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msk Flashcards

1
Q

describe osteogenesis imperfecta. what is the most common type?

A
  • group of collagen metabolism disorders
  • autosomal dominant
  • causes fragile bones, lots of fractures
  • Type 1
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2
Q

describe the signs of type 1 osteogenesis imperfecta

A
  • frequent fractures
  • blue sclera
  • hearing loss
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3
Q

treatment for osteogenesis imperfecta?

A

bisphosphonates

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4
Q

which type of osteogenesis imperfecta is lethal and why?

A
  • type 2
  • causes multiple fractures in the womb
  • stillborn
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5
Q

what is the inheritance pattern of Marfan syndrome?

A

autosomal dominant

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6
Q

signs of Marfan syndrome?

A
  • tall stature
  • long thin digits
  • big arm span
  • hyperextensible joints
  • high arched palate
  • dislocated lenses of eyes
  • myopia (short-sighted)
  • scoliosis
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7
Q

which 2 manoeuvres are used in DDH diagnosis?

A
  • Barlow = dislocating hip from acetabulum posteriorly

- Ortolani = relocating the hip on abduction

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8
Q

how does DDH normally present?

A
  • found on exam (doing B + O manoeuvres)
  • limp
  • abnormal gait
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9
Q

signs of DDH?

A
  • limping
  • abnormal gait
  • asymmetrical skin folds around hip
  • reduced abduction of hip
  • shortening of affected leg
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10
Q

management of DDH?

A
  • splint

- keeps the hip flexed

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11
Q

describe growing pains

A
  • nocturnal idiopathic pains
  • might wake them up at night
  • lower limbs
  • eased by massage
  • NO limp or morning pain
  • normal physical exam
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12
Q

what are the 2 commonest sites for osteomyelitis?

A
  • distal femur

- proximal tibia

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13
Q

which organism causes most osteomyelitis cases?

A

staph aureus

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14
Q

presentation of osteomyelitis?

A
  • severely painful, immobile limb
  • red, swollen, tender
  • pain on movement
  • acute fever
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15
Q

investigations for osteomyelitis?

A
  • blood cultures are positive
  • WCC raised
  • CRP raised
  • XR: normal initially, but shows swelling 10 days later
  • USS
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16
Q

treatment for osteomyelitis?

A
  • antibiotics
  • surgical
  • splint and rest
  • decompression of subperiosteal space
  • surgical drainage
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17
Q

what is Osgood-Schlatter disease?

A

osteochondritis of the patellar tendon insertion at the knee

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18
Q

who is the demographic for Osgood-Schlatter disease?

A

physically active teenage boys (esp football)

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19
Q

presentation of Osgood-Schlatter disease?

A
  • knee pain after exercise
  • tender knee
  • swelling over tibial tuberosity
  • hamstring tightness
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20
Q

management of Osgood-Schlatter disease?

A
  • rest
  • physio to strengthen quadriceps
  • knee immobiliser splint
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21
Q

what is the commonest cause of acute hip pain in children?

A

transient synovitis

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22
Q

what age group does transient synovitis affect?

A

2-12 year olds

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23
Q

presentation of transient synovitis?

A
  • sudden hip / limb pain
  • no pain at rest
  • reduced internal rotation
  • often follows viral infection so child may be mildly febrile but well overall
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24
Q

causes of acute, painful limp in 1-3 year olds?

A
  • septic arthritis
  • osteomyelitis of hip / spine
  • transient synovitis
  • trauma (A or NA)
  • malignancy
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25
Q

causes of acute, painful limp in 3-10 year olds?

A
  • transient synovitis
  • septic arthritis
  • osteomyelitis
  • overuse injuries and trauma
  • Perthes disease
  • JIA
  • malignancy
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26
Q

differentials for acute, painful limp in 11-16 year olds?

A
  • overuse / sports injuries
  • trauma
  • slipped capital femoral epiphysis
  • Perthes disease
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27
Q

what is Perthes disease?

A

avascular necrosis of the capital femoral epiphysis of femoral head

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28
Q

what is the M:F in Perthes disease? which age does it present at?

A

5:1 (much more common in boys), 5-10 year olds

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29
Q

what is the first investigation in Perthes disease and what would it show?

A

X-ray, shows increased bone density in femoral head, later shows fragmentation

30
Q

treatment in mild Perthes disease?

A
  • bed rest

- traction

31
Q

treatment in moderate-severe Perthes disease?

A

femoral osteotomy

32
Q

what does SCFE stand for?

A

slipped capital femoral epiphysis

33
Q

which demographic does SCFE affect?

A

8-15 year old obese boys

34
Q

what might SCFE be associated with?

A
  • hypothyroidism

- hypogonadism

35
Q

presentation of SCFE?

A
  • limp
  • hip pain
  • knee pain (referred from hip)
36
Q

investigation for SCFE?

A

X-ray

37
Q

examination findings in SCFE?

A
  • reduced abduction of hip

- reduced internal rotation of hip

38
Q

what is the crucial differential for transient synovitis?

A

septic arthritis!!!!!

39
Q

what is the commonest form of arthritis in childhood?

A

reactive arthritis

40
Q

define reactive arthritis

A

post-infectious joint swelling that lasts <6 weeks

41
Q

which joints are commonly affected in reactive arthritis?

A

ankles or knees

42
Q

what is the main source of reactive arthritis in children?

A
  • following an enteric infection

- e.g. salmonella, shigella, campylobacter

43
Q

which age group does septic arthritis present in?

A

< 2 year olds

44
Q

what causes septic arthritis?

A
  • mostly systemic infection spreading in the blood
  • needle puncture site
  • chickenpox
45
Q

what is the commonest causative organism of septic arthritis in anyone older than a neonate?

A

staph aureus

46
Q

presentation of septic arthritis?

A
  • red, warm, acutely tender joint
  • reduced ROM at joint
  • child is acutely unwell and febrile
  • infant cries if the limb is moved
47
Q

which other condition does septic arthritis often coexist with?

A

osteomyelitis (15% of these cases also have septic arthritis)

48
Q

investigations and findings in septic arthritis?

A
  • WCC (raised)
  • ESR, CRP (both raised)
  • USS hip (effusion)
  • X-ray (widened joint space, soft tissue swelling)
49
Q

treatment of septic arthritis?

A
  • long course of antibiotics, initially IV

- surgical drainage if this does not fix it

50
Q

what is the consequence of untreated septic arthritis?

A

infection spreads from the joint space to the bone and destroys articular cartilage and bone

51
Q

what is the commonest chronic inflammatory joint disease?

A

juvenile idiopathic arthritis (JIA)

52
Q

define JIA

A
  • persistent joint swelling lasting >6 weeks
  • presenting in <16s
  • in absence of infection or other defined cause
53
Q

what is the commonest subtype of JIA?

A

oligoarthritis

54
Q

what is the M:F for JIA?

A

1:5, much more common in girls

55
Q

history in JIA?

A
  • gelling (feeling stiff after long car rides)
  • morning joint stiffness
  • widespread joint pain
  • fatigue
56
Q

presentation of JIA in an infant?

A
  • intermittent limp
  • irritability
  • bad behaviour
  • avoidance of activity
57
Q

why is it difficult to diagnose JIA?

A
  • blood tests initially look normal, with negative rheumatoid factor
  • antinuclear factor is quite non-specific
58
Q

long-term consequences of JIA?

A
  • bone expansion from overgrowth
  • leg lengthening
  • valgus deformity (knock knees)
  • digit length discrepancy
59
Q

complications of JIA?

A
  • chronic anterior uveitis
  • flexion contractures of joints
  • growth failure, delayed puberty
  • anaemia (of chronic disease)
  • osteoporosis
  • amyloidosis (rare)
60
Q

systemic features in JIA?

A
  • fever
  • salmon pink rash on limbs
  • malaise
61
Q

management of JIA?

A
  • ibuprofen
  • joint injections (first line in oligoarticular JIA)
  • methotrexate
  • biological therapies (anti-TNF a, where methotrexate fails)
62
Q

what could a slit lamp exam show in JIA?

A

chronic anterior uveitis

63
Q

what is the most common vasculitis in childhood?

A

Henoch-Schonlein purpura

64
Q

presentation of Henoch-Schonlein purpura?

A
  • purpuric rash over lower legs and buttocks
  • arthritis of ankles or knees
  • abdominal pain
  • haematuria
  • proteinuria
65
Q

which childhood demographic might SLE present in?

A

adolescent girls

66
Q

presentation of SLE?

A
  • malaise
  • arthralgia
  • malar, photosensitive rash
  • other organ involvement
67
Q

differentials for nocturnal waking with leg pain?

A
  • growing pains
  • osteoid osteoma
  • leukaemia
  • lymphoma
  • neuroblastoma (young child)
68
Q

differentials for a toxic-looking, febrile child with limited ROM at the hip?

A
  • septic arthritis

- osteomyelitis

69
Q

differentials for sudden limp and unilateral reduced ROM in hip, in an otherwise well child?

A
  • transient synovitis

- Perthes disease

70
Q

M:F in DDH?

A

1:6

paediatrics (10 decks)

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