The limping child

Question 1

Sorter stance phase aka

Answer 1

A limp (is on that leg for less time)

Question 2

anatalgic gait meaning

Answer 2

Your typical limp, is off the leg asap becuase of pain. Think trauma, infection or tumour

Question 3

Trendelenberg gait

Answer 3

Swaying of upper body. Often due to weakness of the abductors

Question 4

metabolic issue eg

Answer 4

Vit D deficiency (Rickets)

Question 5

trimodal ages and respective causes?

Answer 5

Pre-primary school (0-5)
-normal varients
-Trauma
-Transient synovitis (remember following that urt infection)
-DDH, JIA

Primary school (5-10)
-Trauma,
-Transient synovitis (really picking up all the bugs from school!)
-Perthes

Secondary (10+)
-Trauma
-SUFE
-Chrondeomalacia
Neoplasm

Ostomyelitis and Septic arthrisis continue to get increasingly common as the child gets older.

Question 6

Ages for DDH, JIA, Perthes ad SUFE

Answer 6

DDH = new born, may present late a year or so old.
Perthes = Primary school (4-10)
SUFE = starting secondary school

Question 7

overuse can upresent as what? What is osgoopds schlatter?

Answer 7

chrondromalacia

Osgoods schlatters = when the patella tendon has been tugging too much at the tibia whilst it is growing and it causes pain (small avulsion fractures)

Question 8

hip issues can present where\/

Answer 8

Knee or leg

Question 9

CAN YOU GET STRESS FRACTURES AS A CHILD?

Answer 9

yes

Question 10

whAT DO WE WANT T O FIND OUT IN THE HISTROY?

Answer 10

Duration, progression, trauma? Pain and socrates, weakness, times when worse, weight bear? normal activities? Sysetmic symptoms (including flu, loss of appitite)? Med history - birth history etc

Question 11

whO DO WE GET THE HISTORY FROM?

Answer 11

The kid! Parents can congtribute in primary school aged kids. But in younger kids then you have to rely on parents as sadly babys who can’t talk can’t giv eyou a comprehensive history.

Question 12

hOW DO WE GO ABOUT THE EXAMONATION?

Answer 12

OBervation is key.
Look sick?
Limp?
Absolute refusal to weight bear?
Localising area- ankle/ tibia/ knee/ thigh/ hip
Hip - obligatory ER?
- which movements hurt?
Ankle- distal tibia or joint line?
Knee- joint line or metaphyseal area?
Upper limb disuse

Remember check: Soles of feet, rom, symettry, shoes, dimples, scoliosis, hairy backs (bifida), circumfrence

Question 13

If someone child is ill what do we do?

Answer 13

Hand over to those with the knowledge to deal with

Question 14

Creatine kinase is elevates in what type of muscelular issues?

Answer 14

Muscular dystrophies

Question 15

transient synovitis vs septic arthritis vs osteromyelitis

Answer 15

Basicailly says iton the tin -> Transient is transient. Septic arthritis and osteomyelitis are a lot more severe and have worse symptoms and presentation.

Question 16

What bloods do we do?

Answer 16

CRP, ESR, Cultures, WBC, creatine kinase

Question 17

most common cause of septic arthritis (how bugs get there)

Answer 17

Through the blood!! Then throughthe bone -> remember in kids the growth plate is very active, so loadsa blood supply and easy access for bugs to infect the bone and then suprise! pop out into the joint capsule. THen is throughcellulitis/skin/soft tissue ifection, then therapeuric and THEN trausma!!

Question 18

MOst cmomon bug (septic arthritis)

Answer 18

Staph AUreus. (Obviously) Its the one creeping round yo skin and lovessss a good joint space

Question 19

How do we treat septic arthrissi?

Answer 19

You clean it all out and then give them IV antibiotics (2 weeks!) and then oral antibiotics (4 weeks!)

Question 20

Acuts osteomyelitits is common when?

Answer 20

6yo, (10yo for pelvis). Blunt trauma/revent indection.

Question 21

Symptoms of osteomyeltitis?

Answer 21

pain, localised symptoms - most common

, fever, reduced rom and reduced weight bearing

Question 22

high dose abx for 48h then what?

Answer 22

If no better then you need help! Remmeber yo FBC, CRP, ESR, Culures, Xray, ULTRASOUND!!! Synovial fluid: WCC, Gram and culture

Question 23

What tests for transient synovitis/what do we find in patient

Answer 23

Slightly unwell
History of viral infection eg URTI/ ear
Apyrexial
Allowing joint to be examined
Low CRP, normal WCC
May have joint infusion
Not that unwell

Question 24

What are thediffertnt types of JIA?

Answer 24

Pau (4 and under), poly and systemic

Question 25

Who does JIA ususally affect?

Answer 25

young girls

Question 26

What is pauci arthriti and what is it important that we do in terms of referal?

Answer 26

it is when there is an early onset of 4 or less joints. Manily guys. Need to refer to opthalmology for geeting the eye checked (associated with uveitis)