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Y5 Paediatrics > MSK > Flashcards

MSK Flashcards

1
Q

What is genu varum

A

Bow legs (knees far apart, legs bowed)

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2
Q

What are pathological causes of gene varum

A 
Rickets 
Blount disease (condition in black children, unilateral)
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3
Q

What is genu valgum

A

knees close when standing, feet far apart

Intermalleolar distance >8cm

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4
Q

What is flat feet

A

aka pes planes

flat medial longitudinal arch (normal before child walks, because of fat pad under foot)

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5
Q

What are three main causes of intoning

A

Metatarsus varus (forefoot adduction)
Medial tibial torsion
Femoral anteversion

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6
Q

What is the latin name for clubfoot

A

Talipes equinovarus

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7
Q

What is the cause of clubfoot

A

oligohydramnios
deformity in utero, from intrauterine compression

OR malformation

OR neuromuscular disorder

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8
Q

What is the foot like in clubfoot

A

inverted
supinated
in plantar flection

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9
Q

How do you treat clubfoot

A

Ponseti method (plaster casing and bracing)

Surgery may be required if severe (Achilles tenotomy)

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10
Q

What is vertical talus like

A

Foot is stiff

Rocker bottom foot

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11
Q

What is pet cavus

A

High arched foot

Associated with neuromuscular disorder e.g. Friedrich Ataxia

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12
Q

What is scoliosis

A

lateral curvature of the spine

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13
Q

What is the dangerous complications scoliosis

A

cardiorespiratory failure

from distortion of the chest

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14
Q

What is torticollis

A

WRY neck

  • restriction of head turning
  • mobile, non-tender nodule (felt within SCM)

W

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15
Q

What is the most common cause of torticollis

A

SCM tumour

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16
Q

What are chromosomal causes of hypermobility

A

Downs

Marfans, Ehler Danlos

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17
Q

What is complex regional pain syndrome

A

Musculoskeletal pain of unknown origin

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18
Q

Who does complex regional pain syndrome occur in

A

teenage females

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19
Q

What kind of pain is experienced in complex regional pain syndrome

A

Extreme / incapacitating
may be locatlised on foot and ankle

Hyperanaestheisa
allodynia

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20
Q

What is osteomyelitis

A

infection of metaphysis of long bones (e.g. femur, tibia)

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21
Q

What does osteomyelitis arise from

A

Haematogeneous spread

Direct spread from infected wound

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22
Q

What are pathogens causing osteomyelitis

A

S aureus
Streptococcus
H influenza

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23
Q

What are features of osteomyelitis

A

painful, immobile limb
swelling and tenderness over site
movement cause s èpain
acute febrile illness

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24
Q

What investigations do you do for osteomyelitis

A 
Blood cultures (+ve)
WCC, CRP 
X rays (normal until 7-10 days, when you get new bone formation) 
MRI 
Radionucleotide bone scan
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25
Q

What is management for acute osteomyelitis

A

high dose IV antibiotics

surgical debridement

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26
Q

What are the two most malignant types of bone tumour

A

Ostoegenic sarcoma

Ewing tumour

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27
Q

What is Osgood-Schattler Disease

A

Osteochondritis of patellar tendon insertion at the knee

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28
Q

Who does Osgood-Schattler Disease affect

A

Adolescent males who are very physically active

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29
Q

What are key symptoms of Osgood-Schattler Disease

A

knee pain after exercise
localised tenderness
swelling over tibial tuberosity

30
Q

What is management for Osgood-Schattler Disease

A

Stop sporting activity

Pain relief (NSAID, paracetamol, ice packs)

31
Q

What is chondromalacia patellae

A

Softening of thew articular cartilage of the patella, affecting adolescent females

32
Q

What is osteochondritis dissecans

A

avascular necrosis of subchondral bone

33
Q

What is Perthes disease

A

Avascular necrosis of the capital femoral epiphysis due to interruption of blood supply

Followed by revascularisation and reossification over next 2 years

34
Q

What is reactive arthritis

A

Transient joint swelling following extra-articular infection

35
Q

What causes reactive arthritis

A 
Enteric bacteria (salmonella, shigella, campylobacter)
STI (chlamydia, gonorrhoea)
36
Q

How do you treat reactive arthtritis

A

You DON’T - SELF RESOLVING

37
Q

What is septic arthritis

A

Serious infection of the joint that can lead to bone destruction

38
Q

How do you treat septic arthritis

A

Prolonged course of antibiotics (IV 2 weeks, oral 4 weeks)

39
Q

What is juvenile idiopathic arthritis

A

persistent joint swelling >6 weeks presenting before 16 years of age in absence of any other causes

40
Q

How do you classify JIA

A

Polyarthritis >4 joints

Oligoarthritis <4 joints

41
Q

What are clinical features of JIA

A

Gelling (stiffness after rest)
Morning stiffness
Joint pain, swelling
Intermittent limp

42
Q

What investigations should you consider for JIA

43
Q

How do you manage JIA

A

Specialised paeds rheum clinic
NSAIDS
Corticosteroids
DMARD (methotrexate PO/SC)

44
Q

What is achondroplasia

A

short stature
short limbs
large head with frontal bossing
pincer grip

45
Q

What is thanatophoric dysplasia

A

results in stillbirth

large head, very short limbs

46
Q

What is arthrogyposis

A

stiffness and contractor of joints

47
Q

What is the difference in presentation between Osgood-Schattler and Chondromalacia Patellae

A

OSD: males, knee pain after lots of exercise

chondromalacia patellae: females, anterior knee pain on rising from sitting, walking upstairs

48
Q

What is another differential for knee pain after exercise

A

osteochondritis dissecans

49
Q

What is the presentation of Perthes disease

A 
5-10 year olds
limp / knee pain 
Pain worse after exercise
Reduced range of movement 
stiffness 
One leg shorter than other
50
Q

How do you investigate Perthes

A

Bilatera x ray (widening of joint space, m decrease in femoral head size)
Bone scan, MRI

51
Q

How do you manage Perthes disease

A

Acute pain with analgesia
<5yo good prognosis from observation only
>5yo consider surgery

52
Q

what is pathophysiology of Slipped Capital Femoral Epiphtysis

A

fracture through growth palate of femur > slippage of femoral ahead epiphysis poster-inferiorly

53
Q

what is classic person that will present with Slipped Capital Femoral Epiphysis

A

Obese teenager
Other metabolic abnormality (hypothyroid, hypogonad)
10-15 year old

54
Q

What is presentation of Slipped Capital Femoral Epiphysis

A

gradual onset limp
hip or knee pain
pain on abduction and internal rotation, restricted movements

55
Q

How do you confirm Slipped Capital Femoral Epiphysis diagnosis

A

Bilateral hip X ray (AP + frog view)

56
Q

How do you manage Slipped Capital Femoral Epiphysis

A

DONT LET THE PATIENT WALK
analgesia
immediate ORTHO REVIEW

Surgical repair: internal fixation

57
Q

What is pattern of inheritance for achondroplasia

A

AUTOSOMAL DOMINANT

So in GoT one parent must’ve been a dwarf also !!

58
Q

What children need to have an USS at 6 weeks to check for DDH?

A 
Breech presentation at 36/40 (regardless of presentation at delivery) 
Breech delivery (incl <36/40)
Family history of DDH
59
Q

when do you change from USS to X ray for DDH

60
Q

What DMARD is first line in JIA

A

Methotrexate

61
Q

how do you manage patient with rickets

A

if vit D deficient: daily calcium + ergocalciferol / cholecalciferol

62
Q

what X ray finding do you see in SCFE

A

Thethowan’s sign: line of Klein does not interset superior femoral epiphysis

63
Q

what is the most common cause of acute hip pain in children, and when does it occur

A

transient synovitis

often with / after viral infection

64
Q

what are symptoms of transient synovitis

A

sudden onset pain in the hip / limp
no pain at rest
decreased range of movement
mild febrile / afebrile

65
Q

What is still’s disease?

A

Arthritis with SALMON PINK RASH

+ pyrexia, uveitis, anorexia, WL

essentially a systemic form of JIA

66
Q

what rash do you get in juvenile dermatomyositis

A

helkiotropid discoloration of eyelids

erythema over bridge of nose

67
Q

what are findings on X ray of Perthes

A

widening of joint space

then decreased femoral head size

68
Q

what are findings on X ray of SCFE

A

Trethowan’s sign: lines of klein does not intersect femoral head

69
Q

what criteria can you use to differentiate septic arthritis from transient synovitiss

A

KOCHER’s CRITERIA

70
Q

What are Kocher’s criteria

A
  • Fever >38.5
  • refusal to bear weight on affected side
  • Raised ESR/CRP
  • Raised WCC

Y5 Paediatrics (30 decks)

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