Rashes

Question 1

Red flags associated with rashes

Answer 1

Fever
Toxic appearance 
Mucosal lesions
Severe pain
Immunosuppressived 
Very old/very young
Commenced new meds
* A rash associated with fever or hypotension is a potential life threatening condition

Question 2

Petechia (pi’ti:kia) rash

Answer 2

Small red lesions due to leaking of blood due to ruptured capillaries under the skin
May be due to minor trauma or widespread due to blood clotting disorder

Question 3

Purpuric

Answer 3

Petechia is referred to purpura when lesions are greater than 0.5cm diameter
Non- blanching when pressure applied
Usually starts on dependent areas of body
May be palpable or non palpable
Palpable- febrile/toxic- meningococcal, disseminated gonococcal infection,
Endocarditis
Afebrile- autoimmune vasculitis

Question 4

Erythemous

Answer 4

Characterised by diffuse red akin from capillary congestion. Appears like bad sunburn
Can be due to a number of inflammatory and infectious conditions that can be life threatening.

Question 5

Maculopapular

Answer 5

Most common type of rash usually due to a viral illness
Macules refer to:Flat red splotches
Papules refers to: solid raised lesions
When assessing establish if pt is febrile and unwell and if lesions are concentrated centrally (chest, abdomen, back) or peripheral (extremities)

Question 6

Vesiculobullous

Answer 6

Characterised by involvement of dermal-epidermal junction resulting in fluid filled lesions
Lesions referred to as vesicles if <1cm and bullae >1cm
Determine if fever and distribution of lesions
Possibly diagnosis: varicella, small pox
Febrile: hand, moot and mouth
Localised - necrotising fasciitis
Afebrile: burns, herpes zoster contact dermatitis

Question 7

Atopic dermatitis

Answer 7

Known as eczema, does not require isolation. The skin does not moisturise well and becomes dried out making the skin open to allergies and effects to irritants
Skin can become infected

Question 8

Cellulitis

Answer 8

Skin infection, presenting as a red, swollen area that is hot and tender to touch. Commonly caused by streptococcus and staphylococcus aureus bacteria entering through a break in the skin
If not treated can spread to lymph nodes causing lymphodema, septacaemia or nec fasciitis.

Question 9

Urticaria

Answer 9

Aka hives
Superficial swelling on the surface of the skin.
Most cases due to a release of histamines from mast cells which irritate nerve endings to cause localised intense itch and irritation and vasodilation of small blood vessels which leak fluid triggering redness and swelling

Question 10

Chicken Pox

Answer 10

Highly contagious
Endemic in winter and early spring
Transmission: airborne droplets and contact with vesicle fluid
Scabs are not infectious
Infectious for 1-2 days(up to 5days)
Fever, malaise, rash
Initially maculopapular then vesicular and progresses to crusted lesion

Question 11

Shingles

Answer 11

Herpes zoster caused by varicella
Characterised by unilateral vesicular eruption
Associated severe pain
Can last weeks
In immunocompromised can be more severe
Blindness can result if near the eye
Management: antiviral meds and pain relief

Question 12

Impetigo (school sores)

Answer 12

Highly contagious
Rapidly spreading skin infection
Common around mouth and nose
Requires OAB

Question 13

Meningococcal

Answer 13

Reportable illness
Peak: winter and spring
Pts generally present with meningitis or sepsis
Clinical manifestations: fever, severe headache, nausea, vomiting, and neck stiffness. A petechial or purpuric rash may be present
Mode of transmission: respiratory droplets