Gwendoline Tan Lydia Akinola For Peer Teaching Society 21915 What we will cover Viralbacterial rashes in children Difficulty breathing Measles Prodrome cough coryza conjunctivitis ID: 502919
Download Presentation The PPT/PDF document "Paediatrics" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Paediatrics
Gwendoline
Tan
Lydia
Akinola
For Peer Teaching Society
21/9/15Slide2
What we will cover
Viral/bacterial rashes in children
Difficulty breathingSlide3Slide4
Measles
Prodrome
: cough,
coryza
, conjunctivitis,
Koplik
spots,
fever
Maculopapular
rash starts
behind
ears
Complications
encephalitis
giant
cell pneumonia
subacute
sclerosing
panencephalitis
febrile
convulsions
keratoconjunctivitis
, corneal ulceration
MMR
within 72h of measles contact for non-
immunised
child Slide5Slide6
Mumps
Fever, malaise,
parotitis
Becomes
bilateral in 70%
Complications
Pancreatitis
Orchitis
Meningitis/encephalitisSlide7Slide8
Rubella
Pink
macular
rash which starts on face and spreads to trunk
Suboccipital
and
postauricular
lymphadenopathy
In utero
1
st
to 4
th
week: eye anomaly
4
th
to 8
th
week: cardiac abnormality
8
th
to 12
th
week: deafnessSlide9Slide10
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 transfusionsSlide11
Roseola
infantum
(sixth disease
)
HHV6
High fever and MP rash when fever subsides
Febrile
convulsions (10-15
%)
Can
cause aseptic meningitis, hepatitisSlide12Slide13
Hand foot mouth disease
Coxsackie
A16/
enterovirus
71
S
ore
throat, fever, oral ulcers then vesicles on palms and
solesSlide14Slide15
Chickenpox
Varicella zoster virus (HHV3)
Can be caught from someone with shingles
Fever, rash often starting on back
Macule
papule vesicle ulcer crust
Complications:
purpura
fulminans
, necrotising fasciitis, pneumonia, meningitis
VZV
Ig
+
aciclovir
if immunosuppressedSlide16Slide17
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 encephalitisSlide18Slide19
Molluscum
contagiosum
Umbilicated
papules caused by Pox virus
Spread by direct contact
More extensive in those with eczema/HIV
Usually resolves w/o treatment in 18mthsSlide20Slide21
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
P
eeling
skin in
armpits/groin/fingers
and toes
Complications: OM, post-strep GN, rheumatic fever,
septicaemia
, pneumonia
P
enicillin
V
POSlide22Slide23
Impetigo
Contageous
staph/strep
skin infection
Erythematous
vesicular
golden honey-
coloured
crusted lesions
T
opical
mupirocin
or
fusidic
acid if mildFlucloxacillin
or
erythromycin if extensiveSlide24Slide25
Meningococcal septicaemia
N
on-blanching
purpuric
rash, fever, unwell child, shock
IM
benzylpenicillin
in community, IV ceftriaxone
Age
Organism
Neonate –
3m
GBS, E. coli,
Listeria
monocytogenes
1m – 6y
N.
meningitidis
,
S.
pneumoniae
, H.
influenzae
>6y
N.
meningitidis
, S.
pneumoniaeSlide26Slide27
Nappy rash
Ammoniac
Crease-sparing
Erythematous
Irritant dermatitis – barrier cream e.g.
Sudocrem
Candida
C
reases involved
S
atellite lesions
T
reat
with antifungalSlide28
Other rashes to revise
Eczema
Dermatitis
herpetiformis
Cellulitis/erysipelas
Henoch-Schonlein
purpura
Tinea
Scabies
Don’t forget to consider NAISlide29
Breathing difficultiesSlide30
Airway Assessment
Secretions or stridor
Foreign body
Unprotected airwaySlide31
Breathing assessment
Respiratory rate
Recession and use of accessory muscles
Oxygen saturations
Auscultation
Age
< 1 year
1-2
years
2-5 years
5-12 years
> 12 years
Resp.
Rate
30-40
25-35
25-35
20-25
15-20Slide32
Wheeze
Common
Rare
Infection
– bronchiolitis, viral induced wheeze, whooping cough, pneumonia
Cystic
fibrosis
Asthma
(> 1 year of age)
Cow’s milk
protein intolerance
Foreign
body inhalation
External compression of airway
Gastro-oesophageal reflux
Heart failure
Recurrent aspirationSlide33
Persistent cough
Common
Uncommon
Post-infection
Pertussis
Recurrent URTIs
Foreign body
Post-nasal drip
Gastro-oesophageal reflux
Asthma (exercise, night)
Cystic fibrosis
Cigarette
smoke
Tuberculosis
Habit
Immune deficiencySlide34
Respiratory distress
Symptom
Signs
Breathlessness
Tachypnoea
Difficulty talking
Tachycardia
Difficulty
feeding
Dyspnoea
Wheeziness
Recession
Sweatiness
Cyanosis
Nasal flaring
Use of accessory muscles
Expiratory grunting
Crackles
Downward
displacement of the lungSlide35
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)Slide36
AsthmaSlide37Slide38
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 treatmentSlide39
Asthma
What are the symptoms of life-threatening asthma?
What might you find on examination?
What might you find on spirometry?Slide40
Asthma
What are the side effects of chronic treatment?Slide41
Cystic fibrosisSlide42Slide43
Cystic fibrosis
Which other organs can be affected?
Name 3 ways that CF may present?
Name 5 people involved in CF MDTSlide44Slide45
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)Slide46
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 throatSlide47
Airway inflammation
Croup
Epiglottis
Time course
Days
Hours
Prodrome
Coryza
None
Cough
barking
Slight
if any
Feeding
Can drink
No
Mouth
Closed
Drooling
saliva
Toxic
No
Yes
Fever
< 38.5°C
>
38.5°C
Stridor
Rasping
Soft
Voice
Hoarse
Weak
or silentSlide48
Croup
Also known as acute
laryngotracheobronchitis
https
://www.youtube.com/watch?v=
XpPVYmALPoA
Most commonly caused by parainfluenza virus
What are the treatment options?Slide49
Pneumonia
Age
Pathogens
Neonates
Group B streptococcus
Escherichia
coli
(and other enterococci)
Chlamydia
trachomatis
Infants
Respiratory
virus (e.g. RSV, adenovirus)
Streptococcus pneumoniae
Haemophilus influenzae
Bordetella pertussis
Staphylococcus aureus
(RARE)
Children
Streptococcus pneumoniae
Haemophilus influenzae
Group A
streptococcus
Adolscents
As above
Mycoplasma pneumoniae
Chlamydia
pnuemoniaeSlide50
Whopping cough
http://www.parents.com/videos/v/97819228/what-does-whooping-cough-sound-
like.htmSlide51
Case
A 6 week old is seen in the ‘failure to thrive’ clinic. For 3 weeks her feeding has been poor with only 30-60 ml of milk taken each feed, in several short bursts.
There is no cough. Her respiratory rate is 60/min she has mild recession and inspiratory crackles.
(taken from Paediatrics: Clinical Case Uncovered)Slide52
Other conditions to revise
Bronchiolitis
URTIs include acute otitis media
Chronic lung disease of prematurity