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Joints Flashcards

1
Q

What is juvenile idiopathic arthritis

A

Arthritis occuring in someone who is less than 16 years old and lasts for more than 6 weeks

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2
Q

Which joints does juvenile idiopathic arthritis tend to occur in

A

Medium sized- ankles, knees and elbows

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3
Q

How does pauciarticular juvenile idiopathic arthritis present

A

Joint pain and swelling of medium sized joints
Limp

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4
Q

What are the different types of juvenile idiopathic arthritis

A

Pauciarticular- 4 joints or less
Polyarticular- more than 5
Systemic- with systemic symptoms like fever

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5
Q

What antibody can be positive in JIA

A

ANA
Risk factor is SLE fhx

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6
Q

Pathophysiology of congenital hip dysplasia

A

When the femoral head does not sit within the acetabulum, as such they grow out of proportion to one another. If femoral head not in the acetabulum get hypertorphy of the ligaments. Caused by an excess of force on hip from various origins

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7
Q

Risk factors for congenital hip dysplasia

A

Anything which causes too much force on hip
- breech position
- first born child
- female
- oligohydramnios

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8
Q

Symptoms of congenital hip dysplasia in newborns

A

Different length legs in children
Asymmetrical skin folds over the hip

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9
Q

Symptoms of congenital hip dysplasia in older children

A

Painless limping
Waddling gait
Painful osteoarthritis

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10
Q

How to visualise congenital hip dysplasia

A

Under 4.5 months- ultrasound
Over 4.5 months- X-ray

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11
Q

How is CHD screened for

A

Barlow and ortolani test

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12
Q

How does barlow and ortolani test diagnose CHD

A

Barlow test initially- adduct hip whilst keeping knee straight
Ortolani test- flexing babies hip and adducting it will put femoral head back in place

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13
Q

How to treat CHD

A

Under 6 months- pavlik harness for 1-2 months which holds femoral head in place
Over- surgery

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14
Q

What should be done in all children under 2 with an acute limp

A

Refer urgently

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15
Q

What is slipped upper femoral epiphysis

A

When the head of the femur (ball) slips off the neck of the femur at the growth plate
It slips postero-inferiorly

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16
Q

Risk factors for slipped upper femoral epiphysis

A

Obese
Males
Aged 10-15
Hypothyroidism
Hypogonadism

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17
Q

How can slipped upper femoral epihysis present

A

Can be acutely following trauma or more commonly with chronic symptoms
These include gradual onset pain (can be anywhere) and limp

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18
Q

How is slipped upper femoral epiphysis diagnosed

A

AP and lateral (frog legs) X-ray on BOTH legs
SUFE can be bilateral in 20% of cases

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19
Q

What movement is lost in SUFE

A

internal rotation when flexed as such on examination the leg is often shortened and extenrally rotated

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20
Q

What is the management for superior upper femoral epiphysis

A

Internal fixation- single cannulated screw placed in the centre of epiphysis

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21
Q

What is transient synovitis

A

Acute synovitis which in children typically occurs a few weeks after an infection- be careful when diagnosing as should exclude all other causes first

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22
Q

Factors which indicate can keep transient synovitis care at the GP

A

Afebrile
Can bear weight
No swelling
Redness
Between 3-9 (rare in under 3s)
Not obese

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23
Q

What is perthes disease

A

Avascular necrosis of the femoral head
Can be bilateral

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24
Q

Presentation of perthes disease

A

Limp
Reduced movement as stiff
Progressive hip pain

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25
Q

X-ray finding of perthes disease

A

Loss of joint space initially then loss of femoral head

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26
Q

How to image perthes disease and if symptoms persist but no changes

A

X-ray
If persist MRI or technetium

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27
Q

Management of perthes disease

A

If under 6 and not severe collapse of the head- observation, physio and serial x-rays
If over 6 surgical management

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28
Q

What is osgood schlatters disease demogrpahic

A

Sporty teens

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29
Q

Presentation of osgood schlatters

A

Pain after excerise in sporty teens
Anterior tibia

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30
Q

Management of osgood schlatters

A

Pain relief- paracetamol or NSAIDS
Lifestyle advice- reduce activity, wear knee brace, ice packs on tuberosities

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31
Q

Complication of juvenile idiopathic arthritis

A

Anterior uveitis
Damage to joint
Osteoporosis
Growth failure

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32
Q

Management of juvenile idiopathic arthritis

A

NSAIDS or paracetamol
Can use intra-articular or oral corticosteroids
IF Fail to respond to these
1st line- oral methotrexate
2nd line- sulfasalazine
Cn use inflammatory cytokine block agents too

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33
Q

What is systemic JIA also known as

A

STILLS disease
S- spiking fever (mainly in evening)
T- there could be arthralgia
I- increase in size of liver and spleen
L- lose weight,anaemia
L- looks like cancer
S- salmon pink rash that comes and goes with fever

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34
Q

What are types of osteogenesis imperfecta

A

T1- mildest and most common
T2- lethal
T3- severely progressive and deforming
T4- moderately progressive

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35
Q

Features of osteogenesis imperfecta

A

Multiple fractures
Blue sclera
Discoloured teeth
Aortic root dilatation
Aortic regurg
Mitral valve prolapse

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36
Q

What is osteogenesis imperfecta

A

Group of collagen metabolism disordersleading to increased bone fragility and thinning of the sclera

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37
Q

Complications of pavlik splinting

A

Avascular necrosis
Temporary femoral nerve palsy

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38
Q

What causes anterior knee pain on exercise or climibing stairs with a grating sound or crepitus on examination

A

Chondromalacia patellae

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39
Q

Management of chondromalacia patellae

A

Physio

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40
Q

What are the 3 types of spina bifida and what are they

A

Spina bifida occurs when there is a failure of the vertebral arch to fuse
Spina bifida occulta- just failure to fuse
Meningocele- herniation of the meninges through the arch causing a sac
Myelomingocele- herniation of meninges containing neural tissue

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41
Q

What presents with dimple, tuft of hair or lipoma over spine

A

Spina bifidia

42
Q

Difference in presentation of the spina bifidas

A

Occulta- can be incidental or through tethered chord syndrome
Meningocele- no abnormal neurology but sac can burst causing meningitis or hydrocepahlus
Myelomeningocele- severe abnormal neurology like bladder/bowel dysfunction, club foot or paresis

43
Q

What is tethered chord syndrome

A

When inelastic tissue of caudal spine fuses to local area
Can present with pain on exercise, gait issues and neurological dysfunction

44
Q

Inheritance of muscular dystrophies

A

X-linked

45
Q

How does duchenne muscular dystrophy present

A

1-3 years of age
Delayed walking and waddling gait
Difficulty to walk stairs
Bulky calfs (pseudohypertrophy as muscle replaced by fibrotic tissue)

46
Q

Prognosis and complications of duchenne muscular dystrophy

A

Cant walk at 12
Get cardiomyopathy and resp muscular issues
Die by 20-30

47
Q

Presentation of reactive arthritis

A

GI infection, throat or UTI
3 weeks later triad of
- conjunctivitis
- arthritis
- urethritis normally first symptoms

48
Q

How does reactive arthritis arthritis present

A

Oligoathritis of large joints
Ethesitis like plantar fasciitis

49
Q

Rarer symptoms of reactive arthritis

A

Keratoderm blenhoragicum- hard nodules on feet
Balanitis- swelling of glans of penis

50
Q

What type of condition is reactive arthritis

A

Seronegative spondyloarthropathy- associated with HLA-B27 and RF negative

51
Q

Risk factors for perthes disease

A

Hyperactivity
Short stature

52
Q

What organism is associated with septic arthritis in SCD

A

Salmonella

53
Q

X-ray findings of septic arthritis

A

Joint widening
Ill defined articular margins

54
Q

Most common site of septic arthritis

A

Hip

55
Q

If patient deteriorates rapidly in osteomyeltis despite IV abx what do

A

Surgical debridement

56
Q

Most common site of osteomyelitis

A

Upper tibia or lower femur

57
Q

What is trendelenburg test in DDH

A

Positive- as hip tilts to one side

58
Q

What is a greenstick fracture

A

When bone breaks and bends
- common in at wrist when children fall forwards

59
Q

What is a greenstick fracture

A

When bone breaks and bends
- common in at wrist when children fall forwards
- no complications

60
Q

Management of greenstick fractures

A

Manipulation plaster immobilisation

61
Q

What is chondromalacia patella

A

Wearing away of cartilage in the patella

62
Q

What do if suspect transient synovitis but feverish

A

Admit

63
Q

Management of stills disease

A

1st line- NSAIDS, steroids
2nd line DMARDS like steroids
3rd line- toclizimumab

64
Q

How do gRowing pains present

A

Pain worse in joints at night

65
Q

Up until when is bowed legs normal

A

3 years

66
Q

What is pes planus

A

Flat feet

67
Q

Up until when is pes planus normal

A

4-8 years

68
Q

How does osteosarcoma present

A

Swelling around a joint
Painless most often
Reduced mobility

69
Q

What is osteochondritis dissecans pathophysiology

A

Get reduced blood flow to patella- leads to fragmentation of bone and cartilage

70
Q

Presentation of osteochondritis dissecans

A

Pain after exercise
Locking and catching of knee
Gives way easily

71
Q

How is reactive arthritis managed

A

Pain relief

72
Q

Long term complications of perthes disease

A

Short leg
Osteoarthritis

73
Q

What rfx require USS for breech detection

A

Breech delivey
FHx

74
Q

Investigations for osteomyelitis

A

Blood cultures
X-ray but wont show anything til 7 days when will see bone destruction, osteopenia

75
Q

Management of osteomyelitis and septic arthritis abx wise

A

IV flucloxacillin (clindamycin if pen allergic)
Vancomycin if MRSA

76
Q

Osteomyelitis presentation

A

Leg swelling
Immobile
Tender and erythematous
Onset insidious

77
Q

Septic arthritis presentation

A

Acute limb pain
Swelling
Not mobilising limb
Red

78
Q

Management of septic arthritis

A

IV fluclox
Joint washout

79
Q

What is gowers sign and what seen in

A

When getting up walk hands up legs and body
Duchenne muscular dystrophy

80
Q

What investigations done for duchenne muscular dystrophy

A

CK initially
If elevated gold standard now is genetic testing

81
Q

What infections can precede reactive arthritis

A

UTI
GI
Throat

82
Q

What is trethowans sign seen in and what is it

A

SUFE
Where the line of klein passess above the femoral head and does not line up with one on other side

83
Q

What is irritable hip

A

Transient synovitis

84
Q

How are growing pains managed

A

Heat packs
Pain relief if needed

85
Q

What causes joint pain and hyperextension of joints

A

Hypermobile joints

86
Q

Recurrent broken bones including bones broken in utero

A

Osteogenesis imperfecta

87
Q

Management if positive barlow and ortolani

A

USS at 6 weeks to assess

88
Q

Differences between becker and duchenne muscle dystrophy

A

Becker presents at around 10 but duchenne between 1 and 6
Becker far less severe
Becker rarer

89
Q

How does spinal muscle atrophy present

A

Difficulty to maintain head
Breathing difficulties
Weak cough and cry
Proximal muscle weakness
Hypotonia

90
Q

Inheritance of spinal muscular atrophy

A

Autosomal recessive

91
Q

Abdo mass with limp

A

Neuoblastoma
Metastasies to bones quickly and evidence of metastatic disease most common presentation

92
Q

What do first; joint aspirate or IV abx

A

Joint aspirate

93
Q

How is positional talipes differentiated from talipes equinovirus

A

In positional talipes the foot van be easily moved from position and isnt fixed

94
Q

How does dislocated knee present

A

Severe knee pain and swelling
Feeling it pop
Wanting to flex the knee

95
Q

Blood findings of osteogenesis imperfecta

A

All normal

96
Q

Presentation of meningocele

A

Protrusion of meninges through vertebrae with no abnormal neurology but are at risk of meningitis and hydrocephalus

97
Q

What is differnece between anencephaly and encephalocele

A

Anencephaly- failure of fusion of cranial neural tube which presents with with stillbirth
Enancephalocele- herniation of brain and meninges through midline skull defect

98
Q

What test is used to determine if leg shortening is tibial or femoral

A

Galleazis

99
Q

Gold standard for duchenne

A

Genetic testing

100
Q

Where do Ewings sarcomas appear vs osteosarcoma

A

Ewings- middle of long bones
Osteosarcoma- around knee

101
Q

How do Ewings sarcomas present

A

Like an infection with a fever

Paeds (17 decks)

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