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Phase 3a conditions list flashcards > Paediatrics - MSK + rheum > Flashcards

Paediatrics - MSK + rheum Flashcards

1
Q

What are some causes of hip (or other joint) pain in 0-4 year olds (3)?

A
  • Septic arthritis
  • Developmental dysplasia of the hip
  • Transient sinovitis
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2
Q

What are some causes of hip (or other joint) pain in 5-10 year olds (3)?

A
  • Septic arthritis
  • Transient sinovitis
  • Perthes disease
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3
Q

What are some causes of hip (or other joint) pain in 10-16 year olds (4)?

A
  • Septic arthritis
  • Slipped upper femoral epiphysis
  • Juvenile idiopathic arthritis
  • Transient
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4
Q

How can hip pain present (3)?

A
  • Pain
  • Refusal to walk/ weight bear
  • Swollen/ tender joint
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5
Q

What are some red flag features for hip pain (6)?

A
  • Child under 3
  • Fever (38.5)
  • Night waking/ pain
  • Swollen/ red joint
  • Persistent pain
  • Other injuries (NAI)
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6
Q

What are some general investigations for joint pain (5)?

A
  • Bloods
  • Xray
  • USS
  • Joint aspiration
  • MRI
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7
Q

What is the most common cause of hip pain in children 3-10?

A

Transient synovitis

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8
Q

What is transient synovitis also known as?

A

Irritable hip

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9
Q

What causes transient synovitis?

A

Inflammation of the synovial membrane typically following a viral URTI

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10
Q

What are the signs/ symptoms of transient synovitis (3)?

A
  • Limp/ inability to weight bear
  • Groin/ hip pain
  • Mild low grade fever
    children should otherwise be well
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11
Q

How should children with transient synovitis be managed?

A

Refer if symptoms not improving after 72 hours

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12
Q

What is an important differential for transient synovitis and how can it be differentiated?

A

Septic arthritis - usually present with a high fever

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13
Q

What age is septic arthritis most common in children?

A

Under 4 years old

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14
Q

What is a risk factor for septic arthritis?

A

Joint replacement

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15
Q

What is the most common bacteria and what other bacteria cause septic arthritis (5)?

A
  • Staph aureus = mc
  • Neiserria gonorrhoea
  • GAS (strep pyogenes)
  • H. influenza
  • E. coli
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16
Q

What are the signs/ symptoms of septic arthritis (5)?

A
  • Red, hot, swollen joint
  • Fever
  • Reduced range of motion
  • Stiffness
  • Non weight bearing
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17
Q

How is septic arthritis investigated (2)?

A
  • Joint aspiration (high WBC, MC+S)
  • Bloods
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18
Q

What criteria can be used to differentiate between transient synovitis and septic arthritis?

A

Kocher criteria

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19
Q

What are the kocher criteria (3)?

A
  • Non weight bearing
  • Temp > 38.5
  • High WCC/ ESR
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20
Q

How is septic arthritis managed (2)?

A
  • IV Abx (3-6 weeks)
  • Surgical debridement (if severe)
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21
Q

What is developmental dysplasia of the hip?

A

Structural abnormality caused by abnormal development of the foetal bones during pregnancy

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22
Q

What are the risk factors for DDH (6)?

A
  • Family history
  • Breech position
  • Fibroids
  • Multiple pregnancy
  • Oligohydramnios
  • First born
    anything that reduces space in-utero
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23
Q

What are the signs/ symptoms of DDH (4)?

A
  • Leg length discrepancy
  • Skin folds on one side
  • Restricted hip abduction
  • Clunking noise when leg examined
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24
Q

What are two special tests that can be used to check for DDH?

A
  • Barlow (hip dislocate posteriorly)
  • Ortolani (hip relocate anteriorly)
    go out to a bar - so barlow is dislocate
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25
Q

When is DDH often picked up/ diagnosed?

A

When examining the baby in the NIPE and again at 6-8 weeks

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26
Q

How is DDH diagnosed (2)?

A
  • USS
  • Xray if > 4.5 months
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27
Q

How is DDH managed?

A

Pavlik harness is worn permanently for 6-8 weeks
if child diagnosed before 6 months old, if not surgery may be required

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28
Q

How is DDH managed if the child is diagnosed after 6 months?

A

Surgery

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29
Q

What is Perthes disease?

A

Disruption of blood flow to the femoral head causing avascular necrosis

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30
Q

What are some risk factors for Perths disease (3)?

A
  • Male
  • Family history
  • Downs
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31
Q

How quickly do symptoms of Perthes disease come on?

A

Slow onset

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32
Q

What are the signs/ symptoms of Perthes disease (4)?

A
  • Slow onset pain in the hip
  • Limp
  • Restricted range of movement (abduction + internal rotation)
  • Trendelenburg +ve (muscle waisting - from lack of use)
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33
Q

What age is Perthes disease most common?

A

Mostly 5-8 years (can be 4-12 years)

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34
Q

How is Perthes disease investigated (3)?

A
  • Xray
  • Bloods
  • MRI
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35
Q

What are the signs of Perthes on x-ray (2)?

A
  • Wide joint space
  • Caffey sign (decreased BMD, thin fracture)
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36
Q

How can Perthes disease be monitored?

A

Using the catterall classification (from xray appearance)

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37
Q

How is Perthes disease managed (2)?

A
  • < 6 = observe
  • > 6 = surgery - osteotomy (reshape joint)
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38
Q

How long can Perthes disease last?

A

5 years

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39
Q

What is a common-ish complication of Perths disease?

A

OA of the hip

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40
Q

What is a slipped upper femoral epiphysis?

A

When the head of the femur is displaced along the growth plate

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41
Q

What type of fracture occurs in SUFE?

A

Salter Harris 1 fracture

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42
Q

What are some risk factors for SUFE (3)?

A
  • Obese
  • Male
  • Trauma
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43
Q

What age is usually affected by slipped upper femoral epiphysis?

A

10 -15 year olds (during growth spurt)

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44
Q

What are the signs/ symptoms of SUFE (3)?

A
  • Hip/ groin/ thigh/ knee pain
  • Restricted range of movement
  • Painful limp
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45
Q

What position do children with slipped upper femoral epiphysis like to rest their leg in?

A

Externally rotated (drehmann sign)

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46
Q

What usually precedes children with SUFE in the history?

A

Minor trauma

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47
Q

How is SUFE investigated (3)?

A
  • Xray (frog leg position - AP + lateral)
  • Blood (rule out other stuff)
  • Other imaging (CT, MRI)
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48
Q

How is SUFE managed?

A

Surgical internal fixation

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49
Q

What is a complication of SUFE?

A

Avascular necrosis of the femoral head as blood supply cut off by fracture

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50
Q

What condition not mentioned yet may cause hip and other larger joint pain?

A

Rheumatic fever associated arthritis

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51
Q

What is a cause of anterior knee pain in childhood?

A

Osgood schlatter disease

52
Q

What is osgood schlatter disease?

A

Inflammation at the tibial tuberosity where the patella ligament inserts

53
Q

What age and gender does osgood schlatter occur?

A

10-15 year old boys

54
Q

What are the signs/ symptoms of osgood schlatter (2)?

A
  • Anterior knee pain
  • Tender boney growth/ lump
55
Q

How is osgood schlatter managed?

A

Analgesics + rest

56
Q

What is a complication of osgood schlatter?

A

Full avulsion fracture (tibial tuberosity completely separates from rest of tibia)

57
Q

What is an abnormal ankle position present from birth known as?

A

Talipes
“clubfoot”

58
Q

What are some risk factors for talipes (3)?

A
  • Family history
  • Oligohydramnios
  • Amniocentesis
59
Q

How is talipes managed?

A

Foot is manipulated into an improved position and a cast is applied on it to hold it there. This process is repeated

60
Q

What is the treatment for talipes known as?

A

Ponseti method

61
Q

What is a more minor version of talipes?

A

Positional talipes
the resting position of the foot is plantarflexion/ dorsiflexion, however there is no boney abnormality preventing the movement to a normal position

62
Q

What is osteomyelitis?

A

Infection in the bone and bone marrow

63
Q

What are three routes osteomyelitis can be introduced?

A
  • Directly (e.g. through open fracture)
  • Haematogenous spread (through blood from other infection e.g. skin)
  • Spread from nearby tissue (e.g. septic arthritis)
64
Q

What is the most common bacteria causing osteomyelitis?

A

Staph aureus

65
Q

What is the most common cause of osteomyelitis in those with sickle cell?

A

Salmonella

66
Q

What are some risk factors for osteomyelitis (5)?

A
  • Male
  • Under 10
  • Open fracture
  • Immunocompromised
  • Sickle cell
67
Q

How does osteomyelitis present (4)?

A
  • Refusing to weigh bear
  • Sever bone pain
  • Swelling + tenderness
  • Fever
68
Q

What are the two types of presentation in terms of time frames of those with osteomyelitis?

A
  • Acute
  • Chronic (more slow growing bacteria in bone)
69
Q

What are some investigations of those with osteomyelitis (3)?

A
  • X-ray = first line
  • MRI
  • Bloods + cultures
70
Q

How is osteomyelitis managed (2)?

A
  • Prolonged antibiotics
  • Surgical debridement
71
Q

What is rickets?

A

Osteomalacia (poor bone mineralisation) in children

72
Q

What minerals are important for the mineralisation of bone (2)?

A
  • Calcium
  • Phosphate
73
Q

What are some causes of low calcium (5)?

A
  • Diet
  • Vitamin D deficiency
  • CKD
  • Hyperparathyroidism (causing absorption of calcium from the bone, so high Ca2+ in blood)
  • Liver disease
74
Q

What are some causes of low phosphate?

A

Various genetic conditions (often X-linked)

75
Q

What are the signs/ symptoms of rickets (6)?

A
  • Poor growth
  • Bone deformities
  • Lethargy
  • Bone pain
  • Dental problems
  • Pathological fractures
76
Q

What bone deformities occur in rickets (5)?

A
  • Tibial bowing
  • Knock knees
  • Harrisons sulcus (indentation in chest)
  • Craniotabes (soft skull + frontal bossing)
  • Delayed teeth
77
Q

How is rickets investigated (2)?

A
  • X-rays
  • Bloods
78
Q

What blood screen should be done on those with rickets (7)?

A
  • Serum 25-hydroxyvitamin D, calcium, phosphate
  • Malabsorption screen (coeliacs)
  • FBC, ferritin
  • LFT, TFT, kidney function
  • PTH
  • Autoimmune antibodies
  • ESR, CRP
79
Q

How is rickets managed?

80
Q

What group of babies are at higher risk of vitamin D deficiency?

A

Breastfed babies (as milk not fortified with vitamin D

81
Q

What is a differential for a bone deformity seen in rickets?

A

Blunts disease = isolated bowed tibia

82
Q

What is a disorder that causes bones to become brittle?

A

Osteogenesis imperfecta

83
Q

What is osteogenesis imperfecta?

A

Genetic condition affecting the formation of collagen

84
Q

What is the usual inheritance pattern of osteogenesis imperfecta?

A

Autosomal dominant
although lots of different types of inheritance pattern

85
Q

What are the most common gene mutations that result in osteogenesis imperfecta?

A

COL1A1 or COL1A2 genes

86
Q

What are the signs/ symptoms of osteogenesis imperfecta (6)?

A
  • Recurrent/ inappropriate fractures
  • Blue sclera
  • Hypermobility
  • Bone deformities
  • Dental problems
  • Short stature
87
Q

How is osteogenesis imperfecta diagnosed?

A

Clinical diagnosis (sillence criteria)

88
Q

How is osteogenesis imperfecta managed (3)?

A
  • Bisphosphinates/ vitamin D
  • PT/ OT
  • Surgical interventions
    managed by MDT
89
Q

What is juvenile idiopathic arthritis?

A

Chronic autoimmune inflammatory arthritis without another identifiable cause

90
Q

What age is affected by JIA?

91
Q

How long does arthritis typically have to last before being classified as JIA?

A

6 weeks or more

92
Q

What are the 5 main types of JIA?

A
  • Oligoarticular = MC
  • Systemic (stills disease)
  • Polyarticular
  • Enthesitis related
  • Juvenile psoriatic
93
Q

How many joints are affected in oligoarticular JIA?

94
Q

How many joints are affected in polyarticular JIA?

95
Q

What are the joint features of inflammatory arthritis (3)?

A
  • Joint pain
  • Swelling
  • Stiffness
96
Q

What are the features of systemic JIA (6)?

A
  • Salmon-pink rash
  • High swinging fevers
  • Lymphadenopathy
  • Weight loss
  • Arthritis
  • Pleuritis, pericarditis
97
Q

What are the blood findings in those with systemic JIA (3)?

A
  • Negative RF, ANA
  • Raised CRP/ESR, ferritin
  • Raised platelets
98
Q

What is a complication of systemic JIA?

A

Macrophage activation syndrome

99
Q

What is macrophage activation syndrome?

A

Severe activation of the immune system with a massive inflammatory response

100
Q

What are the features of macrophage activation syndrome?

A
  • DIC (non blanching rash)
  • Anaemia
  • Thrombocytopenia (bleeding)
101
Q

What is a key finding in macrophage activation syndrome?

102
Q

How is macrophage activation syndrome treated (2)?

A
  • IV fluids
  • Steroids
103
Q

What are some key differentials for a high fever lasting for more than 5 days (4)?

A
  • Systemic JIA
  • Kawasaki disease
  • Leukaemia
  • Rheumatic fever
104
Q

What are the features of polyarticular JIA (5)?

A
  • Affects small and large joints
  • Symmetrical
  • Mild fever
  • Anaemia
  • Reduced growth
    childhood equivalent to RA
105
Q

What is a key blood finding in those with polyarticular JIA?

A

Can be positive or negative RF

106
Q

What are the features of oligoarticular JIA (3)?

A
  • Anterior uveitis
  • Larger joints more commonly affected
  • Often monoarticular
107
Q

What are the key blood findings in oligoarticular JIA?

A
  • ANA often +ve
  • RF usually -ve
108
Q

Who is most commonly affected by oligoarticular JIA?

A

Girls under 6

109
Q

What is the adult equivalent of enthesitis related arthritis?

A

Seronegative spondyloarthropathy

110
Q

What are the key features of enthesitis related arthritis (4)?

A
  • Enthesitis (inflammation of the tendon)
  • HLA-B27 positive
  • Anterior uveitis
  • IBD
111
Q

What are the key features of juvenile psoriatic arthritis (5)?

A
  • Psoriasis
  • Nail pitting
  • Onycholysis
  • Dactylitis
  • Enthesitis
112
Q

How is JIA managed (4)?

A
  • NSAIDs
  • Steroids
  • DMARDs
  • Biologics
113
Q

What are 3 DMARDs used for the treatment of JIA?

A
  • Methotrexate
  • Sulfasalazine
  • Leflunomide
114
Q

What are 3 biologics used for the treatment of JIA?

A
  • Etanercept
  • Infliximab
  • Adalimumab
115
Q

What are some complications of JIA (3)?

A
  • Anterior uveitis
  • Pericarditis/ pleuritis
  • Osteoporosis
116
Q

What is the most common cause of dwarfism?

A

Achondroplasia

117
Q

What is achondroplasia?

A

Genetic disorder affecting fibroblast growth factor receptor 3 (FGFR3) gene on chromosome 4
this causes abnormal function of the epiphyseal growth plate

118
Q

What are the features of achondroplasia (5)?

A
  • Short stature
  • Short digits
  • Bow legs
  • Frontal bossing
  • Foramen magnum stenosis
119
Q

What are some complications of achondroplasia (4)?

A
  • Recurrent otitis media
  • Kyphoscoliosis
  • Spinal stenosis
  • OSA
120
Q

How is achondroplasia inherited?

A

Autosomal dominant

121
Q

What are the main causes of scoliosis in children (6)?

A
  • Idiopathic (probably genetic cause)
  • Congenital e.g. spina bifida
  • Neuromuscular e.g. cerebral palsy
  • Tumours
  • Trauma
  • Infections
122
Q

What is torticollis?

A

Abnormal head position causing the head to be tilted to one side (the cause is often unknown)

123
Q

What can cause knee pain in 6-10 year olds often triggered by twisting or squatting whilst playing sports?

A

Discoid meniscus

124
Q

What is a discoid meniscus?

A

An abnormality in the way the meniscus (cartilage) has formed

Phase 3a conditions list flashcards (31 decks)

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