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Skin, rashes and infections Flashcards

1
Q

What is chickenpox also known as?

A

herpes zoster

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2
Q

What causes chickenpox?

A

varicella zoster

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3
Q

What is the incubation period of chickenpox?

A

1-3 weeks

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4
Q

What is the prodrome for chickenpox?

A 
nausea
myalgia
anorexia
headache
malaise
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5
Q

Explain the nature of the rash in chickenpox

A 
Starts on head and trunk 
Progresses to peripheries
1. Macule to papules
2. Vesicles (itchy)
3. Pustules
4. Crusts w/in 5 days1
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6
Q

How is chickenpox spread?

A

personal contact and droplets

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7
Q

What is the treatment for chickenpox?

A

its self-limiting
topical calamine for itch
Chlorphenamine if >1yr
If immunocompromised: IV aciclovir

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8
Q

What are the complications of chickenpox?

A
  1. Secondary bacterial infection(staph, group A strep) -> TSS, NF
  2. Encephalitis -> VZV associated cerebellitis
  3. Purpura fulminans
  4. Primary VZV in immnocomp -> severe disseminated disease
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9
Q

What is the cause of rubella?

A

Rubella virus

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10
Q

What is the incubation period of rubella?

A

2-3 weeks

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11
Q

When is someone with rubella infectious?

A

5 days before and after start of rash

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12
Q

What are the signs of rubella other than rash?

A

Prodrome of mild fever

Lymphadenopathy

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13
Q

What is the nature of the rash in rubella?

A 
Maculopapular rash on face which spreads to whole body 
Not itchy (unlike adults)
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14
Q

How long does a rubella rash take to fad?E

A

3-5days

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15
Q

What are the ix for rubella

A

can be confirmed serologically

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16
Q

What is the rx of rubella

A

self-limiting
prevention in immunisation
inform HPT

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17
Q

What are the complications of rubella

A

arthritis
encephalitis
thrombocytopenia
myocarditis

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18
Q

What is the cause of mumps?

A

RNA paramyxovirus

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19
Q

What is the incubation period of mumps?

A

2-3 weeks

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20
Q

wHEN IS mumps contagious?

A

7 days before and 9 days after parotid swelling

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21
Q

What are the features of mumps?

A

prodrome malaise and increased temp
painful parotid swelling unilateral -> bilateral
mild rash

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22
Q

What is rx of mumps

A

rest
prevention in immunisation
notifiable

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23
Q

What is the cause of measles?

A

RNA paramyxovirus

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24
Q

How is measles spread?

A

droplets

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25
Q

What is the incubation period of measles?

A

10-14days

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26
Q

wHEN is measles contagious?

A

prodrome until 4 days of rash

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27
Q

What are the features of measles?

A

prodrome: fever, cough, coryza, conjunctivitis

Koplik spots

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28
Q

Describe the nature of measles rash

A

Spread downwards from behind ears to whole body

discrete maculopapular rash becoming blotchy and confluent

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29
Q

What is the treatment of measles?

A

self-limiting
painkillers
notifiable

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30
Q

what is rx of measles in immunocompromised?

A

ribavirin

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31
Q

What is the cause of HSP?

A

IgA mediated small vessel vasculitis

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32
Q

What are the features of HSP?

A

SMALL artery biopsy showing IgA deposition
increased ESR
proteinuria

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33
Q

What are the features of HSP

A
  1. Abdo pain
  2. Polyarthritis
  3. IgA nephropathy: haematuria, proteinuria, rbc casts
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34
Q

describe the nature of HSP rash

A

palpable purpura on extensor surfaces of feet, legs, arms and buttocks w localised oedema

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35
Q

What is the cause of slapped cheek syndrome?

A

parvovirus B19

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36
Q

How is SCS spread?

A

resp route

direct contact w nose/throat discharges

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37
Q

Describe the rash in SCS

A

Slapped cheek facial rash week after viraemic phase

progressing to maculopapular ‘lace’ like rash on trunk and limbs

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38
Q

What isn’t usually involved in a rash in SCS?

A

palms and soles

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39
Q

What is the rx of SCS?

A

SELF-limiting

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40
Q

what are the complications of SCS?

A

aplastic crisis

fetal disease

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41
Q

When is SCS no longer infectious?

A

when rash appears

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42
Q

What is the cause of scarlet fever?

A

reaction to erythrogenic toxics produced by Group A haemolytic streptococci - usually S. Pyogenes

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43
Q

What is the incubation period of scarlet fever?

A

2-4 days

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44
Q

What are the features of scarlet fever?

A 
fever 1-2days
sore throat 
malaise, headache, N&V
flushed face + circumoral pallor 
strawberry tongue
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45
Q

How is scarlet fever diagnosed?

A

throat swab

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46
Q

Describe the nature of the rash in scarlet fever

A

red-pinprick blanching rash on the chest, axillae or behind ears

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47
Q

When does a rash appear in scarlet fever?

A

12-48hrs after fever

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48
Q

what is the treatment of scarlet fever?

A

penicillin 10 days (start before results of throat swab)
clarithromycin if pen allergic
notifiable

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49
Q

What are the complications of scarlet fever?

A

otitis media
rheumatic fever
acute glomerulonephritis
sydenhams chorea

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50
Q

What is the cause of eczema?

A

Multifactorial:
genetic - atopy, FHx
infection

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51
Q

What is needed for a diagnosis of eczema?

A 
Diagnosis: itchy skin + ≥3:
1.	Onset <2yrs
2.	Past flexural involvement 
3.	Hx of dry skin
4.	PHx of other atopy
Visible flexural dermatitis
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52
Q

What ix are done for eczema?

A

increased plasma IgE
RAST
skin prick

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53
Q

What are the features of eczema?

A

pruritus (main sx)
excoriations that become red, weeping and crusted
dry skin
lichenifications due to XS scratching + rubbing

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54
Q

What is the treatment of eczema?

A
  1. Emollients - equal parts liquid paraffin and soft paraffin
  2. Topical CS
  3. Immunomodulators: tacrolixus, pimecrolimus
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55
Q

What can be used to help break the itch cycle in eczema?

A

sedating anti-histamines -hydroxyzine at night

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56
Q

What is a complication of eczema and how is it treated?

A

infection - abx w hydrocortisone

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57
Q

What is the cause of ITP

A

Immune mediated reduction in platelet count

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58
Q

What are the features of itp

A

Acute bruising
petechiae (looks like rash)
purpura

59
Q

What are the ix of ITP?

A 
Measure platelets (<20x10^9)
Blood film to exclude other abnormalities
60
Q

What is the management of ITP

A

Most managed at home
platelet transfusion if XS bleeding
Splenectomy if chronic and Rx falls
Rituximab and anti-D reduce need for splenectomy

61
Q

What is a serious complication of ITP?

A

life-threatening bleeding

62
Q

What is the name of the organism causing scabies?

A

sarcoptes scabiei

63
Q

How is scabies spread?

A

prolonged skin contact

64
Q

What parts of the body are especially affected by scabies in infants?

A

palms soles

face scalp

65
Q

What are the effects scratching in scabies?

A

excoriation and infection

66
Q

Describe the nature of scabies rash

A

v itchy papules, vesicles,, pustules and nodules affecting finger webs, wrist flexures, axillae, abdo, buttocks groin

67
Q

What is an almost diagnostic feature of scabies?

A

itchy red penile or scrotal papules

68
Q

What is rx of scabies?

A

permethrin for 24hr covering whole body

ivermectin if severe

69
Q

What causes erythema multiforme?

A 
hypersensitivity reaction, due to:
mostly HSC
CMV, orf 
drugs e.g. penicillin
mycoplasma
70
Q

What are the features of major erythema multiforme?

A

systemic upset
fever
mucosal involvement

71
Q

What are the features of the rash in erythema multiforme?

A

target lesions
initially on backs of hands and feet then on torso
upper limbs> lower
pruritus sometimes

72
Q

what is the rx of erythema multiforme?

A

none usually
rx cause: aciclovir for HSV
abx for mycoplasma
topical steroids for sx

73
Q

What is the cause of impetigo?

A

bacterial skin infection:
staph. aureus
strep pyogenes

74
Q

what is the incubation period of impetigo?

A

4-10 days

75
Q

What are the features of impetigo?

A

golden crusted lesions typically round the mouth

usually starts around nose and face

76
Q

What is rx for impetigo?

A

topical fusidic acid
oral flucloxacillin
erythromycin if pen allergci

77
Q

What can impetigo be a complication of ?

A

existing skin condition e.g. eczema

or scabies

78
Q

What is the cause of scalded skin syndrome?

A

exfoliative staph toxin

79
Q

What are the clinical features of scalded skin syndrome?

A

fever
malaise
purulent crusting localised infection around eyes, nose and mouth
widespread erythema and tenderness
Nikolsky sign - epidermis separates on gentle pressure which dry and heal w no scarring

80
Q

What is the management of scalded skin syndrome

A

IV anti-staph abx
analgesia
fluid balance

81
Q

What is scalded skin syndrome also known as?

A

ritter’s disease

82
Q

What is the cause of periorbital cellulitis

A

staph aureus
strep pyogenes
H. influenzae in those not vaccinated

83
Q

How can someone get periorbital cellulitis infection

A

local skin trauma
paranasal sinus infection
dental abscess

84
Q

What are the features of periorbital cellulitis?

A

fever
red, tender swollen eyelid
usually unilateral

85
Q

What is the rx of periorbital cellulitis?

A

IV abx promptly

86
Q

What are the complications of periorbital cellulitis?

A

Abscess formation
Meningitis
Cavernous sinus thrombosis (blood clot within the cavernous sinus)

87
Q

What are the features of orbital cellulitis?

A

proptosis
painful limited ocular movement
reduced visual acuity

88
Q

How is orbital cellulitis confirmed

A

CT

89
Q

What are the causes of napkin rash?

A
  1. contact dermatitis
  2. infantile seborrhoeic dermatitis
  3. candida infection
  4. atopic eczema
90
Q

What is a distinguishable feature of irritant dermatitis as a cause of napkin rash?

A

creases spared

91
Q

What is a distinguishable feature of candida dermatitis as a cause of napkin rash

A

red rash involving flexures

characteristic satellite lesions

92
Q

What is a distinguishable feature of seborrhoeic dermatitis as a cause of napkin rash?

A

red rash w flakes

may be coexistent scalp rash

93
Q

What is a distinguishable feature of psoriasis or atopic eczema as a cause of napkin rash?

A

other areas of the skin will be affected

94
Q

What is the general management of napkin rash?

A

disposable nappies > towel nappies
expose nappy area to air when possible
barrier cream - zinc and castor oil
mild steroid cream (hydrocortisone) in severe cases

95
Q

What is the rx of candida dermatitis causing nappy rash?

A

topical imidazole (antifungal)

96
Q

What are examples of pigmented birthmarks?

A

moles
cafe au lait spots
mongolian spots

97
Q

What are 4 or more cafe au lait spots associated w?

A

neurofibromatosis

98
Q

What are pigmented birth marks due to?

A

XS skin pigment cells

99
Q

What are examples of vascular birthmarks?

A

macular stains
haemangiomas (strawberry mark)
port wine stains

100
Q

What is the difference between strawberry marks and port wine stains?

A

port wine stains don’t fade w age

strawberry marks resolve by age 10

101
Q

What is the cause of toxoplasmosis ?

A

toxoplasma gondii

102
Q

What is the usual animal reservoir of toxoplasmosis?

A

cat

103
Q

How does toxoplasmosis present?

A

most asymptomatic

if symptomatic: fever, malaise, lymphadenopathy

104
Q

when is treatment of toxoplasmosis required? what is rx

A

severe inf. or immunosuppressed

pyrimethamine plus sulphadiazine for at least 6 weeks

105
Q

What are the effects of congenital toxoplasmosis?

A

microcephaly
hydrocephalus
cerebral calcification
choroidoretinitis

106
Q

What are the causes of acne?

A

familial tendency
androgens
acne bacteria
immune activation w inflammatory mediators
distension and occlusion of hair follicles

107
Q

what is an open comedones also known as?

A

blackhead

108
Q

what is a closed comedones also known as?

A

whitehead

109
Q

What are the types of scarring caused by acne?

A

hypertrophic or keloidal

110
Q

What lesions are involved in severe acne?

A

nodules

pseudocysts

111
Q

what is mild acne classed as?

A

lesion count <30

112
Q

What is moderate acne classed as?

A

lesion count 30-125

113
Q

What is severe acne classed as?

A

> 125

114
Q

What is the 1st line therapy of acne

A

topical agents:

  • keratolytics - benzoyl peroxide
  • topical retinoids - tretinoin or isotretinoin
115
Q

what is 2nd line therapy of acne

A

low dose oral abx

hormonal - cyproterone and ethinylestradiol

116
Q

What is a major contraindication of retinoids?

A

pregnancy

117
Q

What are the signs of encephalitis?

A 
flu like prodrome
reduced consciousness
odd behaviour
vomiting
fits
increased temp
meningism
118
Q

What are the infective causes of encephalitis?

A 
HSV
enteroviruses (coxsackie, echo)
mumps
varicella zoster
rabies
parvovirus
immunocompromised
influenza
toxoplasmosis
119
Q

What are non-infective differentials of encephalitis?

A 
hypoglycaemia
DKA
kernicterus 
hepatic failure
lead poisoning
SAH
malignancy
120
Q

What are the IX for encephalitis?

A 
CSF
PCR
blooods (enteroviruses)
stools
urine
EEG/CT/MRI
121
Q

What are the specific investigations that would aid a diagnosis of herpes simplex encephalitis?

A

EEG/ct/mri - temporal lobe changes

HSV abs in CSF

122
Q

What is rx of herpes simplex encephalitis?

A

High dose IV aciclovir

123
Q

What are the causes of viral meningitis?

A

enteroviruses
EBV
Adenovirus

124
Q

How do the sx of viral meningitis compare to bacterial?

A

like bacterial but much less severe

125
Q

How is a diagnosis of viral meningitis confirmed?

A

culture/ PCR of CSF

culture of stool, urine, nasopharyngeal etc

126
Q

What is in a septic screen?

A 
Blood cultures
urine microscopy and culture
CXR
LP
Throat swabs/skin swabs 
(FBC/CRP - won't identify source of infection)
127
Q

what is sepsis

A

bodys overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death

128
Q

What are red flags of sepsis

A

temp <36 or >38.5
inappropriate tachycardia
altered mental status (lethargy, floppiness)
reduced peripheral perfusion, prolonged CRT

129
Q

how does sepsis differ from bacteraemia?

A

bacteraemia is presence of bacteria in the blood screen

130
Q

what are causes of bacteraemia in neonates?

A

GBS
E. coli
Listeria

131
Q

What are causes of bacteraemia in infants?

A 
staph aureus
strep pneumoniae
Group A streptococcus
Neisseria
Haemophilus influenzae
132
Q

What are causes of bacteraemia in adolescents?

A

neisseria meningitids
staph aureus
group a strep
strep pneumonia

133
Q

How does meningococcal disease present

A

has two presentations - either meningococcal sepsis or meningitis

134
Q

what is a severe presentation of meningococcal sepsis?

A

purpura fulminans

135
Q

how does UTI present in infants compared to older children

A

Infants - non specific (fever, lethargy, vomiting/diarrhoea, poor feeding, failure to thrive, prolonged jaundice)
Older - dysuria, frequency, fever, riggers, D&V, abdominal pain, incontinence)

136
Q

what are you looking for in urine dip for uti

A

nitrites, proteins, white cells

137
Q

What is criteria for urine culture to diagnose UTI

A

> 10^5

138
Q

What are investigations following UTI?

A

Micturating cystourethrogram - reflux
DMSA - renal scarring (wait 3 months)
US - structural abnormalities e..g multicystic kidney

139
Q

what causes bacterial tracheitis ?

A

staph aureus

140
Q

what is common sx of pneumonia that can confuse It with other x?

A

abdo pain

141
Q

what are signs of resp distress

A 
rapid rr 
head bobbing
tracheal tug
intercostal/subcostal recession
grunting 
agitated/ frightened look
142
Q

typical hx of mycoplasma

A 
headache
vomitng
temp
cough
occasional wheeze and creps
give clarithromycin
143
Q

what causative organisms re associated w empyema?

A

strep pneumoniae

group A strep

144
Q

what is rx of empyema?

A

chest drain
urokinase
prolonged cause of empyema
consider underlying immune deficiency

Paeds (15 decks)

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