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Paediatrics > Paediatric MSK & Rheumatology > Flashcards

Paediatric MSK & Rheumatology Flashcards

1
Q

Causes of a limp in children under 4yrs

A 
Acute = NAI
Soft tissue or fracture injury
Malignancy/tumour
Osteomyelitis or septic arthritis
Discitis

Chronic = DDH
Cerebral palsy
JIA
Duchene muscular dystrophy.

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2
Q

Causes of a limp in a child between 4 and 10yrs

A 
Fracture or soft tissue injury
Malignancy/tumour
Osteomyelitis or septic arthritis
Transient synovitis
Perthe's disease
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3
Q

Causes of a limp in a children between 10-18yrs

A 
Fracture or soft tissue injury
Tumour or malignancy
Osteomyelitis or septic arthritis
Perthe's disease
Slipped upper femoral epiphysis
Osgood-Schlatter disease
Osteochondritis deissecans
Chondromalacia patellae
JIA
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4
Q

Difference between osteomyelitis and septic arthritis

A

Osteomyelitis - infection of bone

Septic arthritis - infection of synovium and joint space

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5
Q

Developmental dysplasia of the hip risk factors, manoeuvres, presentation in later life

A

Barlow or Ortolani manoeuvre at birth then repeated at 8weeks.
RF = female sex, breech position at birth, family history, high brith weight, oligohydramnios, first born.
Presents = abnormal gait, limp, asymmetrical skin folds at hip, poor hip abduction, shorter let on affected side. Rx = Pavlik harness, splint and surgery.

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6
Q

Transient synovitis

A

Acute and sudden limp and pain on exercise (NOT AT REST).
Post viral infection in boys.
Can precede Perthe’s disease
Self-limiting.

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7
Q

Perthe’s Disease pathology and features

A

Avascular necrosis of the femoral head.
More common in boys.
Limp/Antalgic gait. Hip pain which can refer to groin, thigh and knee.

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8
Q

Slipped Upper femoral epiphysis

A

Slipped capital femoral epiphysis. Proximal femoral epiphysis is displaced.
More common in males, in rapid growing/growth spurt, obese, has been associated with endocrine abnormalities.
Ix = frog-leg x-ray
Rx = surgical pinning to prevent necrosis.

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9
Q

Osgood-Schlatter disease

A

Anterior knee pain during adolescence

Inflammation of patellar ligament.

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10
Q

Osteochondritis dissecans

A

Separation of part of cartilage and bone.

Mostly in athletes and exacerbated by activity

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11
Q

Chondromalacia patellae

A

Softening of cartilage in knee. Commonly seen in athletes.

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12
Q

Malignancies which cause limps

A

Primary bone tumours e.g. osteosarcoma, soft tissue sarcoma, leukaemia, lymphoma.

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13
Q

Discitis

A

Infection or inflammation of the intervertebral disc space, uncommon in children. Limited back movement and local tenderness.

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14
Q

Muscular dystrophies and limps

A

Duchenne and Becker muscular dystrophies cause muscle weakness.
Duchenne presents within first 3 years.
Becker preened around 11yrs.
X-linked. Duchenne’s is worse.

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15
Q

Definition of Juvenile Idiopathic Arthritis

A

Collection of chronic (great than 6weeks) paediatric arthropathies. Diagnosis of exclusion/idiopathic.

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16
Q

Different types of Juvenile Idiopathic Arthritis

A 
Systemic arthritis 
Oligoarticular
Polyarticular rheumatoid factor + or - ve
Psoriatic arthritis 
Enthesitis-related arthritis
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17
Q

Risk factors for JIA

A

Female
HLA polymorphism
Under 6yrs
Family history of autoimmune disease

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18
Q

Systemic arthritis JIA

A

Associated with BIG pyrexia and generally unwell
Lymphadenopathy, splenomegaly and hepatomegaly.
Erythematous rash
Serositis

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19
Q

Oligoarticular JIA

A 
Most common!
2 types - persistent or extended.
4 or more joints, most commonly hands, knees elbow, wrist, ankle. 
Asymmetrical
Associated with chronic anterior uveitis
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20
Q

Polyarticular JIA

A

5 or more joints involved.

Rheumatoid factor positive or negative. Positive is more common.

21
Q

Psoriatic artheritis

A

Arthritis + psoriasis or arthritis + dactylics/nail pitting or nail changes.
RF = 1st degree relative with psoriasis.

22
Q

Other symptoms apart form arthritis seen in enthesitis related arthritis JIA.

A

Enthesitis (inflammation at muscle to bone insertion) Symptoms of acute anterior uveitis (red eye, pain, blurred vision and photophobia)
Sacroiliac tenderness
HLAB27 +VE
Rheumatoid factor and ANA negative.

23
Q

General presentation of JIA

A 
Functional loss of range of movements
persistent swlling
MORNING stiffness
Joint deformity
Warm, pain, colour change due to increased blood flow, increased growth factors.
24
Q

Signs of an inflamed joint (untreated JIA)

A 
Periarticular osteoporosis
Inflamed or fibrosis synovium
Increased synovial fluid
Loss of cartilage
Erosion of bone
25
Q

Investigations for JIA

A

FBC - anaemia, thrombocytosis, exclude malignancies.
ESR - elevated in systemic and polyarticular JIA.
ANA - +ve with oligoarticular and polyarticular JIA, -ve in systemic and enthesitis JIA
RF - positive in RF-positive polyarticular.
X-ray of joint
Infection screen.

26
Q

Management of JIA

A

MDT
NSAID
Disease modifying anti-rheumatic drug e.g. Methotrexate or Sulfasalazine
Corticosteriods oral or intra-articular
Biologics and novel drugs e.g. cytokine IL-6 inhibitor Tocilizumab or TNF-α

27
Q

Causes of osteoporosis in children

A

Congenital - osteoporosis imperfecta, inborn errors, haematological problems, idiopathic.
Acquired - drug-induced esp steroids, major endocrinopathies, malabsorption, immobilisation

28
Q

Osteoporosis definition

A

Low bone mass and micro-architecture deterioration. Increased fragility and fracture risk.

29
Q

Osteoporosis imperfecta genetics

A

Most are autosomal dominant inheritance. Mutations in collagen gene.

30
Q

Different types of osteoporosis imperfecta

A

I - most common, blue sclerae.
II - lethal with fracture present before birth.
III - progressively severe
IV - mild with variable age onset.

31
Q

Symptoms of osteoporosis imperfecta

A 
Bone fragility and brittle
Fractures
Deformities such as bowed-leg.
Bone pain
Poor growth
Impaired mobility
32
Q

Management of osteoporosis imperfecta

A

MDT (surgeon, physio, nurse, surgeon)

Biphosphonate medications reduce fracture rate, increase growth height, reduce pain, increase mobility.

33
Q

Uses of vitamin D

A

Increase calcium and phosphorus gut absorption
Increase calcium release from bone (resorption)
Role in immunity

34
Q

Definition of rickets

A

Failure to mineralise growing bone or osteoid tissue at epiphyseal growth plates.

35
Q

Causes of low vit D

A 
Insufficient exposure to sunlight.
Inadequate dietary intake
Poor absorption (coeliac, CF or Crohn's)
Obesity
Poor Vit D activation due to CKD, enzyme deficiency, or enzyme inactivity due to anticonvulsant meds.
Anti-epileptic drugs e.g. carbamazepine
36
Q

Risk factors for vitamin D deficiency

A 
Covered up skin (e.g. Muslim females)
Dark skin (e.g. African)
Exclusively breast-fed babies due to maternal vit D deficient will cause low vit D in breast milk.
Veganism
High BMI
37
Q

Presentation of low Vit D/Rickets

A 
Bowed legs
Hypocalcaemia convulsions
Motor delay
Metaphyseal swelling
Slow growth rate
Hypotonia
Fractures
Frontal bossing of the skull
Craniotabes
Muscle weakness
Bone pain
Weak tooth enamel = more cavities.
38
Q

Investigations for Rickets

A 
X-ray - cupping, splaying or fraying or metaphases/champagne glass appearance.
Vitamin D levels via (25[OH)D)
Serum calcium and phosphorous
High ALP
Parathyroid hormone raised
39
Q

Differentials for rickets

A 
Soft tissue sarcoma or bone malignancy
Fracture at bone
osteomyelitis
Parathyroid hormone disease
Rheumatoid arthritis
Muscular dystrophies
40
Q

Management of Rickets

A

Vitamin D supplements and calcium mostly D3

41
Q

Knee pain differentials

A

Osgood-Schlatter disease
Chondromalacia patella
Osteochondiritis dissecans
Patella dislocation

42
Q

Causes of a more chronic onset limp in under 4yrs

A

DDH
Neuromuscular e.g. cerebral palsy
JIA
Duchenne’s muscular dystrophy

43
Q

Causes of a more chronic onset limp in 4-10yrs

A

Perthe’s

JIA

44
Q

Causes of a more chronic onset limp in over 10yrs

A

SUFE

JIA

45
Q

3 features on an x-ray for Perthe’s

A

Fragmentation of proximal femoral epiphysis
Flattening of the proximal femoral epiphysis
Increased density of the femoral head

46
Q

Criteria for septic arthritis

A

Kocher’s

Fever, can’t weight bear, high ESR and high WCC

47
Q

Movement of hip with SUFE

A

Flexion of hip leads to external rotation.

48
Q

Example of bisphosphonate

A

Alendronic acid

Paediatrics (16 decks)

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