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Year 4 Paeds- A > Paeds orthopaedics > Flashcards

Paeds orthopaedics Flashcards

1
Q
  • Septic arthritis is most common in children of what age?
A

under 4

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2
Q
  • Septic arthritis is a common and important complication of
A

joint replacement

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3
Q
  • Septic arthritis presentation
A
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4
Q
  • …is the most common causative organism of septic arthritis. Other bacteria include:
A
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5
Q

Septic arthritis differentials

A
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6
Q

Investigation findings and management of septic arthritis

A
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7
Q

Slipped upper femoral epiphysis (SUFE) definition

A

head of the femur is displaced (“slips”) along the growth plate

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8
Q

Slipped upper femoral epiphysis (SUFE) more common in which group? Typical age presentation

A

It is more common in boys and typically presents aged 8 – 15 years, with the average age of 12 in boys.
It presents slightly earlier in females, with an average age of 11 years.

It is more common in obese children.

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9
Q

Slipped upper femoral epiphysis (SUFE) presentation including examination findings

A
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10
Q

SUFE investigations

A

The initial investigation of choice in SUFE is xray.

Other investigations that can be helpful in establishing the diagnosis are:

  • Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
  • Technetium bone scan
  • CT scan
  • MRI scan
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11
Q

SUFE management

A

Surgery is required to return the femoral head to the correct position and fix it in place to prevent it slipping further.

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12
Q

Perthes disease definition and age group

A
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13
Q

Perthes disease main complication

A
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14
Q

Perthes presentation

A
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15
Q

perthes vs SUFE differentation in presentation

A

no history of trauma in perthes. If the pain is triggered by minor trauma —> slipped upper femoral epiphysis, particularly in older children.

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16
Q

investigations in perthes

A
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17
Q

Perthes management

A
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18
Q

Reactive arthritis definition and presentation

A

Reactive arthritis involves synovitis in one or more joints in response to an infective trigger.

Typically it causes acute monoarthritis, affecting a single joint (most often the knee), presenting with a warm, swollen and painful joint.

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19
Q

reactive arthritis important differential

A

A significant differential is septic arthritis, where an infection is inside the joint. Patients with reactive arthritis do not have an infection in the joint.

20
Q

The most common triggers of reactive arthritis are

A

gastroenteritis or sexually transmitted infections.

Chlamydia may cause reactive arthritis.

Gonorrhoea typically causes septic arthritis rather than reactive arthritis.

21
Q

Reactive arthritis is what type of arthropathy?

A

seronegative spondyloarthropathy

There is a link with the HLA B27 gene

22
Q

Reactive arthritis is more common in patients with

A

HIV
(HIV needs to be excluded in patients with reactive arthritis)

23
Q

Reactive arthritis associated conditions

A
  • Bilateral conjunctivitis (non-infective)
  • Anterior uveitis
  • Urethritis (non-gonococcal)
  • Circinate balanitis (dermatitis of the head of the penis)

TOM TIP: The classic triad of conjunctivitis, urethritis and arthritis are remembered with the mnemonic, “can’t see, pee or climb a tree”.

24
Q

Reactive arthritis investigations and management

A
25
Q

DDH definition and what it leads to

A
26
Q

How is DDH usually picked up?

A

DDH is either picked up during the newborn examinations or later when the child presents with hip asymmetry, reduced range of movement in the hip or a limp.

27
Q

Risk factors of DDH

A
28
Q

Screening for DDH including examination findings

A
29
Q

Diagnosis of DDH

A
30
Q

Management of DDH

A
31
Q

Transient synovitis cause

A

temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis).
It is the most common cause of hip pain in children aged 3 – 10 years.
It is often associated with a recent viral upper respiratory tract infection.

32
Q

the most common cause of hip pain in children aged 3 – 10 years

A

transient synovitis

33
Q

transient synovitis vs septic arthritis

A

Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.

34
Q

Transient synovitis presentation

A
35
Q

Transient synovitis management

A
36
Q

Transient synovitis prognosis

A

Typically there is a significant improvement in symptoms after 24 – 48 hours. Symptoms fully resolve within 1 – 2 weeks without any lasting problems. Transient synovitis may recur in around 20% of patients.

37
Q

Rickets definition

A

Rickets is a condition affecting children where there is defective bone mineralisation causing “soft” and deformed bones. In adults the same process leads to a condition called osteomalacia. Osteo– means bone and –malacia means soft.

38
Q

Rickets causes

A
  • deficiency in vitamin D or calcium
  • rare form of rickets caused by genetic defects that result in low phosphate in the blood.
    This is called hereditary hypophosphataemic rickets. The most common form is x-linked dominant, however it also has other modes of inheritance.
39
Q

Which conditions tend to have vitamin D deficiency?

A
  • Patients with malabsorption disorders (such as inflammatory bowel disease) are more likely to have vitamin D deficiency.
  • The kidneys are essential in metabolising vitamin D to its active form, therefore vitamin D deficiency is common in chronic kidney disease.
40
Q

Inadequate vitamin D leads to…

A
41
Q

Presentation of rickets

A
42
Q

Bone deformities that can occur in rickets include:

A
43
Q

Risk factors to ask in history of rickets

A

risk factors for vitamin D deficiency in your exams and clinical practice.
Patients with rickets are likely to have risk factors such as
* darker skin
* low exposure to sunlight
* live in colder climates and
* spend the majority of their time indoors.

44
Q

Investigations for rickets

A
45
Q

Management of rickets

A
46
Q

An older child with missed DDH may present with

A

An older child with missed DDH may present with a Trendlenberg gait and leg length discrepancy

Year 4 Paeds- A (15 decks)

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