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Paeds > MSK > Flashcards

MSK Flashcards

1
Q

what is the term for bow legs

A

genu varum

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2
Q

pathological cause bow legs

A

rickets, blounts disease

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3
Q

what do bow legs look like

A

knees far apart

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4
Q

what is the term for knock knees

A

genu valgum

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5
Q

what does knock knees look like

A

feet wide apart

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6
Q

usual age of genu varum (bow leg)

A

1-3 y. normal toddler broad based gait

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7
Q

usual age of genu valgum (knock knees)

A

2-7y

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8
Q

what is the term for flat feet

A

pes cavus

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9
Q

when are flat feet common

A

in hypermobility

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10
Q

how do flat feet children present

A

standing on tiptoe

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11
Q

3 main causes of in toeing

A

metatarses varus (infants), medial tibial torsion, persistent anteversion of the femoral head

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12
Q

what is out toeing

A

uncommon, may occur in infants 6-12m

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13
Q

associations out toeing

A

hypermobility, Ehlers Danlos, Marfans

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14
Q

what can be a cause of toe walking

A

mild cerebral palsy, tightness of the Achilles tendon, inflammatory athritis

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15
Q

how do you check for DDH

A

neonatal screening- see if hip can be dislocated posterior out of the acetabulum (barlow manoeuvre) or relocated back in (ortolani)

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16
Q

presentation DDH

A

limp, abnormal gait, asymmetry skinfolds around hip, limited abduction of hip, shortening of affected leg

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17
Q

management DDH

A

splint or harness to keep hip flexed and abducted for a few months. surgery if fails

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18
Q

complications DDH

A

necrosis of femoral head

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19
Q

when do growing pains affect children

A

3-12 years. (nocturnal idiopathic pain)

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20
Q

presentation growing pains

A

wake in the night with pain, symmetrical pain in lower limbs doesnt radiate. never presents at the start of the day on waking

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21
Q

are physical activities affected in growing pains

A

no- no limp. physical exam normal

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22
Q

presentation hypermobility

A

MSK pain in the lower limbs often worse after exercise, join swelling absent. hyperextendable thumbs, elbows, knees, flat feet

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23
Q

advice for hypermobility

A

footwear, exercises, orthotics

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24
Q

associations hypermobility

A

downs, collagen- Ehlers Danlos, Marfans

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25
Q

causes of acute onset limb pain

A

trauma, NAI, osteomyelitis, tumour

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26
Q

what is osteomyelitis

A

infection of metaphysis of long bones. distal femur and proximal tibia

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27
Q

how is the infection spread in osteomyelitis

A

haem or direct spread from infected wound

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28
Q

what may osteomyelitis lead to

A

septic arthritis

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29
Q

what is the main cause of osteomyelitis

A

staph aureus (others- strep, H influenza)

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30
Q

presentation of osteomyelitis

A

painful immobile limb, acute febrile illness, swelling and tender over site, erythematous and warm, moving the limb causes severe pain

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31
Q

investigations in osteomyelitis

A

cultures, MRI, WCC and acute phase reactant increased, X ray, radionuclide bone scan increases uptake

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32
Q

treatment osteomyelitis

A

antibiotics. initially in a splint then mobilise the affected limb

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33
Q

what do you want to prevent in osteomyelitis

A

necrosis, chronic infection, limb deformity

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34
Q

bone pain due to malignant disease

A

ALL, neuroblastoma, osteogenic sarcoma, osteoid osteoma

35
Q

what is a benign tumour present in teenagers especially males

A

osteoid osteoma

36
Q

what is important when assessing a painful knee

A

check the hip as pain from the hip can be referred to the knee

37
Q

what is osgood schlatter disease

A

osteochondritis of the patellar tendon inserting into knee

38
Q

who does osgood schlatter disease affect

A

adolescent active males

39
Q

presentation osgood schlatter disease

A

knee pain after exercise, tender, swelling, hamstring tenderness.

40
Q

management osgood schlatter

A

decreased activity, physio, strengthening, hamstring stretches, orthotics

41
Q

what is chondromalacia patellae

A

softening of articular cartilage of patella

42
Q

who does chondromalacia patellae typically affect

A

adolescent females

43
Q

presentation chondromalacia patellae

A

pain when standing up from sitting, walking up the stairs

44
Q

associations chondromalacia patellae

A

flat feet and hypermobility

45
Q

is back pain worrying in young

A

yes

46
Q

mechanical causes back pain

A

muscle spasm, soft tissue pain- sport related, poor posture, abnormal loading

47
Q

causes back pain

A

mechanical, tumours, vertebral osteomyelitis, spinal cord/root entrapment, spondylosis, complex regional pain syndrome

48
Q

red flags back pain

A

young age, high fever, night waking, persistent pain, painful scoliosis, focal neuro signs, weight loss, systemic malaise

49
Q

causes of acute limp in 1-3 yr

A

infection, transient synovitis, trauma, malignancy

50
Q

causes chronic limp 1-3 y

A

DDH, talipes, neuromusc eg CP, JIA

51
Q

causes acute limp 3-10 yrs

A

transient synovitis, septic arthritis/osteomyelitis, trauma, perthes, JIA, malignancy, complex regional pain syndrome

52
Q

causes chronic limp 3-10 yrs

A

perthes, NMD eg DMD, JIA, tarsal coalition

53
Q

causes acute limp 11-16 yrs

A

mechanical- trauma, sport, slipped capital femoral epiphyses, avascular necrosis of femoral head, reactive arthritis, JIA, septic arthritis, bone tumours/malignancy, CRPS

54
Q

what is the most common cause of acute hip pain in children 2-12yr

A

transient synovitis

55
Q

what does transient synovitis usually accompany

A

viral infection

56
Q

presentation transient synovitis

A

sudden onset, no pain at rest, decreased range of movement, may be referred to the knee, afebrile or mild fever, doesn’t appear ill

57
Q

what can transient synovitis precede in some children

A

perthes disease

58
Q

what is perthes disease

A

avascular necrosis of capital femoral epiphysis of femoral head due to interruption of blood supply

59
Q

who does perthes disease mainly affect

A

boys. 5-10y

60
Q

how does recovery take place in perthes

A

revascularisation and reossification follows it over 18-36m.

61
Q

presentation perthes disease

A

insidious onset- limp, hip or knee pain. bilat in 10-20%.

62
Q

what signs are seen on x ray in perthes

A

early- increased density femoral head. fragments and irregularities

63
Q

management perthes

A

early- bed rest and traction. if seen late- maintain hip in abduction with plaster or calpers. pelvic or femoral osteotomy

64
Q

what is the prognosis of perthes

A

good. but if older, and more extensive involvement can have deformity of femoral head

65
Q

signs of an acute arthritis

A

pain, redness, swelling, heat, restricted movement, systemically unwell with fever

66
Q

what is the most common form arthritis in children

A

reactive arthritis

67
Q

presentation reactive arthritis

A

transient joint swelling

68
Q

what does reactive arthritis follow

A

extra articular infection. in children- enteric bacteria- shigella, salmonella, campylobacter, yersinia

69
Q

other causes reactive arthritis

A

viral infections, STI, mycoplasma

70
Q

treatment reactive arthritis

A

NSAIDs

71
Q

when is septic arthritis common

A
72
Q

what organism is implicated beyond the neonatal period in septic arthritis

A

staph aureus

73
Q

what can lead to septic arthritis

A

osteomyelitis

74
Q

presentation septic arthritis

A

erythematous, warm, acutely tender joint, reduced range of movement, acutely unwell febrile child, infants often hold limbs still (pseudoparesis), usually affects only one joint

75
Q

what may initial presentation be in septic arthritis

A

limp referred to knee

76
Q

investigations in septic arthritis

A

incr WCC, incr acute phase reactant, cultures, ultrasound, x ray, bone scan, MRI

77
Q

management septic arthritis

A

joint aspiration- definitive investigation. prolonged course of antibiotics

78
Q

what is juvenile idiopathic arthritis

A

joint swelling >6 weeks before 16yrs in absence of infection or other cause

79
Q

features JIA

A

gelling (stiff after periods of rest), morning joint stiffness and pain. in the young child- limp or behaviour change

80
Q

long term results of JIA

A

may be expansion of bone from overgrowth- leg lengthening causing valgus deformity, hands, wrist.

81
Q

complications JIA

A

chronic anterior uveitis, flexion contractures of joints, growth failure, osteoporosis, constitutional, amyloidosis

82
Q

management JIA

A

NSAIDs, joint injections (1st line oligoarthritis) , methotrexate (polyarthritis), corticosteroids, biologics and immunotherapies

83
Q

how many patients go on to have active adult disease in JIA

A

1/3

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