- Low Vit D - High PTH - High Alk Phos - Calcium / Phosphate normal or low

Musculoskeletal Flashcards by Ellie Harrison

What is the treatment for hip congenital hip dysplasia and what is the risk?

Pavlik harness - keeps hip flexed and abducted
Risk = avascular necrosis to head of femur

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What is Perthes Disease?

Avascular necrosis of the femoral head –> revascularisation over 18-36m
More common boys 4-8y

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What is Osgood-Schlatter?

Avascular necrosis of the tibial tuberosity

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What is slipped upper epiphysis?

Displacement of the epiphysis of femoral head postero-inferiorly
More in obese teenage boys

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Features of transient synovitis

2-12y
Often associated with recent / intercurrent viral illness
Sudden onset hip / knee (referred) pain
Otherwise well

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Genetics and presentation of osteogenesis imperfecta

Dominant / recessive
Mutation COL1A1 or 2 –> abnormalities in production in alpha chain of Type 1 collagen –> bone fragility and low bone mass
Presentation: bowing frequent fractures, hypermobility

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Causes of Rickets

Vitamin D Deficiency (1,25-dihydrocholecalciferol deficiency)
Phosphate deficiency (low calcium)

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Presentation of Rickets

Bowed limbs
Metaphyseal swelling
Bone pain / miserable
Gross motor delay, delayed growth
Hypotonia, weakness
Bossed forehead
Delayed dentition
X-ray: cupping, splaying, fraying. General osteopenia

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Rickets Biochemistry

Low Vit D
High PTH
High Alk Phos
Calcium / Phosphate normal or low

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What is osteopetrosis and how does it present?

Failure of bone resorption –> brittle
Faltering growth
Recurrent infection
Hypocalcaemia
Anaemia, thrombocytopenia

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Common organisms for septic arthritis

Staph. aureus
Group A strep
Gram negative bacilli

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Common infections preceding reactive arthritis

Salmonella
Shigella
Campylobacter
STIs
Strep
Mycoplasma
Lyme’s

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Extra-articular features of JIA

Anterior uveitis
Leg length discrepency
Rheumatoid nodues in RF +ve
Low grade fever - polyarthritis

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Define oligoarticular JIA

4 or fewer joints in the 1st 6 months of disease. Commonly larger joints eg knees, ankles, elbows. Usually presents 2-4y.

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Difference between extended oligoarthritis and polyarthritis

Extended oligoarthritis = Asymmetrical large and small
Polyarthritis = Symmetrical large and small (often fingers)

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Features of systemic arthritis (Still’s disease)

Oligo / poly
Acute illness
Malaise, anorexia, weight loss
Daily fever >2w
Salmon pink rash (worse with fevers)
Hepatosplenomegaly
Serositis
Raised inflammatory markers, low Hb
More in young girls

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Treatment of systemic onset JIA

IV Methylprednisolone

Features of psoriatic arthritis

Asymmetric large and small
Dactylysis
Nail pitting
Psoriasis
+/- ant. uveitis
FHx

Features of enthositis related arthritis

HLA B27 +ve
Lower limb large joints
Milder spine
Tendon / ligament inflammation

What is macrophage activation syndrome and how does it present?

10% children with systemic JIA
Life threatening
Excessive activation and expansion of T cells and macrophages
- Presents: Continuous fever, low leukocytes / platelets –> multiple organ failure

Presentation of juvenile onset SLE

Usually teens. Need 4 of:
Rash - malar, discoid
Photosensitivity
Mouth ulcers
Arthritis
Serositis - pleural, pericarditis
Renal disease - proteinuria, casts
Neuro-psych disorders - psychosis, seizures
Low Hb / Plt / WCC
Positive for: Anti-DNA, anti-Smith, antiphospholipid Ab, ANA

Antibodies that may be present in SLE

Anti-Ro
Anti-La
Anti-dsDNA (most specific!)
Anti-Sm
Anti-RNP
ANA

Treatment for SLE

Supportive, avoid sun
Analgesia
ACEi for HTN / proteinuria
Steroids
DMARDs - hydroxychloraquin, cylophosphamide (AI suppression)

Why might children with SLE require life-long prophylactic ABx?

Can get vasculitis –> splenic infarction –> immunodeficiency

Presentation of jeuvenile dermatomyositis

Teens - AI Erythematous rash + 2 of: -Symmetrical weakness of prox muscles - Periorbital swelling / discolouration - Grotton's papules - scaly rash of PIP/ MIPs - Increased muscle enzyme: CK, AST, LDH - EMG changes - Biopsy - necrosis + inflammation - MRI changes - diffuse white Also may get lung disease, oligoarthritis

Presentation of Duchenne Muscular Dystrophy

More commonly boys. Progressive muscle degeneration. Around 5y Waddling gait Gower's sign (weak limb girdle) Enlarged calves Language delay Slower, climbs stairs 1 by 1 Raised CK Beyond ant. horn, no fasiculations

Inheritance pattern of Duchenne Muscular dystrophy

X-linked recessive deletion of dystrophin gene (Xp21)

Inheritance of myotonic dystrophy

Autosomal Dominant Expanding CTG trinucleotide repeats on Ch 19 --> anticipation

Presentation of myotonic dystrophy

Congenital - severe. Hypotonia, feeding difficulty, resp. distress Later onset - hypotonia, myopathic face, GDD. Later complications - DM, cataracts, cardiac involvement

Common sites for osteomyelitis and most common organism

Distal femur Proximal tibia Organism: Staph. Aureus

Presentation of HSP (small vessel vasculitis)

1. Abdominal pain 2. Arthritis 3. Non-thrombotic palpable purpura occur over buttocks and legs. May follow URTI. +/- intussusception = IgA immune complex deposition in smaller vessels

Diagnostic criteria of Kawasaki (medium vasculitis)

Fever >38 for 5 days or more, + 4 of: - Erythema / cacking lips and oral mucosa - Bilateral non-purulent conjunctivitis - Rash (diffuse, maculopapular, erythematous - Erythema and oedema of hands / feet --> desquamation and peeling - Cervical LN >1.5cm

Major complication of Kawasaki

MI and coronary artery aneurysm

Treatment for Kawasaki

IV Ig High dose aspirin Antiplatelet Some may need steroid / immunosuppression

Describe Erb's palsy

- Injury C5 and C6 roots. - Motor: shoulder abduction and forearm flexion “waiter’s tip” deficit - Sensory deficits – reduced sensation over posterior lateral aspect of arm, thumb, index finger (digital branches of medial nerve).

Describe presentation C7/8 injury

‘Ulnar claw’ – difficultly extending at elbow and wrist. Sensory – posterior and medial aspects of the arm.

Which antibody is most associated with Polyarticular JIA?

Rheumatoid factor

Which antibody is most associated with Oligoarticular JIA?

ANA

Antibody associated with Sjogren's syndrome

Anti-Ro

What is present in the urine in Rhabdomyolisis?

Myoglobin

Which fracture is most associated with NAI?

Metaphyseal fracture Caused by shearing forces "corner" or bucket handle" fractures