Paeds Flashcards
1
Q
Diagnosing T1DM in a child
A
Fasting glucose >/= 7
*Random blood glucose >/= 11.1
HbA1c >/= 48
Extra: Blood pH to exclude DKA Diabetes antibodies U&Es Autoimmune screen
2
Q
1st presentation of T1DM1 management
Immediate
+
Long term
A
SAME DAY MDT paediatric diabetes team
Insluin ASAP
Admission for education + support
1) Insulin therapy: technique, dose adjustment
2) Nutritional: Complex carb high, <30% fat, 15-20% protein, refined sugar <25%
3) Monitoring of glucose: 4 x per day
Regualar management
- Avoid hypos
- Manage acute illness and avoid DKA
- Screen for micro and macrovascular complciations
Insulin need varies with age
Ongoing integrated package of care by MDT diabetes team
24 access to the team
Home-based care with support from local paediatric diabetes team
Initial inpatient management IF:
< 2 years
social/emotional factors
Home very far from hospital
Liase with school staff + education etc etc
Record details on Diabetes Register
3
Q
Hypoglycaemia signs + cut off
Treatment
A
<4 blood glucose
Symptoms:
Hungry, dizzy, tummyache, faint, wobbly, progression to coma and seizures
Frequent episodes equals losing awareness of symptoms
Treating hypo
Early: sugary drinks or glucose tablet. Buccal if child unco-operative
Severe: glucagon injection kit if reduced consciousness (IM)
Unconscious: hospital to treat with IV glucose
After treatment biscuit/sandwich to prevent drop again
4
Q
DKA management
A
Blood pH <7.3 + blood glucose >11.1, bicarb <15, capillary ketones >3mmol/l
A: Airway if coma. NGT if vom or coma
B: 100% oxgen face mask
C: Iv cannula, take bloods
- if shocked - 10ml/kg 0.9% saline bolus (Discuss more with consultant)
Diagnosis confirmation
Investigations: Blood glucose, Na, Cl, Ur, Cr, venous/cap blood gas
FLUIDS = requirement = deficit + maintenance
- Deficit 5% if ph>/= 7.1. 10% if <7.1.
- Maintenance if <10kg (2ml/kg/h), 10-40 (1ml/kg/h), more (fixed 40ml/hr)
FLUID = 0.9% NaCl (with 20 mmol/l KCl per 500ml)
Hourly rate = (10 x deficit/48) + maintenence/hour
BUT subtract boluses if >20ml/kg given before dividing
INSLUIN 1-2h after beginning IV fluid therapy
(dose 0.05-0.1 units/kg/hr)
Hourly monitoring: Cap glucose, fluid balance, GCS, vital signs
5
Q
DKA risk
A
Cerebral oedema
Hypokalaemia
Aspiration pneumonia
6
Q
T1DM follow up
A
4 x per year Regular dental Optician every 2 years Autoimmune screening Carry bracelet
7
Q
Hypothyroid congenital vs acquired presentation
A
Congenital Usually asymptomatic and picked up on screening – faltering growth – feeding problems – prolonged jaundice – prolonged jaundice – constipation along – horse cry – delayed development – constipation along – hoarse cry – Congenital abnormalities e.g. heart defects
Acquired
SHORT STATURE
Classic
Females more than males
8
Q
Why does neonatal hyperthyroidism occur
A
In infants of mothers with thyrotoxicosis from transplacental transfer of auntie TSH receptor antibodies – requires treatment as fatal but resolved with regression of maternal antibodies
9
Q
CAH diagnosis
Presentation
A
Diagnosis
- 17-a-hydroxyprogesterone elevated for classical deficiency in 21 alpha hydroxylase
- 11-deoxycortisol if beta hydroxylase deficiency
DO blood gase \+ U&Es Genetic analysis Urinary steroids Pelvic and adrenal US for ambiguous genetalia at birth
Presentation
- F: At birth, virilisation
- M: salt losing crisis in the 80% that are salt loser ~ 1-3 weeks old = vom, weight loss, hypotonia, FTT
- -> Hypotension, hyponatraemia, hyperkalaemia, metabolic acidosis
Later features = Precocious puberty + final height below expected
10
Q
Delayed puberty in female tests
A
Unlikely to be constitutional so do
- karyotyping
- TFTs
- Sex steroid hormones
- Consider eating disorder and pituitary pathology
11
Q
Precocious puberty girl ultrasound
A
Uterus goes from tubular to pear shaped and can identify endometrial lining near menarche
12
Q
Males causes of precocious puberty and how to differentiate
A
Differentiate based on testicular size
Bilateral enlargement (>l4m) = GDPP
Prepubertal testes = GIPP e.g. Adrenal tumour/CAH
Unilateral enlargement equals gonadal tumour
13
Q
Normal puberty males
A
First sign is testicular growth at around 12 years of age (range = 10-15 years)
testicular volume > 4 ml indicates onset of puberty
maximum height spurt at 14
14
Q
Normal puberty girls
A
first sign is breast development at around 11.5 years of age (range = 9-13 years)
Height spurt reaches its maximum early in puberty (at 12) , before menarche
Menarche at 13 (11-15)
Increase of only about 4% of height following menarche
15
Q
Precocious puberty males
A
Secondary sexual characteristics <9
16
Q
Precocious puberty causes (broadly)
A
- Gonadotrophin dependent (‘central’, ‘true’)
Due to premature activation of the hypothalamic-pituitary-gonadal axis
FSH & LH raised - Gonadotrophin independent (‘pseudo’, ‘false’)
due to excess sex hormones
FSH & LH low
17
Q
Thelarche
A
Premature breast development
Typically between six months to 2 years
Rarely be on stage three puberty
Non-progressive and self-limiting
18
Q
Adrenarche
A
Premature appearance of androgen dependent secondary sexual hair development acne and exhilarate odour
- Less than eight years in females
- Less than nine years in males
19
Q
Causes of HIE
Biochem picture
A
[1] fail of gas exchange across the placenta - abruption, uterine rupture, excess contactions
[2] Interruption of umbilical bloodflow - prolapse, compressionl
[3] Inadequate placental profusion perfusion - PET, HTN
[4] Compromised fetus - IUGR, anaemia
Hyperoxia hypercarbia metabolic acidosis
Due to cardiorespiratory depression
20
Q
Classification of H I E
How to diagnose
A
Mild: hyperventilation, hypertonia, Impaired feeding, responds excessively to stimulation
Moderate: movement abnormalities, hypotonic, cannot feed,? Seizures
Severe: no spontaneously response to pain, tone fluctuates, prolonged seizures, multi organ failure
Diagnosis needs
- Asses for intrapartum problen (e.g. CTG, prolapse)
– Resp depression at birth + need to resuscitate (Five minute Apgar <5)
– ACIDOSIS soon after birth (pH less than 7.0)
– Encephalopathy within 24 hours of birth
– Other causes of encephalopathy excluded
Management
- Resp suppor, AVOID HYPERTHERMIA (33-34 degrees best), fluid restrict, treat hypotension, monitor electrolytes and glucose, CFAM
Prognosis
- Mild - expect full recovery
- Moderate and feeding by 2 weeks = good prognosis
- Abnormalities persiting beyond 2 weeks = unlikely recovery
30% mortality if severe
21
Q
What is PVL
A
Periventricular white matter lesions - echogencity, cysts = diagnosis on cranial US or MRI
- Due to severe HIE, poor cerebral perfusion, ischaemia, inflammation
Risk factors Extreme prematurity Hypertension Severely ill Hypercarbia
Prognosis
CP - SPASTIC DIPLEGIA LIKELY
22
Q
Define with cause
Caput secuccedaneum
Cephalhaematoma
Chignon
A
Caput secuccedaneum
- Bruising and oedema of presenting part
- ACROSS SUTURE LINES
- above periosteum
- Resolves in a few days
Cephalhaematoma
- Haematoma from bleed below periosteum
- Condfined so doesn’t cross sutures
- Centre feels soft
- Resolves over several weeks
Chignon
- Oedema and brusing from Ventouse
23
Q
Respiratory distress syndrome
Risk factors
Cause
Presentation
Management
- Oxygen sats to aim for and why
A
Risk factors
- PREMATURITY
- Male
- C-section
- 2nd of premature twins
- Diabetic mum?
Cause
- Surfactant deficiency –> alveolar collapse + inadequate gas exchange
Presentation
- WITHIN 4h
- Tachypnoea >60, Recession, nasal flaring, expiratory grunting, cyanosis if severe
Management - Oxygen (21-30%) --> 91% to 95% <91% = NEC + DEATH risk >95% = ROP
May need surfactant therapy or additional resp support
24
Q
Prematurity pneumothorax causes
Symptoms
Diagnosis
Management
A
1) Premature (RDS)
2) Meconium aspiration
3) Pulmonary hypoplasia
4) Pneumonia
5) TTN
6) Mechanical ventilation
Clinical picture
- Reduced breath sounds and chest movement on affected side
Dx: Transillumination with fibre optic light
Management
- Chest drain if tension
- Otherwise resolves alone
- prevent with lowest pressure ventilaton
25
Causes of feeding difficulties/ weight loss >10% of newborn
Tongue... tell me more
Inexperienced mum
Tongue tie (ankyloglossia)
- M>F. Short lingual frenulum
- Symptoms - difficulty attaching/staying attached, unsettled, hungry all the time, clicking sound as they feed
- Management: nil if no feeding problems else tongue tie division (no anaesthetic if baby :O)
- Later if speech difficulties or feeding continues, same procedure but GA and stitches
26
```
Left subclavicular thrill
Continuous murmur
Bounding collapsing pulse
Wide pulse pressure
Heaving apex beat
```
Diagnosis
Risk factors
Management
Diagnosis
- PDA
Risk factors
- Congenital rubella
- Premature
- Born at high altitude
Echo to diagnose
Management if symptomatic
- Prostaglandin synthetase inhibitor e.g. INDOMETHACIn or IBUPROFEN to close duct
27
NEC clinical picture
cause
Characteristic findings
1st few weeks
```
Clinical picture
– sudden change in feeding
– vomiting (maybe be bile stained)
– distended abdomen
– store may have blood (fresh)
```
Cause
Bowel vulnerable to ischaemic injury and bacterial invasion in preterm infants
– can perforate --> Leaking into abdomen
```
Characteristic findings
– Dilated bowel loops
– bowel wall oedema and thumbprinting
– Pneumastosis intestinalis (intramural gas)
– If severe pneumoperitoneum
```
Management
STOP ORAL FEED AND GIVE BROAD ANTIBIOTICS
– Rest bowl
– energy to dream stomach, IV fluids and medicine
– surgery if perforation
Prognosis
Mortality of 20%
28
Newborn hypoglycaemia management
If 2 readings <2.6 inspite adequate feeds or 1 v low (<1.6) or symptoms
- IV glucose to maintain above 2.6
29
Jaundice risk factors
Tests to do
Sibling needing food therapy
Premature low-birth-weight
Exclusively breastfeeding
Jaundice in lesson 24 hours
Tests
<24h needs serum bilirubin in <2h
24h-2weeks needs serum bilirubin in <6h if TC reading >250
```
And other tests for less than 24 hours
– blood group (mum and baby)
– DAT
– blood packed for volume
– FBC, blood Film
– G6PD levels
– microbiology (blood you're in CFF if needed)
```
30
What is Kernicterus
Presentation
Long term sequelae
Deposition of unconj bilirubin in basal ganglia and brainstem
Presentation
- Unstable
- Opisthotonus
- Seizures
- Coma
Long term sequelae
- DYSKINETIC CP
- LD
- Sensorineural deafness
31
Biliary atresia
Progressive fibrosis and obliteration of extra and intra hepatic biliary tree --> leads to liver fibrosis failure and death within two years
Aetiology unknown
Mild jaundice, Pale stools and dark urine and faltering growth
```
Diagnosis
Increase conjugated bilirubin is
PT, INR (INR may be raised)
Pepsi
LFTs: GGT hight
Ultrasound
GOLD STANDARD = ERCP (lack of patency) WITH LIVER BIOPSY
```
Management
KASAI - same time as ERCP
= Hepatoportoenterostomy + Ursodeoxycholic acid
32
Low galactose 2 phosphate uridyl transferase on baby bloods
Diagnosis
Presentation
Treatment
Galactossoemia - can't metabolise galactose --> identify in urine
Dx is low enzyme levels on blood
Features: Poor fed, vom, jaundice, heatomegaly
Treatment - no lactose
33
Alpha 1 antitrypsin deficiency
Diagnosis
Diagnosis
- <20 alpha -1 antitrypsin in plasma
Accumulation of protein in hepatocytes --> prolonged jaundice and bleeding due to vit K deficiency
Autosomal recessive
34
TTN
Delay in absorption of long fluid
More common after Caesarean
Chest x-ray make show fluid in horizontal Fissure
Usually settles within one day
35
When to suspect meconium aspiration
Management
Late born babies
Management only needed if respiration not established in 1 min
Complications
Airleak leading to pneumothorax and pneumomediastinum
36
Newborn pneumonia predisposing factors
Management
1. prolonged rupture of membranes
2. chorioamnionitis
3. low-birth-weight
Management
Broad-spectrum antibiotics
37
Newborn pneumothorax predisposing factors
1. meconium aspiration
2. respiratory distress syndrome
3. complication of mechanical ventilation
38
Persistent pulmonary hypertension of the newborn
Associations
Presentation
```
Birth asphyxia
Meconium aspiration
Septicaemia
Respiratory distress syndrome
Fluoxetine in 3rd trimester
```
Presentation
– Cyanosis soon after birth
Diagnosis: chest x-ray normal heart size
– urgent echo to exclude congenital heart disease and identify signs of raised pulmonary hypertension
39
Newborn coughing and choking when fed
Possible cyanotic episodes
Aspiration into lungs
Oesophageal atresia
- Associated with polyhdramnios
- Associated with oesophageal-tracheal fistula
- Absent stomach bubble on antenatal US
MUST SUCTION + surgery
40
What is port wine stain
Present from birth and usually grows with infant
- Vascular malformationin capillaries in dermis
- May be associated with Sturge Webber
- Disfiguring lesions can be treated with laser
41
What is strawberry naevi
Cavernous hemangioma
Usually not present at birth but appear in first month of life
More common in preterm infants
– increase in size until 3 to 15 months then regress
– ulceration or haemorrhage maker
– no treatment if small, topical propanolol may speed regression
42
DDH Risk factors
Describe the tests
```
Female
Breach
History
First born
Oligohydramnios
```
Barlow: Attempt to dislocate an articulated femoral head
- adduction of hip with posterior force on knee
Ortalani: Attempts to re-locate a dislocated family head
- Abduct hip with anterior force on femur
US ALL BREECH BABIES at 6 weeks
X-ray if >4.5months
Management
- Usually stabilise by 3-6 weeks spontaneously
- Pelvic harness if <4-5months
- Older children may require surgery
43
Croup
Presentation
Management
6m - 6yrs. Peak ~ 2yo
Viral - mostly parainfluenza
```
Starts with coryzal symptoms
Stridor
Barking cough
Worse at night
Hoarseness
Variable difficulty breathing system include cyanosis, LOC, stridor, air entry,
```
Management depends on severity - scoring
1) Mild = no stridor at rest
- Oral single dose dexamethasone. Can go home
2) Moderate = stridor at rest; no agitation/lethary
- Oral single dose dexamethasone + Nebulised adrenaline
- Admit
3) Severe = stridor at rest; agitation/lethary
- Oral single dose dexamethasone + Nebulised adrenaline
- High flow O2
- Admit
44
Laryngomalacia
Define
Risk factors
Congenital abnormality of larynx cartilage – predisposes to supraglottic collapse during inspiration
– intermittent upper airway obstruction and strider
```
Risk factors
– GORD
– neurological
– male
– Genetics e.g. Down's syndrome
```
Usually resolves by 12 to 24 months
Management
– observe and treat GORD if mild
– endoscopic supraglottoplasty if severe
– tracheostomy is possible
45
Indication to admit a child with respiratory problems
```
Apnoea
Saturation is less than 92% on air
Fluid intake reduced (75% of usual)
Severe Respiratory distress
– Grunting
– marked chest recession
– respiratory rate greater than 70
```
46
Bronchiolitis
Presentation
causative organism
```
Dry wheezy cough
Tachypnoea tachycardia
Subcostal and intercostal recession
Hyperinflation of the chest (liver displaced)
Fine and inspiratory crackles
High-pitched wheeze (expitatory mostly)
```
RSV
47
Whooping cough (pertusis)
Presentation
Risk factors
Complications
Diagnosis
Management
[1] A week of coryza (catarrhal phase)
```
[2] Characteristic paroxysmal or spasmodic cough followed by inspiratory whoop (paroxysmal phase). Lasts up to 3 months what the F
– Worse at night
– may vomit
– go red or blue in the face
– mucus from nose and mouth
EPISTAXIS AND CONJUNCTIVAL HAEMORRHAGE
```
[3] SymptomsDecrease (convalescent phase)
Risk factors
– less than six months old
– lack of Vaccine
– contact
```
Complications
– pneumonia
– seizures
– bronchiectasis
Rare to get complications
```
Diagnosis
– I need a swab (identification of Bordetella pertussis)
– PCR: more sensitive
– FBC: Marked lymphocytosis over 15
Management
Admit and isolate if paroxysms of face
Antibiotics only work if started in catarrhal phase. ONLY GIVE IN 1st 21 days
<1 month old: seven days clarithromycin
>1 month old: azithromycin or clarithromycin
SCHOOL EXCLUSION
– Until 48 hours of antibiotics
– for 21 days after onset of symptoms if not treated
VACCINATE THE DAMN CHILD AFTER
+ PH ENGLANDfvs
48
Indications for tonsillectomy
```
Recurrent episodes of tonsillitis
Peritonsillar abscess (Quincy)
Obstructive sleep apnoea (Remove adenoids to)
```
49
Cystic fibrosis
| pathology
Carrier rate: One in 25
Incidence: one and 2500 Live births
Autosomal recessive
Defect in the CF transmembrane conductance regulator (CFTR)
– CFTR = cAMP Dependent Chloride channel Found in cells that line the lungs, Intestine, pancreatic duct, sweat glands, reproductive organs
– CFTR gene is on chromosome 7
– Main mutation (78%) = deltaF508
Results in abnormal Ion transport
– Airway: reduced hourly service liquid layer, impaired celery function, retention of mucopurulent secretions
– Dysregulation of inflammation
– Interestine: Thick viscous meconium --> Meconium ileus in 10 to 20%
– Pancreatic duct: blocked my fix secretions --> Pancreatic enzyme deficiency and malabsorption
– Sweat glands –: XS sodium and chloride in sweat
50
Cystic fibrosis diagnosis
management
Newborn screen: IRT
– IRT high --> screened for common gene mutations
– If two mutations, sweat test To diagnose >60
Set test: low voltage current to pilocarpine applied to skin
– sweat collected
– Then confirm with gene abnormalities
NB: normal sweat test: Cl = 10-40
Also low faecal elastase
Faltering growth
Steatorrhoea
Management
ALWAYS MDT - specialist cystic fibrosis centre: physio, nurses, dieticians
– Physiotherapy at least twice a day to clear the Airway, regular nebulised hypertonic saline to decrease secretions
– Continuous prophylactic oral antibiotics (flucloxacillin) Plus additional rescue
– Pancreatic enzymes with all meals plus high calorie diet plus fat soluble vitamin supplements
weekly in their first month of life
- every 4 weeks when they are between 1 and 12 months old
- every 6 to 8 weeks when they are between 1 and 5 years old
- every 8 to 12 weeks when they are over 5 years
- old every 3 to 6 months as adults
51
Long-term picture with cystic fibrosis
Newborn
– screening
– meconium alias
```
Infancy
– prolonged jaundice
– growth filtering
– recurrent chest infection
– malabsorption, steatorrhoea
```
Young child – bronchiectasis
– rectal prolapse
– nasal polyps
– sinusitis
All the child/adolescent
– allergic bronchopulmonary aspergillosis
– DIABETES MELLITUS - check from age 10
– liver cirrhosis and portal hypertension
– distal intestinal obstruction (basically Maconi wireless)
– pneumothorax
– STERILITY IN MALES (absence of vas deferens)
52
Asthma management stepwise
[1] Diagnosis and assessment = SABA prn
[2] Using SABA 3 or more times a week
= + ICS v low dose
[3] Control still poor
5yo or more = + LABA
<5yo = + LTRA
[4] Control still poor in 5yo or more
Partial LABA response = + Increase ICS dose to low
No LABA response = STOP LABA + Increase ICS dose to low
[5] Control still poor. Consider
- Increase ICS dose to moderate
- Addition of theophylinne
REFER TO SPECIALIST
[6] Consider oral steroids
53
Hirschsprung's disease
Cause
Where is the junction
Association
Presentation
Failure of ganglion cells to migrate into hindgut
= Absence of coordinated pal peristalsis an OBSTRUCTION is at the junction between normal bowel distal aganglionic bowel
80%: transition zone in rectum/sigmoid = short segement disease
20%: entire colon is involved = Long segment disease
```
Presentation
– Usually first few days of life with lower intestinal obstruction
1. bile stained vomiting
2. .abdominal distension
3. failure to pass meconium
```
OCCASIONALLY CHILD PRESENTS with short segment disease and constipation
- Associated with trisomy 21
54
Investigation of Hirschsprung's Disease
Management
Outcome
AXR: Obstruction but NOT SPECIFIC
CONTRAST ENEMA: Shows location of transition soon. Most valuable initial screening diagnostic test
Rectal biopsy: no ganglionic cells in submucosa
Initial management
– Bowel irrigation/rectal washout
Surgical treatment
– single stage pull through
Outcome
– 5% get normal bowel control
– 15 to 20% have partial control
– 5% never gain control (may have permanent stoma)
ENTEROCOLITIS = worst complication. 10% mortality
55
Threadworm infection
Presentation
Management
Perry anal itching, with at night, associated with insomnia
No systemic symptoms
Very infectious
Diagnosis is adhesive tape - Three consecutive days. Examination for eggs or adult worms
Management
For all patients and family members
– Single oral dose: Mebendazole
+ HYGIENE
May need repeat dose in 2weeks
56
Childhood constipation red flags
```
Lack of meconium within 48 hours of birth
Failure to thrive/growth problems
Abdominal distension
Lower limb weakness
Perianal bruising or multiple fishes
```
57
Childhood constipation diagnosis
– <3 complete stores in a week
– overflow soiling (greater than one year old) = v smelly, loose, no sensation
– distress or Straining
– reduced appetite that improves on passing store
– history of constipation
– history of anal fisher
58
Causes of constipation
Mainly idiopathic
– low fibre diet
– lack of ability to exercise
– family history and
```
GI
– hash brown disease
– anal disease
– coeliac
– partial obstruction
– food hypersensitivity
```
```
Non-GI
– Hypothyroid
– hypercalcaemia
– drugs (opiate/auntie cholinergic's)
– neuro disease
– dehydration
– sexual abuse
```
59
Management of constipation
How long to continue treatment
Treatment of the associated condition
For all
[1] Diet: fibre cereal, whole wheat, fruit peel, veg, beans, nuts, juice, GOOD FLUID INTAKE
[2] BEHAVIOURAL: SET TOILET TIMES, STAR CHANCE, REASSURANCE, ENCOURAGEMENT
Mild constipation
– polyethylene glycol 3350 + electrolytes (Movicol paediatric plan) LOW DOE REGIMEN
+/- Stimulant e.g Senna if inadequate response
Action impaction
– polyethylene glycol 3350+ electrolytes (Movicol paediatric plan) ESCALATING DOE REGIMEN for 2/52
+ Senna if inadequate response
Continue treatment for a minimum of six months
Consider treating anal fissures
E.g. topical anaesthetic: Lidocaine
60
Differentiate IgE CMPA from non-IgE
```
IgE
– Symptoms within two hours of ingestion (actually mins)
Skin
GI
Resp
```
```
Non-IgE mediated
– sentence 48 hours to 1 week after ingestion
GI
Skin
Resp
```
Diagnosis = elimination for 2-4 weeks, reintroduce 1 week
Eliminate from diet (eHF or AAF if not good enough) or maternal diet.
Continue for minimum 6 months until 9-12 months of age
As long as new eczema
– reintroduction at home using milk ladder
If eczema
– serum IgE of skin prick test
– If negative reintroduction home with milk ladder
– if positive refer to allergy clinic
61
Coeliac disease associations
Genetic factors
Management
```
Associations
– type one diabetes
– autoimmune viroid
– down syndrome
– family history of coeliac disease
```
Genetic factors
– HLA DQ2/8
Management
– dietician
– lifelong gluten free diet plus calcium Plus vitamin di plus/minus iron
62
Dehydration: define
```
Not clinically detectable
vs
Clinical
vs
Shock
```
Not clinically detectable
Less than 5% body weight lost
```
Clinical
5 to 10% body weight lost
– increased HR increased our our
– driving rain
– reduced Urine Output
– reduced skin turgor
```
```
Shock
Greater than 10% body weight lost
– hypotensive
– reduced conscious nurse
– increased capillary refill time
– week with a pulse
– cold extremities
– pale
```
63
Went to give IV fluids to a child
IF not needed, what is given and how much for dehydration
Advice for gastroenteritis recovery
Only if shook
ORS and still dehydrated
Persistent vomiting
ORS 50ml/kg over 4h
```
Voice juice and carbonated drinks
Hand washing
Stay off school for 48 hours after last episode of diarrhoea
Milk as normal when we hydrated
Slowly introduce solid foods
```
64
GORD treatment
Complications
[1] Don't overfeed: Max 150 mil per kilogram per day
[2] Increased feed frequency (Two to 3 hourly) small feeds though
[3] Feed thickener e.g. carobel
If not better in two weeks
– Omeprazole (PPI)
– ranitidine (H to antagonist)
```
Prognosis is great
Complications are rare
– oesophagitis
Aspiration pneumonia
Faltering growth
Apparent life-threatening events
```
65
GORD prevalence
DORD risk factors
What a whopping 40% of Less than one-year-olds
```
Risk factors
– premature
– neuro disability
– diaphragmatic hernia
– oesophageal atresia
```
66
Pyloric stenosis features
Risk factors
2 to 8 week old
Non-bilious limiting, because projectile, characteristic bloods
Weight loss
Dehydration
Rest factors
– Male
– 1st bordn
– family history
O/E: Olive in RUQ. Test feed: peristalsis left to right
US DIAGNOSIS: Thickness of muscle > 3mm, length >15mm
Management
ONLY WHEN U&;ES STABLE
Pre-op fluids to correct dehydration, NG trip and suck, maintenance fluids
Op: Pyloromyotomy
67
Meckles diverticulum
Congenital diverticuli small intestine: remnant of the Vitello intestinal duct
– contains pancreatic, ectopic, ileal Orgastic mucosa
2ft from ileocaecal valve, 2inches long, 2% of populatoon
Asymptomatic
PAINLESS Rectal bleeding
Obstruction (volulus, hernia)
Technechium scan
US if suspect intusussception
AXR to check obstruction
Management
- Asymptomatic found in surgery = excise
- Symptomatic - Remove - wedge excision of small bowel excision and anastamosis
68
Malrotation
Diagnosis
Management
Congenital abnormality of the opposition
--> complicated by volvulus
Can be asymptomatic, obstruction with Compromise blood supply, bilious vomiting and abdominal pain
Diagnosis
- Upper GI CONTRAST STUDY
- X-ray check for volvulus and obstruction
```
Management
ABCDE
LADD procedure
1) Detorsion of bowel
2) Recection of any necrotic bowel
3) Lysis of Ladd's bands
4) Caecum placed on left, small bowel on right
5) Appendicectomy
```
69
Define convulsive status epilepicus
Continuous seizure lasting more than 30 minutes
or
Intermittent clinical or EEG seizures lasting more than 30 minutes without full recovery of consciousness in between
[0mins]
Record time. ABC. High flow O2. Check GLUCOSE
[5mins]
Midazolam (0.5mg/kg) buccal
or
Lorazepam (0.1mg/kg) IV if access
[15mins]
Lorazepam (0.1mg/kg) IV
PREP PHENYTOIN + SENIOR
[25mins]
Phenytoin 20mg/kg over 20mins IV
or if regualar phenytoin
Phenobarbitol 20mg/kh over 5mins IV
INFORM ICU AND ANAESTHETIST
[45mis]
Induce anaesthesia using thiopental sodium IV
70
Paeds sepsis 6
```
[1] High flow oxygen
[2] IV access
- Blood glucose
- Blood gas
- Blood cultue
- If poss U&Es, FBC, CRP
[3] IV or IO antibiotics
[4] Consider fluids
- Aim UO >0.5ml/kg/hr
- 10-20ml/kg isotonic fluid over 5-10mins
- Repeat as necessary and monitor UO
[5] Senior
[6] Consider inotropes
```
71
Child adrenalise dose
1:1000
>12yo: 500micrograms (0.5ml)
6-12yo: 300micrograms (0.3ml)
<6yo: 150micrograms (0.15ml)
```
Start with ABC
Then IM adrenaline
HIgh flow ox
Then fluid challenge
Chloramphenamine
Hydrocortisone
```
72
Hepatosplenomegaly and the presence of bruising together with the symptoms of anaemia (soft systolic murmur and shortness of breath on exertion
DO NOT MISS ALL
Anaemia: Pallor, therargy, SOB
Leukopenia: Infections
Thrombocytopenia: bruising and bleeding
Other features:
– bone pain (secondary to bone marrow infiltration)
– splenomegaly
– hepatomegaly
– fever is present in up to 50% of new cases (representing infection or constitutional symptom)
– testicular swelling
73
ALL poor prognosis
```
<2yo or >10yo
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
```
74
Nappy rash causes and presentations
Irrirant dermatitis
Most common - due to irritant effect of urinary ammonia and faeces. Creases are characteristically spared
Candida dermatitis
- Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
Seborrheic dermatitis
Erythematous rash with flakes. May be coexistent scalp rash
Atopic eczema
- Other areas of the skin will also be affected
75
Nappy rash management
Disposable nappies are preferable to towel nappies
Expose napkin area to air when possible
Apply barrier cream (e.g. Zinc and castor oil)
Mild steroid cream (e.g. 1% hydrocortisone) in severe cases
Management of suspected candidal nappy rash is with a topical imidazole. Cease the use of a barrier cream until the candida has settled
76
Neonatal examination a systolic heart murmur is heard. An echocardiogram shows right atrial hypertrophy and the septal and posterior leaflet of the tricuspid valve attached to the right ventricle.
What is the systolic murmur like
Ebstein's anomaly
- Associated with lithium use
PANSYSTOLIC
77
At what age to kids talk in short sentences (3-5words)
2.5-3yrs
78
SUFE presentation
Diagnosis
Management
10-15 years
More common in obese children and boys
Displacement of the femoral head epiphysis postero-inferiorly
Bilateral slip in 20% of cases
May present ACUTE following trauma or more commonly with CHRONIC persistent symptoms
hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
Diagnosis = x-ray AP and lateral (frog views)
Management = internal fixation: typically a single cannulated screw placed in the center of the epiphysis
79
When is Men B vaccine given
2, 4, 12 months
80
Foreskin can't be retracted diagnosis
Phimosis
Chill until after 2yo as will self resolve. Then refer
81
Newborn normal RR and pulse
HR: 110-160
Pulse: 30-60
82
Hand foot and mouth disease
Cause: COXACKIE A16 and enterovirus 71
= Hand, foot and mouth disease
Clinical features
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet
Management
symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school*
83
APGAR SCORE INTERPRETATIOn
7-10 good
4-6 ok
0-3 v low
Done at 1 min, 5 min and 10min
84
Features of Edward's
```
Trisomy 18
Small Jaw
Overlapping fingers
Rocker bottom feet
Low set ears
```
85
What is kawasaki disease
```
5 days or more of fever along with 4 of the following:
[1] Dry cracked lips
[2] Bilateral conjunctivitis
[3] Peeling of skin on fingers and toes
[4] Cervical lymphadenopathy
[5] Red rash over trunk
```
Management
High dose aspirin and IvIg
86
Most common complication of roseola infantum
FEBRILE SEIZURES ??? in 10-15%
Also
- Aseptic meningitis
- hepatitis
87
Newborn with rash at 2-3days with white pinpoint papules at centre of erthematous base. Fluid contains eosinophils. They are on the trunk. Come and go
Erythema toxicum
88
Management of impetigo
[1st line] Topical Fusidic acid if localised
[2nd line] topical retapamulin
If extensive --> Flucloxacillin
KEEP OFF SCHOOL UNTIL CRUSTED OVER or 48h after antibiotics
89
Bow legs
Normal age
Refer when
Present 1-2yrs old
Typically resolves by the age of 4-5 years
Increased intercondylar distance
90
Knock knees
Nromal age
Present 3-4y
Increased intermalleolar distance
91
Meconium ileus vs Hirschprung baby
Meconium ileus
Usually delayed passage of meconium and abdominal distension
The majority have CF
NO fluid level as the meconium is viscid, PR contrast studies may dislodge meconium plugs and be therapeutic
Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs
Hirschsprung's
Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births
Full-thickness rectal biopsy for diagnosis
Delayed passage of meconium and abdominal distension
Treatment is with rectal washouts initially, after that an anorectal pull through procedure
92
What age does a child play near other
What age with others
Near: 2y
With: 4yo
93
Where to check pulse in an infant
Brachial and femoral
94
Swelling in multiple joints and stiffness plus salmon pink rash
JIA
95
Perthes presentation
INSIDOUS onset of limp or hip or kww pain
X-RAY both hops including frog views
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
If persists and normal x-ray - MRI/Tch
Management <6yo
- Observe
>6yo
- screws and plates
96
life-threatening asthma attack are:
```
Cyanosis
Poor respiratory effort
Peak expiratory flow rate < 33%
Silent chest
Altered level of consciousness
```
97
absence of red-reflex, replaced by a white pupil (leukocoria)
the most common presenting symptom
strabismus
visual problems
Retinoblastoma
98
What age does a child crawl
8 months
99
What age does a child sit
What age to refer
7-8 months
Refer at 12
100
Suspect septic arthritis over transient synovitis
Management of septic arthritis
Kocher’s criteria states that certain factors are more likely to indicate septic arthritis over transient synovitis:
temperature >38.5C,
PAIN AT REST as well as movement
refusal to bear weight on affected limb
raised inflammatory markers (erythrocyte sedimentation rate >40 mm/hour and CRP > 20.0 mg/litre)
a peripheral white cell count of > 12.0 x 109 (normal range 3.5 – 10.5 x 109 cells per cubic litre)
Management of septic arthritis
- Must do bloods (WCC), CRP, aspiration under US
- Prolonged antibiotic course
- Immobilize joint initially then mobilise
101
Nitrogen washout test
The nitrogen washout test (also known as the hyperoxia test) may be used to differentiate cardiac from non-cardiac causes. The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease
Causes of cyanotic congenital heart disease
tetralogy of Fallot (TOF)
transposition of the great arteries (TGA)
tricuspid atresia
102
Infantile spasm attacks
Presentation
EEG
Prognosis
Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4 to 8 months of life and is more common in male infants. They are often associated with a serious underlying condition and carry a poor prognosis
Features
characteristic 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap
Investigation
the EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used
103
HF in a child presentation
Heart failure typically presents in infants with symptoms of breathlessness worse on exertion (e.g. feeding), sweating, poor feeding and recurrent chest infections.
On examination you should: examine the growth charts (?failure to thrive), examine for tachycardia, tachypnoea, murmurs and pre and post-ductal saturations.
Heart failure may be due to duct dependant systemic circulations (<2 weeks old) e.g. coarctation of the aorta or left-to-right shunts (>2 weeks old) e.g. VSD as the pulmonary vasculature resistance begins to fall.
In this case the baby has a large VSD causing decompensated heart failure. Cardiac lesions can be missed during the foetal anomaly scan and this baby would need a detailed foetal echocardiogram and discussion with the cardiac team on management strategies.
104
What does Guthrie sport screen for
```
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
```
105
Turner syndrome murmur
Systolic over the aortic valve
- Biscuspid aortic valve
106
VSD murmur
What at risk of
Pansystolic (low left sternal edge aka tricuspid)
```
Endocarditis
PULMONARY HTN (not essential)
```
107
Neonate needs review from neonatal team
respiratory rate above 60 per minute
the presence of grunting
heart rate below 100 or above 160 beats/minute
capillary refill time above 3 seconds
temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart
oxygen saturation below 95%
presence of central cyanosis
108
What age can you use triptans in migrane from
12
109
Mild-moderate asthma attack treatment
Bronchodilator therapy
- give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask). give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital
Steroid therapy
should be given to all children with an asthma exacerbation treatment should be given for 3-5 days
NB moderate = >92% sats >50 PEF
```
Severe in >5
pO2 < 92%
PEF 33-50% best or predicted
Can't complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min
Respiratory rate > 30/min
Use of accessory neck muscles
```
110
When is hand preference normal
12 months
111
Correcting for developmen milestones until what age
2
THIS IS SNEAKY IN QUESTIONS
112
Head lice treatment
Combination of: malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
113
Weight faltering definition
Indications to investigate
Causes
Investigations
Management
Drop down 2 centiles
Indications for more investigations
- Weight crossing 2 centiles
- Below 0.4th centile
- BMI <2nd centile
Causes
- INTAKE - feeding problems, type of feed, access to food, psycosocial deprivation, neglect/child abuse
- Underlying pathology of low intake - cleft palate, CP, Chronic illness e.g. CKD, Chron's, CF, liver disease
- INADEQUATE RETENTION - vom, GORD (severe)
- MALABSORPTION - coeliac, CF, CMPA, NEC
- FAILURE TO UTILISE NUTRIENTS - Down's, IUGR, congenital infection, metabolic disorders, diabetes
- INCREASED REQUIREMENTS - Thyrotoxicosis, CF, malignancy, CKD, CHD
```
Investigations - only FBC and ferritin usually
– FBC and WBC differential
– U&Es (renal function, metabolic disturbance)
– LFTs
– TFT
– CRP
– ferritin
– tissue transglutaminase antibodies
– urine microscopy and culture and dip
– to microscopy culture and dip
– karyotyping girls
Sweat test, chest x-ray
```
Management
MDT in GP - health visitor, paediatric dietician, SALT, child psychologist, social services
- If severe - admit?
Takes 4-8 weeks
114
Short stature definition
below 2.5th centile
```
Causes
– Constitutional
– familial
– chronic disease (CF, CHD, coeliac)
– sickle-cell disease
– thalassaemia
– IBD
– hypothyroid
Dash down syndrome
– malnutrition
Less commonly - GH deficiency, CNS tumours, Turner, Noonan, Prader Wili
```
115
Where to refer developmental problems to
Causes of global developmental delay
Local MDT services: Paediatricians and therapists
- Screening tests
- Standardized tests looking at specific areas of development
```
Causes
[1] Antenatal
- Chromosomal/DNA
- Infections
- Toxins/alcohol
- Nurocutaneous
[2] Perinatal
- Extreme prematurity
- HIE
- Symptomatic hypoglycaemia
- Hyperbilirubinaemia
[3] Postnatal
- Infection: Meningitis, encephalitis
- Anoxia (seizures)
- Head injury
[4] Other
- Chronic illness, physical abuse, emotional neglect
```
Tests
- Chromosome analysis
- FBC and ferritin
- U&Es
- TFTs
- CK
- Vision and hearing assessment
116
ADHD pathophysiology
Managagement approach
Genetic component (0.7 heritability)
- Prenatal exposure to nicotine
- Pre and perinatal complications
- LBW
Refferral to community pediatrics/CAMHs - full assessment and diagnosis by psychiatrist. Must be in 2 or more setting
- CONNERS rating scale (parent, teacher and child)
Management
- Behavioural + educational AKA MDT
- 10 weeks watchful waiting possible - parent support groups then refer. If severe - immediate 2ndry care referral
- PSychotherapy
- Behavioral therapy
- Parent education courses
- CBT
117
CP management approach
Urgent assessment by child development centre --> local integrated MDT approach with local child development team: Specialist health visitor co-ordinated
- SALT
- OT
- Physiotherapy
- SENCO
Support: SCOPE
118
What is a seizure
Paroxysmal abnormality of cognitive, autonomic, motor or sensory function due to transient brain dysfunction
Epileptic seizure: when this is due ti underlyng electrical activity in the brain - usually excessive, hypersynchronous
119
Growing pains
```
3-12yo
Often wakes and relived by massaging
- symmetrical lower limb pain (NOT limited to joints)
- NOT present on walking
- NOT limiting activities
- NOT limping
- Normal physical examination
```
120
What is osteomyelitis
Infection of metaphysis of long bone (often femur)
- Can spread to joint causing septic arthritis
PAINFUL, IMMOBILE, ACUTE febrile illness
- Skin swollen, erythematous, warm and tender oabove
Investigations
- Blood cultures: +ve
- WCC, WRP raised
- US: Periosteal elevation
- X-ray changes from 10 days: mottled rarefefaction, involucrum, lytic destruction, sequestra
Management
- Prompt antibiotics for 6 weeks (to prevent bone necrosis, chronic infection and limb deformity)
- IV!!!!!! until CRP normal and symptoms reside
- May need surgical drainage if response is poor
121
Osteochondritis dissecans
Localised tenderness over femoral condyles
FOLLOWING AVASCULAR NECROSIS of medial femoral condyle
- Slipping/locking/giving way
Investigations
- X-ray
Management
- Rest and quadriceps exercises
- Sometime surgery required
122
Chondromalacia patellae
Softening of the articular cartilage of the patella
- Pain when standing from sitting or going up stairs
Management
- Physio for quadrecep muscle straining
- Painkillers
123
Limp red flags
```
<3
>9
Fever
Pain waking at night - malignancy
Redness, swelling or stiffness
Weightloss anorexia, night sweats, fatigue
Unexplained rash/bruising
Worse in the morning - inflammatory joing disease
Unable to weight bear
Severe pain
Suspect maltreatment
```
124
Reactive arthritis
Join swelling <6 weeks
Oftern after an enteric infection: salmonella, shigella, campylobacter. Also viruses, STIs, Myocplas,a RF, post-strep
Management
- CRP mildly elevated only
- X-ray normal
NO TREATMENT NEEDED
125
CMPA management
Determine symptoms + relationship to milk. IF <2h - refer to allergy clinic
If >2 hours, suggests not IgE mediated.
Dietician supported trial of elimination from baby's diet/maternal diet WITH SUPPLEMENTS for 4 WEEKS (eHF for formula fed)
- Clear improvement - confirm diagnosis with re-introduction (1 week)
- Is symptoms return = confirms and get support of dietician
- Cows milk protein free diet until 9-12 months - planned reintroduction (home if no atopic dermatitis or any hx of any immediate symptoms) - MILK LADDER
126
LP contraindications
```
Prolonged or focal seizure
Focal neurological signs
A widespread purpuric rash
A Glasgow Coma Scale score 13
Abnormal posture or movement e.g. decerebrate posture
An inappropriately low pulse, raised blood pressure and irregular breathing
(suggesting impending brain herniation)
Thrombocytopenia or clotting disorder
Pupillary dilatation
Papilloedema
Hypertensio
```
127
Meningitis investigations once in hospital
```
FBC + CRP
Glucose, gas,
Coagulation screen, culture
Blood PCR for N.meningitidis
LP unless CI + cultue +/- PCR
Rapid antigen tests on blood and urine
Throat swabs for bacterial culture and viral PCR
```
Management
- <3months: Cefotaxime
- >3months: Ceftriaxone + dexamethasone
CONSIDER ACICLOVIR IF SUSPECT ENCEPHALITIS
Complications
- Hearing impairment
- Local vasculitis
- Local cerebral infarction
- Subdural effusion
128
pGALS
Any pain in back, muscles or joints? Trouble with stairs,?getting dressed?
Gait
- Walk normally
- Tip toe
- Heel walk
Arms
- Hand up to the ceiling
- Hands behind your ears
- Hands behind back
- Hands straight out in front
- Make a fist and turn (squeeze fists)
- Touch fingers to thumb quick
- Praying hands + FLIP
- Bend thumb + fingers back
Legs - on couch
- Lift leg and bend - both legs
- Flex and dorsiflex feet
- Feel knee?
-
Spine
- Look at back - trace down spine
- Knees straight and touch your toes
- Use kneck to look up
- Chin down over chest
- Look right, look left
- Ear to shoulder on one side then the other
- Open mouth and see if you can put three fingers in your mouth
129
Inhaler technique
1. Take off the cap and shake the inhaler
2. Put the inhaler into the end of your spacer
3. Breathe out gently as long as feels comfortable
4. Put the mouthpiece between your teeth and lips, making a seal so no medicine can escape
5. Press the canister to put one puff of your medicine into the spacer
6. Breathe in slowly and steadily (not hard and fast) through the mouthpiece
7. Keep the spacer in your mouth with your lips sealed around it and breathe in and out of the mouthpiece five times. Repeat the steps for each dose needed
Clean spacer once a week by soaking in warm soapy water. Let air dry
130
JIA risk factors
```
Autoimmune disease
Female
Onset before 6
No infection or other cause
Objective arthritis - >6 weeks
```
Characteristics
- Worse in morning
- Stiff
- Most get better by adulthood
```
Management = MDT - specialist nurse, rheumatology,
Exercise - swimming, cycling
NSAIDs
Steroids
Methotrexate
Immuno drugs
```
131
Turner syndrome
On fetal US scan
Complications
45, X. Usually maternal X chromosome.
Many with Turner’s experience only short stature and ovarian failure.
Picked up on fetal US
Cystic hygroma
Oedema of hands, neck and feet
Heart abnormalities eg. bicuspid aortic valve
Kidney abnormalities eg. horseshoe or pelvic kidney
Complications
1. Heart defects (bicuspid aortic valve/coarctation of
aorta/aortic root dilatation)
2. Kidney abnormalities eg. horseshoe kidney, recurrent
UTIs
3. Lymphoedema
4. Hypothyroidism
5. HTN
6. Recurrent ear infections, hearing loss
7. Osteoporosis
8. Obesity and diabetes
9. ADHD in childhood
Normal IQ in most but have difficulty with spacial reasoning
132
Investigations for Turner syndrome
Management
```
Full examination inc. ENT
Urine dip
Developmental assessment
Gonadotrophin levels
Karyotype
Pelvic USS to rule out Mullerian agenesis
```
```
Investigations for complications
TFTs, thyroid abs
HbA1c
Renal function tests: UEs, urine culture, imaging
ECG, echo
XR for bone age – delayed due to oestrogen def (GH
contraindicated if epiphyses are fused)
Hearing tests
```
Management
Explain nature of lifelong condition, and that Turner’s is NOT inherited.
Main issues: growth, puberty, fertility, general health.
MDT! Paediatric endocrinology, psychiatrist, gynaecologist,
geneticist, nephrologist, ENT, cardiologist, specialist nurse
give GH if epiphyses not fused
give oestrogen and progestogen (initially low dose oestrogen then add progestogen; later use COCP)
Fertility may be achieved with oocyte donation, and gamete or
embryo transplantation.
Screen for complications (see above)
May need psych support also
Educational support – SEN
Support for family – can offer SW
133
Eczema management
Determine severity
Mainstays of management
- Triggers + conservative
- Emollients - trial and error. Liberal
- Topical corticoseroids (applied 20mins after emollients)
- Immunomodulator and occlusive bandages by specialists only
- Dietician mediated elimination of foods
- Psychological support
Steroids contine 48h after exacerbation
Consider admission need
Review anti-histamistamines every 3 months (can give short courses sedating for 2 weeks if bad)
Review sterpods every 3-6 months
134
Fungal rash
KOH microscopy if unsure: Hyphae MUST FOR NAILS
Woodlamp examination - UV light fluorescene of lesion
Dermoscopy
Fungal culture
PCR
Nail clippings
Managmenet
Tinea capitis
- 4 weeks oral terbinafine
+/- topical antifungals to reduce transmission - ketoconazole shampoo
Tinea corporis - 7-8 days topical antifungal
Tinea ungium - oral terbinafine OD 12 weeks (toenails), 6 weeks (finger nails)
135
Scabies investigation
Management
Burroes pathognomic
Ink burrow test
Microscopy of skin scrapings from lesions = diagnosis
Permethrin cream - leave on overnight. 2 doses, 1 week apart. WHOLE FAMILY
- To cool skin that is clean
- reapply to hands if wasshed
- Mittens for infants
Antihistamines for sleep
Wash everything at 60 or higher after 1st treatment
