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YR5 Specialties > Paeds MUSC > Flashcards

Paeds MUSC Flashcards

1
Q

What are the most common causes of fracture in a neonate?

A

Clavicle: from shoulder dystocia
Humerus/ femur: from breech delivery

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2
Q

What is the prognosis for neonatal fracture?

A

Great

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3
Q

How old does a child have to be prescribed codeine and morphine?

A

16

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4
Q

How should paediatric fractures be managed?

A

Pain management
Manipulation and reduction

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5
Q

How old does a child need to be to get a intramedullary nail?

A

4

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6
Q

What is Perthe’s disease?

A

Avascular necrosis of the femoral epiphysis from an interruption of blood supply, followed by re-vascularisation + re-ossification over 18-36 months

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7
Q

In which age group/ gender is Perthe’s most common?

A

4-8y boys

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8
Q

Recall the signs and symptoms of Perthe’s

A

Insidious presentation: limp, knee pain, hip pain –> limb shortening

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9
Q

What investigations should be done for Perthes?

A

X ray: AP + frog leg Lateral views

MRI

Roll test: guarding on internal rotation

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10
Q

What would an x ray show in Perthe’s disease?

A

Increased density of femoral head
Femoral head fragmentation/ sclerosis

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11
Q

What is the roll test?

A

Patient supine, roll affected hip internally + externally –> guarding or spasm in Perthe’s

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12
Q

How is Perthe’s managed?

A

Simple analgesia for pain Mx
<6y: observation/ non-surgical containment using splints
>6y: surgery

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13
Q

What is Osgood Shlatter Disease?

A

Osteochondritis (inflammation of cartilage/ bone) of the patellar tendon insertion at the knee

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14
Q

Recall the most at-risk group for OSD?

A

10-15y who are physically active

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15
Q

Recall the signs and symptoms of OSD?

A

Gradual onset knee pain after exercise that is relieved by rest

Localised tenderness + swelling over tibial tuberosity

Hamstring tightness

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16
Q

What might be seen on X ray in OSD?

A

Fragmentation of the tibial tubercle + overlying soft tissue swelling

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17
Q

How should OSD be managed?

A

Simple analgesic packs (intermittent)

Protective knee pads

Stretching

Reassure - this will resolve over time, but may persist until end of growth spurt

Advise stopping/ reducing all sporting activity

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18
Q

What is chondromalacia patellae?

A

Anterior knee pain from degeneration of articular cartilage on posterior surface of patella

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19
Q

What is the general cause of chondromalacia patellae?

A

Overuse in physical activity

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20
Q

Recall the signs and symptoms of chondromalacia patellae

A

Anterior knee pain: exacerbated by movement
Painless passive movement but pain + grating sensation on repeated extension

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21
Q

How should chondromalacia patellae be managed?

A

Physio

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22
Q

What is osteochondritis dissecans?

A

Idiopathic disease affecting subchondral bone + its overlying articular cartilage due to loss of blood flow.
May result in separation + instability of a segment of cartilage + free movement of fragments within the joint space

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23
Q

Recall the signs and symptoms of osteochondritis dissecans?

A

Pain after exercise
Catching
Locking
Giving way

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24
Q

What is osteomyelitis?

A

Infection of metaphysis of long bones, commonly the distal femur + proximal tibia

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25
Q

What is the most common pathogen implicated in osteomyelitis?

A

Staph aureus

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26
Q

What is the most common age group affected by osteomyelitis?

A

<5 years

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27
Q

How does the presentation of osteomyelitis compare to the presentation of septic arthritis?

A

Usually chronic in onset + less severe than septic arthritis (over a week rather than a day)

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28
Q

Recall the signs and symptoms of osteomyelitis?

A

Fever
Acute onset limb pain, immobile limb, skin swollen, tender + erythematous

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29
Q

What investigations should be done for suspected osteomyelitis?

A

Septic screen
BCs + FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)

30
Q

How should acute osteomyelitis be managed?

A

High dose IV empirical- narrow spec Abx
1st line is flucloxacillin
Take BCs before staring IV Abx
Change to oral Abx as soon as CRP is back to normal
Surgical debridement may be necessary

31
Q

What is septic arthritis?

A

Infectious arthritis of the synovial joint (vs osteomyelitis of bone)

32
Q

Which joint is affected in 75% of cases of septic arthritis?

A

Hip

33
Q

What is the usual pathogen implicated in septic arthritis?

A

S aureus

34
Q

Recall the signs and symptoms of septic arthritis

A

Single joint warm
Erythematous
Tender
Reduced range of movement
Infants will hold the limb still

35
Q

What investigations should be done for septic arthritis?

A

SAME AS OSTEOMYELITIS
Septic screen
BCs and FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)

36
Q

How should septic arthritis be managed?

A

Similar to osteomyelitis but not the same

IV flucloxacillin –> oral

Joint wash out + aspirated to dryness PRN

37
Q

What is Still’s disease?

A

Persistent joint swelling presenting before 16 years, in the absence of infection/ other defined cause

38
Q

What are the signs and symptoms of Still’s?

A

May be any number of joints
Gelling (stiffness after periods of rest)
Intermittent limp
Morning joint stiffness/ pain
Limited movement

39
Q

Recall some late signs of Still’s

A

Inflammation + bone expansion - ‘knock knees’
Salmon-coloured rash (pathogenomic of systemic Still’s)

40
Q

What investigations should be done in suspected Still’s?

A

Clinical diagnosis mainly
Bloods + imaging to prove classification + prognostic info
ANA, FBC, RhF, CRP/ESR, anti-CCP
USS/ MRI

41
Q

How should Still’s be managed?

A

MDT rheuatology
NSAIDs
Corticosteroids (high to low dose)
DMARDs - if disease fails to respond to conventional treatments - methotrexate or sulfalazine
TNF alpha inhibitors if needed

42
Q

What is the prognosis for Still’s disease?

A

Most children can expect good disease control and quality of life
If poor disease control –> anterior uveitis and fractures

43
Q

What is the former name of reactive arthritis?

A

Reiter’s syndrome

44
Q

What are the most likely causative organisms in reactive arthritis?

A

Enteric bacteria - salmonella, shigella, campylobacter, yersinia

45
Q

Recall the signs and symptoms of reactive arthritis

A

Transient joint swelling (<6 weeks) following an extra-articular infection
Low grade fever

46
Q

Which joints are most typically affected by reactive arthritis?

A

Ankles/ knees

47
Q

What investigations should be done in suspected reactive arthritis?

A

A diagnosis of exclusion as no positive findings
Bloods (CRP normal or mildly elevated)
Normal XR

48
Q

How should reactive arthritis be managed?

A

Self-limting, NSAIDs will do for analgesia

49
Q

What is SUFE?

A

Displacement of epiphysis of femoral head posteroinferiorly

50
Q

Why does SUFE need prompt treatment?

A

To prevent avascular necrosis

51
Q

What age group is usually affected by SUFE?

A

10-15 years

52
Q

What is the biggest RF for SUFE?

A

Obesity

53
Q

What are the signs and symptoms of SUFE?

A

Limp/ hip pain +/- referred to the knee
Insidious or acute onset
“Loss of internal rotation of a flexed hip”
Trendelenburg gait positive

54
Q

What investigations should be done in suspected SUFE?

A

Hip XR in AP and frog-lateral view (both hips)

55
Q

How should SUFE be managed?

A

Analgesia, bed-bound
Surgical internal fixation at growth plate

56
Q

What is transient synovitis?

A

Irritable hip - 3-10 years

57
Q

What age group is affected by transient synovitis?

A

3-10 years

58
Q

What is a red flag for urgent hospital assesment in transient synovitis?

A

Age <3 with an acute limp

59
Q

What is the cause of transient synovitis?

A

Viral infection (so causes a low grade fever)

60
Q

How should transient synovitis be investigated and managed

A

Clinically - it is self-limiting

61
Q

What is DDH?

A

A spectrum of conditions affecting proximal femur and acetabulum - ranging from subluxation to frank dislocation

62
Q

What is true DDH?

A

Femoral head has a persistently abnormal relationship with the acetabulum–> abnormal bony development, premature arthritis and significant disability

63
Q

What are the 2 manoevres that are key to early detection of DDH?

A

Barlow: dislocate posteriorly out of the hip

Ortolani: relocate back into acetabulum on hip abduction

64
Q

What is the biggest RF for DDH?

A

Female

65
Q

Recall the signs and symptoms of DDH

A

Limp/ abnormal

Delayed crawling/ walking: toe-walking

Asymmetrical skin folds

Limb length discrepancy

66
Q

What age group are the Barlow and Ortolani manoevres appropriate for?

A

<6 months

67
Q

What other investigation can be done alongside B and O manoevres in suspected DDH?

A

USS

68
Q

What investigation should be done in children too old for B and O manoevres?

A

X ray

69
Q

What are the indications for USS neonatally regardless of presentation, and when is this USS done?

A

Born breech or FH of DDH
Done at 6 weeks

70
Q

How should DDH be managed in the newborn?

A

Pavlik harness (most resolve spontaneously by 3-6w)
Keeps hips flexed + abducted

71
Q

How should DDH be managed in those >6 months old?

A

Surgery if conservative measures fail or there is no progress with harness

YR5 Specialties (27 decks)

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