Skin conditions - Distribution- Eczema
- Inside of the arms
and the back of the knees (flexor surfaces)
- Chronic eczema is found on the ankles
more often than psoriasis
- Psoriasis
- Back of the elbows and front of the
knees (extensor surfaces)
- Similarities:
- Both tend to affect the hands, feet, and nape of the neck
- Both rashes appear
frequently on the scalp
UTI Cutoffs- Single organism cultured
- > 40 WBC
- +ve nitrities
- CFU cutoff
- 1E4 - 1E6?
- Depends on degree of suspicion, gender, etc
- Thickened urothelium on USS
Kidney scans
- DMSA
- Static scan
- Good for showing "missing" bits of kidney e.g. from scarring
- MAG3
- Shows renal elimination (dynamic)
- Good for monitoring reflux
Constipation- You should NEVER have poo in your rectum
- Shows loss of recto-colic reflex
- Takes months to return
- Fix with movicol/dulcolax
Failure to thrive
- Endogenous
- Inborn error of metabolism
- GI problems (e.g. gas and acid reflux) causing pain
- Absorption problems (Cystic fibrosis, diarrhoea, liver disease, celiac disease)
- Problems getting food in (e.g. cleft palate, tongue tie)
- Allergies (e.g. milk)
- Raised metabolism (e.g. parasites, asthma, urinary tract infections, fever-inducing infections, heart disease)
- Exogenous
- Physical inability to produce enough breastmilk
- Insufficient numbers of feeds (sleepy baby syndrome)
- Inability to procure formula when needed
- Purposely limiting total caloric intake
- Not offering sufficient age-appropriate solid foods for babies and toddlers over the age of six months
- Mixed
- e.g. A child who is not getting sufficient nutrition may act content so that caregivers do not offer feedings of sufficient frequency or volume
- e.g. A child with severe acid reflux who appears to be in pain while eating may make a caregiver hesitant to offer sufficient feedings
Fluid balance
- Dehydration
- 5% mild
- 10% moderate
- 15% severe
- Calculate needs based on surface area:
- Neonate 10%
- 3 years 30%
- 5 years 50%
- 12 years 75%
- Replacement
- Calculate maintenance fluids based on % of adult needs
- Add the additional deficit over 48 hours
- 2/3 in the first day
- 1/3 in the second day
- Check the sodium and switch to hypotonic fluid if necessary
Osmolar gap
- Twice the sodium and potassium, plus urea
- Gap is GLUCOSE and ALCOHOL
Notes- Kidney malformation
- Duplex normally fine
- Horseshoe => Obstruction
- Cloaca develops into urogenital system and rectum
- Some animals retain just a single opening
- Hypospadias = Birth defect of the urethra in the male that involves an abnormally placed urinary meatus
- Take bloods from external jugular, if you're brave!
- Buy the Oxford handbook of clinical specialties
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