Rashes

Question 1

What is suspected if parents come in with a child complaining of cough and conjunctivitis that started 3 days after the onset of a rash?

Answer 1

Measles

Question 2

What is suspected in a child with abdominal pain, a rash, and joint pain and swelling?

Answer 2

HSP - Henoch-Schonlein Purpura

Question 3

What is suspected if the child is lethargic, have bleeding gums and a rash?

Answer 3

Leukemia

Question 4

What is suspected if there is a rash, conjunctivitis, and a fever for more than 5 days?

Answer 4

Kawasaki’s disease

Question 5

What are cafe-au-lait spots?

Answer 5

Cafe-au-lait spots are macules (flat light brown lesions)

Question 6

What conditions are cafe-au-lait spots associated with?

Answer 6

Neurofibromatosis Type 1 and McCune-Albright syndrome

Question 7

What is the incubation period of Measles?

Answer 7

10-14 days

Question 8

When is the infectious period of Measles?

Answer 8

2-3 days before onset of rash and 4-5 days after rash disappears

Question 9

What are the prodromal signs in Measles?

When will they present?

Answer 9

Koplik Spots
High fever
3 “C”s: Cough, Coryza and Conjunctivitis

These present 3 days before onset of rash.

Question 10

What are the complications of Measles?

Answer 10

1. Secondary bacterial infection: such as otitis media and pneumonia
2. Acute Measles Postinfectious Encephalitis: Develops 7-10 days after rash fades
3. Subacute Sclerosing Pan-encephalitis (SSPE): develops 6-10 years after Measles infection resolves

Question 11

Who are at higher risk of developing SSPE as a complication of Measles infection?

Answer 11

Toddlers infected with Measles at <2 years old are more at risk

Question 12

What are the 3 P’s of small vessel vasculitis?

These signs and symptoms are also seen in HSP.

Answer 12

Painful, palpable, purpura

Question 13

What is HSP?

Answer 13

Henoch-Schonlein Purpura is an IgA-mediated autoimmune hypersensitivity vasculitis condition that cause small vessels in the skin, joint, intestines and kidneys to leak.

Question 14

Who commonly presents with HSP?

Answer 14

Children aged 2-11 years old.

Question 15

Describe the distribution of the purpura in HSP.

Answer 15

Painful palpable purpura seen with symmetrical distribution, spread mainly over the buttocks and the back of legs.
Within 24 hours, the petechiae will coalesce and form slightly raised purpuric lesions.

Question 16

HSP commonly occurs after?

Answer 16

HSP commonly occurs after an infection, especially an Upper RTI.

Question 17

Which immunoglobulin is often raised in HSP?

Answer 17

IgA

Question 18

What is ITP? What commonly precedes ITP and for by how long?

Answer 18

ITP - Idiopathic Thrombocytopenic Purpura.
This is an autoimmune condition where antibodies are produced against platelets.
Usually occurs 2-3 weeks after an infection.

Question 19

Who are commonly affected by ITP?

Answer 19

Children aged 5-6 years old.

Question 20

What is advised to children who are diagnosed with ITP?

Answer 20

Children are advised not to take part in contact sports as they are more likely to bleed with minor injuries.

Question 21

How is ITP in adults different from ITP in children?

Answer 21

In adults, ITP manifests more gradually and it is usually a chronic condition. It may not be preceded by an infection.
In children, ITP often manifest 2-3 weeks after an infection (occassionally after immunisation). It usually resolves within 6-8 weeks.

Question 22

What is the most common cause of impetigo?

Answer 22

Staphylococcus Aureus infection.

Question 23

How long does most cases of impetigo take to resolve?

Answer 23

Usually resolve within 2-3 weeks