Peds Path Part 2 Flashcards
Developmental Hip Dysplasia
Displacement of femoral head from normal relationship w/ acetabulum - 1 or 2 in 1000 births - * F>M - Unilateral 2X as frequent as bilateral - Varying severities - Risk factors: In utero positioning * Breech presentation - PE: Ortolani/Barlow maneuvers - Imaging: Ultrasound ideally at six weeks, or Xray AP frog leg 4-6 months (ossification not begun till that time)
Findings in developmental hip dysplasia:
Femoral head lateral & superior to normal position
Acetabulum may be shallow
Physiologic genu varum
Bowlegged Seen in 1-3 yr olds Associated w/ laxity of other joints & internal tibial torsion Waddling gait or kick heels Tx: rarely indicated, resolves w/ growth
Physiologic genu valgum
Knock-kneed Seen in 3-5 yr olds F>M May be associated w/ ligamentous laxity R/o rickets/renal dz Tx: not generally indicated - Corrects w/ time
Nursemaid’s Elbow
Radial head subluxation
Supination-flexion technique
Hyperpronation/forced pronation technique
Slipped capital femoral epiphysis (SCFE)
SCFE occurs when the epiphysis slips off the end of the femur
Overweight 11-16 yo boys>girls; AA>whites
Pain in hip, thigh, groin, or knee
- Stable-can walk with or without crutches
- Leg maybe stiff, limp, or painful (comes & goes)
- – Leg may externally rotate or appear shorter
- Unstable-very painful; pt will not want to move leg
Diagnosed with x-ray
- Widened physis
- Step off (late sign)
Treatment is surgery (screw)
Complications include avascular necrosis and chondrolysis
Osgood-Schlatter disease
- Traction apophysitis of tibial tubercle
M>F
Cause:
- Differential rates of osseous & soft tissues
- Stress on apophyses by vigorous physical activity
Pain often relieved w/ rest
PE: tenderness/swelling
Duration: 6-24 months
Tx: rest, NSAIDS, cast/splint (if severe)
Steroid contraindicated
Septic arthritis and Osteomyelitis
“The sun must never rise nor set on a septic joint.”
Presenting symptoms: Fever, bone pain, swelling, redness, limp if ambulatory
Pathophysiology:
* Hematogenous spread to the synovium
* Rich vascular supply in their growing bones
Neonates and young children often have coexisting septic arthritis and osteomyelitis
Septic arthritis pathogens:
- Neonates: Staph aureus, E coli, GBS
- Older children: Staph aureus, MRSA
- – also: Neisseria, GAS, and Salmonella
Osteomyelitis pathogens:
- Staph aureus, Strep pyogenes, Strep pneumoniae
Septic arthritis and Osteomyelitis
“The sun must never rise nor set on a septic joint.”
Presenting symptoms: Fever, bone pain, swelling, redness, limp if ambulatory
Pathophysiology:
* Hematogenous spread to the synovium
* Rich vascular supply in their growing bones
Neonates and young children often have coexisting septic arthritis and osteomyelitis
Septic arthritis pathogens:
- Neonates: Staph aureus, E coli, GBS
- Older children: Staph aureus, MRSA
- – also: Neisseria, GAS, and Salmonella
Osteomyelitis pathogens:
- Staph aureus, Strep pyogenes, Strep pneumoniae
Impetigo
- Honey crusted lesions: red, crusting, dried pus or discharge, or oozing patches
- Staph infections, sometimes secondary to scratching of skin (itching from other etiologies)
Treatment: topical antibiotic cream, oral antibiotics for larger areas, keep clean with antibacterial soap and water
Hand-foot-mouth
- Coxsackie A 16
At risk: preschoolers
Highly contagious
Incubation: 4-6 days
Prodrome: 1-2 days before rash
Low grade fever, anorexia, malaise, sore throat
- Painful, shallow, yellow ulcers surrounded by red halos
- Found on buccal mucosa, tongue, soft palate, uvula and anterior tonsillar pillars
Exanthem involves * palmar, plantar and interdigital surfaces of the hands and feet +/- buttocks
Oral lesions without the exanthem = * herpangina
Erythema infectiosum
(5th disease)
* Parvovirus B19 At risk: school age children (4-10) Season: sporadic Incubation: 4-14 days Infectious: until the onset of the rash
Rash on face is characteristic “slapped cheek” appearance*
Lacy reticular rash on trunk
>50% asymptomatic
Prodrome
Mild fever (15-30%), sore throat, malaise
Dangerous for pregnant women in 1st trimester
Can cause severe anemia, hydrops fetalis
Roseola infantum
Aka Exanthem subitum Human Herpes Virus 6 (7) At risk 6-36 months (peak 6-7 months) Season: sporadic Incubation: 9 days Infectious: until onset of rash * High fever for 3-4 days * Abrupt drop in fever with appearance of rash Associated seizures likely due to infection of the meninges by the virus
Herpetic gingivostomatitis
Human Herpes Virus 1
Gingivostomatitis most common 1º infection in children
- Fever, irritability, cervical nodes
- Small yellow ulcerations with red halos on mucous membranes
Involvement more diffuse – easy to differentiate from herpangina and exudative tonsillitis
Treatment: supportive
Herpetic whitlow
Lesions on thumb usually 2° to autoinoculation
Group, thick-walled vesicles on erythematous base
Painful
Tend to coalesce, ulcerate and then crust
May require topical or oral acyclovir
