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Paediatrics > 2: Paediatric MSK - JIA, Rickets, DDH, Leg-Calve Perthes, Slipped Upper Epiphyseal Plate, Transient Synovitis, Osgood Schlatter's > Flashcards

2: Paediatric MSK - JIA, Rickets, DDH, Leg-Calve Perthes, Slipped Upper Epiphyseal Plate, Transient Synovitis, Osgood Schlatter's Flashcards

1
Q

What is juvenile idiopathic arthritis

A

Onset of rheumatic joint disease before age of 16. Involving joint inflammation for more than 6 weeks

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2
Q

Why is a timeframe of 6W set on JIA

A

To differentiate from septic arthritis

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3
Q

What age-group does JIA occur in

A

<16Y

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4
Q

What gender is JIA more common in

A

Females

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5
Q

What is the most common for of JIA

A

Oligo-articular JIA

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6
Q

What is oligoarticular JIA

A

JIA affecting less than 4 joints within 6 months

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7
Q

What joints are affected first in oligoarticular JIA

A

large weight-bearing joints

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8
Q

What is associated with oligoarticular JIA

A

anterior uveitis

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9
Q

How will oligoarticular JIA present on blood tests

A
  • Raised ESR/CRP
  • -ve RF
  • positive ANA
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10
Q

How will seronegative polyarticular JIA present

A

affects more than 5 joints within 6 months of onset

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11
Q

How will polyarticular JIA present on blood tests

A
  • Raised ESR/CRP
  • -ve RF
  • positive ANA
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12
Q

What blood test is positive in seropositive polyarticular JIA

A

Positive RF

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13
Q

What is systemic JIA called

A

Still’s disease

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14
Q

In which age group is Still’s disease more common

A

2-4y

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15
Q

What is the clinical criteria for stills disease

A

Must have

  • More than one joint involved
  • Intermittent fever for at least 2W, with T spikes on at least 3d
  • One extra-articular manifestation
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16
Q

What are extra-articular manifestations of stills disease

A
  • Salmon pink rash
  • Lymphadneopathy
  • Hepatosplenomegaly
  • Serositis
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17
Q

How will arthritis present in still’s disease

A

Red swollen joint
Early morning stiffness
Limited/painful movement

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18
Q

Who manages JIA

A

Paediatric rheumatology

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19
Q

Describe management of JIA

A
  • Physio
  • Encourage swimming/cycling
  • Orthoses
  • Naproxen
  • Intra-articular corticosteroid injections
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20
Q

What is the prognosis of JIA

A

95% resolves by puberty

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21
Q

What are 4 complications of JIA

A
  • Serositis (pericarditis, pleuritis)
  • Growth retardation secondary to premature epiphyseal plate closure
  • Chronic anterior uveitis
  • Leg-length discrepancy
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22
Q

In a child 0-5y what are the causes of a limp affecting the back

A

Discitis

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23
Q

In a child 0-5y what are the 3 causes of a limp affecting the hip

A
  • Transient synovitis
  • Developmental dysplasia
  • Septic arthritis
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24
Q

In a child 0-5y what is a causesof a limp affecting the femur

A
  • Osteomyelitis
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25
Q

In a child 0-5y what is a cause of a limp affecting the knee

A
  • Septic arthritis
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26
Q

In a child 5-10y what are the 3 causes of a limp affecting the hip

A
  • Transient synovitis
  • Perthe’s disease
  • Septic arthritis
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27
Q

In a child 5-10y what are the 2 causes of a limp affecting the knee

A
  • Discoid meniscus

- Septic arthritis

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28
Q

In a child 10-15y what are the 2 hip

A
  • Septic arthritis

- Slipped upper epiphyseal disc

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29
Q

In a child 10-15y what are the 3 conditions causing limp at the knee

A
  • Osgood schlatters
  • PFP syndrome
  • Osteochondritis dessicans
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30
Q

What is the commonest cause of a child with a limp

A

Trauma

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31
Q

What age is septic arthritis more common

A

<2

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32
Q

How will septic arthritis present

A
  • Affects single synovial joints
  • Erythematous, warm, swollen joint
  • Child may present with a limp
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33
Q

What is osteomyelitis

A
  • Infection of metaphysic of long bone
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34
Q

How will child present with osteomyelitis infection

A
  • febrile, painful and immobile limb. Overlying skin may be swollen, hot and erythematous.
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35
Q

What is the commonest cause of paediatric hip pain

A

transient synovitis

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36
Q

What age group does transient synovitis occur

A

2-12

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37
Q

How will transient synovitis present

A
  • Afebrile

- Acute hip pain on movement, that is ok on rest

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38
Q

What condition is juvenile idiopathic arthritis associated with

A

Chronic anterior uveitis

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39
Q

What should be done to prevent blindness in JIA

A

Regular eye screening

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40
Q

Why may children with JIA have growth retardation

A

Chronic inflammation can cause stiffening and deformity of the joints.

Also chronic disease - present with frequent infections, malnutrition, stress and corticosteroid use.

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41
Q

Define rickets

A

Poor bone mineralisation prior to fusion or epiphyseal plates

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42
Q

What is poor bone mineralisation after epiphyseal fusion called

A

Osteomalacia

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43
Q

What cause rickets

A

Deficiency in vitamin D:

  1. Malnutrition - low vitamin D diet
  2. Poor sunlight exposure
  3. Malabsorption
  4. Impaired hydroxylation: liver or kidney disease
  5. Congenital defect in metabolism
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44
Q

Does breast milk have a high or low vitamin D concentration

A

Low

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45
Q

What can cause malabsorption of vitamin D

A

Coeliac Disease

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46
Q

What is the clinical presentation of Ricket’s disease

A
  • Bending of long bones
  • Knocked Knees
  • Bow legs
  • Harrison groove
  • Rachitic rosary
  • Marfan’s sign
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47
Q

What is rachitic rosary

A

Distention of bone-cartilage junction at ribs

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48
Q

What is marfans sign

A

Increase space between bone-cartilage junctions

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49
Q

What is Harrison groove

A

Softened lower rib are pulled in by the diaphragm causing a groove at thoracic outlet.

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50
Q

Explain normal vitamin D processing

A
  • Cholecalciferol (D3) is ingested or made in the skin by converting UVB
  • Liver hydoxylates D3 to 1-OH vitamin D
  • Kidney hydroxylates D3 to 1,25 di-OH vitamin D3
  • Vitamin D deficiency results in decrease mineralisation and hypocalcaemia. Causing PTH release
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51
Q

What is first-line investigation of vitamin D deficiency

A

Bone profile

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52
Q

What will be seen on bone profile in Ricket’s

A
  • Low vitamin D
  • Hypocalcaemia
  • Raised ALP
53
Q

What is second-line investigation of ricket’s

A

X-Ray

54
Q

What will be seen on x-ray in ricket’s disease

A

Cupped, ragged, metaphyseal edges

55
Q

How is ricket’s disease managed

A

Cholecalciferol: vitamin D3 (5,000- 10,000 IU)/day

56
Q

What is a limp

A

abnormal gait pattern due to weakness, pain or deformity

57
Q

What is discitis

A

infection of IV disc

58
Q

How will discitis present

A
  • Fever
  • Irritable
  • Back pain
  • Not willing to walk
59
Q

What are investigations for discitis

A

FBC
CRP/ESR
MRI

60
Q

What is developmental dysplasia of the hip

A

Acetabular Dysplasia

61
Q

What age range does DDH occur

A

0-5y

62
Q

What gender is DDH more common

A

Girls (4:1)

63
Q

If under 4 months how should DDH be investigated

A

USS

64
Q

If over 4 months how should DDH be investigated

A

X-ray

65
Q

What is septic arthritis

A

Infection of a synovial joint

66
Q

What organism is the most common cause of septic arthritis

A

Staph.A

67
Q

If a spinal fracture presents in an infant up to 9 months-old, what should be suspected

A

Non-accidental injury

68
Q

If non-accidental injury is suspected what should be done

A

Refer for skeletal survey

69
Q

What is transient synovitis of the hip also known as

A

Irritable hip

70
Q

What age-range does transient synovitis of the hip occur

A

2-12

71
Q

In which gender is transient synovitis of the hip more common

A

Male (2:1)

72
Q

How will transient synovitis of the hip present

A
  • URTI in recent weeks
  • Pain in the hip on movement absent at rest
  • Afebrile
73
Q

What is Leg Calve Pethes Disease

A

Avascular necrosis of the femoral head

74
Q

What age group does LCP disease occur

A

4-10

75
Q

How will LCP present

A
  • Hip pain that radiates to the knee
76
Q

What is slipped upper femoral epiphyseal

A

Posterior-inferior displacement of femoral head to femoral neck and growth plate

77
Q

What age range does slipped upper femoral epiphysis occur

A

10-16

78
Q

How will slipped upper epiphyseal plate present

A

Dull pain in the hip, groin or knee

79
Q

What is Osgood-Schlatter disease

A

Over-use of quadriceps during growing period leads to increase traction through patella ligament - causes tibial tuberosity apophysitis

80
Q

What age group does Osgood Schlatter disease occur

A

9-14

81
Q

How will Osgood-Schlatter schlatter disease present

A

Anterior knee pain worse on activity

82
Q

What is a mnemonic to remember causes of limping child

A

STOP LIMPING

83
Q

What are the causes of a limp in a child

A 
Septic arthritis 
Trauma 
Osgood schlauer
Perthes 
Leg length discrepancy
Inflammatory - transient synovitis 
Malignancy 
Pyomyositis 
Illiopsoas abscess 
Neurological 
Gullian barre, GI (torsion, appendicits)
84
Q

When should a child with a limp be referred for urgent assessment

A
  1. <3Y
  2. > 9Y with reduced internal rotation
  3. Suspect NAI
  4. Red flags of malignancy
  5. Unable to weight bear
85
Q

Why is a child less than 3 urgently referred

A

suspected septic arthritis

86
Q

Why is a child older than 9 with reduced internal rotation urgently referred

A

slipped upper femoral epiphyseal disc is suspected

87
Q

When should a same-day x-ray be carried out in limping children

A

No indications urgent assessment.

History trauma
Localised bony tenderness

88
Q

What is DDH

A

Hip instability, subluxation and dislocation of femoral head

89
Q

In which gender is DDH more common

A

Females (5:1)

90
Q

What signs are positive in DDH in infants <6m

A

Barlow

Ortolani sign

91
Q

How will a child 6-18m with DDH present

A
  • No Barlow or ortolans sign
  • Unable to abduct hip
  • Asymmetrical gluteal folds
92
Q

How will a child, older than 18 months, with DDH present

A
  • Leg length discrepancy
  • Hip pain referred to anterior thigh
  • Trendelenburg gait
93
Q

What is a distinguishing feature of children with bilateral DDH

A

they will not have leg length discrepancy

94
Q

How is DDH typically identified

A

Newborn baby check

95
Q

When is screening for DDH recommended

A

If a child has one or more RF:

  • FH
  • Features DDH
  • Breech
96
Q

What is main investigation for DDH if child is under 4 months

A

USS

97
Q

What is used to investigate DDH if child is older than 4 months

A

X-Ray

98
Q

If less than 6 months how is DDH managed

A

Palvik Harness

99
Q

How does palvik harness hold the hips

A
  • 90-100’ flexion

- 50’ abduction

100
Q

How is DDH 6-18m managed

A

Closed reduction + immobilisation

101
Q

How is DDH >18m managed

A

Open reduction + immobilisation

102
Q

What is Legg Calve Perthes Disease

A

Idiopathic avascular necrosis of the femoral head

103
Q

What age range does legg calve perves disease occur

A

4-10

104
Q

What gender is Legg calve perves disease more common

A

Male

105
Q

How will LCP disease present

A

Hip pain that radiates to anterior knee

106
Q

What is first-line investigation for LCP disease

A

x-ray

107
Q

What is problem with x-ray in LCP disease

A

no findings in first-3m

108
Q

How is LCP disease on x-ray graded

A

lateral pillar classification

109
Q

What are poor prognostic indicators in LCP

A

lucency femoral head

increased joint space

110
Q

What are the two options for managing LCP disease

A
  1. Conservative

2. Surgical

111
Q

When is conservative management preferred in LCP disease

A

Child <6
Lateral Pillar A
Undamaged femoral head

112
Q

What is conservative management of LCP disease

A

Physiotherapy

Reduced weight bearing

113
Q

When is surgical management of LCP disease preferred

A

Child >8
Lateral Pillar B/C
Damaged femoral head

114
Q

How is LCP disease managed surgically

A

Femoral Osteotomy

115
Q

What is a complication of LCP disease

A

Secondary OA

116
Q

What is slipped capital femoral epiphysis

A

posterior and inferior displacement of the femoral head relative to femoral neck and growth plate

117
Q

What is the most common hip disorder in adolescents

A

slipped capital femoral epiphysis

118
Q

what age range does slipped capital femoral epiphysis happen

A

10-16

119
Q

which gender is slipped capital femoral epiphysis more common

A

Males

120
Q

what are 5 risk factors for slipped capital femoral epiphysis

A 
Obesity 
Trauma 
Hypothyroid 
Down syndrome 
FH
121
Q

what are the two types of slipped capital femoral epiphysis

A

chronic and acute

122
Q

how will slipped capital femoral epiphysis present clinically

A
  • dull ache in medial thigh, knee, hip or groin.

- limited movement on internal rotation

123
Q

why will children with slipped capital femoral epiphysis have knee pain

A

due to referred pain form obturator

124
Q

what is a sign of slipped capital femoral epiphysis

A

reduced internal rotation - may hold leg in external rotation

125
Q

what is first line investigation for slipped capital femoral epiphysis

A

x-ray

126
Q

how will x-ray appear in slipped capital femoral epiphysis

A
  • Widening joint space

- Displacement femoral head inferior and posteriorly

127
Q

what is management for slipped capital femoral epiphysis

A
  • Avoid weight bearing

- Surgical fixation

128
Q

what are two problems of slipped capital femoral epiphysis

A

Avascular Necrosis

OA

Paediatrics (61 decks)

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