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Paediatrics cabinetchip > Paediatric arthritis > Flashcards

Paediatric arthritis Flashcards

1
Q

important factor on spetic arthritis

A

surgical emergency

-irreparable changes in the articular cartilage occur within HOURS of inoculation

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2
Q

top 3 organisms for septic arthitis

A

staphylococcus aureus

strep pneumonia

Haemophilus influenzae (incidence falling with immunisation)

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3
Q

presentation of septic arthiris excluding the joint 3

A

systemically unwell
-fever
-headache

-may have another focus of infection (septicasemia, pharyngitis, meningitis, cellulitis)

joints issues

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4
Q

presentation of septic arthitis regarding the joint 5

A

exquisitely painful

hot

swollen

red

held immobile (pseudoparalysis)

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5
Q

how can joint presentation differ in septic arthitis

A

joints covered by lots of muscel or subcut itssue (particulary hip) will not be red hot or swollen

those signs are more common in superfical joints

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6
Q

how can presentation in septic arthitis differ

A

presentation may be more subtle- particulary in neonates
-only physical signs may be irritability and (more importatnly) pseudoparalysis

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7
Q

fact about pesuoparalysis in a neonate 1

A

is the result of bone/joint sepsis until proven otherwise

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8
Q

differentials for septic arthritis 2

A

transient synovitis

reactive arthritis

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9
Q

how to differentiate transient synovitis and reactive arthritis from septic arthritis 4

A

pyrexia >38.5 within last week

inability to weight bear through that limb

raised ESR >40mm/h

WBC >12x10(9)/l

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10
Q

management of septic arthritis 4

A

ABC- resusitaction if unwell

urgent aspiration (usually under GA) with immediate microscopy and gram stain, subsequenent culure and sensitivity

blood cultures- minimum of 2 (not always postiive)

High dose IV ABx

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11
Q

classical presentation of osteomyelitits 3

A

acutely unwell child

pyrexia

local erythema and tenderness

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12
Q

what often procedes a subacute presentation of osteomyelitis 1

A

recent varicella zoster infection
-common
-scratching typically introduced haematogenous spread of S. aureus)

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13
Q

subacute presentation of osteomyelitis 4

A

point tenderness (often near metaphyses)

night pain

Limp

Remember- Fever may be absent

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14
Q

management of osteomyelitis

A

blood culture

bone aspiration - if absecee is present

High dose IV ABx

Splintage of the limb

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15
Q

Abx for septic arthritis 3

A

fluclos

vanc

gent if MRSA

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16
Q

ABx for osteomyelitis 3

A

fluclox

metro

gent

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17
Q

more insidious cause of septic arthritis and osteomyelitis 1

how to diagnose- 1

A

tuberculosis

quickly by PCR (cultures take over 6 weeks)

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18
Q

most common cause of joint swelling in children

A

reactive arthitis

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19
Q

overview of causes of reactive arhtitis

A

usually by an unidentified viral infection

short lived and self limiting illness
-if persists -> consider other causes

20
Q

what causes rheumatic fevere

A

streptococcal pyogenes infection

21
Q

symtpoms of rhuematic fever (overview) 4

A

carditis
arthritis
neuro features
rash

22
Q

neuroogical features in rhuematic fever

A

sydenham chorea
-rapid ivoluntary movements of the limbs, trunnk and facial muscles

23
Q

rash in rhuematic fever 1

A

erythema marginatum

24
Q

raised biochem in rheuamtic fevere 3

A

raised ESR

ASO titre
DNase B

25
Q

managemtn of reheumatic fever 4

A

antibiotics: oral penicillin V
anti-inflammatories: NSAIDs are first-line
treatment of any complications that develop e.g. heart failure

-need life long penicillin prophylaxis

26
Q

how is rhuematic fever assocaited with joints

A

can cause reactive arhtitis

27
Q

symtpoms of HLA B27 assoacited reactive syndrome

A

reactive arthitis

urethrisi

conjunctivits ± plantar fascitis

28
Q

what else is HLA B27 associated reactive syndrome called

A

REiters syndrome

29
Q

what type of infections lead to HLA B27 associated reactive syndrome

A

post enteric or genitourinary infection
-Yersinia
-SHigella
-Salmonella
-E coli
-STDs

30
Q

managemtn of reactive arthitis in HLA B27 associated reactive syndrome

A

self-limiting conditino once infection treated

31
Q

what else is transient synovitis of the hip called

A

irritable hip

32
Q

who gets transient synovitis of the hip

A

idiopathic disorder in children ,3-10yo
-often preceded by infection

33
Q

presentation of transient synovitis of the hip 3

A

sudden or gradual onset of hip pain+ limp

hip is held flexed and externally roated

-pain can refer to knee

34
Q

biochem in transient synovitis of the hip

A

ESR and WCC are normal or mildly raised

35
Q

managment of transient synovitis of the hip 2

A

conservative -analgesi and allow child to rest until happy to weight bear

-condition should resolve after one week

-> if symptoms prolonged or recurrent-> may need to revist diagnosis

36
Q

overview of discitis

A

unclear if infective aetiiologu of the spine

-usually self limiting and not associated w culture or organisms

peak onset 1-3 years
-child refuse to walk ± low grade fever

diangosis can be confusion
-should have well localised tendernes of spine
-radiographs normal until alte indisase
-MRI helpful
-if in doubt-> ABx

37
Q

overview of juvenile idiopathic arthritis

A

childhood onset of chornic inflammatory arhtitis of unknown aeitology
-no single diagnostic test and investigation aims to exclude other diagnoses

38
Q

esentatino of juvenile idiopathic arthritis

A

PERSISTENT joint swelling in one or more joints

inflammatory featurtes of early morning stiffness and warmth

clinical diagnosis w no diagnostic tests

39
Q

what occurs in 1/3 of juvenile idopathic arthirits

A

chornic anterior uveitis

-leading cause of child blindness

40
Q

managemnt of chronic anterior uveitis 2

A

early referral for regular eye screening by slit lapm
-screening by ophthalmologist
-key to early diagnosis and preservation of vision

41
Q

types of connective tissue disease in children 4

A

systemic lupus erythematous (SLE)

dermatomyositis

scleroderma (particulary localised)

Vasculitis

42
Q

two vascultic conditions more common in children than adults

A

Henoch Schonlein Purpura

Kawasaki disae

43
Q

why is henoch schonlein purura important in children 1

A

because of the assocated renal disease

44
Q

why is kawasaki disease important

A

associagted mortality assocaited w coronary artery aneurysms
-preventable with early diagnosis and treatment with IVIG

45
Q

key early features of kawasaki disease 10

A

high and persistent evere (>39.5) for 5 days

rash

red palms, soles and perineum

Miserable ( v important sign reflecting aspectic menigeal irritatoin)

mucositis

non-purluent conjunctivits

arthtis

high platelet count

lymphadenopthy

high acute phase response

46
Q

late features of kawasaki disease 5

A

aneurysms

peeling skin

cardiac ischaemia

myocardial infarctoin

claudication- where other aneuryms have occured

Paediatrics cabinetchip (80 decks)

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