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I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Friday, 23 August 2019

Other Rashes

Chicken Pox
Often blistering and crusting.
Incubation 10-21days
Infectivity when symptoms start

Measles 
Starts from the top and moves down. Often associated with conjunctival problems.
Incubation 7 - 21days
Infective - before symptoms to four days after appearance of rash
Rash - maculopapular, spreads head downwards
One of cough, conjunctivities or coryza
- Get Koplik's spots, red throat
- throat swab
- notify if suspicious
- off school until 5 days after rash
- need immunoflobulin if under 12months, immunocompromised or pregnant.
- MMR if unimmunised within 72hours of exposure
MMR side effects are in the 2nd week after immunisation - fever and rash.

Rubella or German Measles
It's benign and self eliminating.
- 2 week incubation
- headache, fever, lymphadenopathy
- infective 7 days efore, 7 days after onset of rash
- rash face down to feet
- fever, tender occipital and post auricular lymphadenopthy, arthralgia
- Forschheimer spots - pin-point red macules and petechiae, seen on soft palate and uvula
- Immuniglobulin G and M assays

Slapped Cheek / Parvovirus / Fifth Disease 

Scarlet Fever
Pastias lines in the flexural folds with circumoral pallor, and pharyngitis. Desquamation of hands, feet and groin. Rash has a sandpaper-link quality.
-aerosol/droplet
- 2-5 days incubation
- infective 5 days from antibiotics
- sore throat, headache, fever, lymphadenopathy, malaise, abdopain. Sandpaper-like rash
  Strawberry tongue, pastias lines, circumoral pallor, pharyngitis, desquamation of hands feet and groin.
- notify clinical suspicion
- off school 5 days after antibiotics (HPA)
- for grop A strep tonsillitis 24hours off after antibiotics.

Roseola
The roseola rash often appears after the fever has settled.
Herpes virus
Fever + febrile illness
5-15days incubation
Respiratory illnesss, 3-5days fever, cervical lymphadenopathy
Rash from behind ears - blanching macules and papules surrounded by halos
Nagayama's spots- erythematous papules on the soft palate
Diarrhoea
Cough


Other References
https://www.rcemlearning.co.uk/foamed/7-pem-rashes/
https://www.rcemlearning.co.uk/reference/common-childhood-exanthems/

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