Paeds MSK

Question 1

A 5 year old complains of a painful hip. OE there is nothing to note
What are your differentials?

Answer 1

Painfull not swollen
Hypermobility
Petes disease
Tumour

Question 2

A 5 year old complains of a painful hip. OE the joint is swollen.
What are your differentials?

Answer 2

JIA
Infection - septic arthritis, osteomyelitis, reactive arthritis
Joint disease related to IBD
Trauma

Question 3

4 year old girl, generalised pains in lower limbs that can wake her. Never in the morning. No limp

a) Transient synovitis
b) Growing pains
c) Hypemobility
d) Perths disease
e) JIA

Answer 3

Growing pains

Question 4

What is perthes disease?

Answer 4

Avascular necrosis of the femoral head due to interruption of the blood supply. Causes some of the bone to die - as part of the healing process revascularisation and reossification occurs - but this is weaker and can cause deformity

Question 5

What is transient synovitis?

Answer 5

Transient synovitis = irritable hip
Acute onset of hip and limp pain in a child that is otherwise well
May be precipitated by infection and trauma

Question 6

What is slipped capital femoral epiphysis?

Who does it commonly affect?

Answer 6

Displacement of the femoral head epiphysis poster-inferiorly
Obese boys, 10-15 years, may have metabolic/endocrine problems

Question 7

For development dysplasia of the hip you can have a range of issues. What is the name for the problem between normal and dislocated hip -
‘Mild, head of femur can be moved out of the socket but not dislocated’

Answer 7

Subluxable

Question 8

Give the 3 main seventies of developmental dysplasia of the hip

Answer 8

3 main severities:

1. Dislocated: head completely out of socket
2. Dislocatable: head can easily be pushed out of the socket
3. Subluxable: mild - head is loose in the socket, cannot be dislocated on examinatio

Question 9

What can cause polyarthtiris in children?

Answer 9

Infections - speticaemia, viral, reactive infections
IBD - Crohns & US
Vasculitis - Henoch-Schonlein purpura & Kawasaki disease
Malignant - leukaemia and neuroblastoma
Connective tissue disorders - JIA, SLE, Polyarteritis nodosa

Question 10

What are the complications that occur following JIA?

Answer 10

Eyes - anterior uvetitis - risk of cataracts and blindness
Growth failure
Joint contractors and deformities
Osteoporosis

Question 11

What are the treatment options for JIA?

Answer 11

NSAIDs 
Joint injections 
Methotrexate - weekly 
Systemic steroids - for systemic JIA 
Biologics - Anti TNF alpha only for refractory disease

Question 12

What are the problems with methotrexate?

Answer 12

Can causes Nausea

Need to check LFTs for BM suppression risk

Question 13

What is Reiter’s syndrome?

Answer 13

Triad of reactive arthritis, conjunctivitis and urethritis - occurs after an infection - chlamydia

Question 14

What organisms can cause septic arthritis?

Answer 14

Caused by:

• Staph aureus
• Group A strep
• Enterobater

Question 15

What is the best investigation for septic arthritis?

Answer 15

Aspiration of joint space under ultrasound guidance for culture and sensitivities

Question 16

How would you treat septic arthritis?

Answer 16

IV flucloxacillin - urgent surgical drainage and lavage of joint

Question 17

Differentials for a febrile toxic looking child who is irritable when getting their nappy changed

Answer 17

Septic arthritis

Osteomyelitis

Question 18

Sudden limp in an otherwise well child

Answer 18

Perthes disease

Transient synovitis of the hip

Question 19

Fever, erythematous rash, red eyes, irritable infant/young child.
Erythema/oedema of hands and feet, oral mucositis and cervical lymphadenopathy

Answer 19

Kawasakis disease

Question 20

Lethargy, unwilling to do physical activities,

proximal muscle weakness, eyelid erythema

Answer 20

Juvenile dermatomyositis

Question 21

Constitutional symptoms, lethargy, arthralgia in adolescent femal
Multisystem abnormalites, haematuria and facial erythema

Answer 21

Systemic lupus erythematosus