Paediatric

Question 1

What is bone age used to assess?

Answer 1

Used to assess skeletal maturity in certain growth/puberty disorders

Question 2

What are some examples of growth/puberty Disorders?

Answer 2

Bone dysplasia – short stature

Endocrine pathology example hypothyroidism – short stature

Question 3

How is bone (skeletal) age estimated?

Answer 3

The dates at which carpal bones ossify

DP rest non-dominant hand must be used if it’s being used for estimation of age

Question 4

When are the carpal bones ossified?

Answer 4

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

Question 5

When do bones in the elbow ossify?

CRITOL

Answer 5

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

Question 6

Why is it difficult to see fractures in paediatric patients?

Answer 6

Grow centres/growth plates may be confused as a fracture fracture may be confused as a growth plate

Question 7

How do children’s bones react differently to trauma?

Answer 7

 they bend more - they are more flexible

Question 8

Give examples of certain fractures that are more common in certain age groups?

Answer 8

Toddlers fracture: 1–2 years

Supracondylar fracture: 4–8 years – distal humerus

Question 9

Give the two fractures which are notorious in paediatrics:

Answer 9

Buckle (Torus) fracture - Turn like shape on cortex upon – only one side and no splintering

Greenstick fracture - partial fracture – pending appearance

Question 10

What is the Salter-Harris classification?

Answer 10

It’s a way to easily classify fractures that occur close to the epiphyseal plates

Question 11

Name the five different types of Salter-Harris classifications:

Answer 11

Type one – physis fracture –

Type two – metaphysis + physis fracture

Type three – epiphysis and physis fracture

Type four – epiphysis and metaphysis fracture

Type five - crush

Question 12

What does SUFE stand for?

Answer 12

Slipped upper femoral epiphysis

Question 13

What is a slipped up a femoral epiphysis and how do patients present?

Answer 13

A growth plate injury
patient’s present with a limp, pain and possibly even leg length discrepancy

Question 14

What is the aetiology of a slipped upper femoral epiphysis?

Answer 14

Unknown - often seen during a period of rapid growth
however obesity is a significant risk factor; history of trauma is in 50% of cases

Question 15

What is the prevalence of a slipped upper femoral if it is this?

Answer 15

M:F
3:1

M -present later 13 to 16 years
F - Present earlier 11 to 14 years

Question 16

What percentage of SUFE injuries are bilateral?

Answer 16

60% of SUFE is bilateral

Question 17

What is the treatment for a slipped open femoral epiphysis?

Answer 17

Surgical opening may lead to physeal closure if so an osteotomy is often required

Question 18

What is Perthes disease (legg–calve– Perthes)?

Answer 18

It’s avascular necrosis of the femoral head epiphysis

Question 19

What is the prevalence of Perthes disease?

Answer 19

M: F equals 5:1; peak presentation 5–6 years

Question 20

What is the incidence of Perthes disease?

Answer 20

Relatively uncommon (5–15 per 100,000 in western world)

Question 21

How is Perthes disease presented?

Answer 21

A traumatic hip pain/limp

Question 22

How is Perthes disease presented radiographically?

Answer 22

Look for changes in femoral head:

early – no appreciable change

Established – reduction in epiphyseal size; areas of lucency

Late – fragmentation, destruction

Question 23

How is Perthes disease treated?

Answer 23

Bedrest and analgesia;
possibly splinting and surgical osteotomy in selected cases

Question 24

What is developmental dysplasia of the hip also known as?

Answer 24

Clicky hips

Question 25

What is development dysplasia of the hip?

Answer 25

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

Question 26

What is the incidence of development dysplasia of the hip?

Answer 26

1.5– 20 in 1000 births

Question 27

What is the prevalence of developmental dysplasia of the hip?

Answer 27

M: F - 1:8

Question 28

What radiological techniques are used to confirm and assess developmental dysplasia of the hip?

Answer 28

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

Question 29

How can developmental dysplasia of the hip be treated?

Answer 29

Brace or surgery

Question 30

What is intussusception?

Answer 30

Segment of owl is pulled into itself or neighbouring Loop by peristalsis  Most common form of intestinal obstruction in infants

Question 31

What does intussusception result in?

Answer 31

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

Question 32

What is the prevalence of an intussusception?

Answer 32

95% of occur in children – common 3/12–2 years; peak incidence 3/12–9/12; rare below 3/12

Question 33

What are the symptoms of intussusception?

Answer 33

Lethargic and pallor important clues

Question 34

What is the treatment of intussusception?

Answer 34

Reduction by air or water-soluble enema

Question 35

How is an intussusception presented radiographically?

Answer 35

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

Question 36

What is vesico-ureteric reflux?

Answer 36

Urine flows back into ureter and kidneys - due to failure of the valve at the distal end of the ureter allowing backflow

Question 37

Vesico-ureter reflux prevalence?

Answer 37

Most frequently diagnosed in infancy and childhood

Question 38

What is the risk of vesico-ureter reflux?

Answer 38

Risk for developing recurrent kidney infections, which over time can cause damage and scaring to the kidneys

Question 39

What is neonatal respiratory distress syndrome (NRDS)?

Answer 39

Occurs when there is not enough surfactant in the lungs

Question 40

What is surfactant made up of and what does it do?

Answer 40

Proteins and fats Helps keep the words inflated of prevent alveoli collapsing (gaseous exchange)

Question 41

When is surfactant produced and what can be the results of premature birth?

Answer 41

- 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

Question 42

What is ductus arteriosus?

Answer 42

Is the communication between the pulmonary artery And descending aorta

Question 43

What is Patent ductus arteriosus?

Answer 43

TBC

Question 44

What is hydrocephalus?

Answer 44

When CSF cannot be observed forcing cerebral ventricles (occasionally subarachnoid spaces) to enlarge substantially

Question 45

What is the prevalence of hydrocephalus?

Answer 45

Can begin at any age Most common in perinatal, foetal and neonatal age group

Question 46

What is the treatment of hydrocephalus?

Answer 46

Difficult to tree and also result in poor neurological outcomes

Question 47

GI atresia - what is it and where can it be found?

Answer 47

Congenital malformation Can be found anywhere along the GI tract: Oesophageal, Do you Denal, jejunoileal, colon also Biliary

Question 48

Clubfeet treatment?

Answer 48

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

Question 49

Forensics postpartum baby technique?

Answer 49

Babygram – beetle x-ray Prenatal a miscarriage as well as cot death

Question 50

Suspicion of physical abuse presentation?

Answer 50

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

Question 51

Suspicion of physical abuse alerting signs?

Answer 51

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

Question 52

Suspected physically abuse clinical signs:

Answer 52

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