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Y4 medicine > Paeds Neuro + Ortho > Flashcards

Paeds Neuro + Ortho Flashcards

1
Q

causes of headaches in children?

A

tension headaches
migraines
ENT infection s
analgesic headache
problems with vision
raised ICP
brain tumours
meningitis
encephalitis

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2
Q

what are febrile convulsions

A

seizures that occur in children due to high fever
only occur in ages 6 months to 5yo

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3
Q

Mx of febrile seizures

A
  • put child in a safe place
  • place them in the recovery position
  • call ambulance if lasts >5mins
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4
Q

features of a tension headache?

A

pain or pressure in a band like pattern around head
no visual changes
resolve in 30 mins
typically symmetrical

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5
Q

tx of tension headache?

A

reassurance
analgesia
regular meals
avoiding dehydration
reducing stress

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6
Q

features of a migraine?

A

unilateral
mroe severe than tension headache
throbbing
last longer than tension headaches
visual aura
photophobia and phonophobia
n+v
can have abdo pain

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7
Q

mx of migraines in children?

A
  • rest, fluids, low stimulus environment
  • paracetamol
  • ibuprofen
  • sumatriptan
  • antiemetics
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8
Q

what is abdominal migraine?

A

presents with episodes of central abdo pain lasting longer than 1 hour with associated n+v, anorexia, headache, pallor

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9
Q

what is a extradural heamorrhage

A

arterial or venous bleeding into the extradural space as a result of head trauma

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10
Q

features of an extradural haemorrhage?

A

lucid interval until conscious level deteriorates, with seizures secondary to increasing size of heamatoma

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11
Q

Ix for suspected extradural heamorrhage and what is seen?

A

ct scan - mango shaped pooling of blood

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12
Q

tx of extradural heamorrhage?

A

correct hypovoleamia
urgent evacuation of heamatoma and arrest bleeding

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13
Q

what are subdural heamorrhages?

A

tearing of bridging veins causes heamatoma in subdural space
can be causes by non accidental injury e.g. shaking or trauma
banana shaped on ct scan

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14
Q

what are subarachnoid haemorrhages

A

severe onset thunderclap headache usually from trauma
associated with vomiting, confusion _ lowered level of consiousness

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15
Q

what are muscular dystrophies?

A

umbrella term for genetic conditions that cause weakening and wasting of muscles

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16
Q

most common type of muscular dystrophy

A

duchennes muscular dystrophy

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17
Q

what is gowers sign?

A

when children with proximal muscle weakness use a specific technique to stand up from lying (using hands and arms to lean on legs to get up)

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18
Q

what is the genetic inheritance of duchennes muscular dystrophy?

A

X linked recessive (mothers are healthy carriers and can pass onto sons that will have symptoms)

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19
Q

how does duchennes muscular dystrophy present?

A

presents around 3-5 yo with progressive weakness in muscles around their pelvis
wheelchair bound by teenager

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20
Q

lfie expectancy of a boy with muscular dystrophy?

A

25-35 years (die from cardiac and resp complications)

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21
Q

Mx for duchennes muscular dystrophy?

A

oral steroids
creatine supplementation
+ occupational therapy and physio

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22
Q

name the types of muscular dystrophies?

A
  • duchennes
  • beckers
  • myotonic
  • fascioscapulohumeral
  • oculopharyngeal
  • limb-girdle
  • emery-dreifuss
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23
Q

what is spinal muscular atrophy?

A

rare autosomal recessive condition that causes a progressive loss of motor neurone in spinal cord = progressive muscular weakness of skeletal muscles

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24
Q

what are the signs of spinal muscular atrophy?

A

lower motor neurone signs:

  • fasciculations
  • reduced muscle bulk
  • reduced tone
  • reduced power
  • reduced or absent reflexes
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25
mx for spinal muscular atrophy?
no cure ! supportive mx physio, splints, braces, wheelchairs non invasive ventilation may be needed (even tracheostomy + mechanical ventilation) PEG may be needed
26
what are the different types of spinal muscular atrophy?
SMA 1: onset in first few months of life, survive to adulthood, most never walk SMA 2: onset within first 18 months of life, survive to adulthood, most never walk SMA 3: onset after 1yo, most can walk, life expectancy normal SMA 4: onset in 20s, most need wheelchairs, resp muscles and life expectancy not affected
27
what is DDH?
developmental dysplasia of the hip is a structural abnormality leading to instability, or subluxation or potential dislocation
28
risk factors fro DDH?
- first degree FHx - breech presentation from 36 weeks onwards - breech presentation at birth if 28 wks onwards - multiple pregnancy - female
29
how is DDH screened for and what tests are done?
screened for in neonatal examination (at birth and 6-8 wks old) do examination and perform ortolani and barlow test (to check for anterior or posterior dislocation of hip)
30
how do you diagnose DDH?
US of hips XR can also be helpful
31
Mx of DDH in < 6 months old
pavlik harness if baby <6 months old - keeps baby's hips flexed and abducted usually fitted for around 6-8 wks if this fails the then surgery required
32
Mx of DDH in over 6 months?
surgery required then hip spica cast used to immobilise the hip for prolonged period
33
causes of joint pain in children aged 0-4yo?
- septic arthritis - DDH - transient sinovitis
34
causes of joint pain in children aged 5-10yo?
septic arthritis transient sinovitis perthes disease
35
cuases of joint pain in children aged 10-15yo?
- septic arthritis - slipped upper femoral epiphysis (SUFE) - juvenile idiopathic arthritis
36
red flags in children with hip pain
child under 3yo fever waking at night w pain weight loss night sweats fatigue persistent pain stiffness in morning swollen or red joint
37
what Ix wld be done if a child presents with hip pain?
- blood tests (inflammatory markers for JIA or septic arthritis) - xrays - fractures, SUFE - USS - effusion in joint - joint aspiration - septic arthritis - MRI - osteomyelitis
38
what is transient synovitis?
temporary irritation and inflammation in synovial membrane of joint (synovitis) associated with viral URTI
39
key distinguishing sign between transient synovitis and septic arthritis
children with septic arthritis will have a fever !!
40
clinical features of transient synovitis?
within few weeks of viral illness limp refusal to weight bear groin or hip pain mild low grade temperature (shld otherwise be well)
41
Mx of transient synovitis?
symptomatic tx -> simple analgesia (paracetamol and NSAIDs) **must ensure safety netting - if fever gets worse come back ! as risk of septic arthritis
42
how quickly will symptoms of transient synovitis improve after symptomatic tx?
significant improvemnet after 24-48 hrs then fully resolve within 1-2 wks
43
what is perthes disease?
when there is disruption to the blood flow to the femoral head causing avascular necrosis of the femoral head
44
what are clinical features of perthes disease?
5:1 boys to girls common in 5-10yo pain in hip or groin no hx of trauma restricted hip movements referred pain to knee
45
Ix to be done wehn suspecting perthes disease?
- blood tests (normal, neeeded to exclude other inflammatory cuases of hip pain) - technetium bone scan - MRI scan
46
Mx of Perthes?
maintain healthy position and alignment in joint to reduce risk of deformity by: - bed rest - traction - crutches - analgesia physio regular x-rays to assess in severe cases if not healing then surgery
47
main complication of perthes disease?
OA in adulthood
48
what is slipped upper femoral epiphysis?
when head of the femur is displaced along the growth plate
49
clincial features of SUFE?
- more common in boys, common in ages 8-15yo hip, groin, thigh or knee pain restricted range of hip movement painful limp prefer to keep hip in external rotation
50
how is SUFE diagnoseD?
- XR (initial Ix) - blood tests (to rule out inflammatory cuases) - technetium bone scan - CT scan - MRI scan
51
Mx of SUFE?
surgery to correct position
52
in what age is septci arthritis most common?
<4 yo
53
what are teh clinical features of septic arthritis?
- hot, red, swollen and painful joint - refusing to weight bear - stiffness and reduced range of motion - systemic symptoms such as fever, lethargy and sepsis
54
most common bacteria that cause septic arthritis?
- staph aureus most common - neisseria gonorrhoea in sexually active teenagers - group A strep - heamophilus influenzae - E coli
55
differential diagnosis of septic arthritis?
- transient synovitis - perthes disease - slipped upper femoral epiphysis - juvenile idiopathic arthritis
56
Mx of septic arthritis?
empirical IV abx until microbial sensitivities come back (from joint aspiration) abx given for 3-6 wks if severe: need surgical drainage and washout
57
what is osteomyelitis?
infection in the bone and bone marrow (usually occuring in long bones)
58
what is the most common causative bacteria for osteomyelitis?
staph aureus
59
what is chronic osteomyelitis?
deep seated, slow growing infection with slowly developing symptoms
60
risk factors for osteomyelitis?
- boys>girls and common <10yo - open bone fracture - immunocomprimised - sickle cell anaemia - HIV - TB
61
risk factors for osteomyelitis?
- boys>girls and common <10yo - open bone fracture - immunocomprimised - sickle cell anaemia - HIV - TB
62
clinical features of osteomyelitis?
- refusing to use limb or weight bear - pain - swelling - tenderness - afebrile or low grade fever (- high fever if acute or caused septic arthritis)
63
Ix to diagnose osteomyelitis?
1. initial - xrays 2. gold standard - MRI alternative - bone scan 3. blood tests show raised inflammatory markers + WCC 4. blood cultures to find a causative organism + possible bone marrow aspiration or biopsy with histology and culture
64
Mx of osteomyelitis?
prolonged abx therapy may require surgery for drainage and debridement of infected bone
65
what is henoch schonlein purpura (HSP)?
it is a IgA vasculitis Inflammation occurs in the affected organs due to IgA deposits in the blood vessels
66
clinical features of HSP?
non blanching purpuric rash (mostly on limbs) joint pain (arthritis/arthralgia of knees/ankles) abdo pain (+ blood in faeces) renal involvement (haematuria and proteinuria)
67
what Ix are needed when HSP is suspected?
Full blood count and blood film for thrombocytopenia, sepsis and leukaemia Renal profile for kidney involvement Serum albumin for nephrotic syndrome CRP for sepsis Blood cultures for sepsis Urine dipstick for proteinuria Urine protein:creatinine ratio to quantify the proteinuria Blood pressure for hypertension
68
what Ix are needed when HSP is suspected?
FBC and blood film -> thrombocytopenia, sepsis and leukaemia renal screen -> kidney involvement Serum albumin -> nephrotic syndrome CRP -> sepsis Blood cultures -> sepsis Urine dipstick -> proteinuria Urine protein:creatinine ratio to quantify the proteinuria BP -> hypertension
69
Mx for HSP ?
supportive -> analgesia, rest and proper hydration
70
what is the important monitoring to do in patients who have HSP?
Blood pressure and urine dipstick for HTN and renal involvement

Y4 medicine (18 decks)

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