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Flashcards in Skin, rashes and infections Deck (144):
1

What is chickenpox also known as?

herpes zoster

2

What causes chickenpox?

varicella zoster

3

What is the incubation period of chickenpox?

1-3 weeks

4

What is the prodrome for chickenpox?

nausea
myalgia
anorexia
headache
malaise

5

Explain the nature of the rash in chickenpox

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

6

How is chickenpox spread?

personal contact and droplets

7

What is the treatment for chickenpox?

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

8

What are the complications of chickenpox?

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

9

What is the cause of rubella?

Rubella virus

10

What is the incubation period of rubella?

2-3 weeks

11

When is someone with rubella infectious?

5 days before and after start of rash

12

What are the signs of rubella other than rash?

Prodrome of mild fever
Lymphadenopathy

13

What is the nature of the rash in rubella?

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

14

How long does a rubella rash take to fad?E

3-5days

15

What are the ix for rubella

can be confirmed serologically

16

What is the rx of rubella

self-limiting
prevention in immunisation
inform HPT

17

What are the complications of rubella

arthritis
encephalitis
thrombocytopenia
myocarditis

18

What is the cause of mumps?

RNA paramyxovirus

19

What is the incubation period of mumps?

2-3 weeks

20

wHEN IS mumps contagious?

7 days before and 9 days after parotid swelling

21

What are the features of mumps?

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

22

What is rx of mumps

rest
prevention in immunisation
notifiable

23

What is the cause of measles?

RNA paramyxovirus

24

How is measles spread?

droplets

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