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Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

Causes of limp in infants (1-3)

A 
Acute: 
Infection - Septic arthritis, osteomyelitis 
Transient synovitis 
Trauma 
Malignancy - leukaemia, neuroblastoma

Chronic:
DDH
Neuromuscular - cerebral palsy
Juvenile idiopathic arthritis

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2
Q

Causes of limp in school aged children (3-10)

A 
Acute: 
Transient synovitis 
Septic arthritis/osteomyelitis 
Trauma and overuse injuries
Juvenile idiopathic arthritis
Perthes disease 
Malignancy 
Complex regional pain syndrome

Chronic:
Perthes disease
Neuromuscular - duchenne muscular dystrophy
JIA

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3
Q

Causes of limp in adolescents (11-16)

A 
Acute: 
Mechanical - trauma, overuse, sports 
Slipped capital femoral epiphysis
AVascular necrosis of femoral head
Osteochondritis dissecans of knee
JIA
Reactive arthritis
Septic arthritis/osteomyelitis 
Malignancy
Complex regional pain syndrome

Chronic:
Slipped capital femoral epiphysis
JIA
Tarsal coalition

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4
Q

Investigations for limp/swollen joint

A 
FBC - raised wcc
CRP
ESR - sensitive for bone involvement/septic arthritis 
Blood culture 
X Ray - 2 views, both joints 
USS - effusion
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5
Q

Clinical features of transient synovitis

A 
2-12 year old 
Preceding upper respiratory infection
Acute painful limp, non-weight bearing 
Hip pain - Not rest, pain on movement 
Restriction of movement - limited internal rotation 
Afebrile
Appears well
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6
Q

Define Perthes disease

A

Self-limiting disease of femoral head, comprising of avascular necrosis, revascularisation, reossification due to interruption of blood supply

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7
Q

Clinical features of perthes disease

A 
School aged (<10) 
Boys (5:1 ratio) 
Insidious onset 
Chronic limp - painless 
Limited range of motion at hip joint 
asymmetric leg length 
Increased folds at hip joint 
Bilateral in 10%
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8
Q

Management of transient synovitis

A

Bed rest

May be preceding perthes disease

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9
Q

Investigations for perthes disease

A 
FBC 
ESR
CRP
Bilateral hip X Rays 
Bone scintigraphy
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10
Q

Define slipped capital femoral epiphysis

A

Displacement of epiphysis of femoral head due to weakness in proximal femoral head

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11
Q

Clinical features of slipped capital femoral epiphysis

A 
Adolescents
Acute painful limp / Chronic limp
Hip pain 
Referred knee pain 
Restricted range of motion if hip joint
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12
Q

Causes of slipped capital femoral epiphysis

A

Weak epiphyseal plate:
Pubertal hormones
Hypothyroidism, endocrine
Obesity

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13
Q

Define transient synovitis

A

Self limiting inflammatory disorder of hip that occurs commonly in young children (2-12)

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14
Q

Causes of swollen joint

A

Infective - septic arthritis, reactive arthritis, rheumatic fever
IBD
Vasculitis - henoch shonlein purpura, Kawasaki
Haematological - haemophilia, sickle cell
Malignancy - leukaemia, neurovlasfom
Connective tissue - JIA, SLE, polyarteritis nodosa

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15
Q

What is reactive arthritis

A

Inflammatory arthritis that occurs after exposure to enterococcal or genitourinary infections

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16
Q

Causes of reactive arthritis

A

Enterococcal bacteria: Salmonella, Shigella, Campylobacter, Yersinia
STIs: chlamydia, gonococcus

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17
Q

Clinical features of reactive arthritis

A

Transient joint swelling (<6wks)
Preceding infection
Arthritis - asymmetrical oligoarthritis of lower joints
Triad - arthritis, urethritis, conjunctivitis

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18
Q

Causes of septic arthritis

A

Haematogenous spread
Direct - puncture injury, chicken pox, osteomyelitis

Streptococcal, staphylococcal - most common
Haemophilus influenzae

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19
Q

Clinical features of septic arthritis

A

Acute onset swollen joint
Acute painful limp, non weight bearing
Acute pain - pseudoparalysis/holds limv still
Reduced range of movement
Febrile
Appears unwell
Erythematous, swollen, tender, restricted joint

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20
Q

Kocher criteria for septic arthritis

A

Non weight bearing
Temp >38.5
ESR raised
WBC raised

3 = 90% diagnostic

21
Q

Management of septic arthritis

A

IV antibiotics 2 weeks

Joint washout

22
Q

Prognosis of septic arthritis

A

Delayed treatment can cause irreversible Joint destruction and subsequent disability

23
Q

Define juvenile idiopathic arthritis

A

Persistent joint swelling (>6 weeks) presenting before 16 years old in absence of infection or any other cause

24
Q

Clinical features of JIA

A 
Joint swelling
Limp 
Joint pain 
Gelling - stiffness after rest
Morning stiffness
25
Q

Clinical features of oligoarthritis JIA

A

Persistent: 1-4 joints affected for 6 months
Extended: >4 joints affected > 6 months
Chronic anterior uveitis in 20%
ANA +/-

26
Q

Clinical features of polyarthritis RF -ve

A

> 4 joints affected

Chronic anterior uveitis

27
Q

Clinical features of polyarthritis RF +ve

A

> 4 joints affected
RF +ve
Rheumatoid nodules

28
Q

Clinical features of systemic arthritis

A

Arthritis in at least 1 joint
Preceded by 2 week fever
Associated with: macular rash, lymphadenopathy, hepatosplenomegaly, serositis

Anaemia, raised WCC + platelets + CRP/ESR

29
Q

Clinical features of Psoriatic arthritis

A

Arthritis + psoriasis

Arthritis + 2 of: nail pitting, dactylitis, onycholysis, family hx of psoriasis

30
Q

Clinical features of enthesitis-related arthritis

A

Arthritis - lower limb, lumbar spine, sacroiliac joint
Enthesitis
Male >6year old
acute anterior uveitis, Reiter’s Syndrome
HLAB27+

31
Q

Complications of JIA

A

Chronic anterior uveitis - cataracts, glaucoma, visual impairment
Flexion contractures - held in comfortable position
Growth failure - generalised, localised overgrowth (leg length discrepancy, valgus deformity), localised undergrowth (micrognathia-jaw)
Osteoporosis
Delayed puberty
Anaemia of chronic disease

32
Q

Management of JIA

A 
Paediatric rheumatology referral 
Physiotherapy 
NSAIDs, analgesia
Corticosteroid joint injections 
Methotrexate
Systemic corticosteroid - induction agent, avoid long term
Biologics - refractory to methotrexate
33
Q

Define developmental dysplasia of hip

A

spectrum of disorders of the femoral head and acetabulum, ranging from hip dysplasia, subluxation to dislocation

34
Q

Clinical features of ddh

A 
Detected on screening 
Limp 
Abnormal gait
Asymmetrical skin folds at hip
Leg length discrepancy 
Limited hip abduction
35
Q

When is DDH screened for

A

Neonatal screening

8 week baby check

36
Q

What are the screening tests for DDH

A

Barlow maneovre: to see of hip is dislocatable; move femoral head down and adduct
Ortolani maneovre: to revert femoral head into acetabulum; abduct head and up, hear ‘clunk’

37
Q

Investigations for DDH

A

Uss hip

X Ray

38
Q

Cause of osteomyelitis

A

Haematogenous spread
Direct spread - skin infection

Staph aureus, streptococcus, H influenzae, salmonella, TB

39
Q

Pathophysiology of osteomyelitis in children

A

Infection of metaphysis of long bones - distal femur, proximal tibia
In infants before maturation of growth plate - spread to cause joint destruction and arrested Growth
Children with mature growth plate - spread limited
Septic arthritis - if joint capsule inserted below growth plate, hips
Subperiosteal abscess

40
Q

Clinical features of osteomyelitis

A

Acute painful immobile limb
With Acute febrile illness
Swelling, erythema, warmth, tenderness at infected site
Severe pain on movement

41
Q

Investigations for osteomyelitis

A

FBC - wcc
CRP, ESR
Blood cultures
X Ray - takes 7 days for bone rarefaction (osteopenia) and subperiosteal new bone formation to appear

42
Q

Management of osteomyelitis

A

Antibiotics IV 2 weeks
+ immobilisation with splint

Surgical drainage - if unresponsive to antibiotics

43
Q

Define Rickets

A

Failure in mineralisation of growing bone

44
Q

Physiology of vitamin D metabolism

A

Intake: diet, synthesis in skin by UVB (cholecalciferol)
Hydroxylated by liver to calcidiol
Hydroxhlated in kidney to calcitriol - active form
Causes bone calcification + intestinal absorption

45
Q

Pathophysiology of rickets

A

Low serum calcium
Triggers PTH secretion
Increased calcitriol synthesis + renal calcium reabsorption + bone resorption
Normalised serum calcium but bone demineralisation

46
Q

Causes of rickets

A

Nutritional:
Decreased sunlight exposure
Maternal vitamin D deficiency
Exclusive breastfeeding into late infancy - deficient in Ca, phosph, vit D
Prolonged parenteral nutrition in infancy - deficient in phosphorus

Intestinal malabsorption - coeliac, CF
Defective production of calcidiol - chronic liver disease
Increased metabolism of calcidiol - antiepileptics
Defective production of calcitriol - CKD

47
Q

Clinical features of rickets

A

Craniotabes - softening of skull, parietal/occipital bones
Rachitic rosary - palpable costochonral junctions
Widened wrists, ankles - expansion of metaphysis
Harrison’s sulcus - horizontal depression on lower chest wall at site of attachment of diaphragm
Bowing of legs (weight bearing)
Poor growth/short stature
Delayed closure of anterior fontanelle

48
Q

Diagnosis of rickets

A

Feeding history

Serum calcium
Serum phosphate
LFTs - ALP high
Serum 25-hydroxyviramin D (low)
Serum PTH (high)
U+E

X Ray wrist - metaphyseal fraying, widened epiphyseal plate

49
Q

Management of rickets

A

Diet: oily fish, egg yolks, milk, dairy, breakfast cereals
Vitamin D3/cholecalciferol Supplementation
Calcium supplementation
Monitoring: ALP, calcidiol, calcium, phosphorus, X Ray

Paediatrics (15 decks)

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