scarlet fev, mono + hand, foot, mouth

Question 1

scarlet fever

Answer 1

reaction to erythogenic toxins produced by group A haemolytic strep (usually strep pyogenes)

commoner in kids 2-6yrs

Question 2

scarlet fever spread + incubation

Answer 2

via resp droplets

incub period = 2-4days

Question 3

scarlet fever presentation

Answer 3

fever - lasts 24-48hrs
malaise, headache, N+V

sore throat
strawberry tongue

rash
- fine punctate erythema (“pinhead”)
- appears first on torso, spares palms + soles
- rough sandpaper texture
- kids = flushed appearance, circumoral pallor

Question 4

diagnosis of scarlet fever

Answer 4

throat swab
- but commence antibiotics before results

Question 5

management of scarlet fever

Answer 5

oral penicillin V for 10days
- pen allerg - azithromycin

notifiable disease

Question 6

when can kids with scarlet fever return to school

Answer 6

24hrs after commencing antibiotics

Question 7

complications of scarlet fever

Answer 7

otitis media = commonest

rheumatic fever - typically occurs 20days after

acute glomerulonephritis - 10days after

Question 8

what causes infectious mononucleosis (glandular fever)

Answer 8

Epstein-Barr virus (EBV)

Question 9

triad presentation in infectious mononucleosis (glandular fever)

Answer 9

sore throat
pyrexia
lymphadenoapthy - in ant + pos triangles of neck

malaise, anorexia, headache
palatal petechie
splenomegaly
hepatitis - transient rise in ALT

Question 10

blood work changes seen in infectious mononucleosis (glandular fever)

Answer 10

hepatitis - transient rise in ALT

haemolytic anaemia - secondary to cold agglutins (IgM)

lymphocytosis - at least 10% atypical lymphocytes

Question 11

diagnosis of infectious mononucleosis (glandular fever)

Answer 11

heterophil antibody test (monospot test)

NICE - FBC + monospot in 2nd weeks of illness to confirm diagnosis

Question 12

management of infectious mononucleosis (glandular fever)

Answer 12

rest, drink fluids, avoid alcohol
simple analgesia (sx resolce after 2-4wks)

avoid contact sports for 4weeks - reduce risk of splenic rupture

Question 13

hand, foot + mouth disease causative organism

Answer 13

coxsackie A16

very contagious, outbreaks in nursery

Question 14

hand, foot + mouth disease presentation

Answer 14

sore throat, fever
oral ulcers
followed later by vesicles on palms + soles of feet

Question 15

management of hand, foot + mouth disease

Answer 15

symptomatic tx only - hydrate, simple analgesia

do NOT need to be excluded from school
- but keep off school until feel better

Question 16

Roeola infantum

Answer 16

(exanthem subitum/6th disease)
common disease of infancy caused by human herpes virus 6 (HHV6)

consequences of HHV6 = aseptic meningitis, hepatitis

Question 17

Roeola infantum incubation period + most affected age group

Answer 17

5-15 days

aged 6months-2years

(school exclusion not needed)

Question 18

Roeola infantum presentation

Answer 18

high fever - lasting a few days
followed later by a maculopapular rash

Nagayama spots = on uvula + soft palate
diarrhoea + cough

febrile convulsions in 10-15%

Question 20

cause of erythema infectiosum (slapped cheek syndrome)

Answer 20

parovirus B19

Question 21

erythema infectiosum (slapped cheek syndrome) presentation

Answer 21

kids feels better as rash apears
months after - warm bath, sunlight, fever - will retrigger rash

no mx