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PAEDS MSK/DERM Flashcards

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1
Q

LIMP OVERVIEW
What is the main source of a limp?

A
  • Hip, then leg > knee > thigh > foot (least likely)
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2
Q

LIMP OVERVIEW
What are some differentials for limp in a child 0–3y?

A
  • Trauma like # (accidental or NAI)
  • Infections (septic arthritis, osteomyelitis)
  • DDH (chronic)
  • Malignancy (Ewing’s, osteogenic sarcoma)
  • Neuromuscular disease (CP, Duchenne’s)
  • ANY CHILD <3Y WITH LIMP NEEDS URGENT ASSESSMENT*
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3
Q

LIMP OVERVIEW
What are some differentials for limp in a child 4–10y?

A
  • Trauma, infection, malignancy
  • Transient synovitis (acute)
  • Perthe’s disease (P for primary school, chronic)
  • Juvenile idiopathic arthritis (chronic)
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4
Q

LIMP OVERVIEW
What are some differentials for limp in a child >10y?

A
  • Trauma, infection, malignancy
  • Slipped upper femoral epiphysis (S for secondary school, acute/chronic)
  • JIA
  • Reactive arthritis
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5
Q

LIMP OVERVIEW
What are some general investigations for a child presenting with limp?

A
  • Full Hx + exam (top>toe)
  • General obs (HR, BP, temp)
  • FBC (WCC), CRP/ESR, blood cultures if septic
  • XR both AP + lateral for joint (+ joints above/below)
  • USS joint to look for thickening of capsule or effusion
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6
Q

DDH
What is developmental dysplasia of the hip (DDH)?

A
  • Abnormal relationship of femoral head to the acetabulum leading to aberrant development of hip causing instability
  • Spectrum of dysplasia (underdevelopment), subluxation (partial dislocation) or frank dislocation of the hip
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7
Q

DDH
What are some risk factors for DDH?
How would you manage them?

A
  • female
  • First degree FHx,
  • breech at ≥36w or breech delivery ≥28w,
  • multiple pregnancy

– USS hip by 6w even if normal NIPE exam
- Other = F>M 6:1, oligohydramnios

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8
Q

DDH
What is the clinical presentation of DDH?

A

SYMPTOMS
- asymptomatic
- abnormal gait (unilateral toe walking or limp)
- leg length discrepancy

SIGNS
- positive ortolani test
- positive barlow test
- asymmetry of thigh or gluteal folds
- limited hip abduction

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9
Q

DDH
What is the main investigation for DDH and what are you looking for?

A

NIPE at 72h + 6–8w

  • Leg length discrepancy
  • Restricted hip abduction of affected side
  • Barlow + ortolani tests
  • Clunking of hips on tests
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10
Q

DDH
What are you assessing for when you look at leg length discrepancy?

A

Galeazzi/Allis sign = difference in knee length when hips flexed + feet flat on bed

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11
Q

DDH
After the NIPE, what would be the investigation of choice if positive?
What other investigation might you perform?

A
  • USS by 2w of age
  • XR may be useful in older infants >3m
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12
Q

DDH
What is the management of DDH?

A
  • If <6m = Pavlik harness to hold femoral head in position (flexed + abducted) to allow the hip socket (acetabulum) to develop normal shape (remove after 6-8w)
  • Surgical reduction if harness fails or Dx >6m = hip spica cast to immobilise hip for prolonged period after surgery (risk of avascular necrosis + re-dislocation)
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13
Q

PERTHE’S DISEASE
What is the pathophysiology of Perthe’s disease?

A
  • Disruption of blood flow to femoral head causing avascular necrosis of the bone
  • Affects the epiphysis of femur, which is bone distal to growth plate (physis)
  • Over time, revascularisation or neovascularisation + healing of the femoral head with remodelling of bone
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14
Q

PERTHE’S DISEASE
What are some risk factors for Perthe’s disease?

A
  • Social deprivation
  • LBW
  • Passive smoking
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15
Q

PERTHE’S DISEASE
What is the clinical presentation of Perthe’s disease?

A

SYMPTOMS
- limp (often painless but may flare)
- pain (uncommon, may affect hip, knee or buttock)

SIGNS
- limited ROM (particularly hip flexion)
- short stature
- muscle wasting (gluteal muscles and quads)
- positive trendelenburgs sign (pelvis drops toward unsupported side during unilateral weight bearing)

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16
Q

PERTHE’S DISEASE
What are the investigations for Perthe’s disease?

A

-1st line = XR of both hips (with frog views) is initial investigation + assesses healing

to consider:
- FBC
- CRP
- ESR
- bone scintigraphy
- MRI hips

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17
Q

PERTHE’S DISEASE
what is the classifications system?

A

Catterall classification

defines severity based on epiphyseal involvement on AP and lateral x-rays

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18
Q

PERTHE’S DISEASE
What are the complications of Perthe’s disease?

A
  • Premature fusion of the growth plates
  • Soft + deformed femoral head can lead to early hip OA
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19
Q

PERTHE’S DISEASE
What is the general management of Perthe’s disease?

A
  • Keep femoral head within acetabulum (cast, braces)
  • Physio to retain ROM in muscles + joints without excess stress on the bone
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20
Q

PERTHE’S DISEASE
What is the management of Perthe’s disease for…

i) <6y + less severe?
ii) older, severe or not healing?

A

i) Conservative + observe, bed rest, traction, crutches, analgesia (good prognosis)
ii) Surgery to improve alignment + function of the femoral head + hip

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21
Q

JIA
What is juvenile idiopathic arthritis (JIA)?

A
  • Autoimmune inflammation in joints > joint pain, swelling + stiffness
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22
Q

JIA
What is the criteria for a clinical diagnosis of JIA?

A
  • Onset before 16y with no underlying cause
  • Joint swelling/stiffness
  • > 6w in duration to exclude other causes (i.e. reactive)
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23
Q

JIA
What is the clinical presentation of JIA?

A

SYMPTOMS
- joint pain
- joint stiffness (in the morning)
- fatigue
- fever (systemic JIA only)

SIGNS
- joint swelling
- joint warmth
- limited range of movement in affected joints
- limping (if lower limbs affected)
- salmon-pink rash (systemic JIA onlY)

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24
Q

JIA
What are the 4 types of JIA?

A
  • Systemic JIA (Still’s disease)
  • Polyarticular JIA
  • Oligoarticular JIA
  • Enthesitis-related arthritis
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25
JIA How does systemic JIA (Still's disease) present?
- Subtle salmon-pink rash - High swinging fevers - Lymphadenopathy, weight loss, muscle pain, splenomegaly - Pleuritis, pericarditis + uveitis
26
JIA What are the investigations for systemic JIA?
- ESR/CRP = may be elevated - rheumatoid factor - HLA-B27 = associated with enthesitis-related + psoriatic arthritis - joint x-ray - joint USS to consider - joint MRI
27
JIA What is the main complication of systemic JIA?
- Macrophage activation syndrome = severe activation of immune system with massive inflammatory response
28
JIA What is polyarticular JIA?
- ≥5 joints affected, equivalent of RA in adults
29
JIA What is oligoarticular JIA?
≤4 joints affected, often just monoarthritis
30
JIA What is oligoarticular JIA classically associated with?
Anterior uveitis = ophthalmologist referral
31
JIA What is enthesitis-relataed arthritis?
- Paeds version of seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic/reactive arthritis, IBD-related arthritis)
32
JIA How might enthesitis-related arthritis present?
- Sx of psoriasis (psoriatic plaques, nail pitting, dactylitis) or IBD
33
JIA What is reactive arthritis?
- Arthritis that develops following an infection where the organism cannot be recovered from the joint
34
JIA How does reactive arthritis present?
- Reiter's = can't see (conjunctivitis), can't pee (urethritis) and can't climb a tree (arthritis)
35
JIA What are the XR features of JIA?
Same as RA (LESS) – - Loss of joint space - Erosions (causing joint deformity) - Soft tissue swelling - Soft bones (osteopenia)
36
JIA What are some complications from JIA?
- Chronic anterior uveitis > severe visual impairment - Flexion contractures of joints - Growth failure + constitutional problems like delayed puberty - Osteoporosis
37
JIA What is the non-medical management of JIA?
- MDT approach = education, psychologist, physio, pain team, rheumatology
38
JIA What is the medical management of JIA?
1st line - intra-articular corticosteroids - IV corticosteroids (for short term control of severe symptoms) - methotrexate - NSAIDs (to reduce pain + inflammation) - physiotherapy + occupational therapy 2nd line - etanercept - anakinra - tocilizumab
39
TRANSIENT SYNOVITIS What is transient synovitis?
- 'Irritable hip' caused by transient inflammation of the joint synovial membrane
40
TRANSIENT SYNOVITIS What is the clinical presentation of transient synovitis?
SYMPTOMS - hip pain - knee pain (referred pain from hip) - limping - joint stiffness SIGNS - joint tenderness - limited range of motion in hip - antalgic gait
41
TRANSIENT SYNOVITIS What are some investigations for transient synovitis?
- #1 = exclude septic arthritis so if suspect = cultures + joint aspiration - Normal WCC, slight increase in CRP - USS may show effusion but XR normal
42
TRANSIENT SYNOVITIS What is the management of transient synovitis?
- Self-limiting with only simple analgesia + rest = rapid Sx improvement - Manage at home with safety netting + review to ensure no fever + Sx resolving - analgesia = ibuprofen +/- paracetamol
43
SUFE/SCFE What is slipped upper/capital femoral epiphysis? (SUFE/SCFE)?
- Displacement of femoral head epiphysis postero-inferiorly along the growth plate (through zone of hypertrophy)
44
SUFE/SCFE What is SUFE/SCFE associated with?
- Boys, >10y, obese + undergoing growth spurt - Metabolic endocrine abnormalities (hypothyroid)
45
SUFE/SCFE What is the clinical presentation of SUFE/SCFE?
SYMPTOMS - unilateral pain in groin, hip, thigh and/or knee - limp (acute or chronic) - bilateral pains in the groin, hip, thigh or knee SIGNS - restricted flexion, abduction and internal rotation of hip joint - antalgic gait
46
SUFE/SCFE What are the investigations for SUFE/SCFE?
- XR initial Ix of choice (AP + frog-leg views) - Bloods (incl. inflammatory markers) normal - ?Technetium bone scan + MRI scan
47
SUFE/SCFE What is the management of SUFE/SCFE?
- Surgery = internal fixation (pinning femoral head into position for prevention)
48
GROWING PAINS What are growing pains?
Diagnosis by exclusion – - Pain never present at start of day after waking but can awaken from sleep - Physical activities are not limited, no limp, settles with massage - Bilateral pain in lower limbs (shins/ankles) + not limited to joints - Can be worse after a day of vigorous activity + intermittent
49
OSTEOGENESIS IMPERFECTA What is osteogenesis imperfecta?
- Autosomal dominant condition leading to brittle bones + prone to fractures
50
OSTEOGENESIS IMPERFECTA What is the clinical presentation of osteogenesis imperfecta?
- Bone fragility = recurrent + inappropriate #, joint + bone pain - Bone deformity (bowed legs, bent bones, scoliosis) - blue/grey sclera - Impaired mobility due to poor muscle mass - Poor growth > short stature - Hypermobility as ligamentous laxity - triangular face - deafness from early adulthood - dental problems
51
OSTEOGENESIS IMPERFECTA What are some associations with osteogenesis imperfecta?
- Conductive hearing loss (otosclerosis) - Blue/grey tinted sclera due to scleral thinness - Valvular prolapse, aortic dissection > aortic incompetence - Hernias - 'Wormian bones' = skull feels like bubble wrap (wiggly black lines on skull XR)
52
OSTEOGENESIS IMPERFECTA What are the investigations for osteogenesis imperfecta?
- Clinical Dx with XR to diagnose fractures + bone deformities - DEXA scan to look at bone mineral density (osteoporosis) - 7 types under the sillence classification
53
OSTEOGENESIS IMPERFECTA In the Sillence classification, what is... i) type 1? ii) type 2? iii) types 3–4?
i) Mildest form, common with blue sclera ii) Lethal form, chest too small to allow breathing, lots of rib # + lungs do not function iii) Normal sclera
54
OSTEOGENESIS IMPERFECTA What is the MDT management of osteogenesis imperfecta?
- Physio + OT to maximise strength + function - Paeds for medical treatment + follow up - Orthopaedic surgeons to manage # - Pain team, specialist nurses for advice + support
55
OSTEOGENESIS IMPERFECTA What is the medical management of osteogenesis imperfecta?
- Vitamin D supplementation to prevent deficiency - Bisphosphonates (IV pamidronate) to increase bone density + reduce #
56
RICKETS What is rickets? What is it caused by?
- Defective bone mineralisation > "soft" + deformed bones (paeds osteomalacia) - Vitamin D deficiency (recommended paeds intake 400IU = 10mg)
57
RICKETS what are the causes?
vitamin D deficiency - nutritional rickets (inadequate intake) - hypophosphataemic rickets (due to renal phosphate wasting) - calcipaenic rickets = abnormal vitamin D metabolism or resistance
58
RICKETS What are some risk factors for rickets?
- Darker skin (need more sunlight) - Lack of exposure to sun - Poor diet or malabsorption - exclusive breastfeeding without vitamin D supplementation - CKD as kidneys metabolise vitamin D to active form
59
RICKETS What is the normal physiology of vitamin D?
- Increases Ca2+ absorption at gut + reabsorption at kidneys + role in immunity
60
RICKETS What happens when there is inadequate vitamin D?
- Lack of Ca2+ + phosphate in blood which are required for bone construction > defective bone mineralisation - Low Ca2+ causes secondary hypoparathyroidism as parathyroid gland tries to raise Ca2+ level by secreting parathyroid hormone - This leads to increased resorption of Ca2+ from the bones, worsening the issue
61
RICKETS What are the symptoms of rickets?
SYMPTOMS - pain in bones or joints - muscle weakness - drowsiness - delayed walking - frequent pathological fractures SIGNS - bowing of legs - rachitic rosary (row of bead-like prominences at junction of rib + cartilage) - reduced muscle tone - widened wrist joints - harrison's groove (indentation on the chest roughly along 6th rib)
62
RICKETS What are some bone deformities seen in rickets?
- Bowing of legs, knock knees - Harrison sulcus = indentation of softened lower ribcage at site of attachment of diaphragm - Rachitic rosary = ends of ribs expand at costochondral junctions causing lumps along chest - Craniotabes = soft skull with delayed closure of sutures + frontal bossing - Expansion of metaphyses (esp. wrist)
63
RICKETS What are some investigations for rickets?
- serum calcium - serum phosphate - serum ALP - serum 25-hydroxyvitamin D - serum PTH - x-rays and bone density scan - urinalysis
64
RICKETS What would serum biochemistry show in rickets?
- Low = calcium + phosphate - High = ALP + PTH - 25-hydroxyvitamin D levels deficient (<25nmol/L)
65
RICKETS What might an XR show in rickets?
- Osteopenia (radiolucent bones) - Cupping - Fraying of metaphyses - Widened epiphyseal plate
66
RICKETS What is the management of rickets?
Prevention - Breastfeeding women should take vitamin D supplement 1st line management - vitamin D supplementation (1000-2000U daily) - calcium supplementation - phosphate supplementation 2nd line - UVB light exposure - orthopaedic intervention
67
COMMON BIRTHMARKS What is a salmon patch?
- 'Stork mark' - Most common vascular birthmark - Flat red or pink patches on baby's eyelids, neck or forehead at birth - Fade completely in few months
68
COMMON BIRTHMARKS What is a cavernous haemangioma?
- 'Strawberry mark' - Raised marks on skin often red, F>M - Not present at birth, appear in first month, increase in size then shrink + disappear - Normally self-limiting, beware over eye + airway
69
COMMON BIRTHMARKS What is a capillary haemangioma?
- 'Port wine stain' = permanent, often unilateral - Present at birth + grows with infant, treated with laser therapy - Seen in Sturge-Weber syndrome (neuro Sx)
70
COMMON BIRTHMARKS What is a naevi?
- Mole, can be multiple present in Turner's
71
COMMON BIRTHMARKS What are café-au-lait spots? What is the significance?
- Flat, light brown patches on skin - >5 = neurofibromatosis
72
COMMON BIRTHMARKS What are milia?
Milk spots (sebaceous plugs where sweat glands plugged by sebum), normal
73
NAPPY RASH What are the 2 main types of nappy rash?
- Irritant dermatitis = friction between skin/nappy + contact with urine + faeces - Candida dermatitis = due to breakdown in skin + the warm, moist environment
74
NAPPY RASH How do you differentiate between irritant dermatitis and candida dermatitis?
- Irritant = sore, red, inflamed skin but spares the skin creases - Candida = involves skin creases, satellite lesions (small similar lesions near edges of principle lesion) + may have oral thrush
75
NAPPY RASH What are some risk factors for developing nappy rash?
- Delayed changing of nappies - Diarrhoea - Irritant soap products + vigorous cleaning - PO Abx predispose to Candida
76
NAPPY RASH What is the management of nappy rash?
- Highly absorbent nappies - Maximise time not wearing + ensure dry before replacing nappy - Change nappy + clean skin ASAP - Water or gentle alcohol-free products to clean - Topical imidazole if candida
77
STEVEN-JOHNSON What is Steven-Johnson syndrome? What versions are there?
- Disproportional immune response causes epidermal necrosis > blistering + shedding of top layer of skin - SJS = <10% body surface, toxic epidermal necrolysis affects >10%
78
STEVEN-JOHNSON What are some potential causes of Steven-Johnson syndrome?
- Meds = AEDs, Abx, allopurinol, NSAIDs - Infections = herpes simplex, mycoplasma pneumonia, CMV, HIV
79
STEVEN-JOHNSON What is the clinical presentation of Steven-Johnson syndrome?
SYMPTOMS - fever and malaise - sore throat and eyes SIGNS - erythematous or purpuric macules, rapidly evolving to widespread blistering + desquamation - mucosal involvement - Nikolsky sign (when lateral pressure is applied, epidermis separates resulting in blisters + erosions) - pyrexia - tachycardia
80
STEVEN-JOHNSON What are some complications of Steven-Johnson syndrome?
- Secondary infection - Permanent skin damage due to skin involvement + scarring - Visual complications such as severe scarring or even blindness
81
STEVEN-JOHNSON what are the investigations?
- skin biopsy = full thickness epidermal keratinocyte necrosis + minimal dermal inflammation - serum granulysin = elevated to consider - FBC, CRP and blood cultures (to exclude staph scalded skin syndrome) - U&Es (look for dehydration + AKI)
82
STEVEN-JOHNSON What is the management of Steven-Johnson syndrome?
1ST LINE - withdrawal of causative agent - hospital admission - supportive care (IV fluids, temp regulation, wound care + nutritional support) - analgesia - eye care - mouth care - IV immunoglobin 2ND LINE - immunosupressants (ciclosporin or cyclophosphamide) - systemic corticosteroids - plasmapheresis
83
DISCOID MENISCUS what is it?
- it is an abnormally shaped meniscus (usually lateral) - it usually presents in younger people - it is more prone to injury as it is more likely to get stuck/tear
84
DISCOID MENISCUS how does it present?
- a visible or audible snap on terminal leg extension along with pain and swelling in the absence of trauma
85
DISCOID MENISCUS what are the investigations?
- MRI - can show abnormal shape and any tears - clinical examination
86
DISCOID MENISCUS what is the management?
- symptomatic = arthroscopic partial meniscectomy - asymptomatic = physiotherapy
87
SCOLIOSIS what is it?
it is lateral curvature in the frontal plane of the spine - measured >10 degrees on x-ray
88
SCOLIOSIS what are the causes?
- idiopathic = most common - congenital = usually from congenital structural defect of the spine e.g. spina bifida - secondary = neuromuscular imbalance (cerebral palsy, muscular dystrophy), disorders of bone or connective tissues
89
SCOLIOSIS what is the clinical presentation?
- visible curve in spine - shoulders, waist or hips look uneven - one shoulder blade appears bigger - ribs stick out further on one side - low back pain - back stiffness - pain + numbness in legs - fatigue (due to muscle strain)
90
SCOLIOSIS what conditions can cause scoliosis?
cerebral palsy muscular dystrophy birth defects infections tumours marfan syndrome down syndrome
91
SCOLIOSIS what is the management?
- braces - spinal fusion surgery - spine and rib-based growing operation
92
TORTICOLLIS what is it?
- tilting of the head to one side caused by contraction of the neck muscles
93
TORTICOLLIS what are the different types?
- congenital - acquired
94
TORTICOLLIS what are the causes of congenital torticollis?
- congenital muscular torticollis (CMT) = usually noticed in 1st month after birth. It causes shortening + fibrosis of sternocleidomastoid (can have palpable mass) - malformed cervical spine - spina bifida
95
TORTICOLLIS what are the causes of acquired torticollis?
- MSK = muscle spasm - infection = URTI, otitis media, dental infection, pharyngeal infection - atlantoaxial rotatory fixation - inflammation = juvenile idiopathic arthritis - neoplasm = CNS tumours
96
TORTICOLLIS how does it present?
- awkward head posture for a prolonged time
97
TORTICOLLIS what are the investigations?
most of the time it is a clinical diagnosis - cervical spine x-ray can be useful
98
TORTICOLLIS what is the management?
treat the cause - muscle spasm = self resolve - infection = antibiotics - Congenital = physiotherapy
99
OSGOOD SCHLATTERS what is it?
it is an overuse injury that is common in skeletally immature athletic young people it occurs secondary to repetitive activities such as jumping, sprinting etc.
100
OSGOOD SCHLATTERS when does it usually develop?
during the stage of bone maturation 10-12 in girls 12-14 in boys
101
OSGOOD SCHLATTERS what is the cause?
repeated traction over the tibial tubercle which results in microvascular tears, fractures and inflammation
102
OSGOOD SCHLATTERS what are the risk factors?
- male gender - age - 12-15 in boys, 8-12 in girls - sudden skeletal growth - repetitive activities such as jumping and sprinting
103
OSGOOD SCHLATTERS what is the clinical examination?
- anterior knee pain with or without swelling - pain aggravated by physical activity
104
OSGOOD SCHLATTERS what are the investigations?
clinical diagnosis
105
OSGOOD SCHLATTERS what is the management?
- conservative treatment - RICE - surgical treatment in severe cases once the child has fully grown - physiotherapy
106
LIMP OVERVIEW What are important differentials?
Intra-abdominal pathology like hernia, testicular torsion
107
DDH What are you assessing for when you look at barlow test?
Posterior hip dislocation (adduct hips + press down on knees)
108
DDH What are you assessing for when you look at ortolani test?
Relocate a dislocated femoral head (abduct + push thigh anteriorly)
109
SEPTIC ARTHRITIS Who is it commonly seen in and how?
- Most common <2y, - usually from haematogenous + soft tissue swelling
110
SEPTIC ARTHRITIS What are common causes in... i) infants? ii) <4y? iii) >4y?
i) GBS, S. aureus, coliforms ii) S. aureus, pneumococcus, haemophilus iii) S. aureus, gonococcus (adolescents)
111
SEPTIC ARTHRITIS what is the criteria for diagnosing septic arthritis?
Kocher's modified criteria /5, ≥3 is likely –Temp>38.5 – Raised CRP/ESR/WCC – Non-weight bearing
112
OSTEOMYELITIS What are the two different types?
- Acute = rapid presentation with acutely unwell child - Chronic = deep seated, slow growing infection + Sx
113
OSTEOMYELITIS What is the epidemiology?
M>F, <10y
114
OSTEOMYELITIS What are some risk factors?
- Open #, - orthopaedic surgery, - sickle cell anaemia (Salmonella predominates), - immunocompromised (HIV),
115
JIA What are the features of polyarticular JIA?
Symmetrical, affects small joints (of hand + feet) as well as large joints (hips + knees)
116
JIA How does polyarticular JIA present?
Mild systemic Sx = mild fever, anaemia + reduced growth
117
JIA What is the immunology of polyarticular JIA?
If rheumatoid factor +ve = seropositive (tend to be older children)
118
JIA what is the immunology of oligoarticular JIA?
ANA +ve but RF -ve
119
JIA What is the main feature?
Enthesitis = inflammation at the point a tendon or muscle inserts to bone
120
JIA What is it associated with?
- HLA-B27 gene - Prone to anterior uveitis = ophthalmology referral
121
JIA What causes reactive arthritis?
Post STI (chlamydia) in older children or Salmonella, Campylobacter
122
JIA What is the general management?
Sx (analgesia, NSAIDs, sometimes intra-articular steroids)
123
TRANSIENT SYNOVITIS What is it associated with?
Recent viral URTI, small % will develop Perthe's
124
OSTEOPOROSIS How would you investigate?
- Bone mineral density less than 2.5 standard deviations below the mean - DEXA scan
125
OSTEOGENESIS IMPERFECTA What is the pathophysiology?
Defects in type 1 collagen protein which is essential for the structure + function of bone, as well as skin, tendons + other connective tissues
126
RICKETS What are some sources of vitamin D?
Sunlight, fortified cereals, eggs, oily fish
127
COMMON BIRTHMARKS What is a slate grey naevi? What are the differentials for slate grey naevi?
- Mole, can be multiple present in Turner's - 'Mongolian blue spot', disappear by 4, commonly lower back/buttocks, more common in non-Caucasian - Bruising + NAI so important to document
128
COMMON BIRTHMARKS What are infantile urticaria?
Erythema toxicum neonatorum by histamine reaction = self-limiting red blotches with eosinophils on biopsy
129
STEVEN-JOHNSON Where does it affect?
- Non-specific Sx of fever, cough, sore throat + itchy skin - Develop purple/red rash that spreads across skin, starts to blister - Few days later skin sheds leaving raw tissue underneath = PAINFUL - Can involve lips + mucous membranes, urinary tract, lungs - Eyes can become inflamed + ulcerated
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JIA How does macrophage activation syndrome present?
- Acutely unwell with DIC, - febrile, - anaemia, - thrombocytopenia, - bleeding, - non-blanching rash, - low ESR
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JIA What is the management of macrophage activation syndrome?
Life-threatening = supportive + steroids

MY REVISION - ALL PHASES (36 decks)

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