Musculoskeletal

Question 1

What are the red flags of MSK disease in children?

Answer 1

Systemic Features - e.g. weight loss, fever, anorexia, 
Night Pain
Inconsistent/Incongruent story ?NAI
Developmental Regression
Inflammatory Symptoms
Acute, hot, swollen joint

Question 2

What is Perthe’s Disease?

Answer 2

Avascular necrosis of the femoral head due to interruption of blood supply.
Followed by revascularisation or reossification over 18-36 months.

Question 3

How might Perthe’s present?

Answer 3

Affects children 5-10 years of age

Presentation is usually insidious with the onset of limp, knee or hip pain

Question 4

How do we manage Perthe’s Disease?

Answer 4

Children under 6 - do well wiithout treatemnt, bed rest and physio may be all thats needed
Children over 6, with more damage - may require surgery to prevent degenerative arthritis in later life.

Question 5

What happens in a Slipped Capital Femoral Epiphysis (SUFE)

Answer 5

Displacement of the epiphysis of the femoral head postero-inferiorly requiring prompt treatment in order to prevent avascular necrosis.

Question 6

How does a SUFE typically present?

Answer 6

Most common at 1-15 years during the adolescent growth spurt, especially in obese boys.
Presentation is with a limp or hip pain which may be referred to the knee.
Onset may be acute following minor trauma or insidious

Question 7

What would you find on examination of a child with a SUFE?

Answer 7

Decreased Abduction and INTERNAL rotation of the hip

Question 8

What is your investigation of choice in a suspected SUFE, and how is it managed.

Answer 8

Hip XR - frog leg position

Surgical management usually with pin fixation in situ

Question 9

How would septic arthritis present in children?

Answer 9

Most common in children

Question 10

What is Transient Synovitis and how does it present?

Answer 10

Acute onset, self-limiting condition thought to be due to viral infection or an autoimmune process.
It is often preceded by a viral upper respiratory tract infection.
Pain is usually not severe but may prevent weight-bearing on the affected leg.
Usually there is no pain at rest and passive movements are only painful at the extreme range of movement.
The child is usually well and the ESR is either normal or slightly raised

Question 11

What is the management and prognosis of Transient Synovitis?

Answer 11

Includes rest and analgesia, with mobilisation once the pain has settled.
Symptoms usually resolve within two weeks but may recur.
There is no evidence of any long-term complications

Question 12

What malignancies may present with bone pain in children?

Answer 12

Acute Lymphoblastic Leukemia may present with bone pain, esp at night
Osteosarcoma and Ewings Sarcoma are rare. Present with pain or swelling, or occasionally from a pathological fracture.

Question 13

How might be define Juvenile Idiopathic Arthritis?

Answer 13

Persistant joint swelling for > 6 weeks presenting before the age of 16 in the absence of infection or any other defined cause

Question 14

How might JIA present?

Answer 14

Gelling, morning stiffness, pain
In the younger child it may present with an intermittent limp or deterioration in behaviour/mood or avoidance of previously enjoyed activities
Knee is the most common joint affected

Question 15

Name the visual complication associated with JIA

Answer 15

Chronic Anterior Uveitis

Common but asymptomatic in the early stages, can lead to severe visual impairment

Question 16

List some of the common sites of non-accidental injury

Answer 16

Skull, ears, eyes, cheek, mouth, neck, shoulders, chest, back, buttocks, thighs, genitals,

Question 17

List some of the common sites of accidental injury

Answer 17

Forehead, Nose, Chin, Bony Spine, Elbows, Forearms, Hands, Knees, Hips, Shins