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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
Sx of SUFE?
> Hip, groin, thigh or knee pain > Restricted range of movement in the hip > Painful limp
26
SUFE examination?
When examining the patient, they will prefer to keep the hip in external rotation. They will have limited movement of the hip, particularly restricted internal rotation.
27
SUFE dx?
> XR > BTs normal > bone scan, CT, MRI
28
Mx of SUFE?
Surgery - returns femoral head to correct position
29
septic arthiritis is most common in?
kids under 4
30
septic arthiritis is a common comp of?
joint replacement
31
presentation of SA?
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
Most common cause of SA?
> STAPH A > Neisseria gonorrhoea (gonococcus) in sexually active teenagers
33
Ix in SA?
> joint aspiration b4 ab if poss - send for gram staining, culture, ab sensitivities
34
Mx of SA?
> IV ab > surg drainage and washout of joint
35
what is osteomyelitis?
> inflammation of bone, usually due to bacteria - mostly staph aureus
36
key RF for osteomyelitis?
> open fractures > Orthopaedic operations, particularly with prosthetic joints > Diabetes, particularly with diabetic foot ulcers > Peripheral arterial disease > IV drug use > Immunosuppression
37
The typical presentation of osteomyelitis is with:
> Fever > Pain and tenderness > Erythema > Swelling
38
osteomyelitis XR findings?
> 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
Imaging for osteomyelitis?
> MRI > Blood tests will show raised inflammatory markers (e.g., WBC, CRP and ESR). > Blood cultures and bone cultures
40
Mx of osteomyelitis?
> Surgical debridement of the infected bone and tissues > Antibiotic therapy
41
Ab req for acute osteomyelitis?
> 6 weeks of flucloxacillin, possibly with rifampicin or fusidic acid added for the first 2 weeks
42
Alt to flucloxacillin for osteomyelitis?
> Clindamycin in penicillin allergy > Vancomycin or teicoplanin when treating MRSA
43
chronic osteomyelitis?
usually requires 3 months or more of antibiotics.
44
diagnosis of SA?
> The Kocher criteria for the diagnosis of septic arthritis: > fever >38.5 degrees C > non-weight bearing > raised ESR > raised WCC
45
Red flags that may indicate an underlying serious disease or condition in a child presenting with an acute limp include
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
What is muscular dystrophy?
umbrella term for genetic conditions that cause gradual weakening and wasting of muscles.
47
Gowers sign?
Children with proximal muscle weakness use a specific technique to stand up from a lying position. This is called Gower’s sign.
48
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
Duchennes muscular dystrophy. They may ask “what is the underlying genetic inheritance of the most likely cause?” The answer is X-linked recessive.
49
Mx of DMD?
> 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
What is DMD?
> Most common dystrophy > caused by defective gene for dystrophin on CX > X LINKED RECESSIVE
51
DMD presentation?
> 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
Beckers muscular dystrophy?
> dystrophin gene less affecred > symptoms appear 8-12 yrs
53
myotonic dystrophy presents in?
adulthood
54
TP of myotonic dystrophy?
> Progressive muscle weakness > Prolonged muscle contractions > Cataracts > Cardiac arrhythmias
55
key feature of myotonic dystrophy?
> prolonged muscle contraction - unable to let go of something, unable to release grip on something
56
Facioscapulohumeral Muscular Dystrophy
> usually presents in childhood > weakness around face> shoulders > arms
57
classical initial symptom of facioscuapulohumeral dystrophy?
> 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
Oculopharyngeal Muscular Dystrophy pres?
usually presents in late adulthood with weakness of the ocular muscles (around the eyes) and pharyn
59
Oculopharyngeal Muscular Dystrophy features?
bilateral ptosis, restricted eye movement and swallowing problems. Muscles around the limb girdles are also affected to varying degrees.
60
Limb girdle dystrophy?
Limb-girdle muscular dystrophy usually presents in teenage years with progressive weakness around the limb girdles (hips and shoulders).
61
Emery-Dreifuss Muscular Dystrophy
> 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
gait in DMD?
waddling gait
63
DMD Ix?
CK - nearly always raised. Genetic testing uded to confirm diagnosus
64
DMD - what to check?
 it is important to check the creatine kinase level in children who cannot walk by 18 months of age to screen for MD
65
Predicted heigh calc?
> Boys: (mother height + fathers height + 14cm) / 2 > Girls: (mothers height + father height – 14cm) / 2

Year 4 (17 decks)

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