Fever and rash

Question 1

Features of Kawasaki’s disease

Answer 1

Fever >/= 5 days plus 4 out of 5 of:

• Bilateral, non-purulent conjunctivitis
• Unilateral cervical lymphadenopathy
• Polymorphous rash
• Peripheral changes: oedema and erythema of hands and feet
• Mucous membrane changes: strawberry tongue, dry cracked lips
• (Desquamation)

Irritable child*

Question 2

What Ix would you do for Kawasaki’s disease?

Answer 2

FBE: neutrophilia, thrombocystosis, anaemia
CRP/ESR
Echo: coronary artery aneurysms

Question 3

What is the treatment for Kawasaki’s disease?

Answer 3

IVIg

Aspirin

Question 4

Unvaccinated child presents with pruritic maculopapular rash over scalp, face and trunk with a prodrome of fever, malaise and anorexia

Answer 4

Varicella Zoster Virus (Chickenpox)

Question 5

What is the treatment for Varicella Zoster Virus?

Answer 5

Symptomatic treatment - calamine lotion

Acyclovir if neonate, immunocompromised or older child

Question 6

Child presents with a low grade fever, sore throat and vesicular lesions on gums, palms and buttocks

Answer 6

Hand, foot and mouth disease

Question 7

What is the treatment for hand, foot and mouth disease?

Answer 7

Symptomatic treatment

Exclusion is not indicated and is impractical as virus is excreted in stool for weeks

Question 8

What causes hand, foot and mouth disease?

Answer 8

Coxsackie A16 and enterovirus 71

Question 9

Child presents with sore throat, strawberry tongue and a diffuse sandpaper like rash with perioral sparing and sparing of the palms and soles

Answer 9

Scarlet fever

Question 10

What causes scarlet fever

Answer 10

Group A strep

Question 11

What is the management for scarlet fever?

Answer 11

Penicillin

Question 12

What should you do if a pregnant women is exposed to Varicella?

Answer 12

Give Zoster Ig within 96 hours of exposure

Question 13

School age child who presents with a red rash over his cheeks 4 days after having a fever, headache and coryza, is now well aside from the rash

Answer 13

Slapped cheek/ fifth disease/ parovirus B19

Question 14

Child presents with a rash after 4 days of a very high fever with no other symptoms, is now afebrile

Answer 14

Roseola infantum

Question 15

Child presents with itchy blisters around his mouth that look yellowish and crusted, like they are covered in honey

Answer 15

Impetigo

Question 16

What causes impetigo?

Answer 16

Staph aureus and group A strep

Question 17

What is the treatment for impetigo?

Answer 17

Bathing to remove crusts from sores
Prevent itching with dressings and cutting child’s fingernails
Topical - mupirocin
Systemic - flucloxacillin, penicillin

Question 18

Child presents with a swollen eye, headache and opthalmopelgia

Answer 18

Orbital cellulitis

Question 19

What is the management for orbital cellulitis?

Answer 19

CT orbits ASAP
ABx - flucloxacillin, cefotaxime (vancomycin if MRSA)
Involve ENT/ ophthalmology

Question 20

Unvaccinated child presents with a maculopapular rash + cough, coryza, conjunctivitis and spots on white lesions on her tongue

Answer 20

Measles

Question 21

What are the TORCH infections?

Answer 21

Toxoplasmosis 
Others: syphilis, varicella 
Rubella 
Cytomegalovirus (CMV)
Herpes simplex

Question 22

Child presents with a fever and swollen salivary glands

Answer 22

Mumps