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The One Deck To Rule Them All > Paeds: MSK > Flashcards

Paeds: MSK Flashcards

1
Q 
< 16 years
Fever
joint pain (<4 joints)
salmon-pink rash
limp
A

Juvenile idiopathic arthritis

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2
Q

2-10 years old
Acute hip pain
Hx of recent viral infection

A

Transient synovitis

Tx: Self-limiting

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3
Q

Osteochondrosis due to inflammation at Tibial tuberosity

- repeated avulsion of apophysis where patellar tendon is inserted

A

Osgood-schlatter Disease

  • found in kids who play a lot of sport
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4
Q

Pain not present at beginning of day
No limitation of activity
Worse after exercise

A

Growing pains

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5
Q

Absent medial arch on standing

A

Pes Planus (flat feet)

  • Self resolves (4-8 years)
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6
Q

Bowed legs

Increased intercondylar distance

A

Genu varum

  • self resolves (4-5 years)
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7
Q

Knock knees

Increases intermalleolar distance

A

Genu algum

  • Self resolves
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8
Q

Inverted + plantar flexed feet

Not passively correctable

A

Talipes Equinovarus
“Clubfoot”

50% bilateral

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9
Q

Risk factors for Talipes equinovarus

A

Spina bifida
cerebral palsy
Edwards syndrome

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10
Q

Management for Talipes equinovarus

A

Ponseti methods

- progressive braces

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11
Q

Widening of the joints due to excess of non-mineralised osteoid at the growth plate

  • bowed legs
  • costochondral swelling
A

Ricket’s

  • Caused by Vit D deficiency
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12
Q

External tibial torsion

Patellofemoral pain

A

Out toeing

  • Resolves by 2 years
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13
Q

Metatarsus adductus: Abnormal heel bisector line
Internal tibial torsion
Femoral anteversion (W sign)

A

In toeing

Self resolve mostly
If not casts/ surgery

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14
Q 
Age 5
Increased CK
Rapid progression
Calf pseudohypertrophy
Uses arms to stand up from squat (Gower's sign)
A

Duchenne’s Muscular dystrophy

  • 30% have intellectual impairment
  • Dilated cardiomyopathy is common

Live into 20-30s

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15
Q

Uses arms to stand up from squat position

  • Seen in Duchenne’s + Becker’s muscular dystrophy
A

Gower’s sign

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16
Q

Age 10
Slow progression
Calf pseudohypertrophy
Uses arms to stand up from squat (Gower’s sign)

A

Becker’s muscular dystrophy

  • colour blindness is common

Live into 40s-50s

17
Q

Genetics for Duchenne’s Muscular dystrophy

A

Frameshift utation in dystrophin

X-linked recessive (gene Xp21)

18
Q

Genetics for Becker’s Muscular dystrophy

A

Non-frameshift utation in dystrophin

X-linked recessive (gene Xp21)

19
Q

Unequal leg lengths
Limp
Discrepancy between skin creases of hip

A

Developmental dysplasia of the hip (DDH)

20
Q

Risk factors for DDH

A 
Female ( x 6 risk)
Breech
FHx
First born
Oligohydramnios
Birth weight >5kg
Congenital calcaneovalgus foot deformity
21
Q

Investigations for DDH

A

<3 months: US (6 weeks post birth to all breech >36w gestation)
>3 months: X-RAY (shenton’s line should be smooth arc)

To diagnose:

Barlow test: attempt to dislocate articulated femoral head
Ortolani test: attempt to relocate a dislocated femoral head

22
Q

attempt to relocate a dislocated femoral head

A

Ortolani test

23
Q

attempt to dislocate articulated femoral head

A

Barlow test

24
Q

Management for DDH

A

Spontaneously stabilise by 3-6 weeks

Palik harness (dynamic flexion-abduction orthosis)
- used <4-5 months

Surgery

25
Q

Age 4-12 years (Primary school)
Hip pain
limp
Stiffness and decreased movement

A

Perthe’s disease (in Primary school)

  • avascular necrosis of the femoral head (epiphysis)
  • 5M:1F
  • 20% bilateral
26
Q

Staging of Perthe’s disease

A

Caterall Staging

  1. Histological features only
  2. Sclerosis + preservation of articular surface
  3. Loss of structural integrity of femoral head
  4. Loss of acetabular integrity
27
Q

Investigations for Perthe’s disease

A

XR: Widening of joint space
Flattening of femoral head
Technetium bone scan
MRI: Gold standard for diagnosis

28
Q

Management of Perthe’s Disease

A

< 6 years: observe
> 6 years: surgery

Keep femoral head in acetabulum (cast + braces)

29
Q

Age 10-15 years (Secondary School)
Obese male
Knee pain (referred from ipsilateral hip, 2 months)
Limits to internal rotation

A

Slipped Upper Femoral Epiphysis (SUFE)

  • displacement of femoral head epiphysis posterior-inferiorly
  • bilateral 20%
  • most common adolescent hip disorder
30
Q

Investigations in SUFE

A

XR: Displacement of femoral epiphysis
Falls inferolaterally (like melting ice cream)
Calculated degree of displacement with Southwick angle

31
Q

Management of SUFE

A

Bed rest + non-weight bearing

Severe: Percutaneous pinning of the hip (internal fixation)

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