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Paediatrics > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is the incidence and risk factors of congenital dislocated hip?

A

6-10 per 1000 live birth
Most resolve spontaneously

Female x6
FH
Breech birth
Neuromuscular disorder

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2
Q

How is congenital dislocated hip screened for?

A

Neonatal screening
Barlow manoeuvre - hip dislocates posteriorly
Ortolani manoeuvre - hip can be relocated back into acetabulum on abduction

Repeated at 8 weeks

USS if still suspected

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3
Q

What is osteomyelitis and what causes it?

A

Infection of metaphysis of long bones
Common sites - distal femur and proximal tibia
Usually haematological spread of pathogen but can spread from wound

Most caused by staph. aureus but streptococcus and Hib if not immunised

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4
Q

How does osteomyelitis present?

A

Markedly painful, immobile limb (BONE) in child with acute febrile illness

Site is swollen, tender and warm
Movement causes severe pain

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5
Q

What investigations are needed for osteomyelitis?

A

Blood culture - usually +ve
WBC and CRP raised
X-ray shows soft tissue swelling, need MRI

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6
Q

What is the treatment for osteomyelitis?

A

IV Abx for several weeks

Aspiration of site

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7
Q

What is sub-acute osteomyelitis?

A

Lack of signs and symptoms - mild pain - worse after exercise or at night

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8
Q

What is chronic osteomyelitis?

A

If acute osteomyelitis isn’t treated -> sepsis, amputation, death

Complications are bone necrosis, chronic infection, discharging sinus, limb deformity and amyloidosis

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9
Q

What is septic arthritis?

A

Serious infection of joint space which can lead to bone destruction

Results from haematological spread or puncture wound or infected skin lesions
Spread from adjacent osteomyelitis in young children

Usually one joint (hip) affected by staph. aureus (always rule out Hib and TB)

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10
Q

How does septic arthritis present?

A

Erythematous, warm JOINT with reduced movements in febrile child

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11
Q

What investigations are done for septic arthritis?

A

WCC and CRP are raised
Blood cultures
USS shows effusion

Aspirate joint space under USS for organisms and culture = DIAGNOSIS

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12
Q

How is septic arthritis treated?

A

IV Abx

Washing out of joint

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13
Q

What fracture suggest NAI?

A

Ribs
Long bones (esp humerus) if child isn’t mobile
Multiple fractures
Complex skull fractures

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14
Q

What are the most common fractures?

A 
Distal forearm
Hand, phalanges
Carpal-metacarpal
Clavicle
Ankle
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15
Q

How are fractures managed?

A

Control haemorrhage
Treat pain
Prevent limb ischaemia
Remove sources of contamination

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16
Q

What is juvenile idiopathic arthritis?

A

Persistant joint swelling (>6 weeks)
Presenting before 16yo
Absence of infection or any defined cause

Gelling (stiffness after periods of rest)
Morning joint sitffness
Pain

Long term bone expansion from overgrowth -. deformities and advanced bone age

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17
Q

What are the types of JIA?

A

Number of joints affected in first 6 months:
Polyarthritis >4
Oligoarthritis

Systemic

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18
Q

What is oligoarthritis?

A

Most common

1-6yo
F>M
Knee, ankle, wrist most common - not symmetrical
Chronic ant UVEITIS - if ANA +ve then more likely
Excellent prognosis

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19
Q

What is polyarthritis?

A

F>M
Symmetrical large and small joints - esp jaw

RF +ve is more severe, occurs in older and has worse prognosis
RF -ve is less severe

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20
Q

What is systemic arthritis?

A

Adolescents
F=M
Oligo/polyarthritis

Acute illness -> malaise, daily high fever, salmon rash, lymphadenopathy, hepatosplenomegaly
Anaemia, raised neutrophils and platelets, v high CRP
Variable to poor prognosis

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21
Q

What is psoriatic arthritis?

A 
7%
1-16yo
F=M
Assymmetrical large and small joints
Psoriasis, nail pitting, chronic ant uveitis
Moderate prognosis
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22
Q

What is enthesitis-related arthritis?

A

7%
6-16yo
F

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23
Q

What is undifferentiated arthritis?

A

1%
1-16yo
F=M
Overlapping articular and extra-articular patterns between sub-types

24
Q

What conditions are associated with JIA?

A

Chronic anterior uveitis - severe visual impairment so need regular opthalmological screening

Flexion contractures of the joints - joint is held in most comfortable position

Growth failure - generalised or from corticosteroid treatment

Osteoporosis - reduce risk by dietary supplements of calcium and vit D, weight bearing exercise

25
Q

What are treatments for JIA?

A

NSAIDs and analgesia - relieve symptoms

Joint injections - under USS guidance
First line treatment for oligoarticular HIA
Bridging treatment for polyarticular when starting methotrexate

Methotrexate - early use reduces joint damage, less effective in systemic disease

Systemic corticosteroids - avoid if poss, may be life saving in severe systemic

Cytokine modulators (anti-TNF, IL-1) - once methotrexate doesn’t work

26
Q

What is Perthe’s disease and what is the epidemiology?

A

Avascular necrosis of capital femoral epiphysis due to interruption of blood suplly followed by revascularisation and reossification

Affects boys 5-10yo

27
Q

How does Perthe’s disease present?

A

Limp, knee or hip pain
Bilateral in 20%

X-ray of hips - increased density in femoral head -> fragmented and irregular

28
Q

What is prognosis of Perthe’s disease?

A

If identified early - bed rest and traction

More severe disease - femoral head must be covered by acetabulum to act as mould so hip is kept in abduction with plaster on calipers

29
Q

What is reactive arthritis?

A

Most common form of arthritis in childhood

Transient joint swelling

30
Q

How does reactive arthritis present?

A

Low grade fever with inflammation of joints, skin, mucous membranes, urinary and GI tract

CRP normal or mildly raised
HLA-B27 +ve
NSAIDs only treatment needed, unless chronic the steroids and methotrexate

31
Q

What is rickets and what causes it?

A

Failure of mineralisation of growing bone or osteoid tissue
Seen in children with malabsorptive conditions, extreme prems from low phosphorus
Drugs - anticonvulsants (phenytoin)
Hepatic and renal disease - impaired metabolic conversion of vit D

32
Q

How is vit D metabolised?

A

Sunlight reacts with 7-dehydrocholesterol on skin -> vitamin D3 (cholecalciferol)

Vit D3 enters liver and is metabolised to 25(OH)D3

Hydroxylated in kidney -> 1,25(OH)2D3 = most active form

33
Q

How does rickets present?

A 
Ping-pong sensation of skull (craniotabes)
Palpable costochondral junctions
Wide wrists and ankles
Bowed legs
Misery
Hypotonia
Seizures
34
Q

What are risk factors for slipped upper femoral epiphysis?

A

Boys 10-15yo, particularly obese
Bilateral in 20%
Associated with hypothyroidism, hypogonadism

35
Q

How is slipped upper femoral epiphysis treated?

A

Surgical pin fixation in situ

36
Q

What is flat foot?

A

Pes planjus
Physiological in toddlers
May indicate congenital tarsal coalition

In older child, rigid flat foot is pathological - tendo-Achilles contracture

37
Q

What is talipes?

A

Positional talipes - common from intrauterine compression - can be passively manipulated

Talipes equinovarus - entire foot inverted and supinated, forefoot adducted
Affected foot is shorter
Associated with DDH and spina bifida

38
Q

What is osteogenesis imperfecta?

A

Group of disorders of collagen metabolism -> bone fragility, bowing and frequent fractures

39
Q

What is type 1 OI?

A

Most common and due to autosomal dominant inheritance
Fractures during childhood
Blue sclera
?hearing loss
Dilated aortic root and thin heart valves

Treat with bisphosphonsates to reduce fracture rate

40
Q

What is type 2 OI?

A

Severe, lethal form with multiple fractures pre-birth

Many are stillborn

41
Q

What is type 3 OI?

A

Severely progressive

May be born with fractures and have short stature and impaired dentition

42
Q

What is polydactly associated with?

A 
>5 digits on hands or feet
Trisomy 13 - Patau
Trisomy 21
Tibial hemimelia
Ellis-van Creveld syndrome
43
Q

What is syndactyly associated with?

A

Fusion of 2 or more digits
Apert syndrome
Poland syndrome

44
Q

What is scoliosis?

A

Lateral curvature of frontal plane of spine

Mainly mild, pain free and cosmetic but can cause cardiorespiratory failure

45
Q

What are causes of scoliosis?

A

Idiopathic - onset before 5 or during puberty growth spurt

Congenital - VACTERL

46
Q

What is skeletal dysplasia?

A

Heterogeneous group of >200 disorders of abnormalities of cartilage and bone growth
Involves growth plate

47
Q

What is achondroplasia?

A 
Autosomal dominant but 50% new mutations
Short limbs
Large head
Frontal bossing
Depression of nasal bridge
Short and broad hands
Lumbar lordosis
48
Q

What is thanatophoric dysplasia?

A

Results in stillbirth
Large head
Extremely short limbs
Small chest

49
Q

What is cleidocranial dyostosis?

A

Autosomal dominant

Absence of part or all of clavicle - can bring shoulders together

50
Q

What is arthrogryposis?

A

Stiffness and contracture of joints with unknown cause
Dislocating hips
Talipes
Scoliosis

51
Q

What is torticollis and what causes it?

A

Flexion, extension or twisting of muscle in neck allowing abnormal movement

Sternocleidomastoid tumour
Muscular spasm
ENT infection

52
Q

What is transient synovitis?

A

Most common cause of acute hip pain in 2-12 yo
Follows or is accompanied by viral infection
No pain at rest but decreased movement
Does not appear ill

Normal WCC
Normal/slightly high ESR

53
Q

What is the diagnostic criteria for Kawasaki disease?

A

Fever >38.5 for >5 days
Plus 4 of:

Bilateral non-purulent conjunctivitis
Oral mucosal changes
Cervical lymphadenopathy
Hands and feet: red, swollen and peeling
Polymorphous rash
54
Q

What are the complications of Kawasaki?

A

Cardiac artery aneurysm
Myocarditis and MI
Pericarditis
Cardiac tamponade

55
Q

How is Kawasaki managed?

A

IV immunoglobulin

Aspirin

Paediatrics (14 decks)

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