Paediatric Flashcards
What is bone age used to assess?
Used to assess skeletal maturity in certain growth/puberty disorders
What are some examples of growth/puberty Disorders?
Bone dysplasia – short stature
Endocrine pathology example hypothyroidism – short stature
How is bone (skeletal) age estimated?
The dates at which carpal bones ossify
DP rest non-dominant hand must be used if it’s being used for estimation of age
When are the carpal bones ossified?
Capitate: 2/12
Hamlet: 3/12
Triquetral: three years
Lunate: four years
Scaphoid: 4–5 years
Trapezium: 4–5 years
Trapezoid: 4–5 years
pisiform: 9–12 years
When do bones in the elbow ossify?
CRITOL
Capitellum: Two months – 2 years
Radiohead: 3–6 years
Internal medial epicondyle: 4–7 years
Trochlea: 8–10 years
Olecranon: 8–10 years
Lateral epicondyle: 10–13 years
Why is it difficult to see fractures in paediatric patients?
Grow centres/growth plates may be confused as a fracture fracture may be confused as a growth plate
How do children’s bones react differently to trauma?
 they bend more - they are more flexible
Give examples of certain fractures that are more common in certain age groups?
Toddlers fracture: 1–2 years
Supracondylar fracture: 4–8 years – distal humerus
Give the two fractures which are notorious in paediatrics:
Buckle (Torus) fracture - Turn like shape on cortex upon – only one side and no splintering
Greenstick fracture - partial fracture – pending appearance
What is the Salter-Harris classification?
It’s a way to easily classify fractures that occur close to the epiphyseal plates
Name the five different types of Salter-Harris classifications:
Type one – physis fracture –
Type two – metaphysis + physis fracture
Type three – epiphysis and physis fracture
Type four – epiphysis and metaphysis fracture
Type five - crush
What does SUFE stand for?
Slipped upper femoral epiphysis
What is a slipped up a femoral epiphysis and how do patients present?
A growth plate injury
patient’s present with a limp, pain and possibly even leg length discrepancy
What is the aetiology of a slipped upper femoral epiphysis?
Unknown - often seen during a period of rapid growth
however obesity is a significant risk factor; history of trauma is in 50% of cases
What is the prevalence of a slipped upper femoral if it is this?
M:F
3:1
M -present later 13 to 16 years
F - Present earlier 11 to 14 years
What percentage of SUFE injuries are bilateral?
60% of SUFE is bilateral
What is the treatment for a slipped open femoral epiphysis?
Surgical opening may lead to physeal closure if so an osteotomy is often required
What is Perthes disease (legg–calve– Perthes)?
It’s avascular necrosis of the femoral head epiphysis
What is the prevalence of Perthes disease?
M: F equals 5:1; peak presentation 5–6 years
What is the incidence of Perthes disease?
Relatively uncommon (5–15 per 100,000 in western world)
How is Perthes disease presented?
A traumatic hip pain/limp
How is Perthes disease presented radiographically?
Look for changes in femoral head:
early – no appreciable change
Established – reduction in epiphyseal size; areas of lucency
Late – fragmentation, destruction
How is Perthes disease treated?
Bedrest and analgesia;
possibly splinting and surgical osteotomy in selected cases
What is developmental dysplasia of the hip also known as?
Clicky hips
What is development dysplasia of the hip?
Irregularity of acetabulum which allows the femoral head to glide out of the joint
Gives Clicky sound which is why it’s also known as clicky hip
What is the incidence of development dysplasia of the hip?
1.5– 20 in 1000 births
What is the prevalence of developmental dysplasia of the hip?
M: F - 1:8
What radiological techniques are used to confirm and assess developmental dysplasia of the hip?
Ultrasound to confirm under six months as femoral head hasn’t ossified
Extra pelvis looking for symmetry; delay in ossification is a sign of DDH
How can developmental dysplasia of the hip be treated?
Brace or surgery
What is intussusception?
Segment of owl is pulled into itself or neighbouring Loop by peristalsis 
Most common form of intestinal obstruction in infants
What does intussusception result in?
Mesentery is also involved so venous return is compromised which may result in a oedema and further restrictions to bloodflow
Eventually an arterial supply to the battle is interrupted leading to ischaemia and necrosis
What is the prevalence of an intussusception?
95% of occur in children – common 3/12–2 years; peak incidence 3/12–9/12; rare below 3/12
What are the symptoms of intussusception?
Lethargic and pallor important clues
What is the treatment of intussusception?
Reduction by air or water-soluble enema
How is an intussusception presented radiographically?
Abdomen x-ray - Demonstrates an along gated soft tissue mass
Bowel obstruction - Air fluid levels and bowel dilation
Absence of gas in distal collapsed bowel
Supine AXR –Doughnut shaped soft tissue density
ultrasound it may present as a target sign
What is vesico-ureteric reflux?
Urine flows back into ureter and kidneys - due to failure of the valve at the distal end of the ureter allowing backflow
Vesico-ureter reflux prevalence?
Most frequently diagnosed in infancy and childhood
What is the risk of vesico-ureter reflux?
Risk for developing recurrent kidney infections, which over time can cause damage and scaring to the kidneys
What is neonatal respiratory distress syndrome (NRDS)?
Occurs when there is not enough surfactant in the lungs
What is surfactant made up of and what does it do?
Proteins and fats
Helps keep the words inflated of prevent alveoli collapsing (gaseous exchange)
When is surfactant produced and what can be the results of premature birth?
- normal surfactant production occurs 24–28 weeks of pregnancy and is done by the 34th week
Premature birth results and insufficient surfactant in the lungs
What is ductus arteriosus?
Is the communication between the pulmonary artery And descending aorta
What is Patent ductus arteriosus?
TBC
What is hydrocephalus?
When CSF cannot be observed forcing cerebral ventricles (occasionally subarachnoid spaces) to enlarge substantially
What is the prevalence of hydrocephalus?
Can begin at any age
Most common in perinatal, foetal and neonatal age group
What is the treatment of hydrocephalus?
Difficult to tree and also result in poor neurological outcomes
GI atresia - what is it and where can it be found?
Congenital malformation
Can be found anywhere along the GI tract:
Oesophageal, Do you Denal, jejunoileal, colon also Biliary
Clubfeet treatment?
Casting Maybe give her the first date to several weeks after birth
Foot is pushed and twisted into an over corrected position - cast is then applied in order and hold the food in that position
Castor changed every two weeks
If not treated after six months old - surgical intervention is required
Forensics postpartum baby technique?
Babygram – beetle x-ray
Prenatal a miscarriage as well as cot death
Suspicion of physical abuse presentation?
25% of all fractures under age 3 are due to SPE
Majority occur under 18/12
25% risk of further injury if not diagnosed of first presentation – 5% die
Suspicion of physical abuse alerting signs?
Discrepancy between this to be a pattern of severity of injury
Lack of parental concerns/uncaring towards child
Delay in seeking medical attention
Child under nourished Or ill cared for
Suspected physically abuse clinical signs:
Soft tissues
Bruises to back, back off legs, Buttocks
Unusual soft tissue marks:
bruises on back, buttocks, finger bruising, bite marks, cigarette burns
torn frenulum
Abdominal injuries:
Uncommon, Involvement of spleen kidneys liver pancreas bowel
Blunt trauma – common after child can walk
This critical injuries most common fatal injuries in toddlers
CNS:
Impaired brain function - visible HI -LOC
Unexplained onset of fits, hemiplegia, or flaccidity
Retinal haemorrhages
Fatal case - infants die from HI
