Final year‎ > ‎

13.09.13 Passmedicine revision

Lichen
  • Planus
    • Purple, Pruritic, Papular, Polygonal rash 
    • On flexor surfaces
    • Wickham's striae over surface
    • Oral involvement common
  • Sclerosus
    • Itchy white spots typically seen on the vulva of elderly women

Septic six
  • Blood cultures
    • Before antibioitics are administered
  • Antibiotics
    • Mortality is reduced by 50% in severe sepsis if these are given within an hour of diagnosis
  • Oxygen -
    • Even if they are not desaturating
    • If they are severe sepsis, give 100% at 15L/m via a non-rebreath mask
  • Fluids 
    • They are highly likely to develop hypovoloemia 
  • Lactate
    • A lactate above 2 means ITU involvement
  • Catheterise
    • You need to monitor urine output

Childhood infections

InfectionFeatures
ChickenpoxFever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
MeaslesProdrome: irritable, conjunctivitis, fever
Koplik spots: white spots ('grain of salt') on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
MumpsFever, malaise, muscular pain
Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
RubellaRash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Erythema infectiosumAlso known as fifth disease or 'slapped-cheek syndrome'
Caused by parvovirus B19
Lethargy, fever, headache
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
Scarlet feverReaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
'Strawberry' tongue
Rash - fine punctate erythema sparing face
Hand, foot and mouth diseaseCaused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet




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