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Paediatrics > Ortho/rheum > Flashcards

Ortho/rheum Flashcards

1
Q

What is Henoch Schonlein purpura?

A

IgA vasculitis presenting w purpuric rash on the lower limbs and buttocks of children. Inflam due to IgA deposits in blood vessels. Often triggered by URTI or gastro enteritis.
Organs affected - skin, kidneys and GI tract

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2
Q

What are the classic features of Henoch Schonlein purpura?

A
  • Pupura - 100% - red/purple lumps palpable under the skin, normally on legs and buttocks, can also be on trunk and arms, severe = skin ulceration and necrosis
  • Joint pain - 75% - knees and ankles mostly
  • Abdominal pain - 50%
  • Renal involvement - 50% (IgA nephritis)
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3
Q

What are the complications of HSP in the GI tract?

A
  • Gastro intestinal haemorrhage
  • Intussusception - telescoping of the bowel, part of the intestine slides backwards into another part, can cause bowel obstruction or bowel ischaemia
  • Bowel infarction
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4
Q

What are the complications of HSP renally?

A

Causes IgA/HSP nephritis - microscopic or macroscopic haematuria and proteinuria .
>2+ protein on dipstick = nephrotic syndrome and has a degree of oedema
Triad - haematuria, proteinuria and oedema

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5
Q

What are the differentials for HSP?

A
  • Meningococcal septicaemia
  • Leukaemia
  • Idiopathic thrombocytopenic purpura
  • Haemolytic uraemic syndrome
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6
Q

What are the ix into HSP?

A
  • FBC and blood film to rule out thrombocytopenia, sepsis and leukaemia
  • U+Es, eGFR, creatinine
  • Serum albumin - nephrotic syndrome
  • CRP and blood cultures - sepsis
  • Urine dipstick and urine protein:cr ratio to quantify proteinuria
  • BP - HTN?
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7
Q

What is the diagnostic criteria for HSP?

A

Palpable purpura and at least one of the following:
- Arthritis/arthralgia
- Diffuse abdo pain
- IgA deposits on histology
- Proteinuria or haematuria

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8
Q

What is the management of HSP?

A

Supportive - simple analgesia, rest and fluids
Steroids may shorten duration of illness but don’t affect long term out comes or recurrence, most likely to be used in severe GI pain or renal involvement
Monitor - blood pressure and urine dipsticks for renal involvement

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9
Q

What is the prognosis of HSP?

A

Abdo pain usually better within a few days.
No kidney invovlement - recover in 4-6 weeks
30% recurrence w/i 6 months
<1% = ESRF

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10
Q

What is the presentation of septic arthritis?

A

Most commonly in children <4 years:
- Hot, red, swollen, painful joint
- Refusing to weight bear
- Single joint - often knee or hip
- Stiffness and reduced ROM
- Systemic sx - fever, lethargy, sepsis
(easily missed in children and confused w things like trauma and transient synovitis)

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11
Q

What bacteria most commonly causes septic arthritis?

A

Staph aureus most commonly but also …
N. gonorrhoea in sexually active teenagers, group A strep, H. influenzae, E.coli

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12
Q

What are the ix of septic arthritis?

A
  • Joint aspiration, prior to abx where possible
  • Sample - gram stain, microscopy, culture and abx sensitivity
  • FBC, CRP
  • Blood cultures
  • If suspect osteomyelitis - MRI/CT, XR
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13
Q

What is the management of septic arthritis?

A
  • Low threshold of treating, esp caution in immunosuppressed patients
  • Admission to hospital and ortho team
  • Empirical IV abx until sensitivities known
  • Cont abx for 3-6 weeks when septic arthritis confirmed
  • Severe = surgical drainage and washout
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14
Q

What are the CF of reactive arthritis?

A
  • Arthritis - several weeks post initial infection, joint stiffness, low back pain, effusion, reduced ROM
  • Urethritis/cervicitis
  • Conjunctivitis

+ fever, malaise, weight loss, fatigue, keratoderma blenorrhagicum

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15
Q

What triggers reactive arthritis?

A
  • Urethritis/cervicitis - Chlamydia trachomatis most commonly causes
  • GI - diarrhoea illness
  • Usually have HLA-B27 allele
  • HIV +ve more likely to get
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16
Q

What is the management of reactive arthritis?

A
  • PT
  • NSAIDs
  • Steroids - injection or systemic
  • > 6 months - DMARDS eg. sulfasalazine, methotrexate, azathioprine
  • Abx if triggering disease still present eg. STI
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17
Q

What are the ix of reactive arthritis?

A
  • ESR, CRP, FBC
  • Men - NAAT for Chlamydia and gonorrhoea, urethral gram stain
  • Women - vulvovaginal NAAT and endocervical swab
  • Screen HIV, syphilis, hep B and C
18
Q

What is Legg Calve Perthes disease?

A

Disruption of blood flow to the femoral head = avascular necrosis, effects the epiphysis of the femur. Is idiopathic. 4-12 years old, most commonly 5-8 year old boys.

19
Q

What is the presentation of Perthes disease?

A
  • Pain in hip or groin
  • Limp
  • Restricted hip movements
  • Referred pain to the knee
  • No hx of trauma
20
Q

What are the ix in Perthes disease?

A
  • XR - but can be normal
  • Bloods - ESR and CRP to exclude alt causes
  • Technetium bone scan and MRI
21
Q

What is the management of Perthes?

A
  • Conservative - bed rest, traction, crutches, analgesia for less severe cases and younger children. Aim to maintain good alignment and reduce risk of deformity.
  • PT to retain ROM
  • Reg XRs to assess healing
  • Surgery in severe cases or older children, aim to improve alignment and func of femoral head
22
Q

What are the complications of Perthes disease?

A

Soft deformed femoral head - early OA of the hip - may need total hip replacement

23
Q

What is SUFE?

A

Slipper upper femoral epiphysis - head of the femur is displaced and slips along the growth plate.
Classically = 8-15 year old boys, avg 12 yo. More common in obese children.

24
Q

What is the presentation of SUFE?

A

Minor trauma triggering sx, pain disproportionate to severity of trauma.
- Hip groin thigh knee pain
- Reduced ROM, esp int rotation
- Painful limp
- Hip = ex rotated

25
Q

Ix and management of SUFE

A

XR and surgery to return femoral head to correct position, usually fix to keep it in place

26
Q

What is DDH? What are the RFs?

A

Developmental dysplasia of the hip - structural abnormality = increased risk of subluxation or dislocation.
RF - FH, breech presentation, multiple pregnancy

27
Q

How is DDH screened?

A

Neonatal exam at birth and 6-8 weeks = symmetry of hips, leg length, skin folds and hip movements.
Ortolani test - baby on back, hip and knees flexed, abduct the hips to see in ant disolcation
Barlow - adduct hip to see if there is post dislocation

28
Q

What is the presentation of DDH?

A
  • Diff leg lengths
  • Restricted hip abduction
  • Difference in knee level when hips flexed
  • Clunking (not clicking, this is normal)e
29
Q

What is the management of DDH?

A
  • Pavlik harness - <6 months, kept on permanently to hold femoral head in correct position for normal shape acetabulum to develop, normally remove after 6-8 weeks
  • Surgery when harness fails or > 6 months, use hip spica cast after
30
Q

What is Osgood Schlatters?

A

Inflam of tibial tuberosity, most common cause of ant knee pain in adolescents, usually 10-15 years and more common in males.

31
Q

What is the presentation of Osgood Schlatters?

A
  • Visible or palpable hard and tender lump on tibial tuberosity
  • Pain in the ant aspect of the knee, made worse by exercise, kneeling and knee extension
32
Q

What is the management of Osgood Schlatters?

A
  • RICE
  • NSAIDs
  • PT
33
Q

What is juvenile idiopathic arthritis?

A

Autoimmune inflam of the joints = arthritis w/o cause >6 weeks under 16 years old

34
Q

What are the different subtypes?

A
  • Systemic JIA - Still’s disease, salmon pink rash, fevers and joint pain
  • Polyarticular JIA - 5 joints+ (RA of children)
  • Oligioarticular JIA - 4 joints or less MOST COMMON
  • Enthesitis related
  • Juvenile psoriatic arthritis
35
Q

What is the management of JIA?

A
  • NSAIDs
  • Steroids in oligoarthritis
  • DMARDS eg. methotrexate, sulfasalazine
  • Biologicals eg. adalimumab, infliximab
  • PT and OT, lots of physical activity
36
Q

What are the complications of JIA?

A
  • Joint deformities
  • Need for joint replacement
  • Uveitis, need regular screening
  • Macrophage activation syndrome
  • OP
  • Growth restriction
37
Q

What are the different paeds fractures?

A
  • Plastic bowing fracture
  • Buckle fracture
  • Greenstick fracture
  • Salter Harris fracture - fracture through the growth plate
38
Q

WHat is the Salter Harris classification?

A

Separated growth plate
Above the growth plate
Lower than the growth plate
Through the growth plate
Erasure of the growth plate

39
Q

What is the worry with higher Salter Harris classifications?

A

The higher the Salter Harris fracture, the more likely the growth plate will arrest and you will have a limb length discrepency.

40
Q

What is a skeletal survery?

A

XR of every bone in the body to investigate for accidental injury and suspected child abuse done in children <2 years.
Will have a follow up skeletal survey 11-14 days later.

41
Q

What are some fractures found in suspected physical abuse?

A
  • Metaphyseal fractures
  • Rib fractures, commonly posterior
  • Skull fractures, usually non parietal and associated w subdural haemorrhage
  • Scapular fracture
  • Sternal fractures
  • Spiral long bone fracture

Paediatrics (15 decks)

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