Limping child

Question 1

What must be suspected in adolescents who have septic arthritis? Especially to the sternoclavicular or shoulder joint.

Answer 1

IV drug abuse must be suspected in adolescent with septic arthritis, especially if it affects the sternoclavicular or shoulder joints.

Question 2

Which joints are most affected by septic arthritis in young children?

Answer 2

Lower limb joints such as the hip, knee and ankle are most affected in young children.

Question 3

Which age group of children are affected by Toddler’s fracture?

Answer 3

Toddler’s fracture affects young ambulatory children aged 9 months to 3 years old.

Question 4

What is Toddler’s fracture?

Answer 4

Toddler’s fracture is a subtle spiral fracture

Question 5

What is the most common organism that can cause septic arthritis?

Answer 5

Staphylococcus Aureus

Question 6

What is septic arthritis and osteomyelitis?

Answer 6

Septic Arthritis is infection of the synovium and joint space.
Osteomyelitis is infection of the bone that leads to inflammation and bone destruction.

Question 7

What are the malignant disorders that can cause polyarthritis?

Answer 7

Leukemia and Neuroblastoma

Question 8

What is the most common cause of acute hip pain?

Answer 8

Transient synovitis

Question 9

What are the signs and symptoms of transient synovitis?

Answer 9

Reduced range of movements: especially internal rotation.
Pain in the hip that is relieved with rest. Pain may be referred to the knee.
Afebrile/slight temperature
Child looks well

Question 10

What signs differentiate transient synovitis from septic arthritis of the hip joint?

Answer 10

In transient synovitis, there is either no fever, or mild temperature. In septic arthritis, there is high fever.

In transient synovitis, the child looks well, but in septic arthritis, child looks ill.

In transient synovitis, pain is relieved with rest, but in septic arthritis, there is severe pain at rest that is worse with attempts to move the joint.

There is normal levels of ESR in transient synovitis, but raised ESR in septic arthritis.

Question 11

In infants, if there is back flexion on changing wet nappies, what is suspected?

Answer 11

Discitis

Question 12

What are the signs of evolving compartment syndrome?

Answer 12

Agitation, pain that is disproportionate to the injury and palpable swelling.

Question 13

What are the management steps for septic arthritis?

Answer 13

Urgent wash-out and drainage of joint

Antibiotics

Question 14

Is CRP or ESR a better predictor of acute infection?

Answer 14

CRP

Question 15

What are Kocher’s rules?

Answer 15

Kocher’s rules are the 4 factors used to predict Septic Arthritis:

1. Fever >38.5 degrees Celsius
2. Non-weight bearing or pain with passive movement of joint
3. ESR >40mm/hr
4. Serum WCC >12x10^9/L

Question 16

Slipped upper femoral epiphysis is more likely in which age group?

Answer 16

Children older than 9 years old.

Question 17

When does Juvenile Idiopathic Arthritis usually present?

What is the definition of JIA?

Answer 17

Juvenile Idiopathic Arthritis usually present in childhood. It is defined as joint inflammation presenting in children under 16 and persisting for at least 6 weeks, with other causes excluded.

Question 18

What is the difference between pauciarticular and polyarticular?

Answer 18

In pauciarticular, less than 4 joints are involved.

In polyarticular, more than 4 joints are involved.

Question 19

What condition are children with pauciarticular JIA at high risk of? What is the screening test done to monitor this?

Answer 19

In children with pauciarticular JIA, there is a high risk of anterior uveitis. Regular slit-lamp examination is needed to screen to this.

Question 20

What are the signs pointing towards diagnosis of systemic JIA?

Answer 20

When there are systemic symptoms such as rash, fever and carditis.

Question 21

Pauciarticular JIA commonly affects children of which gender and what age range?

Answer 21

Pauciarticular JIA commonly affects young girls under age 6

Question 22

At which age does transient synovitis present itself?

Answer 22

Transient synovitis peaks at 3-8 years old.

Question 23

At which age range does Perthes’ disease affect children? What is the peak age range?

Answer 23

Perthes’ disease affects children 3-12 years old and peaks at 5-7yo.