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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
What is the incubation period of measles?
10-14days
26
wHEN is measles contagious?
prodrome until 4 days of rash
27
What are the features of measles?
prodrome: fever, cough, coryza, conjunctivitis | Koplik spots
28
Describe the nature of measles rash
Spread downwards from behind ears to whole body | discrete maculopapular rash becoming blotchy and confluent
29
What is the treatment of measles?
self-limiting painkillers notifiable
30
what is rx of measles in immunocompromised?
ribavirin
31
What is the cause of HSP?
IgA mediated small vessel vasculitis
32
What are the features of HSP?
SMALL artery biopsy showing IgA deposition increased ESR proteinuria
33
What are the features of HSP
1. Abdo pain 2. Polyarthritis 3. IgA nephropathy: haematuria, proteinuria, rbc casts
34
describe the nature of HSP rash
palpable purpura on extensor surfaces of feet, legs, arms and buttocks w localised oedema
35
What is the cause of slapped cheek syndrome?
parvovirus B19
36
How is SCS spread?
resp route | direct contact w nose/throat discharges
37
Describe the rash in SCS
Slapped cheek facial rash week after viraemic phase | progressing to maculopapular ‘lace’ like rash on trunk and limbs
38
What isn't usually involved in a rash in SCS?
palms and soles
39
What is the rx of SCS?
SELF-limiting
40
what are the complications of SCS?
aplastic crisis | fetal disease
41
When is SCS no longer infectious?
when rash appears
42
What is the cause of scarlet fever?
reaction to erythrogenic toxics produced by Group A haemolytic streptococci - usually S. Pyogenes
43
What is the incubation period of scarlet fever?
2-4 days
44
What are the features of scarlet fever?
``` fever 1-2days sore throat malaise, headache, N&V flushed face + circumoral pallor strawberry tongue ```
45
How is scarlet fever diagnosed?
throat swab
46
Describe the nature of the rash in scarlet fever
red-pinprick blanching rash on the chest, axillae or behind ears
47
When does a rash appear in scarlet fever?
12-48hrs after fever
48
what is the treatment of scarlet fever?
penicillin 10 days (start before results of throat swab) clarithromycin if pen allergic notifiable
49
What are the complications of scarlet fever?
otitis media rheumatic fever acute glomerulonephritis sydenhams chorea
50
What is the cause of eczema?
Multifactorial: genetic - atopy, FHx infection
51
What is needed for a diagnosis of eczema?
``` Diagnosis: itchy skin + ≥3: 1. Onset <2yrs 2. Past flexural involvement 3. Hx of dry skin 4. PHx of other atopy Visible flexural dermatitis ```
52
What ix are done for eczema?
increased plasma IgE RAST skin prick
53
What are the features of eczema?
pruritus (main sx) excoriations that become red, weeping and crusted dry skin lichenifications due to XS scratching + rubbing
54
What is the treatment of eczema?
1. Emollients - equal parts liquid paraffin and soft paraffin 2. Topical CS 3. Immunomodulators: tacrolixus, pimecrolimus
55
What can be used to help break the itch cycle in eczema?
sedating anti-histamines -hydroxyzine at night
56
What is a complication of eczema and how is it treated?
infection - abx w hydrocortisone
57
What is the cause of ITP
Immune mediated reduction in platelet count
58
What are the features of itp
Acute bruising petechiae (looks like rash) purpura
59
What are the ix of ITP?
``` Measure platelets (<20x10^9) Blood film to exclude other abnormalities ```
60
What is the management of ITP
Most managed at home platelet transfusion if XS bleeding Splenectomy if chronic and Rx falls Rituximab and anti-D reduce need for splenectomy
61
What is a serious complication of ITP?
life-threatening bleeding
62
What is the name of the organism causing scabies?
sarcoptes scabiei
63
How is scabies spread?
prolonged skin contact
64
What parts of the body are especially affected by scabies in infants?
palms soles | face scalp
65
What are the effects scratching in scabies?
excoriation and infection
66
Describe the nature of scabies rash
v itchy papules, vesicles,, pustules and nodules affecting finger webs, wrist flexures, axillae, abdo, buttocks groin
67
What is an almost diagnostic feature of scabies?
itchy red penile or scrotal papules
68
What is rx of scabies?
permethrin for 24hr covering whole body | ivermectin if severe
69
What causes erythema multiforme?
``` hypersensitivity reaction, due to: mostly HSC CMV, orf drugs e.g. penicillin mycoplasma ```
70
What are the features of major erythema multiforme?
systemic upset fever mucosal involvement
71
What are the features of the rash in erythema multiforme?
target lesions initially on backs of hands and feet then on torso upper limbs> lower pruritus sometimes
72
what is the rx of erythema multiforme?
none usually rx cause: aciclovir for HSV abx for mycoplasma topical steroids for sx
73
What is the cause of impetigo?
bacterial skin infection: staph. aureus strep pyogenes
74
what is the incubation period of impetigo?
4-10 days
75
What are the features of impetigo?
golden crusted lesions typically round the mouth | usually starts around nose and face
76
What is rx for impetigo?
topical fusidic acid oral flucloxacillin erythromycin if pen allergci
77
What can impetigo be a complication of ?
existing skin condition e.g. eczema | or scabies
78
What is the cause of scalded skin syndrome?
exfoliative staph toxin
79
What are the clinical features of scalded skin syndrome?
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
What is the management of scalded skin syndrome
IV anti-staph abx analgesia fluid balance
81
What is scalded skin syndrome also known as?
ritter's disease
82
What is the cause of periorbital cellulitis
staph aureus strep pyogenes H. influenzae in those not vaccinated
83
How can someone get periorbital cellulitis infection
local skin trauma paranasal sinus infection dental abscess
84
What are the features of periorbital cellulitis?
fever red, tender swollen eyelid usually unilateral
85
What is the rx of periorbital cellulitis?
IV abx promptly
86
What are the complications of periorbital cellulitis?
Abscess formation Meningitis Cavernous sinus thrombosis (blood clot within the cavernous sinus)
87
What are the features of orbital cellulitis?
proptosis painful limited ocular movement reduced visual acuity
88
How is orbital cellulitis confirmed
CT
89
What are the causes of napkin rash?
1. contact dermatitis 2. infantile seborrhoeic dermatitis 3. candida infection 4. atopic eczema
90
What is a distinguishable feature of irritant dermatitis as a cause of napkin rash?
creases spared
91
What is a distinguishable feature of candida dermatitis as a cause of napkin rash
red rash involving flexures | characteristic satellite lesions
92
What is a distinguishable feature of seborrhoeic dermatitis as a cause of napkin rash?
red rash w flakes | may be coexistent scalp rash
93
What is a distinguishable feature of psoriasis or atopic eczema as a cause of napkin rash?
other areas of the skin will be affected
94
What is the general management of napkin rash?
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
What is the rx of candida dermatitis causing nappy rash?
topical imidazole (antifungal)
96
What are examples of pigmented birthmarks?
moles cafe au lait spots mongolian spots
97
What are 4 or more cafe au lait spots associated w?
neurofibromatosis
98
What are pigmented birth marks due to?
XS skin pigment cells
99
What are examples of vascular birthmarks?
macular stains haemangiomas (strawberry mark) port wine stains
100
What is the difference between strawberry marks and port wine stains?
port wine stains don't fade w age | strawberry marks resolve by age 10
101
What is the cause of toxoplasmosis ?
toxoplasma gondii
102
What is the usual animal reservoir of toxoplasmosis?
cat
103
How does toxoplasmosis present?
most asymptomatic | if symptomatic: fever, malaise, lymphadenopathy
104
when is treatment of toxoplasmosis required? what is rx
severe inf. or immunosuppressed | pyrimethamine plus sulphadiazine for at least 6 weeks
105
What are the effects of congenital toxoplasmosis?
microcephaly hydrocephalus cerebral calcification choroidoretinitis
106
What are the causes of acne?
familial tendency androgens acne bacteria immune activation w inflammatory mediators distension and occlusion of hair follicles
107
what is an open comedones also known as?
blackhead
108
what is a closed comedones also known as?
whitehead
109
What are the types of scarring caused by acne?
hypertrophic or keloidal
110
What lesions are involved in severe acne?
nodules | pseudocysts
111
what is mild acne classed as?
lesion count <30
112
What is moderate acne classed as?
lesion count 30-125
113
What is severe acne classed as?
>125
114
What is the 1st line therapy of acne
topical agents: - keratolytics - benzoyl peroxide - topical retinoids - tretinoin or isotretinoin
115
what is 2nd line therapy of acne
low dose oral abx | hormonal - cyproterone and ethinylestradiol
116
What is a major contraindication of retinoids?
pregnancy
117
What are the signs of encephalitis?
``` flu like prodrome reduced consciousness odd behaviour vomiting fits increased temp meningism ```
118
What are the infective causes of encephalitis?
``` HSV enteroviruses (coxsackie, echo) mumps varicella zoster rabies parvovirus immunocompromised influenza toxoplasmosis ```
119
What are non-infective differentials of encephalitis?
``` hypoglycaemia DKA kernicterus hepatic failure lead poisoning SAH malignancy ```
120
What are the IX for encephalitis?
``` CSF PCR blooods (enteroviruses) stools urine EEG/CT/MRI ```
121
What are the specific investigations that would aid a diagnosis of herpes simplex encephalitis?
EEG/ct/mri - temporal lobe changes | HSV abs in CSF
122
What is rx of herpes simplex encephalitis?
High dose IV aciclovir
123
What are the causes of viral meningitis?
enteroviruses EBV Adenovirus
124
How do the sx of viral meningitis compare to bacterial?
like bacterial but much less severe
125
How is a diagnosis of viral meningitis confirmed?
culture/ PCR of CSF | culture of stool, urine, nasopharyngeal etc
126
What is in a septic screen?
``` Blood cultures urine microscopy and culture CXR LP Throat swabs/skin swabs (FBC/CRP - won't identify source of infection) ```
127
what is sepsis
bodys overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death
128
What are red flags of sepsis
temp <36 or >38.5 inappropriate tachycardia altered mental status (lethargy, floppiness) reduced peripheral perfusion, prolonged CRT
129
how does sepsis differ from bacteraemia?
bacteraemia is presence of bacteria in the blood screen
130
what are causes of bacteraemia in neonates?
GBS E. coli Listeria
131
What are causes of bacteraemia in infants?
``` staph aureus strep pneumoniae Group A streptococcus Neisseria Haemophilus influenzae ```
132
What are causes of bacteraemia in adolescents?
neisseria meningitids staph aureus group a strep strep pneumonia
133
How does meningococcal disease present
has two presentations - either meningococcal sepsis or meningitis
134
what is a severe presentation of meningococcal sepsis?
purpura fulminans
135
how does UTI present in infants compared to older children
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
what are you looking for in urine dip for uti
nitrites, proteins, white cells
137
What is criteria for urine culture to diagnose UTI
>10^5
138
What are investigations following UTI?
Micturating cystourethrogram - reflux DMSA - renal scarring (wait 3 months) US - structural abnormalities e..g multicystic kidney
139
what causes bacterial tracheitis ?
staph aureus
140
what is common sx of pneumonia that can confuse It with other x?
abdo pain
141
what are signs of resp distress
``` rapid rr head bobbing tracheal tug intercostal/subcostal recession grunting agitated/ frightened look ```
142
typical hx of mycoplasma
``` headache vomitng temp cough occasional wheeze and creps give clarithromycin ```
143
what causative organisms re associated w empyema?
strep pneumoniae | group A strep
144
what is rx of empyema?
chest drain urokinase prolonged cause of empyema consider underlying immune deficiency

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