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Paediatrics > Musculoskeletal disease > Flashcards

Musculoskeletal disease Flashcards

1
Q

What are some differentials for joint pain in children?

A

Septic arthritis
Juvenile idiopathic arthritis
Haemophilia
Reactive arthritis
Psoriasis
Trauma
Chrons disease
HSP

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2
Q

What is JIA?

A

Joint inflammation lasting for 6 weeks for which no other cause is found.

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3
Q

What is the epidemiology of JIA?

A

1 in 1000 children affected

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4
Q

What is the classification of JIA?

A

Systemic - Still’s disease - 9%
Polyarticular (>4 joints) 19%
Pauciarticular (<4 joints) - 49%
Spondyarthropathies - 7%
Juvenile psoriatic arthritis - 9%

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5
Q

What is pauciarticular JIA?

A

The most common type of JIA
Usually affects large joints (knees, ankles, elbows)
Commonly affects girls under 4
Minimal systemic symptoms

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6
Q

What are some biomarkers for pauciarticular JIA?

A

ANA +VE
RF -ve

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7
Q

What is pauciarticular JIA?

A

<4 joints affected

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8
Q

What needs to be screened for in children with pauciarticular JIA?

A

Screen for chronic uveitis
Slit lamp testing

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9
Q

What are some useful tests for joint disease in children?

A

FBC
ASOT
Rheumatoid factor + ANA
Titers (viral)

Viral titres
ANA
Radiology
Ultrasound
CRP
Aspiration

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10
Q

What is the prognosis of pauciarticular JIA?

A

80% of cases will resolve

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11
Q

What are the features of polyarticular JIA?

A

Less common than pauciarticular JIA
Symmetrical involvement of small and large joints
There may be poor weight gain and mild anaemia
Morning stiffness
Irritability in young children

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12
Q

What biomarkers are seen in polyarticular JIA?

A

ANA +ve
RF -ve

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13
Q

What is the prognosis of polyarticular JIA?

A

12% develop severe arthritis
Low risk of eye involvement

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14
Q

What is polyarticular JIA?

A

> 4 joints affected
symmetrical
large and small
TMJ involvement?

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15
Q

What is Still’s disease?

A

Adult onset Still disease, also known as systemic onset juvenile idiopathic arthritis, is a rare systemic inflammatory disorder characterized by inflammatory polyarthritis, daily fever, and a transient salmon-pink maculopapular rash. A serum ferritin level of more than 1000 ng/ml is common in this condition.

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16
Q

What are the features of Still’s disease?

A

Spiking fever, severe malaise
Salmon pink rash
Anaemia
Weight loss
Arthralgia
Pericarditis
Myalgia
May resemble malignancy
Hepatosplenomegaly

17
Q

What is a mnuemonic for Still’s disease?

A

SPARAMOS

Pericarditis
Arthralgia
Rash - salmon pink
Anaemia
Myalgia
Organomegaly
Spiking fever

18
Q

Suggest how swollen joint pain and fever should be managed in ED?

A
19
Q

How should JIA be managed?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), reduce pain and swelling. …
Disease-modifying antirheumatic drugs (DMARDs). …
Biologic agents. …
Corticosteroids.

20
Q

How do growing pains normally manifest?

A

Preschool children
Pain often by night, but no limp by day
Often bilateral and felt in shins or thighs
Healthy and no interference of ADLs

21
Q

How does transient synovitis normally present?

A

Benign and common in children age 2-8 years
Limp resolves by 1-3 weeks
No systemic symptoms
Often proceeded by URTI

22
Q

How does septic arthritis present?

A

Looks septic, hot and swollen

23
Q

How does osteomyelitis normally present?

A

Fever, swelling, erythema,
High CRP and WCC
Use radiography to distinguish from septic arthritis

24
Q

How does Legg-Perthes normally present?

A

4:1 ratio males:females
Age 4-11
Peak at 4-7
Initially painless
Pain and limp when fracture occurs
Diagnosed by radiography

25
Q

How does SUFE present normally?

A

Restricted internal rotation of hips
Worse if overweight
Gradual onset groin pain
Diagnosis by X fray frog lateral pelvis

26
Q

How should the X ray be done for SUFE?

A

Frog lateral pelvis

27
Q

What else may cause leg pain and limp in a child?

A

R/O tumours and malignancy
Pain, tenderness and a mass
Destructive mass on radiography
Gnawing pain in leukemia

28
Q

What investigations should be done for limp pain?

A

FBC
ESR
MRI
US
Radiography

29
Q

What is shown here?

A

Pectus carinatum

30
Q

What is shown in the picture on the right?

A

Pectus excavatum

31
Q

What is shown here?

A

Plagiocephaly

32
Q

What is VACTERL?

A
33
Q
A

Paediatrics (12 decks)

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