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CP2 PAEDS > MSK > Flashcards

MSK Flashcards

1
Q

What does the GALS in Pgals stand for

A

Gait
Arms
Leg
Spine

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2
Q

Other name for Bow legs

A

Varus deformit

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3
Q

What is Bow leg due to?

A

Rickets

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4
Q

Other name for Knock Knees

A

Valgus deformity

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5
Q

What age gets Valgus deformity

A

2-7

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6
Q

What is the intramalleolar distance in valgus deformity?

A

> 8cm

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7
Q

Prognosis knock-knees

A

Resolves

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8
Q

Incidence of Developmental Hip Dysplasia (DDH)

A

1-3%

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9
Q

In DDH, where is the abnormality? (3)

A

Either:
Shape of head of femur
shape of acetabulum
Supporting structures

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10
Q

RF DDH (8)

A 
FHX
F 
Oligohydramnios 
Breech presentation 
First born 
Multiple pregnancy 
Premature 
NM - CP
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11
Q

What % of children w. DDH are female

A

80%

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12
Q

Screening for DDH

A

Barlow
Ortolani
Repeat test at 6-8w

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13
Q

Late presentation of DDH (2)

A

Usually abnormal gait or limp Short limp or asymmetric skin folds

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14
Q

If DDH is found, what is the next step?

A

USS to give detailed assessment of hip/degree of dysplasia

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15
Q

Mx DDH if <6 months

A

Bracing = 1st line

Or Palvik Harness - maintains hip flexion + abduction

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16
Q

When do most DDH resolve by ?

A

2-6 weeks

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17
Q

If other Tx fail for DDH, what is the final resort + what age must the child be?

A

Surgery

> 5 months

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18
Q

Other name for flat feet

A

Pes planus

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19
Q

Anatomically, what is flat feet

A

Absence in medial longitudinal arch

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20
Q

What condition could flat feet be part of?

A

Ehlers Danlos

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21
Q

Mx flatfeet

A

If Sx - footwear advice + arch support

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22
Q

Another name for forefoot

A

Talipes

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23
Q

What is Positional Talipes due to?

A

Intrauterine compression

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24
Q

Mx Positional Talipes

A

Passive manipulation/exercises by physio

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25
Q

What is Talipes equinovarus?

A

Entire foot = inverted + supinated, heel rotated inwards

Foot = shorter, calf mm thinner

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26
Q

Mx Talipes equinovarus

A

Plaster cast + bracing

Surgery if severe

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27
Q

What is scoliosis?

A

Lateral curvature of frontal plane of spine

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28
Q

What can scoliosis cause in servere cases?

A

Chest distortions –> cardioresp failure

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29
Q

causes of scoliosis (6)

A 
Idiopathic 
Congenital - spina bifida 
NM - CP or MD 
NFM 
Marfans 
Leg length discrepancy
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30
Q

Mx severe scoliosis

A

Specialist Tx
Bracing
Surgery

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31
Q

What is Torticollis

A

Wry and twisted neck

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32
Q

Why does torticollis occur?

A

SCM tumour - mobile, non-tender nodule

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33
Q

Later presentatations of torticollis may be due to: (4)

A

Mm spasm
ENT infection
Spinal tumour
Cervical spine arthritis

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34
Q

How long does torticollis due to mm spasm tend to resolve in?

A

1-2 weeks

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35
Q

Mx of torticollis caused by URTI/soft tissue infection

A

Passive stretching

Usually resolves 2-6 months

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36
Q

What is osteomyelitis

A

Infection of the metaphysis of long bones

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37
Q

Which 2 bones does osteomyelitis usually occur in>

A

Distal femur

Proximal tibia

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38
Q

Features osteomyelitis (7)

A 
Acute onset
Painful limb 
Immobile 
Acute febrile illness 
Over infected site - swelling, tenderness, erythema, warm 
Vertebral? Back pain
Pelvic? Groin pain/limp
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39
Q

Causes osteomyelitis (4)

A

S. aureus
Strep
H influ
TB if immunocom

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40
Q

Ix osteomyelitis (3)

A

Bloods
Xray
MRI

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41
Q

What would you see on an oestomyelitis MRI?

A

Boen infection

Subperiosteal pus + purulent debris in bone

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42
Q

Mx osteomyelitis (5)

A 
IV ABx several weeks 
Then PO ABx
Aspiration/decompression if atypical 
Surgical drainage if no response 
Limb in splint - mobilise
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43
Q

What is subacute osteomyelitis?

A

Bone pain + radiographic changes with no systemic symptoms

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44
Q

Risks of osteomyelitis is left untreated (4)

A 
Widespread infection --> 
Cellulitis 
Sepsis 
Death 
Amputation
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45
Q

Who is septic arthritis common in?

A

<2 y/o

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46
Q

Causes of septic arthritis (2)

A

Following puncture wound/infected skin lesions

From adjacent osteomyelitis

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47
Q

Most common causative organism septic arthritis

A

Staph aureus

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48
Q

Features septic arthritis (7)

A 
Erythemataous/warm 
Tender
Decr ROM 
Acutely unwell/febrile 
Pseudoparesis 
Joint effusion 
Limp/pain
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49
Q

Ix septic arthritis (4)

A

Bloods - WCC, acute phase proteins, culture
USS - effusion
Xray - norm
MRI

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50
Q

Mx septic arthritis

A

Prolonged IV ABx

Surgical drain/wash out

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51
Q

Fractures in what bones would make you think of NAI? (4)

A

Ribs
Humerus
Skull
Multiple

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52
Q

Define Juveinile Idiopathic Arthritis

A

Persistent joint swelling >6w

Present before 16 y/o w/ no infection/other cause

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53
Q

What is the most common type of juvenile idiopathic arthritis?

A

Persistent oligoarthritis

54
Q

Age Persistent oligoarthritis

55
Q

Artiucular pattern Persistent oligoarthritis

A

<4 joints

Knees, ankle, wrist

56
Q

Other features Persistent oligoarthritis

A

Uveitis

Leg-length discrepancy

57
Q

Prognosis Persistent oligoarthritis

58
Q

Lab features Persistent oligoarthritis

59
Q

Age range Extended oligoarthritis

60
Q

Joint pattern Extended oligoarthritis

A

> 4 joints

61
Q

Other features Extended oligoarthritis

A

Uveitis

Asymmetrical growth

62
Q

Lab features Extended oligoarthritis

63
Q

Age range polyarthritis RF -ve

64
Q

Joint pattern polyarthritis RF -ve

A

Symmetrical large + small joints
Fingers
TMJ/Spine

65
Q

Other features polyarthritis RF -ve

A

Low grade fever
Uveitis
Decr growth

66
Q

Prognosis polyarthritis RF -ve

A

Moderate prognosis

67
Q

Age range polyarthritis RF +ve

68
Q

Joint pattern polyarthritis RF +ve

A

Symmetrical large + small joints
Fingers
TMJ/Spine

69
Q

Prognosis polyarthritis RF +ve

70
Q

Lab feature polyarthritis RF +ve

71
Q

Age range Systemic Juvenile Arthritis

72
Q

Joint pattern Systemic Juvenile Arthritis

A

Arthralgia/myalgia

Originally no arthritis

73
Q

Other features Systemic Juvenile Arthritis

A

Illness/fever/Malaise

Rash

74
Q

Prognosis Systemic Juvenile Arthritis

75
Q

Lab features Systemic Juvenile Arthritis

A

Anaemia
Neutrophilia
Thrombophilia

76
Q

Age range Psoriatic Juvenile Arthritis

77
Q

Joint pattern Psoriatic Juvenile Arthritis

A

Asymmetrical

Large + small joints

78
Q

Other features Psoriatic Juvenile Arthritis

A

Psoriasis
Nail dystrophy
Uveitis

79
Q

Associated conditions Juvenile Idiopathic Arthritis (7)

A 
Chronic ant uveitis 
Flexion contractures joints 
Growth failure 
Anaemia Chronic disease 
Delayed puberty 
OP
Amyloidosis
80
Q

Tx Juvenile Idiopathic Arthritis (4)

A

NSAIDs
Joint injections
Methotrexate
Corticosteroids

81
Q

What must be monitored for methotrexate (2)

82
Q

What is the most common form of arthritis in childhood?

A

Reactive arthritis

83
Q

What is reactive arthritis

A

Transient joint swelling for <6w

84
Q

Causes of Reactive arthritis (4)

A

Enteric bacteria - salmonella, campy, shigella
Viral infection
STI - chlamydia, gonorrhoea
Mycoplasma

85
Q

PS Reactive arthritis (3)

A

Low grade fever
Norm APP
Norm xray

86
Q

Mx Reactive arthritis (5)

A 
No 'Tx' needed
NSAIDs
Rest
Avoid using joint 
Graded exercise
87
Q

What is Perthe’s

A

Disrupted blood supply to capital femoral epiphysis –>
Avascular necrosis
Revascularisation
Re-ossification

88
Q

What are the 3 stages of Perthe’s

A

1 - avascular necrosis
2 - Fragmentation/resorption
3 - Re-ossification

89
Q

Who does Perthe’s mainly affect?

A

Males

Aged 5-10

90
Q

PS Perthe’s (2)

A

Insidious onset limp

Hip/knee pain

91
Q

What % Perthe’s is bilateral

92
Q

What would you see on a Perthe’s xray

A

Incr density femoral head

Fragmented/irreg or flattened

93
Q

Mx Perthe’s - early detection

A

Bed rest + traction

94
Q

Mx Perthe’s - late/severe (2)

A

Need to maintain hip in abduction so

Plaster cast
Pelvic/femoral osteotomy

95
Q

Indicators for good prognosis Perthe’s

A

<6 y/o

< 1/2 head affected

96
Q

What is slipped upper femoral epiphysis

A

Displacement of epiphysis of femoral head postero-inferiorly

97
Q

RF Slipper upper femoral epiphysis (3)

A

10-15 y/o during GROWTH spurt
Obese/males
Metabolic/endocrine abnormalities

98
Q

PS Slipper upper femoral epiphysis (4)

A

Limp
Hip –> knee pain
Acute onset
Restricted abduction + int rotation hip

99
Q

How to confirm slipped upper femoral epiphysis

100
Q

Mx slipped upper femoral epiphysis (3)

A

Pin fixation - surgery
NSAIDS
Crutches 6-8w

101
Q

What is the most common cause of acute hip pain?

A

Transient synovitis

102
Q

Cause transient synovitis

A

Following/accomp viral infection

103
Q

PS transient synovitis (4)

A

Sudden onset hip pain
NO pain @ rest
Limp + Decr ROM
Afebrile

104
Q

DDx painful limps - aged 1-3 (4)

A

Septic arthritis
Osteomyelitis
Transient synovitis
Trauma

105
Q

DDx painful limps - aged 3-10 (6)

A 
Transient synovitis 
Septic arthritis 
Osteomyelitis 
JIA
Perthe's 
Malignancy
106
Q

DDx painful limps - aged 11-16 (5)

A 
SUFE
JIA
Trauma 
Septic 
Arthritis
107
Q

DDx painless limp - aged 1-3 (4)

A

DDH
Neuromuscular - CP
Unequal length
JIA

108
Q

DDx painless limp - aged 3-10 (4)

A

Perthe’s - chronic
DDH
Neuromuscular
JIA

109
Q

DDx painless limp - aged 11-16 (3)

A

SUFE (chronic)
JIA
Dysplastic hip

110
Q

Mx transient synovitis (3)

A

Bed rest
Analgesia
Skin traction (rare)

111
Q

What is Rickets

A

Failure in mineralisation of growing bone/osteoid tissue

112
Q

Causes of Rickets (6)

A 
Decr sun absorption 
Decr dietary intake 
Malabsorption; coeliac, CF, cholestatic liver disease
CLD
Incr metabolism of 25(OH)D
Defective 1,25(OH)2D3
113
Q

PS Rickets (9)

A 
FTT
Ping pong ball in head
Delayed dentition 
Delayed closure of ant fontanelle 
Costochondral jct palpable 
Widened wrists/ankles 
Harrison sulcus 
Bowed legs/VARUS
Hypotonia
114
Q

Ix rickets (4)

A

Bloods
Urine microscopy - CKD
Wrist x-ray initially
Long bone xray

115
Q

Features on long bone xray rickets (5)

A 
Cupping, splaying metaphysis 
Deformities - bowing 
Wide gap betw shaft + epiphyseal centre 
Coarse appearance 
Poorly ossified (greyer in centre)
116
Q

Mx Rickets (4)

A

Dietary advice
PO Calciferol
Ca supplement
Monitor serum Ca, vit D, PTH

117
Q

Sources of Vit D (4)

A

Sunlight
Fish liver oil
Fatty fish
Egg yolk

118
Q

What is Osteogenesis imperfecta

A

Inherited condition that causes incr fragility in bones

119
Q

Type 1 Osteogenesis imperfecta (4)

A

Mild
Decr amount of bone
AD
Fractures in childhood + blue appearance

120
Q

Type 2 Osteogenesis imperfecta (3)

A

Lethal
Multiple fractures + short limbs
Infants die immediatetly

121
Q

Type 3 Osteogenesis imperfecta (3)

A

Severely progressive
incr w/ age
Short stature - repeated fracture

122
Q

CF Osteogenesis Imperfecta (8)

A 
Easily fractured bones
Teeth gross 
Blue sclera 
Cardiac effects 
Hypermobility joints 
Hearing impaired
Deformed skull 
Scoliosis
123
Q

Ix Osteogenesis Imperfecta (3)

A

Xray
Bone density
Genetics

124
Q

Mx Osteogenesis imperfecta (3)

A

Physio/bracing
Surgery
Bisphosphates

125
Q

What is Polydactyly?

A

> 5 digits

126
Q

What conditions is Polydactyly associated with? (3)

A

Downs
Turners
Tibial hemimelia

127
Q

What is Syndactylyl>

A

Abnormal joining of fingers

128
Q

Which conditions is Syndactylyl associated with? (3)

A

Apert syndrome

Polert syndrome

129
Q

Mx skeletal dysplasia (5)

A 
Bone lengthening 
Braces + splints
Physiotherapy 
OT
Bone marrow transplants??
130
Q

Clinical features SLE (3)

A

Malaise
Arthralgia
Malar + photosensitive rash

CP2 PAEDS (18 decks)

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