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Hasbro and PEM > Pediatric Rashes > Flashcards

Pediatric Rashes Flashcards

1
Q

Kid has a rash for 5 days. What disease should come to mind and what other symptoms help to confirm the diagnosis?

A

Kawasaki
Fever > 5 days with 4 of the 5 following:
(CRASH)
Conjunctivitis, Rash, Adenopathy (cervical), Strawberry tongue, Hands and feet erythema

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2
Q

Kid has a fever for 5 days, red hands and feet, lymph nodes in the neck, a strawberry tongue, and a rash. What is the treatment and feared complication of this disease?

A

Concern for Kawasaki’s

IVIG and High dose aspirin to help prevent coronary artery aneurysm

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3
Q

Kid has palpable purpura on buttocks and legs. What other symptoms are common and what is the cause of this disease?

A

Henoch-Schonlein Purpura
IgA vasculitis of the small arteries leading to blood leakage and issues with perfusion leading to abdominal pain, arthralgias, hematuria, and kidney injury

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4
Q

Kid has palpable purpura on buttocks and legs. What is the workup and treatment?

A

HSP
Usually self limited, but can affect the kidneys for long term.
Check UA for protein and red casts
Labs for kidney and liver function
Coags and platelet count
Rule out intussusception if needed
Supportive care with NSAID’s and if severe, steroids

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5
Q

What is the prognosis of HSP?

A

Usually resolves within 3–4 weeks
Can have lasting kidney issues and needs to be monitored
1/3 will have recurrence
Many can be treated at home

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6
Q

What is the classic rash pattern in measles?

A 
Morbiliform rash (maculopapular) from head to toe
Red circles flat, 1–10mm with healthy skin in between
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7
Q

What disease has koplik spots?

A

Measles

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8
Q

What are the classic symptoms of measles?

A

Cough, Coryza, Conjunctivitis

Koplik spots

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9
Q

What are the complications of measles?

A

Pneumonia, Myocarditis, Pericarditis, Weakens immune system, Encephalitis, Death
ADEM: acute disseminated encephalitis
SSPE: subacute sclerosing panencephalitis that progresses to a vegetative state

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10
Q

What is the treatment for measles?

A

Isolation as this is a very infectious disease! The most infectious known to man!
Infectious from 4days before and after the rash starts
Supportive care otherwise

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11
Q

What infection causes an itchy anus in kids and what is the treatment?

A

Enterobius (Pinworm)
Single dose of mebendazole or pyrantel
Treat all family members

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12
Q

What is eczema?

A

Atopic dermatitis
Chronic pruritic skin condition
Inflammatory condition

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13
Q

What makes eczema worse and how is it treated?

A

Skin dryness and winter months make it worse
Triggers such as bathing, dessicants, heat, contact irritants, allergens
Treated with steroids, strong steroids cannot be used on the face
Use vaseline, aquaphor, emmolients QID
benadryl for itchiness, minimize bathing and drying soaps

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14
Q

Patient with eczema presents with weeping skin lesions. What should come to mind?

A

Bacterial superinfections including strep

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15
Q

Which viral kid disease causes Subacute sclerosing panencephalitis or an acute disseminated encephalopathy?

A

Measles

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16
Q

Kid has had a high fever that resolved and then a rash appeared. What is this classic disease?

A

Roseola infantum or exanthem subitum (“sudden flowering”)

Generally benign

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17
Q

A patient with eczema has been treated with topical steroids and is complaining of a change in the rash with increased pain and vesicles. What is the issue and what is the treatment?

A

Concern for Herpes infection of the eczema
Eczema herpeticum
Mortality as high as 10%!
Need to start IV acyclovir immediately and admit and test for HSV
Cover for bacterial infection as well if indicated
Brought on by immune suppression, possible from the topical steroids

18
Q

What is the best approach when using steroids to treat eczema?

A

Use lowest dose that works
Only low potency on the face or groin and medium on the trunk or extremities
Potency is a measure of vasoconstriction
If increased potency is needed, it is better to change the drug than to change the concentration
Steroids cause tachyphylaxis and therefore brief periods of a break can be helpful to prevent this

19
Q

Is eczema more common on flexor or extensor surfaces?

A

Eczema on flexor

Psoriasis on extensors

20
Q

Kid has a dry and peeling scalp that is at times yellow and crusty. What is the likely cause and treatment?

A

Seborrheic dermatitis or cradle cap

Treat with anti-fungal shampoo (ketoconazole)

21
Q

Kid has a fever, is miserable, is refusing to eat or drink. They are dehydrated. There are red lesions in the back of the throat. What other symptoms are likely, what disease and cause, and treatment?

A

Hand-Foot-Mouth
Coxsackie virus
This is NOT Herpetic gingivostomatitis, which has anterior lesions
This IS herpangina
Check hands, feet, and buttocks for lesions
Give analgesics to help kid drink
Admit if cannot drink and dehydrated, otherwise supportive care at home
Mouth rinses are not recommended
Remind parents that the kid won’t eat and that is fine

22
Q

Why are mouth rinses not a good idea for kids with mouth pain?

A

Benzocaine leads to methemoglobinemia, especially in kids less than 2
Magic mouthwash cannot be swallowed and can lead to sedation and seizures

23
Q

What is the rash location progression in varicella?

A

Face to trunk

24
Q

Which disease has lesions in various stages or groups?

A

Varicella

25
Q

What are complications of varicella?

A

Encephalitis, ataxia, pneumonia, hepatitis, bacterial super infection

26
Q

What is the treatment for varicella?

A

Antihistamines for itching
Oatmeal bath
Cut nails
NO ASPIRIN!

27
Q

When are antivirals given for varicella?

A

less than 1 year old

or greater than 1 year that is high risk and symptoms less than 24 hours

28
Q

Patient has a sibling with chicken pox. What does this patient need?

A

VZV vaccine or VZIG or antivirals

29
Q

What is Reye’s syndrome?

A

Rapidly progressive encephalitis
Hepatic dysfunction
Most common after varicella or influenza
Vomiting –> confusion –> seizures and coma
Hepatomegaly
Renal and cardiac failure
Increased ICP
VERY rare nowadays
Can come from ASA in kawasaki’s or NSAIDs in juvenile arthritis
Labs show increased LFT’s, pt and ammonia with low glucose

30
Q

Kid had the flu and now is vomiting and rapidly becoming confused and unresponsive. Labs show elevated LFT’s and ammonia level. Liver is palpable. What is going on?

A

Reye’s syndrome
Rapidly progressive encephalitis
Liver involvement
Given aspirin with the flu or varicella

31
Q

How is scabies treated?

A

Permethrin neck down for adults and face/scalp for kids for 8–12 hours and then washed off in shower
Decontaminate all textiles in the house with hot water or place in a bag for 10 days
Ivermectin is used for crusted scabies in immune compromised people

32
Q

How are tineas treated?

A

Topical antifungals except for capitis which is systemic therapy

33
Q

What is a kerion?

A

Boggy, painful hair loss region from tinea capitis
Treated with griseofulvin with shampoos as adjunct
Sometime prednisone as well

34
Q

How is impetigo treated?

A

topical mupirocin or keflex

35
Q

Kid has thin walled blisters that burst and leave round red lesions the size of a coin. What is this?

A

Bullous impetigo
Gram positive disease
Spreads rapidly
Usually benign but is concerning in neonate

36
Q

How is staph scalded skin same or different from SJS or TEN?

A

No mucous membrane involvement

Red skin with + Nikolsky’s sign

37
Q

What are the symptoms of staph scalded skin? Treatment?

A

Usually in young kids
Fever, sensitive skin that desquamates in large sheets
Treated as a burn with fluids and admitted
Caused by toxins
Treat with nafcillin or oxacillin

38
Q

What condition has circumoral pallor?

A

Scarlet fever

39
Q

What are the features of scarlet fever?

A

Fever, malaise, pharyngitis, sandpaper rash, strawberry tongue, desquamation

40
Q

How is the rash with scalded skin and scarlet fever kinda similar?

A

Both cause desquamation, but scalded skin is way worse

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