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Paeds > MSK Disorders > Flashcards

MSK Disorders Flashcards

1
Q

What is a single painful swollen joint until proven otherwise?

A

Septic arthritis

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2
Q

Inttial management of someone with a single painful swollen joint

A

send to paeds A&E urgently for further assessment and management

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3
Q

Most common organism in septic arthritis

A

Most common organism is staphylococcus aureus

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4
Q

Investigations for septic arthritis

A

Bedside – basic obs, examination (look for local trauma)
Bloods – FBC, U+E, blood cultures,
Imaging/other – joint aspiration (in theatre, purulent), XR or MRI considered

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5
Q

Most important investigations in septic arthritis

A

Blood cultures + joint aspiration

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6
Q

Management of septic arthritis

A

Broad spectrum ABX according to Trust policy then switch to pathogen targeted after consulting micro for advice –> Usually IV course followed by several weeks of oral medication

Analgesia for pain

Refer to orthopaedics if complications arise

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7
Q

What is the most common chronic joint disease of childhood?

A

Juvenile idiopathic arthritis

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8
Q

How to diagnosis JIA?

A

Diagnosis of exclusion

Inflammation of one or more joints lasting at least 6 weeks in a child under 16 years of age where all other differentials have been ruled out.

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9
Q

Clinical features of JIA

A

Joint pain and swelling
Stiffness with rest (particularly in the mornings)
Fatigue
Rash
Fever

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10
Q

What is the specific fever pattern in JIA?

A

Spiking fever in quotidian pattern

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11
Q

What is the pathognomonic rash seen in JIA?

A

Salmon pink rash

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12
Q

Investigations for JIA

A

Bedside
Urine Dipstick (to check for evidence of glomerulonephritis that may suggest underlying vasculitic condition)

Bloods
Autoimmune Screen (ANCA, ANA, anti-dsDNA, anti-CCP)

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13
Q

What marker may be raised in JIA?

A

ANA

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14
Q

Management of JIA

A

Requires specialist paediatric rheumatology input
Regular physiotherapy input
Analgesia (usually NSAIDs)
Steroids may be used as adjuncts
DMARDs (e.g. methotrexate)
Biologic Agents (e.g. TNF-alpha inhibitors)
Most children respond well to treatment

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15
Q

What is the most common cause of acute hip pain in children? What is it often associated with?

A

Transient synovitis

Often associated with a preceding viral infection

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16
Q

Clinical features of transient synovitis

A

Acute-onset hip pain
Limp
Symptoms of viral infection (usually URTI)

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17
Q

Investigations for transient synovitis

A

Primarily a clinical diagnosis
Ultrasound may demonstrate a joint effusion
Joint aspiration if there is any concern about septic arthritis

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18
Q

What diagnosis MUST you exclude before diagnosing transient synovitis?

A

Septic arthritis

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19
Q

Management of transient synovitis

A

Rest
Analgesia (paracetamol and/or NSAIDs)
Often resolves within days

NOTE: NICE says if child is well, afebrile, sx <72h, then can be considered for community management

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20
Q

What does reactive arthritis present with? How do you remember this?

A

Triad of arthritis, urethritis, and conjunctivitis

“can’t see, can’t pee, can’t climb a tree”

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21
Q

What is reactive arthritis? What does it occur after?

A

Inflammatory arthritis that occurs 1-4w post genitourinary or GI ix

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22
Q

What diagnosis must be excluded before diagnosing septic arthritis?

A

septic arthriits

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23
Q

Management of reactive arthritis

A

Supportive + pain managment

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24
Q

What is ehler danlos syndrome?

A

Autosomal dominant condition that affects Type 3 collagen

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25
Q

Genetic inheritance of ehler danlos syndrome

A

AD

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26
Q

What is affected in ehler danlos syndrome? What does this lead to?

A

Autosomal dominant condition that affects Type 3 collagen
Tissue is more elastic resulting in joint hypermobility and elasticity of skin

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27
Q

When to suspect ehler danlos syndrome?

A

If recurrent joint dislocation occurs

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28
Q

What conditions are associated with ehler danlos syndrome?

A

Associated conditions: aortic regurgitation, mitral valve prolapse, aortic dissection, easy bruising, subarachnoid haemorrahge

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29
Q

What is SUFE? Who is it more common in?

A

Displacement of the femoral head epiphysis posteriorly and inferiorly.
More common in male and obese children.

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30
Q

Clinical features of SUFE

A

Gradual-onset hip pain
It may also manifest with knee pain (referred from the hip)

Limp

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31
Q

What to consider if child presents with knee pain?

A

Pain is referred from the hip

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32
Q

How does SUFE present on investigation?

A

Loss of internal rotation when leg is flexed

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33
Q

Investigations for SUFE

A

AP and lateral frog-leg views bilaterally

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34
Q

Management of SUFE

A

Internal fixation with cannulated screw

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35
Q

What sign may be seen on XRay with SUFE?

A

Threthowan’s sign

36
Q

What is Perthe’s disease? Who is it more common in?

A

Disorder of the hip characterised by avascular necrosis of the femoral head

More common in boys

37
Q

Presentation of Perthe’s disease

A

Gradual-onset hip pain
Some patients may present with knee pain (referred from the hip)
Limp
redcued ROM

38
Q

Investigations for Perthre’s disease

A

XR bilaterally shows widened joint space, and later a small/flat femoral head

39
Q

Management of perthe’s disease if <5 years

A

Simple analgesia + mobilisation and monitoring

40
Q

Management of Perthe’s disease if >5 years

A

simple analgesia + may consider surgical containment, or the salvage procedure (remodelling of the acetabulum)

41
Q

Salvage procedure

A

Remodelling of the acetabalum

Used in children >5 with perthe’s disease

42
Q

What is DDH? What does it lead to an increased risk of?

A

An abnormality of the hip joint in which the acetabulum is shallow and does not fully cover the head of the femur. Leads to an increased risk of joint dislocation.

43
Q

RFs for DDH

A

female (6x), breech, FHx, oligohydramnios, LBW, multiple pregnancy

44
Q

When is DDH usually picked up?

A

In neonatal screening, or in NIPE. See a Positive Ortolani test
+ Positive Barlow test

45
Q

Which tests are positive in DDH? What’s the difference between them?

A

Barlow + Ortolani

Barlow –> attempts to use posterior force + adduction to dislocate
Ortolani –> attempts to use anterior force + abduction to relocate

46
Q

What may patients with DDH present with if missed on neonatal screening?

A

abnormal gait, leg length discrepancy, ASYMETRICAL SKIN FOLDS

47
Q

Investigations for DDH

A

All infants screened at newborn exam + 6week check with Barlow and Ortolani’s → ortho referral with US in 2-4w

Some infants require routine US scanning if B+O negative in 4-6w:
1st degree FHx of early hip problems
Breech 36w+ gestation regardless of px at birth or MOD
Multiple pregnancy

48
Q

Which infants still require routine US scanning for DDH even if Barlow and Ortolani tests are normal? When is this carried out?

A

1st degree FHx of early hip problems
Breech 36w+ gestation regardless of px at birth or MOD
Multiple pregnancy

Carried out in 4-6 weeks

49
Q

What imaging is done in DDH?

A

Ultrasound of hips (if 6 weeks-6 months)
Hip X-ray (>6 months)

50
Q

Management of DDH

A

depends on the age

Most unstable hips will spontaneously stabilise by 3-6 weeks of age

Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months

Older children may require surgery

51
Q

What is chondromalacia patellae?

A

Knee condition characterised by inflammation of the cartilage on the under-side of the patella.

52
Q

Clinical features of chondromalacia patellae

A

Common in teenage girls

Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting

53
Q

Management of chondromalacia patellae

A

Simple analgesia (Paracetamol and/or NSAIDs)
Physiotherapy

54
Q

What is os-good schlatter disease? WHo does it typically affect?

A

Common condition involving the knee joint caused by inflammation of the patellar ligament at its insertion into the tibial tuberosity.
Typically affects physically active adolescents.

55
Q

How does osgood-schlatter disease present?

A

Knee pain
Worse after exercise
Swelling and tenderness over tibial tuberosity

56
Q

Management of osgood schlatter disease

A

Analgesia
Paracetamol and/or NSAIDs
Application of ice packs over tibial tuberosity

Consider reducing or stopping all sporting activity whilst the pain abates
Consider recommending a change in the type of activity (I.e. avoiding activities that involve running and jumping)

57
Q

What is osteochondritis dissecans? Who does it affect?

A

Joint condition characterised by avascular necrosis of subchondral bone. Fragments of bone and cartilage can then break loose and cause joint pain and dysfunction.

Most commonly affects the knee joint and is more common in children and adolescents.

58
Q

Clinical features of osteochondritis dissecans

A

Joint pain and swelling
Patients may describe a sensation of locking within the knee joint and may complain that the knee feels like it ‘gives way’
Joint crepitus

59
Q

Management of osteochondritis dissecans

A

Most cases resolve with rest and simple analgesia
Surgery may be performed in some cases where the symptoms fail to resolve with rest

60
Q

anterior knee pain on walking up and down stairs and rising from prolonged sitting

A

chondromalacia patellae

61
Q

Pain, tenderness and swelling over the tibial tubercle

A

Osgood-schlatter disease

62
Q

Intermittent swelling and locking of knee joint

A

Osteochondritis dissecans

63
Q

Clinical features of patellar subluxation

A

Medial knee pain due to lateral subluxation of the patellaKnee may give way

64
Q

Clinical features of patellar tendonitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

65
Q

What is talipes equinovarus? AKA?

A

Congenital defect characterised by inversion and supination of the foot usually resulting from intrauterine compression.
Also known as clubfoot.

66
Q

talipes equinovarus

A

clubfoot

67
Q

Clinical features of talipes equinovarus

A

Inverted and supinated foot
May be bilateral

68
Q

Management of talipes equinovarus

A

Passive manipulation
Using plaster casting and bracing (Ponseti method)
May require physiotherapy input
Surgery in cases that fail to improve with manipulation

69
Q

Ponseti method

A

Passive manipulation using plaster casting and bracing for clubfoot

70
Q

What is the most common bone cancer in children? Where does it most often affect?

A

Osteosarcoma

Most common in the knee (60%)

71
Q

What is seen in Xray in osteosarcoma?

A

XR – sunburst appearance, elevated periosteum (Codman’s triangle)

72
Q

What is the most common bone cancer in adolsecents? Where does it present?

A

Ewing’s sarcoma

HIGHLY MALIGNANT, in long bones and pelvis

73
Q

What is seen on Xray in Ewing’s sarcoma?

A

onion skinng periostium

74
Q

What is osteomyelitis? Most common organism?

A

Bone infection, staph aureus

75
Q

Presentation of osteomyelitis

A

warmth over bone, local pain/swelling, febrile

76
Q

Investigations of osteomyelitis

A

blood culture, bone biopsy, MRI

77
Q

Management of osteomyelitis

A

IV abx according to trust policy

78
Q

What is Achrondoplasia? What is affected ?

A

Autosomal dominantdisorder associated with short stature.
Caused by a mutation (70% sporadic) in the fibroblast growth factor receptor 3 (FGFR-3) gene = abnormal cartilage

79
Q

Genetic inheritance of achrondoplasi

A

AD

80
Q

Mutation that is seen in achrondoplasia

A

Caused by a mutation (70% sporadic) in the fibroblast growth factor receptor 3 (FGFR-3) gene = abnormal cartilage

81
Q

Presentaiton of achrondoplasia

A

short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis

THINK: Tyrian Lannister (Peter Dinkage)

82
Q

Trident hands, lumbar lordosis, frontal bossing

A

Achrondoplasia

83
Q

What is Rickets due to? What is it called in adults?

A

It is usually due to vitamin D deficiency. In adults, the equivalent condition is termed osteomalacia

84
Q

RFs for rickets

A

Ca deficiency (malnutrition), unsupplemented cow’s milk formula, lack of sunlight

85
Q

Presentation of rickets

A

genu varum (bow legs) in toddlers, genu valgum (knock knees) in older children, aching bones/joints,

86
Q

genu varum

A

bow legs, seen in toddlers

87
Q

genu valgum

A

knock kness, seen in older children

Paeds (14 decks)

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