Bones, Joints And Rheumatic Disorders Flashcards
Genu varum
Bow legs seen in rickets
Pes planus
Flat feet
Common in hyper mobility
Two causes of in-toeing
Medial tibial torsion - self corrects by aged 5
Persistent anteversion of the femoral neck - joint hyper-mobility, usually self corrects
Toe walking is often from habit but what four things must you rule out?
Achilles tendon tightness
Inflammatory arthritis in foot/ankle
Mild cerebral palsy
Duchenne muscular dystrophy (in an older male)
What is talipes equinovarus and what causes it?
Fixed inversion and supination of the foot
May be idiopathic or secondary to ologohydramnios/spina bifida
Associated with DDH
Barlow test
Dislocate the hip posteriorly
Ortolani test
Relocate a dislocated hip back into acetabulum
What is osteomyelitis and what causes it
Infection of the metaphysis of long bones due to haematogenous pathogen spread
Usually staph aureus, but can be strep/haemophilus influenza
Young chap with an acutely painful limb which is tender to touch and immobile. X-ray is unremarkable. WCC count is raised.
What is the next investigation and step in management?
MRI - may show subperiosteal pus/purple to debris indicative of osteomyelitis.
Needs parenteral antibiotics for several weeks to prevent bone necrosis
Osgood-Schlatter disease
Osteochodritis of the patellar tendon insertion at the knee
Active adolescent male who has come in with localised tenderness of the knee and swelling of the tibial tuberosity. This is a recurrent problem which resolves if he rests.
Osgood-Schlatter disease
Chondromalacia patella
Softening of articulate cartilage of patella seen in females with hypermobility
Adolescent female with known hypermobility and flat feet presents with pain in her knees when standing up or going up stairs. The pain goes away with rest.
Chondromalacia patella
Persistent knee pain in a very active male teenager with localised tenderness more marked over the femoral condyles
Osteocondritis dissecans
Osteochondritis dissecans
Separation of bone and cartilage (avascular necrosis) from the medial femoral condyle
Four conditions to consider in a child 1-3 years with an acute limp
Infection - septic arthritis/osteomyelitis
Transient synovitis
Trauma
Malignancy - leukaemia/neuroblastoma
Six conditions to consider in a child ages 3-10 with an acute limp
Transient synovitis
Infection - septic arthritis/osteomyelitis
Mechanical - trauma/overuse
Perthes disease
Juvenile idiopathic arthritis
Malignancy - leukaemia
Five conditions to consider in a teenager with an acute limp
Mechanical - trauma/overuse
Slipped capital femoral ephysis
Avascular necrosis of the femoral head
Reactive arthritis
Infection - septic arthritis/osteomyelitis
Six causes of a chronic or intemittent limp
1-3 years : DDH/JIA
3-10 years: Chronic Perthes/Duchenne muscular dystrophy/JIA
11-16 years: JIA/tarsal coalition/SUFE (chronic)
Six red flags for back pain
Young age
High fever
Night waking/persistent - osteoid osteoma
Painful scoliosis - malignancy
Focal neurological signs (bladder/bowel) - cord compression
Weight loss/systemic malaise
Scheuermann disease
Osteochondrosis of the vertebral body resulting in fixed thoracic kyphosis +/- back pain
Spondylolysis
Stress fracture of the par interarticularis of the vertebra
Pain on spine extension and localised tenderness
Teenager with an acute limp and restricted abduction and internal rotation of the hip. Mother thinks it is just so he can avoid doing sport which he hates. No trauma or swelling to the site and no obvious deformity.
Slipped capital femoral epiphysis
Needs X-ray and surgery
Acute limp in a well looking child who is comfortable at rest.
Transient synovitis
Resolves in under a week
Acute onset limp with the hip held flexed, in a child who is uncomfortable at rest.
Septic arthritis
Perthes disease
Avascular necrosis of capital femoral ephysis due to interruption of blood supply
Transient joint swelling in a child with salmonella gastroenteritis and a low grade fever
Reactive arthritis
Common causative organism of septic arthritis in under 2s
Staph aureus
Child with persistent joint swelling for more than 6 weeks with stiffness after long rests and pain.
A leg length discrepancy is noticed due to bone overgrowth.
A salmon pink rash is also noted.
Juvenile idiopathic arthritis
Four main complications from juvenile idiopathic arthritis
- Chronic anterior uveitis –> common. Can cause severe visual impairment
- Flexion contractures –> can lead to destruction
- Growth failure –> localised overgrowth = leg length discrepancy. Or undergrowth due to premature fusion of epiphysis
- Osteoporosis –> not weight bearing and steroid use
Child with abdominal pain and haematuria presents with painful ankles as well as a rash over the legs
Henoch-Schonlein purpura
Achondroplasia inheritance and signs
Autosomal dominant
Marked limb shortening. Frontal bossing. Broad and short hands
A baby is born and you can bring his shoulders together so that they touch each other
Cleidocranial dystosis - absence of clavicles
Osteogenesis imperfecta
Recurrent fractures and bowing of bones due to fragility. Disorder of collagen metabolism
Blue sclera
Red flags in a child with nocturnal waking in pain
Anaemia, bruising or irritable –> leukaemia/lymphoma
