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
2
Q
Why is a timeframe of 6W set on JIA
A
To differentiate from septic arthritis
3
Q
What age-group does JIA occur in
A
<16Y
4
Q
What gender is JIA more common in
A
Females
5
Q
What is the most common for of JIA
A
Oligo-articular JIA
6
Q
What is oligoarticular JIA
A
JIA affecting less than 4 joints within 6 months
7
Q
What joints are affected first in oligoarticular JIA
A
large weight-bearing joints
8
Q
What is associated with oligoarticular JIA
A
anterior uveitis
9
Q
How will oligoarticular JIA present on blood tests
A
- Raised ESR/CRP
- -ve RF
- positive ANA
10
Q
How will seronegative polyarticular JIA present
A
affects more than 5 joints within 6 months of onset
11
Q
How will polyarticular JIA present on blood tests
A
- Raised ESR/CRP
- -ve RF
- positive ANA
12
Q
What blood test is positive in seropositive polyarticular JIA
A
Positive RF
13
Q
What is systemic JIA called
A
Still’s disease
14
Q
In which age group is Still’s disease more common
A
2-4y
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
16
Q
What are extra-articular manifestations of stills disease
A
- Salmon pink rash
- Lymphadneopathy
- Hepatosplenomegaly
- Serositis
17
Q
How will arthritis present in still’s disease
A
Red swollen joint
Early morning stiffness
Limited/painful movement
18
Q
Who manages JIA
A
Paediatric rheumatology
19
Q
Describe management of JIA
A
- Physio
- Encourage swimming/cycling
- Orthoses
- Naproxen
- Intra-articular corticosteroid injections
20
Q
What is the prognosis of JIA
A
95% resolves by puberty
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
22
Q
In a child 0-5y what are the causes of a limp affecting the back
A
Discitis
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
24
Q
In a child 0-5y what is a causesof a limp affecting the femur
A
- Osteomyelitis
25
In a child 0-5y what is a cause of a limp affecting the knee
- Septic arthritis
26
In a child 5-10y what are the 3 causes of a limp affecting the hip
- Transient synovitis
- Perthe's disease
- Septic arthritis
27
In a child 5-10y what are the 2 causes of a limp affecting the knee
- Discoid meniscus
| - Septic arthritis
28
In a child 10-15y what are the 2 hip
- Septic arthritis
| - Slipped upper epiphyseal disc
29
In a child 10-15y what are the 3 conditions causing limp at the knee
- Osgood schlatters
- PFP syndrome
- Osteochondritis dessicans
30
What is the commonest cause of a child with a limp
Trauma
31
What age is septic arthritis more common
<2
32
How will septic arthritis present
- Affects single synovial joints
- Erythematous, warm, swollen joint
- Child may present with a limp
33
What is osteomyelitis
- Infection of metaphysic of long bone
34
How will child present with osteomyelitis infection
- febrile, painful and immobile limb. Overlying skin may be swollen, hot and erythematous.
35
What is the commonest cause of paediatric hip pain
transient synovitis
36
What age group does transient synovitis occur
2-12
37
How will transient synovitis present
- Afebrile
| - Acute hip pain on movement, that is ok on rest
38
What condition is juvenile idiopathic arthritis associated with
Chronic anterior uveitis
39
What should be done to prevent blindness in JIA
Regular eye screening
40
Why may children with JIA have growth retardation
Chronic inflammation can cause stiffening and deformity of the joints.
Also chronic disease - present with frequent infections, malnutrition, stress and corticosteroid use.
41
Define rickets
Poor bone mineralisation prior to fusion or epiphyseal plates
42
What is poor bone mineralisation after epiphyseal fusion called
Osteomalacia
43
What cause rickets
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
44
Does breast milk have a high or low vitamin D concentration
Low
45
What can cause malabsorption of vitamin D
Coeliac Disease
46
What is the clinical presentation of Ricket's disease
- Bending of long bones
- Knocked Knees
- Bow legs
- Harrison groove
- Rachitic rosary
- Marfan's sign
47
What is rachitic rosary
Distention of bone-cartilage junction at ribs
48
What is marfans sign
Increase space between bone-cartilage junctions
49
What is Harrison groove
Softened lower rib are pulled in by the diaphragm causing a groove at thoracic outlet.
50
Explain normal vitamin D processing
- 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
51
What is first-line investigation of vitamin D deficiency
Bone profile
52
What will be seen on bone profile in Ricket's
- Low vitamin D
- Hypocalcaemia
- Raised ALP
53
What is second-line investigation of ricket's
X-Ray
54
What will be seen on x-ray in ricket's disease
Cupped, ragged, metaphyseal edges
55
How is ricket's disease managed
Cholecalciferol: vitamin D3 (5,000- 10,000 IU)/day
56
What is a limp
abnormal gait pattern due to weakness, pain or deformity
57
What is discitis
infection of IV disc
58
How will discitis present
- Fever
- Irritable
- Back pain
- Not willing to walk
59
What are investigations for discitis
FBC
CRP/ESR
MRI
60
What is developmental dysplasia of the hip
Acetabular Dysplasia
61
What age range does DDH occur
0-5y
62
What gender is DDH more common
Girls (4:1)
63
If under 4 months how should DDH be investigated
USS
64
If over 4 months how should DDH be investigated
X-ray
65
What is septic arthritis
Infection of a synovial joint
66
What organism is the most common cause of septic arthritis
Staph.A
67
If a spinal fracture presents in an infant up to 9 months-old, what should be suspected
Non-accidental injury
68
If non-accidental injury is suspected what should be done
Refer for skeletal survey
69
What is transient synovitis of the hip also known as
Irritable hip
70
What age-range does transient synovitis of the hip occur
2-12
71
In which gender is transient synovitis of the hip more common
Male (2:1)
72
How will transient synovitis of the hip present
- URTI in recent weeks
- Pain in the hip on movement absent at rest
- Afebrile
73
What is Leg Calve Pethes Disease
Avascular necrosis of the femoral head
74
What age group does LCP disease occur
4-10
75
How will LCP present
- Hip pain that radiates to the knee
76
What is slipped upper femoral epiphyseal
Posterior-inferior displacement of femoral head to femoral neck and growth plate
77
What age range does slipped upper femoral epiphysis occur
10-16
78
How will slipped upper epiphyseal plate present
Dull pain in the hip, groin or knee
79
What is Osgood-Schlatter disease
Over-use of quadriceps during growing period leads to increase traction through patella ligament - causes tibial tuberosity apophysitis
80
What age group does Osgood Schlatter disease occur
9-14
81
How will Osgood-Schlatter schlatter disease present
Anterior knee pain worse on activity
82
What is a mnemonic to remember causes of limping child
STOP LIMPING
83
What are the causes of a limp in a child
```
Septic arthritis
Trauma
Osgood schlauer
Perthes
Leg length discrepancy
Inflammatory - transient synovitis
Malignancy
Pyomyositis
Illiopsoas abscess
Neurological
Gullian barre, GI (torsion, appendicits)
```
84
When should a child with a limp be referred for urgent assessment
1. <3Y
2. >9Y with reduced internal rotation
3. Suspect NAI
4. Red flags of malignancy
5. Unable to weight bear
85
Why is a child less than 3 urgently referred
suspected septic arthritis
86
Why is a child older than 9 with reduced internal rotation urgently referred
slipped upper femoral epiphyseal disc is suspected
87
When should a same-day x-ray be carried out in limping children
No indications urgent assessment.
History trauma
Localised bony tenderness
88
What is DDH
Hip instability, subluxation and dislocation of femoral head
89
In which gender is DDH more common
Females (5:1)
90
What signs are positive in DDH in infants <6m
Barlow
| Ortolani sign
91
How will a child 6-18m with DDH present
- No Barlow or ortolans sign
- Unable to abduct hip
- Asymmetrical gluteal folds
92
How will a child, older than 18 months, with DDH present
- Leg length discrepancy
- Hip pain referred to anterior thigh
- Trendelenburg gait
93
What is a distinguishing feature of children with bilateral DDH
they will not have leg length discrepancy
94
How is DDH typically identified
Newborn baby check
95
When is screening for DDH recommended
If a child has one or more RF:
- FH
- Features DDH
- Breech
96
What is main investigation for DDH if child is under 4 months
USS
97
What is used to investigate DDH if child is older than 4 months
X-Ray
98
If less than 6 months how is DDH managed
Palvik Harness
99
How does palvik harness hold the hips
- 90-100' flexion
| - 50' abduction
100
How is DDH 6-18m managed
Closed reduction + immobilisation
101
How is DDH >18m managed
Open reduction + immobilisation
102
What is Legg Calve Perthes Disease
Idiopathic avascular necrosis of the femoral head
103
What age range does legg calve perves disease occur
4-10
104
What gender is Legg calve perves disease more common
Male
105
How will LCP disease present
Hip pain that radiates to anterior knee
106
What is first-line investigation for LCP disease
x-ray
107
What is problem with x-ray in LCP disease
no findings in first-3m
108
How is LCP disease on x-ray graded
lateral pillar classification
109
What are poor prognostic indicators in LCP
lucency femoral head
| increased joint space
110
What are the two options for managing LCP disease
1. Conservative
| 2. Surgical
111
When is conservative management preferred in LCP disease
Child <6
Lateral Pillar A
Undamaged femoral head
112
What is conservative management of LCP disease
Physiotherapy
| Reduced weight bearing
113
When is surgical management of LCP disease preferred
Child >8
Lateral Pillar B/C
Damaged femoral head
114
How is LCP disease managed surgically
Femoral Osteotomy
115
What is a complication of LCP disease
Secondary OA
116
What is slipped capital femoral epiphysis
posterior and inferior displacement of the femoral head relative to femoral neck and growth plate
117
What is the most common hip disorder in adolescents
slipped capital femoral epiphysis
118
what age range does slipped capital femoral epiphysis happen
10-16
119
which gender is slipped capital femoral epiphysis more common
Males
120
what are 5 risk factors for slipped capital femoral epiphysis
```
Obesity
Trauma
Hypothyroid
Down syndrome
FH
```
121
what are the two types of slipped capital femoral epiphysis
chronic and acute
122
how will slipped capital femoral epiphysis present clinically
- dull ache in medial thigh, knee, hip or groin.
| - limited movement on internal rotation
123
why will children with slipped capital femoral epiphysis have knee pain
due to referred pain form obturator
124
what is a sign of slipped capital femoral epiphysis
reduced internal rotation - may hold leg in external rotation
125
what is first line investigation for slipped capital femoral epiphysis
x-ray
126
how will x-ray appear in slipped capital femoral epiphysis
- Widening joint space
| - Displacement femoral head inferior and posteriorly
127
what is management for slipped capital femoral epiphysis
- Avoid weight bearing
| - Surgical fixation
128
what are two problems of slipped capital femoral epiphysis
Avascular Necrosis
| OA
