locomotive

Question 1

what is septic arthritis

Answer 1

it is an infection of the synovial joint by blood infection seeding to the joint

Question 2

what is the most common age of septic arthritis

Answer 2

50% presenting < 2 yrs old

M:F 2:1

Question 3

what are the commonly affected joint?

Answer 3

knee> hip > ankle

Question 4

common pathogens causing septic arthritis in < 12 months old

Answer 4

staph aureus
group B strep
candida albcians

Question 5

common pathogens causing septic arthritis in 1-5 yrs old

Answer 5

staph aureus
Haemophilus influenza (if not immunised)
group A strep
strep pneumoniae

Question 6

common pathogens causing septic arthritis in 1-5 yrs old and if sexually abuse

Answer 6

N. gonorrhoea

Question 7

common pathogens causing septic arthritis in 5-12 yrs old

Answer 7

staph aureus

group a strep

Question 8

common pathogens causing septic arthritis in 12 - 18 yrs old

Answer 8

staph aureus

N. gonorrhoea (if sexually active)

Question 9

symptoms of septic arthritis

Answer 9

red, hot, swollen joints 
fever (only in 50% of ppl) 
restricted range of movement of affected joints 
inability to weight bear 
psuedo-paralysis
systemic infection signs

Question 10

what is psudeo-paralysis

Answer 10

voluntary restriction of movement due to pain, incoordination etc

Question 11

investigations for septic arthritis

Answer 11

FBC - raised WCC
raised CRP

x-ray of the joint - might show widening of joint space - effusion (subluxation/dislocation, joint space narrowing nad erosion changes are late signs

USS guided aspiration - for MC+S - purulent

blood culture before abx

LP - if Haemophilus influenza inc risk of meningitis

Question 12

what serious infection can septic arthritis

Answer 12

haemophilus influenza - meningitis

Question 13

management of septic arthritis

Answer 13

IV flucloxacillin + ceftriaxone
vancomycin if penicillin allergy

mini-arthrotomy - washout of the joint

splint joint - to reduce pain

physiology - to avoid joint stiffness

Question 14

prognosis of septic arthritis

Answer 14

if early intervention - good outcome

if treated late, can lead to joint destruction

Question 15

what is slipped femoral epiphysis

Answer 15

it is when the proximal femur epiphysis displaced due to the weakness of growth plate

Question 16

aetiology of slipped femur epiphysis

Answer 16

unknown - can be due to endocrine function

Question 17

RF for slipped femoral epiphysis

Answer 17

Obese children (> 95th centile)
african american
FX
puberty (accelerated growth )

Question 18

clinical features of the slipped femoral epiphysis

Answer 18

pain in groin, thigh and knee
antalgic gait
abduction + external rotation and limted internal rotation of the hip

limb shorted

thigh atrophy

Question 19

Ix for slipped femur epiphysis

Answer 19

X-ray to investigation and diagnosis

MRI can help

TFT - theortical associated link

Question 20

mx of slipped femour epiphysis

Answer 20

surgical - pin in situ allow growth

Question 21

What is perthe’s disease

Answer 21

It is avascular necrosis of femoral head

Secondary to repeated micro-trauma or follow episodes of transient synovitis and recurrent episodes of hip irritability

Question 22

What is the common age group for perthe’s disease

Answer 22

2-12 ys - adverb 7

M>F

Question 23

Clinical features of Perthe’s disease

Answer 23

Initially painless —> crush fracture develops —> pain in the hip/knee + limp

Question 24

Ix/diagnosis of perthe’s disease

Answer 24

Diagnosed by X-RAY/bone scan

Question 25

Management of Perthe’s disease

Answer 25

Symptomatic - rest, analgesia, observation if < 6 yrs old

Bracing or traction - recovery may take 2-3 years

Surgery for olde chiller if severe involvement

Question 26

Prognosis of Perthe’s disease

Answer 26

Risk of later degenerative arthritis

Worse prognosis if > 10 yrs old

Extensive femoral head deformity
Very good prognosis in children < 5 yrs old