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Paediatrics > Locomotor > Flashcards

Locomotor Flashcards

1
Q

What must always be ruled out with presentation of joint pain?

A

Septic Arthritis

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2
Q

What are the commonest acute causes of a painful limp in 1-3 year olds?

A

Septic arthritis
Transient synovitis
Trauma/ Non accidental injury

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3
Q

What is transient synovitis?

A

‘Irritable hip’ - commonest cause of acute hip pain in children aged 2-12 years. Usually follows a viral illness and ROM is limited but no pain at rest

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4
Q

Management of transient synovitis?

A

Bed rest + treatment of viral symptoms

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5
Q

What are the commonest causes of chronic painless limp in a child aged 1-3?

A

Developmental dysplasia of the hip/talipes
CP
Unequal leg length
Juvenile idiopathic arthritis

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6
Q

At what age would you suspect Perthe’s disease as a diagnosis?

A

5-10 years

Mainly affects boys (5:1)

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7
Q

What is perthe’s disease?

A

Ischaemia of the femoral epiphysis and results in avascular necrosis of the joint

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8
Q

How is Perthe’s disease diagnosed?

A

X - ray: shows increased density of femoral head

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9
Q

How does Perthe’s disease present?

A

Insidious onset of hip pain or limp

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10
Q

How is Perthe’s disease managed?

A

If caught early: bed rest + physio

If late: may need cast and fixation in abducted position using calipers or surgery

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11
Q

What are the malignancies that commonly cause bone/joint pain?

A

Neuroblastoma (0-5 years)
Osteosarcoma (5-15 years)
Ewing’s sarcoma (0-15 years)

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12
Q

What is Ewing’s sarcoma?

A

Malignant, small, round blue cell tumour found in bone or soft tissue

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13
Q

What must you consider in children reaching adolescent presenting with joint pain?

A

Mechanical overuse due to sport

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14
Q

At what age is septic arthritis most common?

A

Under 2 years old

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15
Q

How does septic arthritis present?

A

Single, hot, red and swollen joint
Painful on movement but also at rest
Systemically unwell
Infant keeps it still and cries if it is moved

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16
Q

What is the main cause of septic arthritis?

A

Staph Aureus

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17
Q

What investigation would you do for septic arthritis?

A

FBC, ESR, CRP, blood culture
Joint aspirate (MC&S)
X ray
In child who is unwell - may consider LP

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18
Q

Management of septic arthritis?

A

Admission!
IV Abx - flucloxacillin, Ben pen for 3 weeks
Oral course after for 4-6 weeks
Infants given 3rd gen ceph to cover H. Influenzae
Physio to avoid stiffness

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19
Q

How common is developmental dysplasia of the hips?

A

1% of children

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20
Q

What is DDH?

A

Mal development of hip/acetabulum so they don;t fit together properly

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21
Q

What are the risk factors for DDH?

A 
The 4 'Fs'
Frank breech position
FH
Female
First born
22
Q

How do you test for DDH?

A

Barlow’s and Ortolani’s tests

23
Q

What is Barlow’s test?

A

With hips in adducted position, apply some pressure posterioirly to the knees. Positive result is when a clunk is felt as the hip slides out of the acetabulum

24
Q

What is Ortolani’s test?

A

With hips in abducted position, apply pressure using finger to the femurs. A dislocated hip will not abduct fully and clunk back into place doing this maneuver

25
Q

What must be checked for early to prevent limp/abnormal gait in later life?

A

Developmental dysplasia of hips

26
Q

How is DDH managed

A

Pavlik’s harness - holds hip in place (abducted) for 3 months whilst acetabular rim develops

27
Q

What is the commonest form of arthritis in children?

A

Reactive arthritis

28
Q

What is reactive arthritis?

A

acute inflammatory arthritis occurring with or following an infection, but without evidence of causative organism in joint. Clasically, gastroenteritis

29
Q

What infections should be suspected in adolescents with reactive arthritis?

A

STI - chlamydia, gonorrhoea

30
Q

What is reiter’s syndrome?

A

Combination of arthritis, urethritis, uveitis

associated with reactive arthritis

31
Q

How is reactive arthritis managed?

A

NSAIDs and rest

32
Q

What is juvenile idiopathic arthritis?

A

Persistent joint swelling lasting more than 6 weeks and presenting before 16 years old. In absence of infection

33
Q

What are the subtypes of Juvenile idiopatic arthritis?

A

Oligoarthritis (most common, 1-4 joints)
Pauciarticular, ANA positive (4+ joints)
Polyarticular, RF negative/positive (4+ joints)
Psoriatic Arthritis
Enthesitis-related arthritis (where tendons attach to bone)
Systemic (still’s disease)

34
Q

When is the pain/stiffness worse in JIA?

A

Morning and after periods of inactivity

35
Q

What is the management for JIA?

A

Need to sort pain and inflammation + keep ROM
NSAIDs
Corticosteroid injections
DMARDs - methotrexate is first line if multiple joints
Biological drugs e.g infliximab

36
Q

In a child with JIA, what must be consistently screened for?

A

Uveitis - often common and asymptomatic in pauciarticular JIA

37
Q

What investigations should be done in JIA

A

ANA blood test
ESR
CRP
X rays

38
Q

What is slipped upper femoral epiphysis?

A

Displacement of the epiphysis of the femoral head potero-inferiorly

39
Q

What group of patients is SUFE most common

A

Fat, growing teenage boys (10-15 years)

40
Q

Is acute of chronic presentation of SUFE more common?

A

Chronic - gradual slipping of the epiphysis

41
Q

How is SUFE classified?

A

Stable - can walk (90%)

Unstable - can’t walk (10 %)

42
Q

How is SUFE managed?

A

Rest and surgery (pin used to fix hip in place)

If acute and large displacement, need urgent surgery to prevent avascular necrosis

43
Q

What is Osgood-schlatter disease?

A

Multiple tiny fractures at point where quads insert into tibia. Caused by exercise so seen in active adolescents

44
Q

How does Osgood-schlatter present?

A

Pain and swelling at tibial tuberosity
Relieved by rest
Pain provoked by knee extension against resistance

45
Q

Treatment of Osgood-schlatter?

A

RICE
Simple analgesia
Reduce physical activity

46
Q

What is the pathological cause of Genu Varum?

A

Rickets

47
Q

Which congenital condition do you see per planus?

A

Elhers-Danlos

48
Q

Which organism most commonly causes osteomyelitis?

A

Staph Aureus (others include strep and H. Influenzae)

49
Q

What is Still’s disease?

A

Systemic arthritis - arthritis with at least 2 weeks of daily fever

50
Q

How does Still’s disease present?

A

A daily high spiking fever.
A salmon rash with fever.
It is usually symmetrical and affects several joints

Paediatrics (2 decks)

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