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Y4 paediatrics > High-yield > Flashcards

High-yield Flashcards

1
Q

Limp ddx

A
  • developmental dysplasia of the hip
  • perthes disease
  • transient arthritis/synovitis
  • septic arthritis
  • slipped upper femoral epiphysis (SUFE)
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2
Q

DDH

A

femoral head does not sit fully in the acetabulum → easily dislocated

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3
Q

DDH risk factors

A
  • first born child
  • breech presentation
  • females
  • fmhx of ddh
  • oligohydramnios
  • birth weight > 5kg
  • congenital calcaneovalgus foot deformity
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4
Q

DDH screening

A
  • following infants require a routine USS:
    • first-degree fhx of hip problems in early life
    • breech presentation at/after 36 weeks gestation
    • multiple pregnancy
  • all infants screened at both the newborn check & six-week baby check using the Barlow and Ortolani tests
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5
Q

DDH signs

A
  • painless limp
  • delayed walking
  • affected leg is shorter → due to atrophy of hip muscles
  • more skin folds on affected leg
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6
Q

DDH ix

A
  • NIPE → barlow (dislocate) & ortolani (relocate)
  • USS of hip (gold standard)
  • x-rays → 1st line if child > 4.5 months
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7
Q

DDH mx

A
  • most unstable hips spontaneously stabilise by 3-6 weeks of age
  • younger kids → Pavlik harness (before 6 months)
  • older kids → combined femoral & pelvic osteotomies
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8
Q

Perthes disease

A

avascular necrosis of the femoral head → flattened & fragmented femoral head is unable to rotate smoothly in acetabulum → restricts mobility

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9
Q

Perthes disease clinical features

A
  • presents in primary school kids, 5x more common in boys
  • hip pain - develops progressively over a few weeks
  • limp
  • stiffness & reduced range of movement
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10
Q

Perthes disease ix

A
  • hip x-ray → increased density in femoral epiphysis
  • technetium bone scan/MRI if normal x-ray and symptoms persist
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11
Q

Perthes disease mx

A
  • <6 years - observation, analgesia & bracing
  • > 6 years - surgical repair
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12
Q

Perthes disease complications

A
  • osteoarthritis
  • premature fusion of growth plates
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13
Q

Transient synovitis

A
  • inflammation of the synovium
  • acute hip pain following a recent viral infection & typical age group is 3-8 years
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14
Q

Transient synovitis clinical features

A
  • acute limp/refusal to weight bear
  • mild/no fever
  • pain on exercise, comfortable at rest
  • limited internal rotation
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15
Q

Transient synovitis ix

A

Diagnosis of exclusion
- blood cultures
- USS-guided joint aspiration
- hip x-ray

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16
Q

Transient synovitis mx

A
  • rest
  • analgesia - NSAIDs
17
Q

Septic arthritis risk factors

A
  • osteomyelitis
  • sickle cell anaemia
  • diabetes/immunocompromised
18
Q

Septic arthritis clinical features

A
  • acute painful joint → unable to weight bear
  • pain at rest, worse on movement
  • high fever
  • unilateral swollen red knee/thigh leg held in flexed, abducted & externally rotated position
  • tenderness over head of femur
19
Q

Septic arthritis ix

A
  • USS-guided joint aspirate
  • blood cultures
20
Q

Septic arthritis mx

A
  • joint aspiration
  • IV flucloxacillin for 4-6 weeks (IV clindamycin in pen allergic)
  • child with limp/hip pain & fever = same day assessment
21
Q

SUFE risk factors

A
  • secondary school boys (10-15)
  • overweight
22
Q

SUFE clinical features

A
  • initially presents with stiff hip
  • loss of internal rotation of the leg in flexion
  • hip pain radiates to knee/thigh presents with externally rotated hip & antalgic gait
23
Q

SUFE ix

A

AP & lateral (typically frog-leg) x-ray views

24
Q

SUFE mx

A
  • bed rest and crutches
  • orthopaedics referral & internal fixation (single cannulated-screw placed in the centre of the epiphysis)
25
Q

SUFE complications

A
  • osteoarthritis
  • avascular necrosis of the femoral head
  • chondrolysis
  • leg length discrepancy
26
Q

HSP

A

IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children

Inflammation occurs in the affected organs due to IgA deposits in the blood vessels

27
Q

HSP clinical features

A

1) purpura

  • rash caused by inflammation and leaking of blood from small blood vessels under the skin, forming purpura
  • typically start on the legs & spread to the buttocks

2) joint pain

  • mostly affecting the knees and ankles

3) abdominal pain

  • can lead to gastrointestinal haemorrhage, intussusception & bowel infarction

4) renal involvement

  • can cause IgA nephritis
28
Q

HSP ix

A
  • FBC & blood film
  • renal profile
  • serum albumin
  • CRP
  • blood cultures
  • urine dipstick
  • urine protein:creatinine ratio
  • blood pressure
29
Q

HSP diagnosis

A
  • most recent criteria is the EULAR/PRINTO/PRES criteria
  • requires patient to have palpable purpura & at least one of:
    • diffuse abdominal pain
    • arthritis or arthralgia
    • IgA deposits on histology (biopsy)
    • proteinuria/haematuria
30
Q

HSP mx

A
  • supportive - simple analgesia, rest & proper hydration
  • steroids may be considered by specialist doctors in patients with severe gastrointestinal pain or renal involvement
  • monitor closely whilst illness is active:
    • urine dipstick monitoring for renal involvement
    • blood pressure monitoring for hypertension
31
Q

ITP

A

Immune-mediated reduction in the platelet count

Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex

Example of type II hypersensitivity reaction

May follow infection or vaccination

32
Q

ITP clinical features

A

Bruising

Petechial or purpuric rash

Bleeding is less common & typically presents as epistaxis/gingival bleeding

33
Q

ITP ix

A

FBC - isolated thrombocytopenia

Blood film

Bone marrow examinations is only required if there are atypical features

  • lymph node enlargement/splenomegaly
  • high/low white cells
  • failure to resolve/respond to treatment
34
Q

ITP mx

A

Usually, no treatment required → resolves in 80% with 6 months, with or without treatment

Advice to avoid activities that may result in trauma (eg. team sports)

If platelet count v low/significant bleeding:

  • oral/IV corticosteroid
  • IV immunoglobulins
  • platelet transfusions in emergency (temporary measure = destroyed by circulatory antibodies)

Y4 paediatrics (8 decks)

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