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Child Health > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What bones is osteomyelitis commonest in in children?

A

Long bones: distal femur + proximal tibia

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2
Q

What pathogens may be causative of osteomyelitis?
How does it spread?

What non-infective cause may present similarly to osteomyelitis?

A 
Usually S.Aureus
Others:
Streptococcus
HiB
TB (esp immunodefc)

Sickle cell disease

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3
Q

How does osteomyelitis present? (5)

A

Fever
Painful immobile limb (pseudoparesis)
Swelling / extreme tenderness esp on movement

Erythematous + warm
Poss sterile effusion of adjacent joint

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4
Q

What Ix are done if suspect osteomyelitis? (2+4)

A 
Blood cultures (usually +ve)
Raised WCC + CRP/ESR

X-Ray (7-10d show subperiosteal new bone formation)
USS (periosteal elevation)
MRI (diff from soft tissue infection)
Radionuclide bone scan (if infection site unclear)

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5
Q

How is osteomyelitis managed? (4)

A

IV Abx immediately (until clinical recovery/ CRP norm)
Aspiration / surg decompression (if atypical/ immunodefc)
Surgical drainage if Abx fail
Limb splinted /then mobilised

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6
Q

What are some complications of acute osteomyelitis if not treated soon enough? (6)

A 
Bone necrosis
Chronic osteomyelitis
Spread → septic arthritis (when adj to epiphyseal plate)
Discharging sinus
Limb deformity
Amyloidosis
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7
Q

How does subacute osteomyelitis present differently to acute?

A 
Mild localised pain / tenderness (warmth, red, swelling)
Exac by activity
Night pain (relieved by aspirin)
Minimal loss of func
Poss adjacent joint effusion
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8
Q

What are some symps of chronic osteomyelitis? (6)

A 
Bone pain
Persistent fatigue
Excessive sweating/chills
Local swelling
Pus draining from sinus
Skin changes
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9
Q

How does chronic osteomyelitis occur?
What organisms involved?
How treated?

A

Untreated acute/ pre-existing syphillis
Multiple organisms involved

Req amputation (due to poor vacs of remaining bone + untreated spreads to other bones → sepsis)

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10
Q

Why is early identification of congenital dislocated hip (DDH) important?

A

Early ID responds to conservative treatment

Late ID requires complex treatment/surgery

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11
Q

How is DDH (developmental dysplasia of hip) screened for?
What is the incidence?

What Ix can Dx DDH?

A

Screened at newborn baby checks (Barlow + Ortolani manoeuvres) + repeated 8wks later as routine surveillance

Screening detects 6-10 in 1000

Barlow = hip dislocated posteriorly out of acetabulum
Ortolani = relocated back into acetabulum on abduction

USS - showship quality + dysplasia quantity

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12
Q

How does DDH present later in life (if not already picked up on screening)? (4)

A 
Limp/abnormal gait
\+
Abnormal skin folds
/Abducted limb
/Shortening of affected leg
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13
Q

What are the RFs for DDH? (4)

A

Female (risk x6)
+ve FH (20% of affected)
Breech (30% of affected)
Neuromuscular disorder

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14
Q

How is DDH managed (conservatively)?

A

Splint/harness for several months (keeps hips flexed / adducted)
Monitor progress with USS/X-Ray

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15
Q

What is septic arthritis?

What is a complication ?

A

Serious infection of joint space

can → bone destruction

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16
Q

What child age group does septic arthritis typically occur in? + what joint?

A

Common in <2y/o boys

Mainly hip affected (only 1 joint)

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17
Q

How may septic arthritis occur?

What organisms involved?

A

Blood spread
Puncture wound/ infected skin lesions (e.g. chicken pox)
From adjacent osteomyelitis in epiphyseal plate

Similar organisms to osteomyelitis (S.Aureus**, strep, TB) + E.Coli

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18
Q

How may septic arthritis present? (5)

A

Acutely unwell, febrile child
Swollen thigh
Marked tenderness over head of femur
Leg held: flexed / abducted / externally rotated (reduces intracapsular pressure)
No spontaneous movement (pseudo paralysis)

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19
Q

How is a Dx of septic arthritis made? What Ix? (7)

A

Dx difficult as joint covered by subcut fat

Joint aspiration using USS + culture → definitive Dx (ideally perform first unless would signify delay Abx admin)

Blood cultures
Raised WCC
CRP/ESR

USS deep joints
X-Ray (exclude trauma)
MRI (demo adjacent osteomyelitis)

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20
Q

How is septic arthritis managed? (3)

A 
IV Abx (then oral)
Wash out / surgical drainage if not rapid resolution/deep seated infection (e.g. hip)
Joint immobilised in functional position → then mobilised to prevent permanent deformity
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21
Q

What are the common fractures seen in NAI? (4)

A

Posterior ribs
Long bones e.g. humerus (esp if child not yet mobile)
Multiple fractures
Complex skull fractures

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22
Q

In a child presenting with a fracture, what 2 conditions (which increase fracture risk) must be ruled out?

A

Osteogenesis imperfecta

Copper defc

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23
Q

What are the main principles of management in a bone fracture? (5)

A

Control haemorrhage
Prevent limb ischaemia
Treat pain
Remove potential sources of contamination

→ then reduce fracture + immobilise

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24
Q

What is Juvenile Idiopathic Arthritis defined as?
What is its prevalence
How are the subtypes classified
Which is the commonest subtype

A

JIA = persistent (>6wk) joint swelling in <16yrs in absence of infection or other defined cause
1 in 1000 children

Classified by no. affected joints in 1st 6m: Polyarthritis (>4), Oligoarthritis (<4), Systemic (w. fever/rash)

Persistent oligoarthritis (50%)

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25
Q

What features in the Hx may you see in Juvenile Idiopathic Arthritis (3)

What are some long-term effects?

A

Initially joint swelling only minimal
Gelling (stiffness after periods of rest)
Morning joint stiffness + pain

Long term: bone expansion (from overgrowth) → deformities

26
Q

What is the typical age onset of oligoarthritis (persistent/extended)
Female:Male?
What lab test/result
List some extra-articular features (2)

A

1-6yrs
Female 5: 1 Male
ANA +/-

Chronic anterior uveitis
Asymmetrical (leg length) growth

27
Q

What articular pattern is seen in polyarthritis (of JIA)?

What are some extra-articular features

A

Symmetrical large + small joints + fingers (+RF-ve poss cervical spine + temperomandibular)

RF-ve: Low-grade fever, Chronic anterior uveitis
RF+ve: Rheumatoid nodules sim to adult RA

28
Q

What is the age onset on systemic arthritis?

What lab results would be abnormal? (4)

A 
1-10y/o
Anaemia
Raised neutrophils
Raised platelets
Raised CRP/ESR
29
Q

What is the articular pattern in systemic arthritis?

What are the extra-articular features?

A

Oligo or poly
May have initial arthralgia/myalgia

Initial acute illness / malaise / high fever
Salmon pink macular rash
Lymphadenopathy
Hepatosplenomegaly
Serositis
30
Q

What is the articular pattern for enthesitis-related arthritis?
What are the extra-articular features(2)

A

Lower limb
Initially large joint → mild lumbar/sacral involvement

Enthesitis (inflame at tendon/lig insertion into bones (often Achilles)
Occasionally acute uveitis

31
Q

What are the different types of Juvenile Idiopathic Arthritis? (8) in the order of most common

A 
Oligoarthritis persistent (50%)
Polyarthritis RF-ve (15%)
Systemic arthritis (10%)
Oligoarthritis extended 
Psoriatic arthritis
Enthesitis-related arthritis
Polyarthritis RF+ve
Undifferentiated arthritis
32
Q

What are some associated conditions with Juvenile Idiopathic Arthritis? (6)

A 
Chronic anterior uveitis
Flexion contractors of joints
Growth failure (general/localised)
Constitutional problems (e.g. delayed puberty, anaemia)
Osteoporosis
Amyloidosis
33
Q

What are some causes for osteoporosis in children? (4)

What can be done to reduce the risk of developing? (4)

A

Diet
Reduced weight bearing
Delayed menarche
Systemic corticosteroids

Dietary VitD + Calcium
Wt bearing exercises
Minimise oral corticosteroids
Bisphosphonates

34
Q

What are the treatment options for JIA? (5)

A 
NSAIDs + analgesia (symp relief)
Joint injections (1st line for oligo)
Methotrexate (for poly)
Systemic corticosteroids (severe systemic arthritis) (avoid to minimise growth suppression / osteoporosis)
Cytokine modulators (e.g. anti-TNFa)
35
Q

What is Perthe’s disease?

Age onset / gender

A

= Avascular necrosis of femoral head epiphyses due to vascular interruption → revascularisation + reossification over 18-36m

5-10yrs
Male 5:1 Female

36
Q

How does Perthe’s disease present?
DDx?
Ix? (3)

A

Gradual onset of limp / hip or knee pain (usually unilateral but bilateral in 10-20%)
DDx: transient synovitis

→ Bilateral hip X-Rays if suspect
Bone scan + MRI may aid Dx

37
Q

What are the features of Reactive Arthritis? (commonest childhood arthritis) (4)

A

Transient joint swelling (ankles/knees) (<6wks)
Low grade fever
Inflamm of joints/skin/mucous membs/ urinary/GI tract
Eyes often involved

38
Q

What are the causes of Reactive Arthritis? (3)

A

Divided into:
Post-Strep (Rheumatic fever)
Classical post-GI/UTI
Post-infective (inc others e.g. STI)

39
Q

What is rickets?

What are the causes? (6)

A

= Failed mineralisation of growing bone / osteoid tissue (type of osteomalacia)

Vit D defc*
Extreme prematurity (diet defc phos/Ca)
Malabsorption (e.g. CF, Coeliac, panc insuff)
Drugs (esp anticonvulsants)
Impaired metabolic conversion / activation of VitD (chronic liver disease, hereditary type 1 Vit-D resistant rickets)
Target organ resistance to activated VitD (hereditary Vit-D dependant rickets type 2)

40
Q

List the features of rickets (5)

A 
Poor growth
Delayed fontanelle closure (big forehead)
Delayed baby teeth
Odd ribs (Harrison sulci)
Varus deformity of elbows + knees
41
Q

How is Rickets Dx?

How is it managed?

A

Wrist X-Ray → shows wider epiphyseal plate
Blood tests → Low Ca/VitD/Phos, High parathyroid

Nutritional / Correction of RFs / daily VitD3

42
Q

What is the cause of SUFE (slipped upper femoral epiphysis) in 10-15yrs + in <10yrs

What is it due to?

A

10-15yrs - obese (commonest)
<10yrs - endocrine abn (e.g. hypothy/hypogonadism) (bilateral)

Due to femoral head epiphysis displacing poster-inferiorly

43
Q

How does SUFE present? (3)

A

Acute (post minor trauma) or insidious
Limp / hip pain (+ poss referred knee pain)
Restricted abduction + internal rotation of hip

44
Q

How is SUFE managed?

A

Dx X-Ray (frog view)
Needs prompt to prevent avascular necrosis
Analgesia
Surgical fixation

45
Q

What are some causes of scoliosis? (6)

A 
Idiopathic (commonest)
Congenital (e.g. VACTERL)
Secondary to:
Neuromuscular imbalance (CP/DMD)
Bone disorders (NF1)
Connective tissue (Marfan)
Leg length discrepancy (JIA one knee)
46
Q

What is Torticollis?

A

= Flexion, extension or twisting of neck muscle → allowing to move beyond normal position

47
Q

What is the commonest cause of acute hip pain in children? + what age group

A

Transient synovitis

Occurs 2-12yrs

48
Q

How does transient synovitis present? (5)

A

During/post-virus
Sudden onset limp / hip pain (poss referred knee pain)
Pain only on movement
Limited range of movement (esp internal rotation)
Afebrile

49
Q

Normal Ix if suspect transient synovitis (5)

A 
WCC (raised)
CRP/ESP (slightly raised)
USS (fluid in joint)
XRay (normal
Joint aspiration + culture (if suspect early septic arthritis of hip)
50
Q

How is transient synovitis managed?

A

Best rest + analgesia

Usually resolves in <1wk

51
Q

What are the DDx for acute painful limp in:
1-3yrs (4)
3-16yrs (6)

A 
1-3yrs:
Infection (septic arthritis, osteomyelitis)
Inflamm - transient synovitis
Trauma
Malignancy (leukaemia, neuroblastoma)
3-16yrs:
Infection (septic arthritis / osteo)
Inflamm - transient synovitis
JIA
Trauma
Malignancy (leukaemia)
Perthe's
Older: SUFE, Reactive arthritis
52
Q

What are the DDx for chronic intermittent limp in:
1-3yrs (3)
3-10yrs (3)
10-16yrs (2)

A

1-3yrs:
DDH / talipes
Neuromuscular (e.g. CP)
JIA

3-10yrs:
Perthe’s (chronic)
Neuromuscular (DMD)
JIA

10-16yrs:
SUFE (chronic)
JIA

53
Q

What should be considered as DDx in a children with nocturnal wakening w. leg pain? (3)

A

Growing pains
Osteoid osteoma
Malignancy (anaemia, bruising, infections)

54
Q

What should be considered in a child with ‘clunking’ hip movement on screening / limp in older infant?
What other features would be seen to match this Dx?

A

DDH

Asymm upper leg skin folds
Limitied hip abduction

55
Q

What are the DDx of a febrile / toxic looking infant, showing irritability with nappy changing? (2)

A

Septic arthritis

Osteomyelitis

56
Q

What are the DDx of a sudden limp in otherwise well child? (2)

A

Transient synovitis of hip

Perthe’s

57
Q

What musculoskeletal disorder would be considered in a child showing fever, erythematous rash, red eyes + irritability (young child / infant)

A

Kawasaki disease

58
Q

What would be considered in a child showing joint pain, stiffness + restriction (+ poss loss of function)?

A

JIA

59
Q

What would be considered in an adolescent obese boy showing hip pain?

A

SUFE

60
Q

What would be considered in an adolescent girl with constitutional delay, lethargy + arthralgia?

A

SLE

Child Health (14 decks)

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