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Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

What age group is transient synovitis (irritable hip) occurs in and what is it preceded with

A

2-12 years old. Following a viral infection

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2
Q

Presentation of transient synovitis

A

Pain only during movement in hip or limb (may be referred to knee). Decreased ROM.

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3
Q

What is an important differential of transient synovitis

A

Septic arthritis - send to A&E if suspect. Children with transient synovitis don’t have a high fever and are otherwise well.

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4
Q

Mx of transient synovitis

A

bed rest, simple analgesia -NSAID.

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5
Q

What is Perthes disease, who mainly affect

A

disruption of blood flow to femoral head, avascular necrosis of the bone. Boys between 5-10 years of age.

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6
Q

Px of Perthes

A

Slow onset of pain in hip or groin, decreased ROM. No history of trauma. Leg length discrepancy is a late sign

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7
Q

Dx of Perthes

A

Xray - joint space widening

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8
Q

Tx of Perthes

A

Dependent on diagnosis. Early diagnosis: bed rest + traction. Late: May need crutches, surgery.

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9
Q

What does Slipped Capital/upper femoral epiphysis mean

A

Where the head of the femur is displaced (slips) along the growth plate

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10
Q

Typical Px of SCFE

A

adolescent, obese 10-15 year old male undergoing a growth spurt. Vague pain - hip, groin, thigh or knee pain. Restricted ROM.

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11
Q

Ix + Mx of SCFE

A

xray. Surgery - return femoral head to correct position.

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12
Q

Px of reactive arthritis

A

arthritis, urethritis, conjunctivitis.

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13
Q

Causes of reactive arthritis

A

Usually follows infection. Enteric bacteria - shigella, campylobacteria, salmonella. Adolescents - STI. Fever usually low grade.

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14
Q

What is septic arthritis and who does it commonly affect

A

Refers to infection inside a joint. Can occur any age but most commonly under 2 Years.

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15
Q

Most common causes of septic arthritis

A

Staph aureus infection. Less common gonorrhoea, gp A strep (neonates), haem. Influenza.
Look for scratches, infected chicken pox.

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16
Q

Px of septic arthritis

A

hot, red, swollen joint. Affecting a single joint - often a knee or hip. Reduced ROM. Fever, lethargy, sepsis.

17
Q

Ix + Mx of septic arthritis

A
  • Blood cultures,CRP.
  • Aspiration of joint - gram staining, crystal microscope, culture.
  • Antibiotics - local guidelines + surgical debridement.
18
Q

What is JIA

A

chronic autoimmune inflammation in the joints before 16 years of age

19
Q

Px of JIA

A 
joint pain, swelling and stiffness (chronic i.e. 2m)
Systemic JIA (Stills disease): pink rash, fever, weight loss, lymphadenopathy (swollen lymph nodes).
20
Q

Ix of JIA

A

Raised ESR/CRP but other Ix are normal. ANA and RhF antibodies negative.

21
Q

In children that have fevers for more than 5 days what are the key non-infective differentials to remember?

A

Kawasaki, Stills disease, rheumatic fever and leukaemia.

22
Q

Mx of JIA

A
  • Initially NSAID (ibuprofen)
  • Steroids - oral or intramuscular
  • DMARDS (methotrexate) or biologics (Infliximab - TNFi)
23
Q

what is Osteogenesis imerfecta

A

= brittle bone syndrome. genetic condition that results in brittle bones that are prone to fractures.
(genetic mutations affect collagen formation)

24
Q

Px of OI

A
  • recurrent, unusual fractures (normally make you consider safeguarding)
  • hypermobility of joints
  • BLUE/grey SCLERA
  • Short, deaf, dental problems, joint/bone pain
25
Q

Dx + Mx of OI

A
  • clinical diagnosis, xrays can be useful in diagnosing fractures.
  • genetic condition cant be cured but:
  • bisphosphate to increase bone density
  • vit D to prevent deficiency
  • Physio/occupational therapy
26
Q

What is Osgood-Schlatter disease

A
  • caused by inflammation at the tibial tuberosity where the patella ligament inserts
  • common cause of anterior knee pain in adolescents
27
Q

Px of Osgood Schlatter

A
  • typically in 10-15 years
  • usually unilateral
  • visible or palpable hard and tender lump at tibial tuberosity
  • pain in anterior aspect of the knee, worse with activity
28
Q

Mx of Osgood-Schlatter

A
  • reduce physical activity
  • Ice
  • NSAIDS
  • symptoms will usually resolve over time.
29
Q

What is DDH

A
  • structural abnormality in the hips caused by abnormal development of fetal bones during pregnancy.
  • leads to instability in hips and a tendency for subluxation or dislocation
30
Q

How is DDH usually diagnsed

A

During the NIPE.

  • different leg lengths
  • restricted hip abduction on one side
  • difference in knee level when hips flexed
  • Ortolani test: gentle pressure used to abduct hips and see if hips will dislocate anteriorly
  • Barlow test: pressure placed on knees through femur to see if will dislocate posteriorly
  • clunking of hips on special tests
31
Q

Mx of DDH

A
  • Pavlik harness if baby presents at less than 6 months of age.
  • Surgery if fails or after 6 months of age

Paediatrics (14 decks)

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