PAEDIATRIC RASHES OSCE - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

PAEDIATRIC RASHES OSCE

Description:

PAEDIATRIC RASHES OSCE Dr S FISH Terminology Macule flat lesion ,usually a circumscribed change of colour Papule small , solid, elevated lesion Nodule a ... – PowerPoint PPT presentation

Number of Views:214
Avg rating:3.0/5.0
Slides: 41
Provided by: Sharon466
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: PAEDIATRIC RASHES OSCE


1
PAEDIATRIC RASHES OSCE
  • Dr S FISH

2
Terminology
  • Macule flat lesion ,usually a circumscribed
    change of colour
  • Papule small , solid, elevated lesion
  • Nodule a large , solid , palpable and elevated
    lesion
  • Plaque a lesion slightly raised over a larger
    area
  • Blister an elevated lesion ,fluid filled
  • Ulcer depressed lesion with loss of surface
    epithelium
  • Atrophy a depressed lesion with intact surface
    epithelium
  • Crust a mixture of scale and serum yellowish
    accretions on the surface of a lesion
  • Petechiae non raised red-brown non blanchable
    lesions

3
Summary of Paediatric Skin Rashes Adapted from
Paediatric Handbook 6th Ed. Royal Children's
Hospital, Melbourne
4
SLIDE 1
5
SLIDE 1
  • 1-Name condition and causative organism
  • 2-Describe what you see
  • 3-How would you treat it

6
SLIDE 2
7
SLIDE 2
  • 1-Name the condition
  • 2-What are typical causative organism
  • 3-describe typical features
  • 4-How would you treat it

8
SLIDE 3
9
SLIDE 3
  • 1-Name the rash and the associated syndrome
  • 2-name infective and drug causes
  • 3-describe typical features

10
SLIDE 4
11
SLIDE 4
  • Name this disease ,what is its cause.
  • Name the features
  • Name a major complication of this disease
  • treatment

12
SLIDE 5
13
SLIDE 5
  • Name this condition
  • What is the causative organism
  • How do you treat it

14
SLIDE 6
15
SLIDE 6
  • What is this rash
  • Describe features

16
SLIDE 7
17
SLIDE 7
  • What is this called
  • What is the causative organism
  • Describe features
  • treatment

18
SLIDE 8
19
SLIDE 8
  • What is the broad term used to describe this
    condition
  • Name the subset of conditions which cause it.
  • How do you treat this condition ?

20
SLIDE 9
21
SLIDE 9
  • Name this condition
  • What is the cause of it
  • How do you treat it

22
SLIDE 10
23
SLIDE 10
  • What is this called
  • What organism causes it
  • treatment

24
SLIDE 11
25
SLIDE 11
  • Name the condition
  • What causes this condition
  • Describe the features
  • How do you treat it

26
SLIDE 12
27
SLIDE 12
  • Name the rash
  • What causes this condition
  • Name 2 types of this condition
  • How do you treat this condition

28
References
  • Pictures Derm atlas
  • Oxford Handbook of Dermatology for primary care
    ,Saxe ,Jessop
  • Topics in Paediatrics ,Basson Ginsberg

29
SLIDE 1
  • 1-Chicken-pox , Varicella zoster virus
  • 2-Crops of vesicles mainly on the trunk and head.
  • -Pass through various stages of papule,
    vesicle, pustule and crust.
  • 3-Symptomatic analgesia paracetamol for
    discomfort and pyrexia.
  • -pruritis antihistamine or calamine lotion
  • - acyclovir only for those at risk of
    complications or immunocompromised.

30
SLIDE 2
  • 1-Impetigo
  • 2-staph areus and streptococcal pyogenes
  • 3-Thinroofed vesicles or bullae surrounded by
    narrow margin of erythema. The vesicles /bullae
    rupture to release thin cloudy yellow fluid. This
    fluid dries to form thick yellow crusts.
  • 4-topical-bactroban(mupirocin) ointment/betadine
    cream
  • - antibiotics flucloxacillin or
    erythromycin

31
SLIDE 3
  • 1-Erythema Multiforme
  • Steven-Johnson Syndrome (mucous membrane
    involvement)
  • 2-Drug
  • most commonly associated-Allopurinol5
  • Recent drugs- Nevirapine, lamotrigine,
    sertraline, pantoprazole, tramadol
  • Antibiotics- Sulphonamides, including
    co-trimoxazole, penicillin cephalosporins,
    fluoroquinolones, vancomycin
  • NSAIDs- Piroxicam, fenbufen, ibuprofen,
    ketoprofen, naproxen, tenoxicam, diclofenac,
    sulindac
  • Anti-TB- Rifampicin, ethambutol, isoniazid,
    pyrazinamide
  • Anticonvulsants- Barbiturates, carbamazepine,
    phenytoin, valproate, lamotrigine
  • - Infective herpes simplex
  • 3-target lesion round ,erythematous papules
    contain central blister or darker area of
    necrosis

32
SLIDE 4
  • 1-Kawasaki Disease, systemic vasculitis
  • 2- Classical features of Kawasaki disease
  • Fever lasting 5 days
  • Marked irritability of the child
  • Erythema, swelling and desquamation affecting the
    skin of the extremities
  • Bilateral conjunctivitis
  • Rash
  • Inflammation of the lips, mouth and/or tongue
  • Cervical lymphadenopathy
  • 3- coronary artery aneurysms
  • 4 -Intravenous Immune Globulin 2g/kg x1
  • Aspirin
  • 80-100 mg/kg/day until fever ? x 14 day, then
  • 3-5mg/kg/day x 6-8 weeks
  • echocardiograms

33
SLIDE 5
  • 1-Scabies
  • 2-Mite sarcoptes scabeii
  • 3 -Clothes, towels, and bed linen should be
    machine-washed (at 50 degrees Celsius or above)
    to prevent re-infestation and transmission. Items
    that cannot be washed can be kept in plastic bags
    for at least 72 hours to contain the mites until
    they die.
  • -benzyl benzoate lotion ,apply for 24hours ,may
    be repeated in 1 week
  • -permethrin cream
  • Antiscabial soap alone is not an effective
    treatment
  • Babies lt2 months -5 sulphur ointment

34
SLIDE 6
  • 1-Measles
  • 2-single stranded RNA Morbillivirus from the
    paramyxovirus family.
  • 3- Symptoms
  • Prodrome - lasts 2-4 days with fever, runny nose,
    mild conjunctivitis and diarrhoea. Koplik spots
    are pathognomic and appear on the buccal mucosa
    opposite the second molar teeth as small, red
    spots each with a bluish-white speck (sometimes
    compared to a grain of rice) in the centre.6 They
    occur in 60-70 of patients during the prodrome
    and for up to 2-3 days before the onset of the
    rash.
  • Rash - (morbilliform measles-like) first seen
    on forehead and neck and spreads, involves trunk
    and finally limbs over 3-4 days. It may become
    confluent in some areas. Rash then fades after
    3-4 days in the order of its appearance. It
    leaves behind a brownish discoloration sometimes
    accompanied by fine desquamation.
  • 4-Uncomplicated measles is usually self-limiting
    and treatment is mainly symptomatic with
    paracetamol or ibuprofen and plenty of fluids.
    Patients should remain at home to limit disease
    spread.
  • It is a notifyable disease

35
SLIDE 7
  • 1- erythema infectiosum, slapped cheek disease,
    slapped cheek syndrome, fifth disease, Parvovirus
    B19 (PV-B19), Sticker's disease
  • 2- Parvovirus B19
  • 3- After 3-7 days, the classic 'slapped cheek'
    rash appears as erythema on the cheeks, sparing
    the nose, peri-oral and peri-orbital regions.6
    This disappears after 2-4 days.
  • About 1-4 days after the facial rash appears, an
    erythematous macular/morbilliform rash develops
    on the extremities, mainly on the extensor
    surfaces.7 It is usually not itchy in young
    children, but may be itchy in older children and
    adults. This gradually fades over the next 3-21
    days, but may recur in reaction to various
    stimuli such as exercise, heat and sunlight
  • 4- It is usually mild and self-limiting in
    healthy people. It may also cause fetal loss or
    fetal hydrops, reactive arthritis in adults, and
    severe anaemia in those with haematological
    conditions or immunocompromise.Detection in
    pregnancy is important for monitoring and
    possible treatment.

36
SLIDE 8
  • 1-Napkin /Daiper dermatitis
  • 2- Contact dermatitis
  • prolonged exposure to urine and faeces,
    friction
  • mild erythematous ,glazed appearance
  • -Seborrhoeic dermatitis
  • salmon coloured greasy lesions and a
    predilection for intertriginous areas.
  • Candidiasis
  • beefy red in colour with pin point
    pustulo-vesicular satellite lesion
  • 3- frequent daiper changes
  • barrier cream zinc and caster oil
  • apply hydrocortisone 1 in aqueous cream bd
  • if candidiasis suspected -10 steriod and
    nystatin 20 in zinc cream

37
SLIDE 9
  • 1- tinea capitis
  • 2- fungal infection by a group of organisms
    called dermatophytes
  • 3-griseofulvin for 6 weeks ,10mg/kg

38
SLIDE 10
  • Meningococcal meningitis
  • Neisseria meningitidis
  • Cefotaxime

39
SLIDE 11
  • 1-Molluscum contagiosum
  • 2-From direct innoculation of pox virus
  • 3-tend to heal spontaneously within 6 months 1
    year
  • -liquid nitrogen 2-3 weeks
  • -express contents with sharp curette
  • -benzoyl peroxide cream apply daily

40
SLIDE 12
  • 1-Miliaria
  • 2-Miliaria is a common disorder of the eccrine
    sweat glands that often occurs in conditions of
    increased heat and humidity. It is thought to be
    caused by blockage of the sweat ducts, which
    results in the leakage of eccrine sweat into the
    epidermis or dermis.
  • 3-Two types
  • -miliaria crystallina-clear superficial pinpoint
    vesicles
  • -miliaria rubra (prickly heat )-small discrete
    red papules,vesicles,papulovesicles
  • 4-No compelling reason to treat miliaria
    crystallina exists because this condition is
    asymptomatic and self-limited. he prevention and
    treatment of miliaria primarily consists of
    controlling heat and humidity so that sweating is
    not stimulated. Measures may involve treating a
    febrile illness removing occlusive clothing
    limiting activity providing air conditioning.
  • Topical treatments that have been advocated
    involve lotions containing calamine
About PowerShow.com