MSK Flashcards

1
Q

What are the RFs for septic arthritis in a child?

A
<2yrs
DM
ImmunoC
Renal failure
IVDU
Prosthetic joint
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2
Q

What are the causes of septic arthritis?

A
Haem spread
Direct inoculation
Osteomyelitis
<12m: Staph Aureus, Group B Strep
1-5: Staph Aureus, Group A Strep, H. influenza
5-12: Staph Aureus, Group A Strep
12-18: Staph Aureus, Gonorrhoea
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3
Q

How is septic arthritis investigated?

A

Bloods: FBC, CRP, Culture
USS guided aspirate
MRI
LP

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4
Q

How is septic arthritis treated?

A

IV Flucloxacillin 2-4weeks then PO
Surgery: Debridement & irrigation
Physio
Immobilise/splint

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5
Q

What is talipes?

A

Excessively turned

High medial longitudinal arch

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6
Q

What are the causes of talipes?

A
Gentic
Neuromuscular
Oligohydramnios
Uterine abnormalities
Multiple pregnancy
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7
Q

How is talipes investigated?

A

Standing

Xray: AP lateral

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8
Q

How is talipes managed?

A

Ponseti method: Stretching & Manipulate feet into correct position
Cast for 5-8w change weekly
Cut Achilles under LA
Boots for 3m nightly until 4-5yo

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9
Q

What is a cephalhaematoma?

A

Haemorrhage between periosteum & skull in newborn

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10
Q

What are the causes of a cephalhaematoma?

A

Prolonged second stage

Instrumental delivery

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11
Q

What are the signs & symptoms of a cephalhaematoma?

A
Doesn't cross fissure lines
Usually over parietal bones
Jaundice
Anaemia
Hypotension
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12
Q

How is a cephalhaematoma treated?

A

Hardens then swelling resolves (may take weeks-months)

Jaundice: Phototherapy

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13
Q

What are the red flags in an MSK exam?

A
Fever
Reduced appetite
Weight loss
Night sweats
Bruising
Lymphadenopathy
Hepatosplenomegaly
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14
Q

What tool can be used for MSK differentials?

A
VITAMIN CD
Vascular: Bleeding (haemophilia/haemangioma)
Infection: Septic arthritis/ TB/ reactive/osteomyelitis
Trauma: Inc non-accidental
Autoimmune: JIA, Lupus, HSP, IBD
Metabolic: Mucopolysaccariodes
Iatrogenic
Neoplasia: Leukaemia/ Osteosarcoma
Congenital
Degenerative
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15
Q

What are the differentials for a swollen joint

A
ARTHRITIS
Acute septic arthritis
Reactive: to infection
Trauma
Haematological: Leukaemia/ Haemophilia
Rheumatological: JIA/ JDM/ Lupus
Immunological: HSP
TB
IBD
Sacroidosis
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16
Q

What are the subtypes of JIA?

A

Oligoarthritis: 1-4joints, persistent, extended
Polyarthritis: RF +ve/-ve
Systemic onset
Psoriatic arthritis
Undifferentiated
Enthesitis related arthritis- linked to ankylosing spondylitis

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17
Q

What are the signs & symptoms of juvenile idiopathic arthritis?

A
Gradual onset
Limp
Swelling
Warmth
Stiffness
Worse after inactivity
Irritable infants
Sore throat
Rash
Fever
Fhx: Psoriasis, arthritis, Colitis, Rheumatic fever
Measure leg length
Assess muscle bulk
18
Q

How is idiopathic juvenile arthritis diagnosed?

A

Onset <16y

>6weeks of joint swelling, limited RoM, tenderness/pain

19
Q

How is idiopathic juvenile arthritis investigated?

A
Diagnosis of exclusion
Bloods: Rheumatoid factor, ANA, FBC (anaemia, thrombocytopenia, neutrophilia-systemic JIA)
Infective screen
Imaging: XR, USS, MRI
Culture aspirate
20
Q

How is idiopathic juvenile arthritis managed?

A

Avoid deformity: RoM exercises, night splints
School & family support
Monitor growth
3m uveitis screen
Counsel: Methotrexate
Analgesia: Ibuprofen, NSAIDs (Ibuprofen 30-40mg/kg)
Control disease activity: Methotrexate IM 10-15mg/m2/week

21
Q

What is the pathophysiology of hip dysplasia?

A

Shallow acetabular leading to tendon laxity
Leads to instability/subluxation
Muscle contracture & progressive acetabular dysplasia
Femoral head becomes hypoplastic

22
Q

What are the RFs for hip dysplasia?

A
FHx
Female
Left hip
Breech
Swaddled babies
Multiple pregnancy
Oligohydramnios
23
Q

What are the signs & symptoms of hip dysplasia?

A

Normal pregnancy
Delayed walking
Painless limb
Prone to falls
Neonates: Ortolani’s test-Elevat & abduct hip to reduce it, Barlow’s test-Adduct & depress femur vulnerable hip dislocates
Infant: Asymmetric gluteal folds, leg lengths, limited abduction, flex knees w/feet together one shorter
Older: Limp, +ve trendelenburg, exaggerated lumbar flexion

24
Q

How is hip dysplasia investigated?

A

USS if <6m

AP Pelvis: Shallow acetabulum, abnormal femoral head position

25
How is hip dysplasia managed?
<6w: Spont resolves <6m: Pavlik harness 6-18m: Manipulate & closed reduction 18m-2y: Trial closed reduction/ open reduction +/- pelvic osteotomy & hip spica plaster cast 2-6y: Open reduction +/- femoral shortening +/- pelvic osteotomy & plaster
26
What are the complications of hip dysplasia?
Redislocation Avascular necrosis Early osteoarthritic changes
27
What is transient synovitis/ reactive arthritis?
Inflammation following an infection Bacterial/viral anywhere in the body Different to viral associated arthritis which develops at the same time as the infection & lasts a few weeks
28
What are the signs of transient synovitis/ reactive arthritis?
``` Pain Swelling Usually lower limbs Sausage fingers/toes Systemic illness ```
29
How is transient synovitis/ reactive arthritis investigated?
Clinical diagnosis Bloods: FBC, Rheumatoid factor, ANA Stool sample
30
How is transient synovitis/ reactive arthritis managed?
``` Self-limiting Analgesia Rest Heat/ice packs Corticosteroids ```
31
What are the components of a normal stance?
Swing phase: 40% | Stance phase: 60% Heel contact, midstance, active propulsion, passive propulsion- Toe off
32
Types of abnormal gait?
Antalgic: Painful Trendelenburg Proximal muscle weakness
33
Describe Antalgic gait
Most common Quick soft steps, short stepping Stance reduced on painful side swing increases
34
Describe Trendelenburg gait
Hip disorders weakness of abductor muscles (gluteals) During stance gluteals on ipsilateral side suppose to contract Problem: hip sinks on contralateral side Effect: Child leans to one side e.g weakness on the left hip drop on the right
35
Describe proximal weakness gait
Use hands & arms to 'walk up the body'
36
In what conditions is gower's sign seen?
Weakness in proximal muscles- Duchenne muscular dystrophy
37
What form of movement is seen in someone walking who has a spastic gait?
Circumduction
38
What are the inflammatory/infectious causes of a limp?
``` Transient synovitis Septic arthritis Osteomyelitis Infectious spondylitis Juvenile Arthritis ```
39
What do the investigations show in TS
Bloods: WBC, CRP, ESR NORMAL Xrays: NORMAL
40
Osteomyelitis?
Clinical, lab, MRI diagnosis | Radiological signs only after 7-10days
41
Osteomyelitis treatment?
Abx