Musc + Neuro Flashcards
What is slipped femoral epiphysis?
overweight boys 10-15 yrs
1/50000
FE displaced posterolaterally following minor trauma/spontaneously
bilateral in 1/5
What is Osgood-Schlatter disease?
traction apophysitis
(cartilage detachment from tibial tuberosity)
due to repeated avulsion during growth spurt i.e. overuse
usually a lump over the tibial tubercle
Req rest + analgesia
Perthes disease
Ischaemia of epiphysis + adjacent metaphysis
Avascular necrosis of the femoral head
Revasc + reossification over 2-3 yrs
Incr density + reduced size of femoral head
Later = fragmented + irreg
Signs of basal skull fracture
Haemotympanum: blood behind tympanic membrane
Raccoon eyes
CSF oto/rhinorrhoea
Battle’s sign: blood at mastoid
Benign rolandic epilepsy
7-10 yrs
Mostly male
Nocturnal involving mouth + face
Excessive salivation, grunting + slurred speech -> generalised seizures
EEG: high amplitude spikes in left centrotemporal region nr Rolandic fissure
Benign, grow out of it by adolescence
Absence seizures
Generalised seizures affecting consciousness Last a few seconds Stares blankly, unresponsive No recollection of event 2-10 yrs More common in girls Frequently grow out of them 3 spike wave complex FHx in 10%
Juvenile myoclonic epilepsy
Begins around puberty
Precipitated by alcohol
Severe symmetrical jerks of arms + trunk -> generalised seizures
Often occur in the morning on waking
Lennox Gastaut type epilepsy
1-4 yrs
Daily seizures, episodes of status epilepticus
Slow psychomotor development + behavioural disorders
Poor prognosis
EEG: slow spike waves, multiple abnormalities
Reflex anoxic seizure
After pain/discomfort/minor injury/fever/cold drink/fright
Infant/toddler
Pallor-> fall to ground -> occasionally tonic clonic movements -> rapid recovery
Reflex cardiac asystole secondary to incr vagal response
Breath holding attacks
Young children usually toddlers
Upset/angry/crying
Hold breath at end of expiration -> goes blue and apnoeic
Brief LOC can occur
Simple vasovagal
Standing for long periods / very warm environment
Dizzy /light headed/ ringing in ears / blurred vision
Syncope
Cardiac arrhythmias
Syncope without warning
May be related to exercise
Other cardiac causes of syncope
SVT
Prolonged QT
You suspect septic arthritis what investigations would you do to confirm your diagnosis?
US joints: painful joint + joints above and below
Radiology will not show signs until later in the course of the infection
Blood cultures should be sent
Joint aspirate should be sent for M, C + S
Start empirical IV abx
How does SUFE present?
Limp + Hip pain referred to knee
Restriction in abduction + int rotation of hip
Management: surgical pinning of epiphysis
Complications: premature epiphyseal fusion + avascular necrosis
How does Perthes’ disease present?
Boys 2-10 yrs (usually >5) Insidious onset hip pain + limp Bilat in 10% Dx by x-Ray: incr density, reduced size femoral head
How is Perthes disease managed?
Bed rest + traction
Femoral head may need to be ‘covered’ by acetabulum so it can act as a mould for the reossification: hip maintained in abduction
Or surgical femoral osteotomy
Usually good prognosis
Poor prognosis if: 1/2 epiphysis involved
Incr risk of deformity of femoral head = degen OA in adult life
Transient synovitis
3-8yrs
Following viral infection
Diagnosis of exclusion
Sudden onset hip pain, mild fever, slight limp, reduced range of movement especially ext rotation
No pain at rest, few systemic sx
-ve FBC, acute phase reactants, x-Ray, blood cultures
Small effusion on USS
How is transient synovitis managed?
Analgesia
Bed rest
Skin traction??
Usually resolves in 7-10 days
How is septic arthritis managed?
US + joint aspirate (usually staph aureas)
Surgical washout
IV abx: fluclox + benpen
Followed by oral abx
Complications: joint destruction, osteomyelitis, ankylosis (fusion across joint)
Risk factors for septic arthritis?
V old / v young
IVDU
DM
Pre-existing joint pathology
Genu varus
Aka bow legs
Medial angulation of lower leg at the knee
Commonest cause: rickets
Also caused by Blount’s disease: asymmetrical growth of tibial physis common in Scandinavian + Afro-Caribbean ethnicities
Signs of an intracranial mass
Focal neuro signs: tremor
Behavioural changes
Headaches worse in am, worse on coughing, bending or straining
Papilloedema on fundoscopy
