12.10.04 Final bits

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

        • 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