Paeds orpho (ILA 1) Flashcards
(40 cards)
List the differentials of hip pain in a child
JIA perthes disease development dysplasia of the hip transient synovitis slipped upper femoral epiphysis septic arthritis
list the differentials of an acutely painful limp in a child under 10
septic arthritis transient synovitis perthes disease trauma malignancy e.g. leukaemia JIA
List the differentials of an acutely painful limp in a child over the age of 10
JIA mechanical - trauma, overuse, sport injuries slipped upper femoral epiphysis reactive arthritis septic arthritis osteochondritis dissecans of the knee bone tumours
List the differentials of a chronic/intermittent limp in a child
development dysplasia of the hip - if newborn cerebral palsy JIA perthes disease duchenne muscular dystrophy tarsal coalition
Define Juvenile Idiopathic Arthritis
persistent joint swelling presenting before 16 years of age in the absence of infection for >3 months
Describe the pathology of a damaged joint in JIA
ligament laxity fibrosis of synovium erosion of bone degeneration of cartilage periarticular osteoporosis
Describe the pathology of an inflamed joint in JIA
erosion of bone loss of cartilage increased synovial fluid inflammation of synovium periarticular osteoporosis
Liste the differentials of an inflamed joint
septic arthritis reactive arthritis trauma non accidental injury osteomyelitis
How does JIA present?
persistent joint swelling joint stiffness in morning pain "can't walk up stairs" joint deformity painful ROM
List the classifications of JIA
- systemic onset JIA
- oligoarticular
- polyarticular
- enthesitis related arthritis
- psoriatic
What is systemic onset JIA and how does it present?
arthritis associated with systemic inflammation
e.g. fever, high spiking temp, salmon pink rash, enlarged lymph nodes
How is systemic onset JIA treated?
RoActerma
What is oligoarticular JIA ?
<4 joints involved
What is oligoarticular JIA associated with?
chronic anterior uveitis
= inflammation of the anterior chamber of the eye
How does psoriatic JIA present and what is it associated with?
psoriasis strongly associated with arthritis with nail pitting and datylitis
strong family history
How is JIA investigated?
- physical examination
- blood tests - rule out other conditions
- x-ray
Outline the steps in managing JIA
- NSAIDs and analgesics
- joint injections
- methotrexate - weekly dose
- systemic corticosteroids
- cytokine modulators “biologics” e.g. anti TNF
What is osteomyelitis?
infection of the metaphysis of the long bone
What is the most common causative organism of osteomyelitis?
staphylococcus aureus
How does osteomyelitis present?
painful, immobile limb
sudden onset
swollen and tender
Outline the investigations for osteomyelitis
FBC - WBC raised
ESR and CRP raised
blood cultures
X-ray - soft tissue swelling
How is osteomyelitis treated?
IV flucloxacillin + aspiration or surgical decompression
What is the most common cause of acute hip pain in children?
transient synovitis
How does transient synovitis present?
often following a viral infection
sudden onset of pain in hip
limp
child well