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Year 4 > child health > Flashcards

child health Flashcards

1
Q

What is perthes disease?

A

childhood orthopaedic condition characterized by idiopathic avascular necrosis of the femoral head

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2
Q

who does perthes disease occur in?

A

boys, aged 4-8

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3
Q

Aetiology of perthes disease?

A

HLA, genetic predis, vascular abn, trauma

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4
Q

staging of perthes disease?

A

Catteral staging

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5
Q

features of perthes disease

A

> Pain - most common.
limping - antalgic or trendeleburg
limited motion
leg length discrepency

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6
Q

what is trendeleburh due to?

A

abductor weakness

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7
Q

pain in perthes disease?

A

> pain localized to the hip, groin, or medial thigh.
The pain may be aggravated by activity and alleviated by rest.
In some cases, pain may be referred to the knee

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8
Q

radiological findings of perthes disease?

A

Findings include femoral head fragmentation, sclerosis, and flattening.

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9
Q

scans used for perthes?

A

> MRI - can detect early stages
bone scintigraphy

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10
Q

Cons management of perthes?

A

> pain management: analgesic, anti-inflammtories
physical therapy
orthotic devices

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11
Q

surgical management of perthes?

A

> Indications for surgery include persistent pain, progressive deformity, or failed conservative management

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12
Q

complications of perthes?

A

> residual deformaty
osteoarth
leg length discrepancy
femoracetabular impingement
avascular necrosis recurrence

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13
Q

DDH?

A

> Often picked up on newborn examination
Barlow’s test, Ortolani’s test are positive
Unequal skin folds/leg length

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14
Q

Transient synovitis (irritable hip)

A

> Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children

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15
Q

FEATURES OF PERTHES DISEASE xr

A

x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

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16
Q

slipped femoral epiphysis epi?

A

> Typical age group = 10-15 years
More common in obese children and boys

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17
Q

how does slipped uppe femoral epiphysis present?

A

May present acutely following trauma or more commonly with chronic, persistent symptoms

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18
Q

features of slipped upper femoral epiphysis?

A

knee or distal thigh pain is common
loss of internal rotation of the leg in flexion

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19
Q

features of juvenile idiopathic arthirits?

A

joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows

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20
Q

JIA is?

A

limp

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21
Q

what can be positive in JIA?

A

ANA - assoc w anterior uveitis

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22
Q

septic arthi?

A

Acute hip pain associated with systemic upset e.g. pyrexia. Inability/severe limitation of affected joint

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23
Q

SUFE epi?

A

> head of femur slips along growth plate
more common in boys and obese children

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24
Q

presentation of SUFE?

A

The typical exam presentation is an adolescent, obese male undergoing agrowth spurt. There may be a history ofminor traumathat triggers the onset of symptoms. Suspect SUFE if the pain is disproportionate to the severity of the trauma.

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25
Q

Sx of SUFE?

A

> Hip, groin, thigh or knee pain
Restricted range of movement in the hip
Painful limp

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26
Q

SUFE examination?

A

When examining the patient, they will prefer to keep the hip inexternal rotation. They will have limited movement of the hip, particularlyrestricted internal rotation.

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27
Q

SUFE dx?

A

> XR
BTs normal
bone scan, CT, MRI

28
Q

Mx of SUFE?

A

Surgery - returns femoral head to correct position

29
Q

septic arthiritis is most common in?

A

kids under 4

30
Q

septic arthiritis is a common comp of?

A

joint replacement

31
Q

presentation of SA?

A

Septic arthritis usually only affects a single joint. This is often a knee or hip. It presents with a rapid onset of:

> Hot, red, swollen and painful joint
Refusing to weight bear
Stiffness and reduced range of motion
Systemic symptoms such as fever, lethargy and sepsis

32
Q

Most common cause of SA?

A

> STAPH A
Neisseria gonorrhoea (gonococcus) in sexually active teenagers

33
Q

Ix in SA?

A

> joint aspiration b4 ab if poss - send for gram staining, culture, ab sensitivities

34
Q

Mx of SA?

A

> IV ab
surg drainage and washout of joint

35
Q

what is osteomyelitis?

A

> inflammation of bone, usually due to bacteria - mostly staph aureus

36
Q

key RF for osteomyelitis?

A

> open fractures
Orthopaedic operations, particularly with prosthetic joints
Diabetes, particularly with diabetic foot ulcers
Peripheral arterial disease
IV drug use
Immunosuppression

37
Q

The typical presentation of osteomyelitis is with:

A

> Fever
Pain and tenderness
Erythema
Swelling

38
Q

osteomyelitis XR findings?

A

> often normal in early disease
Periosteal reaction (changes to the surface of the bone)
Localised osteopenia (thinning of the bone)
Destruction of areas of the bone

39
Q

Imaging for osteomyelitis?

A

> MRI
Blood tests will show raised inflammatory markers (e.g., WBC, CRP and ESR).
Blood cultures and bone cultures

40
Q

Mx of osteomyelitis?

A

> Surgical debridement of the infected bone and tissues
Antibiotic therapy

41
Q

Ab req for acute osteomyelitis?

A

> 6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks

42
Q

Alt to flucloxacillin for osteomyelitis?

A

> Clindamycin in penicillin allergy
Vancomycin or teicoplanin when treating MRSA

43
Q

chronic osteomyelitis?

A

usually requires 3 months or more of antibiotics.

44
Q

diagnosis of SA?

A

> The Kocher criteria for the diagnosis of septic arthritis:
fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

45
Q

Red flags that may indicate an underlying serious disease or condition in a child presenting with an acute limp include

A

Pain waking the child at night — may indicate malignancy.
Redness, swelling, or stiffness of the joint or limb — may indicate infection or inflammatory joint disease.
Weight loss, anorexia, fever, night sweats, or fatigue — may indicate malignancy, infection, or inflammation.
Unexplained rash or bruising — may indicate haematological or inflammatory joint disease, or child maltreatment.
Limp and stiffness worse in the morning — may indicate inflammatory joint disease.
Unable to bear weight or painful limitation of range of motion — may indicate trauma or infection.
Severe pain, anxiety, and agitation after a traumatic injury — may indicate neurovascular compromise or impending compartment syndrome.
A palpable mass — may indicate malignancy or infection

46
Q

What is muscular dystrophy?

A

umbrella term for genetic conditions that cause gradual weakening and wasting of muscles.

47
Q

Gowers sign?

A

Children withproximal muscle weaknessuse a specific technique to stand up from a lying position. This is calledGower’s sign.

48
Q

there is a 5 year old boy presenting with vague symptoms of muscle weakness and the description is that you notice them using their hands on their legs to help them stand up, the answer is probably

A

Duchennes muscular dystrophy. They may ask “what is the underlying genetic inheritance of the most likely cause?” The answer is X-linked recessive.

49
Q

Mx of DMD?

A

> Imp QOL - occupational therapy, physiotherapy and medical appliances (such as wheelchairs and braces)
surgical and medical management of complications such as spinal scoliosis and heart failure.

50
Q

What is DMD?

A

> Most common dystrophy
caused by defective gene for dystrophin on CX
X LINKED RECESSIVE

51
Q

DMD presentation?

A

> Boys with Duchennes present around 3 – 5 years with weakness in the muscles around their pelvis.
The weakness tends to be progressive and eventually all muscles will be affected.
They are usually wheelchair bound by the time they become a teenager.

52
Q

Beckers muscular dystrophy?

A

> dystrophin gene less affecred
symptoms appear 8-12 yrs

53
Q

myotonic dystrophy presents in?

A

adulthood

54
Q

TP of myotonic dystrophy?

A

> Progressive muscle weakness
Prolonged muscle contractions
Cataracts
Cardiac arrhythmias

55
Q

key feature of myotonic dystrophy?

A

> prolonged muscle contraction - unable to let go of something, unable to release grip on something

56
Q

Facioscapulohumeral Muscular Dystrophy

A

> usually presents in childhood
weakness around face> shoulders > arms

57
Q

classical initial symptom of facioscuapulohumeral dystrophy?

A

> A classic initial symptom is sleeping with their eyes slightly open and weakness in pursing their lips.
They are unable to blow their cheeks out without air leaking from their mouth.

58
Q

Oculopharyngeal Muscular Dystrophy pres?

A

usually presents in late adulthood with weakness of theocular muscles(around the eyes) andpharyn

59
Q

Oculopharyngeal Muscular Dystrophy features?

A

bilateral ptosis, restricted eye movement and swallowing problems. Muscles around the limb girdles are also affected to varying degrees.

60
Q

Limb girdle dystrophy?

A

Limb-girdle muscular dystrophy usually presents in teenage years with progressive weakness around the limb girdles (hips and shoulders).

61
Q

Emery-Dreifuss Muscular Dystrophy

A

> Emery-Dreifuss muscular dystrophy usually presents in childhood with contractures, most commonly in the elbows and ankles.
Patients also suffer with progressive weakness and wasting of muscles, starting with the upper arms and lower legs.

62
Q

gait in DMD?

A

waddling gait

63
Q

DMD Ix?

A

CK - nearly always raised. Genetic testing uded to confirm diagnosus

64
Q

DMD - what to check?

A

it is important to check thecreatine kinase levelin children whocannot walk by 18 months of ageto screen for MD

65
Q

Predicted heigh calc?

A

> Boys: (mother height + fathers height + 14cm) / 2
Girls: (mothers height + father height – 14cm) / 2

Year 4 (9 decks)

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