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Int Spec (Ortho) > Paediatric Orthopaedics > Flashcards

Paediatric Orthopaedics Flashcards

1
Q

What investigation is used to diagnose SUFE and Perthes’ disease?

A

Hip x-ray

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2
Q

What is the commonest chronic form of arthritis seen in children?

A

Juvenile idiopathic arthritis

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3
Q

Why are regular slit lamp examinations essential for all children with juvenile idiopathic arthritis?

A

1 in 5 will develop chronic anterior uveitis

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4
Q

A mutation affecting the gene responsible for what protein underlies the pathogenesis of Marfan’s syndrome?

A

Fibrillin

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5
Q

Are boys or girls more likely to be affected by juvenile idiopathic arthritis?

A

Girls

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6
Q

In any child with a high temperature and a swollen, painful joint, what diagnosis should be assumed until proven otherwise?

A

Septic arthritis

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7
Q

What investigation is used to assess for DDH in individuals aged more than 6 months?

A

X-ray

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8
Q

What diagnosis may be suspected if short limbs, particularly short femur length, are seen on an antenatal ultrasound scan relative to abdominal and head circumference measures?

A

Achondroplasia

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9
Q

What respiratory condition is often seen in individual’s with Marfan’s syndrome?

A

Spontaneous pneumothorax

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10
Q

How is osteomyelitis treated?

A

IV antibiotics +/- surgical debridement

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11
Q

What movement of the hip is usually first to be lost in children with Perthes’ disease?

A

Internal rotation

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12
Q

A ‘rib hump’ will be seen in which subtype of scoliosis?

A

Structural scoliosis

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13
Q

Asymmetrical skin creases at the inner upper thigh is suggestive of what condition?

A

DDH

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14
Q

What percentage of children affected by juvenile idiopathic arthritis will have active disease into adulthood?

A

30%

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15
Q

How is SUFE managed?

A

Bilateral screw fixation of the epiphysis

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16
Q

Is DDH more likely to be unilateral or bilateral? Which hip is more likely to be affected?

A

Unilateral, and the left hip

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17
Q

Femoral neck anteversion is caused by an excess of what movement at the hip joint?

A

Internal rotation

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18
Q

How are the vast majority of cases of osteogenesis imperfecta inherited?

A

Autosomal dominant

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19
Q

How is Perthes’ disease managed?

A

Avoidance of activity, mechanical appliances or surgical osteotomy

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20
Q

How does Perthes’ disease typically present?

A

Limp +/- pain in the hip or knee

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21
Q

In talipes equinovarus, the ankle is in what position?

A

Plantarflexed and supinated

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22
Q

What are some features that may be seen in systemic onset juvenile idiopathic arthritis (formerly known as Still’s disease)?

A

Swinging fever, salmon pink macular rash, organomegaly, pericarditis

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23
Q

What are the two main clinical features of Ehler’s Danlos syndrome?

A

Joint hypermobility and vascular fragility (easy bruising)

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24
Q

A baby with DDH presenting before 6 months of age is treated how?

A

Pavlik harness

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25
What investigation is used to confirm scoliosis?
Spine radiographs
26
Juvenile idiopathic arthritis is defined as arthritis starting before what age? To be diagnosed, it must last for at least how long?
16 years / 3 months
27
Klumpke's palsy involves damage to which nerve roots? In the simplest terms, how does this present?
C8 and T1, presents as a claw hand
28
What is the most significant orthopaedic complication associated with Down's syndrome?
Atlanto-axial joint instability
29
What investigation is used to assess for DDH in individuals aged less than 6 months?
Ultrasound
30
What is the commonest subtype of juvenile idiopathic arthritis? What joints is this most likely to involve?
Oligo-articular, most commonly affecting the knee/ankle/elbow
31
What medication can be given as prophylaxis against fractures to children with osteogenesis imperfecta?
Oral bisphosphonates
32
Any painful scoliosis warrants what urgent investigation?
Spinal MRI
33
What is the typical demographic of a child affected by Perthes' disease?
Small, hyperactive boy aged 4-10 years
34
Describe the typical demographic of child that will be affected by Osgood-Schlatter's disease?
Active child, more commonly a boy, aged 10-16
35
Which clinical test is this describing: reducing a dislocated hip with abduction and anterior displacement?
Ortolani's test
36
What is meant by the term syndactyly?
The fusion of two digits
37
How should transient synovitis of the hip be treated?
NSAIDs and rest
38
A Pavlik harness is used to keep a baby's hips in what position?
Flexed and abducted
39
The majority of cases of abnormal knee alignment will resolve by what age?
10 years
40
In a child presenting with back pain, what are the two most important pathologies to exclude?
Infections and tumours
41
In those who present acutely, an adolescent who cannot weight bear has what condition until proven otherwise?
SUFE
42
In osteogenesis imperfecta, the defect is in the maturation and organisation of what component of bone?
Type I collagen
43
A child with sickle cell anaemia is at particular risk of septic arthritis caused by what organism?
Salmonella
44
Pain and swelling at the tibial tuberosity is characteristic of what condition?
Osgood-Schlatter's disease
45
At which spinal levels is spondylolisthesis most likely to occur?
L4/L5 or L5/S1
46
What screening is required in individual's with Marfan's syndrome?
Regular ECHO scans and ophthalmologist review
47
What is the correct term to describe a child who, when walking and standing, will have feet that point towards the midline?
Intoeing
48
What is the typical demographic of a child affected by SUFE?
A pre-pubertal adolescent boy with obesity/hypothyroidism
49
What is the commonest acute form of arthritis seen in children?
Reactive arthritis
50
When is the knee pain associated with Osgood-Schlatter's disease worse?
After repetitive running or jumping activities
51
What surgical procedure is usually required alongside splinting for the correction of talipes equinovarus?
Achilles tendon tenotomy
52
What is the commonest type of obstetric brachial plexus palsy? This involves damage to which nerve roots?
Erb's palsy, damage to C5 and C6
53
How often should adolescents with scoliosis be x-rayed to assess for progression of the curve?
Every 6-12 month
54
Babies with talipes equinovarus should undergo screening for what other condition?
DDH
55
Which babies should always have an ultrasound to screen for DDH, even if clinical tests are normal?
Those in breech position or with a positive family history in a first-degree family member
56
How is septic arthritis managed?
Joint aspiration, irrigation and IV antibiotics
57
Which clinical test is this describing: dislocating the hip with flexion and posterior displacement?
Barlow's test
58
How may Marfan's syndrome be inherited?
Autosomal dominant or sporadic
59
For juvenile idiopathic arthritis to be classified as a polyarthritis, how many joints must be involved?
5 or more
60
A baby born with internal rotation of the shoulder, resulting in the 'waiter's tip' position is suggestive of what diagnosis?
Erb's palsy
61
Other than skeletal abnormalities, what are the most significant clinical features of Marfan's syndrome?
Aortic root dilatation and lens dislocation
62
Is DDH more common in first or later born children? Is it more common in boys or girls?
Firstborns, and girls
63
What organism is the most common cause of septic arthritis and osteomyelitis?
Staph aureus
64
Other than fragility fractures and bony deformities, what are some other non-bony clinical features of osteogenesis imperfecta?
Blue sclera and hearing loss
65
The diagnosis of Osgood-Schlatter's disease is clinical, however, what investigation is usually performed anyway to exclude other pathology?
Knee x-ray
66
Ortolani's and Barlow's tests are used to detect what clinical condition?
DDH
67
What is the most common type of chondroplasia? How is this most likely to be inherited?
Achondroplasia- most likely to be a sporadic mutation
68
How is talipes equinovarus treated?
Splinting using the Ponseti technique
69
What condition is this describing: a lack of blood supply to the epiphysis of the femoral head, and consequent avascular necrosis resulting in loss of bone mass and deformity of the femoral head?
Perthes' disease
70
Pain from SUFE is often felt where?
In the knee
71
Severe scoliosis can cause what complication?
Restrictive lung defects
72
What are some risks associated with osteomyelitis in children?
Pathological fractures and growth arrest
73
How is DDH treated if the Pavlik harness doesn't work or the child presents later than 6 months of age?
Surgery (open reduction and femoral osteotomy)
74
How long should it take for pain associated with transient synovitis of the hip to pass?
Up to a few weeks
75
What is spondylolisthesis?
The slippage of one vertebra over another
76
Growing pains usually cause pain when?
Overnight (often wakes the child from sleep)
77
Radiography showing a flattened femoral head with increased bone density is suggestive of what diagnosis?
Perthes' disease
78
Describe the typical phenotype of an individual with Marfan's syndrome?
Tall stature and wide arm span
79
What is the most common cause of non-idiopathic scoliosis?
Neuromuscular disease
80
Describe the alignment of the developing knees?
Children are born with varus knees which become neutrally aligned at 14 months; they then progress to 10-15 degrees of valgus at 3 years and then regress to the physiological 6 degrees of valgus by 7-9 years
81
Which gender is more likely to be affected by talipes equinovarus?
Boys
82
In children, reactive arthritis (including transient synovitis of the hip), most commonly occurs as a result of what infection?
URTI

Int Spec (Ortho) (10 decks)

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