Presentation of scarlet fever
Fever and sore throat prodromal
Sandpaper rash over legs and trunk
Swollen red tongue
Cervical lymphadenopathy
Needs 10 day course of penicillin V
Diagnosis and management of scarlet fever
Penicillin V first or azithromycin if allergic
Throat swab
Notifiable disease
Most common complication is otitis media
May cause rheumatic fever or glomerulonephritis
Measles
Prodrome of irritability, conjunctivitis,fever etc
Koplik spots on buccal mucosa
Rash starts behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent
Test for IgM antibodies within a few days of rash onset
Mainly supportive management
Commonest complications are otitis media, pneumonia, encephalitis, febrile
Whooping cough
Bordetella pertussis
Persistent cough with inspiratory whoop- may lead to subconjunctival haemorrhages
Test with nasal swab culture or PCR
Treat with a macrolide if onset of cough was within 21 days
Intussusception
Presents at 6-18 months Paroxysmal abdominal colic pain Drawing knees to chest and turning pale Bloodstained stool ‘red currant jelly’ late sign Sausage shaped mass in RUQ
target mass on US
Treated with air insufflation or surgery
Turner’s syndrome
Single X chromosome Short stature, webbed neck Bicuspid aortic valve, aortic coarctation Primary amenorrhoea High- arched palate
Kawasaki disease
High grade fever resistant to antipyretics Conjunctival injection Bright red cracked lips Strawberry tongue Cervical lymphadenopathy Red palms and soles which peel
Manage with high dose aspirin, IV immunoglobulin and echo to screen for CA aneurysms
Fragile X syndrome
Learning difficulties, autism Large low set ears with thin face and high arched palate Macroorchidism Hypotonia Mitral valve prolapse
Transient synovitis
3-8 years
acute hip pain following recent viral infection
Pain, limp and refusal to weight bear
Low grade fever
Infantile spasms (West’s syndrome)
4-8 months
Short recurring seizures
Progressive mental handicap
EEG shows hypsarrhythmia
CT shows diffuse or localised brain disease
Chickenpox
Fever
Itchy rash, initially maculopapular then becomes vesicular
Manage with calamine lotion
Hirchsprungs disease
Delayed passage of meconium
Abdominal distension
Dilated loops of bowel with fluid levels on plain abdominal X-ray
Necrotising enterocolitis
Main risk factor is prematurity
Abdominal distension and passage of bloody stools
X ray shows pneumatosis intestinalis and evidence of free air
Meconium ileus
Delayed passage of meconium and abdominal distension
Majority have CF
NO fluid level on xray
PR contrast study may be used therapeutically
Mesenteric adenitis
Central abdominal pain and URTI
Conservative management
Pyloric stenosis
FH and more common in males
Projectile non bile stained vomiting at 4-6 weeks of life
Diagnosis bus test feed or USS
Intussusception
Telescoping bowel 6-9 months of age Colicky pain, diarrhoea and vomiting Sausage shaped mass Red jelly stool Reduction with air insufflation
Hand, foot and mouth disease
Mild systemic upset, sore throat and fever
Oral ulcers
Followed later by vesicles on palms and soles
Differentials for constipation in a child
Dehydration Low fibre diet Medication Anal fissure Over-enthusiastic potty training Hypothyroidism Hirschsprung’s disease Hypercalcaemia Learning disabilities
Risk factors and treatment for DDH
Female sex Breech presentation Family history First born Oligohydramnios Birth weight > 5kg
Barlow and ortolani tests to dislocate and relocate an articulated femoral head
US or x ray if >4.5 months
May resolve itself or Pavlik harness or surgery
