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Welcome Applicants

Welcome Applicants. February 4 th , 2011. The Child With Pain. Multiple Joint Involvement. Single Joint Involvement. With Fever Septic arthritis/Osteomyelitis Sympathetic arthritis Foreign body with infection Traumatic arthritis Soft Tissue infection Rheumatic Diseases

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Welcome Applicants

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  1. Welcome Applicants February 4th, 2011

  2. The Child With Pain Multiple Joint Involvement Single Joint Involvement With Fever Septic arthritis/Osteomyelitis Sympathetic arthritis Foreign body with infection Traumatic arthritis Soft Tissue infection Rheumatic Diseases Reactive arthritis Toxic synovitis Diskitis Sarcoidosis Hemoglobinopathy Malignancies Without Fever Trauma Mechanical derangement Rheumatic Diseases Toxic synovitis Avascular necrosis Subacuteosteomyelitis Diskitis Hemoglobinopathy Reflex sympathetic dystrophy Malignancies Psychogenic pain With Fever Bacterial infections Sepsis Viral infections Lyme disease Reactive arthritis Rheumatic diseases Post immunization Immune deficiencies Serum sickness Inflammatory bowel disease Sarcoidosis Familial Mediterranean fever Malignancies Without Fever Rheumatic diseases Joint hypermobility Growing pains Post immunization Immune deficiencies Guilain-Barre Lyme Disease Fibromyalgia syndrome Chronic fatigue syndrome Psychogenic pain Malignancies

  3. Evaluation of Bleeding Disorder • Am I dealing with a bleeding disorder? • What is the clinical phenotype? • Is it congenital or acquired? • Systemic disease or drug causing exacerbation?

  4. Am I dealing with a bleeding disorder? • With bruising • Trauma is most common • Abuse is more common than hemophilia

  5. Am I dealing with a bleeding disorder? • Bruising • Typical areas: boney protuberances of extremities • More pronounced, more numerous, recurrent • Larger than quarter-size • Associated hematoma • Intramuscular hematoma or hemarthrosis • Out of proportion to mechanism

  6. Am I dealing with a bleeding disorder? • Epistaxis • ER visit • Both nostrils simultaneously • Associated with other signs of bleeding • Family history of similar bleeding

  7. Am I dealing with a bleeding disorder? • Menorrhagia • Associated with anemia • Frequent pad changes (<q2hrs) • Menses >7days

  8. Am I dealing with a bleeding disorder? • Surgical Bleeding • Uncontrolled bleeding in surgical field • Other sites (drains, lines) • Unexpected need for transfusion

  9. What is the clinical phenotype? • Primary hemostasis (platelets, vWF, vessel) • Easy bruisability • Petechiae • Epistaxis • Menorrhagia • Surgical wound oozing • Coagulation factor (Hemophilia) • Hematomas • Hemarthrosis • Delayed surgical bleeding

  10. Inheritance Patterns • Hemophilia • X-Linked • Glanzmannthrombasthenia • Factor XIII • Autosomal recessive • Von Willebrand • Autosomal Dominant

  11. Acquired Bleeding Abnormality • Underlying medical illness • Liver disease • Vitamin K deficiency • Disseminated intravascular coagulation • Medications

  12. Lab Evaluation • Screening Studies • CBC, smear, PT, PTT, Bleeding time/PFA • PT: extrinsic and common pathways • PTT: intrinsic and common pathways • Factor XIII can have normal PT and PTT • Incidental prolonged PTT • Lupus Anticoagulant

  13. Hemophilia • X-Linked • Female carriers may be symptomatic • Presentation • Circumcision • With ambulation • Labs: prolonged PTT • Hemophilia A: Factor VIII • 1:5,000 • Hemophilia B: Factor IX • 1:30,000

  14. Hemophilia: Treatment • Infusion of factor concentrates • Prophylactically • Minor hemorrhage • 50% correction • Major hemorrhage • 100% correction

  15. What’s going on? • 16y/o athlete with h/o hemophilia • Cc: Left groin pain, limp • No h/o trauma • Exam: decreased sensation anterior L thigh • Painful extension L hip • Decreased strength with flexion L hip

  16. What to do? • 3y/o with h/o hemophilia • Was playing on back of couch and fell to floor • Struck head • Acts drowsy

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