Specials

Question 1

When is usually the onset of atopic eczema? How many will resolve

Answer 1

First year of life, but not in the first 2 months.

Seborrhoeic dermatitis is common in first 2 months.

resolving in 50% by 12 years of age, and in 75% by 16 years

Question 2

Diagnosis of eczema

Answer 2

Clinical diagnosis

If tested, most affected children have an elevated total plasma IgE level.
Skin-prick and radioallergosorbent (RAST) tests if history suggests a specific allergen

Exclude immune deficiency disorder if the disease is unsually severe

Question 3

Clinical features of atopic eczema

Answer 3

Pruritus is the main symptoms at all ages.

Scratching and exacerbation of the rash.
Excoriated areas become erythematous, weeping and crusted.
prolonged scratching and rubbing of the skin may lead to lichenification

Distribution tends to change with age. Predominantly face and trunk in infant. Flexor surfaces in older children.

Question 4

Complications of eczema.

Answer 4

Flare-ups are common:
bacterial infection (staph, strep)
Viral infection (HSV)
Contact with an irritant or allergen

Environment (heat. humidity)

Psychological stress

Question 5

Treatment of eczema

Answer 5

Avoid irritants and precipitants
Emollients
Topical corticosteroids
Immunomodulators
Occlusive bandages
Antibiotics and antiviral agents

Psychosocial support

Question 6

Recognize a herpes simplex rash

Answer 6

(HSV) usually enters the body through the mucous membranes or skin. Site of primary infection may be associated with intense local mucosal damage.
HSV1 - lip and skin lesions (eg. cold sores)
HSV2 - genital

Asymptomatic HSV is common
Gingivostomatitis is the most common form
Eczema herpeticum (serious). if secondary bacterial infection, septicaemia may result

Question 7

Describe gingivostomatitis

Answer 7

From 10 months to 3 years.

Vesicular lesions on the lips, gums and anterior surfaces of the tongue and hard palate. Often progress to extensive painful ulceration with bleeding.
High fever
Miserable child

May persist for 2 weeks. Eating and drinking are painful which may cause dehydration

management is symptomatic, but severe disease may necessitate intravenous fluids and aciclovir

Question 8

Treatment of herpes simplex rash

Answer 8

First line is acyclovir

May be used in severe symptomatic skin, ophthalmic, cerebral and systemic infections

Question 9

Eye disease caused by herpes simplex

Answer 9

Blepharitis or conjunctivitis

May extend to involve the cornea, producing dendritic ulceration. Can lead to corneal scarring and loss of vision. requires split lamp exam

Question 10

Usual sites of impetigo (highly contagious, staphylococcal or streptococcal skin infection in infants an young children mostly).

Appearance?

Answer 10

Mostly where there is pre-existing disease such as atopic eczema.

Face
Neck
Hands

Begin as erythematous macules which may become vesicular/pustular or even bullous

Rupture of the vesicles with exudation of fluid leads to the characteristic confluent honey-coloured crusted lesions. Rapid spread because of exudate

Question 11

Treatment of impetigo

Answer 11

Topical abx (mupirocin) are effective for MILD.

Severe needs narrow-spectrum systemic antibiotics (eg. flucloxacillin)

Although.. broad-spectrum abx such as co-amoxiclav have simpler oral administration regimens and taste better, therefore have better adherence

Affected children should NOT go to school until lesions are dry!
Nasal carriage is an important source of infection which can be eradicated with a nasal cream of mupirocin

Question 12

What is staphylococcal scalded skin syndrome?

Presentation

Answer 12

Caused by exfoliative staphylococcal toxin

Affects infants and young children

Fever
Malaise
Purulent, crusting, localised infection around eyes, nose, and mouth.

Subsequent widespread erythema and tenderness of the skin

Areas of epidermis separate on gentle pressure (Nikolsky sign). Leaves denuded areas of skin. They subsequently dry and heal without scarring

Question 13

Management of Staphylococcal Scalded skin syndrome

Answer 13

Iv anti-staphylococcal abx
Analgesia
Monitoring of fluid balance

Question 14

What are the causes of urticaria?

Answer 14

Exposure to an allergen or viral infection

Triggers urticarial skin reaction

May also involve deeper tissues to produce swelling of the lips and angioedema or even anaphylaxis

Question 15

Treatment of urticaria

Answer 15

Second-generation, non-sedating antihistamines

Question 16

What is papular urticaria?

Answer 16

Delayed hypersensitivity reaction - most commonly on legs, following a bite from flea, bedbug or animal or bird mite

Irritation, vesicles, papules and weals appear and secondary infection due to scratching is common

May last weeks or months and may be recurrent

Question 17

Recognize a varicella rash

Answer 17

Papules
then vesicles
then pustules
They have surrounding erythema

Finally crusts (5-6 days in)

200-500 lesions start on head and trunk and progress to peripheries.
May also just be a few lesions.

Question 18

Incubation period of varicella

Answer 18

14 days. Highly infection 2 days before and until 6 days after the illness starts

Question 19

Complications of varicella

Answer 19

Bacterial superinfection which may lead to toxic shock syndrome or NF

Cerebellitis
Generalised encephalitis

Aseptic meningitis

Immunocompromised
Haemorrhagic lesions
Pneumonitis
DIC

Question 20

Commonest pathogens causing adeno/tonsillar hypertrophy

Answer 20

Group A beta-haemolytic streptococci.

Epstein Barr virus.

marked constitutional disturbance, such as headache, apathy and abdominal pain, white tonsillar exudate and cervical lymphadenopathy, is more common with bacterial infection

Question 21

Management of severe adeno/tonsillitis

Answer 21

May require hospital admission for iv fluids and analgesia if unable to swallow fluids or liquids

Amoxicillin is best avoided! widespread rash if Epstein Barr V

Question 22

Indications for tonsillectomy in children

Answer 22

Controversial.

Recurrent severe tonsillitis. Reduces number of episodes, but not symptoms.

Peritonsillar abscess (quinsy)

Obstructive sleep apnoea!!! - adenoids as well usually
Recurrent OME with hearing loss is an indication of tonsil+adenoidectomy

Question 23

Symptoms and signs of rhinitis

Answer 23

Coryza
Conjunctivitis

There may be a cough due to post-nasal drip

Sleep disturbance from chronically blocked nose with impaired daytime behavior and concentration

Question 24

Associations of rhinitis

Answer 24

Eczema
Sinusitis
Adenoidal hypertrophy

ASTHMA!

Question 25

Treatment of rhinitis

Answer 25

Second-generation non-sedating antihistamines. Topically or systematically.

Topical corticosteroid nasal or eye preparations. (ophthalmology supervision needed for latter)

LTRA (montelukast)
Nasal decongestants (no more than 10 days! risk of rebound effect)

NO systemic corticosteroids due to risk of adverse effects

Question 26

Key aspects of history in OSA

Answer 26

Loud snoring
Witnessed pauses in breathing (apnoeas)
Restlessness
Disturbed sleep

Affected child may be obese or have growth failure

Question 27

Consequences of OSA

Answer 27

Excessive daytime sleepiness
Learning and behavior problems
Acute life-threatening cardiorespiratory events
Pulmonary HTN

Question 28

Causes of OSA in childhood

Answer 28

Comonly adenotonsillar hypertrophy

Predisposing factors are hypotonia, muscle weakness and anatomical problems.

(Downs, achondroplasia, CP, craniofacial abnormalities - these groups may be screened regularly)

Question 29

Assessment of OSA

Answer 29

Overnight pusle oxymetry. At home. Quantify frequency and severity of periods of desaturation (92%)
-normal oxymetry does not exclude it