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3A > PAEDIATRIC MSK > Flashcards

PAEDIATRIC MSK Flashcards

1
Q

three risk factors for developmental dysplasia of the hip (DDH)

A

female, firstborn, breech

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2
Q

How can developmental dysplasia of the hip be screened for?

A

Barlows and Ortolani’s test

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3
Q

If a Barlows and Ortolani’s test is positive, what test should be done and when?

A

A hip ultrasound at 4-6 weeks

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4
Q
A
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5
Q

What is slipped upper femoral epiphysis (SUFE)

A

An adolescent hip disorder where there is weakness of the proximal femoral growth plate leading to displacement of the capital femoral epiphysis.

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6
Q

Risk factors for SUFE

A

Male (80%)
Adolescent (10-15)
Obesity
Endocrine disorders (hypothyroidism, hypogonadism)
Race (particularly Afro-Caribbean and Hispanic

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7
Q

How does SUFE present?

A

Hip pain and limp
Reduced range of movement- loss of internal rotation and in flexion
Pain may refer to knee
Trendelenburg gait test is positive

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8
Q

What physical test can be used for SUFE

A

Trendelenburg gait test

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9
Q

How is SUFE diagnosed

A

X rays - anterolateral and frog-leg
Shows shortened displaced epiphysis and widened growth plate

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10
Q

Differentials for SUFE

A

Osteoarthritis, hip fracture, perthes disease, septic arthritis

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11
Q

How is SUFE treated

A

Immediate surgical fixation to prevent further slipping

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12
Q

Complications of SUFE

A

Avascular necrosis, osteoarthritis

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13
Q

What is osteogenesis imperfecta?

A

A group of genetic disorders of collagen metabolism that lead to bone fragility and fractures

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14
Q

What is the inheritance of osteogenesis imperfecta?

A

Autosomal dominant

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15
Q

PAthophysiology of osteogenesis imperfecta

A

Abnormality in type 1 collagen production leading to decreased synthesis

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16
Q

What is the most common type of osteogenesis imperfecta

A

Type 1

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17
Q

Presentation of osteogenesis imperfecta (type 1)

A

Fractures from minor trauma
Blue sclera
Deafness (due to otosclerosis)
Dental imperfections
Bone deformities- leg bowing, barrel chest

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18
Q

How is osteogenesis imperfecta diagnosed

A

Bloods will be normal -calcium, PTH, ALP etc
Genetic testing
DEXA scan and bone biopsy

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19
Q

How is osteogenesis imperfecta treated?

A

Surgical treatment of deformities- e.g intramedullalry rods
Bisphosphonates
Dental procedures.

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20
Q

What is rickets

A

Failure of mineralisation of growing bone or osteoid tissue - usually dye to vitamin D deficiency

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21
Q

Causes of rickets

A

Nutritional - dark skin, decreased sunlight (northern latitudes), diet low in calcium, phosphorus and vitamin D
(E.g exclusive breastfeeding)

Intestinal - coeliac, pancreatic insufficiency (e.g CF)

Defective production of 24-hydroxyvitamin D (e,g chronic liver disease)

Defective production of 1,25-dihydroxyvitamin D (e.g kidney disease)

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22
Q

Presentation of rickets

A
  • sensation of a ping pong ball being firmly pressed over the occipital or parietal bones
  • frontal bossing of the skull
  • rickety rosary (swelling of the costochondral junction)
  • leg bowing or knock knees
  • Harrison’s sulcus
  • pigeon chest
  • dental deformities
  • muscle weakness
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23
Q

What can rarely present in rickets due to hypocalcaemia

A

Numbness, tetany, seizures

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24
Q

How is rickets diagnosed

A

Bloods: serum calcium, phosphorus, ALP (will be elevated), vitamin D, parathyroid hormone

X ray of wrist

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25
Q

What can be seen on X ray of the wrist in rickets

A

Cupping and fraying of the metaphysis and a widened epiphyseal plate

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26
Q

How is rickets managed?

A

Vitamin D supplementation
May need other treatments depending on cause (e.g coeliacs)

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27
Q

What is transient synovitis?

A

Also known as irritable hip- it is the most common cause of hip pain in children

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28
Q

Who does transient synovitis commonly effect?

A

Children aged 3-8
More common in boys

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29
Q

When might transient synovitis present?

A

After a viral infection

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30
Q

How does transient synovitis present?

A

Sudden onset hip pain- may be referred to the knee
No pain at rest
Decreased range of movement
Low grade fever - if high think septic arthritis

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31
Q

How is transient synovitis treated?

A

Bed rest
Usually self limiting
NSAIDs for symptomatic relief

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32
Q

What is Perthes disease?

A

Avascular necrosis of the capital femoral epiphysis of the femoral head due to an interruption in blood supply.

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33
Q

Who does Perthes disease effect?

A

Children usually under the age of 10
Much more common in boys
Rare in black people

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34
Q

Presentation of Perthes disease

A

Gradual onset limp/ hip pain (may be referred to the knee)
Limited range of movement
Short stature
Muscle wasting

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35
Q

How would Perthes disease and transient synovitis differ on presentation

A

Perthes disease should be suspected if pain is for more than 4 weeks (TS usually resolves after 2 weeks)

36
Q

How is Perthes disease diagnosed?

A

Bilateral hip X ray
Technetium bone scan if X ray is normal.

37
Q

Pathophysiology of Perthes disease

A

Ischaemia of the femoral head stops the epiphysis growing
Dead fragments of the bone are resorbed and replaced with tissue which is then revascularised and ossified

38
Q

How is Perthes disease treated

A

If less than 50% of femoral head is involved then supportive measurements- bed rest
If more than 50% then immobilisation (keep the femoral head in the acetabulum by casts/ braces)
Surgical containment may be needed.

39
Q

What is osteomyelitis

A

Infection of the metaphysis of long bones/

40
Q

RF for osteomyelitis

A

Previous osteomyelitis
Penetrating injury
Diabetes
Recent surgery
Local infection
Immunocompromised

41
Q

Most common bacteria involved in osteomyelitis

A

Staphylococcus aureus

42
Q

What are the two types of osteomyelitis?

A

Haematogenous osteomyelitis (results from bacteraemia)
Non-haematogenous osteomyelitis (results for contiguous spread of infection from adjacent soft tissues or from direct injury

43
Q

Risk factors for haematogenous osteomyletitis

A

sickle cell
IV drug use
immunosuppression
Infective endocarditits

44
Q

Risk factors for non-haematogenous spread of osteomyelitis

A

diabetic foot ulcers, pressure sores, diabetes, peripheral artery disease

45
Q

How does osteomyelitis present?

A

an acutely febrile child
painful immobile joint- movement will cause severe pain

46
Q

What is Pott’s disease

A

vertebral osteomyelitis that results from haematogenous spread of TB
Damage to two adjacent bodies leads to vertebral collapse and abscess formation

47
Q

Gold standard test for osteomyelitis

A

MRI scan

48
Q

Diagnosis of osteomyelitis

A

Blood cultures,
X-rays (initially normal)
USS- periosteal elevation
MRI
May consider bone biospy

49
Q

How is osteomyelitis treated?

A

6 weeks IV flucloxacillin
May need aspiration or sugical decompression

50
Q

What is osgood schlatters

A

a common cause of knee pain in adolescents that is caused by overuse of the patella tendon at its insertion point on the tibial tuberosity

51
Q

Who is affected by osgood schlatters

A

adolescents aged 10-15 years.
More common in males
Typically athletes- basketball, football, gymnastics e.g

52
Q

How does osgood schlatters present ?

A

anterior knee pain
Pain exacerbated on movement
Swelling and tenderness of the tibial tuberosity

53
Q

How is osgood schlatters diagnosed

A

mainly clinical diagnosis
May use imaging studies- Xray, USS, MRI

54
Q

Management of osgood schlatters

A

supportive- pain management, encouragement of strengthening exercises

55
Q

What is juvenille idiopathic arthritis

A

joint inflammation in children under 16 which persists for at least 6 weeks when other causes have been excluded

56
Q

Epidemiology of JIA

A

most common rheumatic disorder in children
more common in females
Under 16 years

57
Q

6 different presentations of JIA

A
  1. oligoarthritis
  2. Polyarthritis with negative RF
  3. Polyarthritis with positive RF
  4. Systemic arthritis
  5. Psoriatic arthritis
  6. enthesitis related arthritis
58
Q

Presentation of JIA

A
  • Joint swelling
  • Joint stiffness
  • Pain: may present as limp
  • Rash - Salmon pink
  • Fevers
  • Malaise
  • Uveitis
59
Q

Explain oligoarticular arthritis JIA

A

affects just 1-4 joints in the first 6 months
Can go on to be extended (>4 joints after 6 months) or persistent (<4 joints after 6 months)
Usually knee and ankle affected

60
Q

Explain polyarthritis JIA with negative RF

A

affects 5 or more joints in first 6 months

61
Q

Explain polyarthritis JIA with positive RF

A

5 or more joints in the first 6 months
usually symmetrical involvement (particularly hands and feet)
may have systemic features- fever, enlarged spleen, lymphadenopathy

62
Q

Explain systemic arthritis JIA

A

Arthritis with at least 2 weeks of daily fever (usually spikes in afternoon) and one of the following:
- salmon pink rash
- lymhpadenopathy
- hepatomegaly or splenomegaly
-serositis

63
Q

what is macrophage activation syndrome

A

a life threatening condition that occurs in 10% of patients with systemic JIA.
Presents as high fever, hepatosplenomegaly, haemorrhagic manigestations and a sepsis -like condition

64
Q

How is JIA diagnosed

A

Diagnosis of exclusion - may x ray, joint aspirate

65
Q

Treatment of JIA

A

DMARDS- methotrexate
NSAIDs for symptom control
Joint injections
Biologics may be needed

66
Q

What may causea fluctuant swelling behind the knee

A

Bakers cyst

67
Q

What part of the bone is effected in osteomyelitis

A

metaphysis

68
Q
A
68
Q

What will calcium, PTH and phosphate be in osteogenesis imperfecta

A

normal

69
Q

What bacteria may cause osteomyelitis in those with sickle cell

A

salmonella

70
Q

What motion may be lossed in a slipped capital femoral epiphysis

A

internal rotation in flexion

71
Q

what does barlow test aim to do

A

it attempts to dislocate a newborns femoral head

72
Q

what is the first line investigation for developmental hip dysplasia in child over 4.5 months

A

hip x ray

73
Q

what bedside test can be used to determine if leg length discrepancy is due to femoral or tibial shortening

A

Galaezzi’s testing

74
Q

Describe ortolani’s test

A

attempts to relocate a dislocated femoral head (IDENTIFIES A DISLOCATED HIP)
- the hip is flexed to 90 degrees and abducted with the examiners fingers placed on the lateral part of the greater trochanter

75
Q

describe Barlows tests

A

attempts to dislocate an articulated femoral head (IDENTIFIES A DISLOCATABLE HIP)- think able for barlow

  • the hip is flexed to 90 degrees and adducted
  • the examiner places hands on the knees and posterior pressure is placed through the hip
76
Q

what features on examination may be used to look for developmental dysplasia of the hip

A
  • ortolani and barlows tests
  • limited hip abduction
  • leg length discrepancy
  • asymmetrical gluteal and thigh skinfolds
  • limp in older children
77
Q

how is developmental dysplasia of the hip diagnosed?

A

USS
if >4.5 months hip x-ray

78
Q

who is screened for developmental dysplasia of the hip?

A
  • infants who have a first degree relative with hip problems in early life
  • those with a breech presentation at or after 36 weeks gestation (irrespective of their birth presentation)
  • those who a part of a multiple pregnancy
79
Q

At what times are all infants screened for developmental dysplasia of the hip?

A

at the NIPE examination and a 6 week baby check

80
Q

How is developmental dysplasia of the hip treated?

A

Most will stabilise on their own
Palvik harness with follow ups over 3 moths
If not working surgery (closed reduction under GA with spica casting)

81
Q

complications of developmental dysplasia of the hip

A

avascular necrosis
residual acetabular dysplasia
palvik harness disease
degenerative joint disease

82
Q

what is torticollis

A

A neck deformity that involves shortening of the sternocleidomastoid muscle leading to limited neck rotation and lateral flexion

This leads to a head tilt to the affected side and rotation to the contralateral side

83
Q

aetiology of torticollis

A

complicated deliveries are thought to be related

84
Q

Under what age should a child with a limp have urgent paediatric assessment

A

under 3 years

85
Q

what is the management of a slipped upper femoral epiphysis

A

insitu fixation with a cannulated screw

86
Q
A

3A (42 decks)

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