MSK

Question 1

Using TIM, which conditions must be excluded before an MSK complaint is discharged?

Answer 1

Tumour/trauma

Infection/inflammation

Malignancy/Mechanical/Metabolic

Question 2

What is the function of osteoblasts?

Answer 2

Produce osteoid composed of type 1 collagen, mineralization of matrix

Question 3

What is the function of osteoclasts?

Answer 3

Remove bones tissue by removing mineral matrix and breaking organic bone

Question 4

How are synovial joints composed?

Answer 4

Covered by hyaline cartilage with joint space enclosed by synovium

Question 5

How does an inflamed synovium affect bone?

Answer 5

Excessive fluid with altered cells and increased cytokines = destroys hyaline cartilage then bone

Question 6

What is an enthesis?

Answer 6

Point of insertion of tendon, ligament, fascia or joint capsule into bone, prone to stresses

Question 7

Give one example of an inflammatory and non-inflammatory primary muscle disease

Answer 7

I: dermatomyositis

NI: Muscular dystrophy associated with calf hypertrophy

Question 8

What is Gower’s sign and which condition is it strongly associated with?

Answer 8

Functional weakness seen classically in DMD where pt. uses hands to splint legs to help them rise from sitting

Question 9

Give 4 MSK history red flags

Answer 9

• Unable to sleep, unremitting pain
• Deep pain unresponsive to pain relief
• Loss of function or altered function
• Unilateral

Question 10

What are the top 3 organisms implicated in septic arthritis?

Answer 10

Staph aureus

Strep. pneumo

Haem influenza

Question 11

How may a joint appear in septic arthritis?

Answer 11

Hot 
Swollen
Exquisitely painful 
Red
Held immobile

Question 12

In neonates, what is pseudoparalysis until proven otherwise?

Answer 12

Bone/joint sepsis

Question 13

Give 4 Tx steps in septic arthritis

Answer 13

1. ABC and resus
2. Urgent aspirate
3. Blood cultures x2
4. IV ABX

Question 14

How does osteomyelitis classically present?

Answer 14

Acutely unwell child

Pyrexia

Local erythema + tenderness

Question 15

Give 3 Tx steps in osteomyelitis

Answer 15

1. Blood cultures
2. High dose IV ABX
3. Splintage of limb

Question 16

Which disease can be cause of insidious onset septic arthritis/osteolitis with vertebral involvement?

Answer 16

Tuberculosis

Question 17

What is the cause and Tx of rheumatic fever?

Answer 17

Strep. infection

Tx: penicillin

Question 18

What is Reiter’s syndrome?

Answer 18

Post enteric/GU infection after gram negative/STI infection

Question 19

How does irritable hip present?

Answer 19

Hip pain and limp

Hip flexed and externally rotated

Question 20

How does the self-limiting condition discitis present ?

Answer 20

Child refuses to walk
Low grade fever
Lumbar spine tenderness

Question 21

What is Juvenile Idiopathic Arthritis?

Answer 21

Group of conditions where investigation aims to rule out other diagnoses

Question 22

Which conditions occurs in JIA patients and can cause blindness?

Answer 22

CHRONIC ANTERIOR UVEITIS

Question 23

Name 2 types of vasculitis common in children

Answer 23

o Henoch Schonlein purpura (HSP)

o Kawasaki disease

Question 24

Which types of Salter-Harris fractures should always be referred to ortho and why?

Answer 24

Type III and IV

Intra-articular with high risk of growth impairment and need for surgery

Question 25

Name 3 types of fractures which occur in children and not adults

Answer 25

Greenstick Buckle Plastic deformation

Question 26

What is Legg-Calve-Perthes disease?

Answer 26

Necrosis of part of femoral capital epiphysis (growth disturbance which can cause degenerative joint disease)

Question 27

How does Legg-Calve-Perthes disease present and what is the Tx?

Answer 27

Knee pain, limp, reduced hip abduction and internal rotation Tx: rest/casts/surgery

Question 28

Which condition can occur when a child rapidly grows or is obese?

Answer 28

Slipped upper femoral epiphysis (SUFE

Question 29

Name 3 risks of Developmental dysplasia of the hip

Answer 29

- 1st degree relative - Female - Breech after 35 weeks

Question 30

How is Developmental dysplasia of the hip treated at birth?

Answer 30

Splintage in abduction for 12 weeks

Question 31

Which deformities are seen in Talipes equinovarus (club foot)?

Answer 31

- Downward and inward heel | - Soles point medially

Question 32

What is scoliosis?

Answer 32

-Lateral curvature of spine, presenting at time of accelerated growth in puberty

Question 33

Give 4 back pain red flags

Answer 33

1. Under 4y/o 2. Night pain 3. Functional disability 4. Postural shift

Question 34

What are the 5S's of normal variants in children?

Answer 34

1. Symmetrical deformity 2. No symptoms underlying systemic disease or skeletal dysplasia 3. No stiffness on examination

Question 35

Name 3 benign conditions in children

Answer 35

1. Osgood Schlatter's 2. Irritable hip 3. Pulled elbow

Question 36

Name 2 conditions in which muscle enzymes like CK, LDH, AST/ALT may be elevated?

Answer 36

Muscular dystrophy Inflammatory disease

Question 37

What is the significance of ANA in JIA children?

Answer 37

Majority of ANA negative

Question 38

Name 2 pathologies which plain X-rays are good at assessing

Answer 38

Hip pathology NAI

Question 39

Which sign is seen in DMD whereby patients use their arms to splint their legs to aid standing?

Answer 39

Gower's sign