Paeds derm

Question 1

What is an exanthema?

Answer 1

• eruptive widespread rash

Question 2

What is measles and how does it spread? Incubation period

Answer 2

• caused by measles virus
• spread by droplets
• 10-12 days incubation

Question 3

What are Koplik spots?

Answer 3

• greyish white spots on buccal mucosa
• appear 2 days after fever
• pathognomic for measles

Question 4

How does measles present?

Answer 4

• fever
• after 3-5 days: rash on face starting behind ears
• spreads to rest of body
• resolves after 7-10 days

Question 5

How is the measles rash described?

Answer 5

• erythematous
• macular
• flat lesions

Question 6

What are complications of measles?

Answer 6

• otitis media
• pneumonia
• encephalitis
• hearing loss
• death

Question 7

How is measles contained?

Answer 7

• notifiable disease to PHE
• isolation until 4 days after symptoms resolve

Question 8

What is scarlet fever?

Answer 8

• group A strep infection
• caused by exotoxin produced by strep pyogenes
• associated with tonsillitis

Question 9

How can the scarlet fever rash be described?

Answer 9

• red-pink
• blotchy
• macular rash
• rough sandpaper skin

Question 10

How does scarlet fever present?

Answer 10

• rash starts on trunk and spreads outwards
• red, flushed cheeks
• fever, lethargy
• sore throat
• strawberry tongue

Question 11

How is scarlet fever managed?

Answer 11

• Penicillin V for 10 days
• notify PHE
• keep off school until 24h after starting Abx

Question 12

What are complications of scarlet fever?

Answer 12

• post streptococcal glomerulonephritis
• acute rheumatic fever

Question 13

What is rubella and how does it spread and how long is the incubation period?

Answer 13

• caused by rubella virus
• spread by resp droplets
• 2 weeks incubation

Question 14

How is the rubella rash described?

Answer 14

• mild erythematous rash
• starts on face and spreads to rest of body
• lasts 3 days

Question 15

How does rubella present?

Answer 15

• mild fever
• joint pain
• sore throat
• lymphadenopathy

Question 16

How is rubella managed?

Answer 16

• supportive
• notify PHE
• keep off school for >5 days after rash appears
• avoid pregnant women

Question 17

What are complications of rubella?

Answer 17

• thrombocytopenia
• encephalitis
• congenital rubella syndrome

Question 18

What is congenital rubella syndrome?

Answer 18

• deafness
• blindness
• congenital heart disease

Question 19

What is Duke’s disease?

Answer 19

• non-specific viral rashes

Question 20

What is parvovirus B19?

Answer 20

• slapped cheek syndrome
• caused by parvovirus B19 virus

Question 21

How does parvovirus B19 present?

Answer 21

• starts with mild fever, coryza
• muscle aches and lethargy
• rash appears after 2-5 days

Question 22

Describe the parvovirus B19 rash

Answer 22

• diffuse bright red rash on both cheeks
• few days later: reticular mildly erythematous rash
• affects trunk and limbs
• raised and itchy

Question 23

How is parvovirus B19 managed and how long do symptoms last?

Answer 23

• supportive
• fluid and analgesia
• symptoms fade over 1-2 weeks
• contagious prior to rash but not after

Question 24

Who is at risk from complications from parvovirus?

Answer 24

• immunocompromised
• pregnant
• sickle cell anaemia
• thalassaemia

Question 25

What testing is done for patients at risk of complication from parvovirus?

Answer 25

- serology testing - FBC and reticulocyte count - check for aplastic anaemia

Question 26

What are complications of parvovirus?

Answer 26

- Aplastic anaemia - Encephalitis or meningitis - fetal death

Question 27

What is roseola and what is the cause?

Answer 27

- roseola infantum - HHV-6 or HHV-7

Question 28

How does roseola present?

Answer 28

- 1-2 weeks incubation - sudden high fever for 3-5 days - coryza, sore throat, lymphadenopathy - rash after fever settles

Question 29

Describe the roseola rash

Answer 29

- Lasts 1-2 days - mild erythematous and macular - across arms, legs, trunk, face - not itchy

Question 30

What is the main complication of roseola?

Answer 30

- febrile convulsions - myocarditis or Guillain-Barre if immunocompromised

Question 31

What is Stevens-Johnson syndrome?

Answer 31

- immune-complex mediated hypersensitivity disorder - ranges from mild to severe - including toxic epidermal necrolysis

Question 32

How does SJS present?

Answer 32

- non-specific symptoms of fever, cough, sore throat and mouth - sore eyes and itchy skin - can affect urinary tract, lungs

Question 33

Describe the rash in SJS

Answer 33

- purple red - spreads and blisters - skin breaks and sheds - also happens to lips and mucous membranes

Question 34

How is SJS/TEN managed?

Answer 34

- medical emergencies - admit to hospital - supportive care - steroids - immunoglobulins - immunosuppresants

Question 35

What is eczema?

Answer 35

- chronic atopic condition - defects in skin barrier - leads to inflammation

Question 36

What is the epidemiology of eczema?

Answer 36

- genetic component - prevalence decreases with age - FHx of atopy is significant - urbanisation associated with higher prevalence

Question 37

What is the pathophysiology of eczema?

Answer 37

- defects in skin barrier - provides entrance for irritants, microbes and allergens - creates immune response - results in inflammation etc

Question 38

What are features of eczema? Which areas are affected in: - infants - younger children - older children?

Answer 38

- itchy erythematous rash - infants: face and trunk - younger: extensor surfaces - older: flexors, creases of face and neck

Question 39

How is eczema managed?

Answer 39

- avoid irritants - emollients:steroids 10:1 ratio - apply emollient, wait 30 mins, apply steroid - wet wrapping under bandages

Question 40

What is the parasite in headlice?

Answer 40

- Pediculus capitis

Question 41

How are headlice diagnosed and treated?

Answer 41

- diagnosis: fine tooth combing - treatment: wet combing, malathion, dimeticone