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Differential Diagnosis > Screening for Pedatrics/Adolescents > Flashcards

Screening for Pedatrics/Adolescents Flashcards

1
Q

list several pediatric/adolescent disorders to be on the look out for

A
  1. Meningitis
  2. Neoplastic disorders
    1. bone tumors
  3. Osteochondrosis
  4. Disorders of Epiphyseal Growth
  5. Myositis Ossificans
  6. Female Athlete Triad
  7. Heat Illness
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2
Q

what is meningitis?

A

inflammation of membranes (meninges) surrounding brain or spinal cord

20% of cases occur in individuals 14-24 years old

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3
Q

what causes meningitis?

A

most cases are caused by viral infection

bacterial and fungal infections can also cause meningitis

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4
Q

what are the hallmark symptoms of meningitis?

A
  1. Fever
  2. HA
  3. stiff and painful neck
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5
Q

List risk factors for meningitis

A
  1. skipping vaccinations
  2. <5 years old (viral meningitis)
  3. people under 20 years old living in community settings (ie dorm, military base, boarding school)
  4. pregnancy
  5. compromised immune system
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6
Q

T/F: benign bone tumors are usually very painful

A

FALSE
they usually do not cause constant severe pain associated malignant tumors

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7
Q

how do bone tumors typically manifest?

A

as pathologic fractures

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8
Q

Clinical Signs of a bone tumor

A
  1. soft tissue swelling
  2. tenderness
  3. joint pain
  4. presence of mass without history of trauma
  5. night pain
  6. pain unrelated to position
  7. fever
  8. weight loss
  9. night sweats
  10. fatigue
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9
Q

what is osteochondrosis?

A

avascular necrosis of the epiphyses

  • these are idiopathic disorders seen in immature skeletons
  • they are most common in middle years of growth (3-10 years old)
  • boys > girls
  • LE > UE
  • present bilaterally 10-15% of the time
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10
Q

List the subcategories of Osteochondrosis

A
  1. Legg-Calve-Perthes Disease (LCP disease)
  2. Freberg’s Disease
  3. Panner’s Disease
  4. Kienbock’s Disease
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11
Q

which of the osteochondrotic diseases is the most common and serious?

A

Legg-Calve-Perthes Disease

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12
Q

describe Legg-Calve-Perthes Disease

A
  1. Involves pressure epiphysis of proximal femur
  2. boys > girls (5:1)
  3. Caucasians > African Americans (10:1)
  4. most often occurs between 4-8 years old
  5. bilateral 10-15% of the time
  6. unknown cause
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13
Q

List Symptoms of Legg-Calve-Perthes Disease

A
  1. Limping
  2. Pain or stiffness in hip, groin, thigh, or knee
  3. limited ROM of hip joint
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14
Q

what is Freiberg’s disease?

A

osteochondrosis of pressure epiphysis of metatarsal heads

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15
Q

describe Freiberg’s Disease

A
  1. Results in forefoot pain with WBing
  2. more common in females
  3. may occur secondary to long 2nd metatarsal or short first metatarsal
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16
Q

how is Freiberg’s disease treated?

A

shoe modifications to redistribute weight

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17
Q

what is Panner’s disease?

A

osteochondrosis of capitellum of the humerus

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18
Q

describe Panner’s disease

A
  1. must be ruled out in pts 3-11 years old presenting with:
    1. pain, swelling and limited ROM in elbow joint
  2. prognosis is good given non-WBing nature of elbow joint
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19
Q

how is Panner’s disease treated?

A

immobilization in sling during symptomatic period

20
Q

what is Kienbock’s disease?

A

osteochondrosis of lunate

21
Q

describe Kienbock’s disease

A
  1. Present with:
    1. aching in wrist
    2. tenderness over lunate
    3. swelling secondary to repetitive microtrauma
  2. present in late adolescence and young adulthood
  3. healing is slower in adults compared to children and adolescents
22
Q

how is Kienbock’s disease treated?

A

excision of lunate before degenerative changes develop in surrounding carpals

23
Q

list several disorders of epiphyseal growth

A
  1. Slipped Capital Femoral Epiphysis (SCFE)
  2. Adolescent idiopathic scoliosis
24
Q

describe SCFE

A
  1. most common hip disorder seen in adolescents
  2. males 13-16 years old 2-5x more likely than females (11-14 years old)
25
Q

list the risk factors for SCFE

A
  1. obesity
  2. African American
  3. endocrine abnormalities
26
Q

describe the clinical presentation of SCFE

A
  1. Limping that increases with fatigue
  2. pain in distal thigh/knee
  3. may have mild hip pain
  4. prefer hip flexion, ER, abduction
27
Q

describe adolescent idiopathic scoliosis

A
  1. develops during pediatric years and typical onset is puberty
  2. most common form of scoliosis
  3. lateral curvature of the spine
  4. females > males
  5. Adam’s forward flexion test = screening tool
28
Q

when is surgical correction indicated with adolescent idiopathic scolosis?

A

progressive curves >45-50 degrees

29
Q

what is myositis ossificans?

A

formation of heterotopic bone within the muscle as a result of a complication of severe or poorly managed contusions

30
Q

________ and ________ are common sites for myositis ossificans

A

quadriceps and biceps brachii

31
Q

list warning signs of severe contusions

A
  1. marked decrease in ROM
  2. sig pain
  3. joint effusion
  4. decreased function
32
Q

what should you be watching for that may indicate myositis ossificans?

A

a palpable mass at the site of injury several days post injury

33
Q

what should you be watching for that may indicate myositis ossificans?

A

a palpable mass at the site of injury several days post injury

34
Q

what is the female athlete triad?

A

refers to relationship between energy availability, menstrual function and bone mineral density

results in:

  1. energy deficiencies
  2. functional hypothalamic amenorrhea
  3. osteoporosis
35
Q

list several clues to screen for female athlete triad

A
  1. low body weight
  2. current or past stress fractures
  3. participation in sport that favors lean body size or that have weight classes
36
Q

list further screening questions for the female athlete triad

A
  1. when was your last menstrual period?
  2. do you skip meals?
  3. have you ever been treated for a stress fracture?
  4. how often do you train/exercise?
37
Q

T/F: there is no difference between children and adults in their ability to acclimate to heat. Children are just more active

A

FALSE

children do not acclimate to heat as well as adults

their ability to dissipate heat improves in adolescences

38
Q

list 2 things to remember to help with prevention of heat illnesses

A
  1. limit time spent playing in hot, humid conditions
  2. ensure adequate fluid intake
39
Q

list the 3 different heat stress disorders

A
  1. heat illness
  2. heat exhaustion
  3. heat stroke
40
Q

list the clinical features of heat illness

A
  1. thirst
  2. chills
  3. clammy skin
  4. cramps
  5. nausea
  6. muscle twitches
  7. weakness
  8. fatigue
41
Q

how is heat illness treated?

A
  1. drink a half-cup of water every 15-20 minutes
  2. rest in shade during breaks
  3. remove extra clothes
42
Q

list the clinical features of heat exhaustion

A
  1. reduced sweating
  2. dizziness
  3. HA
  4. SOB
  5. lack of saliva
  6. extreme fatigue
  7. weak and rapid pulse
  8. lack of coordination
  9. thirst
43
Q

how is heat exhaustion treated?

A
  1. stop activity and move to a cool place
  2. drink 2 cups of water for every pound lost
  3. remove wet clothes and sit in a chair in a cold shower
44
Q

how is heat stroke defined?

A

a temp > 105 degrees

45
Q

list clinical features of heat stroke

A
  1. lack of sweat
  2. dry, hot skin
  3. lack of urine
  4. hallucinations
  5. swollen tongue
  6. deafness
  7. aggression
  8. ataxia
  9. high temperatures
  10. seizures
  11. vomiting, diarrhea
  12. rapid HR
46
Q

how is heat stroke treated?

A
  1. medical emergency!
  2. stop activity and move to a cool place
  3. place ice bags on head and back until help arrives
  4. DO NOT attempt to give water → aspiration possible

Differential Diagnosis (14 decks)

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