Paeds orpho (ILA 1) Flashcards

(40 cards)

1
Q

List the differentials of hip pain in a child

A
JIA
perthes disease 
development dysplasia of the hip
transient synovitis 
slipped upper femoral epiphysis 
septic arthritis
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2
Q

list the differentials of an acutely painful limp in a child under 10

A
septic arthritis 
transient synovitis
perthes disease
trauma 
malignancy e.g. leukaemia
JIA
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3
Q

List the differentials of an acutely painful limp in a child over the age of 10

A
JIA
mechanical - trauma, overuse, sport injuries 
slipped upper femoral epiphysis 
reactive arthritis 
septic arthritis 
osteochondritis dissecans of the knee 
bone tumours
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4
Q

List the differentials of a chronic/intermittent limp in a child

A
development dysplasia of the hip - if newborn 
cerebral palsy 
JIA
perthes disease
duchenne muscular dystrophy 
tarsal coalition
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5
Q

Define Juvenile Idiopathic Arthritis

A

persistent joint swelling presenting before 16 years of age in the absence of infection for >3 months

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6
Q

Describe the pathology of a damaged joint in JIA

A
ligament laxity 
fibrosis of synovium 
erosion of bone 
degeneration of cartilage 
periarticular osteoporosis
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7
Q

Describe the pathology of an inflamed joint in JIA

A
erosion of bone
loss of cartilage 
increased synovial fluid 
inflammation of synovium 
periarticular osteoporosis
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8
Q

Liste the differentials of an inflamed joint

A
septic arthritis
reactive arthritis 
trauma
non accidental injury 
osteomyelitis
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9
Q

How does JIA present?

A
persistent joint swelling 
joint stiffness in morning 
pain "can't walk up stairs"
joint deformity 
painful ROM
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10
Q

List the classifications of JIA

A
  1. systemic onset JIA
  2. oligoarticular
  3. polyarticular
  4. enthesitis related arthritis
  5. psoriatic
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11
Q

What is systemic onset JIA and how does it present?

A

arthritis associated with systemic inflammation

e.g. fever, high spiking temp, salmon pink rash, enlarged lymph nodes

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12
Q

How is systemic onset JIA treated?

A

RoActerma

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13
Q

What is oligoarticular JIA ?

A

<4 joints involved

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14
Q

What is oligoarticular JIA associated with?

A

chronic anterior uveitis

= inflammation of the anterior chamber of the eye

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15
Q

How does psoriatic JIA present and what is it associated with?

A

psoriasis strongly associated with arthritis with nail pitting and datylitis

strong family history

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16
Q

How is JIA investigated?

A
  1. physical examination
  2. blood tests - rule out other conditions
  3. x-ray
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17
Q

Outline the steps in managing JIA

A
  1. NSAIDs and analgesics
  2. joint injections
  3. methotrexate - weekly dose
  4. systemic corticosteroids
  5. cytokine modulators “biologics” e.g. anti TNF
18
Q

What is osteomyelitis?

A

infection of the metaphysis of the long bone

19
Q

What is the most common causative organism of osteomyelitis?

A

staphylococcus aureus

20
Q

How does osteomyelitis present?

A

painful, immobile limb
sudden onset
swollen and tender

21
Q

Outline the investigations for osteomyelitis

A

FBC - WBC raised
ESR and CRP raised
blood cultures
X-ray - soft tissue swelling

22
Q

How is osteomyelitis treated?

A

IV flucloxacillin + aspiration or surgical decompression

23
Q

What is the most common cause of acute hip pain in children?

A

transient synovitis

24
Q

How does transient synovitis present?

A

often following a viral infection
sudden onset of pain in hip
limp
child well

25
How is transient synovitis managed?
bed rest | improves within a few days
26
How does transient synovitis and septic arthritis differ?
TS child has no fever and well, SA child has fever and ill TS comfortable at rest and in SA hip held flexed and severe pain
27
How does septic arthritis present?
acute onset high fever severe pain at rest in joint red, hot, swollen and tender joint
28
How is septic arthritis managed?
joint aspiration under ultrasound guidance prolonged antibiotics rest and analgesia
29
Who is mainly affected by perthes disease?
boys 5-10 y/o short hyperactive
30
What is perthes disease?
avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of the blood supply
31
how is perthes disease managed?
rest | physiotherapy - can take 2/3 years to heal
32
What is slipped capital femoral epiphysis?
displacement of the femoral head epiphysis postero-inferiorly
33
Describe the typical patient of slipped capital femoral epiphysis
obese adolescent male groin pain*
34
Describe the associations with osgood schlatter
young athletic teens swelling below knee - worse on activity
35
Which features of a history indicate non accidental injury?
history incompatible with injury/ unclear history multiple fractures - rib fracture, skull fracture, metaphysical corner fracture bruising on ear, cheeks, buttocks, forearms, neck
36
What is osteogenesis imperfecta?
'brittle bone disease' group of disorders of collagen metabolism resulting in bone fragility and fractures
37
What is the most common type of osteogenesis imperfecta and how is this caused?
type 1 = autosomal dominant abnormality of type 1 collagen due to decreased synthesis of pro-alpha 1 and pro-alpha 2 collagen polypeptides
38
How does osteogenesis imperfect present?
``` frequent fractures after minor trauma bowing blue sclera deafness dental imperfections ```
39
How can fracture rates be reduced in osteogenesis imperfecta?
bisphosphonates splinting of fractures
40
when would you suspect a NAI?
history incompatible with injury/ unclear multiple fractures (e.g. rib fracture, skull) retinal haemorrhages bruising e.g. ear, cheeks, buttocks, forearms, neck