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Phase 3a - Paediactrics > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Osteogenesis Imperfecta

A

An autosomal dominant genetic condition that results in brittle bones that are susceptible to fractures. - A genetic mutation that affects the formation of collagen which is needed to maintain the structure and function of bone, skin, tendons and other connective tissues.

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2
Q

Presentation of Osteogenesis Imperfecta

A

Recurrent and inappropriate fractures - Blue/grey sclera
- Hypermobility
- Triangular face
- Deafness from early adulthood
- Dental problems
- Bone deformities

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3
Q

Ix for Osteogenesis Imperfecta

A

Mainly a clinical diagnosis - X-rays can be helpful for diagnosing fractures and deformities - Genetic testing is done rarely

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4
Q

Management of Osteogenesis Imperfecta

A

Bisphosphonates to increase bone density - Vit D supplementation - Physio and occupational therapy input to maximise strength and function - Management of fractures

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5
Q

Rickets

A

A condition where there is defective bone mineralization causing ‘soft’ and deformed bones

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6
Q

Causes of Rickets

A

Vitamin D deficiency - produced by the body in response to sunlight or through food such as eggs, oily fish - Calcium deficiency - found in dairy products and some green vegetables - Hereditary hypophosphatemic rickets - an X-linked dominant condition

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7
Q

Pathophysiology of Rickets

A

Vit D is a hormone created from cholesterol by the skin in response to UV radiation. - Those with malabsorption disorders such as IBD are more likely to have Vit D deficiency as well as those with CKD. - Vitamin D is essential in calcium and phosphate absorption from the intestines and kidneys as well as regulating bone turnover and promoting bone reabsorption. - Inadequate vit D leads to a lack of calcium and phosphate which are needed for bone formation therefore there is defective bone mineralisation. - Low calcium causes secondary hyperparathyroidism as the parathyroid gland tries to raise calcium levels by secreting PTH which stimulates increased reabsorption of calcium and causes further bone mineralisation problems.

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8
Q

Risk Factors of Rickets

A

Darker skin - Low exposure to sunlight - Colder climates -Spending majority of time indoors

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9
Q

Presentation of Rickets

A

Lethargy - Bone pain - Poor growth - Dental problems - Muscle weakness

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10
Q

Bone Deformities of Rickets

A
  1. Bowing of the legs - legs curve outwards 2. Knock knees - legs curve inwards 3. Rachitic rosary - the ends of the ribs expand at the costochondral junctions causing lumps along the chest 4. Craniotabes - soft skull with delayed closure of the sutures and frontal bossing 5. Delayed teeth
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11
Q

Ix for Rickets

A
  • Serum 25-hydroxyvitamin D - <25 nmol/L establishes deficiency - X-rays - Serum calcium and phosphate may be low - Serum ALP and PTH may be high - Full blood tests to rule out other pathology including FBC, ESR, CRP, LFTs, TFTs, Malabsorption screen
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12
Q

Management of Rickets

A

Prevention is the best management - NICE recommend 400 IU supplements for children and young people - Children with deficiency can be treated with ergocalciferol (vit D) - For those with diagnosed rickets, vit D and calcium supplementation is needed.

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13
Q

Transient Synovitis

A

Irritable hip ;Temporary irritation and inflammation in the synovial membrane - often associated with a viral URTI

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14
Q

What is the most common cause of hip pain in children aged 3-10?

A

Transient Synovitis

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15
Q

Who is typically affected by Transient Synovitis

A

Ages 4-8 (uncommon in <3s (think Septic Arthritis))

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16
Q

Presentation of Transient Synovitis

A

Symptoms usually occur within a few weeks of a viral illness - Limp - Refusal to weight bear - Groin or hip pain - Mild low grade temperature - Otherwise well - no signs of systemic illness. 30% have a low grade fever (exlude septic arthritis)

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17
Q

Management of Transient Synovitis

A

Symptomatic management - Exclusion of other diagnoses particularly septic arthritis

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18
Q

Prognosis of Transient Synovitis

A

Generally good prognosis with recovery within 1-2 weeks without any long term effects

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19
Q

Septic Arthritis

A

Infection inside a joint

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20
Q

Septic Arthritis is most common in children under __ years

A

4

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21
Q

Who does Septic Arthritis affect?

A

Any age but common in <4 y/o

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22
Q

Causes of Septic Arthritis

A
  • Staphylococcus aureus - Neisseria gonorrhoea in sexually active teenagers - Group A Strep - Strep Pyogenes - Haemophilus influenzae - E coli
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23
Q

Presentation of Septic Arthritis

A
  • Only affects a single joint - knee or hip - Hot, red, swollen and painful joint - Refusal to weight bear - Stiffness and reduce range of motion - Fever, lethargy and sepsis
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24
Q

Management of Septic Arthritis

A
  • Admission to hospital with involvement of the orthopaedic team - Joint aspiration prior to antibiotics -> gram staining, crystal microscopy, culture and antibiotic sensitivities - Empirical IV antibiotics followed by specific antibiotics once sensitivities are received - Surgical drainage and washout may be needed
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25
Q

Osteomyelitis

A

Infection of the bone and bone marrow - typically in the metaphysis of the long bones. Infection can be introduced directly into the bone e.g open fracture or travelled to the
bone from the blood after entering through another medium

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26
Q

What is the most common cause of Osteomyelitis ?

A

Staph aureus

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27
Q

What is chronic Osteomyelitis ?

A

Chronic osteomyelitis is a deep seated, slow growing infection with slowly developing symptoms

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28
Q

Risk Factors of Osteomyelitis

A
  • Males under 10 - Open bone fractures - Orthopaedic surgery - Immunocompromised
  • Sickle cell anaemia
  • HIV
  • TB
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29
Q

Presentation of Osteomyelitis

A
  • Systemic symptoms such as fever - Refusing to use the limb or weight bear - Pain - Swelling - Tenderness
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30
Q

First Line Ix for Osteomyelitis

A

X -rays

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31
Q

Gold Standard Ix for Osteomyelitis

A

MRI

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32
Q

Other Ix for Osteomyelitis

A

Bloods including CRP, ESR and white cells - Blood cultures - Bone marrow aspiration

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33
Q

Management of Osteomyelitis

A

Extensive and prolonged antibiotic therapy - Surgery may be needed for drainage and debridement of the infected bone

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34
Q

Perthes Disease

A

Disruption of blood flow to the femoral head causing avascular necrosis of the bone - affecting the epiphysis of the femur. Over time, there is revascularization or neovascularization and healing of the femoral head with remodelling of the bone as it heals

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35
Q

Perthes Disease affects those between ages __ and __

A

4 to 12

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36
Q

Perthes Disease most commonly affects ___

A

5-8 year old boys (M:F = 5:1)

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37
Q

Causes for Perthes Disease

A

Mainly idiopathic

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38
Q

Presentation of Perthes Disease

A
  • Slow onset of pain in the hip or groin - Limp - Restricted hip movements - Referred pain to the knee - No history of trauma
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39
Q

Ix for Perthes Disease

A
  • X-ray which can be normal - Blood tests can typically normal, particularly inflammatory markers - Technetium bone scan - MRI scan
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40
Q

Initial Management of Perthes Disease

A
  • Initial management is conservative to maintain healthy position and alignment in the joint and reduce the risk of damage or deformity to the femoral head including bed rest, traction, analgesia and crutches
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41
Q

Other Management options for Perthes Disease

A
  • Physiotherapy is used to retain movement in the muscles and joints - Regular x-rays - Surgery may be used in severe cases, older children or those that are not healing
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42
Q

What is a discoid meniscus?

A

A discoid meniscus is a congenital abnormality of the knee joint where the meniscus is thicker and more disc-like than the typical crescent shape, leading to potential knee pain and mechanical symptoms.

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43
Q

Which of the following is a type of discoid meniscus?

A) Incomplete

B) Complete

C) Wrisberg-ligament variant

D) All of the above

A

D) All of the above

Explanation: The three types of discoid meniscus are:

Incomplete: The meniscus is slightly thicker and wider than normal, usually asymptomatic.

Complete: The meniscus covers the tibial plateau completely.

Wrisberg-ligament variant: The meniscus is not attached to the femur or tibia due to missing ligaments, leading to instability.

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44
Q

What are common symptoms of a discoid meniscus?

A

Knee pain, especially on the lateral side

Swelling

Locking or catching sensations

Limited range of motion

Quadriceps weakness

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45
Q

Which imaging modality is commonly used to diagnose a discoid meniscus?

A) X-ray

B) MRI

C) Ultrasound

D) CT scan

A

B) MRI

Explanation: MRI is effective in diagnosing discoid meniscus and evaluating associated meniscal tears.

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46
Q

What is the initial treatment for a symptomatic discoid meniscus?

A) Rest and physical therapy

B) Surgical resection

C) Corticosteroid injections

D) Arthroscopic meniscectomy

A

A) Rest and physical therapy

Explanation: Initial treatment includes immobilization, restricted activities, and quadriceps muscle strengthening. Surgical intervention is considered if symptoms persist.

47
Q

True or False: Total meniscectomy is the preferred surgical treatment for discoid meniscus in children.

A

False

Explanation: Partial meniscectomy is preferred to preserve meniscal function and reduce the risk of degenerative changes.

48
Q

True or False: With appropriate treatment, the prognosis for children with discoid meniscus is generally good.

A

True

Explanation: Early recognition and appropriate management can lead to favorable outcomes for children with discoid meniscus.

49
Q

What are potential complications of an untreated discoid meniscus?

A

Meniscal tears

Knee instability

Early-onset osteoarthritis

50
Q

Which of the following is a preventive measure for discoid meniscus?

A) Regular knee exercises

B) Early diagnosis and management

C) Avoiding high-impact sports

D) None of the above

A

B) Early diagnosis and management

Explanation: While discoid meniscus is a congenital condition and cannot be prevented, early diagnosis and appropriate management can prevent complications

51
Q

Which organization provides information and support for knee joint abnormalities?

A) American Academy of Orthopaedic Surgeons (AAOS)

B) American Heart Association

C) National Institute of Mental Health

D) American Cancer Society

A

A) American Academy of Orthopaedic Surgeons (AAOS)

Explanation: The AAOS offers resources and support for individuals with musculoskeletal conditions, including knee joint abnormalities.

52
Q

Slipped Femoral Epiphysis

A

Head of the femur is displaced along the growth plate

53
Q

Slipped Femoral Epiphysis commonly affects ___

A

More common in males and typically between ages of 8-15 years old - More common in obese children

54
Q

Presentation of Slipped Femoral Epiphysis

A
  • Adolescent, obese male undergoing a growth spurt - History of minor trauma which may trigger the onset of symptoms - Hip, groin, thigh or knee pain - Restricted range of hip movement - Painful limp - Restricted movement in the hip - Wanting to keep the hip in external rotation with restricted internal rotation.
55
Q

First Line Ix for Slipped Femoral Epiphysis

A

X -rays

56
Q

Other Ix for Slipped Femoral Epiphysis

A

Blood tests are normal, but inflammatory markers may be used to exclude other causes of joint pain - CT/MRI scan

57
Q

Management of Slipped Femoral Epiphysis

A

Surgery is needed to return the femoral head to correct position and fix it in place

58
Q

Complications of Slipped Femoral Epiphysis

A

Osteoarthritis, Perthes Disease, Leg Length Discepancy

59
Q

Osgood-Schlatter Disease is caused by __

A

Caused by inflammation at the tibial tuberosity where the patellar ligament inserts - a common cause of anterior knee pain in adolescents. Normally is unilateral but can be bilateral

60
Q

Osgood-Schlatter Disease typically occurs in ___

A

Typically occurs in male patients aged 10-15 years

61
Q

Pathophysiology of Osgood-Schlatter Disease

A

Patella tendon inserts into the tibial tuberosity which is at the epiphyseal plate - Stress from running, jumping and other movements at the same time as growth in the plate results in inflammation on the tibial epiphyseal plate. - There are small avulsion fractures where the patellar ligament pulls away tiny pieces
of the bone, leading to growth of the tibial tuberosity, causing a visible lump below the
knee
- Initially, the bump is tender due to inflammation but as the bone heals and
inflammation settles, it becomes hard and non-tender.

62
Q

Presentation of Osgood-Schlatter Disease

A

Gradual onset of symptoms - Visible or palpable hard and tender lump at the tibial tuberosity - Pain in the anterior aspect of the knee - Pain is exacerbated by physical activity, kneeling and on extension of the knee

63
Q

Management of Osgood-Schlatter Disease

A

Reduction in physical activity - Ice - NSAIDs for symptomatic relief - Stretching and physiotherapy can be used to strengthen the joint once symptoms settle. - Symptoms will generally resolve over time but the patient is usually left with a hard, boney lump on their knee

64
Q

Developmental Dysplasia of the Hip

A

Structural abnormality in the hips caused by abnormal development of the foetal bones during pregnancy leading to instability in the hips and a tendency for dislocation

65
Q

When is Developmental Dysplasia of the Hip diagnosed?

A

Usually picked up during the newborn examinations or later when the child presents with hip asymmetry, reduced range of movement in the hip or limp

66
Q

Risk Factors for Developmental Dysplasia of the Hip

A

female (6:1), oligohydramnios, macrosomia

67
Q

Indications for routine US in Developmental Dysplasia of the Hip

A

First degree family history - Breech presentation from 36 week onwards - Breech presentation at birth if 28 week onwards - Multiple pregnancy

68
Q

Screening for Developmental Dysplasia of the Hip

A

NIPE examination usually picks this up - this may be suggested with 1. Different leg lengths 2. Restricted hip abduction on one side 3. Significant bilateral restriction in abduction 4. Difference in the knee level when the hips are flexed 5. Clunking of the hips on special tests - Ortolani and Barlow tests

69
Q

Ix for Developmental Dysplasia of the Hip

A

If suspected, ultrasound will establish the diagnosis. - X-rays can also be helpful in older infants

70
Q

What is Barlow Test ?

A

Attempts to dislocate femoral head

71
Q

What is Ortolani Test ?

A

Attempts to relocate femoral head

72
Q

Management of Developmental Dysplasia of the Hip

A

Pavlik harness if the baby presents at less than 6 months of age which is fitted and kept on permanently and adjusts for the growth of the baby. - The aim of this is to hold the femoral head in the correct position to allow the hip socket to develop a normal shape and helps to keep the baby’s hips flexed and abducted - reviewed after 6-8 weeks - Surgery may be needed when the harness fails or if the diagnosis is made after 6 months of age

73
Q

Juvenile Idiopathic Arthritis

A

Autoimmune inflammation which occurs in the joints

74
Q

When is Juvenile Idiopathic Arthritis diagnosed?

A

Diagnosed when there is arthritis without any other cause, lasting more than 6 weeks in a patient under the age of 16

75
Q

Key features of Juvenile Idiopathic Arthritis

A

Key features are joint pain, swelling and stiffness

76
Q

Presentation of Systemic Juvenile Idiopathic Arthritis

A
  • Subtle salmon-pink rash - High swinging fever - Enlarged lymph nodes - Weight loss - Joint pain and inflammation - Splenomegaly - Muscle pain
77
Q

Ix for Juvenile Idiopathic Arthritis

A

ANA and RF will be negative - Raised CRP, ESR, platelets and serum ferritin

78
Q

What is Polyarticular Juvenile Idiopathic Arthritis

A

Idiopathic inflammatory arthritis in 5 joints or more which tends to be symmetrical and can affect small or large joints

79
Q

Symptoms of Polyarticular JIA

A

Minimal systemic symptoms but can have mild fever, anaemia and reduced growth

80
Q

Polyarticular JIA : RF?

A
  • Most children will be RF negative but in older children and adolescents, they can be RF positive - similar pattern to RA.
81
Q

What is Oligoarticular JIA?

A

Involves 4 joints or less, often only a single joint

82
Q

Who is Oligoarticular JIA more common in?

A

More common in girls under the age of 6 and affects the larger joints

83
Q

Classic feature of Oligoarticular JIA

A

Classic feature is anterior uveitis for which patients should be referred to ophthalmology

84
Q

Symptoms of Oligoarticular JIA

A

No systemic symptoms, inflammatory markers may be normal or mildly elevated, ANA positive but RF is usually negative.

85
Q

Enthesitis - Related Arthritis is more common in ___

A

More common in male children over 6 years

86
Q

What is Enthesitis - Related Arthritis the paediatric version of ?

A

The paediatric version of the seronegative spondyloarthropathies such as ankylosing spondylitis

87
Q

What is Enthesitis?

A

Enthesitis is inflammation at the point where the muscle inserts into a bone - can be caused by traumatic stress or an autoimmune process.

88
Q

Majority of patients with Enthesitis - Related Arthritis will have which gene?

A

HLA-B27 gene

89
Q

Signs/Symptoms of Enthesitis - Related Arthritis

A

They may have signs and symptoms of psoriasis and IBD

90
Q

Complications of Enthesitis - Related Arthritis

A

Prone to anterior uveitis

91
Q

Juvenile Psoriatic Arthritis

A

Seronegative inflammatory arthritis associated with psoriasis - Can be symmetrical polyarthritis affecting the small joints or an asymmetrical arthritis affecting the large joints in the lower limbs

92
Q

Signs of Juvenile Psoriatic Arthritis

A

May have nail pitting, dactylitis, enthesitis, plaques of psoriasis on the skin

93
Q

Management of JIA

A
  • NSAIDs such as ibuprofen - Steroids either oral, IM or intra-articular in oligoarthritis - DMARDS such as methotrexate - Biologicals such as TNF inhibitors such as infliximab/adalimumab
94
Q

What is scoliosis?

A

Scoliosis is a lateral (side-to-side) curvature of the spine, typically exceeding 10 degrees, leading to a C-shaped or S-shaped appearance.

95
Q

Which of the following is the most common type of scoliosis in children?

A) Idiopathic scoliosis

B) Congenital scoliosis

C) Neuromuscular scoliosis

D) Degenerative scoliosis

A

A) Idiopathic scoliosis

Explanation: Idiopathic scoliosis is the most prevalent type in children, with no known specific cause.

96
Q

What are common symptoms of scoliosis in children?

A

Uneven shoulders or hips

Prominent rib hump on one side

Leaning to one side

Back pain (less common in children)

97
Q

Which physical examination test is commonly used to assess scoliosis?

A) Trendelenburg test

B) Forward bend test

C) Straight leg raise test

D) Patrick’s test

A

B) Forward bend test

Explanation: The forward bend test helps identify asymmetry in the back, indicating potential scoliosis.

98
Q

Which imaging modality is considered the gold standard for evaluating scoliosis?

A) X-ray

B) MRI

C) CT scan

D) Ultrasound

A

A) X-ray

Explanation: X-rays are used to measure the degree of spinal curvature and assess skeletal maturity

99
Q

What is the primary goal of bracing in scoliosis management?

A) To correct the spinal curvature

B) To prevent further progression of the curve

C) To alleviate back pain

D) To improve posture

A

B) To prevent further progression of the curve

Explanation: Bracing aims to halt the progression of the spinal curve, especially during periods of growth.

100
Q

True or False: Surgery is recommended for all children with scoliosis.

A

False

Explanation: Surgical intervention is typically reserved for cases with severe curvature or when non-surgical treatments fail to prevent progression

101
Q

True or False: Most children with mild scoliosis require lifelong treatment.

A

False

Explanation: Children with mild scoliosis often require monitoring but may not need ongoing treatment

102
Q

What are potential complications of untreated scoliosis?

A

Chronic back pain

Respiratory issues due to reduced lung capacity

Cardiovascular problems

Neurological deficits

103
Q

Which of the following is a recommended preventive measure for scoliosis?

A) Regular spinal exercises

B) Routine screening during growth periods

C) Avoiding heavy lifting

D) Maintaining a healthy weight

A

B) Routine screening during growth periods

Explanation: Early detection through screening can lead to timely interventions, preventing progression

104
Q

What is torticollis?

A

Torticollis is a condition characterized by a persistent tilt of the head to one side, often accompanied by limited neck movement.

105
Q

Which of the following is the most common type of torticollis in children?

A) Congenital muscular torticollis

B) Acquired torticollis

C) Spasmodic torticollis

D) Cervical dystonia

A

A) Congenital muscular torticollis

Explanation: Congenital muscular torticollis is the most prevalent form in children, often presenting at birth.

106
Q

What are common symptoms of torticollis in children?

A

Head tilts to one side

Limited neck movement

Swollen neck muscles

Uneven shoulders

107
Q

Which physical examination test is commonly used to assess torticollis?

A) Trendelenburg test

B) Forward bend test

C) Neck rotation test

D) Straight leg raise test

A

C) Neck rotation test

Explanation: The neck rotation test helps assess the range of motion and identify any restrictions in neck movement.

108
Q

What is the first-line treatment for congenital muscular torticollis?

A) Physical therapy

B) Surgical intervention

C) Botulinum toxin injection

D) Oral analgesics

A

A) Physical therapy

Explanation: Early intervention with physical therapy focusing on stretching and strengthening exercises is the primary treatment.

109
Q

True or False: Most children with congenital muscular torticollis recover completely with early treatment.

A

True

Explanation: With early and appropriate treatment, most children experience full recovery.

110
Q

What are potential complications of untreated torticollis?

A

Facial asymmetry

Developmental delays

Persistent neck deformity

111
Q

Which of the following is a recommended preventive measure for torticollis?

A) Regular neck exercises

B) Avoiding prolonged positioning on one side

C) Early screening for neck abnormalities

D) All of the above

A

D) All of the above

Explanation: Regular neck exercises, avoiding prolonged positioning on one side, and early screening can help prevent torticollis.

112
Q

Which condition should be considered in the differential diagnosis of torticollis?

A) Cervical spine fracture

B) Meningitis

C) Both A and B

D) None of the above

A

C) Both A and B

Explanation: Cervical spine fractures and meningitis can present with similar symptoms and should be ruled out.

113
Q

True or False: Support groups and educational resources are beneficial for families managing a child with torticollis.

A

True

Explanation: Support groups and educational resources provide valuable information and emotional support for families.

Phase 3a - Paediactrics (17 decks)

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