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Year 4 Paediatrics > MSK > Flashcards

MSK Flashcards

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1
Q

State three variations of normal posture

A

Genu Varum
Genu Valgum
Pes Planus

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2
Q

What is Genu Varum?

A

AKA Bow Legs

Common in under 2s

Pathological causes include Rickets and Blount Disease

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3
Q

What is Blount Disease?

A

Autosomal recessive osteochondrodysplasia

Often unilateral

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4
Q

What is Genu Valgum?

A

AKA knock knees

Physiological from ages 4-7

Refer if intermalleolar distance >8cm

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5
Q

What is Pes Planus?

A

AKA Flat Feet

Normal in toddlers as they have flat medial arch and fat pad

Demonstrated by tip toes

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6
Q

How is Pes Planus managed?

A

Footwear support and arch device

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7
Q

What does a fixed painful flat foot indicate?

A

Tendoachilles contracture

Juvenile Idiopathic Arthritis

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8
Q

Name two variations of Abnormal Gait

A

In Toeing

Toe Walking

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9
Q

Give three causes of In Toeing

A

Metatarsus Varum (Adduction Deformity)

Medial Tibial Torsion

Persistent anti version of femoral neck (‘W Sit’)

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10
Q

How does Toe Walking present?

A

Normally resolves by 3y
Common in ASD

If still present consider DMD in boys or Cerebral Palsy

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11
Q

State two ABNORMAL postures

A

Talipes (Club foot)

Pes Cavus

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12
Q

Talipes is a fixed abnormal ankle position presenting at birth. What are the three types?

A

Equinovarus (plantarflexed and supinated)

Calcaneovalgus (dorsiflexed and pronated)

Positional (resting is equinovarus, but not fixed, treated wrath physio)

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13
Q

Talipes is treated by Ponseti. What is this? (Give 5 points)

A

Started immediately after birth

Foot is manipulated and cast is applied

Repeated over and over until corrected

Achilles tenotomy at some point to release tension

After casts a boot is used for four years

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14
Q

What is Pes Cavus?

A

Abnormally high longitudinal arch

Associated with neuromuscular disorders such as Friedreich’s Ataxia and Sensory Neuropathy

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15
Q

How might a child with Hip Pain present?

A

Limp
Refusal to use affected leg
Inability to walk

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16
Q

Describe the aetiology of Hip Pain in different age groups: 0-4y

A

Septic Arthritis
DDH
Transient Synovitis

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17
Q

Describe the aetiology of Hip Pain in different age groups: 5-10y

A

Septic Arthritis
Transient Synovitis
Perthes

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18
Q

Describe the aetiology of Hip Pain in different age groups: 10-16y

A

Septic Arthritis
Slipped Upper Femoral Epiphyses
Juvenile Idiopathic Arthritis

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19
Q

Give three red flags for hip pain

A

<3y
Fever
Night Pain

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20
Q

How can you investigate Hip Pain?

A 
Bloods
XRay
USS
Joint Aspiration
MRI (?Osteomyelitis)
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21
Q

Define Perthes Disease?

A

Disruption of blood supply to femoral head causing Avascular Necrosis of Femoral Epiphyses

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22
Q

Describe the pathophysiology of Perthe’s Disease

A

Mostly occurs in 5-8 year olds

Idiopathic

Overtime there is revascularisation and neovascularisation which can lead to Hip OA

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23
Q

How does Perthes Disease present?

A

Slow onset hip/groin pain that may refer to knee
Limp
Restricted hip movements

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24
Q

How would you investigate Perthes Disease?

A

XRay (Early - widening of joint space, Late - Flattening of Femoral Head)
Full range of bloods (Normal)
MRI
Technetium Bone Scan

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25
Q

How is Perthes Disease managed?

A

Bed rest, crutches, Physio

Regular XRays

Surgery if severe/older/non healing to improve joint alignment

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26
Q

What is SUFE?

A

Where the head of the femur slips along the growth plate

Most common in boys aged 8-15

More common in obese children

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27
Q

How does SUFE present?

A

May be triggered by minor trauma

Hip/Groin/Knee/ Thigh Pain

Painful Limp

Restricted Hip Movement

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28
Q

How does SUFE appear OE?

A

Hip is often externally rotated

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29
Q

How is SUFE investigated?

A

Frogs Leg XRay

Bloods (Generally normal)

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30
Q

What XRay views can be used for SUFE?

A

AP

Frogs Leg Lateral (May worsen slip)

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31
Q

Describe the XRay changes in SUFE

A

Pre Slip - Widening and irregularity of growth plate, demineralisation of metaphysis

Slip - Posteromedial

Chronic Slip - Physis becomes sclerotic and metaphysis widens

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32
Q

How is SUFE managed?

A

Corrective surgery

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33
Q

What is Developmental Dysplasia of Hip?

A

Structural abnormality in hips caused by abnormal development of foetal bones in pregnancy, leading to a tendency for subluxation/dislocation

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34
Q

How does DDH present?

A

May be picked up on newborn examinations

Hip Asymmetry/Reduced ROM/Limp

Can persist into adulthood (weakness, recurrent dislocation)

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35
Q

Give three risk factors for DDH

A

Family History
Breech Presentation
Multiple Pregnancies

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36
Q

How would you investigate DDH?

A

USS (<4m)

XRay (>4m) - Shallow Acetabulum and Head displacement

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37
Q

What are the USS findings in DDH?

A

Measures alpha-angle, which is a measurement of the bony roof of the acetabulum
Uses Graf’s Classification

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38
Q

You may see abormal skin folds or differing leg lengths in a newborn with DDH. What are the two screening tools for DDH in NIPE?

A

Barlow - Downward pressure at 90 degrees to see if dislocatable

Ortolani- Abduct and push forwards to see if dislocated

Isolated clicking is normal, clunking requires USS

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39
Q

How is DDH managed?

A

If less than 6 months, a Pavlik Harness is used (kept on permanently for 6-8 weeks)

Surgery if harness fails or child is diagnosed after 6 months

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40
Q

What is Scoliosis?

A

Lateral curvature in the frontal plane of the spine

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41
Q

Describe the pathophysiology of Scoliosis

A

Rotation of vertebral bodies causes prominence in back from rib asymmetry

If severe can cause cardioresp failure due to rib distortion

42
Q

What causes Scoliosis?

A

Idiopathic (Girls aged 10-14)

Congenital (Spina Bifida, VACTERL)

Secondary (Cerebral Palsy, Marfans)

43
Q

Why do you ask a patient with suspected Scoliosis to lean forward?

A

If it disappears - leg length discrepancy

44
Q

How is Scoliosis managed?

A

Mild may resolve spontaneously

Severe may require bracing or corrective surgery

45
Q

What is Osgood Schlatters Disease?

A

Inflammation at tibial tuberosity (where patella tendon inserts)

46
Q

Describe the pathophysiology of Osgood Schlatters Disease

A

Stress from running jumping at same time as growth in epiphyses, growth plate results in inflammation of tibial epiphyseal plate

Multiple avulsion fractures where tendon pulls away bone leading to visible lump below knee

Typically males aged 10-15

47
Q

How does Osgood Schlatters Disease present?

A

Gradual onset of symptoms

Visible/Palpable hard tender lump

Anterior knee pain

48
Q

How is Osgood Schlatters Disease managed?

A

Rest, Ice, NSAIDs, Stretching, Physio

May be left with lump

49
Q

What is Chondromalacia Patellae?

A

Softening of articulate cartilage of patella, normally affecting adolescent females

50
Q

How does Chondromalacia Patellae present?

A

Pain when Patella is slightly opposed to femoral condyles (eg standing, or walking up stairs)
Often associated with hyper mobility and flat feet

51
Q

How is Chondromalacia Patellae managed?

A

Physio for quad muscle tightening

52
Q

What is Osteochondritis Dissecans?

A

Persistent knee pain in physically very active individual and localised tenderness over femoral condyles

53
Q

Describe the pathophysiology of Osteochondritis Dissecans

A

Bone and cartilage separate from medial condyles due to Avascular Necrosis

Complete separation results in loose body formation and locking/giving away

54
Q

How is Osteochondritis Dissecans managed?

A

Rest and Quadriceps exercises

Arthroscopic surgery

55
Q

Septic Arthritis is a serious joint infection, most common in under 2s. Describe the pathophysiology

A

Usually haematogenous spread but can be from puncture wounds/infected skin lesions

Usually affects hip

Most common organism is S.Aureus

56
Q

How does Septic Arthritis present?

A

Erythematous, warm, acutely tender joint

Reduced ROM

Acutely unwell/febrile child

Limp or referred pain

57
Q

How would you investigate Septic Arthritis?

A

Bloods (inc CRP and FBC)
Hip USS (look for effusions, aspirate for organisms)
XRay (excludes fracture, may show soft tissue swelling)

Measured against Kocher criteria

58
Q

How is Septic Arthritis managed?

A

Empirical IV Abx for 2-4 weeks

<3m or Sickle Cell - IV Ceftriaxone
>3m - IV Flucloxacillin

Can switch to oral when showing improvement

If severe may require surgical drainage and washout

59
Q

Reactive arthritis is the most common form of arthritis in children. How does it present?

A

Transient joint swelling (<6 weeks) often of ankles or knees following extra articular infection

Low grade fever

60
Q

Name four infections associated with Reactive Arthritis

A

STI
Lyme Disease
Rheumatic Fever
Campylobacter

61
Q

How is Reactive Arthritis investigated?

A

Bloods (Acute Phase Reactants May be elevated)

XRays (normal)

62
Q

How is Reactive Arthritis managed?

A

NSAIDs

63
Q

What is Osteomyelitis?

A

Infection in the bone and marrow, normally in metaphysis

64
Q

Describe the pathophysiology of Osteomyelitis

A

Most commonly caused by S.Aureus

May be due to direct inoculation or haematogenous spread, or spread from septic arthritis

Risk factors include open fractures, sickle cell, TB, HIV

65
Q

State the clinical features of Acute and Chronic Osteomyelitis respectively

A

Acute (<2 weeks) - refusal to weight bear, pain, swelling

Chronic - slowly developing symptoms

66
Q

How is Osteomyelitis investigated?

A

MRI
Bloods (raised WCC and Inflamm)
Blood Culture
Bone Biopsy

67
Q

How is Osteomyelitis managed?

A

Extensive Abx
<3m or Sickle - IV Ceftriaxone
>3m - IV Flucloxacillin

May require drainage and debridement

68
Q

What is Transient Synovitis?

A

Temporary irritation and inflammation in the synovial membrane of joint

Most common cause of hip pain ages 3-10y

Associated with recent viral URTI

69
Q

How does Transient Synovitis present?

A

AFEBRILE
Limp
Refusal to weight bear
Groin pain

Within a few weeks of viral illness

70
Q

How is Transient Synovitis managed?

A

Simple analgesia

If they develop a fever - A and E

Follow up at 48h and at one week

71
Q

What is an Osteosarcoma?

A

Bone cancer commonly presenting in adolescents aged 10-20, usually affecting femur

72
Q

How do Osteosarcomas present?

A

Persistent bone pain, particularly worse at night
Bone swelling/mass
Restricted movements

73
Q

How is a suspected Osteosarcoma investigated?

A

Urgent XRay within 48 hours
Bloods (raised ALP)
CT/MRI Staging

74
Q

What are the XRay findings of an Osteosarcoma?

A

Poorly defined lesions with fluffy appearance

Periosteal reaction that’s described as sun burst

75
Q

How is an Osteosarcoma managed?

A 
Surgical resection (?limb amputation)
Adjuvant Chemo
76
Q

Define Rickets

A

Defective bone mineralisation due to Vitamin D Deficiency (equivalent in adults is Osteomalacia)

77
Q

Describe the pathophysiology of Rickets

A

Reduced calcium and phosphate lead to secondary hyperparathroidism and increased bone resorption

78
Q

Rickets can be asymptomatic. How else can it present?

A 
Lethargy
Bone pain
Bone deformity
Poor growth
Dental problems
79
Q

State four bone deformities associated with Rickets

A

Bowing of knees
Knock knees
Delayed Teeth
Craniotabes (soft skull)

80
Q

How is Rickets investigated?

A

Serum 25 Hydroxyvitamin D (<25nmol/l)

XRay (Osteopenia)

U and Es, LFTs, TFTs

81
Q

How is Rickets managed?

A

Breast fed babies are at higher risk so mothers and babies should take Vitamin D supplements

Ergocalciferol - 6000IU per day for 8 to 12 weeks
Calcium supplements

82
Q

What is Achondroplasia?

A

Most common cause of disproportionate short stature (skeletal dysplasia) caused by an Autosomal Dominant genetic defect of fibroblast growth factor
Abnormal function of epiphyseal plates restricts bone length

83
Q

Give four clinical features of Achondroplasia

A

Short stature (4ft)
Femur and Humerus most affected
Short digits
Disproportionate skull

84
Q

Why do patients with Achondroplasia have a disproportionate skull?

A

Skull bases fuse by endochondrial ossification which is affected, whereas vault grows my membranous ossification (unaffected)

Leads to frontal bossing and flattened nasal bridge

85
Q

How is Achondroplasia managed?

A

No cure

Leg lengthening may add height but cause chronic pain

86
Q

What complications are patients with Achondroplasia more at risk of?

A

Kyphoscoliosis
OSA
Cervical Cord Compression
Hydrocephalus

87
Q

What is Osteogenesis Imperfecta?

A

A group of 8 different types of mutations affecting type 1 collagen, causing recurrent and inappropriate fractures

Some of the mutations are inherited in an autosomal dominant manner

88
Q

How does Osteogenesis Imperfecta present? Name 5 features

A 
Recurrent and inappropriate fractures
Hyper mobility
Blue Sclera
Short Stature
Early deafness
89
Q

How is Osteogenesis Imperfecta diagnosed?

A

XRays

Genetic Testing

90
Q

How is Osteogenesis Imperfecta managed?

A

Bisphosphonates and Vitamin D

91
Q

Define Charcot Marie Tooth Disease

A

Symmetrical slowly progressive distal muscular wasting due to mutations in myelin. Various forms of inheritance

92
Q

How does Charcot Marie Tooth Disease present?

A

May trip over a lot when young
Bilateral foot drop
Loss of ankle reflexes progressing to knees
Pes Cavus

93
Q

How is Charcot Marie Tooth disease investigated?

A 
Nerve conduction studies (motor and sensory neuropathy)
Nerve biopsy (onion bulb, may be hypertrophic)
94
Q

What is Guillaine Barre Syndrome?

A

Acute post infectious polyneuropathy

Typically presents 2-3 weeks after URTI/Campylobacter with ascending progressive symmetrical weakness over a few days to weeks

95
Q

How does Guillaine Barre present?

A

Loss of tendon reflexes and autonomic involvement
Sensory symptoms in distal limbs
Bilateral facial weakness

70% Dysautonomia (tachy,Brady,hypo, hypertension etc)

96
Q

How is Guillaine Barre diagnosed?

A

MRI spinal cord (exclude lesion)

2nd week - increased protein in CSF, reduced velocity in conduction studies

97
Q

How is Guillaine Barre managed?

A

Supportive

Full recovery might take up to two years

98
Q

Give a brief description of Endochrondrial Ossification

A

Development of bone from a cartilage precursor, using ossification centres.

How majority of long bones are formed

Physiologically stops at around 2y

99
Q

Give a brief description of membranous ossification

A

Development of bone directly from mesenchyme

Uses osteoblasts which secrete osteoid, become embedded to form osteocytes, and then form mature bone (osteons)

Carries on into adulthood

100
Q

How to bones grow?

A

Interstitial - Length

Appositional - Width

Year 4 Paediatrics (15 decks)

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