Paeds Other

Question 1

Causes of polyarthritis

Answer 1

Infection
Bacterial- septicaemia/septic arthritis, TB
Viral- rubella, mumps, adenovirus, coxsackie B, herpes, hepatitis, parvoV
Other- mycoplasma, Lyme disease, rickettsia
Reactive-GI Infectio, streptococcal infection
Rheumatic fever
IBD
Crohn’s disease, UC
Vasculitis
Henoch-Schonlein purpura, Kawasaki disease
Haematological disorders
Haemophilia, SCD
Malignant disorders
Leukaemia, neuroblastoma
CTD
JIA, SLE, Dermatomyositis, mixed CTD, polyarteritis nodosa
Other
CF

Question 2

Transient Synovitis (vs Septic arthritis) 
Onset, fever, appearance, movement, WCC, ESR, US, Radiograoh, Mx, Course

Answer 2

Onset; acute limp, non-weight bearing
Fever; mild/absent
Child’s appearance; well
Hip movement; comfortable at rest, limited internal rotation and pain on movement
WCC; normal
APreactant/ESR; slightly increased/normal
US; fluid in joint
Raduograph; normal
My; rest, analgesia
Course; resolves <1wk, approx 3% ~> Perthes disease

Question 3

Septic arthritis (vs Transient synovitis) 
Onset, fever, appearance, movement, WCC, ESR, US, Radiograph, Mx, course

Answer 3

Onset; acute limp, non-weight bearing
Fever; moderate/high
Child’s appearance; ill
Hip movement; help flexed, severe pain at rest, worse on attempt to move
WCC; normal/high
APreactant/ESR; raised
US; fluid in joint
Radiograph; normal/widened joint space
Mx; joint aspiration under US guidance. Prolonged ABX, Rest, analgesia
Course; progressive and severe joint damage if not treated

Question 4

Headaches; primary, secondary, other

Answer 4

*primary* 
Migraine 
Tension-type headache 
Cluster headache (and other trigeminal autonomic cephalagias) 
?other

secondary
Head &/or neck trauma
Cranial or cervical vascular disorder; vascular malformation or ICH
Non-vascular intractranial disorder; raised ICP, Idiopathic intracranial hypertension
Substance/withdrawal; ETOH, Solvent, drug abuse
Infection; meningitis or encephalitis
Disorder of homeostasis; hypercapnia or HTN
Disorder of facial or cranial structures; acute sinusitis
Psychiatric disorder

other
Trigeminal and other neuralgia sand central causes of facial pain
?other

Question 5

Headache Red Flag Symptoms; SOL

Answer 5

Headache-worse on lying down/coughing/straining
Headache-wakes child (not on waking)
Assoc-confusion, nausea and vomiting
Change in- personality, behaviour, educational performance

Question 6

Headache Red flag signs; SOL

Answer 6

Growth failure
 Visual field defects
Squint 
Cranial nerve Abn 
Torticollis 
Abn coordination; cerebellar lesions 
Gait; UMN/cerebellar sign 
Fundi; papilloedema 
Bradycardia 
Cranial bruits; AV malformation