NBE CME programme for DNB consultants - National Board Of ...

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NBE CME programme for DNB consultantsrash should be seeked. Associated features should be looked for e.g. diarrhoea(enteroviral) andsevere illness(meningococcal). Lcocatino of rash would also give a clue about the aetiology.History of similar illness in the neighborhood or siblings, and the use of drugs must be noted. Asystematic history, clinical examination further aided by investigations would assist in the diagnosisof the disorder. A pertinent differential diagnosis can at least be deduced, thus making themanagement easier. The following key issues need to be addressed while discussing/presentinga case of fever with rash.History- Age of the child; Temporal relationship of fever with rash; Prodromal symptoms; Site ofonset of rash and its distribution; direction and rate of spread of rash; Morphology of rash(macular,popular, pustular) ; Progression/Course of rash; +/- Pruritis photosensitivity(waxing & waningpattern in erythema infectiousness) ; Associated systemic symptoms-Cough, coryza, conjunctivitis,arthritis, LN pathy, diarrhoea, abdominal pain, chest pain, bleeding from any other site, carditis;Did the patient become toxin at any point int h4 course of illness; Immunization history(rules outvaccine preventable exanthems); H/o contact with individuals with similar illness(infectiousaetiology); Is the individual immunocompromised; H/o intake of drugs, food allergy(drug rash);Travel history to endemic areas vital(viral hemorrhagic fevers); H/o animal or arthropod bites(bodylics, rat fleamite, rat bite); Similar illness in the nighbourbood or siblings; H/o joint pains; H/o PicaExamination - Fully expose the area preferably in natural light.Rash–Morphology-Colour,size,consistency,margins,surfacecharacteristics;Distribution-Symmetrical/ asymmetrical, centrifugal/centripetal; Flexor/Extensor configurations - Nummular/discoid, annular, circiant4e, arcirate, gyrati/serpiginous, linecir, grouped, reticulate; Are onlytheexposed areas affected ; Are the genitals/mucous membrane also involved; Nikolskyi sign(positivein SSSS, TEN) ; Vitals;Signs and symptoms of sepsis.Shock – Strep Toxic Shock Syndrome(TSS), staph TSS, ecthyma gangrenosum, purpurafulminans, dengue hemorrhagic fever, meningococcemia.152
NBE CME programme for DNB consultantsOral Examination; Koplik spots – Measles; Forchheimer spots – palatal petichiae – Germanmeasles, Infectious mononucleosis, scarlet fever. Pharyngitis – Rh fever, IMN; Strawberry tongue– Scarlet fever, Kawasaki disease;L.N. - Post auricular and sub-occipital group-German measlesJoints - Arthritis in German measles; Meningitis; Enteroviruses, meningococcemia, asepticmeningitis. Hepatosplenomegaly – infectious mononucleosis, typhoid, TORCH infectious(neonates); Heart – Murmur (Rh. Fever, SABE)153
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