Paeds MUSC Flashcards by Georgia Leggett

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

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

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What is the prognosis for neonatal fracture?

Great

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

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How should paediatric fractures be managed?

Pain management
Manipulation and reduction

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

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What is Perthe’s disease?

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

4-8y boys

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Recall the signs and symptoms of Perthe’s

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

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What investigations should be done for Perthes?

X ray: AP + frog leg Lateral views

MRI

Roll test: guarding on internal rotation

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

Increased density of femoral head
Femoral head fragmentation/ sclerosis

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What is the roll test?

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

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How is Perthe’s managed?

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

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What is Osgood Shlatter Disease?

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

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Recall the most at-risk group for OSD?

10-15y who are physically active

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Recall the signs and symptoms of OSD?

Gradual onset knee pain after exercise that is relieved by rest

Localised tenderness + swelling over tibial tuberosity

Hamstring tightness

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What might be seen on X ray in OSD?

Fragmentation of the tibial tubercle + overlying soft tissue swelling

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How should OSD be managed?

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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What is chondromalacia patellae?

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

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What is the general cause of chondromalacia patellae?

Overuse in physical activity

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Recall the signs and symptoms of chondromalacia patellae

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

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How should chondromalacia patellae be managed?

Physio

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What is osteochondritis dissecans?

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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Recall the signs and symptoms of osteochondritis dissecans?

Pain after exercise
Catching
Locking
Giving way

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What is osteomyelitis?

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

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What is the most common pathogen implicated in osteomyelitis?

Staph aureus

What is the most common age group affected by osteomyelitis?

<5 years

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

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

Recall the signs and symptoms of osteomyelitis?

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

What investigations should be done for suspected osteomyelitis?

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

How should acute osteomyelitis be managed?

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

What is septic arthritis?

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

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

Hip

What is the usual pathogen implicated in septic arthritis?

S aureus

Recall the signs and symptoms of septic arthritis

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

What investigations should be done for septic arthritis?

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

How should septic arthritis be managed?

Similar to osteomyelitis but not the same IV flucloxacillin --> oral Joint wash out + aspirated to dryness PRN

What is Still's disease?

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

What are the signs and symptoms of Still's?

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

Recall some late signs of Still's

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

What investigations should be done in suspected Still's?

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

How should Still's be managed?

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

What is the prognosis for Still's disease?

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

What is the former name of reactive arthritis?

Reiter's syndrome

What are the most likely causative organisms in reactive arthritis?

Enteric bacteria - salmonella, shigella, campylobacter, yersinia

Recall the signs and symptoms of reactive arthritis

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

Which joints are most typically affected by reactive arthritis?

Ankles/ knees

What investigations should be done in suspected reactive arthritis?

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

How should reactive arthritis be managed?

Self-limting, NSAIDs will do for analgesia

What is SUFE?

Displacement of epiphysis of femoral head posteroinferiorly

Why does SUFE need prompt treatment?

To prevent avascular necrosis

What age group is usually affected by SUFE?

10-15 years

What is the biggest RF for SUFE?

Obesity

What are the signs and symptoms of SUFE?

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

What investigations should be done in suspected SUFE?

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

How should SUFE be managed?

Analgesia, bed-bound Surgical internal fixation at growth plate

What is transient synovitis?

Irritable hip - 3-10 years

What age group is affected by transient synovitis?

3-10 years

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

Age <3 with an acute limp

What is the cause of transient synovitis?

Viral infection (so causes a low grade fever)

How should transient synovitis be investigated and managed

Clinically - it is self-limiting

What is DDH?

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

What is true DDH?

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

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

Barlow: dislocate posteriorly out of the hip Ortolani: relocate back into acetabulum on hip abduction

What is the biggest RF for DDH?

Female

Recall the signs and symptoms of DDH

Limp/ abnormal Delayed crawling/ walking: toe-walking Asymmetrical skin folds Limb length discrepancy

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

<6 months

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

USS

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

X ray

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

Born breech or FH of DDH Done at 6 weeks

How should DDH be managed in the newborn?

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

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

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