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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
Q

mx for spinal muscular atrophy?

A

no cure ! supportive mx

physio, splints, braces, wheelchairs
non invasive ventilation may be needed (even tracheostomy + mechanical ventilation)
PEG may be needed

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26
Q

what are the different types of spinal muscular atrophy?

A

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

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27
Q

what is DDH?

A

developmental dysplasia of the hip is a structural abnormality leading to instability, or subluxation or potential dislocation

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28
Q

risk factors fro DDH?

A
  • first degree FHx
  • breech presentation from 36 weeks onwards
  • breech presentation at birth if 28 wks onwards
  • multiple pregnancy
  • female
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29
Q

how is DDH screened for and what tests are done?

A

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
Q

how do you diagnose DDH?

A

US of hips
XR can also be helpful

31
Q

Mx of DDH in < 6 months old

A

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
Q

Mx of DDH in over 6 months?

A

surgery required then hip spica cast used to immobilise the hip for prolonged period

33
Q

causes of joint pain in children aged 0-4yo?

A
  • septic arthritis
  • DDH
  • transient sinovitis
34
Q

causes of joint pain in children aged 5-10yo?

A

septic arthritis
transient sinovitis
perthes disease

35
Q

cuases of joint pain in children aged 10-15yo?

A
  • septic arthritis
  • slipped upper femoral epiphysis (SUFE)
  • juvenile idiopathic arthritis
36
Q

red flags in children with hip pain

A

child under 3yo
fever
waking at night w pain
weight loss
night sweats
fatigue
persistent pain
stiffness in morning
swollen or red joint

37
Q

what Ix wld be done if a child presents with hip pain?

A
  • blood tests (inflammatory markers for JIA or septic arthritis)
  • xrays - fractures, SUFE
  • USS - effusion in joint
  • joint aspiration - septic arthritis
  • MRI - osteomyelitis
38
Q

what is transient synovitis?

A

temporary irritation and inflammation in synovial membrane of joint (synovitis)
associated with viral URTI

39
Q

key distinguishing sign between transient synovitis and septic arthritis

A

children with septic arthritis will have a fever !!

40
Q

clinical features of transient synovitis?

A

within few weeks of viral illness
limp
refusal to weight bear
groin or hip pain
mild low grade temperature (shld otherwise be well)

41
Q

Mx of transient synovitis?

A

symptomatic tx -> simple analgesia (paracetamol and NSAIDs)

**must ensure safety netting - if fever gets worse come back ! as risk of septic arthritis

42
Q

how quickly will symptoms of transient synovitis improve after symptomatic tx?

A

significant improvemnet after 24-48 hrs then fully resolve within 1-2 wks

43
Q

what is perthes disease?

A

when there is disruption to the blood flow to the femoral head causing avascular necrosis of the femoral head

44
Q

what are clinical features of perthes disease?

A

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
Q

Ix to be done wehn suspecting perthes disease?

A
  • blood tests (normal, neeeded to exclude other inflammatory cuases of hip pain)
  • technetium bone scan
  • MRI scan
46
Q

Mx of Perthes?

A

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
Q

main complication of perthes disease?

A

OA in adulthood

48
Q

what is slipped upper femoral epiphysis?

A

when head of the femur is displaced along the growth plate

49
Q

clincial features of SUFE?

A
  • 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
Q

how is SUFE diagnoseD?

A
  • XR (initial Ix)
  • blood tests (to rule out inflammatory cuases)
  • technetium bone scan
  • CT scan
  • MRI scan
51
Q

Mx of SUFE?

A

surgery to correct position

52
Q

in what age is septci arthritis most common?

A

<4 yo

53
Q

what are teh clinical features of septic arthritis?

A
  • 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
Q

most common bacteria that cause septic arthritis?

A
  • staph aureus most common
  • neisseria gonorrhoea in sexually active teenagers
  • group A strep
  • heamophilus influenzae
  • E coli
55
Q

differential diagnosis of septic arthritis?

A
  • transient synovitis
  • perthes disease
  • slipped upper femoral epiphysis
  • juvenile idiopathic arthritis
56
Q

Mx of septic arthritis?

A

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
Q

what is osteomyelitis?

A

infection in the bone and bone marrow (usually occuring in long bones)

58
Q

what is the most common causative bacteria for osteomyelitis?

A

staph aureus

59
Q

what is chronic osteomyelitis?

A

deep seated, slow growing infection with slowly developing symptoms

60
Q

risk factors for osteomyelitis?

A
  • boys>girls and common <10yo
  • open bone fracture
  • immunocomprimised
  • sickle cell anaemia
  • HIV
  • TB
61
Q

risk factors for osteomyelitis?

A
  • boys>girls and common <10yo
  • open bone fracture
  • immunocomprimised
  • sickle cell anaemia
  • HIV
  • TB
62
Q

clinical features of osteomyelitis?

A
  • refusing to use limb or weight bear
  • pain
  • swelling
  • tenderness
  • afebrile or low grade fever
    (- high fever if acute or caused septic arthritis)
63
Q

Ix to diagnose osteomyelitis?

A
  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
Q

Mx of osteomyelitis?

A

prolonged abx therapy
may require surgery for drainage and debridement of infected bone

65
Q

what is henoch schonlein purpura (HSP)?

A

it is a IgA vasculitis
Inflammation occurs in the affected organs due to IgA deposits in the blood vessels

66
Q

clinical features of HSP?

A

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
Q

what Ix are needed when HSP is suspected?

A

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
Q

what Ix are needed when HSP is suspected?

A

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
Q

Mx for HSP ?

A

supportive -> analgesia, rest and proper hydration

70
Q

what is the important monitoring to do in patients who have HSP?

A

Blood pressure and urine dipstick for HTN and renal involvement

Y4 medicine (18 decks)

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