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ResearchEazy FINALSEAZY Pediatrics 2 Ravanth Baskaran AFHEA FINALSEAZY Pediatrics Pulmonology Ravanth Baskaran AFHEAAn 8-month-old girl presents to the A) Intravenous Dexamethasone emergency department with coryzal symptoms,dyspnoea , tachypnoeaand a mild B) High-flow humidified oxygen via fever of 39.2 C for the past 4 days. On a tight nasal cannula examination, tracheal tug is seen, and on C) Intravenous Antibiotics auscultation, crackles and wheezes are heard. The baby was born prematureat 34+3. D) Intravenous Palivizumab Her observations are as follows: HR: 168, BP: 110/61, RR: 66, SaO2: 90% E) Nebulized Salbutamol What is the most appropriate next step in managingthispatient?An 8-month-old girl presents to the A) Intravenous Dexamethasone emergency department with coryzal symptoms,dyspnoea , tachypnoeaand a mild B) High-flow humidified oxygen via fever of 39.2 C for the past 4 days. On a tight nasal cannula examination, tracheal tug is seen, and on C) Intravenous Antibiotics auscultation, crackles and wheezes are heard. The baby was born prematureat 34+3. D) Intravenous Palivizumab Her observationsare as follows: HR: 168, BP: 110/61, RR: 66, SaO2: 90% E) Nebulized Salbutamol What is the most appropriate next step in managingthispatient? SUBCOSTAL INTERCOSTAL RETRACTIONS RETRACTIONS TACHYPNOEA HEAD BOBBING NASAL FLARING TRACHEAL TUG CYANOSIS GRUNTING & TRIPOD WHEEZE POSITION STRIDOR SIGNS OF RESPIRATORY DISTRESS IN INFANTS NASAL FLARING TACHYPNOEA GRUNTING STRIDOR USE OF ACCESSORY MUSCLES INTERCOSTAL/ SUBCOSTAL RETRACTIONS TRACHEAL TUG PALE/ CYANOSIS WHEEZE SUPRACLAVICULAR RETRACTIONS HEAD BOBBING TRIPOD POSITION BRONCHIOLITIS PATHOPHYSIOLOGY CLINICAL FEATURES • Common cause of serious lower respiratory tract • Initial prodrome • Leading cause of hospital admission in infants • Coryza • Most commonly caused by respiratory syncytial virus • Fever • Most prevalent in winter • Risk factors Underlying lung disease, prematurity, • Dry cough immunodeficiency, congenital heart disease • Respiratory distress • Difficulty feeding • Commonly occurs at 3-6 months • Apnoea • Maternal IgG protects against RSV • Widespread fine end-inspiratory crackles ± wheeze DIAGNOSIS TREATMENT • Clinical diagnosis • Nasopharyngeal aspirate test for RSV • Supportive care • Chest X-rayà exclude pneumonia, pneumothorax • Antipyretics e.g. paracetamol/ ibuprofen • Hydration support (e.g. NG tube/ IV fluids) • Relieve nasal congestion e.g. saline drops • Oxygen and ventilation if needed PREVENTION • No evidence for antibiotics, bronchodilators, corticosteroids • Consider hospital admission if: • Palivizumab • Poor feeding (<50% usual intake) • Vaccine • Monoclonal antibody against RSV • Signs of respiratory distress, 2aO ≤94% • Given to high-risk infants • History of apnoea, • Resp rate >70 Viral Induces Wheeze PATHOPHYSIOLOGY CLINICAL FEATURES • Rhinovirus • Causes inflammation and oedema in the airways Fever, cough and coryzal symptoms for 1-2 days preceding • Restricted space for air to flow Short of breath • Narrow space for air to flow causes a wheeze Respiratory distress • Eventually leads to respiratory distress if it gets Expiratory wheeze THROUGHOUT THE CHEST worse DIAGNOSIS TREATMENT • Clinical diagnosis • Management is the same as acute asthma • Oral swab • Supplementary oxygen • Bronchodilators (SABA, Ipratropium bromide) • IV magnesium sulphate • IV Aminophylline • Steroids (Reduce inflammation in the airways) • Intubation and ventillationSTEEPLE SIGN STRIDOR BARKING COUGHA 16-month-old boy presents to the A) Intravenous Dexamethasone emergency department increased work of 150mcg/kg breathing, stridor and a seal like cough for the past hour. The child’s observationsare as B) Oral Dexamethasone 150mcg/kg follows: HR: 110, BP: 105/57, RR: 40, SaO2: o C) Intravenous Antibiotics 98%, Temp38.1 C. D) Sit the child up What is the most appropriate next step in managingthispatient? E) Intubation and ventilationA 16-month-old boy presents to the A) Intravenous Dexamethasone emergency department increased work of 150mcg/kg breathing, stridor and a seal like cough for the past hour. The child’s observationsare as B) Oral Dexamethasone 150mcg/kg follows: HR: 110, BP: 105/57, RR: 40, SaO2: o C) Intravenous Antibiotics 98%, Temp 38.1 C. D) Sit the child up What is the most appropriate next step in managingthispatient? E) Intubation and ventilationA 3-year-old boy comes to the emergency A) Endotracheal Intubation department with difficulty breathing, high fever and a low-pitched voice that started 2 B) Oral Dexamethasone 150mcg/kg days ago. His parents mention that he has been droolingexcessively . You noticethat he C) Intravenous ceftriaxone is sitting forward with his hands on his D) X-Ray knees. His observations are as follows: HR: 155, BP: 110/51, RR: 43, SaO2: 90%, Temp 39.2 C E) Nebulised salbutamol What is the most appropriate next step in managingthispatient?A 3-year-old boy comes to the emergency A) Endotracheal Intubation department with difficulty breathing, high fever and a low-pitched voice that started 2 B) Oral Dexamethasone 150mcg/kg days ago. His parents mention that he has been droolingexcessively . You noticethat he C) Intravenous ceftriaxone is sitting forward with his hands on his D) X-Ray knees. His observations are as follows: HR: 155, BP: 110/51, RR: 43, SaO2: 90%, Temp 39.2 C E) Nebulised salbutamol What is the most appropriate next step in managingthispatient? CROUP PATHOPHYSIOLOGY CLINICAL FEATURES • Also known as laryngotracheobronchitis • Initial prodrome • Upper respiratory tract infectiooedema • Coryza, fever & inflammatory cell infiltratioairway • Sudden-onset seal-like barking cough narrowing • Most commonly caused by parainfluenza • Inspiratory stridor virus • Respiratory distress • Most prevalent in late autumn • Symptoms worse at night- typically last 4-7 days • Commonly occurs at 6-36 months • Severity can be based on Westley Score DIAGNOSIS TREATMENT • Minimal handling • Clinical diagnosis • Oral dexamethasone, supportive care • Consider neck X-ray • Admit if moderate/severe/ respiratory failure • Steeple sign • Oxygen • Nebulised adrenaline (1:1000) • Consider intubation/ PICU referral EPIGLOTTITIS PATHOPHYSIOLOGY CLINICAL FEATURES • Life-threatening emergency • Early: Dysphagia & Drooling • Bacterial invasion Inflammation of epiglottis & • Late: Distress (respiratory) & Dysphonia surrounding mucosa à oedema & inflammatory • Muffled voice cell infiltratioairway narrowing • Tripod positioning • Primarily caused by Haemophilus influenza type B • Fever • Rare due to widespread vaccination • Inspiratory stridor • Typically occurs fro-12 years old • Rapid onset • Risk of rapid deterioration • Cough is absent DIAGNOSIS TREATMENT • Clinical diagnosis • Airway must be secured BEFORE investigations • Immediate airway management • Consider laryngoscopy • Endotracheal intubation • High flow oxygen • Lateral neck X-ray Thumbprint sign • Call anaesthetist/ ENT for help • Blood cultures • Empiric IV broad-spectrum antibiotics • Throat swab • Check vaccination status • Rifampicin for chemoprophylaxis of close contacts CYSTIC FIBROSIS PATHOPHYSIOLOGY CLINICAL FEATURES • Pulmonary (most common) • Autosomalrecessive disorder • Recurrent chest infections • CFTR gene defect impaired sodium, chloride transportacross • In children S.aureus& H.influenza epithelial cells→ thick, dehydrated secretions • In teens & adultsP.aeruginosa • Bronchiectasis • Chronic productive cough • Chronic sinusitisnasal polyps TREATMENT • Progressive decline in lung function • Gastrointestinal • Tertiary referral & MDT care • Meconium ileus • Failure to pass the first stool in neonates • Pulmonary disease • Bilious vomiting • Chest physiotherapy twice daily • Abdominal distension • Mucolytics e.g. rhDNase, Hypertonic saline • Antibiotics for exacerbations/ prophylaxis • Distal intestinal obstruction syndrome • Prophylactic Floxacillinfor 3-6 year olds • Occurs later in childhood • Regular monitoring of1FE • Malabsorption due to pancreatic insufficiency • Bronchodilators • Steatorrhea, failure to thrive, diabetes • Bilateral lung transplantaend-stage disease • Infertility in men, sub-fertility in women • Pancreatic insufficiency • Salty taste of skin • Pancreatic enzymes reon) • Screen for diabetes, insulin for treatment • Gastrointestinal DIAGNOSIS • Nutritional optimisation (including fat-soluble vitamins) • Fertility • Newborn Screening • In-vitro fertilisation in sterile males, genetic counselling • Immuno-reactive trypsin test • CFTR modulators • Sweat chloride testconfirmatory test (>60 nmol/L) • Genetic testing for CFTR geneA 6-year-old boy comes into the emergency A) Haemophilus Influenzae B department with tachypnoea and breathlessness. His mom mentions that his B) Respiratory Syncytial Virus coughs come and go, and he developssevere left sided chest pain on severe coughing. His C) Parainfluenza virus mom mentionsthat she cannot remember if he has had his routine vaccinations in their D) Group A Streptococcus homecountry. E) Bordetella Pertussis Whatis the mostlikelycausativeorganismof hissymptoms?A 6-year-old boy comes into the emergency A) Haemophilus Influenzae B department with tachypnoea and breathlessness. His mom mentions that his B) Respiratory Syncytial Virus coughs come and go, and he developssevere left sided chest pain on severe coughing. His C) Parainfluenza virus mom mentionsthat she cannot remember if he has had his routine vaccinations in their D) Group A Streptococcus homecountry. E) Bordetella Pertussis Whatis the mostlikelycausativeorganismof hissymptoms? WHOOPING COUGH (PERTUSSIS) PATHOPHYSIOLOGY CLINICAL FEATURES • Catarrhal stage: • Coryza, fever • Severe paroxysmal coughing • Caused by Bordetella pertussis (Gram- • Dry and prolonged negative) • Followed by ahigh-pitched inspiratory whoop • Transmitted via airborne droplets (coughing) • Accompanied by tongue protrusion • Posttussive vomiting • Rednessin face, arms flailing • May lead to petechiae on the face • Convalescent state • Persistentcough (lasting up to 3 months) DIAGNOSIS TREATMENT • Notifiable diseaseà contact public health • Supportive care • Pernasalswab for PCR/ culture • Macrolide antibiotics (do not alter disease • Blood cultures will always be negative course) • Lymphocytosis • Children and pregnant women receive vaccinationA 14-year-old boy comes to the General A) Switch to moderate dose Practitionerfor his annualasthmareview. He beclomethasone is currently on Salbutamol, low-dose beclomethasone and Montelukast inhalers. B) Switch to Maintenance and His mother mentions that he still feels reliever therapy breathlessduring the nighttimeand uses his inhalersdaily. C) Stop Montelukast and trial ipratropium What is the next step in managing this patient? D) Stop Montelukast and start Salmeterol E) Refer for specialist managementA 14-year-old boy comes to the General A) Switch to moderate dose Practitionerfor his annualasthmareview. He beclomethasone is currently on Salbutamol, low-dose beclomethasone and Montelukast inhalers. B) Switch to Maintenance and His mother mentions that he still feels reliever therapy breathlessduring the nighttimeand uses his inhalersdaily. C) Stop Montelukast and trial ipratropium What is the next step in managing this patient? D) Stop Montelukast and start Salmeterol E) Refer for specialist management STEPWISE MANAGEMENT OF CHRONIC ASTHMA IN CHILDREN GIVE SABA AS REQUIRED TO ALL PATIENTS STEP 1 STEP 2 STEP 3 STEP 4 Refer to paediatrician for < 5 years Paediatric dose ICS Add LTRA specialist management 5 -12 years Paediatric dose ICS Add LABA/ LTRA Increase dose of ICS + LABA/ Refer to paediatrician for LTRAOR add LABA + LTRA specialist management ALL CHILDREN SHOULD USE A pMDI WITH SPACER DEVICE ICS = INHALED CORTICOSTEROID SABA = SHORT-ACTING BETA AGONIST ADAPTED FROM BTS GUIDELINES LABA = LONG-ACTING BETA AGONIST LTRA = LEUKOTRIENE RECEPTOR ANTAGONIST DIFFERENT TO NICE GUIDELINES pMDI = PRESSURISED METRED-DOSE INHALER STEPWISE MANAGEMENT OF CHRONIC ASTHMA IN CHILDREN GIVE SABA AS REQUIRED TO ALL PATIENTS STEP 1 STEP 2 STEP 3 STEP 4 Step 5 Stop LTRA and refer to - < 5 years Moderate-dose Add LTRA paediatrician for specialist ICS management 5 -16 years Paediatric low- Paediatric low -dose ICS Paediatric low-dose ICS MART (Low- MART dose) (Moderate- dose ICS + LTRA + LABA dose) ICS = INHALED CORTICOSTEROID SABA = SHORT-ACTING BETA AGONIST LABA = LONG-ACTING BETA AGONIST LTRA = LEUKOTRIENE RECEPTOR ANTAGONIST ADAPTED FROM NICE GUIDELINES pMDI = PRESSURISED METRED-DOSE INHALER MART = MAINTENENCE AND RELIEVER THERAPY ACUTE ASTHMA IN CHILDREN MODERATE SEVERE LIFE-THREATENING NEAR-FATAL • Increasing symptoms of • Inability to complete • Confusion asthma sentences in one breath • Hypotension • Exhaustion CLINICAL FEATURES • Silent chest • Tachycardia • Arrhythmia • Cyanosis • Poor respiratory effort • Respiratory rate ≥ 25/min •PaO2 <8 kPa Raised PaCO2 and/or - requiring mechanical VITAL SIGNS • Heart rate ≥ 110/min • Normal PaCO2 ventilation with raised inflation pressures OXYGEN SATURATIONS ≥ 92% ≥ 92% < 92% PEFR ≥ 50–75% 33-50% <33% • SABA via spacer • High flow oxygen (aim for 94-98%) • Oral prednisolone • SABA via an oxygen-driven nebuliser (back to back) MANAGEMENT • Oral prednisolone • Consider nebulised ipratropium bromide, magnesium sulphate • PICU referral if not responding (intravenous routes can be used) NEONA TAL RESPIRA TOR Y DISTRESS SYNDROME PATHOPHYSIOLOGY CLINICAL FEATURES • Surfactant is produced in the final trimester • Impaired secretion of surfnotant • Occurs shortly after birth. reduction of alveolar surface tension • Respiratory distress increased alveolar collimpaired gas exchang→ hypoxia and hypercapnia • Risk factorprematurity, maternal diabetes, C-section, perinatal asphyxia • Risk of pneumothorax & PDA TREATMENT • Supportive care DIAGNOSIS • Nasal CPAP • Prolonged oxygen therapy has risks: • Retinopathy of prematurity • Clinical diagnosis • Intraventricular haemorrhage • ABG • Patent ductus arteriosus • Chest X-rayground glass infiltrate with • Bronchopulmonary dysplasia air bronchogram • Artificial surfactant via endotracheal tube • Antenatal corticosteroids given to mother prior to delivery if premature birth expected FINALSEAZY Paeds Infectious Disease Ravanth Baskaran AFHEAA 3-day old baby has become increasingly A) Neonatal Sepsis irritable neonatal intensive care unit. She was born 33+6 weeks premature . Her notes B) Neonatal Encephalitis record that the duration between the rupture of membrane and delivery was 19 C) Neonatal Septic Shock hours. The observations of the baby are as follows: HR: 180, BP: 140/81, RR: 33, SaO2: 97%,D) Roseola Infantum Temp38.8 E) Measles What is the most likely diagnosis this baby has?A 3-day old baby has become increasingly A) Neonatal Sepsis irritable neonatal intensive care unit. She was born 33+6 weeks premature . Her notes B) Neonatal Encephalitis record that the duration between the rupture of membrane and delivery was 19 C) Neonatal Septic Shock hours. The observations of the baby are as follows: HR: 180, BP: 140/81, RR: 33, SaO2: 97%,D) Roseola Infantum Temp38.8 E) Measles What is the most likely diagnosis this baby has? • Macrophages, Lymphocytes, Mast cells release cytokines, I, NONF • Vasodilation and increased permeability causes fluid shift to the extracellular space Neonatal Sepsis • Deposition of fibrin through the body causes clotting factors to be used up (DIC) • Hypo-perfused tissue leads to anaerobic respiration (raised lactate) NEONA TAL SEPSIS SIGNS AND SYMPTOMS CAUSES FEVER, HYPOTHERMIA GROUP B STREP POOR FEEDING/VOMITING E.COLI CRYING OR CHANGE IN BEHAVIOUR FLOPPY TONE STAPH EPIDIDERMIS CYANOSIS OR MOTTLED APPREARANCE PSEUDOMONAS AERUGINOSA RESPIRATORY DISTRESS (HEAD BOBBING, NASAL KLEBSIELLA FSEIZURE ENTEROBACTER RISK FACTORS MANAGEMENT OXYGEN PROM > 18 HRS FLUIDS LOW BIRTH WEIGHT PREMATURE ANTIBIOTICS RAISED TEMPERATURE IN MOTHER LACTATE (CBG) BLOOD CULTURES MATERNAL CHORIOAMNIONITIS URINE OUTPUT https://www.healthline.com/health/cutis-marmorata MENINGIOCOCCAL SEPT ACAEMIA LUMBAR PUNCTURE OXYGEN FLUIDS ANTIBIOTICS LACTATE (CBG) BLOOD CULTURES URINE OUTPUT NICU http://www.mrfpaediatricguide.info/diagnosis.php.htmlA 4-year-old boy comes to the General A) Intravenous Ceftriaxone Practitioner with his mother complaining of malaise and fever over the past week. On B) High Dose Aspirin examination, you notice bilateral conjunctivitis, cervical lymphadenopathy C) Intravenous Fluids and an erythematous rash on his torso. His tongueappearsas so: D) Supportive Management E) High Dose Aspirin and Intravenous Immunoglobulins Whatis the mostappropriatetreatment?A 4-year-old boy comes to the General A) Intravenous Ceftriaxone Practitioner with his mother complaining of malaise and fever over the past week. On B) High Dose Aspirin examination, you notice bilateral conjunctivitis, cervical lymphadenopathy C) Intravenous Fluids and an erythematous rash on his torso. His tongueappearsas so: D) Supportive Management E) High Dose Aspirin and Intravenous Immunoglobulins Whatis the mostappropriatetreatment? STRAWBERRY TONGUE CRACKED LIPS CERVICAL LYMPHADENOPATHY KAWASAKI DISEASE WIDESPREAD BILATERAL ERTHEMATOUS DESQUAMATION OF RASH PALMS AND TOES CONJUNCTIVITIS FEVER PERSISTING > 5 DAYS • ACUTE: FEVER, RASH, LYMPHADENOPATHY (1 WEEKS) • SUBACUTE: DESQUAMATION, ARTHRALGIA (2-4 WEEKS) KAWASAKI • CONVALSCENT: REGRESSING PHASE WHERE EVEYTHING DISEASE STARTS TO BECOME NORMAL HIGH DOSE ASPIRIN IVIG TRANSTHORACIC US (CORONARY ARTERY ANEURYSMS)A 6-year-old girl comes to the General A) Thrombocytopaenia Practitioner with her father complaining of abdominal pain, arthralgia and skin lesions B) New murmur (See Picture). The symptoms were said to have started 3 weeks ago. She is well at rest C) Conjunctivitis and her observationsare as follows, HR: 120, BP: 110/61, RR: 20, SaO2: 97%, Temp37.1. D) Neck Stiffness E) Haematuria Further evaluation is likely to show which of the following?A 6-year-old girl comes to the General A) Thrombocytopaenia Practitioner with her father complaining of abdominal pain, arthralgia and skin lesions B) New murmur (See Picture). The symptoms were said to have started 3 weeks ago. She is well at rest C) Conjunctivitis and her observationsare as follows, HR: 120, BP: 110/61, RR: 20, SaO2: 97%, Temp37.1. D) Neck Stiffness E) Haematuria Further evaluation is likely to show which of the following? THE 6 RASHES FIRST SECOND THIRD FOURTH FIFTH SIXTH MEASLES SCARLET FEVER RUBELLA DUKES’ DISEASE PARVOVIRUS B19 ROSEOLA INFANTUMA 4-month-old baby is brought into the A) Pneumonia emergencydepartmentby his mother. She is concerned about a rash he has developed B) Otitis Media behind his ears yesterday. She also reports that he hasdevelopedcoryzalsymptomsand C) Encephalitis diarrhea over the past 7 hours. On examination, you notice conjunctivitis. The D) Myocarditis babyseemsirritableandrefusingfeeds. E) Gastroenteritis What is the most likely complication this babywoulddevelop?A 4-month-old baby is brought into the A) Pneumonia emergencydepartmentby his mother. She is concerned about a rash he has developed B) Otitis Media behind his ears yesterday. She also reports that he hasdevelopedcoryzalsymptomsand C) Encephalitis diarrhea over the past 7 hours. On examination, you notice conjunctivitis. The D) Myocarditis babyseemsirritableandrefusingfeeds. E) Gastroenteritis What is the most likely complication this babywoulddevelop? MEASLES SCARLET FEVER MEASLES VIRUS GROUP A STREP (PYOGENES) 10-12 DAYS AFTER EXPOSURE RED-PINK BLOTCHY MACULAR RASH WITH A ROUGH SANDPAPER TEXTURE FEVER, CORYZAL SYMPTOMS AND CONJUNCTIVITIS KOPLIK SPOTS FEVER, LETHARGY, SORE THROAT (TONSILLITIS) RASH STARTS ON THE FACE (BEHIND THE EARS) STRAWBERRY TONGUE, CERVICAL LYMPHADENOPATHY MACULAR RASH WITH FLAT LESIONS NOTIFIABLE DISEASE MX: PHENOXYMETHYLPENNICILLIN FOR 10 DAYS OTITIS MEDIA IS THE MOST COMMON COMPLICATION NOTIFIABLE DISEASE, 24HR SCHOOL EXCLUSION https://ww/managementscarlet-fever-paediatric https://www./media/259736/viewkoplhttps://w/conditions/measlehttps://www.healthline.com/health/strmedicine/ aediatricsarticle/1087062 RUBELLA DUKES’ DISEASE RESPIRATORY DROPLETS SIMILAR TO RUBELLA ERYTHAMATOUS MACULAR RASH (3 DAYS) ENLARGED LYMPH NODES NON-SPECIFIC VIRAL RASHES NO ORGANISM OR EXPLANATION NOTIFIABLE DISEASE RARE COMPLICATIONS: THROMBOCYTOPENIA AND ENCHEPHALITIS CONGENITAL RUBELLA SYNDROME: DEAFNESS, BLINDNESS, CONGENITAL HEART DISEASE httwww.nh/conditions/rubella/A 7-year-old boy presents to the General A) Roseola Infantum Practitioner with an erythematous macular rash that came on today. His mother B) Parvovirus B19 mentions that he has had a high fever of 39.2 C for the past 3 days which has abated. C) Hand Foot Mouth Disease His past medical history includes sickle cell D) Molluscum Contagiosum anemia. What is the most likely diagnosis given the E) Rubella patient’spresentation?A 7-year-old boy presents to the General A) Roseola Infantum Practitioner with an erythematous macular rash that came on today. His mother B) Parvovirus B19 mentions that he has had a high fever of 39.2 C for the past 3 days which has abated. C) Hand Foot Mouth Disease His past medical history includes sickle cell D) Molluscum Contagiosum anemia. What is the most likely diagnosis given the E) Rubella patient’spresentation? PARVOVIRUS B19 ROSEOLA INFANTUM SLAPPED CHEEK APPEARANCE HHV-6 1-2 WEEKS AFTER INFECTION WITH HIGH FEVER THAT MILD FEVER, CORYZAMUSCLE ACHE AND COMES ON FOR 3-5 DAYS AND DISAPPEARS SUDDENLY LETHARGY CORYZAL SYMPTOMS, CERVICAL LYMPHADENOPATHY, DIFFUSE BRIGHT RED RASH ON CHEEKS 2- 5 DAYS AFTER EXPOSURE SORE THROAT NET-LIKE (RETICULAR) RASH COULD MILD ERYTHEMATOUS MACULAR RASH ACROSS THE APPEAR A FEW DAYS LATER ON THE BODY BODY RECOVERY WITHIN A WEEK; NO SCHOOL EXCLUSION APLASTIC ANEMIA, PREGNANCY RELATED COMPLICATIONS (FETAL DEATH), FEBRILE CONVULSIONS DUE TO HIGH TEMPERATURES ENCHEPHALITIS OR MENINGITIS https://www.nhs.uk/conditionsslapped-cheek-syndrome/ps://www.babycenter.com/health/illness-and-infection/roseola_1616 HAND FOOT MOUTH MOLLUSCUM CONT AGIOSUM DISEASE MOLLUSCUM CONTAGIOSUM VIRUS (POXVIRUS) COXSAKIE A VIRUS (3-5 DAYS) SMALL FLESH COLOURED PAPULES WITH A TIREDNESS, SORE THROAT, DRY COUGH, RAISED CENTRAL DIMPLE TEMPERATURE PAINFUL MOUTH ULCERS, BLISTERS ACROSS THE BODY SUPPORTIVE MANAGEMENT DO NOT SHARE MATERIALS DIAGNOSED CLINICALLY SUPERINFECTIONS CAUSE OF SCRATCHING SUPPORTIVE MANAGEMENT (10 DAYS) (TOPICAL FUSIDIC OR ORAL FLUCLOXACILLIN) DO NOT SHARE MATERIALS https://en.wikipedia.org/wiki/Hand,_foot,_anhttps://walk/patient-ed-contagiosum/scum SEBORRHOEIC DERMA TITIS NAPPY RASH AFFECTS AREA WITH LARGE AMOING OF OIL GLANDS (SCALP, NASOLABIAL FOLDS, CONTACT DERMATITIS (FRICTION) EYEBROWS) STAPH/STREP OR CANDIDA MALASSEZIA FURFUR RF: ORAL ABX PREDISPOSES TO CANDIDA INFECTION INFANTILE: CRADLE CAP SORE, RED INFLAMMED SKIN AROUND THE NAPPY REGION MX (BABY): BABY/VEGETABLE/OLIVE OIL WHITE PETROLEUM JELLY CLOTRIMAZOLE OR MICONAZOLE EROSIONS/ULCERATIONS MX (ADULT): KETOCONAZOLE SHAMPOO MX: SWITCH TO HIGH ABSORBENT NAPPIES, AREA DRY, CLEAN WITH WATER OR GENTLE ALCOHOL FREE TOPICAL STEROIDS PRODUCTS, DO NOT WEAR NAPPY https://community.whattoexpect.com/forums/african-american-mommies/topic/help-me-is-this-cradle-cap-85433749.htmlrn/nappyrash-tipsA 3-year-old boy presents to the General A) Permethrin 5% Practitioner widespread pruritis, excoriation marks and irritability. On examination, you B) Hydrogen Peroxide cream noticethison hishands: C) Topical steroids D) Skeletal survey E) Malathion 0.5% What is the next step in managing this patient?A 3-year-old boy presents to the General A) Permethrin 5% Practitioner widespread pruritis, excoriation marks and irritability. On examination, you B) Hydrogen Peroxide cream noticethison hishands: C) Topical steroids D) Skeletal survey E) Malathion 0.5% What is the next step in managing this patient? SCABIES IMPETIGO SARCOPTES SCABIES GROUP A STREP (PYOGENES) PRURITIS, SMALL RED SPOTS WITH TRACK MARKS (BETWEEN FINGER WEBS) GOLDEN CRUSTED LESIONS MX: PERMETHRIN CREAM (5%) APPLIED ON WHOLE HIGHLY CONTAGIOUS AND SCHOOL EXCLUSION BODY (8-12 HOURS) APPLIES MALATHION (0.5%) SECOND LINE MX: ANTISEPTIC CREAM (H 2 2REAM) ORAL IVERMECTIN FOR DIFFICULT OR CRUSTED TOPICALFUSIDIC ACID (2 LINE) LESIONS EXTENSIVE DISEASE: ORAL FLUCLOXACILLIN BULLOUS MANIFESTATION = STRAIGHT TO ALL HOUSEHOLD/CLOSE CONTACTS TREATED THE FUSIDIC ACID SAME WAY AS HIGHLY CONTAGIOUS ITCHING: CROTAMITON CREAM https://www.nhs.uk/conditions/scabies/ https://www.babycentre.co.uk/a548384/impetigoin-babies PERTUSIS (WHOOPING DIPTHERIA COUGH) BORDETELLA PERTUSSIS (GRAM –VE ENCAPSULATED) CORYNEBACTERIUM DIPHTHERIAE (GRAM +VE ROD) CORYZAL SYMPTOMS WITH A LOW GRADE FEVER AND DRY COUGH COLD - NASAL DISCHARGE – PURULENT – BLOODSTAINED INSPIRATORY WHOOP WHEN THE COUGHING ENDS CULTURE FROM NASAL SECRETIONS COUGH REALLY HARD – FAINTING/SYNCOPE MACROLIDES: AZITHROMYCIN, ERYTHROMYCIN, CLARITHROMYCIN (CO-TRIMOXAZOLE) NASOPHARYNGEAL SWAB WITH PCR TESTING SINGLE REINFORCING DOSE OF DIPTHERIA >2 WEEKS ANTI- PERTUSSIS TOXIN IGG VACCINE NOTIFIABLE DISEASE ERYTHROMYCIN FOR CONTACTS MACROLIDES: AZITHROMYCIN, ERYTHROMYCIN, CLARITHROMYCIN (CO-TRIMOXAZOLE) COMPLICATIONS: CARDIOMYOPATHY, NEUROPATHY, NEPHRITIS COMPLICATION: BRONCHIECTASIS SALMON P A TCHES STRAWBERR Y NAEVUS BIRTH MARKS CAUSED BY DILATATIONS OF TINY BLUE OR RED SPOTS OR PATCHES BLOOD VESSELS HEAD OR NECK TEND TO FADE BY 1-2 YEARS IF AGE SURGICAL INTERVENTION REQUIRED IF VISUAL PINK, RED, FLAT, IRREGULARLY SHAPED OR AIRWAY DISTURBANCE SELF RESOLVING INVOLUTE SPONTANEOUSLY PROPRANOLOL FOR PROLIFERATING STRAWBERRY NAEVUS https://www.nhs.uk/conditions/birthmarks/s://dermnetnz.orgtopics/infantilehaemangiomadefinition-and-pathogenesisA 7-year-old boy presents to the General A) Exclude for 5 days Practitioner with increased pruritis on his head. On examination, you notice the B) Exclude for 4 days presenceof smalllice in hishair. C) Exclude for 24 hours What advice would you give the patient’s parentsregardingschoolexclusion? D) No Exclusion E) Exclude until recoveredA 7-year-old boy presents to the General A) Exclude for 5 days Practitioner with increased pruritis on his head. On examination, you notice the B) Exclude for 4 days presenceof smalllice in hishair. C) Exclude for 24 hours What advice would you give the patient’s parentsregardingschoolexclusion? D) No Exclusion E) Exclude until recovered NO EXCLUSION 24 HOURS AFTER ABX 2 DA YS AFTER ABX -CONJUNCTIVITIS -PERTUSSIS (OR 21 DAYS AFTER -ROSEOLA INFANTUM SCARLET FEVER ONSET OF SYMPTOMS) -EBV -IMPETIGO -HEAD LICE -THREAD WORM 2 D AYS -HFMD TH DIARRHOEA AND VOMITTING -PARVOVIRUS B19DISEASE) 4 DA YS 5 D AYS UNTIL RECOVERED MEASLES (AFTER ONSET OF RASH) -RUBELLA (AFTER ONSET TO -SCABIES (TREATED) RASH) -INFLUENZA (RECOVERED) -MUMPS (AFTER ONSET OF SWOLLEN GLANDS) FINALSEAZY Post Lecture Notes Pulmonology FOREIGN BODY ASPIRA TION PATHOPHYSIOLOGY CLINICAL FEATURES • Sudden episode of coughing • Most cases in toddlers • Typically occurs with food • Choking • Right main bronchus is more often affected • Respiratory distress than the left main bronchus • Cyanosis • Widespread fine inspiratory crackles +/ - stridor • Focal area od diminished breath sounds DIAGNOSIS TREATMENT • Chest X-ray • Bronchoscopy • Most are not seen on a chest x-ray • Mother’s kiss procedure if foreign body stuck in nose • If radiolucent, sequelae of the obstruction • See paediatric choking algorithm are seen • Prevention: • Atelectasis • Unilateral hyperinflation • avoidance of easily aspirated foods until the • Mediastinal shift child is able to chew safely • feed sitting upright • Secondary pneumonia. • avoid playing whilst eating • Bronchoscopy à gold-standard • keep small objects out of reach. PAEDIATRIC CHOKING ALGORITHM ASSESS SEVERITY INEFFECTIVE COUGH EFFECTIVE COUGH ENCOURAGE COUGH CONTINUE TO CHECK FOR DETERIORATION UNCONSCIOUS CONSCIOUS OPEN AIRWAY 5 BACK BLOWS 5 BREATHS 5 THRUSTS START CPR (ABDOMEN FOR CHILD > 1 YEAR) ADAPTED FROM RESUS GUIDELINES VIRAL-INDUCED WHEEZE VS ASTHMA VIRAL-INDUCED WHEEZE ASTHMA No history/ family history of atopy History/ family history of atopy Symptom-free between bouts May be wheezy between bouts Precipitated by viral infection Precipitated by ‘triggers’ e.g. cold air, exercise, pollen Symptoms most common < 3 years old Symptoms persistent > 5 years old Unpredictable response to bronchodilators Significant response to bronchodilators PRIMAR Y CILIAR Y DYSKINESIA PATHOPHYSIOLOGY CLINICAL FEATURES • Autosomal recessive • Kartagener’s syndrome • Defect in the dynein arm of microtabsent/ • Recurrent sinusitnasal polyps dysfunctional cilia • Bronchiectasis • More common in consanguineous populations • Situs Inversudisplaced heart sounds • Infertility in men, sub-fertility in women DIAGNOSIS • Nasal nitric oxide test • Chest x-ray/ CT Chest • Situs invertus, dextrocardia, bronchiectasis TREATMENT • Similar to cystic fibrosis and bronchiectasis RESPIRATORY DISTRESS IN CHILDREN TRANSIENT TACHYPNOEA OF PERSISTENT PULMONARY MECONIUM ASPIRATION APNOEA OF PREMATURITY THE NEWBORN HYPERTENSION OF THE NEWBORN SYNDROME TERM • Preterm • Usually full-term • Usually full-term of post-term • Usually post-term CAUSE • Immature respiratory • Delayed resorption of lung • Failure of pulmonary vasodilation • Passage of meconium and centre fluid aspiration airway obstruction RISK • Preterm delivery • Caesarean delivery • Low oxygen in foetus • Foetal distress FACTORS • Preterm delivery (e.g. Meconium aspiration syndrome) • Intrapartum hypoxia ONSET • Within 3 days after birth • Within 2 hours after birth • Within 24 hours after birth • Immediately after birth • Apnoeic spells (> 20s) • Respiratory distress • Respiratory distress • Respiratory distress SYMPTOMS • Hypoxaemia • Hypotension • Green amniotic fluid DIAGNOSIS • Clinical diagnosis • Chest x-ray • Echocardiography • Chest x-ray • Supportive care • Supportive care • Supportive care • Neonatal resuscitation • Nasal CPAP • Consider inhaled nitric oxide • Supportive care TREATMENT • Caffeine citrate • Consider extracorporeal membrane • Consider inhaled nitric oxide oxygenation (ECMO) • Consider surfactant FINALSEAZY Post Lecture Notes Immunology JUVENILE IDIOPATHIC ARTHRITIS ENTHESITIS- RELATED SYSTEMIC POLYARTICULAR OLIGOARTICULAR PSORIATIC SERONEGATIVE STILLS DISEASE ENTHESITIS WITH SALMON-PINK RASH >5 JOINTS 4 JOINTS OR LESS SYMMETRICAL INFLAMMATORY HIGH SWINGING FEVERS SYMMETRICAL GIRLS < 6 YEARS POLYARTHRITIS ARTHRITIS WEIGHT LOSS MILD FEVER ANTERIOR UVEITIS SERONEGATIVE HLA B27 SWOLLEN LYMPH NODES REDUCED GROWTH ANA POSITIVE PSORIASIS JOINT AND MUSCLE PAIN ANEMIA RAISED CRP AND ESR NSAIDS DMARDS INTRA-ARTICULAR OR IM STEROIDS 8 WEEKS 12 WEEKS 16 WEEKS 6 IN 1 VACCINE (DIPTHERIA, TETANUS,6 IN 1 VACCINE (DIPTHERIA, 6 IN 1 VACCINE (DIPTHERIA, PERTUSSIS – WHOPPING COUGH, TETANUS, PERTUSSIS – TETANUS, PERTUSSIS – WHOPPING POLIO, HIB, HEP B) WHOPPING COUGH, POLIO, HIB, COUGH, POLIO, HIB, HEP B) HEP B) MEN B VACCINE MEN B PNEUMOCOCCAL ROTAVIRUS ORAL ROTAVIRUS 1 YEAR 3 YEARS 4 MONTHS 12 YEARS 2 IN 1 (HIB AND MEN C) HPV VACCINE 4 IN 1 (DIPTHERIA, TETANUS, PERTUSSIS, POLIO) PNEUMOCOCCAL MMR 14 YEARS MEN B 3 IN 1 (TETANUS, DIPTHERIA, MMR POLIO) MEN ACWY *ANNUAL INFLUENZA VACCINE