Musc + Neuro

Question 1

What is slipped femoral epiphysis?

Answer 1

overweight boys 10-15 yrs
1/50000
FE displaced posterolaterally following minor trauma/spontaneously
bilateral in 1/5

Question 2

What is Osgood-Schlatter disease?

Answer 2

traction apophysitis
(cartilage detachment from tibial tuberosity)
due to repeated avulsion during growth spurt i.e. overuse
usually a lump over the tibial tubercle
Req rest + analgesia

Question 3

Perthes disease

Answer 3

Ischaemia of epiphysis + adjacent metaphysis
Avascular necrosis of the femoral head
Revasc + reossification over 2-3 yrs
Incr density + reduced size of femoral head
Later = fragmented + irreg

Question 4

Signs of basal skull fracture

Answer 4

Haemotympanum: blood behind tympanic membrane
Raccoon eyes
CSF oto/rhinorrhoea
Battle’s sign: blood at mastoid

Question 5

Benign rolandic epilepsy

Answer 5

7-10 yrs
Mostly male
Nocturnal involving mouth + face
Excessive salivation, grunting + slurred speech -> generalised seizures
EEG: high amplitude spikes in left centrotemporal region nr Rolandic fissure
Benign, grow out of it by adolescence

Question 6

Absence seizures

Answer 6

Generalised seizures affecting consciousness
Last a few seconds
Stares blankly, unresponsive
No recollection of event
2-10 yrs More common in girls
Frequently grow out of them 
3 spike wave complex
FHx in 10%

Question 7

Juvenile myoclonic epilepsy

Answer 7

Begins around puberty
Precipitated by alcohol
Severe symmetrical jerks of arms + trunk -> generalised seizures
Often occur in the morning on waking

Question 8

Lennox Gastaut type epilepsy

Answer 8

1-4 yrs
Daily seizures, episodes of status epilepticus
Slow psychomotor development + behavioural disorders
Poor prognosis
EEG: slow spike waves, multiple abnormalities

Question 9

Reflex anoxic seizure

Answer 9

After pain/discomfort/minor injury/fever/cold drink/fright
Infant/toddler
Pallor-> fall to ground -> occasionally tonic clonic movements -> rapid recovery
Reflex cardiac asystole secondary to incr vagal response

Question 10

Breath holding attacks

Answer 10

Young children usually toddlers
Upset/angry/crying
Hold breath at end of expiration -> goes blue and apnoeic
Brief LOC can occur

Question 11

Simple vasovagal

Answer 11

Standing for long periods / very warm environment
Dizzy /light headed/ ringing in ears / blurred vision
Syncope

Question 12

Cardiac arrhythmias

Answer 12

Syncope without warning

May be related to exercise

Question 13

Other cardiac causes of syncope

Answer 13

SVT

Prolonged QT

Question 14

You suspect septic arthritis what investigations would you do to confirm your diagnosis?

Answer 14

US joints: painful joint + joints above and below
Radiology will not show signs until later in the course of the infection
Blood cultures should be sent
Joint aspirate should be sent for M, C + S
Start empirical IV abx

Question 15

How does SUFE present?

Answer 15

Limp + Hip pain referred to knee
Restriction in abduction + int rotation of hip
Management: surgical pinning of epiphysis
Complications: premature epiphyseal fusion + avascular necrosis

Question 16

How does Perthes’ disease present?

Answer 16

Boys
2-10 yrs (usually >5)
Insidious onset hip pain + limp
Bilat in 10%
Dx by x-Ray: incr density, reduced size femoral head

Question 17

How is Perthes disease managed?

Answer 17

Bed rest + traction
Femoral head may need to be ‘covered’ by acetabulum so it can act as a mould for the reossification: hip maintained in abduction
Or surgical femoral osteotomy
Usually good prognosis
Poor prognosis if: 1/2 epiphysis involved
Incr risk of deformity of femoral head = degen OA in adult life

Question 18

Transient synovitis

Answer 18

3-8yrs
Following viral infection
Diagnosis of exclusion
Sudden onset hip pain, mild fever, slight limp, reduced range of movement especially ext rotation
No pain at rest, few systemic sx
-ve FBC, acute phase reactants, x-Ray, blood cultures
Small effusion on USS

Question 19

How is transient synovitis managed?

Answer 19

Analgesia
Bed rest
Skin traction??
Usually resolves in 7-10 days

Question 20

How is septic arthritis managed?

Answer 20

US + joint aspirate (usually staph aureas)
Surgical washout
IV abx: fluclox + benpen
Followed by oral abx
Complications: joint destruction, osteomyelitis, ankylosis (fusion across joint)

Question 21

Risk factors for septic arthritis?

Answer 21

V old / v young
IVDU
DM
Pre-existing joint pathology

Question 22

Genu varus

Aka bow legs

Answer 22

Medial angulation of lower leg at the knee
Commonest cause: rickets
Also caused by Blount’s disease: asymmetrical growth of tibial physis common in Scandinavian + Afro-Caribbean ethnicities

Question 23

Signs of an intracranial mass

Answer 23

Focal neuro signs: tremor
Behavioural changes
Headaches worse in am, worse on coughing, bending or straining
Papilloedema on fundoscopy