3. Paeds [MSK] Flashcards
Describe differences in clinical examination features for septic arthritis vs transient synovitis in terms of systemic features, height of fever, movement and resting posture:
Septic:
Systemic illness present
Fever of >38.5 in last week
Pseudoparalysis or very restricted e.g. by pain
Flexed and externally rotated.
Transient:
Well
Low grade fever
Antalgic gait / limp, will allow to weight bear
Reduced ROM int ext rotation with end range pain
2 most likely causative organisms of SA in children:
Staph aureus
Strep pneumoniae
Causes of non-traumatic joint swelling in a child:
Septic arthritis
Tumour / malignancy
JIA
Osteomyelitis
Principles of management of a supracondylar fracture:
Reduce, open or closed
Retain reduction e.g. wires and cast
Rehabilitation / physio / pain relief
What is Codman’s triangle?
Triangular periosteal ossification at upper and lower poles of bone tumour
Increased risk of septic arthritis:
Immunocompromised
Steroids
Itchy skin rash as cutaneous source of infection
Underlying arthritis
Overlying wound / joint injection
4 MSK features associated with leukaemia?
Joint effusions
Night pain
Pathological fracture
Metaphyseal tenderness
A group of children who are at high risk of developing leukaemia?
Trisomy 21
5 possible signs of a basal skull fracutre:
Battle’s sign
Haemotympanum
Panda eyes
CSF nasal
CSF auricular
5 measures to reduce ICP:
Nurse head up
Ventilate to normal CO2 levels for vasodilation
Adequate BP
IV mannitol
IV hypertonic saline
Perthe’s disease examination findings:
Reduced INTERNAL rotation and abduction
Limited global ROM
Antalgic gait
Reduced weight bearing on affected side
X-ray features that would support a diagnosis of Perthe’s disease:
Osteonecrosis of femoral head
Flattening of femoral head
Radiolucency of proximal metaphysis
Fragmentation of femoral head
Management of Perthe’s when surgery is not indicated:
Analgesia
Limit activity until pain resolves and ROM is restored
Non-surgical containment - abduction case with splints / braces
Typical presentation of Osgood-Schlatter’s disease:
Sporty teenager
Prominent tibial tuberosity, tender to palpate
Normal ROM
No pain on weight-bearing
Limping over last 3 weeks, no recent illness, regression in development e.g. not walking down stairs anymore:
JIA
Pain in right hip / proximal femur, worse at night waking from sleep but settles on taking ibruprofen. Most likely diagnosis?
Osteoid osteoma
Inflammation of which structure leads to symptoms in Osgood-Schlatter’s disease?
Patellar tendon insertion
A two year old boy presents with an insidious onset of swollen left knee with fixed flexion deformity and bony overgrowth. What is this a classic presentation of, what other condition does this boy have a 30% risk of and therefore which investigation should be carried out as well?
JIA
30% of developing anterior uveitis; slit lamp examination is required
What unusual facial feature can be present in a patient with osteogenesis imperfecta?
Blue sclera
What is the treatment for talipes equinovarus and how long does it usually last?
Ponsetti method casting starting soon after birth
Usually corrected within 6-10 weeks but requires night braces until 4 years old
Associations with talipes equinovarus:
Spina bifida
Cerebral Palsy
Edward’s / Trisomy 18
Oligohydramnios
Arthrogryposis (contractures)
What does JIA refer to? Pauci-articular?
Arthritis in anyone under 16 lasting for 6 weeks or more
Pauci-articular = 4 joints or less
What is Still’s disease?
Systemic JIA
Symptoms include:
Fever
Salmon-pink rash
Lymphadenopathy
Arthritis
Uveitis
Anorexia and weight loss
ANA maybe positive
