MSK + Specials

Question 1

What is varus and valgus?

Answer 1

Genu varus: Bow legs ie the joint below the knee is positioned close together
Genu valgus: Knock knees ie the joint below the knee is positioned apart

Question 2

What is flat foot? What are the causes? How common is it? How is it managed?

Answer 2

Pes Planus
Seen in toddlers walking due to presence of fat pad and flattened medial longitudinal arch. Can be elicited by getting them on tip toes/ passively extending big toe. Normal ages 1-2
May indicate hypermobility e.g. Ehlers Danlos Syndrome, or tarsal fusion.
Older children w/ persistent flat foot that is painful who lack an arch even on tiptoes may indicate JIA or ankle contracture and req referral to paeds rheumatologist/ surgeon.
Footwear advice/ orthotics is usually all that is required for symptomatic flat foot unless older child.

Question 3

What is forefoot adduction? Who does it usually affect? What other issues may look similar to this?

Answer 3

Metatarsus varus. An adduction deformity where medial toe points to midline.
Common in infants 1-2 years old. Resolves on own/ requires intervention if persists beyond 5 years. Can be passively corrected by holding heel in correct position.

1. Medial tibial torsion- associated w bowing of legs, tibia are less laterally rotated than femurs. self resolves. seen in toddlers.
2. persistent anteversion of the hip- femoral neck is twisted forward more than normal. presents in childhood and kids are able to sit between their feet and their hips are fully internally rotated “W” sitting. usually self resolves but can req surgical osteotomy of femur.

Question 4

How might rickets present in childhood?

Answer 4

Genus Varus

Question 5

What are the clinical manifestations of osteogenesis imperfecta?

Answer 5

Genus Varus

Question 6

what is the incidence of Developmental Dysplasia of the Hip (DDH)? What are the RF for its development? How do you screen for it?

Answer 6

1.5/1000
RF: fhx, breech presentation, female gender, foot positioning abnormalities.
Two screening tests: Barlow manouver + Ortolani manouver. (B)- can hip be dislocated posteriorally from acetabulum. Hip flexed to 90° and adducted, the examiner’s hand is placed on the knee, and posterior pressure is placed through the hip to identify dislocatable hips. (O)- can hip be relocated into acetabulum on abduction. Hip flexed to 90° and abducted, examiner’s fingers placed laterally over the greater trochanter or hip joint. Examiner then uses anterior pressure over the trochanter to identify a dislocated hip that is relocatable.

Question 7

How does Developmental Dysplasia of the hip present? How is it managed?

Answer 7

Spectrum of disorders from acetabular immaturity to subluxation + total dislocation of the hip.
Can be identified on screening/ or presents later with limp, abnormal gait, limited or assymetric hip abduction.
Pavlik harness that keeps hips in flexed + abducted position for sev months, monitored with US/XR.
If this fails may require closed/ open reduction procedure (bones into place) + trunk + limb casting.

Question 8

What is scoliosis? What are the causes? What is its significance?

Answer 8

Lateral curvature of the spine in the frontal plane. When severe, can cause cardiopulmonary failure due to distortion of the chest but this is v rare. can create a restrictive lung disease pattern on Lung Function tests.

1. Idiopathic: either under 5 or 10-14 affecting primarily girls during their growth spurt.
2. Congenital: either due to spinal abnormalities e.g. hemivertebrae, spina bifida or syndromes e.g. VACTERL - vertebral, anorectal, cardiac, tracheal-oeophageal, renal, limb abnormalities.
3. Secondary: to CP or muscular dystrophy, to connective tissue disorders Marfan’s, disorders of bone, or leg length discrepancy e.g. due to JIA of knee

Question 9

What are the principles behind scoliosis management?

Answer 9

Prevent progression of spinal deformity until the pt reaches skeletal maturity at which point the chance of curve progression dramatically decreases.
For the most mild cases, pt is discharged and advised to remain active partic to improve core strength + conditioning.
For more mod cases, kept under active surveillance with AP/lateral XR at certain intervals
For more than 20 degrees, bracing is used
For more than 45 degrees, spinal fusion surgery is recommended to correct deformity, limit its progression and reduce associated complications.

Question 10

What is torticollis (basic)? What are its causes?

Answer 10

Shortening of one SCM causing reduced head rotation + flexion. Results in head rotated to contralateral side+ head tilted towards ipsilateral side.
Chronic causes: 
congenital
cervical spine arthritis/ malformation
spinal tumour
posterior fossa tumour

Acute causes:
ENT infection - causing inflamm of neck nodes
muscle spasm

Question 11

How does Osteomyelitis present?

Answer 11

Fever, a painful immobile limb, swelling + extreme tenderness particularly when moving the limb. Most commonly affects the femur + prox tibia.

Question 12

How does Osteomyelitis present?

Answer 12

Fever, a painful immobile limb “pseudoparesis”, swelling (skin overlying affected site)+ extreme tenderness particularly when moving the limb. Most commonly affects the femur + prox tibia. May be sterile effusion of adjacent joint. Can be due to blood borne pathogen or direct spread from wound. Can spread to joint to cause septic arthritis.

Question 13

What are the causitive organisms of OSteomyelitis?

Answer 13

Staph aureus, Streptococcus, H influenzae. Other more rare: staph osteomyelitis/ salmonella in sickle cell and TB

Question 14

what causes SSS (scalded skin syndrome)? What does it look like? How is it treated?

Answer 14

widespread erythema with fluid filled blisters (bullae) that burst easily leaving wet tender erythematous skin due to the release of two endotoxins by staphylococcus aureus the endotoxins bind to desmosomes causing skin cells to break apart from each other. common in kids under 5, particularly neonates due to low immunity and poor renal clearance of toxins. (armpits, groin, umbilicus).
Hospitalize, IV Fluclox + supportive tx includ analgesia, fluids/ electrolyte management, emollients

Question 15

what is cradle cap? How is it treated?

Answer 15

Cradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies
treated with Regular washing of the scalp with a baby shampoo, followed by gentle brushing with a soft brush to loosen scales and improve the condition of the skin. can soften scales with baby oil, gently brush + wash off. Soak crusts with vaseline/ olive oil + shampoo in morning. Can use greasy emollient/ soap substitute. if persistent, topical imidazole cream.