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65 Cards in this Set

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What is the adult equivalent of juvenile idiopathic arthritis?
RA
What is the incidence of arthritis in children?
2.2/1000
How is juvenile idiopathic arthritis classified?
-Onset at age <16
-Duration >=6 weeks
-Exclusion of other arthritis
What is the diagnostic test for juvenile idiopathic arthritis?
NONE
What are 2 features of osteomyelitis and what investigations are/are not helpful?
Fever and pin point bone tenderness

X-rays normal early, bone scan or MRI helpful
What are the featuresof parvovirus arthritis?
-Painful, swollen joints of feet and hands
-Bright red "slapped cheeks"
-Adolescence

Rash and arthritis due to immunological rxn, not infection itself
What are the features of acute rheumatic fever?
-2 weeks after Gp A strep (sore throat and fever)
-Can get arthritis without carditis
-Responds well to NSAIDs
-Major disease: Subcut nodules Pancarditis Arthritis Chorea Erythema marginatum
What are the features of post-infectious/reactive arthritis?
-Arthritis 1-3 weeks after infection at another site
-Joint fluid sterile
-Gp A strep or enteric (e.g. Salmonella)
What are the features of acute rheumatic fever?
-2 weeks after sore throat and fever (gp A strep)
-Can get arthritis without anyother features
SPACE
-Subcut nodules
-Pancarditis
-Arthritis
-Chorea
-Erythema marginatum

-Responds well to NSAIDs
Which malignancies can have arthritis as a component?
Systemic: leukaemia, lymphoma and neuroblastoma

Local: osteoid osteoma, eosinophillic granuloma, sarcoma
What symptoms would make you think of malignancy?
-Fever, weight loss
-Pain >> physical findings
-Night pain
-Hepatosplenomegaly
-Lymphadenopathy
-Anaemia
-Metaphyseal lucency
What are some paediatric overuse syndromes?
Little leaguer's elbow, swimmer's shoulder, avascular necrosis of the femoral head, slipped capital femoral epiphysis
What is hip pain usually in ages 2-6?
Transient synovitis
-May follow viral infection
-Benign course
-Normal x-ray
-Slight effusion on u/s
What is hip pain usually in ages 4-10?
Legg-Perthe's
-Avascular necrosis of the femoral head
-More common in boys
-Decreased ROM (red flag)
-X-ray: sclerosis, loss of height in femoral head
What is hip pain usually in ages 10-14?
Slipped capital femoral epiphysis
-Older boys, obese
-Stand with leg slightly externally rotated
-Fracture through growth plate
What are the features of growing pains?
-No relation to growth
-Age 3-10
-Usually limited to calf, thigh, shins
-Occurs at night (fine next morning)
-Normal physical exam and tests
What are the types of JIA and what proportions of patients are in each?
- Systemic arthritis (e.g. Still's disease): 10%
- Oligoarticular arthritis (<4 joints) 50%
- Polyarthritis (>4 joints) 30%
- Enthesitis related
- Psoriatic arthritis
- Unclassified
What are the features of systemic JIA?
M=F
- Fever (spikes irregularly but returns to normal between spikes)
- Rash (salmon pink that comes and goes)
- Arthritis
- Hepatosplenomegaly
- Lymphadenopathy
- Serositis (pericarditis)
- Anaemia, high ESR, CRP, platelets
What are the features of oligoarticular JIA?
- Age < 5 years
- Girls > boys
- Large joints (knee most common)
- ANA =ve in 80%
What are the complications associated with oligoarticular JIA?
- Knee flexion contracture
- Quadriceps atrophy
- Leg-length discrepancy
- Uveitis (in 20%, ass'd with +ve ANA, assymptomatic but if untreated blindness in 2-3%. Does not parallel disease course so screen every 3-4 months)
What are the features of RF-negative polyarticular JIA?
- Young girls > boys
- Small and large joints, neck, TMJs
- Uveitis in 10%
- Cervical spine arthritis
- Growth disturbance (small jaw)
What are the features of RF-positive polyarticular JIA?
- Older girls
- Symmetrical large and small joint arthritis
- Rheumatoid nodules over pressure points in 30%
- ANA may be +ve
What are the features on seronegative spondyloarthropathies?
- Older boys >> girls
- PHx
- Peripheral and axial arthritis
- Absent ANA and RF
- HLA B27 +ve
- Enthesitis
What is the histologic diagnosis of Henoch-Schonlein purpura?
Leukocytoclastic vasculitis
What is Henoch-Schonlein purpura?
- Small vessel vasculitis
- Affects skin, joints, GI tract, kidneys
- Acute morbidity from GI complications (bleeding, intusseception)
- Chronic morbidity related to end-stage renal disease
- Can get acute scrotum, penis and abdomen
What are the classification criteria for Henoch-Schonlein purpura?
Must have 2/4 of:
- Palpable purpura
- Age <20 at onset
- Bowel angina (after meals)
- Granulocytes in walls of arterioles or venules on biopsy
What are the features of juvenile dermatomyositis?
- Not related to malignancy
- Bright signal on MRI
- Muscle weakness
- Dilated capillary loops at the base of the fingernails
- Gottren's papules (on knuckles)
What are the features of localised scleroderma?
- Bands of thickened skin that run down a limb
- Can cause significant limitation of motion
- Patches on skin
What are the features of SLE?
- Butterfly rash on nasolabial folds
- Palatial ulceration
- +/- vasculitis (immune deposits)
- weight loss, night sweats, lethargy common
What is the epidemiology of SLE?
- 20% of all cases commence at age <18 years
- Commoner in blacks, hispanics and asians
- F:M 4.5:1
What is the 6 step asthma management plan?
1. Assess severity
2. Achieve best lung function
3. Maintain best lung function (triggers)
4. Maintain best lung function (meds)
5. Develop an asthma action plan
6. Educate and review
What are the features of mild, moderate and severe asthma?
Pulse
- Mild <100
- Moderate 100-200
- Severe >200
SaO2
- Mild >94%
- Moderate 90-94%
- Severe <90%

Central syanosis in severe only
What is Ipratropium (atrovent)?
An anticholinergic drug. It blocks the muscarinic cholinergic receptors in the smooth muscles of the bronchi in the lungs
Failing salbutamol and itrapropium, what are the next steps in acute asthma management?
- IV bolus or infusion of salbutamol
- Magnesium sulphate bolus (a smooth muscle relaxant)
- Aminophylline (loading and infusion) rarely used
- Anaesthetic agents and muscle relaxants
- CPAP
- Intubation and ventillation
How is acute asthma therapy reduced?
- "stretch" ventolin
- Wean O2
What is described in a reducing medication plan?
- Covers 3-5 days
- # of puffs and frequency of reliever
- Oral steroid doses (mls)
- Time until reviewed by GP
What are the different intervals of paediatric asthma (early morning/night cough, missing school, exercise symptoms)?
- Infrequent intermittant (75%)
- Frequent intermittant (20%)
- Persistent (mild, mod, severe) 5%
At what mental age can spirometry be performed?
4-6 years
What are some questions to ask in the assessment of asthma severity?
- How often is sleep disturbed due to asthma?
- Is reliever used on waking?
- Does asthma limit exercise?
- How often in reliever used?
- How long does the reliever last?
- How much school has your chils missed due to asthma?
What investigations should be done for asthma?
- Spirometry if old enough
- Possibly skin prick testing
- Chest x-ray possibly if 1st presentation
What is contained in an asthma action plan?
- Regular use of preventer
- How to increase reliever in response to symptoms
- How to access medical care

Evidence: improved adherence, decreased hospitalisation
What is the commonest cause of death and disability in the paediatric population?
Trauma. Blunt injury commonly.
Falls and sporting injuries are commonest followed by MVAs
Home is the commonest place of injury
What has brought about the decreased deaths from trauma?
Prevention
What is different about children in trauma?
- Relatively bigger heads and organs
- Bones pliable (intrathoracic injury without fracture)
- Refuse to communicate when injured
- Small child: abdo injury in MVA
- Non-compliance and peer pressure re: safety devices
What are the airway considerations in a traumatised child?
- Big occiput (put blanket under shoulders to avoid flexing head, or used paeds spinal board)
- Short neck
- Loose soft tissue swells a lot when burned
- Short trachea (tube often inserted too far)
- Crico-thyroidotomy difficult due to small membrane (if no other options use a needle and high pressure O2 but only works for 15min due to hypercarbia)
What do you need to consider in the breathing of a traumatised child?
- Child's chest wall is thinner: difficult to localise added sounds
- Ribs more horizontal in younger children (less chest expansion)
- Crying: air filled stomach pushes up on diaphragm
- Infant RR 40-60/min
- Tidal volume 7-10mL/kg
What do you need to consider in the circulation of a traumatised child?
- Early signs of shock when ~1/4 blood loss (tachycardia)
- Shock can mimic head injury
- Pulse pressure initially narrows, then widens late
- Hypotension = 45% loss of volume
What Rx do you give when a child is tachcardic after trauma?
- Give bolus of 20mL/kg
- Don't overresuscitate in penetrating injury
- Start with normal saline or Hartmann's
- Give 3 x crystalloid then blood
- Remember BSL in infants
What are the circulatory parameters in a child?
- Blood volume 80mL/kg
- Systolic BP = 80 + 2x age in years
- Diastolic = 2/3 x systolic
What are the disability considerations in traumatised children?
- Difficult to assess in children
- AVPU used (if P, GCS = 9)
- Children have thin cranial bones
What does the secondary survey comprise of in traumatised children?
- Head to foot exam
- AMPLE Hx (allergies, medications, past MHx, last meal, events surrounding)
- Imaging (additional apart from trauma series)
- Consider transfer early
What is a Chance fracture?
- Flexion fracture of the spine
- Usually T12-L2
- Check for hollow viscus injury if present
What should be considered in abdo trauma in children?
- Usually blunt
- Children have thin abdo wall and an abdominal bladder
- FAST: fluid +stable = CT, fluid + unstable = surgery
- Spare spleen if stable
- Handlebar injuries surprisingly serious (and seatbelt)
What should be considered in head trauma in children
- Commonest cause of death
- Maintain ABCs: most important in preventing secondary injury
What should be considered in chest trauma in children?
- Uncommon
- Most invasive Rx is likely to be a chest train
- Consider lung contusion in the absence of fracture
What is the epidemiology of acute respiratory infections?
- 50% of all illnesess in age <5
- 30% in 5-12
- 95% of these URTIs
- LRTI: early life and boys
What are some URTIs children can get?
- Colds/coryza
- Pharyngitis
- Tonsillitis
- Otitis media
- Sinusitis
What are some LRTIs children can get?
- Laryngo tracheobronchitis
- Epiglottitis
- Acute bronchitis
- Acute bronchiolitis
- Pneumonia
What are the viral aetiologies of ARIs in children?
- 90%
- Rhinovirus
- Respiratory syncitial virus
- Parainfluenza types 1, 2 & 3
- Influenza types a & b
- Adenovirus
- Metapneumovirus
What are the bacterial aetiologies of ARIs in children?
- 10%
- Beta-haemolytic streptococcus
- Streptococcus pneumoniae
- Haemophillus influenzae
- Staphlococcus aureus
- Mycoplasma pneumoniae, Chlamydia, pneumoniae, Leigonella
What are the red flags for resuscitation in children?
- Purpuric rash
- Bulging fontanelle
- Biphasic stridor
- High-pitched scream
- Bile-stained vomit
- Persistent tachycardia
- Grunting respiration
What is the ABCD of recognising serious illness early in children?
A: airway, alertness, activity
B: breathing difficulty
C: circulatory impairment
D: daily fluid balance (input & output)
What id decorticate posturing and where is the lesion?
- Flexing of arms and wrists
- Suggests lesion is above the brainstem
What id decerebrate posturing and where is the lesion?
- Extension at elbows and flexion at wrists
- Suggests midbrain or pontine lesion
What are the signs of increased effort of breathing?
- Grunting
- Audible inspiratory/expiratory noises
- Nasal flare
- Recession
- Accessory muscle use
- Respiratory rate
- Head bobbing