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Child Health > Orthopaedics And Rheumatology > Flashcards

Orthopaedics And Rheumatology Flashcards

1
Q

Juvenile idiopathic arthritis

A

Autoimmune inflammation occurs in the joints
Arthritis without any other cause
Lasting >6 weeks
<16s

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2
Q

Key features of inflammatory arthritis

A

Joint pain
Swelling
Stiffness

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3
Q

Subtypes of juvenile idiopathic arthritis

A 
Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis
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4
Q

Systemic juvenile idiopathic arthritis features

A 
Still’s disease
Systemic illness
Subtle salmon-pink rash
High swinging fevers
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritic and pericarditis
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5
Q

Systemic JIA (Stills disease) investigations

A

ANA and RF negative
Raised inflammatory markers
Raised CRP, ESR, platelets, serum ferritin

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6
Q

Complications of systemic juvenile idiopathic arthritis

A 
Macrophage activation syndrome:
Acutely unwell child 
DIC
Anaemia
Thrombocytopenia
Bleeding
Non-blanching rash
Life-threatening
Low ESR key finding
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7
Q

Polyarticular juvenile idiopathic arthritis presentation

A

Idiopathic inflammatory arthritis in 5 joints or more
Symmetrical and can affect small joints of hands and feet
Can also affect hips and knees
Mild fever, anaemia, reduced growth
Mild systemic symptoms

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8
Q

Polyarticular JIA investigations

A

Rf negative, seronegative in younger

Seropositive patients are older

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9
Q

Oligoarticular JIA presentation

A

<4 joints
Usually only affects a single joint, mono arthritis
Tends to affect larger joints, often knee or ankle
Occurs more frequently in <6year old girls
Anterior uveitis, refer to ophthalmology, follow-up for uveitis
No systemic symptoms usually

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10
Q

Oligoarticular JIA investigations

A

Inflammatory markers normal or mildly elevated
ANA often positive
Rf often negative

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11
Q

Enthesitis- related arthritis presentation

A

Males >6 years
Inflammation of point where tendon inserts into bone
Check for psoriasis, IBD, anterior uveitis

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12
Q

Seronegative spondyloarthropathies

A 
Ankylosing spondylitis 
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease- related arthritis
Inflammatory arthritis 
Enthesitis
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13
Q

Causes of enthesitis

A

Traumatic stress

Repetitive stress during sporting activities, caused by autoimmune inflammatory process

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14
Q

Investigations enthesitis-related arthritis

A

MRI

HLA B27

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15
Q

Key areas to palpate to elicit tenderness of entheses

A

Interphalangeal joints in hand
Wrist
Over greater trochanter on lateral aspect of hip
Quadriceps insertion at anterior superior iliac spine
Quadriceps and patella tendon insertion around patella
Base of Achilles, at calcaneus
Metatarsal heads on base of foot

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16
Q

Juvenile psoriatic arthritis presentation

A

Symmetrical poly arthritis affecting small joints

Asymmetrical arthritis affecting large joints in lower limb

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17
Q

Juvenile psoriatic arthritis signs on examination

A 
Plaques of psoriasis on skin
Nail pitting
Onycholysis: separation of nail from nail bed
Dactylitis; inflammation of full finger
Enthesitis: inflammation of entheses
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18
Q

Management of JIA

A

Paediatric rheumatology
MDT
NSAIDs: ibuprofen
Steroids: oral, intramuscular, intra-articular in oligoarthritis
DMARD: methotrexate, sulfasalazine, leflunomide
Biologic therapy: TNFi, etanercept, infliximab, adalimumab

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19
Q

Ehler-Danlos syndrome

A

Genetic condition
Defects in collagen
Hyper mobility of joints
Abnormalities in connective tissue

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20
Q

Hyper mobile Ehlers-Danlos syndrome presentation

A 
Hyper mobility in joints
Joint pain after exercise or inactivity
Joint dislocations, shoulders or hips
Soft- stretchy skin
Easy bruising
Poor healing of wounds
Bleeding
Headaches
Autonomic dysfunction causing dizziness and syncope
Abdominal pain 
IBS
Menorrhagia and dysmenorrhea
Premature rupture of membranes in pregnancy
Urinary incontinence
Pelvic organ prolapse
Temporomandibular joint dysfunction 
Myopia and other
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21
Q

Beighton score for hyper mobility

A 
Palms flat on floor with straight legs 
Elbows hyperextend
Knees hyperextend
Thumb can bend to touch forearm 
Little finger hyper extends past 90 degrees
22
Q

Management of Ehlers Danlos

A

Physiotherapy: strengthen and stability joints
Occupational therapy: maximise function
Maintaining good posture in joints
Moderating intensity of activity to minimise flares
Psychology

23
Q

Postural orthostatic tachycardia syndrome

A

Autonomic dysfunction in hyper mobile Ehlers-Danlos syndrome
Inappropriate tachycardia on sitting or standing up
Distressing symptoms: pre-syncope, syncope, headaches, disorientation, nausea and tremor

24
Q

Types of Ehlers-Danlos

A

Hyper mobile
Classical
Vascular
Kyphoscoliotic

25
Q

Salter Harris classification

A 
TY1: straight across growth plate
TY2: above
TY3: below
TY4: through 
TY5: crush
26
Q

Fracture management

A

Mechanical alignment via reduction

Provide relative stability

27
Q

Pain ladder for children

A

Paracetamol or ibuprofen

Morphine

28
Q

Causes of hip pain 0-4 years

A

Septic arthritis
DDH
Transient synovitis

29
Q

5-10 years hip pain

A

Perthes
Septic arthritis
Transient synovitis

30
Q

10-16 years joint pain

A

Septic arthritis
SUFE
Juvenile idiopathic arthritis

31
Q

Red flags for hip pain

A 
Child <3 years
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in morning
Swollen or red joint
32
Q

Criteria for urgent referral for assessment in a limping child

A 
Child under 3 years
Child older than 9 with a restricted or painful hip
Not able to weight bear
Evidence of neurovascular compromise
Severe pain or agitation
Red flags for serious pathology
Suspicion of abuse
33
Q

Investigations for hip pain

A

Blood tests including inflammatory markers (CRP and ESR) for JIA and septic arthritis

Xrays are used to diagnose fractures, SUFE and other boney pathology

Ultrasound can establish an effusion (fluid) in the joint

Joint aspiration is used to diagnose or exclude septic arthritis

MRI is used to diagnose osteomyelitis

34
Q

Septic arthritis presentation

A 
Most common in <4s
Hot, red, swollen and painful joint
Refusing to weight bear
Stiffness and reduced range of motion
Systemic symptoms: fever, lethargy, sepsis
35
Q

Bacteria in septic arthritis

A

Staph aureus most common
Neisseria gonorrhoea (gonococcus) in sexually active teenagers
Group A streptococcus (Streptococcus pyogenes)
Haemophilus influenza
Escherichia coli (E. coli)

36
Q

DD for septic arthritis

A

Transient sinovitis
Perthes disease
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

37
Q

Septic arthritis management

A

Admission
Involve orthopaedics
Aspirate joint prior to giving antibiotics
Send sample for gram staining, Crystal microscopy, culture and antibiotic sensitivities
Joint fluid may be purulent
Empirical IV antibiotics 3-6weeks
Surgical drainage and joint washout

38
Q

Transient synovitis presentation

A 
Recent URTI
3-10 years
Limp
Refusal to weight bear
Growing or hip pain
Mild low grade temperature
39
Q

Management of transient synovitis

A

Symptomatic management

Resolve in 1-2weeks

40
Q

Perthes disease

A

Avascular necrosis of femoral head
Revascularisiation and healing, remodelling
Complication: hip osteoarthritis

41
Q

Perthes presentation

A 
Pain in hip or groin
Limp
Restricted hip movements
Referred pain to knee 
No history of trauma
42
Q

Perthes investigations

A

XRAY
Blood tests normal
Technetium bone scan
MRI

43
Q

Perthes management

A

Bed rest, traction, crutches, analgesia
Physiotherapy
Regular X-rays
Surgery in severe case

44
Q

Slipper upper femoral epiphysis presentation

A 
8-15 years
Obese children 
Minor trauma
Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted movement in the hip 
Restricted internal rotation
45
Q

SUFE diagnosis

A 
XRAY
Blood tests normal
Technetium bone scan
CT
MRI
46
Q

Management of SUFE

A

Screw surgery

47
Q

Development dysplasia of hip risk factors

A

First degree family history
Breech presentation from 36 weeks onwards
Breech presentation at birth if 28 weeks onwards
Multiple pregnancy

48
Q

DDH screening

A

Neonatal examination
Birth
6-8 weeks

49
Q

Features of DDH

A

Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in the knee level when the hips are flexed
Clunking of the hips on special tests

Ortolans
Barlow

50
Q

DDH diagnosis

A

Ultrasound

XRAY

51
Q

DDH management

A

Pavlik harness 6-8 weeeks
Surgery
Hip spica cast post surgery

Child Health (20 decks)

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