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Skin infections

Exanthems key points test

The following features are characteristic of an exanthem: *! It may be associated with a febrile illness * In children, it is usually due to an adverse reaction to a drug * It is never due to a bacterial infection * There are five different viruses that cause exanthems Explanation: An exanthem is a widespread erythematous rash that is accompanied by systemic symptoms such as fever, headache and malaise. It is commonly due to a variety of viral infections in children and is less often due to bacterial infection. Drug eruptions may cause similar clinical features. Crops of vesicles and pustules are characteristic of: *! Varicella * Measles * Rubella * Roseola Explanation: The exanthem associated with varicella results in vesicles and pustules. Cough and an erythematous rash are characteristic of: * Varicella *! Measles * Rubella * Roseola Explanation: Characteristically, measles results in malaise, cough, conjunctivitis and a morbilliform eruption that starts on the face and spreads widely. Lymphadenopathy and an erythematous rash are characteristic of: * Varicella * Measles *! Rubella * Roseola Explanation: The rash of rubella can be subtle, and is accompanied by mild systemic symptoms and lymphadenopathy. Fifth disease is characterised by: *! Red cheeks and erythematous rash on limbs * Lymphadenopathy, conjunctivitis, strawberry tongue, fever and rash * Scaly rash on the trunk * Headache, fever and purpuric rash Explanation: Fifth disease results in a slapped cheek appearance followed by an evanescent rash with a characteristically lacy pattern. Kawasaki disease is characterised by: * Red cheeks and erythematous rash on limbs *! Lymphadenopathy, conjunctivitis, strawberry tongue, fever and rash * Scaly rash on the trunk * Headache, fever and purpuric rash Explanation: Kawasaki disease is a febrile illness accompanied by mucocutaneous signs and lymphadenopathy. The rash is often prominent in the perineum. Pityriasis rosea is characterised by: * Red cheeks and erythematous rash on limbs * Lymphadenopathy, conjunctivitis, strawberry tongue, fever and rash *! Scaly rash on the trunk * Headache, fever and purpuric rash Explanation: Pityriasis rosea rarely causes systemic symptoms but presents as oval plaques on the trunk with characteristic trailing scale and fir tree distribution. Meningococcal disease is characterised by: * Red cheeks and erythematous rash on limbs * Lymphadenopathy, conjunctivitis, strawberry tongue, fever and rash * Scaly rash on the trunk *! Headache, fever and purpuric rash Explanation: A sick child with petechial rash must be presumed to be due to meningococcal disease, treated promptly with penicillin and admitted to hospital for investigation. Staphylococcal scalded skin syndrome should be treated with: * Aspirin and intravenous immunoglobulin * Acyclovir * Penicillin *! Flucloxacillin Explanation: Flucloxacillin and dicloxacillin are the drugs of choice for infections due to S. aureus. Erythromycin may be used in case of allergy to penicillin but there is increasing staphylococcal resistance to macrolide antibiotics. To prevent aneurysms, Kawasaki disease should be treated with: *! Aspirin and intravenous immunoglobulin * Acyclovir * Penicillin * Flucloxacillin Explanation: Although aspirin is generally contraindicated in children (it may cause Reye's syndrome), it is prescribed for Kawasaki disease as it appears to prevent coronary aneurysms. Intravenous immunoglobulin may be more effective. Meningococcal disease should be treated with: * Aspirin and intravenous immunoglobulin * Acyclovir *! Penicillin * Flucloxacillin Explanation: Penicillin is the most commonly used antibiotic for meningococcal disease. Scarlet fever should be treated with: * Aspirin and intravenous immunoglobulin * Acyclovir *! Penicillin * Flucloxacillin Explanation: As scarlet fever is due to Streptococcus pyogenes, penicillin is the drug of choice.