• 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
  

• 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
  
• NB Reflux grades I - IV

• You should NEVER have poo in your rectum
• Shows loss of recto-colic reflex
• Takes months to return
• Fix with movicol/dulcolax
  
• For months/years

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
  

• 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