Paeds: The Limping Child (1) Flashcards

1
Q

The general classification of MSK disorders in children (3)

A
  • Inflammatory / tissue threatening
  • Mechanical
  • Idiopathic – often medically unexplainable/non tissue threatening (including non organic/functional)
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2
Q

What to ask about in the Hx taking of MSK problems

A

Specific symptoms:

  • Limp
  • Stiffness
  • Joint swelling
  • Pain
  • Loss of function/stiffness

Extra-articular symptoms:

fever, weight loss, weakness, rash, sleep, bruising etc…

Review of systems

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3
Q

Examination of a child presenting with MSK problems (+mnemonic)

A
  • Height/weight
  • Temp/pulse/BP
  • MSK including gait
  • Full examination of systems inc rashes
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4
Q

Aetiology of MSK problems (inflammatory, mechanical, idiopathic) based on the presence of:

  • pain
  • stiffness
  • swelling
  • sleep disturbance
  • instability
  • physical signs
A
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5
Q

Examples of inflammatory MSK childhood disorders

A
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6
Q

Examples of mechanical MSK childhood disorders

A
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7
Q

Examples of idiopathic MSK conditions in children

A
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8
Q

Organisms responsible for septic arthritis

A

Source: local or haematogenous

  • Staph Aureus: 60%
  • Streps
  • Gonococcus
  • Gm-ve bacilli
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9
Q

Risk factors for septic arthritis

A
  • Joint disease (e.g. RA)
  • Chronic renal failure
  • Immunosuppression (e.g. DM)
  • Prosthetic joints
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10
Q

What criteria are used for diagnosis of septic arthritis?

Name and describe them

A

The Kocher criteria for the diagnosis of septic arthritis:

  • fever >38.5
  • non-weight bearing
  • raised ESR
  • raised WCC
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11
Q

Symptoms of septic arthritis

A
  • acutely inflamed tender
  • swollen joint
  • ↓ROM
  • systemically unwell: fever
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12
Q

Possible investigations in septic arthritis

A
  • Joint aspiration for MCS
  • ↑↑ WCC (e.g. >50,000/mm3) : mostly PMN
  • ↑ESR/CRP
  • ↑WCC
  • Blood cultures
  • X-ray
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13
Q

Management of septic arthritis

A
  • synovial fluid should be obtained before starting treatment
  • intravenous flucloxacillin or clindamycin (if penicillin-resistant)
  • (BNF states 6-12 weeks)
  • needle aspiration should be used to decompress the joint
  • arthroscopic lavage (joint wash out under GA) may be required
  • splint joint
  • physiotherapy after infection resolves
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14
Q

Possible complications of septic arthritis

A
  • Osteomyelitis
  • Arthritis
  • Ankylosis: fusion
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15
Q

antibiotics in septic arthritis for children aged birth-one month + what organisms are likely to be responsible

A

Likely organisms:

  • Gp B strep
  • Staph aureus
  • Kingella kingae

Antibiotics:

IV cefotaxime + flucloxacillin (clindamycin if allergic)

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16
Q

Alder Hay protocol for choosing antibiotics in septic arthritis for children aged one month- 5 years + what organisms are likely to be responsible for the infection

A

Organisms likely to cause infection:

  • Staph aureus
  • Gp A strep
  • Kingella kingae

Antibiotic: IV cefuroxime

17
Q

Alder Hay protocol for choosing antibiotics in septic arthritis for children aged 5 years and above + what organisms are likely to be responsible for the infection

A

Organisms:

  • Staph aureus
  • Gp A strep
  • Strep pneumoniae

Antibiotic: IV Flucloxacillin

18
Q

Organisms that may cause acute osteomyelitis

A

Organisms:

  • Staph. aureus is the most common
  • except in patients with sickle-cell anaemia where Salmonella species predominate.
19
Q

Risk factors for acute osteomyelitis

A
  • Vascular disease
  • Trauma
  • Sickle Cell Disease
  • Immunosuppression (e.g. DM)

Children

  • rich blood supply to growth plate
  • usually affects metaphysis
20
Q

Signs and symptoms of osteomyelitis

A
  • Pain
  • tenderness
  • erythema
  • warmth
  • ↓ROM
  • Effusion in neighbouring joints
  • Signs of systemic infection
21
Q

Possible investigations of acute osteomyelitis

A
  • MRI
  • ↑ESR/CRP, ↑WCC
  • +ve blood cultures in 60%
  • X-ray
    *
22
Q

X-ray changes in osteomyelitis

A
  • changes take 10-14 days
  • Haziness
  • ↓ bone density
  • Sub-periosteal reaction
  • Sequestrum and involucrum

sequestrum → a piece of devitalised bone that has been separated from its surrounding bone during the process of necrosis

involucrum → if sequestrum becomes encased in a thick sheath of periosteal new bone

23
Q

Management of osteomyelitis

A
  • IV antibiotics: flucloxacillin for 6 weeks
  • Drain abscess and remove sequestra
  • Analgesia
24
Q

The classic triad of reactive arthritis + presentation

A

Classic triad:

  • urethritis
  • conjunctivitis
  • arthritis
  • Typically lasts around 4-6 months
  • No systemic features, maybe recent infection
  • typically an asymmetrical oligoarthritis of lower limbs
  • skin: circinate balanitis (painless vesicles on prepuce)
  • keratoderma blenorrhagica (waxy yellow/brow n papules on palms and soles)

‘Can’t see, pee or climb a tree’

25
Q

Management of reactive arthritis

A
  • symptomatic: analgesia, NSAIDS, intra-articular steroids
  • sulfasalazine and methotrexate are sometimes used for persistent disease
  • symptoms rarely last more than 12 months
26
Q

Henoch-Schonlein Purpura (HSP)

A

HSP = commonest paediatric vasculitis (small vessel)

  • ARIANA
  • Arthralgia
  • Rash (purpuric)
  • Ig
  • A mediated
  • Nephritis
  • Abdo pain

+ headaches

  • most common in 2-6 yr olds
  • Mx: usually self limiting
27
Q
A