Musculoskeletal

Question 1

What is the likely Dx for a teenage girl that has anterior knee pain that is worse on rising after prolonged sitting, and when going up and down stairs?

Answer 1

Chondromalacia patellae

Question 2

What is the likely Dx when a child has medial knee pain and their knee occasionally gives way?

Answer 2

Patellar subluxation

Question 3

What is the likely Dx when a child has pain in their knee after exercise and their knee tends to lock?

Answer 3

Osteochondritis dissecans

Question 4

Where is the tenderness in Osgood-Schlatter disease?

Answer 4

Tibial tubercle

Question 5

What are the RFs for DDH?

Answer 5

1. F
2. Breech
3. FHx
4. First-born
5. BW >5kg
6. Oligohydramnios

Question 6

In which hip is DDH more common?

Answer 6

L hip

Question 7

By what age will DDH probably stabilise?

Answer 7

3-6 weeks of age

Question 8

What are the features of a HxPC of growing pains?

Answer 8

1. Never present on waking
2. No limp
3. No limitation of movement
4. Systemically well
5. Normal O/E
6. Motor milestones normal
7. Sx worse after a day of activity

Question 9

What are the possible causes of a painful limb?

Answer 9

1. Osteomyelitis
2. Septic arthritis
3. Fracture
4. Sickle cell disease
5. Bone tumours

Question 10

Where is the infection in osteomyelitis?

Answer 10

Metaphysis of long bones

Question 11

What are the most common sites of osteomyelitis?

Answer 11

1. Proximal tibia

2. Distal femur

Question 12

How does osteomyelitis usually spread?

Answer 12

Haematogenous spread

Question 13

What are the causative pathogens of osteomyelitis?

Answer 13

1. S.aureus (mostly)
2. Streptococcus
3. H.influenzae

Question 14

What are the different fracture patterns?

Answer 14

1. Plastic deformation (not technically a fracture)
2. Buckle fracture
3. Greenstick frature
4. Complete fracture

Question 15

Whom gets plastic deformations?

Answer 15

Children, unique to them - bone angulated beyond elastic limit, but energy insufficient to cause a fracture

Question 16

In what bones may plastic deformations be seen?

Answer 16

Ulna, occasionally fibula

Question 17

Where are buckle fractures most commonly seen?

Answer 17

At the junction of the metaphysis and the diaphysis in the distal radius, usually caused by fall on an out-stretched hand

Question 18

What are the different types of complete fracture?

Answer 18

Spiral - created by rotational force
Transverse
Oblique

Question 19

How are physeal fractures classified?

Answer 19

Salter-Harris (SH) classification

Question 20

What is a SH Class I physeal fracture?

Answer 20

Transverse fracture through the growth plate, the epiphysis seperating from the metaphysis

Question 21

What is the most common SH classification of a physeal fracture?

Answer 21

SH Class II

Question 22

What is a SH Class II fracture?

Answer 22

Transverse fracture through the growth plate and an oblique or vertical fracture through the metaphysis

Question 23

What is a SH Class III fracture?

Answer 23

Transverse fracture through the growth plate and a vertical fracture through the epiphysis

Question 24

What is a SH Class IV fracture?

Answer 24

Vertical fracture through the metaphysis, physis and epiphysis

Question 25

What is a SH Class V fracture?

Answer 25

Compression/crushing fracture of the growth plate

Question 26

What are the complications of physeal injury?

Answer 26

Majority heal quickly and recover fully. BUT may cause growth disturbance/arrest, which can then result in deformity and impaired function

Question 27

What are the common causes of paediatric fractures?

Answer 27

1. Child abuse 2. Birth injury 3. Rickets 4. Osteomyelitis 5. Copper deficiency

Question 28

What are the differentials for a limping child?

Answer 28

1. Transient synovitis 2. CDH 3. Perthes disease 4. SCFE

Question 29

What does SCFE stand for?

Answer 29

Slipped capital femoral epiphyses

Question 30

What is the most common cause of acute hip pain in children?

Answer 30

Transient synovitis

Question 31

What is the HxPC of transient synovitis?

Answer 31

1. Accompanies/follows viral infection frequently 2. Sudden onset 3. No pain at rest 4. Reduced ROM, esp. internal rotation 5. Pain may be referred to the knee

Question 32

What is Perthes disease?

Answer 32

Avascular necrosis of the capital femoral epiphysis

Question 33

What is SCFE?

Answer 33

Displacement of the epiphysis of the femoral head posterio-inferiorly

Question 34

When is SCFE most common?

Answer 34

During the adolescent growth spurt, esp. in obese boys

Question 35

What is the most common causative organism of septic arthritis?

Answer 35

S.aureus (beyond the neonatal period)

Question 36

What are the complications of juvenile idiopathic arthritis (JIA)?

Answer 36

1. Chronic anterior uveitis 2. Flexion contracture of the joints 3. Growth failure 4. Constitutional problems - e.g. anaemia of chronic disease/delayed puberty 5. Osteoporosis 6. Amyloidosis