Paediatrics

1. Paediatrics Gwendoline Tan Lydia Akinola For Peer Teaching Society 21/9/15

2. What we will cover • Viral/bacterial rashes in children • Difficulty breathing

4. Measles • Prodrome: cough, coryza, conjunctivitis, Koplik spots, fever • Maculopapular rash starts behind ears • Complications • encephalitis • giant cell pneumonia • subacutesclerosingpanencephalitis • febrile convulsions • keratoconjunctivitis, corneal ulceration • MMR within 72h of measles contact for non-immunised child

6. Mumps • Fever, malaise, parotitis • Becomes bilateral in 70% • Complications • Pancreatitis • Orchitis • Meningitis/encephalitis

8. Rubella • Pink macular rash which starts on face and spreads to trunk • Suboccipital and postauricularlymphadenopathy • In utero • 1st to 4th week: eye anomaly • 4th to 8th week: cardiac abnormality • 8th to 12th week: deafness

10. Erythema infectiosum (fifth disease) • Parvovirus B19 • Lethargy, fever, headache, ‘slapped-cheek' rash on face and limbs • Can cause marrow to stop producing RBCs  aplastic crisis  transfusions

11. Roseolainfantum (sixth disease) • HHV6 • High fever and MP rash when fever subsides • Febrile convulsions (10-15%) • Can cause aseptic meningitis, hepatitis

13. Hand foot mouth disease • Coxsackie A16/enterovirus71 • Sore throat, fever, oral ulcers then vesicles on palms and soles

15. Chickenpox • Varicella zoster virus (HHV3) • Can be caught from someone with shingles • Fever, rash often starting on back • Macule  papule  vesicle  ulcer  crust • Complications: purpurafulminans, necrotising fasciitis, pneumonia, meningitis • VZV Ig + aciclovir if immunosuppressed

17. Herpes simplex • Gingivostomatitis: vesicles on lips, gums, tongue, palate  high fever, painful eating and drinking • Cold sores – usually HSV1 • Complications • Eczema herpeticum • Herpetic whitlows • Blepharitis/conjunctivitis • Aseptic meningitis • HSV encephalitis

19. Molluscumcontagiosum • Umbilicated papules caused by Pox virus • Spread by direct contact • More extensive in those with eczema/HIV • Usually resolves w/o treatment in 18mths

21. Scarlet fever • Group A strep (S. pyogenes) – seen post-strep/impetigo • Fever, sore throat, strawberry tongue, rash • Rash 12-48h after fever, feels like sandpaper/goosebumps • Peeling skin in armpits/groin/fingers and toes • Complications: OM, post-strep GN, rheumatic fever, septicaemia, pneumonia • Penicillin V PO

23. Impetigo • Contageous staph/strep skin infection • Erythematous  vesicular golden honey-colouredcrusted lesions • Topical mupirocinor fusidic acid if mild • Flucloxacillinor erythromycin if extensive

25. Meningococcal septicaemia • Non-blanching purpuric rash, fever, unwell child, shock • IM benzylpenicillin in community, IV ceftriaxone

27. Nappy rash • Ammoniac • Crease-sparing • Erythematous • Irritant dermatitis – barrier cream e.g. Sudocrem • Candida • Creases involved • Satellite lesions • Treat with antifungal

28. Other rashes to revise • Eczema • Dermatitis herpetiformis • Cellulitis/erysipelas • Henoch-Schonleinpurpura • Tinea • Scabies • Don’t forget to consider NAI

29. Breathing difficulties

30. Airway Assessment • Secretions or stridor • Foreign body • Unprotected airway

31. Breathing assessment • Respiratory rate • Recession and use of accessory muscles • Oxygen saturations • Auscultation

32. Wheeze

33. Persistent cough

34. Respiratory distress

35. Case A 14 month old girl is seen with a 2 day history of a loud cough. She has a fever of 38.5°C, a respiratory rate of 35, stridor and marked intercostal and subcostal recession. She is playful and is feeding well. (taken from Paediatrics: Clinical Case Uncovered)

36. Asthma

38. Asthma Features of episode that suggest asthma include: • Nocturnal symptoms • Recurrent cough, shortness of breathe, wheeze • Worse following exposure to trigger • Personal/family history of atopy • Widespread wheeze on auscultation • Improvement with treatment

39. Asthma • What are the symptoms of life-threatening asthma? • What might you find on examination? • What might you find on spirometry?

40. Asthma What are the side effects of chronic treatment?

41. Cystic fibrosis

43. Cystic fibrosis • Which other organs can be affected? • Name 3 ways that CF may present? • Name 5 people involved in CF MDT

45. Case A 3 year old boy is in acute respiratory distress. There is no past history of note except he has not been immunised. He has a temperature of 40C, looks flushed and unwell, is drooling and has an inspiratory stridor. His cough is muffled. A colleague asks for help examining the boy’s throat. Which is the single most appropriate advice to give? (taken from Oxford Assess & Progress)

46. A – do not disturb the child, and call for senior help urgently B – give neb budesonide and then examine the throat C – go ahead and examine the throat, but have a laryngoscope and endotracheal tube to hand D – go ahead and examine the throat straight away to help make diagnosis E – site an IV line and give a dose of cefotaxime first, then examine the throat

47. Airway inflammation

48. Croup • Also known as acute laryngotracheobronchitis • https://www.youtube.com/watch?v=XpPVYmALPoA • Most commonly caused by parainfluenza virus • What are the treatment options?

49. Pneumonia

50. Whopping cough • http://www.parents.com/videos/v/97819228/what-does-whooping-cough-sound-like.htm