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Paediatrics > MSK > Flashcards

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
Q

How is hip dysplasia managed?

A

<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
Q

What are the complications of hip dysplasia?

A

Redislocation
Avascular necrosis
Early osteoarthritic changes

27
Q

What is transient synovitis/ reactive arthritis?

A

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
Q

What are the signs of transient synovitis/ reactive arthritis?

A 
Pain
Swelling
Usually lower limbs
Sausage fingers/toes
Systemic illness
29
Q

How is transient synovitis/ reactive arthritis investigated?

A

Clinical diagnosis
Bloods: FBC, Rheumatoid factor, ANA
Stool sample

30
Q

How is transient synovitis/ reactive arthritis managed?

A 
Self-limiting
Analgesia
Rest
Heat/ice packs
Corticosteroids
31
Q

What are the components of a normal stance?

A

Swing phase: 40%

Stance phase: 60% Heel contact, midstance, active propulsion, passive propulsion- Toe off

32
Q

Types of abnormal gait?

A

Antalgic: Painful
Trendelenburg
Proximal muscle weakness

33
Q

Describe Antalgic gait

A

Most common
Quick soft steps, short stepping
Stance reduced on painful side swing increases

34
Q

Describe Trendelenburg gait

A

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
Q

Describe proximal weakness gait

A

Use hands & arms to ‘walk up the body’

36
Q

In what conditions is gower’s sign seen?

A

Weakness in proximal muscles- Duchenne muscular dystrophy

37
Q

What form of movement is seen in someone walking who has a spastic gait?

A

Circumduction

38
Q

What are the inflammatory/infectious causes of a limp?

A 
Transient synovitis
Septic arthritis
Osteomyelitis
Infectious spondylitis
Juvenile Arthritis
39
Q

What do the investigations show in TS

A

Bloods: WBC, CRP, ESR NORMAL
Xrays: NORMAL

40
Q

Osteomyelitis?

A

Clinical, lab, MRI diagnosis

Radiological signs only after 7-10days

41
Q

Osteomyelitis treatment?

A

Abx

Paediatrics (26 decks)

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