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Finals Systems > Paeds MSK > Flashcards

Paeds MSK Flashcards

1
Q

What is Osgood-Schlatter disease

A

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

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2
Q

What is Osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

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3
Q

What is Patellar tendonitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

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4
Q

Growth plate fractures

A

Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush

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5
Q

Undisplaced spiral fracture of the tibia

A

toddlers fracture

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6
Q

Presentation transient synovitis

A

limp/refusal to weight bear
groin or hip pain
a low-grade fever is present in a minority of patients
after respiratory illness

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7
Q

Management transient synovitis

A

Transient synovitis is self-limiting, requiring only rest and analgesia.

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8
Q

Investigations ?septic arthritis

A

USS, if shows effusion and with corroborating history, treat as septic arthritis
joint aspiration: for culture. Will show a raised WBC
raised inflammatory markers
blood cultures

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9
Q

Most common causative organism septic arthritis

A

Staphylococcus aureus is the most common causative organism

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10
Q

If you were going to get septic arthritis from an STI, what would it be?

A

neisseria gonorrhoea

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11
Q

what is the kocher criteria

A

fever >38.5 degrees C
non-weight bearing
raised ESR > 40
raised WCC >12

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12
Q

Best imaging for osteomyelitis

A

MRI

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13
Q

Most common organism osteomyelitis

A

staph aureus

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14
Q

Management osteomyelitis

A

sepsis 6 and local protocol

adult and over 5 1. fluclox 2. vancomycin if pen allergic
<5 1. ceftriaxone

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15
Q

How does perthes present

A

Pain in the hip or groin
Limp
Restricted hip movements
There may be referred pain to the knee
no trauma!!

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16
Q

investigations perthes

A

plain x-ray

technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist

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17
Q

Management perthes

A

rest
cruches
analgesia
physio

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18
Q

Age typical SUFE

A

typically presents aged 8 – 15 years, with the average age of 12 in boys

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19
Q

Presentation SUFE

A

Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted movement in the hip
Minor trauma history

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20
Q

Investigations SUFE

A
  1. X-ray

Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
Technetium bone scan
CT scan
MRI scan

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21
Q

Management SUFE

A

surgery

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22
Q

Inheritance osteogenesis imperfecta

A

autosomal dominant
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides

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23
Q

Features of osteogenesis imperfecta

A

fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common

24
Q

Blood tests osteogenesis imperfecta

A

adjusted calcium, phosphate, parathyroid hormone and ALP results are usually normal in osteogenesis imperfecta

25
Q

manaagement osteogenesis imperfecta

A

Bisphosphates to increase bone density
Vitamin D supplementation to prevent deficiency

26
Q

Investigatons rickets

A

Serum 25-hydroxyvitamin D is the laboratory investigation for vitamin D. A result of less than 25 nmol/L establishes a diagnosis vitamin D deficiency, which can lead to rickets.

Xray is required to diagnose rickets.

27
Q

Dosage vitamin D for kids whoa re deficient

A

6 months and 12 years is 6,000 IU per day for 8 – 12 weeks.

28
Q

Whos at more risk of vitamin D deficiency - breast fed babies or bottle fed

A

breast fed

29
Q

Management kawasaki disease

A

High dose aspirin to reduce the risk of thrombosis
IV immunoglobulins to reduce the risk of coronary artery aneurysms

30
Q

Features of kawasaki/ criteria

A

Conjunctivitis (non-exudative, bilateral)
Rash (nonvesicular)
Adenopathy
Strawberry tounge
Hands (peeling, redness)

and burn (5 days of fever)

4 of 5 symptoms WITH fever > 5 days fever (above 39 degrees)

31
Q

What is rheumatic fever?

A

Acute rheumatic fever is an autoimmune condition triggered by streptococcus bacteria.

It is caused by antibodies created against the streptococcus bacteria that also target tissues in the body.

32
Q

Criteria for rheumatic fever

A

A diagnosis of rheumatic fever can be made when there is evidence of recent streptococcal infection, plus:
Two major criteria OR
One major criteria plus two minor criteria
The mnemonic for the Jones criteria is JONES – FEAR.

Major Criteria:
J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea
Minor Criteria:
Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)

33
Q

Investigations for rheumatic fever

A

Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and chest xray can assess the heart involvement

34
Q

What causes rheumatic fever

A

Group A strep - strep pyogenes

35
Q

How does stills disease present?

A

salmon pink rash, high swinging fevers, arthritis

36
Q

How does polyarticular arthritis present?

A

5 or more joints, symmetrical

37
Q

How does oligoarticular/pauciarticular arthritis

A

4 joints or less
Larger joints
60% of JIA
Girls under 6 years
Anterior uveitis

38
Q

How does enthesitis present?

A

Boys over 6 years
Tender entheses

39
Q

How do psoriatic arthritis present?

A

symmetrical polyarthritis affecting the small joints similar to rheumatoid, or an asymmetrical arthritis affecting the large joints in the lower limb.
Pitting
Dactylitis
Psoriatic plaques
enthesitis

40
Q

Most common juvenile arthritis

A

Oligoarticular/pauarticular

41
Q

Which JIA do you get raised inflammatory markers

A

systemic/stills

42
Q

Which JIA is associated with HLA-B27

A

enthesitis

43
Q

What arthtitis is ANA positve

A

oligoarticular/pauarticualr

44
Q

What JIA may be RF positive

A

polyarticualr
in older children

45
Q

Acute inflammation JIA

A

NSAIDs
Steroid injections or oral

46
Q

Long term management JIA

A
  1. DMARDs methotrexate or IM sulfasalazine
  2. Biologics: adalimubab
47
Q

Kids and methotrexate

A

upset stomach

48
Q

Symptoms of reactive arthritis

A

‘Can’t see, pee or climb a tree’

49
Q

What pathogens causes reactive arthritis

A

Chlamydia
Shigella
Salmonella
Yersinia
Campylobacter

50
Q

Management reactive arthritis

A

symptomatic: analgesia, NSAIDS, intra-articular steroids

sulfasalazine and methotrexate are sometimes used for persistent disease

symptoms rarely last more than 12 months

51
Q

Associations reactive arthritis

A

Bilateral conjunctivitis (non-infective)
Anterior uveitis
Circinate balanitis is dermatitis of the head of the penis

52
Q

What rheumatological condition is POTS associated with

A

ehlers danlos

53
Q

features of growing pains

A

never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity

54
Q

features of rickets

A

Rickety rosary
I pigeon chest (pectus carinatum)
Craniotabes (soft skull bones)
Knock knees (older), bowed legs (toddler)
End of long bones –> wide
Teeth hypoplasia
Skull frontal bossing and delayed closure of fontanelles

aching bones and joints

Genu varum (bow legs)
Genu valgum (knock knees) - stuck together with gum

‘rickety rosary’ - swelling at the costochondral junction
kyphoscoliosis
craniotabes - soft skull bones in early life
Harrison’s sulcus

widening of joints on imaging

55
Q

What collagen is implicated in osteogenesis imperfecta?

A

type 1

56
Q

genetics achondroplasia

A

The achondroplasia gene, fibroblast growth factor receptor 3 (FGFR3), is on chromosome 4. Achondroplasia results from either a sporadic mutation or inheritance of an abnormal copy of this gene. The condition is inherited in an autosomal dominant pattern. Homozygous gene mutations, meaning two abnormal gene copies with one from each parent, is fatal in the neonatal period. Therefore, patients with achondroplasia have one normal gene and one abnormal gene.

Mutations in the FGFR3 gene causes abnormal function of the epiphyseal plates (growth plates). This restricts the bone growth in length, leading to short bones and short stature.

Finals Systems (27 decks)

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