This EM Mastery is actually a quiz on rashes. Try it.
Below you will find a series of images of rashes. Diagnose them and them view the video, which will give you the answers.
RASH 1: What are the rashes in the next 2 images?
Now what about this?
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Rubeola vs Roseola
Rubeola (Image 1)
- Cough, coryza, conjunctivitis, fever
- Rash appears after 3-5 days
- Starts on face then moves to body after 2-3 days
- Koplik spots precedes rash
- Unwell child
- Fever spike at rash onset
- 2 doses of MMR confers lifelong immunity
Roseola
- Sudden high fever
- URTI Sx
- Fever lasts 3-5 days
- As fever subsides, rash appears
- Rash appears on the body and spreads to the arms and legs; it is rarely seen on the face.
- Rash lasts ~ 2 days
- Child is well at onset of rash
- Commonly see febrile
RASH 2: What is this rash?
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Chickenpox
- Herpes virus
- Airborne – 70-80% risk of infection if exposed
- Incubation 10-21 days
- Itchy red papules stomach, back and face then spread all over
- Can have fever, headache, URTI, D&V concurrently
- May be no prodrome in kids
- Only neonates <28days and immunocompromised kids are ZIG eligible
- Zoster can cross dermatomes in kids
- Single dose vax 85% effective (>98% with 2nd
What is this rash and what causes it?
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Erythema Multiforme
- target lesions
- Typically seen in young adults
- mucosal involvement = major vs minor
- most common trigger is HSV, others include infection, medications, vaccinations.
What about this rash in a well child?
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Henoch-Schonlein Purpura
- Small vessel vasculitis
- Vasculitic rash, arthritis and abdo pain
- Renal complications
- Preceded by URTI/fever/headache/myalgia
- Palpable purpura BUT NOT SICK
- Lower legs, buttocks, elbows, knees
- Arthritis in 75% – ankles & knees
- Abdo pain 50-75% – may have diarrhoea
- Measure BP and check urine
An elderly patient presents with an itchy rash. What is it?
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Scabies
- Intensely itchy
- More common in elderly/care residents/overcrowding/indigenous
- Look for burrows
- Treat whole family (ivermectin or permethrin cream)|
- Hot wash all linen.
What is this rash, that has been there for a week?
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Erythema Toxicum
- 50% infants
- Benign
- First few days – 2 weeks onset
- Well baby
- Face to forso and limbs
- Migratory
- Can last weeks
- No treatment (no need for emollients etc)
What is this rash in an unwell patient?
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SJS/TEN
- Rare, potentially fatal
- Almost always caused by medication (40% Abx)
- unpredictable onset
- URTI prodrome
- sheet like skin and mucosal loss
What is this rash, which is mostly seen in children?
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Gianotti Crosti
- Infantile papular acrodermatitis
- Response to viral infection
- Lasts several weeks
- Children only (rarely seen in adults)
- Presents over 3-4 days
- Profuse eruption of dull red spots – thighs and buttocks, then ext arms then face
- No treatment – fades in 2-8
Watch the video above and tune in next week for part II.