Rashes

Question 1

Describe macule

Answer 1

Small (<1cm) flat area of altered colour

Question 2

Describe papule

Answer 2

Raised discrete lesion (<1cm)

Question 3

Describe vesicle

Answer 3

A small clear blister

Question 4

Describe petechiae, purpura and ecchymoses

Answer 4

All from bleeding into skin/mucosa
Petechiae (<3mm), purpura (3-10mm), ecchymoses (>10mm)

Question 5

Causes of maculopapular (or just macular) rashes with fever (viral, bacterial, other)

Answer 5

Viral - Roseola, Fifth disease, measles, rubella
Bacterial - Scarlet fever, rheumatic fever, Typhoid, Lyme’s
Other - Kawasaki, Juvenile RA

Question 6

Causes of vesicular/pustular rashes with fever (viral, bacterial, other)

Answer 6

Viral - Herpes, Chickenpox, hand-foot-and-mouth
Bacteria - Boils, Impetigo
Other - Erythema multiforme, toxic epidermal necrolysis, Steven-Johnson syndrome

Question 7

Causes of petechial/purpural rashes with fever (viral, bacterial, other)

Answer 7

Viral - enterovirus, adenovirus
Bacterial - Meningococcal sepsis, infective endocarditis
Other - Henoch-Schonlein purpura, ITP, vasculitis

Question 8

Scarlet fever presentation

Answer 8

Sore-throat, fever and swollen neck glands followed by rash (after 24 hours)
Maculopapular rash - starts on neck and trunk, sandpaper texture
Tends to affect skin folds (antecubital fossa, axilla, groin)
Strawberry tongue
Can last for over a week

Question 9

Scarlet fever causative organism

Answer 9

Exposure to Group A Strep (pyogenes)

Question 10

Scarlet fever treatment & school exclusion

Answer 10

Penicillin V for 10 days
Return to school 24 hours after commencing antibiotics

Question 11

Roseola presentation

Answer 11

Usually in infants from 6months to 1 year
Rash appears when ~3days of high fever abruptly resolves
Maculopapular, blanching rash - starts on neck and trunk and spreads to extremities (can persist for up to 4 days)
Cervical, post-auricular, suuboccipital lymphadenopathy

Question 12

Roseola causative organism

Answer 12

Human herpes virus 6

Question 13

Roseola treatment and school exclusion

Answer 13

Self-limiting
No school exclusion

Question 14

Fifth disease presentation

Answer 14

Initial non-specific illness (fever, headache, myalgia, nausea, diarrhoea)
Rash appears after 2-5 days
Macular, erythematous, malar rash with circumoral pallor (white area around mouth) followed by reticulated rash on trunk + extremities

Question 15

Fifth disease causative organism

Answer 15

Parovirus B19

Question 16

Fifth disease school exclusion

Answer 16

None

Question 17

Measles presentation

Answer 17

Prodrome of fever (drops after 5 days), cough and non-purulent conjunctivitis
Initial maculopapular, blanching rash on face and then spreads downwards
Koplik spots (white elevaions with erythematous base in buccal mucosa)

Question 18

Measles period of contagiousness & school exclusion

Answer 18

5 days before and 4 days after rash
Exclusion until 4 days after rash

Question 19

Measles complications

Answer 19

Immunosuppression
Respiratory - Otitis media, croup, pneumonia, bronchiectasis
Neurology - encephalitis

Question 20

Kawasaki disease presentation/diagnostic criteria

Answer 20

Unexplained fever for 5 days or more plus 4 of:

• Bilateral, non-purulent conjunctivitis
• Macular rash on trunk/extremities (targetoid lesions)
• Cervical lymphadenopathy
• Oral changes (cracked lips, strawberry tongue)
  Extremity changes (hand/foot oedema, erythema of palms/soles)

Acute inflammation can last up to 12 days

Question 21

Kawasaki disease treatment

Answer 21

IV immunoglobulin
Aspirin
Cardiac assessment + follow-up - including echocardiogram - assess for coronary artery aneurysm

Question 22

Acute urticaria presentation

Answer 22

Pruritic maculopapular rash (circumscribed raised plaques usually)
Confluent macular rash in younger children
Not painful, disappear within 24h
Angioedema of face, lips, extremities

Question 23

Acute urticaria management

Answer 23

Appropriate testing (based on cause of urticaria)
Non-sedating antihistamines (cetirizine, loratadine, fexofenadine)

Question 24

Hand, foot and mouth disease presentation

Answer 24

Usually under 5s
Mild fever, sore throat
Small vesicles in/around mouth (can be painful)
Vesicular/maculopapular rash on palms and soles (go within a week)
Can also affect buttocks, arms and genitalia

Question 25

Hand, foot and mouth management and school exclusion

Answer 25

Self-limiting
No school exclusion

Question 26

Hand, foot and mouth causative organism

Answer 26

Coxsackie A16 virus

Question 27

Herpes simplex virus presentation of primary infection

Answer 27

Abrupt onset fever, inability to eat/drink
Gingivitis (swollen, red, bleeding gum)
Vesicular lesions in mouth can extend to lips and face (ulceration)
Submandibular, cervical adenopathy

Question 28

Chickenpox presentation

Answer 28

Prodrome of fever, malaise and pharyngitis
Generalised, pruritic vesicular rash appears within 24h
Then appears in crops (different body areas develop it at different times)
New lesions stop after 4 days, should mostly crust over by 6 days

Question 29

Chickenpox causative organism and school exclusion

Answer 29

Varicella zoster virus
Until all lesions have crusted over

Question 30

Chickenpox complications

Answer 30

Soft tissue infection
Acute cerebellar ataxia
Diffuse encephalitis
Reye’s syndrome
Pneumonia
Hepatitis