Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > MSK & Orthopaedics > Flashcards

MSK & Orthopaedics Flashcards

1
Q

What is Perthes’ disease?

A

A degenerative condition affecting the hips of children, typically between 4-8 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiology of Perthes’ disease?

A

Avascular necrosis of the femoral head, specifically the epiphysis - impaired blood supply eventually causes femoral necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiology of Perthes’ disease?

A

5x more common in males, 10% of cases are bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of Perthes’ disease?

A
  • Hip pain: progressively over a few weeks
  • Limp
  • Stiffness and reduced range of hip movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the diagnostic investigations for Perthes’ disease?

A
  • Plain x-ray
  • Technetium bone scan or MRI if normal x-ray and symptoms persist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of Perthes’ disease on x-ray?

A
  • Joint effusion: widening of the medial joint space
  • Asymmetrical femoral epiphyseal size
  • Blurring of the physeal plate
  • Radiolucency of proximal metaphysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the complications of Perthes’ disease?

A
  • Osteoarthritis
  • Premature fusion of the growth plates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What staging is used to classify Perthes’ disease?

A

Catterall staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management of Perthes’ disease?

A
  • Keep the femoral head with the acetabulum (cast, braces)
  • If less than 6 years: observation
  • Older/ if failed to respond to conservative measures: surgical management
  • If severe deformities: surgical management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the prognosis of Perthes’ disease?

A

Most cases resolve with conservative management
Early diagnosis improves outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes Perthes’ disease?

A

The trigger for avascular necrosis is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is muscular dystrophy?

A

Muscles appearing poorly nourished due to degeneration

Dys - bad
Trophy - nourish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can muscular dystrophies and neuropathies be distinguished?

A

In muscular dystrophy, the neuromuscular junction is in tact but the muscles are dystrophied

In neuropathies that NMJs are not preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the dystrophinopathies?

A

Muscular dystrophies that occur due to mutations in the dystrophin gene (allelic disorders)

  • Duchenne muscular dystrophy
  • Becker muscular dystrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What mutation leads to duchenne muscular dystrophy?

A

Nonsense or frameshift mutation leading to no production of the dystrophin protein (one or both of the binding sites are lost)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What mutation leads to becker muscular dystrophy?

A

Misshapen dystrophin caused by missense mutations (both binding sites are preserved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the difference between DMD and BMD?

A

DMD:
- More severe
- Symptoms tend to present by age 5
- Earlier onset complications

BMD:
- Less severe
- Symptomatic by age 10-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the inheritance pattern of the dystrophinopathies?

A

X-linked recessive

2/3 of the time, the mother is a carrier
1/3 of the time, the mutation is sporadic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is lyonization?

A

The inactivation of one x chromosome in females (as they inherit 2) to ensure that females only have one functional copy of the x chromosome in cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are manifesting carriers?

A

Carriers of an x-linked recessive genetic condition where more of the x-chromosomes with the functional copy of the gene undergo lyonization, leading to over-expression of the defective gene and manifestation of the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the function of the dystrophin protein?

A

It links intracellular actin to the dystrophin-associated protein complex on the muscle cell membrane, which links with the extracellular matrix, and provides structure (like a wooden support beam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens to muscle cells without dystrophin?

A

The integrity of the sarcolemma (muscle cell membrane) is compromised leading to release of intracellular proteins eg. CK and cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens to muscle tissue in the short term, for a patient with dystrophinopathy?

A

Muscle regeneration:
- Cell death leads to muscle tissue loss
- Muscle fibres of different sizes are produced leading to some tissue regain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens to muscle tissue in the long term, for a patient with dystrophinopathy?

A

Muscle atrophy:
- Fat and fibrotic tissue infiltrates the muscle tissue
- Muscles become weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does Duchenne muscular dystrophy present?

A
  • Progressive proximal muscle weakness from 5 years old
  • Waddling gait
  • Pseudohypertrophy of the calfs
  • Gowers’ sign
  • 30% of patients have intellectual impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is Gower’s sign?

A

When lying on their stomach, the child will use their arms to help themselves stand due to muscle weakness in the legs and upper hips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the later symptoms of dystrophinopathies?

A
  • Wheelchair use
  • Respiratory failure - diaphragmatic weakness
  • Scoliosis
  • Dilated cardiomyopathy
  • Arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the cause of the cardiac symptoms in dystrophinopathies?

A

Dystrophin is expressed in cardiac muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How are dystrophinopathies diagnosed?

A
  • High serum creatine kinase
  • Genetic testing: DNA test, Western blot
  • Muscle biopsy: staining for dystophin (genetic testing has replaced this as the way to achieve a definitive diagnosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the medical management for dystrophinopathies?

A
  • Glucocorticoids - slow the degeneration, but there are side effects eg. weight gain
  • Ataluren - restores dystrophin synthesis (>=5 years old)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the prognosis for DMD?

A
  • Most children can’t walk by the age of 12
  • Patients typically survive to 25-30 years
  • Associated with dilated cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the physiotherapy for Perthe’s disease?

A

Stretching of the quadriceps and hamstring muscles, strengthen quads and encourage hip abduction

Continue activity

33
Q

What is the supportive care for acute pain in Perthe’s?

A
  • Simple analgesia
  • Ice packs
34
Q

What is the supportive management for DMD?

A
  • Physiotherapy (prevent contractures)
  • Exercise and psychological support
  • Dietician (gastric feeding in some patients, vitamin D and calcium supplementation if bone fragility)
35
Q

Why can DMD lead to nocturnal hypoxia?

A

Weakness of the intercostal muscles

36
Q

What is the management for DMD with nocturnal hypoxia?

A

Overnight CPAP

37
Q

What is the management for DMD if left ventricular fraction drops?

A

Cardioprotective drugs (eg. carvedilol) and left ventricular assist devices

38
Q

What is the managment for DDH in <6 months old?

A

1st line
- Observation: monitor via repeat USS or X-ray

2nd line
- Splint/ Pavlik’s harness to keep hip flexed and abducted (follow up with x-ray at 6 months)

3rd line
- Surgery if conservative measures fail

39
Q

What is the surgery for DDH?

A

Reduction with spica casting

40
Q

What are the indications for USS at 6 weeks to check for DDH?

A
  • Breech presentation (36/40)
  • Breech delivery (including <36/40)
  • Family hx DDH
41
Q

What imaging is better for DDH >6 months?

A

Hip x-ray

42
Q

Which sex is at greater risk of DDH?

A

Female

43
Q

Does DDH tend to resolve?

A

Most resolve spontaneously by 3-6 weeks

44
Q

What is the initial management of fractures?

A

Initial pain management and immobilisation
- Oral ibuprofen and/or paracetamol
- IV opiods for severe pain
- Acute stage assessment and diagnostic imaging

45
Q

What is the management of distal radius fracture in ED?

A

Manipulation
Consider:
- A below-elbow plaster cast
- K-wire fixation if the fracture is completely displaced

46
Q

What is the first step in management of femoral fracture in ED?

A

Admit all children

47
Q

Femoral fracture managment 3-18 months?

A

Gallows traction

48
Q

Femoral fracture managment 1-6 years?

A

Straight leg traction with possible conversion to hip spica cast to enable early discharge

49
Q

Femoral fracture managment 4-12 years?

A

Elastic intramedullary nail

50
Q

Femoral fracture managment >11 years (weight >50kg)?

A
  • Elastic intramedullarly nails supplemented by endcaps

OR
- Lateral entry antegrade rigid intramedullary nail

OR
- Submuscular plating

51
Q

Who should patients with JIA be managed by?

A

Specialist paediatric rheumatology MDT

52
Q

Why should patients with JIA continue activity?

A

Inactivity leads to deconditioning, disability and decreased bone mass (continue activities like swimming and cycling)

53
Q

What is the management of JIA?

A

Pharmacological
WHO Pain ladder
- Simple analgesia
- NSAIDs (controlling pain and stiffness)
- Consider weak opiates

Intra-articular corticosteroids (or oral/IV)
- Adjunctive agents (avoided if possible due to growth suppression and osteoporosis)

DMARDs (when disease fails to respond to conventional treatment)
- 1st line: oral or SC methotrexate
- 2nd line: sulfasalazine

Other (biologics)
- Inflammatory cytokine blockage eg. TNF-alpha inhibitors, IL receptor antagonists, anti-emetics

54
Q

What are the complications of JIA?

A
  • Joint damage
  • Anterior uveitis
  • Osteoporosis
  • Growth failure
55
Q

When is Osgood-Schlatter referred to orthopaedic surgeons?

A

If symptoms don’t improve or worsen or persist to adulthood despite management

56
Q

What is the management of Osgood-Schlatter?

A

Pain relief
- Analgesia (paracetamol/ NSAIDs)
- Ice packs over tibial tuberosity (10-15 mins up to x3 per day)
- Protective knee pads (pain when kneeling)

57
Q

Should sporting activity be stopped in Osgood-Schlatter?

A
  • Reduce sporting activity
  • Change type of exercise to limit running and jumping
  • As sx decrease, gradually increase exercise levels
  • Low impact quadriceps exercises (cycling, swimming, straight leg raises)
58
Q

What is the management for osteochondritis dissecans?

A
  • Pain relief
  • Rest and quads exercises
  • Sometimes surgical intervention needed to remove intra-articular loose bodies
59
Q

What is the management for acute osteomyelitis?

A
  • High dose IV empirical abx (usually 2-4 weeks)
  • Clinical recovery (acute phase proteins normal) switch to oral abx
  • Alter abx regimen when blood cultures are back
  • Affected limb immobilised, analgesia given
60
Q

When should blood cultures be taken for osteomyelitis?

A

Before starting abx

61
Q

When can early transition to oral abx be started for children with osteomyelitis?

A

If they respond well, early transition to oral abx (after 3 days- 1 week) can be considered

62
Q

How long is the course of oral abx for osteomyelitis?

A

6 weeks

63
Q

When is surgical debridement considered for osteomyelitis?

A

If there’s dead bone or a biofilm

64
Q

How is chronic osteomyelitis staged?

A

Using Cierney-Mader classification

65
Q

What is the management for chronic osteomyelitis?

A
  • Surgical debridement
  • IV abx
  • Functional rehabilitation
66
Q

What is the management for reactive arthritis?

A
  • Self-resolving
  • Symptomatic relief: NSAIDs, steroids (severe), DMARDs (ongoing)
67
Q

What is the management of Rickets?

A

Calcium and vitamin D deficiency
- Daily calcium
- Daily ergocalciferol (V D2)/ cholecalciferol (V D3)

Pseudo-vitamin D deficiency (defect in 1-alpha hydroxylase)
- Calcitriol/ 1-alfacalcidiol

Dietary
- Oily fish, egg yolk

68
Q

What is given in hypophosphataemic rickets?

A

Phosphate salts

69
Q

What is the antibiotic course length for septic arthritis?

A

Initially IV for 2 weeks, followed by 4 weeks of oral abx

70
Q

Which abx are used for septic arthritis in a neonate <3 months?

A

IV cefotaxime

71
Q

Which abx are used for septic arthritis 3 months - <=5 years?

A
  • IV ceftriaxone
  • If penicillin allergic, give clindamycin
72
Q

Which abx are used for septic arthritis >=6 years?

A
  • IV flucloxacillin
  • If penicillin allergic, give clindamycin
73
Q

What are the oral step-down abx for septic arthritis?

A
  • Co-amoxiclav
  • Flucloxacillin
74
Q

Which methods are used for joint aspiration in septic arthritis?

A

Joint aspirated to dryness
- Closed needle aspiration
- Arthroscopically

75
Q

What is the management of SUFE?

A
  • Patient remains non-weight bearing, analgesia and IMMEDIATE ORTHO REFERRAL
  • Surgical repair: in situ fixation across the growth plate
76
Q

What are the x-ray findings of SUFE?

A

Trethowan’s sign: Klein line doesn’t intersect superior femoral epiphyses/ asymmetry between Klein line on either side

77
Q

What is the managment of transient synovitis?

A
  • Bed rest
  • Pain relief (paracetamol or NSAIDs)
  • Usually resolves after a few days
78
Q

What is the management of femoral fractures at birth or due to prematurity?

A

Simple padded splint

79
Q

What is the management of femoral fractures 0-6 months?

A

Pavlik’s harness or Gallows traction

Paediatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions