MSK

Question 1

What are the risk factors for DDH?

Answer 1

female
breech
>5kg birth weight
oligohydramnios 
family history

Question 2

What are the signs a baby may have DDH?

Answer 2

• limited abduction
• limb shortening
• asymmetrical gluteal/thigh folds

Question 3

Name and describe the screening tests for DDH. If they are positive what is done?

Answer 3

Galeazzi: lead supine with hips and knees flexed there is asymmetry in height

Barlow: adduct and push posterior to dislocate

Ortalani: abduct and pull anteriorly to relocate

+ve test = USS hip

Question 4

When is an USS hip needed for suspected DDH?

Answer 4

+ve screening tests
Positive first degree family history
Still breech at 36 weeks

Question 5

How is DDH managed?

Answer 5

<6 weeks = wait for spontaneous resolution

>6 weeks = Pavlick harness

Question 6

What is Perthes disease and in whom does it commonly effect?

Answer 6

AVN of the femoral head affecting boys <8 y/o

Question 7

What are the signs and symptoms of Perthes disease?

Answer 7

• limited internal rotation and abduction
• may have groin/thigh pain
• limp (antalgic then Trendelenburg)

Question 8

How is Perthes disease investigated? What is seen?

Answer 8

x-ray hip

• widened joint space
• flattened femoral head

Question 9

At what age is surgical intervention indicated for Perthes disease?

Answer 9

> 6 y/o

if younger can just observe

Question 10

Where (bones and part of bone) does osteomyelitis most commonly affect children?

Answer 10

Distal femur and proximal tibia

Metaphysis

Question 11

What are the signs and symptoms of osteomyelitis?

Answer 11

Fever and systemically unwell
Limp
Pain exacerbated by movement
Tender, erythematous and swollen

Question 12

What is the stepwise management of osteomyelitis?

Answer 12

1. 72 hours of IV flucloxacillin

2. surgical debridement and 6 weeks oral flucloxacillin

Question 13

Which joint is most commonly affected by septic arthritis in children?

Answer 13

Hip

Question 14

What are the signs and symptoms of septic arthritis?

Answer 14

Fever and systemically unwell
Pain on passive movement
Limp
Swollen, hot joint

Question 15

How is septic arthritis investigated and managed?

Answer 15

Joint aspirate to examine synovial fluid
MRI

Surgical drainage and IV flucloxacillin

Question 16

What are the signs and symptoms of transient synovitis?

Answer 16

Post viral infection: 
Limp
Pain on active movement
Pain on passive movement ONLY at extreme ROM
Low grade fever

Question 17

How is transient synovitis investigated and what may be seen?

Answer 17

x-ray frog, lateral and AP: widened joint space

Question 18

What are the signs and symptoms of juvenile idiopathic arthritis?

Answer 18

• Arthritis for >6 weeks
• Salmon pink rash
• Lymphadenopathy
• Low grade fever

Question 19

What antibody is seen in juvenile idiopathic arthritis?

Answer 19

ANA

Question 20

What are the red flags of a limping child?

Answer 20

• <3 years old (probably not transient synovitis)
• Fever
• Unable to weight bear
• Neurovascular compromise
• Night pain
• Weight loss

Question 21

What is Rickets?

Answer 21

Decreased mineralisation of the bone before closure of the growth plates

Question 22

What are the risk factors for developing Rickets?

Answer 22

• Non Caucasian
• Antiepileptics
• Vegetarian
• Exclusively breast fed >6 months
• IBD, coeliac, CF

Question 23

What are the signs of Rickets?

Answer 23

• Delayed closure of fontanelles
• Frontal bossing
• Dental hypoplasia
• Swollen ankles and wrists
• Bowing of the legs
• Pectus carinatum
• Rachitic rosary

Question 24

How is Rickets investigated and what is seen?

Answer 24

X-ray wrist: metaphyseal cupping, splaying, fraying

Question 25

Describe growing pains

Answer 25

• Bilateral
• Worse on activity and NOT on waking
• Intermittent

The child is systemically well with a normal examination and no limitations to activity

Question 26

In whom and how does SUFE present?

Answer 26

Obese teenagers:

• limp
• hip pain radiating to knee
• limited abduction and internal rotation

Question 27

How is SUFE investigated and what is seen?

Answer 27

Hip x-ray frog leg and AP shows femoral head slipping inferolateral (ice cream cone melting)

Question 28

How is SUFE managed?

Answer 28

Non-weight bearing

May require pinning if AVN risk

Question 29

What are the symptoms of Ewing’s sarcoma and what is seen on x-ray?

Answer 29

Pain in the pelvis and long bones

X-ray: lytic lesion of the diaphysis with an onion skin appearance

Question 30

What is osteochondroma?

Answer 30

Benign cartilage capped bony projections on the surface of the bone

Question 31

Where does osteosarcomas affect and therefore how does it present?

Answer 31

Metaphysis of long bones prior to growth plate closure.

Presents as pain and swelling at the site

Question 32

Describe the x-ray of an osteosarcoma

Answer 32

Sunburst lesion