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Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

What is a congenital cause of Osteoporosis on Children

A
  • Osteogenesis Perfecta: Brittle Bone disease
  • Majority AD
  • Inherited disease of Type 1 collagen
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2
Q

What are the signs of Osteogenesis Imperfecta (OI)

A 
Joint laxity and fragility 
Bone Fractures and Deformity 
Low density, BRITTLE, fragile bones
Poor Growth
Bone Pain 
Impaired Mobility 
Deafness, hernias and Valvular Prolapse
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3
Q

What can OI be mistaken for

A

Child abuse

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4
Q

How do you class OI

A

Type 1: mildest and commonest - blue sclerosae and hearing loss
Type 2: lethal form - born with multiple factors and blue sclerae
Type 3: Severe form - Fractures at birth and progressive deformity - blue/white sclerae
Type 4: Moderate form: fragile bones and white sclerae

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5
Q

How do you Ix OI

A

X-ray: many fractures, osteoporotic bones, bowing deformity of long bones
Histology: immature disorganised bone

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6
Q

How do you treat OI

A

Prevent Injury: Physio, Rehab and Occy health
Osteotomy: to correct deformity
Bisphosphates

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7
Q

What is the most common cause of Septic Arthritis and what are its risk factors

A

Staph Aureus - children 2yrs
Strep B - neonates
Neisseria Gonorrhoeae - adolescents

  • Prematurity
  • C-section
  • Invasive procedures
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8
Q

How does septic arthritis present

A
  • Temp and vital signs to exclude haemodynamic instability
  • Localized swelling
  • Effusion, tenderness, warmth
  • Position of comfort – flexion, abduction, and external rotation
  • Severe pain with passive ROM
  • Unwillingness to move joint
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9
Q

What are the 4 prognostic signs for septic arthritis

A 
Kocher Criteria 
- Temp - >38.5
- WCC - > 12
- ESR - > 40 
- Non weightbearing 
(3 or more high chance septic arthritis)
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10
Q

What Ix should you do for septic arthritis

A

Blood Culture +/- US guided Aspiration

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11
Q

Whats is the treatment for septic arthritis and what are complications

A

Urgent surgical drainage and lavage of joint
IV Antibiotics e.g flucloxacillin

operative rarely indicated for Gonorrhoea

Complications; 
Femoral Head destruction 
Deformity 
Joint Contracture 
Limb Length Discrepancy
Gait Abnormalites
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12
Q

What is Transient Synovitis of the Hip

A

Inflammation of the Synovium causing hip pain

May be a mild/absent fever

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13
Q

What is the cause Transient Synovitis

A

Considered to precede a viral illness e.g URTI
OR
Bacterial Infection e.g post strep toxic synovitis
OR
trauma or allergy

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14
Q

How do you examine for Transient Synovitis and what would be found on Ix

A

Pain in extremities of movements

Normal bloods and radiology

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15
Q

What is the treatment for Transient Synovitis

A

Selflimiting usually resolved by 1-2 weeks

Rest and Analgesia

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16
Q

What is Perths Disease

A

Avascular necrosis (caused by lack of blood supply) of the femoral head/epiphysis - leading to bone remodelling distorting the epiphysis/femoral head

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17
Q

What is Perths most common in

A

3 - 11 yr old boys

Cause unknown

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18
Q

How does Perthes Disease present

A
  • Pain in knee and hip causing limp
  • Gait disturbance - antalgic, trendelenburg gait
  • Late finding - limb length discrepancy
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19
Q

What will be found on examination of Perthes Disease

A

Movement of hip limited

Especially internal rotation and abduction

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20
Q

What investigations may be performed in Perthes

A

X- ray and MRI

  • Joint space widening - due to decrease size of femoral head
  • Collapse and Deformity of femoral head
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21
Q

What is the prognosis of Perthes

A

Risk of early onset OA and hip replacement in deformed hip

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22
Q

What is the treatment for Perthes disease

A

Lateral Pillar Classification:
Group A - Height of Lateral Pillar is 100%
Group B - Height of Lateral Pillar is >50%
Group C - Height of Lateral Pillar is <50%

Conservative treatment: limited weight bearing, physical therapy, bed rest and NSAIDS:

  • Young children (< 6y of age) usually do well
  • Lateral pillar A classification
  • Femoral head mostly undamaged
  • Consider casting and bracing before surgery if femoral head deformity develops or range of motion worsens

Surgery: femoral osteotomy
Older children (> 8y of age)
Lateral pillar B/C classification
Extensive damage to the femoral head

  • Group C rarely do well whatever you do!
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23
Q

What is slipped upper femoral epiphysis

A

Displacment through growth plate with epiphysis slipping down and back

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24
Q

What are the risk factors for SUFE

A

Boys
10-16
Obesity
Endocrine Disorders: Hypothyroidism, renal osteodystrophy, GH deficiency

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25
Q

What are the signs of SUFE

A

Presents after minor injury:
Limp - antalgica with externally rotated foot
pain in groin, thigh and knee
90% weightbear and 10% cannot

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26
Q

What may be seen on examination and X-ray of SUFE

A

Examination:
- Loss of Hip IR, abduction and flexion
- obligatory ER during passive flexion
X-ray: Anteriorposterior and Frog leg lateral of both hips - widening of joint space, femoral head slipped posteriorly and inferiorly

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27
Q

What is the Rx of SUFE

A

Avoid weight bearing until surgery

  • Urgent surgical internal fixation with pinning of femoral head
  • Prophylactic pinning of contralateral hip
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28
Q

What are complications of SUFE

A

Avascular necrosis of femoral head

Early OA

29
Q

What is Rickets

A

Normal bone density but abnormal mineral content during bone growth

30
Q

What are the S/S of Rickets

A
  • Soft bones - bowed legs, knocked knees
  • Growth Retardation
  • Motor Delay
  • Malaise
  • Hypotonia
  • Fractures
31
Q

What are the causes of rickets

A

Vitamin D deficiency:

  • malabsorption,
  • poor diet
  • lack of sunlight,
  • maternal Vit D deficiency - breastmilk
32
Q

What Ix may be performed in rickets

A

plasma:
- Vit D deficiency: low 25-(OH)D3 and raised PTH
- Alkaline phosphate high
- low PO4 and
- Ca2+ variable - normal or low

X-ray - cupped ragged/frayed metaphyses, bowing of legs

33
Q

How do you Rx rickets

A

Treat Underlying Problem:

- Give Calciferol (vit D) +/- Calcium (if hypocalcaemia)

34
Q

What are the 3 ways osteomyelitis can occur

A
  1. Direct Innocculation of infection into bones (trauma/surgery)
  2. Continuous spread of infection e.g soft tissue and joints
  3. Haematogenous seeding - high blood floe in developing bones
35
Q

Where does haematogenous seeding most commonly occur in children

A

Long bones

36
Q

What are the risk factors for Osteomyeltis

A

Risk of trusts
Vascular supply e.g sickle cell
Pre-existing bone/joint problems
Immunodeficnency

37
Q

What organism most commonly causes Osteomyelitis

A

Staph Aureus

38
Q

What organism most commonly causes osteomyelitis in sickle cell and immunocomprimised

A

SS: Salmonella
IC: TB

39
Q

What are the clinical features of Osteomyeltits

A

Fever
Pain gradual onset
Local findings: pain, tenderness, warmth and erythema
Cortex erosion of bone and exudation of pus
Sequata - infected dead bone

40
Q

What may you find on Ix of Osteomyelitis

A 
ESR/CRP raised 
WCC raised
Blood culture 
Bone Biopsy - gold standard
X-ray - early changes not visible!! 
MRI - most sensitive showing inflammation
41
Q

What is the treatment of Osteomyelitis

A

Surgical Debridement

IV Vancomycin and Cefotaxime

42
Q

What is Osofod - Schlotter Disease

A

Inflammation of the Patellar Ligament at Tibial tuberosity (apophysitis)
90% self limiting

43
Q

Who is OSD common in

A

10-15 yrs

Sporty boys

44
Q

What are the signs of OSD

A

Pain below the knee and worse on strenuous exercise

45
Q

What may be found on Ix of OSD

A

X-ray: tibial tuberosity enlargement +/- fragmentation

MRI - tendonitis

46
Q

What is the treatment for OSD

A

Limitation of activity, ice and NSAIDS
Knee padding and Physiotherapy
Tibial Tubercle excision once skeletally mature if all else fails

47
Q

What is discoid Meniscous

A

Rare anatomical variant usually affecting lateral meniscus of knee

48
Q

How does discoid Meniscous present

A

Asymptomatic until the meniscus tears causing pain, swelling and snapping

49
Q

What will be found on Ix of Discoid Meiscuc

A

MRI - thickened meniscal body

50
Q

What is the Rx of Discoid Meniscus

A

Stretching and strenghting knee muscles

Surgical excision partial or total depending on damage

51
Q

What is developmental dysplasia of the hip (DDH)

A

Ranges from slight acetabular dysplasia to established hip dislocation

52
Q

What is important about DDH

A

Early Diagnosis - appropriate realignment can result in good outcome
Late diagnosi more complex outcomes

53
Q

When should all babies be assessed for DDH

A

Hip examination 1st few days and at 6 wks of life

54
Q

What are the signs of DDH

A

Unequal leg length
Shortening
Widened Peritoneum and buttock flattening on affected side
Skin Crease Asymmetry
Delay in walking
Limited abduction of hip whilst in flexion

55
Q

What are risk factors for DDH

A 
Breech Birth 
Increased birth weight 
Oligohydamniosis
Older mother
Postmaturity 
Sibling with DDH
56
Q

What Examinations and Investigations should be done for DDH

A

Neonatal Hip tests: Ortolani, Barlow and Galeazzi Manouveres
US - in high risk/abnormal exam babies
X-ray

57
Q

What is the Rx for DDH

A

Hips still unstable by 6 wks

  • Long term splinting in flexion-abduction in Pavlik Harness
  • 6-18 mths - arthography and closed reduction and period of immobilisation - open reduction If closed techniques fail
  • After 18mths - Open Reduction
58
Q

What is JIA

A

Inflammation of the joints that isn’t caused by any other condition

59
Q

What is Oligoarthritis

A

When 4 or fewer joints are affected in first 6 months child may go on to develop arthritis in other joints after 6 months - extended oligoarthritis

60
Q

What is Polyarthritis

A

5 or more joints affected In first 6 months
Two types:
- positive RF
- negative RF

61
Q

what is enthesitis related Arthritis

A

Affects joints of legs and spine causing inflammation where tendon attaches bone - stiffness in neck and back

62
Q

What is Psoriatic Arthritis

A

Can affect any joint but usually the fingers and toes (swollen sausages) with psoriasis a scaly rash

63
Q

What is systemic onset/stills disease JIA

A 
Arthritis involving ≥ 1 joint 
AND
intermittent fever that lasts for at least two weeks with fever spikes occurring on at least 3 consecutive days  
AND
≥ 1 extra-articular manifestation when fever spikes:
-pink macular rash on trunk and limbs 
-Hepatomegaly/Splenomegaly 
-Lymphadenopathy 
-Serositits
64
Q

What are the signs of JIA

A 
Painful, swollen or stiff joints 
Joints warm to touch 
Increased tiredness
Fever 
Limp but no injury
65
Q

What investigations should be done for JIA

A 
Bloods 
WCC raised 
ESR/CRP raised 
RF - in seropositive polyarthritis 
LFT - raised in systemic 
ANA raised - oligo, poly and psioratic

US and MRI
Joint Aspiration - rule out septic arthritis

66
Q

What is the treatment of JIA

A

MDT approach: PT, OT, dieticians
1st line: NSAIDS low disease activity

2nd: DMARDS in active disease e.g Methotrexate
biological therapy e.g Tocilzumab if not responding to DMARDS
Systemic Corticosteroids used in short courses in severe disease e.g Prednisalone

67
Q

What should you do if there is knee pain

A

Think hip!

68
Q

What do growing pains cause

A

No Limp!!!!!

Paediatrics (13 decks)

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