Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the prognosis for neonatal fracture?

A

Great

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How should paediatric fractures be managed?

A

Pain management
Manipulation and reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

4-8 y/o boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Recall the signs and symptoms of Perthe’s

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations should be done for Perthes?

A

X ray +/- MRI

Roll test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

Increased density of femoral head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the roll test?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is Perthe’s managed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Osgood Shlatter Disease?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Recall the most at-risk group for OSD?

A

10-15y who are physically active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What might be seen on X ray in OSD?

A

Fragmentation of the tibial tubercle + overlying soft tissue swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is chondromalacia patellae?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the general cause of chondromalacia patellae?

A

Overuse in physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How should chondromalacia patellae be managed?

A

Physio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Recall the signs and symptoms of osteochondritis dissecans?

A

Pain after exercise - catching, locking and giving way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is osteomyelitis?

A

Infection of metaphysis of long bones, commonly the distal femur and proximal tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the most common pathogen implicated in osteomyelitis?

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the most common age group affected by osteomyelitis?

A

<5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does the presentation of osteomyelitis compare to the presentation of septic arthritis?

A

Usually chronic in onset and less severe than septic arthritis (over a week rather than a day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Recall the signs and symptoms of osteomyelitis?

A

Fever
Acute onset limb pain, immobile limb, skin swollen, tender and erythematous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What investigations should be done for suspected osteomyelitis?

A

Septic screen
BCs + FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How should acute osteomyelitis be managed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is septic arthritis?

A

Infectious arthritis of the synovial joint (vs osteomyelitis of bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which joint is affected in 75% of cases of septic arthritis?

A

Hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the usual pathogen implicated in septic arthritis?

A

S aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Recall the signs and symptoms of septic arthritis

A

Single joint warm
Erythematous
Tender
Reduced range of movement
Infants will hold the limb still

37
Q

What investigations should be done for septic arthritis?

A

SAME AS OSTEOMYELITIS
Septic screen
BCs and FBC
Joint aspiration and MC+S
XR –> MRI of joint (shows soft tissue)

38
Q

How should septic arthritis be managed?

A

Similar to osteomyelitis but not the same

IV flucloxacillin –> oral

Joint wash out + aspirated to dryness PRN

39
Q

What is Still’s disease?

A

Persistent joint swelling presenting before 16 years, in the absence of infection/ other defined cause

40
Q

What are the signs and symptoms of Still’s?

A

May be any number of joints
Gelling (stiffness after periods of rest)
Intermittent limp
Morning joint stiffness/ pain
Limited movement

41
Q

Recall some late signs of Still’s

A

Inflammation + bone expansion - ‘knock knees’
Salmon-coloured rash (pathogenomic of systemic Still’s)

42
Q

What investigations should be done in suspected Still’s?

A

Clinical diagnosis mainly
Bloods + imaging to prove classification + prognostic info
ANA, FBC, RhF, CRP/ESR, anti-CCP
USS/ MRI

43
Q

How should Still’s be managed?

A

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
Q

What is the prognosis for Still’s disease?

A

Most children can expect good disease control and quality of life
If poor disease control –> anterior uveitis and fractures

45
Q

What is the former name of reactive arthritis?

A

Reiter’s syndrome

46
Q

What are the most likely causative organisms in reactive arthritis?

A

Enteric bacteria - salmonella, shigella, campylobacter, yersinia

47
Q

Recall the signs and symptoms of reactive arthritis

A

Transient joint swelling (<6 weeks) following an extra-articular infection
Low grade fever

48
Q

Which joints are most typically affected by reactive arthritis?

A

Ankles/ knees

49
Q

What investigations should be done in suspected reactive arthritis?

A

A diagnosis of exclusion as no positive findings
Bloods (CRP normal or mildly elevated)
Normal XR

50
Q

How should reactive arthritis be managed?

A

Self-limting, NSAIDs will do for analgesia

51
Q

What is SUFE?

A

Displacement of epiphysis of femoral head posteroinferiorly

52
Q

Why does SUFE need prompt treatment?

A

To prevent avascular necrosis

53
Q

What age group is usually affected by SUFE?

A

10-15 years

54
Q

What is the biggest RF for SUFE?

A

Obesity

55
Q

What are the signs and symptoms of SUFE?

A

Limp/ hip pain +/- referred to the knee
Insidious or acute onset
“Loss of internal rotation of a flexed hip”
Trendelenburg gait positive

56
Q

What investigations should be done in suspected SUFE?

A

Hip XR in AP and frog-lateral view (both hips)

57
Q

How should SUFE be managed?

A

Analgesia, bed-bound
Surgical internal fixation at growth plate

58
Q

What is transient synovitis?

A

Irritable hip - 3-10 years

59
Q

What age group is affected by transient synovitis?

A

3-10 years

60
Q

What is a red flag for urgent hospital assesment in transient synovitis?

A

Age <3 with an acute limp

61
Q

What is the cause of transient synovitis?

A

Viral infection (so causes a low grade fever)

62
Q

How should transient synovitis be investigated and managed

A

Clinically - it is self-limiting

63
Q

What is DDH?

A

A spectrum of conditions affecting proximal femur and acetabulum - ranging from subluxation to frank dislocation

64
Q

What is true DDH?

A

Femoral head has a persistently abnormal relationship with the acetabulum–> abnormal bony development, premature arthritis and significant disability

65
Q

What are the 2 manoevres that are key to early detection of DDH?

A

Barlow: dislocate posteriorly out of the hip

Ortolani: relocate back into acetabulum on hip abduction

66
Q

What is the biggest RF for DDH?

A

Female

67
Q

Recall the signs and symptoms of DDH

A

Limp/ abnormal

Delayed crawling/ walking: toe-walking

Asymmetrical skin folds

Limb length discrepancy

68
Q

What age group are the Barlow and Ortolani manoevres appropriate for?

A

<6 months

69
Q

What other investigation can be done alongside B and O manoevres in suspected DDH?

A

USS

70
Q

What investigation should be done in children too old for B and O manoevres?

A

X ray

71
Q

What are the indications for USS neonatally regardless of presentation, and when is this USS done?

A

Born breech or FH of DDH
Done at 6 weeks

72
Q

How should DDH be managed in the newborn?

A

Pavlik harness (most resolve spontaneously by 3-6w)
Keeps hips flexed + abducted

73
Q

How should DDH be managed in those >6 months old?

A

Surgery if conservative measures fail or there is no progress with harness

74
Q

What is the inheritance pattern of Duchenne muscular dystrophy?

A

X-linked recessive

75
Q

At what age does duchenne muscular dystrophy present, and at what age can it be diagnosed?

A

1-3y presentation
Can be diagnosed at 5y

76
Q

Which gene is deleted in Duchenne muscular dystrophy?

A

Dystrophin

77
Q

Describe the pathophysiology of duchenne muscular dystrophy?

A

Dystophin gene connects cytoskeleton to muscle fibres to ECM through membrane

Where deficient –> influx of Ca –> calmodulin breakdown –> excess free radicals –> myofibre necrosis

78
Q

What type of gait is seen in Duchenne muscular dystrophy?

A

Waddling

79
Q

Other than gait, what else is affected in DMD?

A

Language delay

80
Q

What is Gower’s sign?

A

The need to turn prone to rise - seen in DMD

81
Q

How is the heart affected by Duchenne muscular dystrophy?

A

Primary dilated cardiomyopathy

82
Q

What is elevated in the plasma in Duchenne muscular dystrophy?

A

CKP (creatine phosphokinase) due to myofibre necrosis

83
Q

How should Duchenne muscular dystrophy be managed?

A

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
Q

What is the difference between Beck’s MD and DMD?

A

Same signs and symptoms but Beck’s MD is often less severe and progresses at a slower rate than DMD

85
Q

What is the genetic cause of myotonic muscular dystrophy?

A

Autosomal dominant trinucleotide repeat disorder

86
Q

When does myotonic muscular dystrophy present?

A

20s to 30s

87
Q

In what way is myotonic muscular dystrophy the reverse of duchenne muscular dystrophy?

A

It affects small muscles more than large muscles

88
Q
A

Year 5 - Paediatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions