Paeds Flashcards
Measles
Epidemiology
Epidemics in winter/spring
Aetiology
Paramyxoviridae virus. Incubation 7-21d.
Clinical Features
Maculopapular rash, initially behind ears spreading to entire body over 3-4 days. Koplik spots - white spots in gum.
Investigations
IgM Measles
Management
Notify Public Health
Avoid school until 5d after the appearance of rash
Supportive unless persisting >1 week
Rubella (German Measles)
Epidemiology
Rare - 3 annually due to vaccination.
Aetiology
RNA Togavirus
Intubation of 2 weeks
Infectivity 7d before and after rash onset
Clinical Features
Pink macular rash starting on face spreading to feet
Suboccipital and postauricular lymphadenopathy
Forschheimer spots (pin-point red macules and petechiae)
Investigations
IgG and IgM assays
Management
Notify Public Health
Self-limiting
Avoid school for at least 5 days from rash onset
Avoid pregnant women due to risk of congenital rubella syndrome
Women should avoid pregnancy until 3 months after immunisation
Chickenpox
Epidemiology
Aetiology
VZV.
Clinical Features
Persistent fever for 2d then rash develops. Macular - Papular - Vesicular then Scabs.
Management
5 day exclusion from the onset of rash.
Henoch Scholein Purpura (HSP)
Epidemiology
Aetiology
Clinical Features
Management
Hand, foot and mouth disease
Epidemiology
Aetiology
Cocksackie virus
Clinical Features
Vesicles on mouth, palms and soles of feet
Management
No school exclusion necessary unless child is unwell
Mumps
Epidemiology
Aetiology
Clinical Features
Painful parotid gland
Fever, headache and loss of appetite
Management
Self-limiting
Scarlet Fever
Epidemiology
Aetiology
Strep. Pyogenes
Exotoxin-mediated by Group A beta-haemolytic streptococci (GABHS) Incubation 2-5d.
Clinical Features
Begins with sore throat, headache, fever and tender cervical lymphadenopathy
Confluent pink sandpaper-like rash
‘Strawberry’ tongue
Management
Notify Public Health
Antibiotics (Penicillin V, Erythromycin or Cephalosporin) 10d
Avoid school for ?24 hours from starting antibiotics
Kawasaki Disease
Epidemiology
Aetiology
Clinical Features
Management
Scarlett Fever vs. Kawasaki Disease
Moluscum Contagiosum
Epidemiology
Aetiology
Molluscum contagiosum virus
Spread via direct contact or towels/bedsheets
Clinical Features
Dome-shaped lesions with central indentation. Sometimes umbilicated.
Appear in ‘crops’
Common on the face, neck, axilla and thighs.
Management
Self-limiting
If bacterial superinfection: topical fusidic acid or oral flucloxacillin.
Salmon Patch
Epidemiology
Commonest birthmark
Aetiology
Clinical Features
Commonly found on forehead, eyelids or neck. Flat pink/red birthmark.
Management
Fades after a few months of life.
Seborrheic Dermatitis
Epidemiology
aka ‘Cradle Cap’
Aetiology
Develops in the first few weeks of life.
Clinical Features
Erythematous rash with yellow scales/flakes.
Management
Erythema Marginatum
Epidemiology
Aetiology
Rheumatic fever
S.pyogenes infection 2-6 weeks prior
Clinical Features
‘Rings’
Solid erythema - round with pale-pink centre
Features of Rheumatic fever (Jones Criteria):
Polyarthritis
Carditis
Syndenham chorea
Management
Capillary Malformation
Epidemiology
Aetiology
Clinical Features
Dark red or purple flat birthmark. Increases in size during puberty, pregnancy or menopause.
Common on the face, chest or back.
Management
Erythema Infectiosum (fifth disease)
Epidemiology
Aetiology
Parvovirus B19
Incubation 4-14d
Infectivity at exposure lasting until symptoms appear
Clinical Features
Early stages with fever and non-specific symptoms
‘Slapped cheek’ rash appearance (4d duration)
Confluent, erythematous, oedematous rash with patches or plaques on cheeks, with sparing of nasal bridge and periorbital areas
Followed by a maculopapular rash to the trunk and limbs
‘Lacy’ appearance as it begins to fade
Management
Self-limiting - symptomatic treatment
Transfusion if aplastic crisis
IVIG if Immunocomprimised
Pregnant women: serological testing and obstetric follow-up.
Impetigo
Epidemiology
Aetiology
S.aureus and S.pyogenes.
Clinical Features
Red sores around mouth/nose. Honey-crusted lesions.
Management
Avoid school until lesions are dry and crusted OR 48 hoiurs after beginning antibiotics.
Candida Dermatitis
Epidemiology
Aetiology
Clinical Features
Erythematous rash involving the flexures
Satellite lesions
Management
Infantile Haemangioma
Epidemiology
Aetiology
Clinical Features
Red, raised birthmark anywhere on the body. Red, raised birthmark anywhere on the body.
Management
Shrinks and disappears by the age of 7.
Scabies
Epidemiology
Aetiology
Sarcopete scabiei
Clinical Features
Linear Burrows. Between interdigital spaces and flexor aspects of wrists. Widespread pruritus.
Management
Roseola Infantum
Epidemiology
Aetiology
HHV-6/7
Clinical Features
1-2 weeks after sudden high fever (3-5d duration)
Mild erythematous macular rash across the arms, legs, trunk and face
Non-puritic
Management
Self-limiting, recovery in 1 week
Erythema Multiforme
Epidemiology
Aetiology
Hypersensitivity reaction to viral infection or medication
HSV (coldsores) and Mycoplasma Pneumonia
Clinical Features
Widespread itchy, erythematous rash
‘Target’ lesions
Stomatitis (sore mouth)
Investigations
CXR
Management
Supportive
Meningococcal Rash
Epidemiology
Aetiology
Clinical Features
Non-blanching petechia or purpura
Investigations
Blood cultures and PCR
LP contraindicated in meningococcal septicaemia
Management
Community: IM/IV Benzylpenicillin
Hospital:
Dosage:
Children younger than 1 year of age — 300 mg.
Children 1–9 years of age — 600 mg.
Adults and children 10 years of age or older — 1200 mg.
NB: A history of a rash following penicillin is not a contraindication to treatment with Penicillin.
Gianotti-Crosti syndrome
Epidemiology
Peak incidence between 1 and 6 years of age
Aetiology
Gianotti-Crosti syndrome is a papular acrodermatitis. It is a self-limiting illness associated with a range of viruses and bacteria
Clinical Features
Low-grade fever
Diarrhoea
Tonsillitis
Lymphadenopathy
Investigations
Investigations of Gianotti-Crosti syndrome are rarely indicated unless there is diagnostic uncertainty or presence of physical findings, e.g. hepatomegaly.
Management
Further management of Gianotti-Crosti patients is rarely indicated unless there is diagnostic uncertainty or atypical presentation. Under these circumstances, follow-up is indicated.
Antihistamines may be needed with some patients for treatment of pruritus.
Umbilical Hernia
Umbilical hernia are relatively common in children and may be found during the newborn exam. Usually no treatment is required as they typically resolve by 3 years of age
Associations
Afro-Caribbean infants
Down’s syndrome
mucopolysaccharide storage diseases
Cow’s Milk Protein Allergy
Epidemiology
most common cause of food allergy in <1 yo children
Clinical Features
urticaria, angio-oedema, itching, cough, hoarseness, wheeze, breathlessness
Investigations
skin pricking test/ verbal consultation/nutritional status or comorbid atopic conditions consultation
Management
A&E transfer if sympoms persistent
allergy specialist referal if IgE-mediated suspected
allergy specialist referal consideration if faltering growth/significant atopic eczema w/ multiple food allergies
cow’s milk-free diet for mom for 2-4w if non-IgE-mediated allergy suspected
cow’s milk-free diet for mom for 6mo until child reaches 9-12mo if non-IgE-mediated allergy confirmed
Developmental Milestones
Gross Motor
Developmental Milestones: Vision/Motor
Developmental Milestones: Hearing/Speech/Language
Developmental Milestones: Social
Developmental Delay
Delayed Puberty
Epidemiology
boys: no testicular development by 14yo
girls: no breast development by 13yo or breast developoment but no period by 15yo
Aetiology
genetic ( more prevalent in boys) / underlying cause
Investigations
hand x-ray (likely adult height)
ultrasound/ MRI scan (glan/organ issues)
Management
treating underlying cause/ medication to increase
Condition
Epidemiology
Aetiology
Clinical Features
Investigations
Management
