I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

This one’s a bit different and is really a landing page for all the different rashes I think might be relevant. The links are to google searches so you’ll have to judge the veracity of the pics for yourself.

Rash description

(from the OHEM 4th p673)

• impalpable coloured <1cm = macule
• impalpable coloured >1cm = patch
• palpable lump <0.5 = papule
• palpable lump >0.5 = nodule
• palpable fluid filled <0.5 = vesicle
• palpable fluid filled >0.5 = bulla

Some relevant rashes

• kawasaki
• erythema-
  • multiforme (HSV, TB, mycoplasma, SJS, EBV, HIV, Hep B, penicillin, anti malarials)
  • nodosum (GAS, TB, mycoplasma, IBD, sarcoid, campylobacter, OCP, penicillin)
  • marginatum (rheumatic fever)
  • migrans (lyme)
• Pyoderma gangranosum
  • usually legs
  • myeloma
  • IBD
  • Rheumatoid
  • Bechets
• HSP (IgA immune complex vasculitis)
• Slapped cheek (parvovirus B19, also called 5th disease)
• hand foot and mouth (coxsackie)(note one of few affecting soles, others include meningococcal, SJA, rocky mountain, kawasaki and syphillis)
• Measles
• Rubella
• meningococcal
• eczema herpeticum
• scabies
  • burrows: genitalia, interdigital\
  • Rx: Premethrin, malathione
  • Treat householders
  • Apply at night, wash off in day
• Chancroid
  • rash of primary syphillis, non painful, non itchy
  • treponema pallidum
  • secondary: a whole bunch but rash, nodes and mucous membrane invovlement
  • tertiary: aortic, neuropsych and gumma
  • give penicillin and wait for the Jarisch-Herxheimer reaction…
• impetigo
• genital herpes
• chancroid
• hypersensitivity vasculitis
  • small vessel, typically lower limb
  • drug induced often (antibiotics, thiazides, phenytoin, NSAID, allopurinol)
  • infections (strep, croglobulin from hep c)
• varicella
• toxic shock syndrome
• staph scalded skin
• SJS/TEN
  • distinct from multiforme major
  • TEN the worse part of the spectrum
  • drugs, drugs, drugs…
    • sulfonamides
    • anti convulsants
    • allopurinol
    • penicilins
    • paracetamol and NSAIDs
  • big association with HIV
  • treat as burns and refer
• pemphigus
  • DermNetNZ
  • autoantibodies form against desmoglein
  • breaks the desmosomes
  • oral lesions first usually
  • 40-60
  • can happen with drugs
  • blisters fragile ++ and often not present in the ED.
  • Typically Nikolsky +ve
  • Management
    • supportive
    • refer to someone smarter – typically for steroids
• pemphigoid
  • DermNetNZ
  • autoantibodies agains basement membrane of the epidermis
  • commoner
  • older (>60)
  • less mucous membrane than pemphigus
  • small association with malignancy
  • bullae are stronger and more likely to be present when you see the patient
  • Typically Nikolsky -ve
  • often idiopathic but happens with drugs
  • Mangement
    • supportive
    • refer to someone smarter (steroids, immunosuppression)
• keratoderma blennorhagicum
  • i know, that’s what i said…
  • association with reactive arthritis (which means gonoccoal and chlamidiya, salmonella, shigella)