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1
Q

Define Slipped upper femoral epiphysis - SUFE

A

The head of the proximal femur epiphysis is displaced (“slips”) along the growth plate

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2
Q

SUFE imaging Ix

A

Bilateral X-ray:Anteropost and ‘frog leg’ lateral position

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3
Q

Septic arthritis gold standard Ix

A

Aspiration of the joint: Gram staining, cell count, glucose level, crystal analysis cultures

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4
Q

Osteomyelitis Risk Factors

A
  • Trauma from injury
  • bones growing more blood supply easier for bacteria to travel into the bone
  • Open bone fracture
  • Orthopaedic surgery
  • Immunocompromised
  • Sickle cell anaemia
  • HIV
  • Tuberculosis
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5
Q

Osteomyelitis Sx

A
  • Fever
  • Tiredness
  • Erythema
  • Oedema
  • Fussiness / irritability
  • Lethargy
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6
Q

Vit D deficiency Loading dose in Age 1–5 months

A

3000 IU daily for 8–12 weeks.

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7
Q

Current guidance on vitamin d supplements in children under 5

A
  • 0-1 year Vit. D RDI:
    8.5-10mcg
  • 1-4 years RDI Vit D RDI: 10 mcg
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8
Q
A
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9
Q

When is vit D supplement not indicated for children

A
  • > 500ml of infant formula a day

Fortified with vit D

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10
Q

Vit D deficieny risk factors

A
  • Low / no exposure to the sun
  • Dark skin tone
  • Exclusively breastfed babies
  • GI / malabsorption disorders: Coeliac, lactose intolerance, Cystic fibrosis
  • Insufficient maternal vit D
  • Premature baby
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11
Q

Define Osgood-Schlatter Disease

A

An inflammation at the tibial tuberosity where the patella ligament inserts

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12
Q

Oliogoarticular JIA

A
  • affecting 1-4 joints in the first 6/12
  • commonly affects the knee and ankle
  • assoc with other inflammation (uveitis)
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13
Q

late stages of arthiriris

A

joint spaces narrowed and spaces fuse together

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14
Q

RED FLAGS in children

A

Fever: Septic arthritis,
WL

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15
Q

Osgood-Schlatter Disease presentation

A
  • Ant. knee pain
  • Pain is exacerbated by physical activity; running, jumping, and on extension of the knee
  • Visible or palpable hard and tender lump at the tibial tuberosity
  • Usually unilateral
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16
Q

OSD pathophysiology

A

There are multiple small avulsion fractures, where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially this bump is tender due to the inflammation, but has the bone heals and the inflammation settles it becomes hard and non-tender.

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17
Q

OSD Risk factors

A
  • Male > Female
    Growth spurt age:
  • Boys 12-15 years
  • Grils 8-12 years
  • Active in sports which include running, jumping, and repetitive bending of the knee are at greater risk of developing the condition.
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18
Q

OSD complications

A
  • Full avulsion fracture
  • Ossicles (bony fragments) formation in the knee - may impinge on the patellar tendon, causing pain and limiting activity
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19
Q

OSD Sx

A
  • Gradual onset of pain
  • Swelling below the knee
  • Pain relived on resting
  • Pain exacerbate by activities
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20
Q

OSD Dx

A
  • Tenderness over the tibial tuberosity that is provoked by knee extension against resistance
  • Firm or bony enlargement of the tibial tuberosity
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21
Q

OSD Mx

A
  • Rest
  • Ice
  • Analgesia / NSAIDs
  • Physios
  • Avoid aggrevating activities
  • Refer Paeds ortho for persistent Sx
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22
Q

SUFE X-ray findings

A
  • Widening of epiphyseal line or displacement of the femoral head
  • Klein’s line does not intersect the femoral head
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23
Q

SUFE Acute presentation

A
  • < 3/52 of Sx onset
  • Painful limp
  • External rotation of the hip joint
  • length discrepency
  • unable to weight bear
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24
Q

SUFE examination findings

A
  • External rotation of the hip
  • Leg length discrepency
  • Limited ROM on internal rotation and abduction of the hip
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25
SUFE Risk Factors
- Obesity - Endocrine disorders - Puberty: Girls 11-12 years Boys 12-13 years
26
SUFE Mx
- Refer to paeds ortho **stat** - Avoid excessive movements / weight bear on the affected hip - Analgesia - **Surgically:** In situ single-screw fixation of the epiphysis
27
SUFE complications
Avascaular necrosis AKA Osteonecrosis
28
Septic arthritis diagnostic criteria in aspiration
WBC > 50,000
29
Septic arthritis diagnostic criteria for **prosthetic** in aspiration
WBC > 1100
30
Septic arthritis presentations
- Acute presentation - Hot, swollen, painful, restricted joint - Fever (60% of cases) - Erythema - Swelling
31
Septic Arthritis examination findings
- Erythema - Effusion - Hot to touch - Pain on palpation - Fever - Systemically unwell
32
Septic arthritis aspiration fluid characteristics
- Purulent - Cloudy
33
Septic arthritis common causative organism
- Staph aureus
34
Septic arthritis Mx
- Empirical Abx until sensitivities - Abx for 6/52 from diagnosis - Surgical drainage and washout of the joint to clear the infection in severe cases
35
Osteomyelitis epidemiology
- < 5 years - long bones: arms / legs
36
Paeds Osteomyelitis common site
metaphysis of the long bones
37
Paeds Osteomyelitis common causative organism
Staph aureus
38
Acute Paeds osteomyelitis
Infection in the bone - over 2/52
39
Paeds osteomyelitis Ix
- **Bloods:** FBC, ESR, CRP - Blood culture: Before commencing Abx - X-rays - MRI - Bone scan
40
Paeds osteomyelitis Mx
1. **Admit** 2. Blood culture 3. Think **Sepsis**: IV Abx after blood culture / within 1h of presenting for high risk sepsis patient
41
Paeds osteomyelitis complications
- Sepsis - Osteonecrosis AKA AVN - Bone abscess - Septic arthritis - Chronic osteomyelitis
42
Paeds Septic arthritis complications
**Joint damage:** Septic arthritis can cause permanent damage to joints, including joint degeneration, stiffness, and dysfunction. **Osteomyelitis:** An infection of the bone itself **Osteonecrosis:** Bone tissue dies due to lack of blood flow **Sepsis:** A widespread inflammation in the body **Death:** In severe cases, septic arthritis can lead to death **Limb length discrepancy:** A difference in the length of one leg compared to the other
43
Vit D deficiency serum level in children
Serum 25-hydroxyvitamin D (25[OH]D) levels < 25 nmol/L
44
Vit D sufficient serum level in children
Serum 25-hydroxyvitamin D (25[OH]D) levels > 50 nmol/L
45
Vit D deficiency in children complications
- Rickets - Osteomalacia and muscle weakness - Hypocalcaemia: seizures - Dilated cardiomyopathy
46
Vit D deficiency Loading dose in Age 6-11 months
6000 IU daily for 8–12 weeks.
47
Vit D deficiency Loading dose in Age 12–18 years
- 10,000 IU daily for 8–12 weeks. - A single or divided oral dose totalling 300,000 IU can be considered if there is concern about compliance with treatment.
48
Vit D deficiancy daily maintenance dose in children post loading dose regime
400–600 IU daily for 1/12
49
Define Juvenile Idiopathic Arthritis (JIA)
A collective term used to describe arthritis that affects children and young individuals under the age of 16
50
Systemic JIA Sx
- Muscle / joint pain - High swinging fever 37-39 - WL - Salmon-pink rash
51
Systemic JIA presentations
- Lymphadenopathy - Serositis: inflammation to the serous membranes (pericarditis, pleuritis, peeritonistis) - Hepato / SPlenomeagly - Salmon-pink rash - High Temp
52
Systemic JIA ANA, RF findings
-ve
53
Systemic JIA inflammatory marker findings
Raised for CRP, ESR, PLTs, Ferritin
54
Systemic JIA complication
Macrophage activation syndrome (MAS) ## Footnote disseminated intravascular coagulation
55
Define Oligoarticular JIA AKA Pauciarticular JIA
Arthritis involving < 4 joints
56
Oligoarticular JIA Risk factors
- Female > Male - Age < 6years
57
Oligoarticular JIA extrarticular complication
Ant. uveitis
58
Oligoarticular JIA Sx
- Pain in joints - Swelling in joints - Morning stiffness **NO Systemic Sx**
59
Oligoarticular JIA auto-antibodies findings
- RF -ve - ANA +ve
60
Oligoarticular JIA Mx
- Refer to paed Rheum - **Intra-articular steroid injection**
61
Oligoarticular JIA commonly affects which joints
Large joints: knee and ankle
62
Define Polyarticular JIA
Idiopathic inflammatory arthritis in > 5 joints
63
Polyarticular JIA presentations
- can be Symmetrical inflammation - affects smaller joints e.g. hands - **Minimal** systemic Sx
64
Polyarticular JIA subtypes
- Seronegative: RF -ve - Seropositive: RF +ve
65
Polyarticular JIA seronegative prevalence
toddler - preschool age Female > Male
66
Polyarticular JIA seropositive prevalence
older children and adolescents
67
Define Juvenile Psoriatic Arthritis
seronegative (RF -ve) inflammatory arthritis associated with psoriasis
68
Juvenile Psoriatic Arthritis presentations
- **Plaques of psoriasis**on the skin - **Pitting of the nails** (nail pitting) - **Onycholysis**, separation of the nail from the nail bed - **Dactylitis** inflammation of the full finger - **Enthesitis**, inflammation of the entheses, which are the points of insertion of tendons into bone
69
Systemic JIA Mx
- Refer to paeds rheum - Physical activities - Physio - Oral steroid
70
JIA bloods Ix
- FBC, CRP, ESR, ANA, RF
71
JIA imaging Ix
- **X-rays:** to exclude trauma, osteomyelitis or malignancy - **Ultrasound:** can show joint fluid, synovial hypertrophy and erosions if present - **MRI:** delineates any bony changes, joint damage and extent of synovitis
72
JIA X-ray findings
- Bone erosion - Narrowing of joint space - Fusion of bones
73
Chronic JIA complications
- Growth failure or abnormality - Osteoporosis - Delayed puberty

Paediatrics (22 decks)

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