Case Files 37-42 (C) Flashcards Preview

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Flashcards in Case Files 37-42 (C) Deck (58)
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1

Explain antalgic gait

Occurs when the "stance phase" of gait is shortened, usually because of pain during weight bearing

 

Remember: normal gait consists of two phases (swing and stance, with stance accounting for ~60% of the cycle)

2

The most common nontraumatic hip pathology in adolescents

Slipped Capital Femoral Epiphysis (SCFE)

3

Hip pathology will frequently present with pain in the...

groin, thigh, and knee

4

Pain with internal rotation of the hip

+

External rotation on passive flexion

SCFE

5

What is the most sensitive mark (on PE) of hip pathology in children

Restricted internal rotation followed by a lack of abduction

6

The FABER test can find pathology located in the...

SI joint

7

Fever greater than ___ and ESR gerater than ___ is 97% sensitive for septic hip joint

Fever > 99.5

ESR > 20

8

Monoarticular with systemic signs (eg, fever)

Think septic arthritis

 

Children with septic hip joint will often lay with their hip flexed, abducted, and externally rotated

9

What are the most common pathogens involved in children with septic hip?

< 4 months: GBS and Staph aureus

 

4 months - 5 years: Staph aureus and Strep pyogenes

10

Spiral fracture of the tibia that results from twisting while the foot is planted

Toddler's fracture

 

Setting = acute limp or change in ambulation

 

*If the child had a painless limp from the time they learned to walk think congenital dysplasia

11

Transient synovitis

A self-limited inflammatory response that often follows a viral infection, leading to hip pain in children ages 3-10 

 

Low-grade to no fever, normal WBC, normal ESR

12

Kocher criteria

Used to assess risk for septic arthritis in children

 

Four criteria:

  1. Fever > 101.3
  2. Nonweight bearing
  3. ESR > 40
  4. WBC > 12,00

13

Purulent aspirate with WBC > 50,000

 

vs

 

Yellow/clear aspirate with WBC <10,000

Septic joint

 

vs

 

Transient synovitis

14

Avascular necrosis of the femoral head

AKA Legg-Calvé-Perthes (LCP)

 

More common in boys than girls

Although any disruption of blood flow to the femoral capital epiphysis, such as trauma or infection, can cause avascular necrosis the etiology of LCP is unknown

15

Capital Femoral Epiphysis

Growth plate that connects the metaphysis (femoral head) to the diaphysis (shaft of the femur)

16

Treatment for SCFE

Surgical pinning (do not let them walk after making diagnosis)

 

33% will develop avascular necrosis and 33% will develop SCFE in the contralateral hip

17

Pain that wakens a child at night

Suspicious for malignancy

 

"Growing pains" is a diagnosis of exclusion (it should be considered if the pain is only at night, is bilateral, and if no other pathology is found)

18

A 6-year-old young boy is brought in for evaluation of a painful hip. He has been limping and not wanting to walk for the past 2 days. He has had no obvious injury. He feels better after taking ibuprofen. He has not had a fever, although he had "the flu" last week. Vitals are normal. Some pain with internal rotation. He walks with a pronounced limp. Can he be sent home?

After getting a CBC and ESR

 

If they are in normal limits he likely has transient synovitis and can be treated with an NSAID with the expectation of a recovery in a few days

19

A 6-year-old boy has a 2-month history of slight limp. No PMHx and no medications. Normal vitals, but an antalgic gait and decreased ROM in the L hip (internal). Mild pain on palpation of the anterior capsule on the L side. X-ray shows fragmentation of the femoral head. What is the most likely diagnosis?

Legg-Calvé-Perthes disease

 

Often a self-healing disorder. Treatment is focused on limiting pain and avoiding functional loss. 

20

Physical exam findings of suprapubic pain and costovertebral tenderness

Suggestive of UTI and most likely acute pyelonephritis

21

Most common organisms leading to UTIs

E coli

Proteus

Klebsiella

Staph epidermidis

Pseudomonas

Candida

22

Drugs that are commonly associated with "drug fever"

B-lactams

Sulfa derivatives

Anticonvulsants

Allopurinol

Heparin

Amphotericin B

23

A rare AD disorder charaterized by fever > 104, tachycardia, metabolic acidosis, rhabdomyolysis, and calcium accumulation in skeletal muscle leading to rigidity

Malignant Hyperthermia

 

May occur up to 24 hrs after exposure to anesthetic agents such as halothane and succinylcholine 

 

Treatment: discontinue offending agents, supportive therapy (antipyretics, oxygen hyperventilation, cooling blankets, sodium bicarbonate, and dantrolene IV)

24

Most common postoperative complication

Fever

25

5 W's of post-op fever

Wind (pneumonia)

Water (UTI)

Walk (DVT)

Wound (SSI)

Wonder where/drugs (Abscess or Fever)

26

Causes of immediate postoperative period

Medications

Blood products

Malignant Hyperthermia

Bacteremia

27

If fever occurs within 36 hours post-laparotomy what two important infectious etiologies should you consider?

Bowel injury with leakage of gastrointestinal contents

 

Invasive soft-tissue wound infection (caused by β-hemolytic streptococci or Clostridium species)

 

*Toxic Shock Syndrome caused by Staph aureus is a rare condition

28

Postoperative pneumonia is typically caused by

polymicrobial 

 

Enterobacteriaceae and S aureus or Enterobacteriaceae and Streptococci

29

When and which type of antibiotics do you give for aspiration penumonia?

Antibiotics are typically given following a witnessed aspiration and discontinued after 48-72 hours with no development of infiltrates

 

Gram (-) coverage is required, with the current choice being piperacillin/tazobactam or ticarcillin/clavulanate

30

Homan sign

Pain in the calf on foot dorsiflexion = DVT
 

Fever caused by DCT usually occurs on the 5th postoperative day