Paeds orpho (ILA 1) Flashcards
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
How is transient synovitis managed?
bed rest
improves within a few days
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
How does septic arthritis present?
acute onset
high fever
severe pain at rest in joint
red, hot, swollen and tender joint
How is septic arthritis managed?
joint aspiration under ultrasound guidance
prolonged antibiotics
rest and analgesia
Who is mainly affected by perthes disease?
boys
5-10 y/o
short
hyperactive
What is perthes disease?
avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of the blood supply
how is perthes disease managed?
rest
physiotherapy - can take 2/3 years to heal
What is slipped capital femoral epiphysis?
displacement of the femoral head epiphysis postero-inferiorly
Describe the typical patient of slipped capital femoral epiphysis
obese
adolescent
male
groin pain*
Describe the associations with osgood schlatter
young
athletic teens
swelling below knee - worse on activity
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
What is osteogenesis imperfecta?
‘brittle bone disease’
group of disorders of collagen metabolism resulting in bone fragility and fractures
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
How does osteogenesis imperfect present?
frequent fractures after minor trauma bowing blue sclera deafness dental imperfections
How can fracture rates be reduced in osteogenesis imperfecta?
bisphosphonates
splinting of fractures
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
