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3a Paediatrics > Paeds orpho (ILA 1) > Flashcards

Paeds orpho (ILA 1) Flashcards

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
Q

How is transient synovitis managed?

A

bed rest

improves within a few days

26
Q

How does transient synovitis and septic arthritis differ?

A

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
Q

How does septic arthritis present?

A

acute onset
high fever
severe pain at rest in joint
red, hot, swollen and tender joint

28
Q

How is septic arthritis managed?

A

joint aspiration under ultrasound guidance

prolonged antibiotics

rest and analgesia

29
Q

Who is mainly affected by perthes disease?

A

boys
5-10 y/o
short
hyperactive

30
Q

What is perthes disease?

A

avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of the blood supply

31
Q

how is perthes disease managed?

A

rest

physiotherapy - can take 2/3 years to heal

32
Q

What is slipped capital femoral epiphysis?

A

displacement of the femoral head epiphysis postero-inferiorly

33
Q

Describe the typical patient of slipped capital femoral epiphysis

A

obese
adolescent
male
groin pain*

34
Q

Describe the associations with osgood schlatter

A

young
athletic teens
swelling below knee - worse on activity

35
Q

Which features of a history indicate non accidental injury?

A

history incompatible with injury/ unclear history
multiple fractures - rib fracture, skull fracture, metaphysical corner fracture
bruising on ear, cheeks, buttocks, forearms, neck

36
Q

What is osteogenesis imperfecta?

A

‘brittle bone disease’

group of disorders of collagen metabolism resulting in bone fragility and fractures

37
Q

What is the most common type of osteogenesis imperfecta and how is this caused?

A

type 1 = autosomal dominant

abnormality of type 1 collagen due to decreased synthesis of pro-alpha 1 and pro-alpha 2 collagen polypeptides

38
Q

How does osteogenesis imperfect present?

A 
frequent fractures after minor trauma 
bowing
blue sclera 
deafness 
dental imperfections
39
Q

How can fracture rates be reduced in osteogenesis imperfecta?

A

bisphosphonates

splinting of fractures

40
Q

when would you suspect a NAI?

A

history incompatible with injury/ unclear
multiple fractures (e.g. rib fracture, skull)
retinal haemorrhages
bruising e.g. ear, cheeks, buttocks, forearms, neck

3a Paediatrics (9 decks)

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