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msk > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the big 3?

A

DDH
Perthes’ disease
SUFE

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2
Q

What is DDH?

A

Development dysplasia of the hip
Structural abnormality in the hips caused by abnormal development of foetal bones during pregnancy
Risk of subluxation or dislocation

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3
Q

When is DDH diagnosed?

A

New-born examinations
Child presenting with hip asymmetry, reduced ROM in hip or limb

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4
Q

What age group is usually affected by DDH?

A

<2 years

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5
Q

What are the risk factors for DDH?

A

FH
Breech presentation
Multiple pregnancy
First born
High birth weight

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6
Q

What features in a neonatal examination suggest DDH?

A

Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in the knee level when the hips are flexed
Clunking of the hips on special tests

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7
Q

What are 2 special tests to check for DDH?

A

Ortolani test- tests for anterior hip dislocation
Barlow test- tests for posterior hip dislocation

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8
Q

What investigations are done for suspected DDH?

A

Ultrasound of hips
X rays for older infants

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9
Q

What is the management of DDH diagnosed before 6 months?

A

Pavlik harness- kept on permanently to allow the acetabulum to develop properly. Keeps the babies hips flexed and abducted

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10
Q

What is the management for DDH diagnosed after 6 months?

A

Surgery
Hip spica cast after surgery to immobilise the hip

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11
Q

What is the general rule for DDH management?

A

The older the child the poorer the result

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12
Q

What is Perthes’ disease?

A

Disruption of blood flow to the femoral head causing avascular necrosis (AVN)
This affects the epiphysis of the femur

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13
Q

What is the pathology of Perthes’ disease?

A

Disruption of blood supply
AVN
Revascularisation or neovascularisation
Remodelling

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14
Q

What is the main complication of Perthes’?

A

Soft and deformed femoral head leading to early OA

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15
Q

What is the presentation of Perthes’?

A

Pain in the hip or groin
Limp
Restricted hip movements
Referred pain to the knee
No history of trauma

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16
Q

What age group is affected by Perthes’?

A

Primary school aged

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17
Q

What are the investigations for Perthes?

A

X ray
Bloods
MRI

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18
Q

What is Perthes treatment?

A

Bed rest
Crutches
Analgesia
Maintain hip motion
Surgery in severe cases

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19
Q

What is the surgery of choice in severe Perthes?

A

Osteotomy

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20
Q

What is SUFE?

A

Slipped Upper Femoral Epiphysis
Head of the femur is displaced along the growth plate

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21
Q

What group is affected by SUFE?

A

Boys
8-15 years
Obese children
Undergoing growth spurt

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22
Q

What is the typical presentation of SUFE?

A

Hip, groin, thigh or knee pain
Restricted hip ROM
Painful limp
Hip kept in external rotation
Restricted internal rotation

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23
Q

What is the initial investigation of choice for SUFE?

A

Lateral Xray

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24
Q

What is the management of SUFE?

A

Surgery to return the femoral head to the correct position

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25
Q

What are the complication of SUFE?

A

AVN
Chondrolysis
Deformity
Early OA
Limb length discrepancy
Impingement

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26
Q

What is the difference between bones in children vs adults?

A

Growth plates
More cancellous bone- spongy, highly vascular
More flexible but less strong

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27
Q

What is the difference between fractures in children vs adults?

A

Heal quicky- metabolic, cellular, vascular
High capacity for remodelling

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28
Q

What are the types of paediatric fractures?

A

Buckle (torus)
Transverse
Oblique
Spiral
Segmental
Salter-Harris (growth plate)
Comminuted
Greenstick
Plastic deformity

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29
Q

What is greenstick fracture?

A

Only one side of the bone breaks whilst the other side stays intact

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30
Q

What is buckle fracture?

A

Longitudinal compression

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31
Q

What is plastic deformity?

A

Sequence of small cracks in the bone

32
Q

How are growth plate fractures graded?

A

Salter-Harris classification

33
Q

What are the types of Salter-Harris fractures?

A

1- Straight across
2- Above
3- Below
4- Through
5- Crush

34
Q

Which SH is most common?

A

SH2- ascends into metaphysis

35
Q

What are the principles of fracture management?

A
  1. Mechanical alignment- closed reduction or open reduction (via surgery)
  2. Stability- casts, wires, braces, screws, splints
36
Q

What is the fracture pain management?

A
  1. paracetamol and ibuprofen
  2. morphine
37
Q

What painkillers are contraindicated in children?

A

Codeine
Tramadol
Aspirin

38
Q

What causes joint pain in 0-4 years?

A

Septic arthritis
Transient synovitis
DDH

39
Q

What causes joint pain in 5-10 years?

A

Septic arthritis
Transient synovitis
Perthes’ disease

40
Q

What causes joint pain in 10-16 years?

A

Septic arthritis
SUFE
Juvenile idiopathic arthritis

41
Q

What are red flags for hip pain?

A

<3
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Morning stiffness
Swollen or red joint

42
Q

What is the most common cause of hip pain in 3-10 years?

A

Transient synovitis (irritable hip)

43
Q

What is the presentation of transient synovitis?

A

Limp
Refusal to weight bear
Groin or hip pain
Not that unwell
Apyrexial

44
Q

What is the management of transient synovitis?

A

Simple analgesia
Safety net if they develop fever

45
Q

What does joint pain AND a fever suggest?

A

Septic arthritis

46
Q

What is rickets?

A

Osteomalacia in children- defective bone mineralisation

47
Q

What causes rickets?

A

Vitamin D or calcium deficiency

48
Q

What is the presentation of rickets?

A

Lethargy
Bone pain
Swollen wrists
Bone deformity
Poor growth
Dental problems
Muscle weakness
Pathological or abnormal fractures

49
Q

What is the labaratory investigation for rickets?

A

Serum 25- hydroxyvitamin D (<25nmol/L is diagnostic)

50
Q

What is required for rickets diagnosis?

A

X ray (osteopenia)

51
Q

What other investigations are used for rickets?

A

Serum calcium low
Serum phosphate low
Serum ALP high
PTH high

52
Q

What is rickets management?

A

Prevention- vitamin D supplements for breastfed babies
Treat rickets with vit D and calcium supplements

53
Q

What are some normal orthopaedic variants?

A

In toed gaits
Bow legs
Flat feet
Curly toes
Late walkers

54
Q

What is varus bow legs?

A

Ankles closer together than knee
<2 years

55
Q

What is valgus bow legs?

A

Knees closer together than ankle2-7 years

56
Q

What is the mean age to start walking?

A

12 months
50% of children walk later

57
Q

Name some manufacturing defects?

A

Spina bifida
Proximal femoral focal deficiency
Thrombocytopenia absent radius (TAR syndrome)
Congenital scoliosis

58
Q

Name some packaging defects?

A

Metatarsus Adductus
Infantile postural scoliosis
Plagiocephaly
Congenital torticollis

59
Q

What is cerebral palsy?

A

A permanent and non-progressive motor disorder due to brain damage before birth or during first 2 years of life

60
Q

What are the prenatal causes of cerebral palsy?

A

Placenta insufficiency
Toxaemia
Smoking, alcohol, drugs
Infection

61
Q

What are the perinatal causes of cerebral palsy?

A

Prematurity
Anoxic injuries
Infections
Haemolytic diseases

62
Q

What are the postnatal causes of cerebral palsy?

A

CMV, rubella infection
Head trauma

63
Q

What is the physiological classification of cerebral palsy?

A

Spastic
Athetoid
Ataxia
Mixed

64
Q

What is the anatomical classification of cerebral palsy?

A

Monoplegia
Hemiplegia
Diplegia
Quadriplegia

65
Q

What is Juvenile Idiopathic Arthritis? (JIA)

A

Autoimmune inflammation occurring in the joints

66
Q

What are the subtypes of JIA?

A

Oligoarticular (pauciarticular)
Polyarticular
Systemic
Enthesitis related
Psoriatic

67
Q

What is oligoarticular JIA?

A

4 joints or less
Affects larger joints
Associated with anterior uveitis
No systemic symptoms

68
Q

What is anterior uveitis significantly related to?

A

ANA positivity
Causes potential blindness

69
Q

What is polyarticular JIA?

A

5+ joints
Symmetrical, small and large joints
Mild systemic symptoms

70
Q

Which RIA is the equivalent of adult RA in children?

A

Polyarticular JIA
Most children are seronegative

71
Q

What is systemic JIA?

A

Extraarticular features define the disease
Fever is characteristic- rises daily then normal in morning

72
Q

What are the features of systemic JIA?

A

Subtle salmon pink rash
High swinging fevers
Enlarged lymph nodes
Weight loss
Joint inflammation and pain
Splenomegaly
Muscle pain
Pleuritis and pericarditis

73
Q

What is enthesitis related JIA?

A

Child version of the seronegative spondyloarthropathies
HLA B27 gene
Associated with anterior uveitis
Tender to localised palpation of the entheses

74
Q

What is juvenile psoriatic arthritis?

A

Seronegative inflammatory arthritis associated with psoriasis

75
Q

What are the features of psoriatic JIA?

A

Psoriasis plaques
Nail pitting
Onchylosis
Dactylitis
Enthesitis

76
Q

What is the management of JIA?

A

Analgesia
NSAIDs- ibuprofen
Steroids
DMARDs- methotrexate, sulfalazine
Biologics- infliximab

msk (20 decks)

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