

Urticaria Mx

A

For acute:

  • Antihistamines - FEXOFENADINE
  • and/or oral steroids (if severe)
  • Avoid triggers

If very severe -> specialist referral:

  • Leukotrine receptor Antagonist (MONTELUKAST)
  • Omalizumab (anti-IgE)
  • Cyclosporin
78
Q

Anaphylaxis

A

Acute + severe type 1 (IgE mediated) hypersensitivity.

Systemic + potentially life-threatening multiple organ invlovement caused by release of histamine + cytokines from mast cells + basophils

Atopic history = RFx

79
Q

Common anaphylaxis triggers

A

Animals:

  • Insect stings
  • Animal dander

Food:

  • NUTS
  • SHELLFISH
  • EGGS
  • Milk

Meds:

  • ANTIBIOTICS
  • IV contrast
  • NSAIDs
80
Q

Anaphylaxis Sx

A
  • Airway: Swollen lips/tongue, sneezing
  • Resp: Wheeze; SOB
  • Cardio: SHOCK - tachycardia, hypotension + ANGIOEDEMA
  • GI: Pain, diarrhoea, vomiting
  • Derm: Urticaria, pruritis, flushing
81
Q

DDx for anaphylaxis

A
  • Vasovagal reaction (no derm involvement)
  • Panic attack (no skin involvement)
  • Asthma exacerbation (not systemic)
  • Carcinoid syndrome (typically more chronic - from serotonin release)
82
Q

Anaphylaxis Ix

A

Bloods - Serum MAST CELL TRYPTASE (rises within an hour of onset)

83
Q

Anaphylaxis Mx

A
  • IM ADRENALINE 300 micrograms (1:1000)
  • Call for help
  • Remove trigger if possible
  • ABCDE
  • Make patient SUPINE + RAISE LEGS

Open airway + supplement O2 once equipment available
- IV fluids if in shock
- monitor for 6-12 hrs

Hydrocortisone if not as urgent

After -> SAFTY NETTING:

  • 2 autoinjectors
  • Written advice
  • Referral for allergy service follow up
84
Q

Common birthmarks

A
  • Salmon patch (flat, pink, on face at birth)
  • Infantile haemangioma (raised, strawberry marks - more common in girls - increase in size after birth)
  • Capillary malformation - aka Port Wine Stain (unilateral, face/chest/back, receptive to hormones)
  • Cafe-au-lait spots (>6 by 5y/o - could be neurofibromatosis)
  • Mongolian spot (blueish - lowe back + buttocks)
  • Congenital melanocytic naevi (noles)
85
Q

Macular rash definition + examples

A

non-palpable rash with colour changes in limited areas (not raised)

e.g. measles, rubella

86
Q

Papular rash definition + examples

A

palpable rash with raised, solid lesions and colour changes in
limited areas up to 0.5 cm

e.g. Gianotti-Crosti, pityriasis rosea

(quite commonly hear maculo-papular ie flat in some places raised in some)

87
Q

Vsicular rash definition + examples

A

Elevate lesions that are filled with clear fluid less than 0.5 cm (small vesicles)

e.g. Chicken pox, herpes simplex, herpes zoster

88
Q

Ulcer definition + examples

A

A skin or mucous membrane lesion occurring as a result of the
loss of superficial tissue, usually involving an inflammatory
process

e.g. Aphthous ulcer

89
Q

What number of cafe au lait spots are suggestive of NF

A

5 or more

90
Q

Erythema toxicum neonatorum

A

Common baby rash caused by being newly exposed to the environment

91
Q

What is the recommendation for chickenpox to reduce risk of secondary bacterial infection

A

Don’t use ibuprofen, only calpol

92
Q

Measles characteristic presentation

A

Rash + CCCK

Cough
Coryza
Conjunctivitis
Koplick’s spots (small white spots in oral mucosa)

93
Q

Which populations are particularly in danger from getting erythema infectiosum (Parvovirus B19)

A
  • Adults
  • Preg
  • Haemoglobinopathies (e.g. sickle cell etc)
94
Q

Roseola infantum natural Hx

A
  • Misery high fever
  • May get febrile convulsions
  • Gets better when rash shows up

Caused by HHV6

95
Q

Which virus causes hand foot mouth

A

Coxsackie A16

or Enterovirus 71

96
Q

Rash esp on one finger

A

Could Herpetic Whitlow from thumb/finger sucking when they had oral HSV

97
Q

When is herpes particularly nasty

A

in immunocomp OR ECZMA (eczema herpeticum)

98
Q

Plaque definition + example

A

A differentiated are on a flat skin surface area (may also occur
on a mucous membrane)

E.g. Urticarial plaque

99
Q

What causes verucas

A

Human papilloma virus 1, 2 + 3

100
Q

Nodule defintion + examples

A

A circumscribed swelling or an elevated lesion

e.g. Nodular prurigo

101
Q

Petechiae definition + example

A

A small red or purple spot that is not elevated and does not
blanche when pressure is applied. Usually the result of
haemorrhages from tiny blood vessels in the skin

AKA a non-blanching rash (bigger ones are called Purpura)

E.g. Meningococcal sepsis, Henoch-Schonlein Purpura, Neutropenia from LEUKAEMIA

102
Q

Most common cause of Peri-orbital cellulitis

A

Staphylococcus (will need IV Abx if bad)

103
Q

Why is it important to act quickly if a kid has ORBITAL involvement in cellulitis

A

Infection can travel back up into brain / cause blood clots

104
Q

Crusts defintion + examples

A

Hard outer layer of lesions which may be due to dried serum or
pus from ruptured vesicles

E.g. Impetigo

105
Q

What symptoms can be caused by Henoch-Schonlein Purpura

A
  • Rash
  • Joint pain / swelling
  • Abdo pain
  • Intussuception
  • Nephritis (rare)
106
Q

Blisters definition + examples

A

A fluid-filled structure within the epidermis or under the dermis

Bullous impetigo,
bullous pemphagoid

107
Q

Classic presentation of tinea capitis

A

Weeping + areas of hair loss

ie RING worm (actually a fungal rash)

108
Q

Rash in nappy area with crease involvement + satellite lesions

A

Candida

Need to treat mum’s nipples too

109
Q
A

Phase 3a (26 decks)

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