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12.08.31 Paediatric images

Erythema nodosum
  • Raised rash on shins
  • Causes
    • Strep.
    • Drugs
  • Check ASOT

Erythema multiforme
  • Causes
    • Strep.
    • Mycoplasma
    • Herpes
    • EBV
  • Appearance
    • Confluent rash over whole body
    • Some central areas spared
  • Life-threatening complication
    • Steven-Johnson syndrome
      • Spread to mucous membranes

Parvovirus
  • Slapped cheek
  • Also mac-pap rash over trunk
  • Can cause aplastic crisis in sickle cell disease

Roseola infantum
  • Usually HHV-6
  • Easily confused with measles

Measles
  • Koplik spots are pathognomonic
  • Miserable
  • Red, watery eyes
  • Complications
    • Sub-acute sclerosing panencephalitis
      • Virus remains dormant for 2-20 years
      • Then => seizures, jerks, developmental regression
      • Irreversible
    • Ototis media
    • Encephalitis
    • Pericarditis
    • Myocarditis
    • Bronchopneumonia

Scarlet fever
  • From group A beta hemolytic Strep
  • Strawberry tongue, palatal petechiae
  • Complication
    • GAS sepsis has 50% mortality

Hand foot and mouth disease
  • Coxackie virus

Molluscum contagiosum
  • Pearl-shaped lesion, with central depression
  • From pox virus

Birth marks
  • Mongolian blue spot
    • Usually resolve spontaneously
  • Strawberry naevus
    • Benign
    • Resolve spontaneously
  • Port wine stain
    • Do not resolve
    • If seizures, check for AV malformation (Sterge-Webber syndrome)
  • Cafe au lait spot
    • cf Neurofibromatosis
    • If associated with precocious puberty => McCune Albright Syndrome

Neuroblastoma
  • Tumour tissue around eyes => Racoon eyes

Sacral defect
  • Usually benign
  • Worry if..
    • You can't see the base
    • Anything coming out
    • Any hair (cf spina bifida)

Congenital cystic adenomatoid malformation (CCAM)
  • Big air-filled cysts in lung
    • Look black on Xray
  • Push lung/heart out of the way
  • Causes breathing trouble

Neurofibromatosis
  • Leish nodules
    • On iris
  • Axillary freckling
  • Cafe at lait spots

NAI
  • Metaphyseal fractures
    • Usually very hard to break
  • Spiral fractures
  • Posterior rib fractures

Other notes
  • Gastroschisis
  • Imperforate anus associations
    • TOF
    • VATER
  • Pre-auricular sinus or skin tag => Check hearing
  • Club foot
    • Congenital talipes equinovarus
    • If you can move it back, probably fixable with physio
  • Kartagener Syndrome / Primary ciliary dyskinesia
    • cf Dextocardia
  • Necrotising enterocolitis => Lots of gas on AXR
  • Brushfield spots on iris => Downs'
  • CHARGE syndrome
    • Coloboma
    • Heart defect
    • Atresia of coanae
    • Retarded growth
    • Genital abnormalities
    • Ear abnormalities
  • Turners syndrome => Coarctation of aorta
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