Orthopaedic + Rheum Flashcards

1
Q

What is the pathophysiology of HSP?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the classical features of HSP?

A
  1. purpura - symmetrical, non-blanching
  2. joint pain
  3. abdominal pain
  4. renal involvement - oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What initial investigations are carried out for HSP?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is HSP diagnosed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is HSP managed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is reactive arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does reactive arthritis present?

A

joint pain + swelling
erythema
conjunctivitis or uveitis
dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is reactive arthritis diagnosed?

A

clinical
blood, stool, urine tests for infection
XR normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is reactive arthritis managed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is septic arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What pathogens must you consider in septic arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does septic arthritis present?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How must septic arthritis be investigated?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is septic arthritis treated?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is juvenile idiopathic arthritis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How might JIA present?

A

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

16
Q

What investigations are carried out in JIA?

A

FBC, ESR, CRP
ANA
RF
anti-CCP etc

17
Q

How is JIA managed?

A

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

18
Q

What are some differentials for a limping toddler?

A

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

19
Q

What are some differentials for a limping child?

A

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

20
Q

What are some differentials for a limping adolescent?

A

slipped capital femoral epiphysis - obese
JIA

21
Q
A