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LS YEAR 4 Paediatrics > Locomotor > Flashcards

Locomotor Flashcards

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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
presentation of Perth disease
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.
26
investigations for Perth disease
xray increased density in fem head maybe be irregular or fragmented repeat may be needed bone and or mir scan
27
prognosis of Perth disease and management
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
28
what is slipped femoral epiphysis | who does it affect
overweight sedentary teen boysd | proximal femur epipysis displaced posterior and inferably due to weakening of growth plate
29
when does it tend to occur with slipped femoral epiphysis | signs of stable or unstable
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 )
30
symptoms of slipped femoral epiphysi
groin pain medial knee pain gradual onset limb shortened
31
investigations of it and management slipped femoral epiphysis
xray | surgical repair
32
what is juvenile idiopathic arthritis
arthritis >6 weeks before 16 age absence of infection or nausea other definite cause types- polyarthritis, olgioarthritis, systemic
33
symptoms of jIA
``` swelling pain tander reduced movement can be multiple involvement ```
34
investigations of JIA
ANA+ may be HLAB27 and rh factor positive depends on type
35
management of jIA
``` physiotherapy analgesia-nsaids methotrexate 2nd line splints biologics ```
36
Barlow and ortolani
Barlow - backwards - promote dislocation | ortolani -outwards - back in/ ahh
37
most common cause of septic arthritis
s aureus
38
which joints does SA affect
Lower limb in 75% e.g. hip knee
39
key thing about septic arthritis in infant
may not have fever or present with fever
40
mx of septic arthritis
2-3 iV antbiotics 4-6 weeks orally irrigation physiotherapy
41
when to consider mRI with septic arthritis
If suspecting osteomyeltisi | presents with bony tenderness
42
when do to LP with Septic arthritis
if h influenza because increased meningitis risk/likeliness
43
most diagnostic test for septic arthritis
aspiration
44
red flags for SEPTIC ARHTITIS
refusal to move joint elevated ESR AND WCC fever
45
rik factors for septic arthritis
haemophilia sickle cell joint surgery prosthetic joints
46
in DDH which hip is most commonly affected
left
47
when is ortolan and Barlow test less reliable
after 3 months so do USS | if over 6 months do XRAY
48
what type of displacement is harder to treat
teratogenic dislocation associated with NMSyndromes such as dwarfism usually before birth idolisation happens
49
what test can be seen after 3 months
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
what blood tests can be done to rule out other causes
HLAB27 to rule out reactive arthritis and JIA
51
what is seen with reiter triad
arhrititis urethritis conjuctivitis hLAB27
52
when is it more likely to be reactive arhtirits
``` systemic involvement diarhroea eye pain sausage toe back pain heel pain etc these are absent in T. syvnonitis ```
53
ESR AND WCC in transient syvnotiis
mildy raised | if grossly raised, consider reactive arhtirits
54
mx of reactive arhtirits
nsaid steriod injections physiotherapy
55
bone scan In Perthe disease
Technetium-99m
56
what movements reduced in Perth disease
abduction | internal rotation
57
classification in Perth
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
when is JIA worse
after inactivity
59
blood to screen for JIA
ANA rhem factor xray
60
three med line for jIA
nsaid METHOTREXATE BIOLOGICALS/ANTI TNF
61
classification of jIA | list
``` enthesis oligoartiullar systemic polyarticualr psoratic ```
62
describe jIA classification
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
arhtirtiss salmon pink rash, spikes in fever over 2 weeks
systemic
64
arthritis Ana positive
oligioarticular
65
rheumatoid factor
polyarticular
66
arthritis with C lymphdeopathy, hepatosplenmegaly
systemic
67
sacrolumbar pain and arthritis
enthesis
68
Felty's syndrome
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
rf for SUFE
radiotherapy pelvic | Hypothyrodism
70
what is cause of hip replacement under 60
1/3 due to DDH
71
complication later on due to DDH
OA | lower back pain
72
which hip DDH
more common left
73
DDH when is prognosis worse with bracing
if after 6-8 weeks
74
when surgery for Perth
if over 8 y/o
75
xray early for what conditions shows what
perthe | joint widening
76
enhler dans sc shows as what
``` hypermobility easy dislocation bruising easily stretching skin clicking ```

LS YEAR 4 Paediatrics (24 decks)

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