Paediatric Conditions

Question 1

What happens in developmental dysplasia of the hip (DDH)?

Answer 1

Dislocation/subluxation of femoral head during perinatal period

Question 2

Girls are more commonly affected by DDH than boys. True/False?

Answer 2

True

Question 3

List risk factors for DDH

Answer 3

Family history
Breech delivery
First-born
Down’s syndrome

Question 4

List clinical features of DDH

Answer 4

Shortened limbs
Asymmetric groin
Thigh skin creases
Ortolani/Barlow +ve tests

Question 5

Describe a +ve Ortolani test

Answer 5

Click upon reducing a dislocated hip with abduction + anterior displacement

Question 6

Describe a +ve Barlow test

Answer 6

Clunk upon dislocating a hip with flexion + posterior displacement

Question 7

What is the name of the special harness used to keep hips in comfortable flexion and abduction?

Answer 7

Pavlik harness

Question 8

When does transient synovitis of the hip usually occur?

Answer 8

After an URT infection

Question 9

Boys are less affected by transient synovitis of the hip than girls. True/False?

Answer 9

False

More affected

Question 10

Is transient synovitis the commonest cause of hip pain in childhood?

Answer 10

Yes

Question 11

List clinical features of transient synovitis

Answer 11

Limp
Reluctance to weight bear
Restricted motion
Low fever

Question 12

Outline treatment for transient synovitis

Answer 12

NSAIDs and rest

Should resolve, if not seek other diagnosis

Question 13

What is Perthes disease?

Answer 13

Idiopathic osteochondritis of the femoral head, causing necrosis + abnormal growth

Question 14

What happens to the femoral head as a result of Perthes disease?

Answer 14

Loses its blood supply
Necrosis
Abnormal growth
Collapse/fracture

Question 15

Who usually gets Perthes disease?

Answer 15

Boys 5:1 girls

Between age of 4-9

Question 16

List clinical features of Perthes disease

Answer 16

Pain
Limp
Loss of internal rotation
Loss of abduction
Trendellenburg +ve

Question 17

In slipper upper femoral epiphysis (SUFE), in which direction does the femoral head epiphysis move?

Answer 17

Inferiorly in relation to femoral neck

Question 18

Who does SUFE typically affect?

Answer 18

Overweight, pre-pubertal adolescent boys

Question 19

List clinical features of SUFE

Answer 19

Pain
Limp
PAIN IN THE KNEE (so examine hip!)
Loss of internal rotation of hip

Question 20

How is SUFE treated?

Answer 20

Pin the femoral head to prevent further slippage

Question 21

Anterior knee pain in adolescence is common. True/False?

Answer 21

True

Question 22

At what age period is dislocation/subluxation of the patella most common?

Answer 22

Adolescence

Question 23

What is another name for talipes equinovarus?

Answer 23

Clubfoot

Question 24

How does clubfoot arise?

Answer 24

In-utero abnormal alignment of joints between talus, calcaneus and navicular

Question 25

List clinical features of clubfoot

Answer 25

Ankle equinus (plantarflexion) Supinated forefoot Varus forefoot Contracted soft tissue

Question 26

Girls get clubfoot more than boys. True/False?

Answer 26

False | Boys 2:1 girls

Question 27

Outline treatment for clubfoot

Answer 27

Splintage (Ponseti technique) | Surgery

Question 28

Back pain in a child/adolescent is a red flag sign. True/False?

Answer 28

True

Question 29

In scoliosis, which way does the spine curve?

Answer 29

Laterally

Question 30

What is spondylolisthesis?

Answer 30

Slippage of one vertebra over another

Question 31

At what spinal region does spondylolisthesis usually occur?

Answer 31

L4/L5 | L5/S1

Question 32

When is DDH most likely to present?

Answer 32

0-18 months

Question 33

When is infection of the hip most likely to present?

Answer 33

2-5 years

Question 34

When is SUFE most likely to present?

Answer 34

10-16 years

Question 35

How is DDH diagnosed?

Answer 35

XR if 3 - 6 months | US if less than 3 months

Question 36

Knees would be expected to be normal alignment by what age?

Answer 36

Age 10

Question 37

Which score is used to test for hypermobility?

Answer 37

Beightons score

Question 38

What test is used in children to differentiate between fixed and felxible flat feet?

Answer 38

Jacks test - In mobile flat feet, medial arch will appear with dorsiflexion of the great toe

Question 39

At birth, children normally have valgus legs. True/False?

Answer 39

False | At birth, legs are normally varus (bow-legged) and eventually develop into valgus (knock-knee) at 3yrs old

Question 40

Flat feet can be physiological. True/False?

Answer 40

True

Question 41

Describe mobile/flexible flat feet

Answer 41

Flatted medial arch forms with dorsiflexion of great toe

Question 42

What can cause flexible flat foot?

Answer 42

Ligamentous laxity | Familial trait

Question 43

Flexible flat foot is only present on weight bearing. True/False?

Answer 43

True

Question 44

Describe rigid flat foot

Answer 44

Medial arch remains flat regardless of weight bearing or dorsiflexion

Question 45

What is the likely underlying abnormality in rigid flat foot?

Answer 45

Tarsal coalition, where bones of hindfoot have abnormal connection