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ΩΩ 3a Bateman - Paeds > Skin and allergy > Flashcards

Skin and allergy Flashcards

1
Q

What is Stevens-Johnson syndrome?

A

Severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction

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2
Q

What can cause Steven-Johnson syndrome?

A

Penicillin

Sulphonamides

Lamotrigine, carbamazepine, phenytoin

Allopurinol

NSAIDs

Oral contraceptive pill

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3
Q

What are the symptoms of Stephens-Johnson syndrome?

A
  1. Rash is typically maculopapular with target lesions being characteristic. May develop into vesicles or bullae
  2. Mucosal involvement
  3. Systemic symptoms: fever, arthralgia
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4
Q

How do you diagnose Stephen’s-Johnson syndrome?

A

Biopsy

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5
Q

What is the treatment for Stephens-Johnson syndrome?

A
  1. The immediate management of SJS includes ceasing the culprit drug
  2. Hospital admission is required, ideally to an intensive care unit or burns unit.
  3. Fluid replacement via intravenous and nasogastric access is required, as there is significant fluid loss from the blisters and red, oozing dermis.
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6
Q

What is eczema?

A

Eczema is a condition wherein patches of skin become inflamed, itchy, cracked, and rough. Some types can also cause blisters.

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7
Q

Where does eczema affect in different ages?

A

In infants the face and trunk are often affected

In younger children eczema often occurs on the extensor surfaces

In older children a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck

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8
Q

What is the management for eczema?

A
  1. Avoid irritants
  2. Simple emollient
    Dermovate
  3. Topical steroids
    Mild - Hydrocortisone
    Moderate - Betamethasone
    Potent - Fluticasone
    Very Potent - Clobetasol
  4. In severe cases wet wraps and oral ciclosporin may be used
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9
Q

WHAT IS ALLERGIC RHINITIS?

A

Allergic rhinitis is an inflammatory disorder of the nose where the nose become sensitized to allergens such as house dust mites and grass, tree and weed pollens

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10
Q

How can allergic rhinitis be classified?

A
  1. Seasonal: symptoms occur around the same time every year. Seasonal rhinitis which occurs secondary to pollens is known as hay fever
  2. Perennial: symptoms occur throughout the year
  3. Occupational: symptoms follow exposure to particular allergens within the work place
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11
Q

What are the symptoms of allergic rhinitis?

A
  1. Sneezing
  2. Bilateral nasal obstruction
  3. Clear nasal discharge
  4. Post-nasal drip
  5. Nasal pruritus
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12
Q

What are the causes of allergic rhinitis?

A
  1. Dust
  2. Mites found in mattresses, carpets, furry toys
  3. Feathers
  4. Animal danders - most commonly cats and dogs
  5. Occupational allergic rhinitis is caused by allergens found at work e.g.people working with latex gloves, bakers(flour dust), wood dust.
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13
Q

What are the investigations for allergic rhinitis?

A
  1. Exposure to an allergen followed by an allergic rhinitis
  2. Skin prick testing to assess IgE
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14
Q

What is the managemnet of allergic rhinitis?

A
  1. Allergen avoidance
  2. If the person has mild-to-moderate intermittent, or mild persistent symptoms:
    * *Oral or intranasal antihistamines**
  3. If the person has moderate-to-severe persistent symptoms, or initial drug treatment is ineffective
    * *Intranasal corticosteroids**
  4. A short course of oral corticosteroids are occasionally needed to cover important life events

NOTE: There may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline).
They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal

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15
Q

WHAT IS URTICARIA?

A

Urticaria describes a local or generalised superficial swelling of the skin. The most common cause of urticaria is allergy although non-allergic causes are seen.

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16
Q

What are some causes of urticaria?

A
  1. Idiopathic
  2. Drugs
    Asprin
    Morphine
    NSAIDs
    Atropine
  3. Allergic
  4. Physical
    Temperature
    Solar
    Exercise
17
Q

What are the clinical features of urticaria?

A
  1. Pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
  2. Pruritic
18
Q

What are the investigations for urticaria?

A
  1. Mainly clinical
19
Q

What is the management for urticaria?

A
  1. Non-sedating antihistamines are first-line
  2. Prednisolone is used for severe or resistent episodes
20
Q

WHAT IS ANAPHYLAXIS?

A

Anaphylaxis may be defined as a severe, life-threatening, generalised or systemichypersensitivity reaction.

21
Q

What are the causes of anaphylaxis?

A
  1. Food (e.g. nuts) - the most common cause in children
  2. Frugs
  3. Venom (e.g. wasp sting)
22
Q

What are the clinical features of anaphylaxis?

A
  1. The sudden onset and rapid progression of symptoms
  2. Airway and/or Breathing and/or Circulation problems
  3. Airway problems may include:
    Swelling of the throat and tongue →hoarse voice and stridor
  4. Breathing problems may include:
    Respiratory wheeze
    Dyspnoea
  5. Circulation problems may include:
    Hypotension
    Tachycardia
23
Q

What is the management for anaphylaxis?

A
  1. Adrenaline
    Can be repeated every 5 minutes if necesssary
    IM anterolateral aspect of the middle third of the thigh

Following stabilisation:

  1. Antihistamines - chlorphenamine
  2. Serum tryptase levels
  3. Allergy clinic
  4. Adrenaline injector
24
Q

What is refractory anaphylaxis and what is the treatment?

A
  1. Defined as respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline
  2. IV fluids should be given for shock
  3. Expert help should be sought for consideration of an IV adrenaline infusion
25
Q

WHAT IS RHEUMATIC FEVER?

A

Rheumatic fever develops following an immunological reaction to recent (2-6 weeks ago) Streptococcus pyogenes infection.

26
Q

What age group is affected in rheumatic fever?

A

5 to 15 years

27
Q

What are the clinical features of rheumatic fever?

A
  1. 50-75% of children will develop acute carditis; in adults this figure is only 35%
    Myocarditis causes arrythmias, usually atrial fibrillation, and a prolonged P-R interval
  2. Cardiac dilatation may occur, resulting in murmurs of valvular insufficiency, mitral most commonly, then aortic, then tricuspid
  3. Valvulitis is marked by the systolic murmur of mitral regurgitation and the diastolic murmur of aortic regurgitation
  4. Other abnormal findings on cardiovascular examination include:
    Sinus tachycardia
    Raised jugular venous pressure, due to heart failure which is now rare
    A Carey-Coombs murmur
28
Q

What is needed for diagnosis of rheumatic fever?

A

Diagnosis is based on evidence of recent streptococcal infection accompanied by:
2 major criteria
1 major with 2 minor criteria

Evidence of recent streptococcal infection

  • Raised or rising streptococci antibodies,
  • Positive throat swab
  • Positive rapid group A streptococcal antigen test

Major criteria

  • Erythema marginatum
  • Sydenham’s chorea: this is often a late feature
  • Polyarthritis
  • Carditis and valvulitis (eg, pancarditis)
  • Subcutaneous nodules

Minor criteria

  • Raised ESR or CRP
  • Pyrexia
  • Arthralgia (not if arthritis a major criteria)
  • Prolonged PR interval
29
Q

What is the management for rheumatic fever?

A
  1. Antibiotics: oral penicillin V
  2. Anti-inflammatories: NSAIDs are first-line
  3. Treatment of any complications that develop e.g. heart failure
30
Q

WHAT IS SUBACUTE BACTERIAL ENDOCARDITIS?

A

Endocarditis most commonly occurs subacutely and is often bacterial in origin - subacute bacterial endocarditis (SBE). It usually occurs on damaged valves and in the elderly.

31
Q

What are the most causative organisms in subacute bacterial endocarditis?

A

Strep. viridans is involved in 45% of cases, often from the teeth.

Faecal Streps are also common, usually from diagnostic and operative procedures.

Staphs account for 25% of cases, frequently from cellulitis or skin abscesses.

32
Q

What are the clinical features of subacute bacterial endocarditis?

A
  1. B Symptoms - Fever, night sweats, weight loss, and weakness, with additional symptoms due to cardiac failure or embolism.
  2. Heart symptoms - Heart murmurs are common.
  3. Kidney symptoms - Also a focal renal infarction, focal nephritis or diffuse glomerulonephritis is very common, resulting in microscopic haematuria and proteinuria.
33
Q

How do you distinguish between infective endocarditis and subacute infective endocarditis?

A

Subacute infective endocarditis is distinguished from the less common acute form of endocarditis on the basis of the virulence of the pathogenic organism involved and clinical presentation

34
Q

What is the treatment for subacute infective endocarditis?

A

Benzylpenicillin

35
Q

What are the investigations for subacute infective endocarditis?

A
  1. Blood cultures
  2. Echocardiography, cardiac doppler, transoesophageal doppler
  3. Urine - microscopic haematuria and proteinuria are common
  4. Blood
36
Q

WHAT IS SEBORRHOEIC DERMATITIS IN CHILDREN?

A

Seborrhoeic dermatitis is a relatively common skin disorder seen in children.

It typically affects the scalp (‘Cradle cap’), nappy area, face and limb flexures.

37
Q

Whata are the features of seborrhoeic dermatitis?

A
  1. Cradle cap is an early sign which may develop in the first few weeks of life.
  2. It is characterised by an erythematous rash with coarse yellow scales.
38
Q

What is the management of seborrhoeic dermatitis?

A
  1. mild-moderate: baby shampoo and baby oils
  2. severe: mild topical steroids e.g. 1% hydrocortisone

ΩΩ 3a Bateman - Paeds (19 decks)

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