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Pediatrics > Limping > Flashcards

Limping Flashcards

1
Q

Antalgic

A
  • Painful
  • Involved leg is shorter
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2
Q

Trendelenburg

A
  • Normal standing
  • Imbalance (front and back)
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3
Q

Duck gait

A

Bilateral gluteus weakness

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4
Q

Toe walking

A
  • Kids that recently started walking
  • Habit, Neuromuscular, Short achilles
  • Checked in older than 3yr olds
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5
Q

Approach (Sudden or chronic)

A

Sudden:
- Infection
- Trauma
- Better prognosis
Chronic:
- Neuromuscular, Metabolic
- Malignancy, Leukemia, Neuroblastoma

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6
Q

Common in kids

A
  • Trauma
  • Immune complex arthritis after infection (Henoch, Rheumatic Fever, EBV)
  • Transient Synovitis of hip
  • Arthritis, Arthralgia, Serum sickness (after cephalosporines) are mostly systemic
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7
Q

Other complaints

A
  • Fever & weight loss: Malignancy, infection
    Osteomyelitis & Septic arthritis are emergencies
  • Long fevers: Malignancy
  • Specific lesions: Dermatomyositis, JRA, Lupus
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8
Q

Limping secondary to pain

A

Pain is in:
Organs, stomach, hip, hip joint

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9
Q

Painful limping (1-3yr old)

A
  • Septic arthritis
  • Osteomyelitis
  • Transient Synovitis
  • Hidden trauma
  • Disc inflammation
  • Malignancy
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10
Q

Painless limping (1-3yrs)

A
  • Hip dysplasia (DDH)
  • Neuromuscular disorder
  • Cerebral palsy
  • Short steps (pressure off the involved leg)
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11
Q

Painful limping (3-10yrs)

A

1-3yrs
+
- Myositis
- Rheumatic disorders
- JRA

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12
Q

Painless limping (3-10yrs)

A

1-3yrs
+
- Legg-Calvé-Perthes (Avascular femur head necrosis)
- Duchenne muscular dystrophy

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13
Q

Painful (>11)

A
  • Septic arthritis
  • Osteomyelitis
  • Myositis
  • Trauma
  • Malignancy
  • Rheumatic disorders
  • Slipped capital femoral epiphysis (SCFE)
    acute & unstable
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14
Q

Painless (>11)

A
  • Slipped capital femoral epiphysis (SCFE)
    chronic & stable
  • Hip dysplasia (DDH)
  • Acetabulum dysplasia
  • Short steps
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15
Q

DDx

A
  • Infectious
  • Orthopedic
  • Inflammatory
  • Neoplasm
  • Neuromuscular
  • Other
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16
Q

Infectious ddx

A
  • Disc inflammation
  • Osteomyelitis, Septic arthritis
  • Myositis
  • Cellulitis, arthralgia or arthritis after infection
17
Q

Orthopedic ddx

A
  • SCFE
  • DDH
  • Avascular necrosis
18
Q

Inflammatory ddx

A
  • Transient Myositis
  • SLE, JRA, Dermatomyositis, Henoch
19
Q

Neoplasm ddx

A
  • Benign Osteochondroma, Osteoma
  • Osteogenic sarcoma
  • Leukemia, Neuroblastoma (Fatigue, weight loss, fever)
  • Metastasis
20
Q

Neuromuscular ddx

A
  • Duchenne (Gowers’s sign)
  • Guillain-barré
  • Tick borne paralysis
  • Weak cerebral palsy
21
Q

Reactive arthritis

A
  • Aseptic
  • Infection in another place
  • Acute Polyarthritis/Tenosynovitis
  • Immune complex
22
Q

Causes of reactive arthritis

A
  • Meningococcemia
  • Gonococcemia
  • Hepatitis
    Immune-complex-causing infections:
    Yersinia, Salmonella, Campylobacter, Shigella, Ureoplasma, Mycoplasma, Chlamydia
23
Q

Reiter syndrome triad

A

1- Non-gonococcal Urethritis
2- Conjunctivitis
3- Reactive arthritis

24
Q

Joint swelling

A
  • Hematogen: 3 days, microbial
  • Immune reaction: 1w, no microbes
  • Hip IAP: Avascular epiphysis & femor head necrosis, EMERGENCY
25
Q

Gonococcal Septic arthritis

A
  • With DGI, most common cause of poly/single arthritis in teens
  • Following bacteremia (Fever, chills, Migrating Polyarthritis)
  • DGI women 4×, period, 2nd&3rd trimester
  • Reiter can mimic DGI
  • Reiter doesn’t respond to antibiotics
26
Q

Septic arthritis treatment duration

A
  • S. Aureus: 4-6w
  • H. Influenza B, Strep A, Pneumococcus: 2-3w, 10-14d
  • Gonococcus: 7-10d
  • Joint Aspiration beginning or 3-5d later
27
Q

Septic arthritis surgery indications

A

1- Fluid more than 7d
2- Any hip septic arthritis
3- Most shoulder arthritis

28
Q

Good prognosis (Septic arthritis)

A
  • Systemic Ab against Staph & Haemophilus
  • Rest, Immobilization, Not putting weight
  • Recovery after 72h if quick diagnosis
29
Q

Bad prognosis

A
  • Under 6m old
  • S. Aureus, Gr -, Fungus
  • Hip involvement
  • Osteomyelitis & Epiphysis destruction
  • Late treatment (5-7d)
  • If fast diagnosis no disability
30
Q

Other limping ddx

A

1- Stomach, substernal, testicular pain
2- Sickle cell
3- Femur head avascular necrosis
4- Hemophilia (Hemarthrosis)

Pediatrics (12 decks)

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