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Paediatrics > Muskuloskeletal > Flashcards

Muskuloskeletal Flashcards

1
Q

Are there any risk factors for developing developmental dysplasia of the hip?

A
  • Family history

- Breech position

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2
Q

How is DDH usually detected?

A

Newborn screening examination (Barlow + Ortolani)

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3
Q

In a case of suspected DDH, how is the diagnosis confirmed?

A

USS

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4
Q

Describe the management of developmental dysplasia of the hip

A
  • Conservative = Pavlik harness

- If this fails/presentation is late, surgery may be required

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5
Q

Describe the pathophysiology of osteomyelitis

A

Inflammation of the metaphysis of long bones, caused by infection

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6
Q

Which sites are most commonly affected in osteomyelitis?

A
  • Distal femur

- Proximal tibia

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7
Q

What is the most common causative organism for osteomyelitis?

A

Staphylococcus aureus

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8
Q

Describe the clinical features of osteomyelitis

A

Fever, plus cardinal signs of inflammation:

  • Pain
  • Redness
  • Warmth
  • Swelling
  • Loss of function
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9
Q

Describe the investigation of suspected osteomyelitis

A
  • Blood cultures

- MRI

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10
Q

Describe the management of osteomyelitis

A
  • IV antibiotics

- Surgery if unresponsive to antibiotics

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11
Q

Are there any risk factors for developing osteomyelitis?

A
  • Immunodeficiency

- Sickle cell disease

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12
Q

Describe the pathophysiology of septic arthritis

A

Inflammation of a joint, caused by infection

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13
Q

What is the most common causative organism for septic arthritis?

A

Staphylococcus aureus

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14
Q

Are there any risk factors for developing septic arthritis?

A
  • Immunodeficiency

- Sickle cell disease

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15
Q

What are the clinical features of septic arthritis?

A

Fever, plus cardinal signs of inflammation:

  • Pain
  • Redness
  • Warmth
  • Swelling
  • Loss of function
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16
Q

Describe the investigation of suspected septic arthritis

A
  • Blood cultures

- Joint aspirate

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17
Q

Describe the management of septic arthritis

A
  • IV antibiotics

- Surgery if unresponsive to antibiotics

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18
Q

Describe the epidemiology of transient synovitis

A

Most common cause of acute hip pain in children

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19
Q

Describe the pathophysiology of transient synovitis

A
  • Transient inflammation of the hip joint

- Often triggered by a preceding viral infection, e.g. URTI

20
Q

Describe the clinical features of transient synovitis

A
  • Hip pain
  • Reduced ROM at hip
  • Limp
21
Q

Describe the investigation of transient synovitis

A

It can be difficult to differentiate between transient synovitis and early septic arthritis. If there is any suspicion it may be septic arthritis, perform:

  • Blood cultures
  • Joint aspiration
22
Q

Describe the management and natural course of transient synovitis

A

Self-limiting:

  • Rest
  • Analgesia
23
Q

Perthes disease is more common in…

A

More common in boys

24
Q

Describe the pathophysiology of Perthes disease

A
  • Avascular necrosis of the femoral head

- Followed by revascularisation and reossification (gradual healing)

25
Q

What are the clinical features of Perthes disease?

A
  • Hip pain
  • Reduced ROM at hip
  • Limp
26
Q

Describe the investigation of Perthes disease

A

XR

27
Q

Describe the management of Perthes disease

A

Usually condition is self-resolving, therefore treatment is mainly supportive:

  • Rest
  • Analgesia
  • Physiotherapy

In severe cases, surgery may be required

28
Q

Describe the prognosis of Perthes disease

A
  • Good prognosis for recovery

- Higher risk of developing degenerative arthritis in later life

29
Q

Describe the pathophysiology of Osgood-Schlatter disease

A

Inflammation of the patellar tendon at its insertion site (tibial tuberosity)

30
Q

Describe the clinical features of Osgood-Schlatter disease

A
  • Knee pain after physical activity

- Palpable lump over tibial tuberosity

31
Q

Describe the management of Osgood-Schlatter disease

A
  • Reduce physical activity

- Physiotherapy

32
Q

What is osteogenesis imperfecta? Describe its pathophysiology

A
  • Group of genetic disorders of collagen metabolism

- This results in bones which are more fragile and become deformed/fracture easily

33
Q

Which is the most common type of osteogenesis imperfecta

A

Type I

34
Q

Describe the clinical features of type I osteogenesis imperfecta (MSK and other)

A

MSK:

  • Frequent fractures
  • Bone deformity

Other:

  • Blue appearance to the sclerae
  • Some children develop hearing loss
35
Q

Describe the management of type I osteogenesis imperfecta

A

Bisphosphonates to reduce frequency of fractures

36
Q

Describe the pathophysiology of slipped femoral epiphysis

A
  • Displacement of the femoral epiphysis postero-inferiorly

- Onset may be acute, e.g. following minor trauma, or insidious

37
Q

Slipped femoral epiphysis is more common in…

A

More common in obese boys

38
Q

Describe the clinical features of slipped femoral epiphysis

A
  • Hip pain
  • Reduced ROM at the hip
  • Limp
39
Q

Describe the investigation of slipped femoral epiphysis

A

XR

40
Q

Describe the management of slipped femoral epiphysis

A

Surgery

41
Q

Describe the epidemiology of juvenile idiopathic arthritis

A

Most common type of chronic arthritis in children

42
Q

What are the clinical features of juvenile idiopathic arthritis? (MSK and other)

A

MSK:

  • Pain
  • Swelling
  • Stiffness

Other:

  • Fever
  • Salmon-coloured rash
  • Lymphadenopathy
43
Q

Describe the classification of juvenile idiopathic arthritis

A
  • Polyarthritis (more than four joints affected)
  • Oligoarthritis (up to and including four joints affected)
  • Systemic (with fever, rash, lymphadenopathy)
44
Q

Describe the management of juvenile idiopathic arthritis (conservative and medical)

A

Conservative:
- Physiotherapy

Medical:

  • Analgesia, e.g. NSAIDs
  • Intra articular corticosteroid injections
  • Methotrexate
  • Biologics
45
Q

Hip pain in a child < 3 years old - how is this managed?

A

Urgent further investigation

46
Q

Which criteria are used to assess the probability of septic arthritis in children?

Describe the interpretation

A

Kocher’s criteria:

  • Non weight bearing = 1 point
  • Fever > 38.5 = 1 point
  • WCC > 12 x 10^9/L = 1 point
  • ESR > 40 = 1 point

1 point = highly unlikely
2 points = 50/50
3-4 points = highly likely

Paediatrics (17 decks)

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