Paeds Flashcards
Transient Synovitis of Hip - PC and O/E , I, T
Child aged 3-10 sudden or gradual hip pain and limpO/E leg held with hip flexed and ext rotatedUSS will confirm effusion + WCC and ESR norm/raisedCONS treatment - analgesia and rest
Juvenile Idiopathic Arthritis - PC / I / T / Prognosis
group of conditions - PERSISTENT JOINT SWELLING and PAIN in 1+ joints for >6 monthsInflammatory joint features, diagnostic tests -ve(can also include anterior uveitis + fever prodrome)Some bloods may be abnormal (ANA, ESR, RF)NSAIDS + lifestyle mod (add in exercise) –> methotrexate/sulfasalizine and folic acid –> corticosteroid inj or oral –> TNF alpha inhib40-60% will achieve remission
NAI - important steps
RECORD everything, fully examine child, go over hx more than once, inform senior of any suspicions.
NAI RF’s/ Signs/ Strategy
- Young mum, unwanted preg, poverty, stress - Delay in presentation, odd story, inconsistent hx compared to what you see in the child in front of you, unexplained injuries (buttock bruise, face bruise, finger grip marks, suffocation signs, whip marks, cigerette burns, forearm/rib fx’s - Inform senior , record all convo’s, inform social services
RF for neglected children
Severely disabled, very young, severe health/mental issue, learning disability, in public care
CF of neglected child
Nappy rash, failure to thrive, poor dental health, untreated medical conditions, delayed development
Malignant leg pain signs
unable to sleep, loss of function the next day, persists till next day, mass o/e
2 most common ortho tumors
Osteosarcoma and ewings sarcoma
?/PC/I/T and prog of each
Osteosarcoma - PC is that of malignant leg pains - metaphysis of bone (esp around knee) - xray showing bone destruction + new bone formation + much periosteal elevation away from underlying bone - Treat with resection and chemo (3 week cycles over 18 weeks) - 50% cure rateEwings - PC is that of malignant leg pains + fever, anorexia, weight loss - Long bones and limb girdles - Xray shows Bone destruction, concentric layers of new bone formation(onion ring sign), soft tissue mass - Treat with chemo+SCT+Bone resection +/- radiotherapy - 50% survival
Salter Harris types
1 - Fx across physis(babies)2 - Fx above physis3 - Fx through physis (from above, through)4 - Fx through both above and below5 - Crush Injury
Difference between kids bones and adults bones
More bend, less dense. Few comminuted fractures.
Common Paeds fx’s + ?
Greenstick - incomplete fx line = must be broken in surgery before re-alignedComplete - same as adultsPlastic deformation - bending force, no fracture line, unique to kidsBuckle - compression, often at junction of metaphysis and diaphysis
Why are growth plate fx’s concerning?
heal quickly so must be correctly aligned or - leg length discrep/ joint incongruency/ angular deformity
Perthe’s Disease - ?/PC/I/T
? - osteochondritis of femoral head affecting between 3-11M 4:1 F and 90% unilateralPC - Pain in hip/knee + Limp + decreased ROM at hipI - Xray (joint space widening/fem head size down/ fem head collapseT - Bed Rest until painfree + radiographic monitoring OR if severe - surgery
Slipped Upper femoral epiphysis - ?/PC/I/T/complication
? - displacement of growth plate and epiphysis posterior and down - typically aged 10-16 - 80% unilateral - M 3:1 F - 50% obesePC - Pain and Limping Groin/Ant thigh/knee + decreased ROM of hip in certain planesI - Lateral XrayT - Minor Slip = fixed in-situ // Severe Slip = femoral osteotomyComplication - AVN femoral head/ malunion leads to arthritis
Developmental Dysplasia - ?/ 2 tests to diagnose/ CF/ T methods for each age
6x more common in female babies and 4x more in Left hip
Click test of ortolani and barlow manoeuvre
CF only seen in older child - Delayed walking, abnormal waddling gait, asym thigh creases, decreased abduction
T - (Neonates) double nappies then reassess in 3 weeks, if needed splint hip in mod abduction / 3 month
(6-18 month) examine under anaesthetic, arthrography, closed reduction then immobilise (splica hip bandage)
(18months) open reduction and corrective femoral/pelvic osteotomies
Scoliosis - CF/ C/ T
Lateral deviation of spinal column, which is painless.
Can limit growth, or cause damage to internal organs if spine doesnt straighten.
Idiopathic, secondary to leg length discrep, DMD, cerebral palsy
T - often just observe, but sometimes requires full trunk cast (if aged
Clubfoot (Talipas Equinovarus) - ? / T name
Fixed deformity of foot in neonates - Inversion, plantar flexed, sole pointing medially (cannot be passively moved)
Ponsetti method
Discitis - Where/ CF/ I/ T
most commonly L3/4 or L5/S1
Pain in leg or hip + limp +/- Back pain
Seen by MRI and treated with IV antibiotics/ rest and support
SAME PATTERN AS OSTEOMYELITIS
Cerebral Palsy - ?/ RF/ CF/ I/ T
combination of chronic disorders of posture + movement before age 2
Linked with pre-term births
Lower limbs more severly affected than upper limbs.
4 categories CF:
- Delayed motor devel - paralyisis, uncordinated
- evolving CNS signs - spasticity, dystonia
- learning disability - speech and lang
- Epilepsy - seizures
MRI brain will diagnose
T - depends on severity but is mostly supportive (physio, OT, SALT, surgery)
Osgoodslatters - Who/ CF/ C/ T
boys between 10-14
tibial tuberosity apophysitis and quads tendonitis (pain)
C - overuse and repeated traction (leg ext against resistnace)
T - Rest
Spina Bifida - ?/ CF/ I/ T
Neural tube defect, part of a spectrum of disorders in which spinal cord is abnormal - specifically, Spina B is a congenital defect, in which part of the spinal cord +/- meninges exposed through a gap in vertabra
Either Open or Closed
CF - bulging fontanelle, hydroceph, cleft lip/palate, breathing abnorm, cardiac murmur, decreased anal tone, abnorm urinary voiding
I - USS antenatally
T - Surgical closure of open wound and shunting of hydroceph and supportive + IV antibiotics
Ant Knee Pain - ?
Ant knee pain worst when sitting, squatting or stairs
Pulled Elbow - ?/ T
Kids under 5, caused by yanking the distal arm causing radius to dislocate (ligament overstretching)
Child will cry and refuse to use arm
T - reduction and analgesia // EXCLUDE FX first
Back Pain in Paeds red flags
- 4 weeks
- Decreased ROM because pain
- Neuro Signs
5 components of Baby Check
- Erbs Palsy - paralysis of arm because birth trauma
- Polydactyly
- Foot deformities - differentiate fixed from postural
- Hip Exam - dev dysplasia hip
- Congenital muscular torticolis
Rickets - ?/ C/ T
Growth retardation, hypotonia, apathy (infants)
Knock knees, Bow-legs, Bone deformaties
C - Vit D def (UV light, vit D diet) Ca2+ def (decreased absorption), Vit D resistant, Drug induced
T - either supplement Vit D or Ca
Kawasaki’s - ?
vasculitis inflaming small to medium arteries causing aneurysms to form (commonly aged 10 months old)
Henoch Schonlein Purpura - ?
purple spots not disappearing with pressure, often over buttocks, scrotum and extensor surfaces +/- arthritis + abdo pain
More common in children
Dermatomyositis - ?
Inflammation of striated muscle with heliotropic rash and scaly red plaques over neck/trunk/extensors + nail changes
How to remember elbow ossification centres and at what age?
CRITOL - capitellum 1 radial head 3 internal (medial) epicondyl 5 trochlea 7 olecrenon 9 lateral epicondyl 11
