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LS YEAR 4 Paediatrics > Locomotor > Flashcards

Locomotor Flashcards

1
Q

what is septic arthiritis

A

serious infection of the joint space usually affecting larger weight bearing joints such as ankle, hip, knee

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2
Q

who is it common in septic Arthritis

A

under 2s

males > females

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3
Q

method of septic arthritis spread

A

haemantenous spread or could be through puncture wound or infected skin lesions e.g. chickenpox

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4
Q

what is the risk if delayed diagnosis septic arhtiritis

A

destruction esp in neonates

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5
Q

how does it present

septic arthritis

A 
erythematous 
warm acutely tender joint
reduced range of movement 
unwell child-febrile 
effusion nearby 
holding limb
limp
referred knee pain if in hip
cries if its moved
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6
Q

what do 15% have

with septic arhritis

A

co-existing osteomyelitis

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7
Q

investigations os septic arthritis

A 
increased white cell count, ESR 
USS -effusion 
xray-exclude trauma
bone scan
MRI scan
aspiration of joint
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8
Q

management of septic arthritis

A

fluxocillin
broad spectrum antibiotic like cephalosporin
surgical drainage
splint joint
arthotomy and wash out
physiotherapy to prevent deformities of the joint

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9
Q

what is development dysplasia of the hip

A

congenital dislocation of the hip diagnosed at birth
abnormal position of femoral head relative to acetabulum (outside socket)
SHALLOW ACETBABULUM

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10
Q

who does it affect DDH

A 
F>m
fhx
those with spina bifida increased risk
breech position ^10x risk 
genetics-joint laxity type 3 collagen , shallow acetabulum 
SWADDLING BABY (wrapping in blanket) 
olgiohydraminos
muliple babies. 
maternal oestrogen increased
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11
Q

what can be done to screen for ddh

A 
USS at six weeks 
screen 
fhx 
breech position 
check at birth, six weeks and 6-9 months
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12
Q

what can happen ifDDH not treated

A

limping, abrnomal gait, leg shortening

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13
Q

what can be seen on examination with DDH

A

assymetical gluteal folds
difference in leg length
restricted
abduction in flexion

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14
Q

what investigations can be done

for ddh

A

Barlow and ortolans screening test

X-ray-femoral head displayed up and laterally from acetabulum

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15
Q

what is the management of dysplasia of the hip

of ddh

A 
pelvic harness <6 months 
immobilise hip joint in  abduction for three months to allow for normal development 
6-18 months  and older 
plaster caster
open reduction
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16
Q

xray who is it not useful in

A

neonates
no value as their joints haven’t ossified
not until 3-4 months

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17
Q

what is transient synovitis

A

also known as irritable hip

most common cause of hip pain acutely in children

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18
Q

when does transient synovitis occur

A

post viral infection or accompanied with it

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19
Q

who does ts AFFECT

transient synovitis

A

boys

2-8 years

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20
Q

presentation of transient synovitis

A 
no pain at rest
well-mild fever, afebrile 
reduced movement range 
knee pain maybe
reduced limb movement, stiffness
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21
Q

how does transient synovitis contrast to septic arhtitiris

red flags

A

septic arthritis

  • painful at rest
  • unwell and fever

red flegs
<2 weeks
pain at night can’t weight bear
pain in multiple joints

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22
Q

investigations transient snovibitis

A

neutrophil , ESR AND WCC may be raised
mild joint effusion on uss
xray normal

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23
Q

management of transient synovitis

A

self limiting
bed rest
resolves itself in a few days
simple analgesia-nsaids

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24
Q

what is Perthes disease

affects who

A

ischaemia of the femoral epiphysis resulting in avascular necrosis following revascularisation and reossification
over 18-36 months
affects boys 5-10 years of age

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25
Q

presentation of Perth disease

A

limb and or hip pain
mistaken for transient synovitis sometimes
bilateral in 10-20%

worsening pain and limping as time goes by.

an occasional limp in the earlier stages.
stiffness and reduced range of movement in the hip joint.
pain in the knee, thigh or groin when putting weight on the affected leg or moving the hip joint.
thinner thigh muscles on the affected leg.

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26
Q

investigations for Perth disease

A

xray increased density in fem head
maybe be irregular or fragmented
repeat may be needed
bone and or mir scan

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27
Q

prognosis of Perth disease and management

A

good if occurs when less than 6 years old and if less of ephysis is involvement
if half of epiphysis or more is involved of over 6 , more likely to lead to deformity and degenerative arthritis

bedrest
in severe keep hip in abduction with callipers or plastic
pelvic osteotomy

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28
Q

what is slipped femoral epiphysis

who does it affect

A

overweight sedentary teen boysd

proximal femur epipysis displaced posterior and inferably due to weakening of growth plate

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29
Q

when does it tend to occur with slipped femoral epiphysis

signs of stable or unstable

A

during periods of acerbated growth after puberty
stable can walk with or without aids
unstable- no ambulation (unable to get out of bed and move around )

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30
Q

symptoms of slipped femoral epiphysi

A

groin pain
medial knee pain
gradual onset
limb shortened

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31
Q

investigations of it and management slipped femoral epiphysis

A

xray

surgical repair

32
Q

what is juvenile idiopathic arthritis

A

arthritis >6 weeks
before 16 age
absence of infection or nausea other definite cause

types- polyarthritis, olgioarthritis, systemic

33
Q

symptoms of jIA

A 
swelling 
pain 
tander 
reduced movement
can be multiple involvement
34
Q

investigations of JIA

A

ANA+
may be HLAB27
and rh factor positive
depends on type

35
Q

management of jIA

A 
physiotherapy 
analgesia-nsaids
methotrexate 2nd line
splints
biologics
36
Q

Barlow and ortolani

A

Barlow - backwards - promote dislocation

ortolani -outwards - back in/ ahh

37
Q

most common cause of septic arthritis

A

s aureus

38
Q

which joints does SA affect

A

Lower limb in 75% e.g. hip knee

39
Q

key thing about septic arthritis in infant

A

may not have fever or present with fever

40
Q

mx of septic arthritis

A

2-3 iV antbiotics
4-6 weeks orally
irrigation
physiotherapy

41
Q

when to consider mRI with septic arthritis

A

If suspecting osteomyeltisi

presents with bony tenderness

42
Q

when do to LP with Septic arthritis

A

if h influenza because increased meningitis risk/likeliness

43
Q

most diagnostic test for septic arthritis

A

aspiration

44
Q

red flags for SEPTIC ARHTITIS

A

refusal to move joint
elevated ESR AND WCC
fever

45
Q

rik factors for septic arthritis

A

haemophilia
sickle cell
joint surgery
prosthetic joints

46
Q

in DDH which hip is most commonly affected

A

left

47
Q

when is ortolan and Barlow test less reliable

A

after 3 months so do USS

if over 6 months do XRAY

48
Q

what type of displacement is harder to treat

A

teratogenic dislocation
associated with NMSyndromes such as dwarfism
usually before birth idolisation happens

49
Q

what test can be seen after 3 months

A

galeazzi sign
flex hip and knees both
should see shorter femur- positive test -unequal knee height
if both hips have ddh THEN WILL BE NEGAITVE TEST

50
Q

what blood tests can be done to rule out other causes

A

HLAB27 to rule out reactive arthritis and JIA

51
Q

what is seen with reiter triad

A

arhrititis
urethritis
conjuctivitis
hLAB27

52
Q

when is it more likely to be reactive arhtirits

A 
systemic involvement
diarhroea
eye pain
sausage toe 
back pain 
heel pain etc 
these are absent in T. syvnonitis
53
Q

ESR AND WCC in transient syvnotiis

A

mildy raised

if grossly raised, consider reactive arhtirits

54
Q

mx of reactive arhtirits

A

nsaid
steriod injections
physiotherapy

55
Q

bone scan In Perthe disease

A

Technetium-99m

56
Q

what movements reduced in Perth disease

A

abduction

internal rotation

57
Q

classification in Perth

A

herring lateral pillar classification

A-C.
a uninvolved lat pillar good prognosis

b >50%
c < 50% poorer prognosis

others include stulberg,Caterall and Salter-Thompson classification

58
Q

when is JIA worse

A

after inactivity

59
Q

blood to screen for JIA

A

ANA
rhem factor
xray

60
Q

three med line for jIA

A

nsaid
METHOTREXATE
BIOLOGICALS/ANTI TNF

61
Q

classification of jIA

list

A 
enthesis 
oligoartiullar
systemic
polyarticualr 
psoratic
62
Q

describe jIA classification

A

enthesis - inflammation of tendon and 2 or more of following : FHX of HLAB27 OR SELF HX, > 6 y.o male, lumbar/sacroiliac pain, uveitis

oligoartiullar : 1-4 joints affected ANA + extended over 4 joints after 6 months, persistent < 4 joints after 6 months usually knee ankle
systemic salmon pink rash, spikes in fever over 2 weeks hepatosplenomegaly, cervical lymphadenopathy . several joints symmetrically

polyarticualr more than 5 joints or so, systemic features, hand, wrist symmetrical, rhematoid factor positive, nodules , if negative RH factor, assymmetrical

psoratic nail changes, lesions on body extensor scaly silvery salmon plaques

63
Q

arhtirtiss salmon pink rash, spikes in fever over 2 weeks

A

systemic

64
Q

arthritis Ana positive

A

oligioarticular

65
Q

rheumatoid factor

A

polyarticular

66
Q

arthritis with C lymphdeopathy, hepatosplenmegaly

A

systemic

67
Q

sacrolumbar pain and arthritis

A

enthesis

68
Q

Felty’s syndrome

A

Felty’s syndrome, also called Felty syndrome, (FS)
rare autoimmune disease
triad of rheumatoid arthritis, enlargement of the spleen and too few neutrophils in the blood

69
Q

rf for SUFE

A

radiotherapy pelvic

Hypothyrodism

70
Q

what is cause of hip replacement under 60

A

1/3

due to DDH

71
Q

complication later on due to DDH

A

OA

lower back pain

72
Q

which hip DDH

A

more common left

73
Q

DDH when is prognosis worse with bracing

A

if after 6-8 weeks

74
Q

when surgery for Perth

A

if over 8 y/o

75
Q

xray early for what conditions shows what

A

perthe

joint widening

76
Q

enhler dans sc shows as what

A 
hypermobility
easy dislocation
bruising easily 
stretching skin 
clicking

LS YEAR 4 Paediatrics (24 decks)

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