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Year 5 - Paediatrics > Paeds MSK > Flashcards

Paeds MSK Flashcards

1
Q

What are the most common causes of fracture in a neonate?

A

Clavicle: from shoulder dystocia
Humerus/ femur: from breech delivery

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2
Q

What is the prognosis for neonatal fracture?

A

Great

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3
Q

How old does a child have to be prescribed codeine and morphine?

A

16

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4
Q

How should paediatric fractures be managed?

A

Pain management
Manipulation and reduction

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5
Q

How old does a child need to be to get a intramedullary nail?

A

4

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6
Q

What is the Ottawa ankle rule?

A

X ray only indicated if:

  • Pain in the malleolar zone AND bone tenderness at the posterior edge/ tip of the lateral malleolus OR
  • Pain in the malleolar zone AND bone tenderness at the posterior edge/ tip of the MEDIAL malleolus OR
  • An inability to bear weight both immediately and in the emergency department for four steps
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7
Q

What is the Ottawa knee rule?

A

X ray only indicated if: age 55+ OR isolated patellar tenderness OR cannot flex to 90 degrees OR an inability to bear weight both immediately + in the ED for 4 steps

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8
Q

What is Perthe’s disease?

A

Avascular necrosis of the femoral epiphysis from an interruption of blood supply, followed by re-vascularisation + re-ossification over 18-36 months

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9
Q

In which age group/ gender is Perthe’s most common?

A

4-8 y/o boys

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10
Q

Recall the signs and symptoms of Perthe’s

A

Insidious presentation: limp, knee pain, hip pain –> limb shortening

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11
Q

What investigations should be done for Perthes?

A

X ray +/- MRI

Roll test

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12
Q

What would an x ray show in Perthe’s disease?

A

Increased density of femoral head

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13
Q

What is the roll test?

A

Patient supine, roll affected hip internally + externally –> guarding or spasm in Perthe’s

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14
Q

How is Perthe’s managed?

A

Simple analgesia for pain management<6 years: observation: non-surgical containment using splints>6 years –> surgery

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15
Q

What is Osgood Shlatter Disease?

A

Osteochondritis (inflammation of the cartilage/ bone) of the patellar tendon insertion at the knee

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16
Q

Recall the most at-risk group for OSD?

A

10-15y who are physically active

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17
Q

Recall the signs and symptoms of OSD?

A

Gradual onset knee pain after exercise that is relieved by rest

Localised tenderness + swelling over tibial tuberosity

Hamstring tightness

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18
Q

What might be seen on X ray in OSD?

A

Fragmentation of the tibial tubercle + overlying soft tissue swelling

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19
Q

How should OSD be managed?

A

Simple analgesic packs (intermittent)

Protective knee pads

Stretching

Reassure - this will resolve over time, but may persist until end of growth spurt

Advise stopping/ reducing all sporting activity

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20
Q

What is chondromalacia patellae?

A

Anterior knee pain from degeneration of articular cartilage on posterior surface of patella

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21
Q

What is the general cause of chondromalacia patellae?

A

Overuse in physical activity

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22
Q

Recall the signs and symptoms of chondromalacia patellae

A

Anterior knee pain: exacerbated by movement –> painless passive movement but pain + grating sensation on repeated extension

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23
Q

How should chondromalacia patellae be managed?

A

Physio

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24
Q

What is osteochondritis dissecans?

A

Reduced blood flow causing cracks to form in the articular cartilage and subchondral bone –> avascular necrosis –> fragmentation of bone and cartilage with free movement of fragments –> activity related joint pain

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25
Recall the signs and symptoms of osteochondritis dissecans?
Pain after exercise - catching, locking and giving way
26
What is osteomyelitis?
Infection of metaphysis of long bones, commonly the distal femur and proximal tibia
27
What is the most common pathogen implicated in osteomyelitis?
Staph aureus
28
What is the most common age group affected by osteomyelitis?
<5 years
29
How does the presentation of osteomyelitis compare to the presentation of septic arthritis?
Usually chronic in onset and less severe than septic arthritis (over a week rather than a day)
30
Recall the signs and symptoms of osteomyelitis?
Fever Acute onset limb pain, immobile limb, skin swollen, tender and erythematous
31
What investigations should be done for suspected osteomyelitis?
Septic screen BCs + FBC Joint aspiration and MC+S XR --> MRI of joint (shows soft tissue)
32
How should acute osteomyelitis be managed?
High dose IV empirical- narrow spec Abx 1st line is flucloxacillin Take BCs before staring IV Abx Change to oral Abx as soon as CRP is back to normal Surgical debridement may be necessary
33
What is septic arthritis?
Infectious arthritis of the synovial joint (vs osteomyelitis of bone)
34
Which joint is affected in 75% of cases of septic arthritis?
Hip
35
What is the usual pathogen implicated in septic arthritis?
S aureus
36
Recall the signs and symptoms of septic arthritis
Single joint warm Erythematous Tender Reduced range of movement Infants will hold the limb still
37
What investigations should be done for septic arthritis?
SAME AS OSTEOMYELITIS Septic screen BCs and FBC Joint aspiration and MC+S XR --> MRI of joint (shows soft tissue)
38
How should septic arthritis be managed?
Similar to osteomyelitis but not the same IV flucloxacillin --> oral Joint wash out + aspirated to dryness PRN
39
What is Still's disease?
Persistent joint swelling presenting before 16 years, in the absence of infection/ other defined cause
40
What are the signs and symptoms of Still's?
May be any number of joints Gelling (stiffness after periods of rest) Intermittent limp Morning joint stiffness/ pain Limited movement
41
Recall some late signs of Still's
Inflammation + bone expansion - 'knock knees' Salmon-coloured rash (pathogenomic of systemic Still's)
42
What investigations should be done in suspected Still's?
Clinical diagnosis mainly Bloods + imaging to prove classification + prognostic info ANA, FBC, RhF, CRP/ESR, anti-CCP USS/ MRI
43
How should Still's be managed?
MDT rheuatology NSAIDs Corticosteroids (high to low dose) DMARDs - if disease fails to respond to conventional treatments - methotrexate or sulfalazine TNF alpha inhibitors if needed
44
What is the prognosis for Still's disease?
Most children can expect good disease control and quality of life If poor disease control --> anterior uveitis and fractures
45
What is the former name of reactive arthritis?
Reiter's syndrome
46
What are the most likely causative organisms in reactive arthritis?
Enteric bacteria - salmonella, shigella, campylobacter, yersinia
47
Recall the signs and symptoms of reactive arthritis
Transient joint swelling (<6 weeks) following an extra-articular infection Low grade fever
48
Which joints are most typically affected by reactive arthritis?
Ankles/ knees
49
What investigations should be done in suspected reactive arthritis?
A diagnosis of exclusion as no positive findings Bloods (CRP normal or mildly elevated) Normal XR
50
How should reactive arthritis be managed?
Self-limting, NSAIDs will do for analgesia
51
What is SUFE?
Displacement of epiphysis of femoral head posteroinferiorly
52
Why does SUFE need prompt treatment?
To prevent avascular necrosis
53
What age group is usually affected by SUFE?
10-15 years
54
What is the biggest RF for SUFE?
Obesity
55
What are the signs and symptoms of SUFE?
Limp/ hip pain +/- referred to the knee Insidious or acute onset "Loss of internal rotation of a flexed hip" Trendelenburg gait positive
56
What investigations should be done in suspected SUFE?
Hip XR in AP and frog-lateral view (both hips)
57
How should SUFE be managed?
Analgesia, bed-bound Surgical internal fixation at growth plate
58
What is transient synovitis?
Irritable hip - 3-10 years
59
What age group is affected by transient synovitis?
3-10 years
60
What is a red flag for urgent hospital assesment in transient synovitis?
Age <3 with an acute limp
61
What is the cause of transient synovitis?
Viral infection (so causes a low grade fever)
62
How should transient synovitis be investigated and managed
Clinically - it is self-limiting
63
What is DDH?
A spectrum of conditions affecting proximal femur and acetabulum - ranging from subluxation to frank dislocation
64
What is true DDH?
Femoral head has a persistently abnormal relationship with the acetabulum--> abnormal bony development, premature arthritis and significant disability
65
What are the 2 manoevres that are key to early detection of DDH?
Barlow: dislocate posteriorly out of the hip Ortolani: relocate back into acetabulum on hip abduction
66
What is the biggest RF for DDH?
Female
67
Recall the signs and symptoms of DDH
Limp/ abnormal Delayed crawling/ walking: toe-walking Asymmetrical skin folds Limb length discrepancy
68
What age group are the Barlow and Ortolani manoevres appropriate for?
<6 months
69
What other investigation can be done alongside B and O manoevres in suspected DDH?
USS
70
What investigation should be done in children too old for B and O manoevres?
X ray
71
What are the indications for USS neonatally regardless of presentation, and when is this USS done?
Born breech or FH of DDH Done at 6 weeks
72
How should DDH be managed in the newborn?
Pavlik harness (most resolve spontaneously by 3-6w) Keeps hips flexed + abducted
73
How should DDH be managed in those >6 months old?
Surgery if conservative measures fail or there is no progress with harness
74
What is the inheritance pattern of Duchenne muscular dystrophy?
X-linked recessive
75
At what age does duchenne muscular dystrophy present, and at what age can it be diagnosed?
1-3y presentation Can be diagnosed at 5y
76
Which gene is deleted in Duchenne muscular dystrophy?
Dystrophin
77
Describe the pathophysiology of duchenne muscular dystrophy?
Dystophin gene connects cytoskeleton to muscle fibres to ECM through membrane Where deficient --> influx of Ca --> calmodulin breakdown --> excess free radicals --> myofibre necrosis
78
What type of gait is seen in Duchenne muscular dystrophy?
Waddling
79
Other than gait, what else is affected in DMD?
Language delay
80
What is Gower's sign?
The need to turn prone to rise - seen in DMD
81
How is the heart affected by Duchenne muscular dystrophy?
Primary dilated cardiomyopathy
82
What is elevated in the plasma in Duchenne muscular dystrophy?
CKP (creatine phosphokinase) due to myofibre necrosis
83
How should Duchenne muscular dystrophy be managed?
No cure - often management is to alleviate the symptoms Physiotherapy to clear lungs and exercise to help prevent contractures Medical: - CPAP (due to weakness of intercostals) - Glucocorticoids (to delay need for wheelchair) - Cardioprotective drugs
84
What is the difference between Beck's MD and DMD?
Same signs and symptoms but Beck's MD is often less severe and progresses at a slower rate than DMD
85
What is the genetic cause of myotonic muscular dystrophy?
Autosomal dominant trinucleotide repeat disorder
86
When does myotonic muscular dystrophy present?
20s to 30s
87
In what way is myotonic muscular dystrophy the reverse of duchenne muscular dystrophy?
It affects small muscles more than large muscles
88

Year 5 - Paediatrics (15 decks)

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