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3a Child Health > MSK > Flashcards

MSK Flashcards

1
Q

What is osteogenesis imperfecta?

A

AD genetic condition leading to bone weakness, brittle bones and fractures

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2
Q

What causes osteogenesis imperfecta?

A

Mutation affecting type I collagen

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3
Q

What is the presentation of osteogenesis imperfecta?

A

Recurrent fractures, hypermobility, blue/ grey sclera, triangular face, short stature, dental problems, bone deformities, bone pain

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4
Q

What is rickets?

A

Defective bone mineralisation causing soft and deformed bones

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5
Q

Give 4 risk factors for rickets

A

Darker skin, low exposure to sunlight, colder climates, long time indoors

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6
Q

What are some causes of rickets?

A

Deficiency in vitamin D or calcium, dark skin, northern latitudes, vegan diets, coeliac disease, cystic fibrosis, fanconi syndrome

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7
Q

What is vitamin D?

A

A hormone created from cholesterol in the skin in response to UV radiation

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8
Q

What is vitamin D essential in?

A

Calcium and phosphate absorption from the intestines and kidneys
Regulating bone turnover
Promoting bone reabsorption to boost calcium

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9
Q

What is the presentation of rickets?

A

Lethargy, bone pain, bone deformity, poor growth, dental problems, muscle weakness, swollen wrists

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10
Q

What are some bone deformities of rickets?

A

Bowing of legs
Knock knees
Rachitis rosary - end of ribs expand causing chest lumps
Kyphoscoliosis
Craniotabes

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11
Q

What is craniotabes in rickets?

A

Soft skull with delayed closure of the sutures and frontal bossing

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12
Q

What is gold standard diagnosis for rickets?

A

X-ray

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13
Q

What are the two investigations that are high in rickets?

A

PTH and alkaline phosphatase

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14
Q

What is transient synovitis?

A

Irritable hip - temporary irritation and inflammation in the synovial membrane of the hip
Associated with a recent viral URTI

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15
Q

What is the presentation of transient synovitis?

A

No fever, limp, hip pain, refusal to weight bear

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16
Q

What is septic arthritis?

A

Infection inside the joint usually from haematogenous spread

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17
Q

What are the causes of septic arthritis?

A

Staph aureus - most common
Neisseria gonorrhoea - sexually active teens
Strep pyogenes
Hib
Staph epidermis - prosthetic joints

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18
Q

What is the presentation of septic arthritis?

A

Single joint, hot, swollen, red and painful
Stiffness and reduced range of motion
Refusal to weight bear
Fever, lethargy and sepsis

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19
Q

What is the management of septic arthritis?

A

Aspirate and send for crystal microscopy, gram staining and culture
Blood cultures
Empirical antibiotics
Surgical drainage and clearance

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20
Q

What is osteomyelitis?

A

Infection in the bone and bone marrow typically metaphysis of long bones

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21
Q

What is the most common site of osteomyelitis?

A

Distal femur and proximal tibia

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22
Q

What is the most common cause of osteomyelitis?

A

Staph aureus

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23
Q

What is the presentation of osteomyelitis?

A

Painful, immobile limb, swelling, tenderness, hot, refusal to weight bear, fever

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24
Q

What is the 1st line and gold standard diagnosis for osteomyelitis?

A

X-ray and MRI

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25
Q

What is the treatment for osteomyelitis?

A

6 weeks IV flucloxacilin and Rifampicin for first 2 weeks

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26
Q

What is Perthes Disease?

A

Disruption in blood flow to the femoral head causing avascular necrosis of the bone followed by revascularisation and reossification

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27
Q

What are the risk factors for Perthes Disease?

A

ADHD, deprivation, passive smoking, low birth weight

28
Q

What does Perthes Disease affect?

A

Epiphysis of the femur

29
Q

What is the main complication of Perthes Disease?

A

Soft and deformed femoral head leading to early hip osteoarthritis

30
Q

What is the presentation of Perthes Disease?

A

Slow onset
Pain in hip or groin
Limp
Reduced ROM of hip

31
Q

What are some investigations for Perthes Disease?

A

X-ray
Blood tests
Technetium bone scan
MRI

32
Q

What is discoid meniscus?

A

Developmental abnormality of the meniscus
It can be complete where the tibia is completely covered by the meniscus

33
Q

What is the presentation of discoid meniscus?

A

Visible or audible palpable snap on terminal extension
Pain
Swelling
Locking
Meniscal tear
Click during movement

34
Q

What is the diagnosis for discoid meniscus?

A

MRI

35
Q

What is the treatment for discoid meniscus?

A

Arthroscopic partial menisectomy

36
Q

What is slipped capital femoral epiphysis?

A

The head of the femur slips along the growth plate from a fracture through the growth plate

37
Q

Who is slipped capital femoral epiphysis most common in?

A

Boys, 8-15 years during a growth spurt
Also obese children

38
Q

What is the presentation of slipped capital femoral epiphysis?

A

History of minor trauma triggering onset
Hip, groin, thigh or knee pain
Painful lump
Reduced hip ROM

39
Q

What are the investigations for slipped capital femoral epiphysis?

A

X-ray (lateral frog view)
Bloods
Technectium bone scan
MRI and CT

40
Q

What is Osgood Schlatters?

A

Inflammation at the tibial tuberosity where the patella ligament inserts.

41
Q

What is the presentation of osgood schlatters?

A

Visible or palpable hard lump on tibial tuberosity
Pain in anterior aspect of knee

42
Q

What is a rare complication of osgood schlatters?

A

Full avulsion fracture where tibial tuberosity is separated from the rest of the tibia requiring surgery

43
Q

What is developmental dysplasia of the hip?

A

Structural abnormality in the hips caused by abnormal development of foetal bones in pregnancy
Instability in hips with tendency for subluxation or discloation

44
Q

What are some risk factors for developmental dysplasia of the hip?

A

Family history
Breech presentation
Multiple pregnancy
Females
First child

45
Q

When is developmental dysplasia of the hip screened for?

A

NIPE

46
Q

What are the special tests for developmental dysplasia of the hip?

A

Barlow (dislocate) and Ortolani (relocate)

47
Q

What are the investigations for developmental dysplasia of the hip?

A

USS, X-ray

48
Q

What is the management of developmental dysplasia of the hip?

A

Pavlik harness
Surgery

49
Q

What is JIA?

A

Autoimmune mediated inflammation which occurs within the joints

50
Q

What are some features of systemic JIA/ Stills?

A

Systemic illness, salmon-pink rash, high fevers, weight loss, joint inflammation and pain, splenomegaly, muscle pain, pericarditis

51
Q

What are the investigations for systemic JIA?

A

ANA and RF negative
Raised CRP, ESR, platelets and ferritin

52
Q

What is a complication of systemic JIA?

A

Macrophage Activation Syndrome - massive inflammatory response causing DIC and low ESR

53
Q

What are features of oligoarticular JIA?

A

4 or less joints, usually large
More in girls under 6
Anterior uveitis is classic

54
Q

What are some features of polyarticular JIA?

A

5 or more joints usually hands and feet
Symmetrical
RA in children basically

55
Q

What is torticollis?

A

Neck muscles spasm and your neck twists to the side

56
Q

What is the most common cause of congenital torticollis?

A

Sternocleidomastoid tumour

57
Q

Name some causes of acquired torticollis

A

JIA, meningitis, osteomyelitis, discitis, URTI, otitis media, CNS or bone tumours

58
Q

What are some investigations for torticollis?

A

Cervical spine plain x-ray
USS
CT or MRI neck

59
Q

List some causes of limp in a child under 4

A

Toddlers fracture
NAI
Osteomyelitis
Septic arthritis
Developmental dysplasia of the hip

60
Q

List some causes of a limp in a child 4-10 years

A

Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Perthes Disease

61
Q

What is the treatment for transient synovitis?

A

Rest
Physio
NSAIDs

62
Q

What investigations should you do if you suspect Septic Arthritis?
What would these investigations show?

A

Blood cultures positive
Raised WCC and CRP
X-ray shows delayed bony changes not evident for 14-21 days

63
Q

Which criteria is used to identify a child with septic arthritis?

A

Kocher’s criteria
Fever over 38.5
Cannot weight bear
ESR over 40 in 1st hour
WCC over 12

64
Q

What test can be used to identify Perthes Disease?

A

Roll test

65
Q

What are the signs of DDH?

A

Unequal leg length
Asymmetrical skin creases in thigh or buttock

3a Child Health (14 decks)

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