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Child Health > MSK > Flashcards

MSK Flashcards

1
Q

What is Gower’s sign?

A

When a child uses hands to ‘walk up’ their body because they have weak proximal (thigh and hip) muscles.

Seen in muscular dystrophy.

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2
Q

Describe the stages of an paediatric MSK examination?

A 
Gait
Standing
Supine (lying on back)
Prone (lying on front)
Sitting down
Abdomen (as pain can be referred here from hip)
Look for Gower's sign
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3
Q

What is lumbar hyperlordosis? In which patients is this commonly seen?

A

When the lumbar spine is curved inwards too much

Muscular dystrophy

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4
Q

What is antalgic gait?

A

When pain causes abnormal gait.

The phase of the gait in which there is weight bearing is shortened to avoid pain

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5
Q

What is short limb gait?

A

When one leg is shorter than other so pelvis moves up and down on side of shorter leg.

Looks like a lurching gait

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6
Q

What is Trendelenburg gait? What causes it?

A

The sound side sags! One hip sags down due to weakness of abductor muscles in lower limb

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7
Q

What is equinus gait? What causes it?

A

Tiptoe walking

Can just be habit, spasticity (in cerebral palsy)

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8
Q

What is steppage gait? What causes it?

A

Lifts knee up high to avoid tripping up on foot affected by foot drop

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9
Q

What is ataxic gait?

A

Uncoordinated gait, as if drunk.

Cerebellum problem, problem with joint proprioception.

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10
Q

Define valgus and varus.

A

Valgus: away from midline
(vulgur, you want to get away!)

Varus: towards midline

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11
Q

What is genu varum?

A

Feet are more towards midline and knees are away from midline

Bow legs

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12
Q

What is genu valgum?

A

Feet are away from midline, knees are towards

Knock knees

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13
Q

What is in-toeing and out-toeing? Cause? Which is more common?

A

When toes point either inwards or outwards.
Children are born with abnormalities that cause both of these.

In-toeing is more common

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14
Q

Name and briefly describe the 3 causes of in-toeing.

A

Metatarsus varus (feet look like crescent moon)

Tibial torsion (tibia is laterally rotated less that normal, so feet point to eachother)

Femoral anteversion (femoral neck is twisted forward more than usual, knees and feet point to eachother)

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15
Q

Most cases of in-toeing resolve themselves. True or false?

A

True, by age 5-8.

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16
Q

What is ‘W sitting’ a sign of?

A

Femoral anteversion, one of the causes of in-toeing

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17
Q

What is clubfoot?

A

Congenital deformity where the foot is rotated inwardly at the ankle.

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18
Q

Treatment of clubfoot?

A

Use plaster and braces to realign the foot, takes several months.
Or in severe cases surgery

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19
Q

What is developmental dysplasia of the hip?

A

AKA hip dysplasia

Actually a spectrum of disorders ranging from subluxation (partial dislocation) to frank dislocation of the hip

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20
Q

What does subluxation mean?

A

Partial dislocation of a joint

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21
Q

Treatment of developmental dysplasia of the hip?

A

If picked up early can be managed conservatively

If picked up late, more complex, may require surgery

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22
Q

Children are screened for developmental dysplasia of the hip at 6 months. True or false?

A

False

They are screened as part of the routine examination of the newborn.

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23
Q

How would a older infant present with developmental dysplasia of the hip?

A

A limp or abnormal gait
Asymmetrical skin folds around hip
Shortening of affected leg
Limited abduction of hip

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24
Q

Most cases of developmental dysplasia of the hip resolve themselves. True or false?

A

True

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25
Q

How should an infant with developmental dysplasia of the hip be monitored during treatment? What are we checking for?

A

USS
To monitor progress
To check for necrosis of the femoral head

26
Q

What is scoliosis?

What are the features seen?

A

Lateral curvature of the spine (sideways)
And rotation of the vertebral bodies causing a twisted spine

Features:

  • Asymmetry of ribs due to twisted spine, causing prominence in the back
  • Difference in shoulder height
27
Q

What are the categories of scoliosis? And list some types of scoliosis that fall in each category.

A

Idiopathic: infantile, juvenile, adolescent, adult

Neuromuscular: cerebral palsy, spina bifida, muscular dystrophy

Syndromic: Marfan’s, neurofibromatosis

Other: tumour, osteoporosis, infection

28
Q

Management of scoliosis?

A

Braces are used to slow progression or prevent worsening

Surgery if scoliosis is causing issues, spinal fusion

29
Q

What is kyphosis? Which part of the spine is most often affected?

A

Curvature of the spine in the sagittal plane (front to back)

Usually the thoracic and cervical spine

30
Q

What is torticollis?
What’s the most common cause in infants?
What are some causes in older children?

A

Abnormal head and neck position

In infants, sternomastoid tumour. This usually resolves itself and is benign.

In children: muscle spasm, secondary to ENT infection, spinal tumour, arthritis

31
Q

List the 3 most common causes of a limp in a child under 4.

A

Osteomyelitis caused by an infection is most common

Fracture of tibia or foot

Inflammatory arthritis

32
Q

List some common causes of a limp in a child aged 4 and above.

A

Stress fracture, epiphyseal fracture

Inflammatory arthritis

Perthe’s disease

Osteomyelitis

33
Q

What’s Perthe’s disease?

A

Ischaemia followed by avascular necrosis of the femoral head

Self-limiting, bone eventually regenerate and remodels.

34
Q

Pathogenesis of Perthe’s disease?

What causes Perthe’s disease?

A

Interruption of blood supply to the femoral epiphysis of the femoral head.

Followed by revascularisation and reossification over 18-36 months

Not known what the cause is

35
Q

Risk factors of Perthe’s disease?

A

Boys 5x more likely to get it than girls
Age 5-10
Rarer in non-Caucasians

36
Q

Presentation of Perthe’s disease?

A 
Insidious onset of limp + hip or knee pain
Effusion in knee
Antalgic gait
Usually unilateral
Limited ROM of hip
37
Q

Investigations of Perthe’s disease?

A

Bloods: FBC, ESR

X-ray: you’ll see increased density

38
Q

Management of Perthe’s disease?

A

If caught early enough it improves on its own.
Bed rest and traction.

In severe cases surgery

39
Q

What’s the difference between septic arthritis and osteomyelitis?

A

Septic arthritis is infection in the joint space

Osteomyelitis is infection of the bone

40
Q

Which age group is commonly affected by septic arthritis?

A

Under 2

41
Q

Pathogenesis of septic arthritis and osteomyelitis?

A

Haematogenous spread

Or from puncture wound or infected skin lesion over joint

42
Q

What’s the most common bug that causes septic arthritis and osteomyelitis?

Name some others!

A

Staph aureus

Others:
Streptococcus
H. influenzae
Kingella kingae

43
Q

Which sites are most commonly affected in osteomyelitis?

A

Distal femur

Proximal tibia

44
Q

Presentation of osteomyelitis and septic arthritis?

A

Painful, immobile joint/limb
Fever
Swelling, erythema, tenderness over area
Effusion

45
Q

Management of osteomyelitis and septic arthritis?

A

Antibiotics IV Flucloxacillin
Sometimes aspiration of joint
Surgery if very severe

46
Q

What is transient synovitis?

A

Inflammation of the synovium of the hip joint that causes pain on movement of joint.

Often follows a minor viral infection, (may be because synovial cells are similar shape to some virus antigens)

47
Q

Management of transient synovitis?

A

Bed rest, painkillers and anti-inflammatories

Gets better by itself

48
Q

List some types of JIA and briefly say

A
  1. Oligoarticular: fewer than 4 joints
  2. Polyarticular: more than 4 joints
  3. Psoriatic arthritis: link with psoriasis
  4. Enthesitis-related arthritis: childhood equivalent of ankylosing spondylitis
  5. Systemic onset JIA: systemic upset as well as joint pain
49
Q

In general what is the presentation of JIA?

A 
Swelling of joint
Morning stiffness
Loss of ROM
Pain
Deformity
Erythema, warmth
50
Q

Which subtype of JIA is this?

A 7 year old boy with painful left knee and right hip. He is limping but still able to play. He has also been struggling to read recently.

A

Oligoarticular JIA

Less than 4 joints involved, milder, association with anterior uveitis

51
Q

Which subtype of JIA is this?

A 4 year old girl with a swollen left little finger, she also has dry elbows and scalp and pitting of the nails.

A

Psoriatic arthritis

Dactylitis, psoriasis, pitting of nails

52
Q

Which subtype of JIA is this?

8 year old boy with painful hips and knees (bilateral) and right wrist. He’s unable to walk to school anymore.

A

Polyarticular JIA

More than 4 joints, severe

53
Q

Which subtype of JIA is this?

12 year old boy who started with painful feet 1 yr ago, he now also has painful legs, pelvis and spine.

A

Enthesitis related arthritis

Childhood equivalent of ankylosing spondylitis, pain and inflammation spreads from feet > legs > spine

54
Q

Which subtype of JIA is this?

13 year old girl with painful right hip and knee, salmon pink rash and low grade fever for 1 week.

A

Systemic onset JIA

Systemic illness as well as joint pain

55
Q

Why should children with JIA be referred to an ophthalmologist?

A

Because of the association between JIA (especially oligarticualr) and anterior uveitis

56
Q

Presentation of anterior uveitis?

A

Often nothing until late stage when there is loss of vision

Can get painful, red eye

57
Q

Which of the JIA’s has associated mortality? Why?

A

Systemic onset JIA

Internal organ involvement, hepatitis, splenomegaly etc.

58
Q

Management of JIA?

A

Painkillers: Paracetamol

NSAIDS: ibuprofen, diclofenac, naproxen

DMARDS: methotrexate

Biologics: etanercept, infliximab

Steroids: injection or oral, prednisolone

59
Q

Differential diagnosis of systemic onset JIA?

A

Malignancy: ALL, lymphoma
Septic arthritis
IBD (can sometimes start as arthritis)

60
Q

Investigations of joint pain?

A

Bloods:

  • FBC (anaemia, leucocytes)
  • ESR/CRP
  • ANA
  • Rheum factor
  • HLA B27

Imaging:

  • XR
  • USS can show effusion
  • (MRI)
61
Q

What are some complications of JIA?

A

Joint deformity, destruction

  • narrow joint spaces
  • swan neck, boutonniere
  • subluxation

Anterior uveitis (can lead to blindness)

Growth restriction

Osteoporosis

Emotional (physical limitations, missing school etc)

62
Q

What is Osgood-Schlatter disease?
Presentation?
Who gets it?

A

Inflammation of the patellar ligament at the tibial tuberosity.

It is characterized by a painful bump just below the knee that is worse with activity and better with rest.

Episodes of pain typically last a few weeks to month.

Sporty teenagers

Child Health (17 decks)

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