Peds E3 -Topic list

What is Scoliosis?

Lateral curvature of the spine that is usually accompanied by rotation

What referral is necessary if pt is having pain with scoliosis?

Neuro- scoliosis should be painless!

How does Scoliosis present?

Asymmetry of the posterior chest wall on forward bending

What region of the spine is most commonly affected in scoliosis?

Right thoracic curve

Is idiopathic scoliosis more common in females or males?

Females

What demographic is Idiopathic scoliosis MC seen in?

Adolescent (11+ yo)

What is the MC brace used to treat idiopathic scoliosis?

Boston brace

When do you refer Scoliosis for surgery?

> 40 degree of curvature

What causes congenital Scoliosis?

hemivertebrae, congenital fusion, or combo

What other organ abnormality may be seen in pts with congenital scoliosis?

Unilateral renal agenesis

What do you need to do on your PE when assessing for Scoliosis?

examine for iliac crest symmetry/obliquity and Adams Forward Bend test

When do your refer pts w/ Scoliosis to ortho?

skeletally immature w/ curve of > 20 degrees

*mature > 40

When is bracing for Scoliosis needed?

20-40 degree curvature in skeletally immature

What is Spondylolysis?

defect of the pars interarticularis without forward slippage of the involved vertebra on to the one below

What is Spondylolisthesis?

Forward slippage or displacement of the involved vertebrae

What is Scheuermann disease?

adolescence kyphosis -cannot correct in standing or prone

What is seen on XR of Scheuermann disease?

Schmorl nodes, narrow disc space, loss of ht, wedging

What is Nursemaid's elbow?

Annular/circular ligament that passes around the base of the radial head and partially slips off with the traction across the elbow

What causes Nursemaid’s elbow?

initiated by a jerk when child falls or when being swung by the arms

How does Nursemaid’s elbow present?

Elbow bent and hand is pronated; child refuses to use hand or cries when the elbow is moved

What is the tx technique for nursemaid's elbow?

Hyperpronate the arm by moving the hand in palm-down position with pressure over the radial head

(can also flex + supinate)

Salter Harris fx:

Epiphyseal separation through the physis

Type I

Salter Harris fx:

Fx through a portion of the physis but exiting across the metaphysis

Type II

Salter Harris fx:

Fx through the physis but exiting across the epiphysis into the joint

Type III

Salter Harris fx:

Fx line extending across the metaphysis, physis, and epiphysis

Type IV

Salter Harris fx:

Crush injury to the physis

Type V

What is the single greatest risk factor for hip dysplasia?

Breech position in 3rd trimester

What is SCFE?

Displacement of the femoral head from the femoral neck through the epiphyseal plate

How does SCFE present?

Painful limp without trauma; hip, thigh, knee pain; M > F, obesity, pubertal onset

What does PE of SCFE reveal?

LE externally rotated w/ limited ROM, antalgic gait w/ abductor lurch gait

What does an XR of SCFE show?

widened and radiolucent physis, frank deformity/displaced femoral head

What is Legg-Calve-Perthes disease?

Impairment of blood supply to the developing femoral head resulting in AVN

How does Legg-Calve-Perthes disease present?

Painless limp, + Trendelenburg sign, flexion contracture of affected hip; 4-11 yo males; insidious onset, unilateral involvement

What is the tx for Legg-Calve-Perthes disease?

self-limited, last 1-2 yrs, surgery if needed

*if synovitis → anti-inflammatory meds

What can Legg-Calve-Perthes disease cause?

Transient synovitis

What is Genu varum?

"Bowlegs"

What is Genu valgum?

"Knock knees"

When does Genu varum resolve?

resolves w/ 6-12 months of independent ambulation; self corrects by 2 y/o

What causes Osgood schlatter disease?

response to stress on the tibial tuberosity (running, jumping)

How does Osgood Schlatter disease present?

Males, adolescent growth spurt, swelling, tenderness, and inc prominence of the tibia tubercle

What is the tx for Osgood schlatter disease?

rest/restriction of activities, NSAIDs are NOT usually beneficial; isometric exercise, strengthening of the quads, ice after activity

What is Juvenile Idiopathic arthritis?

< 16 yo, sx > 6 weeks; initial sx: morning stiffness, gelling

What is Systemic arthritis?

1+ arthritis joint, fever 2+ weeks, + 1 or more of the following: rash, hepatomegaly, splenomegaly, lymph node enlargement, or serositis

How does the fever tend to occur in pts with systemic arthritis?

usually in the evening, 1-2 spikes to >101.3 daily, when gone child feels better

What does the rash associated with Systemic arthritis look like?

pink/salmon color, migratory, macular, Koebner phenomenon

Is Uveitis common in Systemic arthritis?

nope -rare

What findings are associated with systemic arthritis?

pericarditis/myocarditis, pleuritis, LAD, hepatosplenomegaly w/ very high LFTs, abd pain, wt loss, fatigue

What do labs show in pts w/ systemic arthritis?

high WBC (>40,000), plts, CRP, ESR

anemia, low albumin, - RF, - ANA

What is a complication of systemic arthritis?

Macrophage activation syndrome

What is the tx for systemic arthritis?

Steroids or cyclosporine

(NOT sulfasalazine or MTX)

What is the dx criteria for Enthesitis related arthritis?

Children with both arthritis and enthesitis, OR arthritis or enthesitis alone + 2 additional criteria

What are the additional criteria for diagnosis of enthesitis related arthritis?

SIJ tenderness or lumbosacral inflammatory pain, + HLA-B27, 1st degree relative w/ uveitis, AS, IBD, reactive arthritis, Uveitis, Onset of arthritis in males >6, Diagnosed with spondyloarthropathy

When should Enthesitis related arthritis be excluded as a differential?

1st degree relative has psoriasis, + RF, or systemic arthritis

How does Psoriatic arthritis present?

DIP joints affected, fingernail abnormalities (pitting/onycholysis), uveitis common, may precede psoriasis by many years

When should psoriatic arthritis be excluded as a differential?

pt has enthesitis related arthritis, systemic arthritis, + RF

What are the key features of Reactive arthritis?

Arthritis + conjunctivitis + urethritis

What is Reactive arthritis?

Arthritis associated with GI or GU infection

What is the tx for reactive arthritis?

NSAIDs

What is a complication of Kawasaki syndrome?

Coronary artery aneurysm

What is the clinical criteria for Kawasaki syndrome?

fever > 5 days, conjunctivitis, LAD, rash, changes in mucous membranes, changes in peripheral extremities

What phase of Kawasaki syndrome:

Fever, irritability, conjunctivitis; Oropharyngeal erythema, LAD, extremity edema

Acute (7-14 days)

What phase of Kawasaki syndrome:

Peeling of hands/fingers/toes; Thrombocytosis & coronary artery aneursym

Subacute (10-25 days)

What phase of Kawasaki syndrome:

Low risk for coronary artery aneurysm, risk for coronary artery vasculitis

Convalescent (21-60 days)

What is the tx for Kawasaki syndrome?

IVIG + ASA

What is added to Kawasaki syndrome tx if the patient is at high risk of IVIG resistance?

Glucocorticoids

Pediatric SLE vs JIA:

Arthritis common, but XR is normal

Pediatric SLE

(JIA shows osteopenia/joint damage)

What is considered a fever in a child?

100.4°F or 38°C

What is the preferred method for temperature measurement from birth to 3 months?

Rectal

What is the tx for congenital toxoplasmosis?

Pyrimethamine + Sulfadiazine + Folinic acid (Leucovorin)

How does Rubella present in newborns?

Blueberry muffin rash (purpura/petechiae), Cataracts/Glaucoma, IUGR, stillbirth, microcephaly, CHD

What congenital heart diseases are MC in rubella?

PDA, PAS

What is the tx for congenital rubella?

Supportive

What is the lab test of choice for CNS involvement in congenital HSV?

HSV PCR

What is the tx for congenital HSV?

IV acyclovir

What is “German measles”?

Rubella

How does the rash associated w/ Rubella present?

Fine maculopapular rash, begins on face and spreads cephalocaudally — spares palms/soles (generalizes w/in 24 hrs)

What are Forchheimer spots?

Petechiae on the soft palate, seen on day 1 of the rash in rubella

Forchheimer spots are associated with what disease?

Rubella

Rubella is most prevalent during what seasons?

Late winter-early spring

What are “measles”?

Rubeola

What virus causes rubeola?

Measles (paramyxoviridae family)

How does Measles (rubeola) present?

prodrome: fever + malaise + dry cough, coryza, conjunctivitis

How does the rash associated with Measles (rubeola) present?

Blotchy, blanching maculopapular rash that spreads cephalocaudally and centrifugally

What are Koplik spots?

Tiny bluish white dots surrounded by red halos on buccal mucosa (pathognomonic)

What disease are Koplik spots associated with?

Measles (rubeola)

What is the tx for Measles (rubeola)?

Ribavirin + Vit A (helps dec length of sx)

What is “5th disease”?

Erythema infectiosum

What virus causes erythema infectiosum?

Parvovirus B19

How does Erythema infectiosum present?

Malar exanthem with circumoral pallor, "slapped cheek appearance"

How does the rash associated with Erythema infectiosum present?

lacy erythematous rash appears on extensor surfaces → flexors surfaces of extremities, buttocks, trunk; resolves in a few days

What is the tx for erythema infectiosum?

Supportive

What is “6th disease”?

Roseola infantum

What virus causes roseola infantum?

HHV-6

How does Roseola infantum present?

Acute onset high grade fever (may be over 104 for 3-5 days), followed by rash

How does the rash associated w/ Roseola infantum present?

Discrete, pink macules that begins on the neck/trunk and spreads to the extremities, face, and scalp

**ONLY viral exanthem that begins on the trunk

What is the only viral exanthem that begins on the trunk?

Roseola infantum

What is the tx for roseola infantum?

Supportive

What virus causes infectious mononucleosis?

EBV

How does Infectious mononucleosis present?

fever, posterior LAD, splenomegaly, atypical lymphocytosis

What is the diagnostic test for Mono?

Heterophile antibody test (Monospot)