Orthopaedic + Rheum

Question 1

What is the pathophysiology of HSP?

Answer 1

IgA vasculitis that presents with a purpuric rash which affects lower limbs and buttocks in children under the age of 10 - triggered by URTI or gastroenteritis

Question 2

What are the classical features of HSP?

Answer 2

1. purpura - symmetrical, non-blanching
2. joint pain
3. abdominal pain
4. renal involvement - oedema

Question 2

What initial investigations are carried out for HSP?

Answer 2

FBC + blood film + CRP
blood cultures
renal profile
albumin
urine protein:creatinine ratio

Question 3

How is HSP diagnosed?

Answer 3

Diffuse abdominal pain
Arthritis or arthralgia
IgA deposits on histology (biopsy)
Proteinuria or haematuria

Question 4

How is HSP managed?

Answer 4

*supportive analgesia + hydration
potentially steroids
monitor urine dipstick for haematuria, BP for HTN
4-6w recovery without renal involvement

Question 5

What is reactive arthritis?

Answer 5

most common form of arthritis in childhood - following an infection
eg: enteric –> salmonella, shigella

Question 6

How does reactive arthritis present?

Answer 6

joint pain + swelling
erythema
conjunctivitis or uveitis
dysuria

Question 7

How is reactive arthritis diagnosed?

Answer 7

clinical
blood, stool, urine tests for infection
XR normal

Question 8

How is reactive arthritis managed?

Answer 8

NSAIDs with full recovery
underlying infection management
steroid injection –> if significant swelling + pain

Question 9

What is septic arthritis?

Answer 9

infection within the joint result from haematogenous spread, infected skin lesions
eg: staph. aureus, N. gonorrhoea etc

Question 10

What pathogens must you consider in septic arthritis?

Answer 10

common - staph. aureus
sexually active - N. gonorrhoea
other - strep. pyogenes, H. influenzae

Question 11

How does septic arthritis present?

Answer 11

single joint - hip or knee often
rapid onset - hot, red, swollen, painful joint, refuse weight bearing, systemic sx
*LIMPING CHILD

Question 12

How must septic arthritis be investigated?

Answer 12

FBC, cultures
USS effusion
XR - widening of joint space and tissue swelling
Joint aspiration (pre-antibiotic) - gram staining, crystal microscopy, cultures, sensitivities

Question 13

How is septic arthritis treated?

Answer 13

IV Abu 3-6w
eg: flucloxacillin, ceftriaxone for N-gonorrhoea
irrigation and debridement of affected joints +/- prosthetic joint

Question 14

What is juvenile idiopathic arthritis?

Answer 14

persistent joint swelling of >6w with absence of other infection or cause
*7 types

Question 15

How might JIA present?

Answer 15

joint swelling and stiffness after rest
intermittent limp in young
systemic - subtile salmon pink rash

Question 16

What investigations are carried out in JIA?

Answer 16

FBC, ESR, CRP
ANA
RF
anti-CCP etc

Question 17

How is JIA managed?

Answer 17

*aim to reduce inflammation, minimise sx, maximise function
NSAIDs, steroids
DMARDs + biologics

Question 18

What are some differentials for a limping toddler?

Answer 18

transient synovitis - viral infection alongside
fracture
non-accidental injury
DDH

Question 19

What are some differentials for a limping child?

Answer 19

transient synovitis
perthes - AVN of femoral head
JIA - painless limp

Question 20

What are some differentials for a limping adolescent?

Answer 20

slipped capital femoral epiphysis - obese
JIA