Rashes

Question 1

Define impetigo

Answer 1

Highly contagious superficial epidermal infection of skin by staphylococcal and streptococcal bacteria characterised by golden crusts

Question 2

What is the key history of a impetigo case?

Answer 2

Infants and shool age children
Very contagious often spread from direct contact (e.g at nursey)
Erythematous macule that vesticulates or pustules becoming a superficial erosion with a golden crust.

Question 3

What are the different classifications of impetigo?

Answer 3

Bullous - fluid filled - typically staph
Non-bullous - more common - staph or strep

Question 4

Name the rash

Answer 4

Impetigo

Question 5

How is impetigo diagnosed?

Answer 5

Typically clinical
May require a skin swab

Question 6

What is the typical management of impetigo?

Answer 6

Local and non-bollous - topical hydrogen peroxide 1% cream
Widespread - topical fusidic acid or oral 5d amoxicillin
Bullous - oral antibiotics - 7d flucloxacillin

Question 7

How long should children with impetigo be off school?

Answer 7

48hrs after starting treatment
Or until all lesions are healed

Question 8

What is a key complication of impetigo to be aware of?

Answer 8

Cellulitis
Ecthyma
Septic arthirits
Sepsis
Scarring
Acute post-streptococcal glomerulonephritis

Question 9

What is Henoch-Schonlein purpura?

Answer 9

Most common vasculitis in children between 3-15yrs
IgA small vessel leukocytoclastic vasculitis often post URTI

Question 10

What are the key signs and symptoms of HSP?

Answer 10

Arthralgia/arthritis
Abdominal pain
Rash (palpable purpura across buttocks and extensor surfaces)
Renal disease -> asymptomatic microscopic haematuria or isolated proteinuria.

Question 11

What are the key investigations for HSP?

Answer 11

Skin biopsies of lesion -> neutrophils and monocytes
Renal function tests and urinalysis -> assess renal impacts

Question 12

What is the typical management for HSP?

Answer 12

Analgesia and supportive measures
Corticosteroids for symptoms control
Severe abdominal pain may require surgical review to assess for risk of intussusception or bowel infarcts
Renal to renal specialist if dialysis needed

Question 13

What are the key complications of HSP?

Answer 13

Pulmonary or GI tract haemorrhage
Renal impairement leading to end stage renal disease
Neurological complication such as headache and seizures
Eye complications like keratitis or uveitis

Question 14

What layer of the skin is affected in cellulitis?

Answer 14

Dermis and subcutaneous tissue

Question 15

What is the most common pathogen causes cellulitis?

Answer 15

Group A Streptococcus - strep, pyrogenes

Question 16

What is the typical management of cellulitis?

Answer 16

Antibiotics - oral or IV - penicillins - flucox
Analgesia
Elevation to reduce swelling
Wound debridement is necessary -> prevent necrosis or abscess formation

Question 17

What is urticaria?

Answer 17

Hives - rapid pruritic (itchy), red raised wheels that vary in size and shape.
Typically resolve within 24hrs
Angio-oedema in severe cases.
Can be acute or chronic (>6w)

Question 18

What are some common triggers for urticaria?

Answer 18

Allergens - foods, medications, insect stings
Physical stimuli - pressure, cold, heat
Infections - viral or bacterial
Autoimmune processes
Stress and emotional factors
Genetics - predisposition

Question 19

What is the process underpinning urticaria?

Answer 19

Can be immune or non-immune - increased vascular permeability and wheal formation due to histamine etc release from mast cells and basophils.

Question 20

What scoring system can be used in urticaria?

Answer 20

Urticaria Activity Score (UAS7) -? patient recoords severity of itching and number of weals for 7days
<7 indicates good disease
>28 indicates severe disease

Question 21

What is the management for urticaria?

Answer 21

Identification and removal of triggers
First line - non-sedating anti-histamines - cetirizine, loratadine
If severe - short course oral prednisolone
Symptoma management - antipruritic creams - calamine lotion
Patient education and regular follow up

Question 22

When should urticaria be referred to a dermatologist?

Answer 22

Pain and persistent
Not controlled by anti-histamines
Anio-oedema and no wheels not responding to treatment
Food or latex allergy
Chronic and difficult to manage - solar or cold

Question 23

What is measels?

Answer 23

Highly contagious viral disease caused by paramyxovirus (measles morbillivirus) -> transmitted by droplets

Question 24

What is the aetiology of the measles morbillivirus?

Answer 24

Single-stranded enveloped RNA virus.
Transmitted by respiratory droplets or direct contact with secretions
Incubation 7-21 days
Infectious from four days before to after the rash

Question 25

What are the signs and symptoms of measles?

Answer 25

Prodromal symptoms for ten days after high fever - above 40 degrees Coryzal symptoms Conjuncitivities Koplik spots - small grey discolouration of the mucosal membranes Rash - behind the ears then spread down the trunk to limbs over 3-4days

Question 26

What investigations should be done for suspected measles?

Answer 26

Requires lab confirmation Oral fluid - measles RNA and measles specific IgM and IgG. Or serology or PCR Note is a notifiable disease

Question 27

What is the typical management of measles?

Answer 27

Supportive care - antipyretics and ensuring adequate fluid intake Vitamin A administration - reduce risk of blindness Remain off school at least 4 days after rash - avoid pregnancy women or immunosuppressed individuals.

Question 28

What is the prevent strategy for measles?

Answer 28

Measles, Mumps and Rubella vaccine Prophylatic immunoglobulin conact for high risk close contacts.

Question 29

What are some potential complications of measles?

Answer 29

Acute otitis media Bronchopneumonia Encephalitis Diarrhoea Keratoconjunctivies and blindness Increased opportunisitic infection for months following Rare but important = sclerosing panencephalitis -> degenerative -> motor, behaviour and cognitive decline to death, occurring often 7yrs after infection

Question 30

What is rubella?

Answer 30

German measles Contagious viral illness - caused by rubella togavirus and transmitted by respiratory droplets.

Question 31

What is the key epidemiology of rubella?

Answer 31

Rare in UK due to vaccination at 12M in MMR Most vulnerable is pregnant women due to risk of congenital rubella syndrome

Question 32

What are the key signs and symptoms of rubella?

Answer 32

Non-specific 2-3weeks after exposure Prodrome low-grade fever, mild conjunctivitis and rhinorrhoea. Erythematous rash on face down trunk lasting 3 days Lymphadenopathy post auricular Arthralgia Asymptomatic in 50%

Question 33

What is the key investigation for rubella?

Answer 33

Primarily confirmed with serological testing - rubella-specific IgM or IgG in acute and convalescent serum samples PCR testing. Notifiable disease

Question 34

What is the key management of rubella?

Answer 34

Supportive majority improve within 1w Paracetamol for joint pain and fever Isolation - 5days after rash, avoid pregnant women

Question 35

What are people considered immune to rubella?

Answer 35

Immunocompetent and received at least 2 doses of the MMR vaccine

Question 36

What are the complications of rubella?

Answer 36

Rubella encephalopathy Arthirits Thrombocytopenia Panencephalitis

Question 37

What are the potential foetal abnormalities in congenital rubella syndrome?

Answer 37

Cataracts Deafness Patent ductus arteriosus Brain damage

Question 38

What is the key feature of chickenpox?

Answer 38

Pruritic vesicles

Question 39

What is the key feature of parvovirus B19?

Answer 39

Slapped cheek appearance Can lead to aplastic anaemia

Question 40

What is an exanthem?

Answer 40

A widespread rash occuring alongside systemic symptoms of infection