Paediatric arthritis

Question 1

important factor on spetic arthritis

Answer 1

surgical emergency

-irreparable changes in the articular cartilage occur within HOURS of inoculation

Question 2

top 3 organisms for septic arthitis

Answer 2

staphylococcus aureus

strep pneumonia

Haemophilus influenzae (incidence falling with immunisation)

Question 3

presentation of septic arthiris excluding the joint 3

Answer 3

systemically unwell
-fever
-headache

-may have another focus of infection (septicasemia, pharyngitis, meningitis, cellulitis)

joints issues

Question 4

presentation of septic arthitis regarding the joint 5

Answer 4

exquisitely painful

hot

swollen

red

held immobile (pseudoparalysis)

Question 5

how can joint presentation differ in septic arthitis

Answer 5

joints covered by lots of muscel or subcut itssue (particulary hip) will not be red hot or swollen

those signs are more common in superfical joints

Question 6

how can presentation in septic arthitis differ

Answer 6

presentation may be more subtle- particulary in neonates
-only physical signs may be irritability and (more importatnly) pseudoparalysis

Question 7

fact about pesuoparalysis in a neonate 1

Answer 7

is the result of bone/joint sepsis until proven otherwise

Question 8

differentials for septic arthritis 2

Answer 8

transient synovitis

reactive arthritis

Question 9

how to differentiate transient synovitis and reactive arthritis from septic arthritis 4

Answer 9

pyrexia >38.5 within last week

inability to weight bear through that limb

raised ESR >40mm/h

WBC >12x10(9)/l

Question 10

management of septic arthritis 4

Answer 10

ABC- resusitaction if unwell

urgent aspiration (usually under GA) with immediate microscopy and gram stain, subsequenent culure and sensitivity

blood cultures- minimum of 2 (not always postiive)

High dose IV ABx

Question 11

classical presentation of osteomyelitits 3

Answer 11

acutely unwell child

pyrexia

local erythema and tenderness

Question 12

what often procedes a subacute presentation of osteomyelitis 1

Answer 12

recent varicella zoster infection
-common
-scratching typically introduced haematogenous spread of S. aureus)

Question 13

subacute presentation of osteomyelitis 4

Answer 13

point tenderness (often near metaphyses)

night pain

Limp

Remember- Fever may be absent

Question 14

management of osteomyelitis

Answer 14

blood culture

bone aspiration - if absecee is present

High dose IV ABx

Splintage of the limb

Question 15

Abx for septic arthritis 3

Answer 15

fluclos

vanc

gent if MRSA

Question 16

ABx for osteomyelitis 3

Answer 16

fluclox

metro

gent

Question 17

more insidious cause of septic arthritis and osteomyelitis 1

how to diagnose- 1

Answer 17

tuberculosis

quickly by PCR (cultures take over 6 weeks)

Question 18

most common cause of joint swelling in children

Answer 18

reactive arthitis

Question 19

overview of causes of reactive arhtitis

Answer 19

usually by an unidentified viral infection

short lived and self limiting illness
-if persists -> consider other causes

Question 20

what causes rheumatic fevere

Answer 20

streptococcal pyogenes infection

Question 21

symtpoms of rhuematic fever (overview) 4

Answer 21

carditis
arthritis
neuro features
rash

Question 22

neuroogical features in rhuematic fever

Answer 22

sydenham chorea
-rapid ivoluntary movements of the limbs, trunnk and facial muscles

Question 23

rash in rhuematic fever 1

Answer 23

erythema marginatum

Question 24

raised biochem in rheuamtic fevere 3

Answer 24

raised ESR

ASO titre
DNase B

Question 25

managemtn of reheumatic fever 4

Answer 25

antibiotics: oral penicillin V anti-inflammatories: NSAIDs are first-line treatment of any complications that develop e.g. heart failure -need life long penicillin prophylaxis

Question 26

how is rhuematic fever assocaited with joints

Answer 26

can cause reactive arhtitis

Question 27

symtpoms of HLA B27 assoacited reactive syndrome

Answer 27

reactive arthitis urethrisi conjunctivits ± plantar fascitis

Question 28

what else is HLA B27 associated reactive syndrome called

Answer 28

REiters syndrome

Question 29

what type of infections lead to HLA B27 associated reactive syndrome

Answer 29

post enteric or genitourinary infection -Yersinia -SHigella -Salmonella -E coli -STDs

Question 30

managemtn of reactive arthitis in HLA B27 associated reactive syndrome

Answer 30

self-limiting conditino once infection treated

Question 31

what else is transient synovitis of the hip called

Answer 31

irritable hip

Question 32

who gets transient synovitis of the hip

Answer 32

idiopathic disorder in children ,3-10yo -often preceded by infection

Question 33

presentation of transient synovitis of the hip 3

Answer 33

sudden or gradual onset of hip pain+ limp hip is held flexed and externally roated -pain can refer to knee

Question 34

biochem in transient synovitis of the hip

Answer 34

ESR and WCC are normal or mildly raised

Question 35

managment of transient synovitis of the hip 2

Answer 35

conservative -analgesi and allow child to rest until happy to weight bear -condition should resolve after one week -> if symptoms prolonged or recurrent-> may need to revist diagnosis

Question 36

overview of discitis

Answer 36

unclear if infective aetiiologu of the spine -usually self limiting and not associated w culture or organisms peak onset 1-3 years -child refuse to walk ± low grade fever diangosis can be confusion -should have well localised tendernes of spine -radiographs normal until alte indisase -MRI helpful -if in doubt-> ABx

Question 37

overview of juvenile idiopathic arthritis

Answer 37

childhood onset of chornic inflammatory arhtitis of unknown aeitology -no single diagnostic test and investigation aims to exclude other diagnoses

Question 38

esentatino of juvenile idiopathic arthritis

Answer 38

PERSISTENT joint swelling in one or more joints inflammatory featurtes of early morning stiffness and warmth clinical diagnosis w no diagnostic tests

Question 39

what occurs in 1/3 of juvenile idopathic arthirits

Answer 39

chornic anterior uveitis -leading cause of child blindness

Question 40

managemnt of chronic anterior uveitis 2

Answer 40

early referral for regular eye screening by slit lapm -screening by ophthalmologist -key to early diagnosis and preservation of vision

Question 41

types of connective tissue disease in children 4

Answer 41

systemic lupus erythematous (SLE) dermatomyositis scleroderma (particulary localised) Vasculitis

Question 42

two vascultic conditions more common in children than adults

Answer 42

Henoch Schonlein Purpura Kawasaki disae

Question 43

why is henoch schonlein purura important in children 1

Answer 43

because of the assocated renal disease

Question 44

why is kawasaki disease important

Answer 44

associagted mortality assocaited w coronary artery aneurysms -preventable with early diagnosis and treatment with IVIG

Question 45

key early features of kawasaki disease 10

Answer 45

high and persistent evere (>39.5) for 5 days rash red palms, soles and perineum Miserable ( v important sign reflecting aspectic menigeal irritatoin) mucositis non-purluent conjunctivits arthtis high platelet count lymphadenopthy high acute phase response

Question 46

late features of kawasaki disease 5

Answer 46

aneurysms peeling skin cardiac ischaemia myocardial infarctoin claudication- where other aneuryms have occured