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Paediatrics > Neurology, Renal, Dermatology > Flashcards

Neurology, Renal, Dermatology Flashcards

1
Q

Cerebral Palsy Definition

A

Non-progressive insult to the brain between Conception-3 years

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2
Q

Classification of Cerebral Palsy

A

Spastic- Hypertonia and abnormal reflexes (+/-Dyskinetic- Abnormal involuntary movement)

Ataxic- Loss of coordination and balance (Abnormal force, Rhythm and accuracy)

Athetoid- Jerky limbs, Hyperkinesia

OR… MIXED

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3
Q

Distribution pattern of Cerebral Palsy symptoms

A 
Paraplegia- Both lower limbs
Hemiplegia- One sided 
Diplegia- Corresponding parts of the body on both sides 
Quadriplegia- All 4 limbs 
Monoplegia- One limb
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4
Q

Circumduction gait vs Scissoring gait in Cerebral Palsy

A

Circumduction gait occurs in Hemiplegia

Scissoring gait occurs in Diplegia

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5
Q

Aetiology of Cerebral Palsy

A

80% because of in utero insult (TORCHES, Chr, Leukomalacia, IVH etc)

Perinatal- Birthy Asphyxia

Post-delivery- Brain injury, Meningitis etc

2/3rds unknown

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6
Q

Key Features of Cerebral Palsy

A

Movement and posture abnormalities

Delayed motor milestones- Sitting (>8/12), Walking (<18/12), Early asymmetry of hand preference (<1 yr)

Early on= Fidgety/Hypotonia/Stiff/Dystonia/Late head control

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7
Q

Associated features of Cerebral Palsy

A 
Learning Disability IQ<70
Epilepsy 
Comm difficulties
Behavioural difficulties E.G. ADHD
Visual and Hearing impairment 
Constipation/Vomiting/GORD/Incontinence/Recurrent UTIs
Pain and sleep disturbance 
FTT B/C eating problems
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8
Q

MDT approach to managing Cerebral Palsy

A 
Developmental Assessment 
Anticonvulsants
Anti-spasticity drugs
Ortho/surgical involvement ?Dorsal Rhizotomy 
Physio/Occupational Therapist
Speech and Language therapist
Education= Special Needs Teaching
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9
Q

Complications of Cerebral Palsy

A 
Contractures
Feeding difficulties... Malnutrition 
Drooling, Dressing problems, sleep problems
Scoliosis, Hip dislocation
Epilepsy
Recurrent Resp infections
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10
Q

Epidemiology of Febrile Fit

A

6 months to 6 years
Commonest seizure disorder of childhood
Potentiated by a rapid increase in temperature induced by a likely viral infection

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11
Q

Presentation of a Simple Febrile Fit

A 
< 15 mins 
Fever >38
Generalised Seizure- Tonic-Clonic- STIFF THEN SHAKE 
Complete recovery within 1 hr 
No recurrence within 24 hours
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12
Q

Presentation of Complex Febrile Fit

A

15-30 minutes (+ Fever)
Focal or Aura
+/- Repeated seizures within 24 hours
Not always rousable for >1 hour after

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13
Q

Febrile Status Epilepticus

A

Febrile seizure lasting >30 minutes

NOTE YOU TREAT IT AFTER 5 MINUTES

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14
Q

Managing Febrile Fits

A

A to E Assessment
Admit for 6 hour monitoring if 1st episode
Rule out meningitis

> 5 mins= IV Lorazepam 0.1mg/kg
(Alt= Buccal Midazolam/Rectal Diazepam 0.5 mg/kg)

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15
Q

Advice to parents for a child with febrile fits

A

Reassure
During another fit- Time, Do not restrain
> 5 mins= Ambulance <5 mins= GP appointment

Antipyretics won’t prevent but can give if child is unwell
Keep Hydrated

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16
Q

Prognosis and Epilepsy risk in febrile fits

A

30% Recurrence risk during another febrile episode

Epilepsy risk 1-2/100 in general population, Febrile fit increases it to 1/50

Elevated risk if (1/20):
1- Neuro abnormalities/Developmental delay
2- FHx of Epilepsy
3- Complex febrile seizure

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17
Q

Concerning recovery time after a febrile fit

A

> 30 minutes

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18
Q

Blue Breath Holding attacks

A

Cries- Goes silent- Breath held on expiration- Cannot inhale- Blue & LoC for < 1 min- Collapses- Floppy or stiff

+/- Post-ictal tiredness

6 months- 6 years

Provoked by temper/frustration

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19
Q

Explaining Blue Breath Holding Attacks to parents

A

Involuntary, not dangerous, no brain damage
Not a sign of poor parenting
Improves with age
Can use a pacemaker if very severe

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20
Q

Reflex Anoxic Seizures

A

6 months to 3 years

Pain or fear induces transient involuntary bradycardia

Opens mouth, pale, LoC, +/- Tonic-Clonic seizure

Likely to grow out of it

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21
Q

Action to take after a Breath Holding Attack or Reflex Anoxic Seizure

A

Take them to the GP- ECG, Bloods

Stay calm, if happens again lie them on their side, don;t make a fuss

If severity or frequency is increasing or stiffness/shaking >1 min then take back to GP

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22
Q

Key Diangostic Criteria for Breath Holding Attacks/Reflec Anoxic Seizure

A

Onset with crying or breath holding
No post-ictal phase only some minor tiredness
No associated behavioural problems
Quick Recovery

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23
Q

Key investigations to do after a seizure

A

BP. BM, ECG, Urine toxicology

Vital signs

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24
Q

Generalised Tonic-Clonic Epilepsy Symptoms

A

Tonic phase- Sudden LoC, Extend limbs, Back arhces, Teeth Clench, Breathing stops, Bitten tongue, eyes roll back

Clonic phase- Intermittent jerking,Irregular breathing +/- Urination and salivation

~15 mins post-ictal drowsiness/tiredness

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25
Q

Absence Seizures

A

Fleeting 5-20s impairment of consciousness
/Daydreaming/Staring

4-8 years

10-15 times a day with a quick recovery and no involuntary movement

EEG shows 3 per second spike and wave

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26
Q

Treatment for absence seizures

A

Sodium Valproate or Ethosuximide

NOT CBZ

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27
Q

Infantile Spasms/West’s syndrome presentation

A

4-6 months
Generalised myoclonic seizure- Symmetrical flexion spasms then arms extend
Lasts seconds in clusters
Hypsarrhythmia on EEG

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28
Q

Prognosis of West’s syndrome

A

Poor

Associated with developmental delay and brain disease

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29
Q

Treatment of West’s syndrome

A

Steroids and Vigabatrin

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30
Q

Actions following 1st seizure in ? Epilepsy

A

EEG +/- MRI

Then start antiepileptics following 2nd seizure

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31
Q

Management of Epilepsy

A

Only start after 2nd seizure

Generalised= Sodium Valproate (?Lamotrigine)
Partia= CBZ then Valproate

Advice: Don’t lock bathrooms, helmet when on bike, tell lifeguards, 1 yr free before driving

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32
Q

Managing an Acute Seizure/Status Epilepticus

A

Recovery position
Oxygen and suction (Remember to check glucose)

1) MAX 2 BZD doses= Iv Loraz 0.1mg/kg or Buccal mid 0.5mg/kg
2) Phenytoin (takes 15 mins to prepare) or phenobarbital
3) RSI- Thipentone from anaesthetist + Observation

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33
Q

Complex Partial Epilepsy

A 
Impaired consciousness 
Usually Isolated unilateral jerking 
Strange sensations 
Chewing/Sucking 
Post-ictal phase
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34
Q

Myoclonic epilepsy

A

Shock like jerks that cause sudden falls can be early morning
More common if known neurological disability
Increased by alcohol and sleep deprivation

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35
Q

Causes of syncope in children

A

Vasovagal
Long QT syndrome
Daydreamng, self gratification
Dissociative seizures in Teenagers (PSYCH)

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36
Q

Headache red flags

A 
Worse on lying 
Systemic symptoms- Vomiting, HTN, Papilloedema 
Focal neurology- Visual, Motor 
Increased head circumference 
Developmental regression
Personality change 
Photo/Phonophobia
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37
Q

Diagnostic criteria for tension headache

A

10+ episodes
No N&V and No Photophobia/Phonophobia
Lasts 30 mins- 7 days
Band like non-pulsating bilateral pain

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38
Q

Number one cause of primary headache in children

A

Migraine without aura

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39
Q

Diagnostic criteria for migraine without aura

A

> /= 5 attacks lasting 2-72 hours
2 of: Inhibits activity/Throbbing/Worsened by activity
1 of: N+V/Photophobia/Phonophobia

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40
Q

Management of migraine without aura

A

1) NSAIDS
2) Nasal Triptans if >12
3) Propanolol or Pizotifen

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41
Q

Diagnostic criteria for migraine with aura

A

2 attacks with at least 3 of:

Headache onset <60mins post aura
One or more fully reversible aura symptoms
>1 aura symptom develops over >4 mins

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42
Q

Examples of aura symptoms

A

Changes in the following domains:

Visual/Motor/Sensory/Speech/Language/Cognitive impairment/LoC/Vertigo/Ophthalmoparesis

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43
Q

What features would make a headache likely secondary to raised ICP

A 
Worse on morning and lying 
Vomiting 
Papilloedema 
Focal Neurology- Weakness, visual, motor 
Cushing's reflex- HTN and low HR/RR
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44
Q

Analgesia headache

A

High NSAIDs use in teenagers

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45
Q

Important history points when a child presents with head injury

A

Event details
Condition Before vs After (crying? LoC? Vomiting? Dizzy? Headache?)
History of fits? Bleeding disorder? Diabetic?

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46
Q

Indications for an immediate CT following head injury

A 
LoC or Amnesia lasting > 5 mins 
> 2 discrete episodes of vomiting 
Post-traumatic seizure with no Hx of epilepsy 
Abnormally drowsy 
GCS<14
? Open or depressed Skull injury 
Basal skull fracture- Otto/Rhinorrhoea, Panda eyes, Battle's 
Focal neurology 
Dangerous mechanism
Swelling/Bruising > 5cm if < 1 yr
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47
Q

What cases of head injury would you admit for observation?

A

Continuing signs and symptoms
Skull fracture
Serious trauma as indicated by mechanism

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48
Q

Advice for parents if discharging a child with head injury

A

Supervision
Rest, Avoid computer games, Plenty of fluids, Avoid noise/stress, pain relief

Safety netting: Headache worsens, vomiting, seizures, Alertness decreases, Visual changes, Walking changes, Weakness

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49
Q

Causes of obstructive hydrocephalus

A

Aqueduct stenosis
Posterior fossa tumour
Other tumours

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50
Q

Causes of Non-obstructive hydrocephalus

A

Meningitis
SAH
IVH

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51
Q

Diagnosis of hydrocephalus

A

CT/MRI

LP may be done for diagnostic and therapeutic purposes only in non-obstructive causes

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52
Q

Presentation of hydrocephalus

A

Older children= Headache, N&V, Papilloedema
Babies= Developmental delay, increased head circumference especially if sutures haven’t fused
Macrocephaly and bulging fontanelle
Sunsetting of the eyes

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53
Q

Management of hydrocephalus

A

Neurosurgical referral

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54
Q

Food/Drinks to avoid in migraine

A

Cheese, Chocolate, Citrus Fruit, Nuts, Caffeine

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55
Q

Plaigocephaly

A

Flat spot on the top or side of the head
Caused by remaining supine for too long or a lack of amniotic fluid in the womb
No impact on the brain!

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56
Q

Management of Plaigocephaly

A

Tummy time and sleep pattern change
Alter positioning of the toys
Alleviate head pressure when in car seat etc
Majority improve as child grows because they adopt a more upright position

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57
Q

What increases tics?

What are risk factors?

A

Stress
Excitement
Boredom
Tiredness

Smoking, FHx and being male increases risk

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58
Q

What decreases tics?

A

Concentration, Exercise, Distraction, Sleep

59
Q

Tourette’s syndrome diagnosis

A

Both motor and 1+ vocal tics
Many times a day, Most days, >1 year
No 3 month tic free period

Isolated Vocal or Motor tics is NOT Tourette’s but a chronic (>1 year) tic disorder, can also be transient (<1 year)

60
Q

Management of Tics/Tourette’s

A

Do not punish child for tics and do not try to stop them doing it
Try to ignore the tics and just reassure the child
Try to educate other children at school etc
Screen for co-morbid mental health problems
If they interfere with functioning then ?Baclofen/Anti-epileptics/Alpha Adrenergic Agonists

61
Q

Genetics of muscular dystrophy

A

X-linked recessive disorder
Deletion of dystrophin gene leads to myofibre necrosis
DMD worse than BMD

62
Q

DMD vs BMD

A

DMD onset ~5 years and loss of ambulation by 10-14 yrs, LE early 20s

BMD onset ~11 years and loss of ambulation by late 20s, LE middle/old age

63
Q

Presentation of DMD/BMD

A 
Gower's sign- turn prone to rise then crawl up own legs with arms
Difficulty walking 
Clumsy 
Waddling gait 
Toe walking 
Incontinence 
Delayed motor milestones 
Enlarged calves because of fatty infiltration 
Intellectual disability (30%)
64
Q

Key blood test that could indicate DMD/BMD

A

Raised CK

Especially if done in boys not walking by 18/12

65
Q

Management of DMD/BDM

A 
Ventilator support in DMD by ~25 years
Overnight CPAP or NI-PAP to alleviate nocturnal hypoxia 
Physiotherapy
Surgery 
Corticosteroids if ambulant?
66
Q

Different forms of Spina Bifida

A

Myelomeningocele (Most common)
Spina Bifida Occulta
Meningocele

67
Q

Myelomeningocele

A

Spinal cord and meninges exposed - Most severe and most common form
Visible overlying sac

68
Q

Spina Bifida Occulta

A 
Minor defects in lumbar vertebrae
No visible overlying sac 
Naevus/Lipoma/Hair at location 
Bone fails to develop over spinal cord but skin does 
Can be clinically insignificant
69
Q

Presentation of spina bifida

A 
Swelling over the spine at any level 
Exposed spinal cord
Paralysis below lesion 
Sudden death 
HYDROCEPHALUS- Rapid head growth and bulging fontanelle 
Urinary and faecal Incontinence
70
Q

What maternal test can detect most spina bifida

A

Maternal serum alpha-fetoproteins

71
Q

Managment of spina bifida

A

Surgery- High risk
Conservative- Poor life expectancy
5mg folic acid up to 12 weeks in future pregnancies

72
Q

Classifications of Enuresis

A

Primary- Nocturnal or Diurnal

Secondary (Previously been dry for 6/12)

73
Q

When do children reach day/night continence?

When should you refer/intervene?

A

3/4 years= majority

5+ then refer ?Intervene

74
Q

Causes of primary enuresis

A 
Decreased bladder awareness 
Stress
UTI/DM/Renal pathology 
Decreased ADH production 
Psych problems
75
Q

Investigations for enuresis

A

DM- random and fasting blood glucose
Urinalysis if symptoms or recent onset
GU tract screening?

76
Q

Management of enuresis

A

5-7 years= Advice + Alarm

  • No drinking 90 mins before bed, avoid caffeine/fizzy drinks, treat constipation
  • Reinforcing behaviour chart (dont punish)
  • Alarm sounds when wet but takes weeks-months

7+
Desmopressin- Lasts 8 hours, short term assess 4/52 and continue 3/12

77
Q

Causes of UTI

A

Infection (90% E.Coli)

Obstruction, VUR, Poor habits, Constipation, Neuropathic bladder

78
Q

Vesico-ureteric reflex

A

Ureters at a perpendicular angle to bladder
Increased UTI risk
Hydronephrosis

MCUS to Dx

79
Q

Methods of collecting urine in UTI

A

Clean catch if possible

Catching bag, sterile pad, catheter, suprapubic stab

80
Q

Interpretation of urinalysis in ?UTI

A

+ve leuko and +ve nitrates= likely UTI
If one +ve and one -ve then send off for culture and treat as a UTI
-ve nitrates make UTI less likely but does not rule it out

81
Q

MC&S in UTI

A

Microscopy, culture and sensitivity

10^5 colony forming units/ml of single organism

82
Q

Definition of recurrent UTIs

A

> /= 2 + symptoms

> /=3 + No symptoms

83
Q

Guidelines on imaging in UTI

A

< 6 months= Always do USS (Usually 6 weeks after)
<6 months + atypical= USS, DMSA, MCUS

> 3 yrs= USS if atypical

<3 years >6 months= DMSA/USS if atypical

84
Q

DMSA

A

Dimercapto Succinic Acid

IV Isotope injected and taken up by kidneys to assess renal scarring

85
Q

MCUS

A

Micturating cysto-urethrography
Contrast dye injected through catheter
Assesses whether it refluxes e.g VUR

86
Q

Features in a UTI which would suggest atypical and require imaging

A

Frequent UTIs
Nil response to treatment within 46 hours
Non-E.coli (Psuedomonas= ?Tract abnormality)
Poor flow, Mass, Deranged U&Es
Systemically unwell

87
Q

UTI history in an infant

A

Non-specific

Fever, fits, septic
Irritable
Lethargic
Vomiting 
Poor feeding 
FTT
\+/- Jaundice
88
Q

Management of UTI in <3 months

A

Admission

IV Cefotaxime or Gent

89
Q

Management of Pyelonephritis

A

Admit

IV Cefuroxime 2-4/7 then 10/7 oral abx like Co-Amox

90
Q

Management of UTI without prophylaxis

A

3 days oral Trime/Nitro/Ceph/Amox
Good hygiene
Fluids
Prompt toileting

91
Q

VUR management

A

Prophylactic Abx

Surgical correction

92
Q

Causes of Hamaturia

A 
Post-strep Glomerulonephritis 
Polycystic Kidneys
Renal stone 
Renal tumour 
UTI
Sickle cell disease
HSP 
Rifampicin
93
Q

Investigating haematuria

A

Urine MC+S
Bloods
Urinalysis of parents to ?Hereditary cause
US tract
No resolution in 6/12 then referral to nephrology

94
Q

Haematuria in the presence of what would indicate a likely more serious cause?

A

Proteinuria

Impaired function

95
Q

HUS triad

A

Microangiopathic Haemolytic anaemia (LOW HB)
Acute kidney Failure (Uraemia)
Thrombocytopenia (LOW PLATELETS)

96
Q

HUS causes

A 
Post-dysentry (E.COLI 0157 or Shigella)
Pregnancy
Tumours
HIV 
Lupus 
Chemotherapy/Ciclosporin
97
Q

FBC in HUS

A

Anaemia
Thrombocytopenia
Fragmented blood film

98
Q

Investigations in HUS

A

FBC, U&Es, Stool culture

99
Q

HUS presenting symptoms

A

Bloody diarrhoea
Abdo pain and N&V
No fever
Painless rash

100
Q

How do you safety net bloody diarrhoea for HUS?

A

Check for painless rash and oliguria

101
Q

Management of HUS

A

Fluids, Blood transfusion, ?Dialysis
Monitor electrolytres
No role for Abx

Plasma exchange?

102
Q

Complications of HUS

A

Encephalopathy

Renal failure

103
Q

Diagnostic features of Nephrotic syndrome

A

Proteinuria >1g/m^2 per 24 hours
Hypoalbuminaemia <25g/l
Oedema

THINK PROTEIN LOSS AND OEDEMA

104
Q

Most common cause of Nephrotic syndrome

A

Minimal change glomerulonephritis

105
Q

Presentation of Nephrotic syndrome

A

2-5 years old

Puffy face and limb oedema 
Ascites and pleural effusion as hypoalbuminaemia 
Frothy urine 
Look unwell
Recent UTI or UTI symptoms
106
Q

Investigations and results in Nephrotic syndrome

A

Urine dip- Albumin +ve, Protein +ve, Hyaline Casts and NO BLOOD

FBC/U&Es- Albumin <25g/L, Inc cholesterol and triglycerides

107
Q

Management of Nephrotic syndrome

A 
Admit 
6 weeks corticosteroids (high dose)
Low sodium diet
Fluid restrict 
Diuretics 
Prophylactic penicillin until proteinuria cleared
108
Q

Fluids in Nephrotic syndrome

A

RESTRICT

Give diuretics to remove!`

109
Q

NAPHROTIC Mnemonic in nephrotic syndrome

A 
Na- LOW
Albumin- Low
Proteinuria >3.5g/day
Hyperlipidaemia/HTN
Renal vein thrombosis 
Orbital oedema 
Thromboembolism 
Infection B/c Ig loss
Coagulability B/c Antithrombin 3 loss
110
Q

3 key features of Nepritic syndrome

A

Haematuria
Oliguria
HTN

111
Q

Key presenting features of Glomerulonephritis

A

Haematuria- 1-2/52 Post-throat infection
or 3-6/52 post-skin infection

Malaise, Oedema, Loin pain, Headache
Oliguria

112
Q

Glomerulonephritis on urinalysis

A

Gross haematuria
Granular and red cell casts
Often proteinuria

113
Q

Management of glomerulonephritis

A

Admission for fluid balance
Treat hyperkalaemia, acidosis and HTN

10 days penicillin

114
Q

Features of Hypospadias

A 
Ventral urethral meatus 
Bend in penis 
Foreskin doesn't wrap all the way around therefore only the top half is covered
Inc UTI risk and sexual dysfunction 
Difficult to urinate when standing
115
Q

Management of hypospadias

A

Surgery < 2 years old

Essential that they aren’t circumcised before this procedure as foreskin is used in reconstruction

116
Q

Vulvovaginitis features

A

Most common between 3-10 years
irritated by heat and humidity
Itching, redness, soreness, yellow/green discharge +/- offensive

117
Q

Cause of vulvovaginitis

A

Bacteria from Gut/Bowel/Nose/Mouth get into VV area

118
Q

Management of vulvovaginitis

A

Wash in bath- no shampoo, soap, sanitary wear etc
Wipe front to back
Non-soap cleanser
No spermicidally lubricated condoms

+/- Emollients +/- Topical antihistamine
+/- Low dose corticosteroids

119
Q

What precipitates eczema flare ups

A 
Dry skin
Irrritants 
Infection 
Sweating
Heat
Emotional stress
Allergies
120
Q

Different location of eczema rash by age

A

Infants- Cheeks, Trunk
Childhood- Flexural, wrists, ankle
Adolescents- Flexural, H&N, Nipples, Palms/Soles

121
Q

Describe the rash in eczema

A

Intensely itchy, red, dry, scaly and thick

Can weep if infected

122
Q

Common causes of secondary infection in eczema

A

Staph

Herpes Zoster

123
Q

Emollient and steroid advice regarding use in eczema

A 
Emolient: Steroid= 10:1
Apply emollient 30mins before steroid 
Oil based emolients better for dry areas; water based better for wet 
"Apply until they shine"
Must apply emollients after bathing 
Use spoon if in tub
124
Q

General advice in eczema

A

Avoid soaps
Wet wraps can reduce scratching
Keep nails short
Sedative antihistamine use if >2 years to help with sleep

125
Q

Steroid ladder

A

Hydrocortisone
Betamethasone 0.025% -> 0.1%
Clobetasol propionate 0.1% is potent <50g week

126
Q

Advice on steroid use in eczema

A

Indicated in severe cases of eczema
1 finger tip= 2X palmar aspect of hand
Symptom improvement in 3-6 days
Keep use short term <3 months

127
Q

Side effects of topical steroids in eczema

A

Skin thinning, Depigmentation, Striae, Dermatitis, Acne, Telangectasia

Adrenal suppression, Cushing’s, decreased growth!

128
Q

Eczema herpeticum

A

Herpes on top of eczema
Sequela: Blindness and Encephalitis

Give IV Aciclovir +/- Flucloxicillin

129
Q

Impetigo classification

A

Bullous (Staph)

Non-bullous

130
Q

Causes and pathophysiology of impetigo

A

Highly contagious bacterial skin infection
Spread via direct contact with discharges from scabs
Increased risk if underlying skin condition

131
Q

Presentation of impetigo

A

Facial areas mainly
Sticky, honey coloured crusts
+/- Lympthadenopathy +/- Fever

132
Q

Management of impetigo

A

Exclusion until healed over/scabbed or Abx 48 hours
PO Macrolide like erythromycin (penicillin also good)
IF MRSA THEN MUPIROCIN
Bathe in cetrimide and fusidic acid cream
Don’t share towels and reduce face touching

133
Q

Staphylococcal scaled skin syndrome

A

Life threatening
tender Bullae that rupture easy and scale (Nikolsky +ve)
Accompanying erythema unlike in Bullous impetigo

134
Q

Different causes of nappy rash

A

Ammoniacal (Most common)
Candida
psoriatic
Seborrhoeic

135
Q

Differentiating between the different causes of nappy rash

A

Ammoniacal will spare skin folds
Candida is bright red and clearly demarcated with satellite lesions beyond border and worse in flexures
Seborrhoeic will have pink greasy lesions with a yellow scale

136
Q

Treating nappy rash

A

Ammoniacal- Wash and change regularly, expose to air, sudocrem to stop secondary infection
Candida- Topical imidazole
Seborrhoeic- Mild topical corticosteroids, Baby shampoo and oil will spont resolve in 8/12

137
Q

Presentation of SJS

A

Flu like symptoms progress to painful purple rash that spreads and blisters
Nikolsky’s sign positive- sloughing upon pressure
Target lesions
Blistering mucosae- eyes, oral, Genital (Polymorphic erythema)

138
Q

Erythema Nodosum

A

Inflammation of the subcutaneous fat
Tender erythematous nodular lesions >0.5cm usually on the skin of shins resolving over 3-6 weeks
Nodules are red
Accompanying GI, Occular or limb involvement

139
Q

Pathophysiology of scabies

A

Sarcoptes Scabei burrows into skin and lays eggs in stratus corneum

Delayed T4 HSN reaction ~30 days post-infection leading to pruritis

140
Q

Presentation of scabies

A 
Itchy papular rash with visible linear burrows 
Excoriations
Eczematisation 
Infection 
Urticaria
Impetigo
141
Q

Treatment of scabies

A

Treat whole household
Permethrin cream 5% 12 hour topic application all areas
or 24 hour malathion liquid 0.5%
Avoid close contact, wash bedding
Calamine lotion or antihistamines for itch
Weak corticosteroids if nodules

142
Q

When is phimosis normal

A

< 2 years

143
Q

Symptoms of phimosis

A

Itchy when physiological separation is occurring

Swelling when urinating although this helps separate the glans from the foreskin

144
Q

Balanitis xerotica obliterans

A

Splitting and scarring of the skin upon foreskin separation

Requires surgery

Paediatrics (6 decks)

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