Conditions Flashcards
Biliary atresia
Congenital narrowing of bile ducts . Jaundice >14 days term vs >21 days neonate. Kasai procedure. Increase in Conjugated bilirubin detected by direct bilirubin test.
Pyloric stenosis
Projectile vomiting and failure to feed and thrive in first few weeks of life. USS abdo and feel olive shaped mass. Hypochloraemic metabolic alkalosis. Ramstedt operation
Sandifers syndrome
Torticollis and dystonia after feed . Complication of GO reflux
Causes of bilious vomiting
Intestinal obstruction
Meconuim ileus
Hirchsprungs disease
Intussecption
Malrotation with volvulus
Imperforate anus
Oesophageal or duodenal atresia
Hirchsprung’s disease
Congenital absence of PNS ganglionic cells in myenteric/auerbach plexus in distal bowel and rectum. FMHX. >24 hrs delay in meconium. 2-4 weeks after birth 20% get hirchsprungs associated entero colitis- fever, abdo distension, sepsis, bloody diarrhoea —> toxic mega colon. RECTAL BIOPSY and abdo x ray
Intussception
6mnths-2yrs old. Associated with viral illness, HSP, polyps, meckel’s diverticulum. Sev colickly pain, red currant jelly stool, sausage shaped mass RUQ. USS. Therapeutic enemas/ surgery
Ileocecal valve is common place and most dangerous
Ileo ileo and cecocecal can sometimes self resolve
Lymphoma, appendix, are common lead points
Causes of short stature and investigations
Normal: familial, CDGP (delayed bone age)
Endo: GH deficiency, hypoT, cushings
Genetic: DS, turner’s, noonan, prader-Willi
Bone: achondroplasia, osteogenesis imperfecta, rickets
Chronic: coeliac, Ibd
IGF-1, predicted height, bone age, growth velocity
Causes of tall stature
Familial, obesity, GH excess, hyperT, precocious puberty, soto, Marian, homocystinuria, klinefelter, fragile X
Precocious puberty define and causes
Secondary sexual characteristics <8 yrs for girls or menarche <9yrs or <9yrs boys
Central: hydrocephalus, lesions
Peripheral: CAH, hypoT, gonadal or adrenal tumours (small testes), mccune Albright syndrome, testotoxicosis
Prematurethelarche
Delayed puberty
No breast dev by 13yrs. Primary amenorrhoea if no periods or secondary sexual characteristics at 14 vs if secondary sexual characteristics present then at 15. Boys testes <4ml at 14 yrs old.
Central: hypogonadotrophic hypogobadism - CDGP, chronic disease, hypoT, Kallman syn, prader-willi
Hypergonadotrohic hypogobadism- cryptochordism, androgen insensitivity syndrome, galactosasmia, thalassaemia,turners, klinefelters
Innocent murmur
Soft, systolic, symptomless, short, situational
Pansystolic murmurs
VSD ( left lower stern also border)
Tricuspid regurgitation
Mitral regurgitation
Ejection systolic murmurs
Aortic stenosis (right 2nd ICAS)
Pulmonary stenosis (left 2nd ICs)
HCOM 4th ICS left
Mid systolic murmur
ASD- crescendo decrescendo at UPPER LEFT STERNAL BORDER with a fixed split 2nd heart sound
PDA murmur
Continuous machinery crescendo decrescendo murmur
Diagnosis echo
Monitor until 1 yr and NSAIDs to close
If no closure after one year then surgery
Coarctation of aorta
Associated with TURNER’s SYNDROME.
3 days post birth collapsed baby when PDA closes. Weak femoral pulses, lower BP in legs, systolic murmur left infraclavicular and below left scapula. PG infusion
Pulmonary stenosis associations
Tetralogy of fallot
Rubella
Noonan syndrome
William syndrome
Tetrology of fallot
Pulmonary stenosis, VSD, RVH, overriding aorta
Cyanosis
Associated with rubella, alcohol, diabetes, increased maternal age
Echo BOOT SHAPED HEART
Ejection systolic murmur
Tet spells : squat, O2, B blockers, morphine, IV fluids, phenylephrine, NaHCO3
Pg infusion and aurgwry
Cyanosis heart disease
Truncus arteriosus
Transposition of great arteries
Triscuspid atresia
Tetrology of fallot
TAPVR
What heart disease is rubella associated with?
PDA
What syndrome is associated with AVSD?
Down’s syndrome
What heart disease is associated with turners syndrome?
Coarctation of aorta
Bronchiolitis
RSV under 1 yo, peaks at 6mnths
Coryzal symptoms that go to chest 1-2 days later.
Admit if under 3 months, pre existing condition, 50-75% normal intake, clinically dehydrated, RR>70, O2<92, signs of mod-severe respiratory distress, apnoeas
Management
NG / IV FLUIDS
SUCTION/ SALINE DROPS
O2- high flow- cpap - intubation
Viral induced wheeze
1-2 days fever/cough then goes to chest- resp distress and widespread expiratory wheeze.
Vs asthma- no atopy
Vs bronchiolitis- can occur up to 3yrs
RSV / rhinovirus
Same management as acute asthma- if <92% 3 BTB salbutamol and ipatropium nebs, O2 and steroid. If >92% salbutamol 10 puffs
Acute asthma
Mod: PEFR>50% predicted, normal speech
Sev: PEFR<50% predicted, can’t complete sentences, O2>92%, RR >40 if under 5yo vs >30 if >5yo, HR >140 if under 5yo vs >125 if over 5yo.
Life threatening: PEFR <33% predicted, <92% O2, silent chest, cyanosis,
Management for mod- sev
- 10 puffs/2 hrs salbutamol
- salbutamol and ipatroium back to back Nebs up to x3 if <92% (5mg/500mcg)
-pred/dex
-IV hydrocortisone
-IV MgSO4
-IV salbutamol
-IV aminophylline
Step down on 6 puffs / 4hrs 48 hours then 4/6hrs
Chronic asthma
2-3 yrs clinical diagnosis
-if improves on treatment
-spirometer with reversibility testing if >5yo , direct bronchial challenge with histamine, FENO, peak flow variability
Management
<5yo SABA, low dose ICS, leukotriene ant
5-12: salbutamol, low dose ICS, LABA, med dose ICS leukoyriene or oral theophylline, high dose ICS
> 12
SABA
low dose ICS
LABA
Medium dose ICS, leukotriene ant, oral theophylline, LAMA tiotropium
High dose ICS
oral steroids
Pneumonia
Productive cough & fever
Bronchial breath sounds coarse crackles
Strep pneumoniae
(Also staph aureus, h influenzae, mycoplasma, group a and B strep
RSV, influenza
Amoxicillin And macride
Croup
6mnths- 2 yrs
Parainfluenza
Not preceded by corzyal
Barking cough, strider, hoarse voice, low grade fever
Oral dex
O2
Nebuliser budenoside
Nebuliser adrenaline
Intubation
Strider causes
Foreign body
Croup
Epiglotitis
Laryngomalacia
Whooping cough
Bordetella pertussis
Mild cough/Coryza/fever —> severe paroxysmal cough (can cause vomiting or pneumothorax) with apnoeas and whooping
Notifiable disease
Macrolides 21 days or co trimoxazole
Complications: long cough or bronchiectasis
Chronic lung disease of prematurity
Risks :
<28 weeks
Required O2/ intubation at birth
RDS
O2 0.01L/min during sleep nasal cannula
Palizivumab injections
CF
AR CFTR Chr7 delta F508
1 in 2500
1 in 25 carriers
Doagnosis
Newborn blood test
Pilocarpine sweat test CL>60
CFTR
Mexonium ileus
Recurrent LRTI
steatorrhira
Chronic cough
Salty
Failure to thrive
Staph aureus
Pseudomonas and burkhoderia most dangerous
H influenza
E. coli
Klebsiella
Prophylactic flycloxacillun
Salbutamol
NEbulised DNAse
Nebuliser hypertonic saline
Creon
Monitor diabetes, osteoporosis, liver failure
HSP
under 10 yo
Purpuric rash on lower legs and buttocks
Abdo pain
Jt pain
Renal
UTI management
<3 months fever iv crftriaxone
>3mnthsnoral
Posterior urethral valve
Tissue proximal urethra near bladder causes bilateral hydronephrosis and UTIs
Usually picked up antenatal scan
Ablate
I descended testes
At 6-12 months orchidopexy
CMPA
under 3 years
Abdo pain and bloating and then allergy symptoms wheeze watery eyes cough rash
Perthes
5-8yo boys idiopathic
Disruption of blood flow to femoral head leads to avascular necrosis
Pain in groin/hip/knee, limp, restricted movement
X ray may be normal
Surgery if severe
5% get hip replacement
developmental dysplasia of the hip
Dislocation/subluxation of hip
RFs: breech, 1st degree FMHX, multiple pregnancy
USS diagnosis
Barlow and otolini test positive
Pavlik harness <6mnths vs surgery >6mnths w hip spica cast
SUFE
Adolescent obese male/ 8-15yo/ slight trauma causes head femur to slip on growth plate
Pain, external rotation , limp
Diagnosis X-ray frog lateral
Internal pinning and fixation of epiphysis
Transient sunovitis
3-10yo
Limp can’t weight bear gradual onset
No fever
Viral urti
Septic arthritis
Single joint <4yo
Rapid onset
Fever
Aspirate
IV flucloxacillin empirical 3-6 weeks
Oesteosarcoma
10-20yo commonly femur
Swelling and bone pain worse at night
Urgent x ray in 48hrs- sunburst periosteal reaction and fluffy appearance
Talipes
Equinovarus/calcaneovalgus
Ponseti method: manipulate to normal position, cast, Achilles tenotony, boot nad bars brace until 4yrs old
Osteogenesis imperfecta
Genetic brittle bones affecting collagen
Hyper mobility
Blue sclera
Triangular face
Scoliosis
Short
Dental problems
Deaf
Jt and bone pain
Bowed legs
Recurrent fractures
M
Bisphosphonates
Vit D
Achondroplasia
AD
disproportionally small
Frontal bossing
Foramen magnum stenosis
Spinal stenosis
Kyphoscoliosis
Recurrent otitis media
Hydrocephalus
OSA
Obesity
Rickets
RFs: dark skin, indoor climate, renal disease, autoimmune, IBD/coeliac
Rachitic rosary
Craniotabes
Undeveloped teeth/bones
Pain
X ray osteopenia
Serum vit D < 25
Low Ca and PO4
High ALP and Pth
Treatment
6000 IU ergocalciterol 8-12weeks
Prevent during pregnancy with 400 IU vit D per day
Down’s Syndrome
Brachycephaly
LD
Dementia
Cataracts/myopia/striabismus
Prominent epicantic folds
Upward slanting palpebreal fissures
Brushfield spots
Recurrent otitis media
Flattened face and nose
Large tongue and small mouth
Atlanto axial instability
Hypothyroidism
Diabetes
Leukaemia
Single palmar crease
Increased sandal gap
Duodenal/jejunal atresia
Investigations
11-14weeks combined test ( increased nuchal thickness > 6mm, decreased PAPPA, increased BHCG)
14-20 weeks triple test (decreased oestriol, increased BHCG, decreased AFP)
14-20 weeks quadruple ( decreased oestriol, decreased AFP, increased BHCG, increased inhibin A)
> 1 in 150 aminocentesis
Noonan syndrome
AD
Broad forehead
Downward sloping eyes and ptosis and hypertelorism
Low set ears
Webbed neck
Short stature
Pulmonary stenosis
Lymphoedema
JMML / neuroblastoma
LD
Bleeding disorders
Cryptorchism
Fragile X syndrome
Tall long face
Speech delay
Small testicles
LD
seizures
Autism
Hyper mobile
Klinefelter syndrome
Male XXY
taller
Wider hips
Small testicles
Gynaecomastia
Infertility
Associated w diabetes, osteoporosis and breast cancer increased risk
Testosterone injections
Turner syndrome
45 XO
Small
Webbed neck
Widely spaced nipples
Cubitus valgus
Downward sloping eyes w ptosis
High arched palate
Undeveloped ovaries
O P replacement
GH therapy
Associated w COARCTATION OF AORTA
recurrent otitis media and UTIs
Osteoporosis
LD
Diabetes
HypoT
Marfan syndrome
AD if till in
Tall, arachnodactylyl
Hypermobility
High arched palate
Downward sloping palpebral fissures
Associated
Pneumothorax
Lens and joint dislocations
Aortic aneurysm
Mitral and aortic regurg
Reflux
Scoliosis
Prader Willi syndrome
Constant insatiable hunger
hypotonia
LD
Management
GH for muscles
Angelmann syndrome
Happy
Water fascination
Widely spaced teeth
LD
ataxia
Epilepsy
Microcephaly
William syndrome
Broad forehead
Starburst eyes
Sociable
Supravalbular aortic stenosis
HyperCa
Digeorge syndrome
C- cleft lip/palate
A- abnormal facies
T- thymus undeveloped/ T cell abnormalities
C-cardiac abnormalities
H-hyper parathyroidism- hypocalcaemua - seizure
22 chromosome deletion
Idiopathic thrombocytopenic pupura
Type II hypersensitivity under 10 yo
Low plt only (exclude leukamia)
Bleeding and bruising
70% resolve in 3 months
If plt<10- prednisolone, IV IgG, plt transfusion
Avoid contact sports, NSAIDs, blood thinners, IM injections
Complications
Anaemia
Intracranial haemorrhage
GI bleed
Chronic ITP
Thalassaemia
Alpha (chr16) vs beta (Chr11- minor, intermedia, major)
Prominent forehead and malar eminences
Jaundice
Splenimrgalu
Microcytic anaemia
Gallstones
Blood transfusions
Splenectomy
BMT
Hereditary spherocytosis
AD
jaundice
Gallstones
Anaemia
Splenimegaly
Aplastic crisis associated w parvovirus B19
I: spherocytes on blood film and increased MCHC and reticulocytes
Folate
Splenectomy
G6PD deficiency
X linked recessive
GP6D protects against reactive oxidative species forming. When deficient it can’t protect and therefore haemolytic occurs causing jaundice, gallstones, splenomegaly and anaemia- in response to infection/meds/anti malarials/fava and broad beans
I
Enzyme assay
Heinz bodies blood film
Leukaemia
ALL most common around 2-3 years old
80% cured
Associated w radiation during pregnancy, DS, noonan, klinefelter, fanconi’s anaemia
2% present with a limp
Pancytopenia with random increased WBC
Tonsillitis and tonsillectomy criteria
Viral global symptoms
Group A strep focal symptoms
Probability it is bacterial:
CENTOR >3
1. Absence of cough
2. tonsillar exudate
3. Lymphadenopathy (anterior cervical)
4. Fever >38°
FEVER PAIN >4
F- fever
P- purulence
A- attended within 3 days onset
I- inflamed tonsils
N- no cough /coryzal
PEN V 10 days
Complications:
Otitis media
Quinsy (abscess treated with co-amoxiclav incision and drainage)
Scarlet/rheumatic fever
Post strep glomerulonephritis/reactive arthritis
Tonsillectomy requirements:
1. Recurrent - >7 in one year, >5 2 yrs, >3 for 3 yrs
2. Recurrent abscesses (>2)
3. Snoring/breathing difficulties
Otitis media
Strep pneumoniae
Management:
1. Resolve 3 days with simple analgesia
2. Delayed prescription if no resolve in 3 days
3. Amoxicillin 5 days if
-otorrhea
-<2years and bilateral
- <3mnths and fever >38° or 3-6mnths and fever >39° ADMIT
COmplications
-glue ear (hearing loss- Eustachian tube blocked, 3mnths resolves or grommets)
-hearing loss
-perforation
-mastoiditis
-abscess
Febrile convulsions
6mnths- 5 yo
Simple:
Under 15mins
Generalised tonic clonic
No recurrence in 24hrs
Complex
15-30mins
Focal/partial
Recurrence in 24hrs
Status epilepticus >30 mins
1in3 risk of further FC
>5mins phone ambulance
Some discharged with buccal midazolam or rectal diazepam
2.5% risk of epilepsy compared to 1.8% general population. Increased if FMHX, complex FC. Neurodevelopmental disorder.
Seizure differentials
All ages:
HYPOGLYCAEMIA- GLUCOSE
CARDIAC ARRHTJYMIA - ECG
babies:
-sandifer’s syndrome
-benign sleep myoclonus (disappears 6-8mnths)
-shaken baby syndrome
toddlers:
- breath holding spells ( cyanosis: after crying- cyanosis vs reflex anoxic seizure- startled, vasobagal response and heart stops and seizure)
-motor stereotypes/tics
-self gratification
Older
Psuedoseizure
Tics
BPPV/ torticollis
Or epilepsy
-generalised tonic clonic (sodium valproate)
-atonic (drop, associated w Lennox-gastaut sun, EEG spike and wave, associated with sleep, <3min- sodium valproate)
-absence - ppt by hyperventilation, 3 second spike and wave EEG, perioral/ocular flickering (na valproate if >12trs onset)
-juvenile myoclonus - 12-18yo gen tonic clonic Na val
-focal - carbamazepine
-BREC (benign rolandic epilepsy w contra temporal spikes) - focal, sleep, prodrome parathesia, post ictal hypersalivation, 3-13yrs male
Infantile spasm 3-6mnths make
Sudden flexor contractions clustered around waking, wests syndrome
EEG hysparrhthmia
Prednisolone, vigabatrin, ACTH
Hydrocephalus
Causes
Aqueducts stenosis congenital
Arachnoid cysts
Arnold chiari malformation
Rapidly increasing head circumference
Sunset sign eyes
Bulging anterior fontanelle
Poor feeding
Sleepy
Poor tone
M
Ventriculo peritoneal shunt
Squint
Idiopathic
Cerebral palsy
Retinoblastoma
Hydrocephalus
Trauma
Hirschbergs test
Cover test
Manage w patch <8yo
Cerebral palsy
Cause
HIE
maternal infections
Birth trauma
Meningitis
Sev neonatal jaundice
Head injury
Types
Spastic/pyramidal
Dyskinesia/athetoid
Ataxic
Mixed
Hand preference before 18 months
Meningitis
NHS
neonatal : GBS, listeria, E. coli
HSV/Vzv/entero virus
C neoformans
Fever hypotonia bulging ant fobtanelle non blanching pupuric if meningococcal
LP if <1mnth and fever, 1-3mnths fever and unwell, <1yr unexplained fever and serious illness
Stat IM/IV benpen in primary care if meningococcal suspected
<3mnths cefotaxime and amoxicillin
>3mnths ceftriaxone and dex 4 days
Contacts single dose ciprofloxacin
Sepsis
<3mnths >38° treat
Neonatal jaundice
Physiological 2-7 days post birth
Pathological in first 24hrs (worried about sepsis/abo etc)
Increased production
-ABO incompatibility
-Rh (haemolytic disease of newborn)
-haemorrhage/IVH
-GP6D deficiency
-polycythameia
Decreased output
-breast milk jaundice
-biliary atresia (>14days in term baby, >21 days preterm)
-cholestasis
-Gilbert/crigler najjar syndrome
-hypothyroidism
-prematurity
I
-SBR and chart
-FBC (haemolytic anamei)
-direct bilirubin (CB- biliary atresia)
-direct Coombs test (ABO)
-TFTs
-LFTs
-blood cultures
-GP6D
M
phototherapy- stop when 5 boxes below treatment line. Check 12-18hrs SBR.
Treatment exchange transfusion
Scarlet fever
2-6 yrs old
Group A strep
Fever (24-48hrs)
Sore throat
Malaise headache
Sandpaper rash torso flexures
Circimoral facial pallor
Desquamation
Oral PenV 10 days
Complications
Rheumatic fever 20 days later
Otitis media
Post strep glomerulonephritis
Vaccines at 8 weeks
6 in 1 (diptheria/tetanus/hepB/Hib/polio/pertussis)
MenB
Oral rotavirus
Vaccines at 12 weeks
6 in 1 (diptheria/tetanus/Hib/HepB/pertussis/polio)
Pneumococcal
Oral rotavirus
Vaccines at 16 weeks
6 in 1
MenB
1 year vaccines
MMR
Men B
Pneumococcal
2 in 1 (Hib, menC)
3yrs 4mnths
4 in 1 (diptheria tetanus pertussis polio)
MMR
Yearly vaccine 2-8
Nasal flu
12-13yrs
HPV x2
14yrs vaccine
3 in 1 (tetanus, diptheria, polio)
Men ACWY
Infective mononucleolis
EBV
Fever sore throat fatigue
Lymphadenopathy splenomegaly tonsillar enlargement
Investigations
Monospot (6weeks to develop)
IgM early
IgG immunity
2-3 weeks recovery avoid alcohol and contact sports
Complications
Chronic fatigue
Haemolytic anaemia
Thrombocytopenia
Splenic rupture
Glomerulonephritis
Mumps
Resp droplet spread
Prodrome
Parotid gland swelling
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
PCR and antibody
Notifiable
Supportive
Encephalitis
Usually HSV 1/2 or VZV
Empirical acicckovir
What prevents HIE?
Therapeutic hypothermia
Caput succedaneum
Crosses sutures
Neonatal sepsis
Group B strep
E. coli
Listeria
Klebsiella
Staph aureus
RFs PROM, maternal infection, GBS previous baby, prematurity
Benzylpeniccilin and gentamicin
CRP at 24hrs
Blood cultures at 36 hrs
If CRP<10 and blood cultures negative then stop
Issues of prematurity
IVH
ROP
feeding difficulties
RDS/apnoeas
Bradycardia
Hypoglycaemia
Hypothermia
Increased infections
Necrotising enterocolitis
Jaundice
RDS
<32 weeks
CXR ground glass appearance
Endotracheal surfactant to manage
Dex to prevent
Necrotising enterocolitis
RFs
Prematurity
Formula fed
Sepsis
PDA
RDS/ventilation
Intolerance to feeds. Bilious vomiting. Blood in stools. Distended tender abdo. Absent BS.
I
FBC (decreased plt and neutropenia)
Cap gas metabolic acidosis
CRP
Blood culture
AXR- distended loops PNEUMATOSIS INTESTINALIS - gas in bowel wall
M
TPN
IV fluids and NG drain
Surgery
Kawasaki disease
5 day >39°
Widespread maculopapular rash
Desquamation hands and soles
Strawberry tongue
Crusted lips
Bilateral conjunctivitis
Cervical lymphadenopathy
I
FBC- increased WCC and plt, decreased Hb
LFTs- increased enzymes, decreased albumin
ESR
Urinalysis increased WCC
ECHO
2-4 weeks is subacute phase with risk of coronary artery aneurysms
High dose aspirin
IV iG
What syndrome can cause regression of developmental milestones?
Retts syndrome
(X linked
Rheumatic fever
2-4 weeks autoimmune post-strep
Type II hypersensitivity
Diagnosis: 2 major or one major and 2 minor
Major JONES
J- joint migratory polyarthritis
O- organ inflammation (carditis/SOB)
N- subcutaneous Nodules
E- Erythema marginatum
S-syndenham chorea
Minor FEAR
F-fever
E- ECG changes
A- arthralgia
R- raised CRP/ESR
M
PENV
aspirin and steroids for carditis
NSAIDs
Prophylactic antibiotics forever to prevent recurrence
Complications
Recurrence
Mitral stenosis
Chronic heart failure
Juvenile idiopathic arthritis
Autoimmune inflammation for over 6 weeks in under 16yo with no other cause
- Still’s disease
-high swinging fevers
-salmon pink rash
-pleuritic/pericarditis
-splenomegaly
-lymphadenopathy
Macrophage activation syndrome - DIC - Polyarticular >5jts
-mild fever anaemia - Olgioarticular <4jts , girls <6yo
-ANA +ve
-anterior uveitis - Ethesitis-related
Male >6yo
Anterior uveitis
IBD - Juvenile psoriatic arthritis
Measles
Infective until 4 days after rash
Prodrome: conjunctivitis, fever, coryzal
Koplik spots
Behind ears maculopapular rash spreading with desquamation of palms and soles
Complications
Otitis media
Pneumonia
Encephalitis
SSPE
Rubella
Stay off school 5 days
Mild fever
Sore throat
Jt pain
Lymphadenopathy
Erythematous macular rash spreading from face
C
Thrombocytopenia
Encephalitis
Parvovirus B19
Prodrome of mild fever, coryza, aches
Slapped cheeks reticular rash raised and itchy (non infectious)
C
Aplastic anaemia
Encephalitis
Myocarditis
Hepatitis
Nephritis
Hydrops fetalis
Roseola infantum
HHV6
Go to school!!!
High fever suddenly 3-5 days then disappears
Coryza/sore throat/ lymphadenopathy
Nagayama spots on soft palate (red)
Then mild eryethamtous non itchy rash
C
Febrile convulsions
Hepatitis
Meningitis
Chicken pox
VZV
Droplet spread / direct contact
Fever first!
Vesicular lesions on trunk and face spreading out
(Non contagious once they scab)
Complications
Bacterial superinfection
Pneumonia
Encephalitis
Conjunctival lesions
Shingles/Ramsay hunt syndrome
ACICLOVIR if immunocompromised, >14yo presenting in 24hrs, neonates, risk of complications
OFF SCHOOL UNTIL 5 DAYS AFTER RASH
Hand foot mouth
Coxsackie A
URTI— mouth ulcers — blistering red spots on hands feet mouth
Fluid and analgesia
Pityriasis rosea
Young adults
HHV6/7
Prodrome
Rash herald patch to Christmas tree pattern faint pink itchy
3mnths resolve
When to scan for UTI??
If atypical then do MCUG, DMSA, USS during illness…
-non E. coli UTI
-not responding to abx in 48hrs
-bladder mass
-poor stream
-septicaemia
/seriously I’ll
-increased Cr
Recurrent UTIs MCUG, DMSA, USS 6 weeks after
-UTI leading to 2 pyelonephritis
-UTI leading to 3 Cystitis
-UTI leading to 1 cystitis and 1 pyelo
