MSK/nephro/endo Flashcards
key signs of rickets
bowed legs/knock kees , bone pain, stunted growth, dental manifestations, Rachitic rosary (which is when bead like structures form on ribs due to swelling at costochondral junctions)
Complications –> dental caries, shunted growth and fractures
what does an xray show of rickets
cupping, fraying, metaphysical widening
MX of rickets
Vit D3, calcium, phosphorus supplements, diet and lifestyle
Ddx for rickets
osteogenesis imperfecta (brittle bone disease where there is a defect in collagen metabolism) –> blue sclera and hearing loss
blood results for rickets
low vit D, low ca, low P, high ALP
signs of hypothyroidism in newborn
prolonged jaundice, hoarse cry, lethargy, poor feeding, constipation
why is it important to pick up hypothyroidism on newborn test
if diagnosed late –> impaired neurocognitive development and growth
at what centile is a child clinically overweight
91st
Dx of T1DM
fasting > or equal to 7 or random > or equal to 11.1
if asymptomatic this must be demonstrated on two separate occasions
what does insulin normally do
-facilitates uptake of glucose into muscle, liver, adipose via GLUT4
-stop lipolysis and enhance glycolysis
-anabolic
-increase protein synthesis
what may cause a false elevated HbA1c
splenectomy , iron deficiency
what may cause a falsely low HbA1c
splenomegaly and haemolytic anaemia
Ix for diabetes insipidus
24 hr urine collection (>3L), urine and serum osmolality, water deprivation test
acquired causes of cranial diabetes insipidus
idiopathic, tumour, trauma, infections
Mx of nephrogenic diabetes insipidus
Tx any underlying cause (lithium toxicity or hypercalcaemia), can use thiazide diuretics, low salt diet
what is neonatal thyrotoxicosis
affects some infants whose mums have graves - should self limit by 1-3 months
what is the Mx of DDOH
- most unstable hips should resolve spontaneously by 3-6 weeks
-pavlik harness if < 6 months which can hold the femoral head in the acetabulum
-older children need surgery
signs of DDOH
clunking, asymmetry in skin folds, discrepancy in leg length
X-ray signs of perthes
joint space widening and decrease in femoral head size
which way is the displacement in SUFE
posterior (neck moves backwards)
O/E of SUFE
leg in external rotation with limited internal rotation
what method is used to manipulate the club foot and cast it
ponseti
associations with club foot
CP and oligohydraminos
what is a toddler fracture
an oblique tibial fracture in infants (needs a cast for 3 weeks)
most common organism in septic arthritis
staph aureus
Abx for septic arthritis
flucloxacillin
kocher criteria for septic arthritis
refusal to weight bear, raised WCC, raised ESR and fever > 38.5
how does osteosarcoma present
bone pain, worse at night, may have a bone swelling (normally affects 10-20-y)
Xray findings of osteosarcoma
periosteal reaction (sunburst appearancE) + fluffy appearance
complications of osteosarcoma
pathological bone fractures, mets, amputation, poor prognosis
what sarcoma shows an onion skin appearance
ewing (this presents in same way to osteosarcoma but is less common)
what is the definitive diagnosis of a bone cancer
bone biopsy
red flags of hip pain
<3 years, pain at night, fever, night sweats, swelling
presentation of JIA
joint pain for >6 weeks, joint swelling, fever and pink salmon rash
what is stills disease
systemic JIA (swinging fevers, pink salmon rash, raised inflammation markers)
why is contrast used in imaging
enhance blood vessels so allows solid organs to be visualised better
poor prognostic factors for ALL
age <1 or >10, WCC > 50, CNS involvement
RF of leukaemia
DS, Li Fraumeni, exposure to ionising radiation, EBV
Ix for leukaemia
FBC (lots of blast cells and pancytopenia)
Blood film - blast cells
BM biopsy - blast cells + do immunophenotyping and cytogenetics to classify the disease and for risk stratification
U+E
coag
CXR!! this is important to identify any mediastinal mass
Maintenance Tx for leukaemia
2 years for girls and 3 years for boys
when is rasburicase used instead of allopurinol for the Tx of tumour lysis syndrome
when it is high risk (WCC > 50)
LT complications of leukaemia / lymphoma
stunted growth, infertility, secondary cancers, avascular necrosis
when is a Dx of leukaemia given from bone marrow biopsy
when there are >20% blast cells
how is lymphoma different to leukaemia
it involves mature cells which arise from sites outside of the bone marrow
on what chromosome is the beta globin gene which mutates in SCD
chromosome 11 (glu to val)
how to recognise acute chest syndrome (vascocculsion of microvasculature which causes infarction
pain! fever, cough, tachypnoea, dyspnoea, new onset hypoxia and will see pulmonary infiltrates on CXR
Mx of acute chest syndrome
antibiotics, oxygen, pain relief, may give transfusion
what is a sequestration crisis in SCD
sickling blocks blood vessel which causes pooling of blood in spleen which causes An acute drop in Hb - may need splenectomy
what does haemoglobin electrophoresis show for SCD
no HBA but you get HbSS
Mx of SCD in general
-avoid triggers of vasoocculsive crisis like cold temperatures, dehydration, exhaustion
-prevent infection (5 yearly pneumococcal and annual influenzae)
-hydroxycarbamide
-transfusion
-genetic counselling
other complications of SCD
-avascular necrosis
-transfusion associated complications
-cholecystitis
-hyposplenism
what would bloods results show for DIC
low platelets, raised APTT, PT and D dimer
-MAHA on blood film - schistocytes
Ix for anaemia in children
-reticulocyte count
-MCV
-blood film
-B12/folate
-direct Coombs
why do we get anaemia of prematurity
less time in utero receiving iron from mother
-red blood cells cannot keep up with rapid growth
-blood tests
why do babies get a physiological anaemia
at birth get increased oxygen, negative feedback on EPO so reduced production of RBC
what’s the basics of thalassaemia
defective Hb so get haemolytic anaemia –> spleen removes it so get splenomegaly. Get extramedulallary haematopoesis with the body trying to keep up.
MX of thalassaemia
transfusions, iron chelation, splenectomy
causes of macrocytic anaemia other than B12 and folate D
liver disease, hypothyroidism
causes of pancytopenia
chemo, leukaemia, EBV, aplastic anaemia, hypersplenism
RF for bed wetting
family history, behavioural problems, obesity
when is bed wetting normal util
age 5
Atypical UTI
-non Ecoli
-not responding to Abx in 48 hours
-v unwell
-poor urine flow
-abdominal mass
criteria for US in UTI
-<6 months
-atypical
-3LUTI
-2UUTI
MX of UTI if < 3 months
IV abx and full septic screen AND ALWAYS ADMIT TO HOSPITAL
Signs of a posterior urethral valve
UTI, weak stream, palpable bladder
MX of posterior urethral valve
ablation of extra urethral tissue on cystoscopy
give a range of causes of CKD in the infant
-ARPKD
-Wilms tumour
-recurrent UTI
-congenital - renal dysgenesis
-PSGN
-MCD
-HUS (thrombocytopenia, anaemia, AKI)
what is a neuroblastoma
tumour in nerves that can invade the kidneys and secrete increasing urinary catecholamines
complications of CKD
-uraemic pericarditis and encephalopathy
-electrolyte abnormality
-growth problems
-anaemia
-BMD
-hyperparathyroidism
nephrotic diseases
MCD
FSGS
membranous
MX of HUS
fluid rehydration, haemofiltration, steroids,
NO ROLE FOR ABX
symptoms of HUS
blood diarrhoea, reduced urine output, abdo pain, bruising, hypertension, jaundice
when should knock knees resolve by
age 8 (can refer to podiatrist if there is flat feet as well)
when do bow legs normally resolve
4th/5th year
what is osteochondritis dissecans
cause pain in knee (worse after exercise), part of the knee bone becomes detached due to a lack of blood supply. Fragment and overlying cartilage can then move around inside the joint and cause pain/swelling/locking.
what is chondromalacia patellae
sensation of grinding / clicking in the knee associated with quadricep weakness, caused after long sitting and pain felt when going up/down stairs, responds to physio
