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Med Finals - Paediatrics > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Classification of fractures

A

Salter-Harris classification - detrmine likely hod to affect growht
SALTR
1- Straight
2 - Above
3 - beLow
4 - Through
5 - cRush

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2
Q

Management of fractures

A

Closed or open reduction
External casts
K wirse
Intramedullary wires
[Intramedullary nails
Screws
Plates

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3
Q

Pain management in children

A

Paracetamol
Ibuprofen
Morphine
Not codeine
Not tramadol

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4
Q

Causes of hip pain in 0-4 years

A

Septic arthritis
Developmental dysplasia
Transient sinovitis

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5
Q

Causes of hip pain in 5-10 years

A

Septic arthritis
Transient sinovitis
Perthes disease

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6
Q

Causes of hip pain in 10-16 years

A

Septic arthritits
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

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7
Q

Red flags of hip pain

A

Child under 3
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in morning
Swollen or red joint

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8
Q

Investigations of hip pain

A

Bloods
Xray
US
Joint aspiration
MRI

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9
Q

Define septic arthritis

A

Infection inside a joint -

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10
Q

Presentation of septic arthritis

A

Hot
Red
Swollen
Painful joint
Refusing to weight bear
Stiffness
Reduced rang of motion
Systemic symptoms - fever, lethargy, sepsis

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11
Q

Commm causitive organism in septic arthritis

A

Staphylococcus aureus

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12
Q

Commm causitive organism in septic arthritis

A

Staphylococcus aureus

Neisseria gonorrhoea
Group A strep
Haemophilus influenza
E. Coli

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13
Q

Investigations in septic arthritis

A

Joint aspiration

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14
Q

Management of septic arthritis

A

IV antibiotics
Surgical drainage and wash out
Supportive management

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15
Q

Define transient synovitis

A

Temporary irritation and inflammation in the synovial membrane of the joint.
Most common cause of hip pain in 3-10 years
Often preceded by URTI

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16
Q

Presentation of transient synovitis

A

URTI
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
Otherwise well!

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17
Q

Management of transient synovitis

A

Symptomatic management
Exclusion and close monitoring for septic arthritis

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18
Q

Define perthes disease

A

Disruption of blood flow to the femoral head causing a vascular necrosis.

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19
Q

Presentation of Perthes disease

A

Pain in the groin or hip
Limp
Restricted hip movement
Referred pain to knee

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20
Q

Investigations in Perthes disease

A

Blood tests
Technetium bone scar
MRI

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21
Q

Management of Perthes disease

A

Conservative
Bed rest
Traction
Crutches
Analgesia
Physio
Monitoring and surgery

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22
Q

Define slipped upper femoral epiphysis

A

Slipped capital femoral epiphysis - where the head of the femur is displaced along the growth plate.

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23
Q

Presentation of SUFE

A

Adolescent
Obese
Male
During growth spurt
Caused by minor trauma
Hip groin thigh or knee pain
Restricted range of movement
Painful limp

24
Q

What movement is normal restricted in SUFE

A

Restriction of internal rotation - like to keep externally rotated

25
Q

Investigation of SUFE

A

Bloods
Technetium bone scan
CT
MRI

26
Q

Management of SUFE

A

Surgery

27
Q

Define osteomyelitits

A

An infection in the bone and bone marrow - typically in the metaphysis of long bones.

28
Q

Risk factors for osteomyelitis

A

Open bone fractures
Orthopaedic surgery
Immunocompromised
Sickle cell anaemia
HIV
TB

29
Q

Presentation of osteomyelitis

A

Refusing to use limb or weight bear
Pain
Swelling
Tenderness
Acutely unwell child
High fever

30
Q

Investigations in osteomyelitis

A

Xrays
MRI
Bloods
Culture
Marrow aspiration

31
Q

Define osteosarcoma

A

Bone cancer usually presenting in 10-20 years in the femur, tibia or humerus

32
Q

Presentation of osteosarcoma

A

Persistent bone pain
Worse at night - disturbing sleeo
Swelling
Palpable mass
Restricted joint movement

33
Q

Investigation of osteosarcoma

A

Xray!
Bloods - ALP
CT MRI
PET
Bone
Biopsy

34
Q

Management of osteosarcoma

A

Surgical resection
Limb amputation
Adjuvant chemo
MDT support

35
Q

Define Talipes

A

Club foot - fixed abnormal ankle position that presents at birth
Corrected with surgery

36
Q

Define developmental dysplasia of the hip

A

Condition where there is a structural abnormality in the hips caused by abnormal development of fetal bones during pregnancy
Leads to instability and dislocation

37
Q

Risk factors for developmental dysplasia of the hip

A

First degree family history
Breech presentation
Multiple pregancy

38
Q

Clinical signs of developmental dysplasia of the hip

A

Different leg lengths
Restricted hip abduction on one side
Signification bilateral restriction in abduction
Ortolani and barlow test

39
Q

Define Ortolani test

A

Baby on back - abduct hips
Applying pressure to identify if likely to dislocate anteriorly

40
Q

Define Barlow test

A

Gentle downward pressure on hip adduction to identify if dislocates posteriorly

41
Q

Investigations in developmental dysplasia of the hip

A

US!
Xray if older

42
Q

Management of developmental dysplasia of the hip

A

Pavlik harness - hold femoral head in correct position
Surgery

43
Q

Define riskets

A

A condition affecting children where there is a defection mineralisation of bones leading to soft and deformed structures.

44
Q

Causes of Riskets

A

Vit D or calcium deficiency

45
Q

Presentation of rickets

A

Bowing legs
Knock knees
Rachitic rosary - ribs expand at the costochondral junction - lumps along chest
Craniotabes - soft skull - delayed closure of sutures and frontal bossing
Delayed teeth
Risk factors for vit D deficiency
Lethargy
Bone pain
Swollen wrists
Bone deformity
Dental problems
Muscle weakness
Pathological fractures

46
Q

Investigations in rickets

A

Vit D
Xray
Serum calcium phosphate
ALP
Parathyroid hormone
Bloods
Autoantibodies

47
Q

Management of rickets

A

Prevention!
Breastfeed!
Formula with fortified vit D
Vit d replacement
Calcium supplementation
Correct deformities

48
Q

Define achondroplasia

A

Most common cause of disproportionate short stature, mostly caused by autosomal dominant patter of homozygous gene mutations

49
Q

Presentation of achondroplasia

A

Limbs affects more than spine.
Short digits
Bow legs
Disproportionate skull
Foramen magnum stenosis

50
Q

COnditions associated with achondroplasia

A

Recurrent otitis media - cranial abnormalities
Kyphosis
Spinal stenosis
Obstructive sleep apnoea
Obesity
Foramen magnum stenosis - cord copression, hydrocephalus

51
Q

Management of achondroplasia

A

MDT supportive management
Leg lengthening

52
Q

Define Osgood-Schlatters disease

A

Caused by inflammation at the tibial tuberosity where the patella ligament inserts - anterior knee pain in adolescents

53
Q

Presentation of Osgood-Schlatter

A

Visible or palpable hard and tender lump
Pain at anterior aspect of knee
Pain exacerbated by physical movement

54
Q

Management of Osgood-Schlatters

A

Reduce physical activity
ICE
NSAIDs
Physio

55
Q

Define osteogenesis imperfecta

A

Genetic condition that results in brittle bones that are prone to fractures - affects formation of collagen

56
Q

Presentation of osteogenesis imperfecta

A

Blue sclera!
Unusual and recurrent fractures
Hypermobility
Triangular face
Short stature
Deafness
Dental problems
Bone deformities - bowed legs
Joint and bone pain

57
Q

Management of osteogenesis imperfecta

A

Genetic counselling
Bisphosphonates
Vit D supplementation
MDT support

Med Finals - Paediatrics (17 decks)

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