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Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

What are the 3 main differentials for a limping child?

A
  1. Infection e.g. sepsis/osteomyelitis.
  2. Trauma e.g. NAI, fracture.
  3. Tumour.
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2
Q

What is the likely cause of a limp in a child aged 0-3?

A
  1. Non-accidental injury
  2. Osteomyelitis/septic arthritis.
  3. DDH.
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3
Q

What is the likely cause of a limp in a child aged 3-10?

A
  1. Trauma.
  2. Transient synovitis.
  3. Osteomyelitis.
  4. Perthe’s disease.
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4
Q

What is the likely cause of a limp in a child aged 10-15?

A
  1. Trauma.
  2. Osteomyelitis.
  3. SUFE.
  4. Perthe’s disease.
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5
Q

What must you remember to consider as a differential in a limping child?

A

Intra-abdominal pathology e.g. hernia, testicular torsion.

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6
Q

Why might you want to ask about socioeconomic class and smoking status in a child presenting with a limp?

A

Social deprivation and passive smoking are RF’s for Perthe’s disease.

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7
Q

What investigations might you want to do on a child presenting with a limp?

A
  1. General observations e.g. HR, BP, T, RR, O2 sats.
  2. FBC, BM, ESR and CRP.
  3. XR - AP and lateral views of the the joint and the joints above and below.
  4. USS - effusion in joints?
  5. CT/MRI.
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8
Q

Describe Kocher’s criteria.

A

fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

3/4 features = septic joint.

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9
Q

Give 3 signs of septic arthritis.

A
  1. Systemically very unwell.
  2. Pain at rest.
  3. Raised WCC and CRP.
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10
Q

What is transient synovitis?

A

Acute onset joint inflammation following illness often respiratory.

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11
Q

How does transient synovitis differ from septic arthritis?

A

Transient synovitis: no pain at rest, XR normal, USS may show effusion, rest, physiotherapy and NSAIDs often help.

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12
Q

Give 3 risk factors for DDH.

A
  1. female sex: 6 times greater risk
  2. breech presentation
  3. positive family history
  4. firstborn children
  5. oligohydramnios
  6. birth weight > 5 kg
  7. congenital calcaneovalgus foot deformity
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13
Q

What tests can be done on clinical examination in the neonatal period to pick up DDH?

A
  1. Ortolani test.
  2. Barlow manoeuvre.

Can be confirmed with USS.

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14
Q

What are the 2 main risks associated with the surgical management of DDH.

A
  1. Avascular necrosis.

2. Re-dislocation.

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15
Q

What is Perthe’s disease?

A

A self-limiting idiopathic disease characterised by avascular necrosis of the femoral head.

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16
Q

Describe the management of Perthe’s disease.

A

To keep the femoral head within the acetabulum: cast, braces

  1. If less than 6 years: observation
  2. Older: surgical management with moderate results
  3. Operate on severe deformities
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17
Q

Give 3 risk factors for Perthe’s disease.

A
  1. ADHD.
  2. Deprivation.
  3. Passive smoking.
  4. LBW and short stature.
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18
Q

What is SCFE?

A

Slipped capital femoral epiphysis - a fracture through the growth plate leads to slippage of the femoral head through the zone of hypertrophy.

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19
Q

Who is likely to be affected by SCFE?

A

A pre-pubescent obese male.

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20
Q

How does SCFE present?

A

hip, groin, medial thigh or knee pain

loss of internal rotation of the leg in flexion

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21
Q

What is the treatment for SCFE?

A

Surgical pinning of the hip.

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22
Q

What is chondrosarcoma?

A

A malignant neoplasm of cartilage.

23
Q

What is the criteria for making a clinical diagnosis of juvenile idiopathic arthritis?

A

Joint swelling/stiffness >6 weeks in children <16 and no other cause is identified.

24
Q

Describe the non-medical mx for JIA.

A

Liaison with school for additional support.

Physiotherapy.

25
Q

Describe the medical mx for JIA.

A
  1. Steroid joint injections.
  2. NSAIDS.
  3. Methotrexate.
  4. Systemic steroids.
26
Q

Give 5 potential consequences that can occur if you fail to treat JIA.

A
  1. Permanent deformity.
  2. Disability.
  3. Pain.
  4. Bony overgrowth.
  5. Uveitis.
27
Q

Define osteoporosis in children.

A

-The finding of one or more vertebral compression (crush) fractures is indicative of osteoporosis, in the absence of local disease or high-energy trauma.

  • In the absence of vertebral compression (crush) fractures, the diagnosis of osteoporosis is indicated by the presence of both a clinically significant fracture history and BMD Z-score ≤ -2.0. A clinically significant fracture history is one or more of the following:
    1) two or more long bone fractures by age 10 years;
    2) three or more long bone fractures at any age up to age 19 years
28
Q

Describe the aetiology of osteoporosis in children.

A
  1. Inherited/congenital e.g. osteogenesis imperfecta, inborn errors, idiopathic.
  2. Acquired e.g. drug induced, malabsorption, immobilisation
29
Q

What investigation might you do to determine if a child has osteoporosis?

A

DEXA scan

30
Q

What is osteogenesis imperfecta?

A

An AD inherited osteoporotic condition that leads to bone weakness in children. It is due to a defect in type 1 collagen genes.

31
Q

Give 5 signs of osteogenesis imperfecta.

A
  1. Bone fragility.
  2. Fractures.
  3. Deformity.
  4. Pain.
  5. Impaired mobility.
  6. Poor growth.
  7. Blue sclera.
  8. Bruises.
  9. Deafness secondary to otosclerosis
  10. Dental imperfections are common
32
Q

Describe the mx of osteogenesis imperfecta.

A

MDT approach - physicians, surgeons, physiotherapists, OT’s.

Bisphosphonates e.g. pamidronate

33
Q

What is Rickets?

A

A disorder of bone mineralisation, it leads to bone weakness.

34
Q

What is the main cause of Rickets?

A

Vitamin D deficiency.

35
Q

Give 3 signs of Rickets.

A

knock-knee, bow leg, Rachitic rosary

36
Q

What might you find when examining a child with Rickets?

A
  • Metaphyseal swelling.
  • Bone deformity e.g. bowed legs.
  • Motor delay.
  • Hypotonia.
  • Fractures.
  • Cupping and spraying seen on XR.
37
Q

What investigations might you do to determine if a child has Rickets?

A
  1. Serum biochemistry e.g. ALP, PTH.
  2. Bone profile.
  3. Measure vitamin D levels.
  4. XR.
38
Q

Describe the treatment for Rickets.

A

Treat the underlying problem.

If vitamin D deficiency, give Adcal D3.

39
Q

What is the role of vitamin D?

A

It acts to increase Ca absorption at the gut and Ca reabsorption at the kidneys.

40
Q

Give 3 sources of vitamin D.

A
  1. Sunlight!
  2. Cereals.
  3. Egg yolk.
  4. Oily fish.
  5. Spreads.
41
Q

Briefly describe how Vitamin D is converted into 1,25-(OH)2-vitamin D.

A

Vitamin D3 (cholecalciferol) -> 25-OH-vitamin D (conversion in liver with 25 hydroxylase) -> 1,25-(OH)2-vitamin D (conversion in kidney with 1 hydroxylase)

42
Q

Secretion of which hormone will increase in response to low calcium?

A

PTH.

Increased PTH = bone resorption, Ca reabsorption at kidneys and Ca absorption at gut.

43
Q

Give 5 differentials for a painful joint.

A

Life-threatening differentials:

  • Leukaemia.
  • Septic arthritis.
  • NAI.

Pain and swelling:

  • Trauma.
  • Infection.
  • Reactive arthritis.
  • JIA.

Pain and no swelling:
- Perthe’s disease.

44
Q

What investigations might you do on a child who you suspect may have JIA?

A
  1. ANA may be positive, especially in oligoarticular JIA
  2. rheumatoid factor is usually negative
  3. ophthalmology review for anterior uveitis
45
Q

Name 5 types of JIA.

A
  1. Oligoarticular.
  2. Polyarticular.
  3. Psoriatic.
  4. Enthesitis related.
  5. Systemic onset JIA.
46
Q

Define oligoarticular JIA.

A

<4 joints involved, often asymmetrical. Normally ANA+ and associated with a high risk of developing uveitis.

47
Q

Define polyarticular JIA.

A

> 4 joints involved, often symmetrical and more destructive.

48
Q

What extra-articular features might you see in someone with JIA?

A
  1. Psoriasis.
  2. Dactylitis.
  3. Nail pitting.
49
Q

Which type of JIA is most similar to ankolysing spondylitis?

A

Enthesitis related arthritis.

The point where the tendon joins a bone is inflamed.

50
Q

Which antigen is closely associated with enthesitis related arthritis?

A

HLAB27.

51
Q

What signs might you see in someone with systemic onset JIA?

A
  1. pyrexia
  2. salmon-pink rash
  3. lymphadenopathy
  4. arthritis
  5. uveitis
  6. anorexia and weight loss
52
Q

What analgesia is appropriate for a paediatric fracture?

A

Paracetamol.

Oromorph.

53
Q

Which age group does transient synovitis most commonly affect?

A

2-10y

54
Q

What is the mx of transient synovitis?

A
  1. Rest

2. Analgesia

Paediatrics (21 decks)

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