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Phase 3a - Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

What is osteogenesis imperfecta?

A

Genetic cdtn that results in brittle bones that are prone to fractures (brittle bone syndrome). This happens due to mutations that affect collagen formation.

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2
Q

Sx of osteogenesis imperfecta?

A
  • Blue/grey sclera
  • Hypermobility
  • Triangular face
  • Short stature
  • Joint + bone pain
  • Bone deformaties (bowed legs + scoliosis)
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3
Q

Ix for osteogenesis imperfecta?

A
  • Clinical diagnosis
  • Xrays
  • Genetic testing
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4
Q

Mx of osteogenesis imperfecta?

A

No cure but can be mx by:
* Bisphosphonates - inc. bone density
* Vit D supplementation - prevent deficiency
* Physio

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5
Q

What is rickets?

A

Defective bone mineralisation causing “soft” + deformed bones

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6
Q

Causes of rickets?

A

MC - Deficiency in vit. D or calcium
Rarely - Genetic (hereditary hypophosphataemic rickets - x-linked dominant)

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7
Q

What are bone deformities that can occur in rickets?

A
  • Bowing of legs (leg curve outwards)
  • Knock knees (leg curve inwards)
  • Rachitic rosary (ribs expand at costochondral junctions causing lumps along chest)
  • Craniotabes (soft skull)
  • Delayed teeth (enamel underdevelopment)
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8
Q

Vit D deficiency/rickets sx?

A
  • Lethargy
  • Bone pain
  • Swollen wrists
  • Bone deformity
  • Dental problems
  • Muscle weakness
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9
Q

Ix for rickets?

A
  • Serum 25-hydroxy vitamin D
  • Xray
  • Serum calcium, phosphate, PTH, alkaline phosphatase
  • Bloods - FBC, ESR, CRP, LFTs
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10
Q

Mx of rickets?

A

Vit D supplement:
* 400 IU per day for children + young people

If vit D deficiency - Vitamin D (ergocalciferol):
* If between 6 mths and 12 yrs give 6000 IU per day for 8-12 wks

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11
Q

What is transient synovitis?

A

Temporary (transient) irritation + inflammation in synovial membrane of joint (synovitis).

Sometimes referred to as irritable hip + often associated with recent viral URTI but typically do not have a fever.

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12
Q

Sx of transient synovitis?

A

Often occurs within a few wks of viral illness:
* Limp
* Refusal to wgt bear
* Groin or hip pain
* Mild low grade temp

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13
Q

Mx of transient synovitis?

A

Simple analgesia + safety net if sx get worse i.e. worsen or develop fever to attend A&E immediately

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14
Q

What is septic arthritis?

A

Infx inside a joint leading to systemic illness.

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15
Q

What are the common bacteria that causes septic arthritis?

A

MC - staph aureus
Other:
* N. gonorrhoea
* Group A strep
* H. influenza
* E.coli

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16
Q

Sx of septic arthritis?

A

Usually only affects a single joint (often knee or hip). Presents with:
* Hot, red, swollen and painful joint
* Refusing to weight bear
* Stiffness + reduced ROM
* Systemic sx i.e. fever, lethargy and sepsis

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17
Q

Ix for septic arthritis?

A

Joint aspiration for gram staining, crystal microscopy and culture

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18
Q

Tx of septic arthritis?

A

Empirical IV antibiotics
If severe - sugical drainage + joint washout

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19
Q

What is osteomyelitis?

A

Infx in bone + bone marrow typically in metaphysis of long bones. The infx may be introduced directly into the bone i.e. during open frax or travel to bone through blood.

20
Q

What is the MC bacteria that causes osteomyelitis?

A

Staph aureus

21
Q

RF for osteomyelitis?

A
  • Open bone frax
  • Ortho surgery
  • Immunocompromised
  • Sickle cell anaemia
  • HIV
  • TB
22
Q

Sx of osteomyelitis?

A
  • Refusing to use limb or weight bear
  • Pain
  • Swelling
  • Tenderness
23
Q

Ix for osteomyelitis?

A
  • 1st line - Xrays
  • GS - MRI
  • Bloods - CRP + ESR + WBCs
  • Bone marrow aspiration
24
Q

Mx of osteomyelitis?

A

Abx
Surgery if severe - drainage

25
Q

What is Perthes disease?

A

Disruption of blood flow to the femoral head causing avascular necrosis of bone. This affects epiphysis of femur.

  • Avascular necrosis = the death of bone tissue due to a lack of blood supply.
  • Epiphysis of femur = the end of the femur that connects with the hip consists of a “ball”
26
Q

Sx of Perthes disease?

A

Slow onset of:
* Pain in hip or groin
* Limp
* Restricted hip movements
* Knee pain

Note - there will be no history of trauma.

27
Q

Ix for Perthes disease?

A
  • 1st line - Xray
  • Bloods
  • Technetium bone scan
  • MRI scan
28
Q

Mx of Perthes disease?

A
  • Initial - conservative (bed rest, crutches, analgesia)
  • Physiotherapy
  • If severe - surgery
29
Q

What is slipped upper femoral epiphysis (SUFE)?

A

When head of femur is displaced (slips) along the growth plate. It’s MC in obese children.

30
Q

Sx of slipped upper femoral epiphysis?

A
  • Hip, groin, thigh or knee pain
  • Restricted hip ROM
  • Painful limp
  • Pts prefer to keep hip in external rotation

Typical exam presentation - adolescent, obese boy undergoing growth spurt

31
Q

Ix for slipped upper femoral epiphysis?

A
  • 1st line - xray
  • Bloods - infl. markers
  • CT/MRI
  • Technetium bone scan
32
Q

Mx of slipped upper femoral epiphysis?

A

Surgery - return femoral head to correct position + fix it in place to prevent further slipping.

33
Q

What is osgood-schlatter?

A

Infl. at tibial tuberosity where patella ligament inserts

34
Q

What causes osgood-schlatter?

A

Stress from running, jumping and other movements at same time as growth in epiphyseal plate.

35
Q

Sx of Osgood-Schlatter?

A
  • Visible or palpable hard + tender lump at tibial tuberosity
  • Pain at anterior aspect of knee
  • Pain exacerbated by physical activity, kneeling + on knee extension
36
Q

Mx of Osgood-Schlatter?

A
  • Ice
  • NSAIDs
  • Reduce physical activity
  • Physio + stretching once sx settle
37
Q

What is juvenile idiopathic arthritis?

A

Arthritis that affects children and young individuals under 16 yrs where the aetiology is unknown.

38
Q

Sx of juvenile idiopathic arthritis?

A
  • Arthritis lasting for 6 wks or more
  • Can affect single or multiple joints
  • Joint swelling + pain
  • Morning stiffness
  • Limited ROM
39
Q

Ix for juvenile idiopathic arthritis?

A
  • Primarily clinical dx
  • Bloods - exclude causes
  • USS/MRI of affected joints
  • Joint aspiration - rule out infx or malignancy
40
Q

Mx of JIA?

A
  • NSAIDs
  • Steroids - control infl.
  • Steroid-sparing agents - methotrexate or biological agents
41
Q

What is discoid meniscus?

A

Abnormality in knee joint where meniscus is shaped more like a disc than crescent shape

42
Q

Sx of discoid meniscus?

A
  • Popping knee sounds
  • Knee pain + swelling
  • Limited ROM
  • Instability
43
Q

What is scoliosis?

A

When spine curves abnormally to the side forming “S” or “C” shape. Usually appears during growth spurt just before puberty.

44
Q

Sx of scoliosis?

A
  • Visible curvature of spine
  • Uneven shoulders or hips
  • Protruding shoulder blade
  • Back pain
  • Restricted ROM
45
Q

Ix of scoliosis?

A
  • Forward bend test
  • Xrays
  • MRI/CT scans
46
Q

What is torticollis?

A

Cdtn where neck muscles contract involuntarily causing head to twist or tilt to one side

47
Q
A

Phase 3a - Paediatrics (14 decks)

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