CLIPP 17 Flashcards
bruises over bony prominences vs bruises over bony areas
typical in toddlers vs non accidental trauma; can age bruises by color
a dx that must always be considered in a kid refusing to walk
leukemia - leukemic cells can replace BM and cause bone pain that presents as limp, refusal to walk, or pain in jaw, long bones, vertebrae, hips, shoulders etc and can precede other constitutional sx - will be chronic and likely not positional
presentation of osteomyelitis and bugs that can cause it
pain/licalized bony tenderness, sometimes fever, refusal to WB if its in a bone and can present indolently
-staph aurues, HIB before vaccine
what is reactive arthritis
an inflammatory condition assoc w/ infection outside a joint, in response to what is often a GI or GU issue
-assoc w/ conjunctivitis, urethritis and often no fever, rare in kids
septic arthritis almost always presents w/
high fever , can have high crp/cbc/esr
acute onset of hip pain w/o constitutional sx
transient synovitis - often during or after URI and can have low-grade fever (if high think septic arty)
most common hip disorder in adolescents
SCFE- Characterized by posterior displacement of the capital femoral epiphysis from the femoral neck through the cartilage growth plate.
Causes limp and impaired internal rotation.
Presentation: Most commonly, months of vague hip or knee symptoms and limp with or without an acute exacerbation.
Etiology: Not clearly defined. Occurs more commonly in obese adolescents, suggesting that mechanical strain on the growth plate could be at least partially responsible for the slip. Endocrine factors also may be important.
Diagnosis: Usually with plain film showing posterior displacement of the femoral head, like an ice-cream scoop slipping off a cone.
Prognosis: Depends on degree of slip and accompanying complications, particularly avascular necrosis of the femoral head and destruction of the articular cartilage.
Therapy usually involves pinning to stabilize the epiphysis but no manipulation.
leggs perth calves dz
AVN of capital femoral epiphyses most commonly in boys 4-10, can lead to degenerative arhtisic, tx conservatively ideally
hip pain secodnary to effusion–> this position in exam and due to what possible things
Hip pain secondary to an effusion (associated with septic arthritis of the hip and transient synovitis) is relieved when the patient “opens” her hip capsule by holding her hip in flexion and external rotation.
key PEx finding in osteomyle
avoids WB, no change w/ ext vs int rotation
can leukemia cause LAD and HSM
yes
CRP vs ESR
rises fatser, is more direct measure, more reproducible, more speciifc
EMLA contains
lidocaine - adequate numbing after 30 min
septic synovial fluid - appearance, wbc, glucose
Turbid appearance
Increased white cell count, predominantly polymorphs
Low glucose
most common causative organisms in septic arth
Staphylococcus aureus
Streptococcus (neonate: group B; infant and older child: Group A and Streptococcus pneumoniae)
Haemophilus influenzae type b (in unimmunized children)
Neisseria gonorrhea (adolescents)
