musculosketal

Question 1

causes of genu varum

Answer 1

rickets

blounts disease

Question 2

causes of pes planus

Answer 2

normal in toddlers
tendo-achilles contracture
INF

Question 3

What causes of toe-walking should be excluded

Answer 3

mild cerebral palsy
achilles tendinitis
inflammatory arthritis
in older people - duchenne’s

Question 4

what is pes cavus and what’s it associated with

Answer 4

high arched foot
neuromuscular disorder (ie friederich's ataxia

Question 5

How does missed DDH present

Answer 5

Asymmetrical skin folds, abduction of hip, abnormal gait

Question 6

what are the indications for DDH investigation

Answer 6

breech presentation at 36/40
breech delivery
FHx of DDH

Question 7

Mx DDH

Answer 7

1st lie - if <6 months old monitor progress with US/X Ray
2nd line - put in pavlik harness if <6 months and follow up with x ray at 6 months
3rd line - surgery if nothing works

Question 8

causes of scoliosis

Answer 8

idiopathic (10-14 weeks)
congenital
secondary -
neuromusclar problems (CP)
bone disorders (neurofibromatosis)
connective tissue disorders (marfan's)
leg length discrepancy (arthritis of knee)

Question 9

where does osteomyelitis occur

Answer 9

metaphysis of bone

Question 10

features of osteomyelitis

Answer 10

painful immobile limb
illness
can see sterile effusion of adjacent limb

Question 11

What does X-ray of osteomyelitis show

Answer 11

after 7-10 days you see new subperiosteal bone formation and localised bone rarefaction

Question 12

mx of osteomyelitis

Answer 12

ACUTE

1. immobilse
2. blood cultures
3. High dose empirical IV Abx (switch to oral when pt improved)
4. surgical debridement

CHRONIC

1. disease staging
2. surgical debridement
3. IV Abx

Question 13

why do you assess hip when pt presents with knee pain

Answer 13

hip pain often referred to knee

Question 14

what is osgood-schlatter disease

Answer 14

osteochondritis of patellar tendon insertin at knee

Question 15

how does osgood schlatter present

Answer 15

knee pain
tibial swelling
hamstring tightness

Question 16

mx osgood schlatter

Answer 16

pain relief
ice packs
reassure it will resolve over time
change sporting activity to less running and jumping (but don’t have to stop sport)

Question 17

what is osteochondritis dissecans

Answer 17

segmented avascular necrosis of subchondral bone

presents as persistent knee pain in active kids

Question 18

Why is transient synovitis significant clinically

Answer 18

most common cause of hip pain between 2-12 year olds
follows/accompanied by viral infection

hard to distinguish it from septic arthritis

Question 19

what is Perthes disease

Answer 19

avascular necrosis of femoral head due to interrupted blood supply
revascularises and reossifies after 18-36 months

Question 20

how does perthes’ present

Answer 20

insidious limp + hip pain

Question 21

mx Perthes’ disease

Answer 21

conservative:
supportive care for acute pain
activity continuation
physio - stretch hamstring and quads

surgical treatment if >6 and not responding

Question 22

What is a slipped capital femoral epiphysis and what is mx

Answer 22

femoral head slips postero-inferiorly
need to operate quickly to prevent avascular necrosis of femoral head

mx - immobilise, immediate ortho referral, screw fixation of growth plate

Question 23

what infections cause reactive arthritis

Answer 23

enteric bacteria - shigella, campylobacter, salmonella
STI - chlamydia, gonococcus
rheumatic fever + post streptococcal arthritis more common in low income countries

Question 24

what usually causes septic arthritis

Answer 24

s. aureus

if immunodeficient or with sickle cell can be others

Question 25

Ix for septic arthritis

Answer 25

US - shows joint effusion
X-Ray - exclude trauma (will normally be normal)
aspirate for diagnosis

Question 26

mx septic arthritis

Answer 26

2 weeks IV Abx followed by 4 weeks of oral
gram +ve - vancomycin
gram -ve - cefotaxime
joint aspiration whenever needed
surgical washing + drainage may also be needed

Question 27

what is the definition of juvenile idiopathic arthritis

Answer 27

persistent joint swelling (>6 weeks) in children <16 with no signs of infection

Question 28

how does JIA present

Answer 28

gelling
morning stiffness
joint pain
young children can have limp

Question 29

complications of JIA

Answer 29

bone deformities and subsequent asymmetry
chronic anterior uveitis (can lead to visual impairment)
flexure contraction of joint
growth failure
osteoporosis
amyloidosis

Question 30

mx JIA

Answer 30

mobility encouraged
NSAIDs for pain relief
can give adjunctive intra-articular steroids
DMARDs if nothing works

Question 31

How does osteochondritis dissecans present

Answer 31

persistent knee pain
localised tenderness over femoral condyles
complete separation of fragments can cause feeling of knee locking or giving way

Question 32

when do you US vs X ray for DDH

Answer 32

US before 6 months

X ray after 6 months