1)Scabies: Sarcoptes Scabeii

Affects: finger webs, neck, axilla,

All the drugs used to treat scabies in (adults and kids are Pml-gc, with only P being
safe for kids as far as i know (please confirm someone!)

Permethrin cream 5%
Permethrin kills the scabies mite and eggs. Permethrin is the drug of choice for the
treatment of scabies.
Two (or more) applications, each about a week apart from neck to toe, may be
necessary to eliminate all mites, particularly when treating crusted (Norwegian)
scabies.

Malathoin - wasn't mentioned in this article.

Lindane isn't used as first line therapy cause it's neurotoxic

Gamma benzene hexa chloride - dunno if it's used in kids.
Crotamiton isn't FDA approved for scabies in kids
Ivermectin is used for crusted and recurrent scabies?

Scabicide lotion or cream should be applied to all areas of the body from the neck
down to the feet and toes. In addition, when treating infants and young children,
scabicide lotion or cream also should be applied to their entire head and neck
because scabies can affect their face, scalp, and neck, as well as the rest of their
body. The lotion or cream should be applied to a clean body and left on for the
recommended time (which is??) before washing it off. Clean clothing should be worn
after treatment.

Bedding, clothing, and towels used by infested persons or their household, sexual,
and close contacts (as defined above) anytime during the THREE days before
treatment should be decontaminated by washing in hot water and drying in a hot
dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours. Scabies
mites generally do not survive more than 2 to 3 days away from human skin.

2)LP NEEDLE indications, contraindications, prerequisites, complications

SITE : L3-L4

INDICATIONS:
1. Diagnostic :Encephalitis
Polio,GBS,
TB meningitis
CNS Malignancy
Subarachnoid hemorhage

2. Therapeutic : Spinal Anesthesia

Giving Chemotherapeutics in leukemia
Intrathecal antibiotics

CONTRAINDICATIONS: Raised ICP , Local infection on site, thrombocytopenia

COMPLICATIONS:
Post-LP headache
Infection
bleeding
Cerebral herniation
Minor neurologic symptoms such as radicular pain or numbness
Back pain

3)Photo of a child with rash. 6 year old boy comes to clinic with history of leg pain,
abdominal pain and joint pain + rash.
a. Describe the rash
b. Whats the likely diagnosis
c. How will you diagnose the rash
d. Management
Answer: Henoch-Schnlein purpura. PALPABLE purpura. ESR will be high, serum igA
can be raised, ASO titer. general supportive therapy. Corticosteroids for very severe
disease. Aspirin for joint pain if ASO is high give penicillin. It's self limiting disease.
Complicateions are renal failure and intussusseption.

4)Whats the difference between persistant and chronic diarrhea?

Answer: Chronic diarrhea is due to malabsorption syndromes. Chronic diarrhea is
defined as diarrhea lasting for more than two weeks(same as persistent) and is
usually noninfectious (unlike persistent which is infectious)

5) ELECTROLYTES:
- So for sodium deficit and Potassium decifit, the formula is as follows:
Normal serum soduim-patients serum sodium multiplie by boy weight (in kg)
multiplied by 0.6
For bicarb, its Normal-patients multiplied by in kg multiplied by 0.3

6) Neonatal Jaundice H/O

1. Greet
2. What is your name ?
3. What brings you here (my baby has Jaundice LAWLS)
4. How many children do you have in total ? Did any of them have this same
condition before (G6PD, Pyruvate Kinase def)

5. Did you have any infection during the pregnancy (TORCH) .

6. Did you have a Coombs Test done ? What is your Blood Group and your husbands
blood group ? (ABO, RH typing) ? Did you ever take an Anti D injection
7. Regular antenatal check ups
8. How was the delivery ? Did the child suffer any such trauma ? Instrumental
Delivery + Forceps ? (Cephalhaematoma)
8. Was the child term ? or preterm ? (Small babies)?
9. Ask about maternal diabetes ?
10. When did you notice the child developing jaundice (since birth Pathological
causes / by 3-5 day physiological / by day 14-15 Breast Milk Jaundice )
11. Did the mother receive transfusion during pregnancy ? or Delayed Cord
clamping (Polycythemia)
12. Ask about Hypothyroidism
13. Ask about projectile vomitting (Pyloric Stenosis)
14. Ask about blood disorders in the family (Thalessemia )
15. Was the mother taking any drugs during pregnancy
16. Did the mother have any tests done to confirm the baby's jaundiced condition
(Direct/Indirect Billi )
17. Has the child been gaining weight adequately ? And feeding well ?
( Malnourishment)

7) difference between polio and GBS: polio is caused by virus. GBS bacteria. polio is
assymetrical, GBS is symmetrical. polio is untreatable, GBS is treatable. GBS is an
ascending infection, polio is descending. Immunization for polio, no immunization
for GBS

8) LOW OSMOLAR ORS in 500 ml (is what they wanted us to tell them in our end of
rotation osce)
NACL: 1.3g
KCL: 0.75g

Trisodiumcitrate: 1.45g
Glucose: 6.45g

LOW OSMOLAR in ONE LITER

NACL:2.6g
KCL:1.5g
Trisodcit:2.9g
Glucose:13.5g

9) Counselling a deaf child:

Introduce yourself, helloblahblahblah.
Dekhaiyay sunnay mai kamzor hona aik bohot hi mushkil cheez hoti hai aur mai
samaj sakti hoon kay aap soch rahay hon gay kay aap ka bacha society mai kaisay
fit in hoga.(address their apprehensions)
yeh cheez yakeenan pareshani ka baais hai magar aap hosla rakhayn isko deal
karnay kay liay hamaray pass options hain.

Aisay bachay zaroori nahi hai kay zehni taur say kamzoar hon, you should treat
them normally, they may or may not achieve their milestones on time (depending
on the time and type of injury that happened, birth asphyxia? meningitis?
aminoglycoside use? kernicterus? (console them)
Magar kyoon kay inhay sunnay mai dikkat hoti hai, yeh bolna bhi dayr say shuru
kartay hain (speech delays)
in kay liay special schools banaye gaye hain, jahan pay in jaisay aur bhi bachay
maujood hotay hain aur aik khaas teacher inko parhata aur sikhata hai. (special
schools, special teachers)

Yeh bachay communicate karna bhi seekh laytay hain via sign language jo inhay in
schoolon mai sikhai jaati hai, for you to be able to communicate with your bacha
you need to learn it as well. (learn sign language to commuic with your kid) Sign

language kay ilawa in bachon ko speech therapy kay liay bhi bheja ja sakta hai
jahan pay yeh bolna seekhtay hain.
'DR Sahib, is ka koi hall nahi hai?!?!?!' Jee haan, bilkul hai (cochlear implant *drum
rolllll* yeh mehnga tou zaroor hota hai magar iskay zariyay aap ka bacha normally
sun sakay ga. Yeh operation kay zariyay aap kay bachay kay (kaan demagh, WHERE
DO WE PUT A COCHLEAR IMPLANT?!?!? lol) mai daala ja sakta hai and aap ka bacha
normally sun sakta hai. Now some good human being is going to read up on
cochlear implants and tell all of us what's the right age for getting one and if i'm
missing anything.
So this counselling has covered: speech delays, special schools, sign language,
cochlear implants...

10) History of seizures

Description of seizure (onset, during, type, postictal phase, associated symptoms)

Past history of fits
History of fits in siblings or parents
Developmetal milestones
Birth history
History of irritability, vomiting, ear discharge, sore throat
Immunization (BCG and Hib important)