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3a > Paed:MSK > Flashcards

Paed:MSK Flashcards

1
Q

What is the definition of Juvenile Idiopathic Arthritis?

A

Persistent joint swelling (>6weeks) presenting before the age of 16 and in the absence of infection or any other defined cause.

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2
Q

What are the seven different subtypes?

A

Persistent oligoarthritis - 1-4joints involved.
Extended oligoarthritis - <4joints involved >6months
Polyarthritis RF-ve
Polyartrtiis RF+ve
Systemic arthritis
Psoriatic arthritis
Enthesistis related

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3
Q

Features of JIA?

A 
Gelling (stiffness after rest)
Morning stiffness
Pain
Swelling
Loss or ROM
Warmth
Systemic arthritis: Malaise, fever, salmon-pink rash, lymohadenopathy
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4
Q

Complications of JIA?

A 
Uveitis
Flexion cotnractures of joints
Growth failure
Anaemia of chronic disase
Osteoporosis
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5
Q

Differentials of JIA?

A

Spetic arthritis
Reactive arthritis
Non-accidental injury
malignanccy

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6
Q

Management of JIA?

A 
NSAIDS + analgesics
Joint injections
Methotrexate
Systemic corticosteroids
Cytokine modulators + other immunotherapies
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7
Q

Diagnosing psoriatic arthritis?

A

Psoriasis and Arthritis
or
Arthritis w/ 2 of: FH of psoriasis, Nail changes, Dactylitis

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8
Q

What is reactive arthritis?

A

Transient joint swelling <6weeks often of ankles or knees, usually following extra-articular infection. Most common form of arthritis in childhood.

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9
Q

What causes reactive arthritis?

A

Enteric bacteria often (Salmonella, shigella, campylobacter)

Also: Viruses and STIs (chlamydia, mycoplasma, borellia burgoferi)

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10
Q

Presentation of reactive arthrtitis

A

Joint swelling with low grade fever.
acute phase reactants normal or slightly elevated
x rays normal

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11
Q

Management of reactive arthritis?

A

NSAIDs

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12
Q

What is septic arthritis?

A

Serious infection of joint space, can lead to bone destruction.

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13
Q

Presentation of septic arthritis?

A 
Erythematous, warm, acutely tender joint. acute in onset
Decreased ROM
Acutely unwell, febrile child
pseudoparesis
joint effusion
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14
Q

Causative organisms of septic arthritis?

A

Neonate: Group B strep
>2yrs: S. Aureus
adolescents: Neisseria Gonorrhoea

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15
Q

How does septic arthritis happen?

A

Haematogenous spread
Puncture wound
Infecred skin lesions (chicken pox)
Adjacent bone extension

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16
Q

Investigations of septic arthritis?

A 
raised WCC and acute phase reactants
Blood cultures
US if deep joints if effusion
X ray to exclude trauma
Bone scan
MRI
Aspiration of joint space - culture
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17
Q

Risk factors for septic arthritis?

A

Prematurity
C section
Pt treated on NICU
Invasive procedures

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18
Q

What is Kocher criteria for?

A

Differentiation of septic arthritis from transient synovitis in the child with a painful hip.

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19
Q

What are the Kocher criteria?

A 
WCC>12,000
Inability to weight bear
Fever >38.5
ESR>40
1= 3% chance of SA
2=40% chance of SA
3=93% chance of SA
4= 99% chance of SA
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20
Q

Management of SepticArthritis?

A

IV Abx
Surgical drainage
Immobilisation then mobilisation

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21
Q

Complications of septic arthritis:

A 
Femoral head destruction
Deformity
Joint contracture
Limb-length discrepancy
Gait abnormalities
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22
Q

What is osteomyelitis?

A

Infection of the metaphysis of long bones. Most commonly femur and proximal tibia

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23
Q

What methods of cause of osteomyelitis?

A

Haematogenous spread from a pathogen

Direct spread from an infected wound

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24
Q

Causative pathogens of osteomyelitis?

A

Staph. Aureus, strep, h.influenzae

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25
Q

Presentation of osteomyelitis?

A 
Painful, immobilised limb
acute febrile illness
swelling and tenderness
warm and erythematous
movement causes pain
sterile effusion of adjacent joint
26
Q

Investigations for osteomyelitis?

A 
Positive blood cultures
Raised WCC, CRP, ESR
Xrays: normal but soft tissue swelling
us: Periosteal elevation
MRI: Subperiosteal pus + purulent debris in bone
Radionuclide bone scan
27
Q

Treatment of osteomyelitis?

A

IV abx
aspiration or surgical decompression of the subperiosteal space
splint

28
Q

What is Perthes disease?

A

Idiopathic avascular necrosis of the proximal femoral epiphysis in children.

29
Q

clinical features of perthes disease?

A

gradual onset
painless limp
intermittent hip, knee, groin or thigh pain

30
Q

Examination findings on Perthes disease?

A

Hip stiffness - loss of IR and abduction
gait disturbance - antalgic, trendelenburg gait
limb length discrepancy

31
Q

Treatment of perthes disease?

A

Sx relief: NSAIDs, traction, crutch
Restore ROM: physio, muscle lengthening
Containment of hip: osteotomy
Operative

32
Q

Pathophysiology of perthes disease?

A
  • OSteonecrosis occurs secondary to disruption of blood supply to femoral head. Followed by revascularisation with subsequent resorption, and later collapse.
    May be ass w/ abnormal clotting factors
    Repeated subclincial trauma and mechanical overload lead to bone collapse and repair
33
Q

What is SUFE?

A 
Slipped upper (capital) femoral epiphysis.
Leads to slippage of the metaphysis relative to the epiphysis.
34
Q

What conditions are associated with SUFE?

A

Endocrine disorders: Hypothyroidism(^TSH), renal dystrophy, GH deficiency, panhypopituitarism

35
Q

Presentation of SUFE?

A

Groin and thigh pain
Limp
Knee pain

36
Q

Examination findings SUFE?

A

Decreased hip ROM - ER happens during passive flexion

Loss of hip IR, abduction, +flexion

37
Q

Treatment of SUFE?

A

Percutaneous pinning in situ
Fixation of contralateral hip
Surgical hip dislocation and capital realignment

38
Q

What is transient synovitis

A

Inflammation if the synovium causing hip pain

39
Q

Risk factors for transient synovitis?

A

Viral infection
Bacterial infection (eg post strep toxic synovitis)
Trauma
Allergic reaction

40
Q

Clinical features of transient synovitis?

A 
Recent URTI
Mild/absent fever
acute/gradual onset of groin/thigh pain
refusal to weight bear
improves during day
41
Q

Examination findings of Transient Synovitis?

A

Mild/moderate restriction of hip IR

painless arc of motion

42
Q

Treatment of Transient Synovitis?

A

NSAIDs

43
Q

Define osteoporosis?

A

A disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to advanced bone fragility and a consequent increase in fracture risk.

44
Q

Diagnosing osteoporosis in children?

A 
1 or more vertebral crush fractures 
OR
Size adjusted bone density <2SD's either:
   - 2 or more long bone # by 10
   - 3 or more long bone # by 19
45
Q

Congenital causes of Osteoporosis?

A

OSteogenesis imperfecta
Inborn errors eg. galctosaemia
Haematological problems
Idiopathic

46
Q

Acquired causes of osteoporosis?

A 
Drug induced (esp steroids!)
Major endocrinopathies
Malabsorption
Immobilisation
Inflammation
47
Q

Wha is osteogenesis imperfecta?

A

AD
Mostly caused by defects in Type 1 collagen genes.
Bone is brittle and fragile.

48
Q

Clinical features of Osteogenesis Imperfecta

A 
Bone fragility, fractures, deformity
Bone pain
Impaired mobility
poor growth
deafness, hernias, valvular prolapse
49
Q

Types of Osteogenesis Imperfecta?

A

1: Mild
2: Lethal
3: progressively deforming, severe
4: Moderate

50
Q

Treatment of osteogenesis imperfecta?

A

Bisphosphonates
Surgery
Physiotherapy
Education

51
Q

What is rickets?

A

Failure in mineralisation of the growing bone or osteoid tissue.

52
Q

What is osteomalacia?

A

Failure of mature bone to mineralise.

53
Q

Causes of Rickets?

A

Nutritional (1) rickets: Dark skin, poor sunlight exposure, low calcium/vit D diet

Intestinal malabsorrption; Small bowel enteropathy(coeliacs), pancreatic insuffiency (CF), chlolestatic liver disease

Defective production of vit D: Fanconi syndrome, chronic renal disease, familial hypophosphataemia rickets

Increased metabolism of vit D: anticonvulsants induce enzymes - pheonobarbitals

Defective production: Chronic liver disease

54
Q

Clinical features of rickets

A 
Earliest sign: Craniotabes (thinning of skull/softenign)
Frontal bossing of skull
Misery
FtT/Short stature
Delayed closure of anterior fontanelle
Rickets rosary
harrison sulcus
bowing of knees
seizures (late)
Resp distress
55
Q

diagnosis of rickets

A 
Dietary hx if vitamins and calcium intake
Bloods:
- Decreased serum calcium
- Decreased phosphate
- Increased plasma alkaline phosphatase
- Decreased 25-hydroxy vit D
- increased PTH
Wrist X-ray: 
- Cupping and fraying of metaphyses
-widened epiphyseal plate
56
Q

Management of rickets?

A

Dietary advice
Correction of predisposing risk factors
Daily vit D
calcium

57
Q

What is Kohlers disease?

A

Infarction of the navicular bone presenting as medial mid foot pain and a limp in younger children, esp with load bearing sports.

58
Q

Treatment of Kohlers?

A

Rest. nowt else

59
Q

What is osgood schlatters disease?

A

Failure of the tibial tubercle apophysis due to repetitive traction and stress from extensor mechanism.

60
Q

Presentation of osgood schlatters?

A

Painful swelling over a prominent tibial tubercle
Usually unilateral
ass w/ running and jumping

3a (25 decks)

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