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Phase 3a > Paeds MSK > Flashcards

Paeds MSK Flashcards

1
Q

What is developmental dysplasia of the hip?

A

Ranges from hip dysplasia to complete dislocation

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2
Q

What are the risk factors for developmental dysplasia of the hip?

A 
Females
First born child
Oligohydramnios
Previous history of it in another child
Big birth weight (>5kg)
Breech presentation
Congenital calcaneovalgus foot deformity
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3
Q

How would you detect developmental dysplasia of the hip in a newborn?

A

(on newborn exam or 8 week check up)
Barlow manoeuvre - to dislocate
Ortolani manoeuvre - to relocate

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4
Q

How would a child with developmental dysplasia of the hip present?

A

Limp / abnormal gait
Asymmetry of hip skin folds
Limited abduction or shortening of affected limb
+ on US of high risk groups

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5
Q

How would you confirm a diagnosis of developmental dysplasia of the hip?

A

US

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6
Q

How would you manage a child with developmental dysplasia of the hip?

A

Pavlik harness to keep hip flexed and abducted

If this doesn’t work or >6 months –> corrective surgery

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7
Q

CASE

A child with a fever, acutely painful limb
Won’t move it at all

O/E limb is swollen and tender, with an effusion in the joint below

Diagnosis?

A

Osteomyelitis

Trauma - fracture
Septic arthritis?
Bone tumour
Transient synovitis

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8
Q

How does osteomyelitis usually present?

+ in which bones

A

Distal femur and proximal tibia

Painful, immobile limb
Fever
Doesn't move the limb at all - movement causes pain
Joint effusion
Tender and swollen on examination
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9
Q

How would you investigate a child with suspected osteomyelitis?

A

Bloods:

  • Raised WCC
  • Raised ESR and CRP
  • Positive blood cultures

CXR - nothing initially, then changes after about a week - new bone formation (subperiosteal) and localised bone thinning

MRI - differentiates bone from soft tissue swelling, shows subperiosteal pus and purulent debris in the bone

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10
Q

How would you manage a child with osteomyelitis?

A

Antibiotics - flucloxacillin basically for a long time - IV
then oral
If no response or / frank pus on aspiration / collection of pus / abscess - surgical drainage and debridement

+ rest limb in a splint and then mobilise

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11
Q

What are pathogens that commonly cause osteomyelitis?

A

Staph aureus
Streptococcus
Haemophilus influenzae

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12
Q

What are the risk factors for developing osteomyelitis?

A 
Diabetes
Sickle cell anaemia
IV drug users
Immunosuppression - due to HIV / medication
Alcohol excess
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13
Q

CASE

A child with hip pain (sudden onset)
O/E decreased range of movement, mild fever

Diagnosis?

A

Transient synovitis (irritable hip)

Rule out septic arthritis

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14
Q

What are the symptoms of transient synovitis?

A

Acute hip pain
After viral illness
Decreased range of movement - lose internal rotation first
Mild fever

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15
Q

How would you investigate a child with sudden onset hip pain?

A

Bloods - ESR / CRP / WCC / cultures (for septic arthritis)
X ray - for fractures, trauma / slipped capital femoral epiphysis
US guided joint aspiration for septic arthritis

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16
Q

How would you manage a child with transient synovitis?

A

NSAIDS

bed rest - improves in a few days

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17
Q

CASE

Overweight 10 year old boy, with gradual onset hip / knee pain

What to look for on the history + exam
Differentials?

A

Hypothyroidism / hypogonadism for SCFE
Decreased range of movement - generally in Perthes, restricted abduction and internal rotation in flexion in SCFE

Slipped capital femoral epiphysis
Perthe’s disease

18
Q

How would you investigate a child with gradual onset hip pain?

A

X ray - shows a slipper capital femoral epiphysis or in Perthes:
- Early joint space widening
- Later increased femoral head density
+ fragmented / irregular femoral head

19
Q

How would you treat a slipped capital femoral epiphysis?

A

Surgical pin fixation
Gradual weight bearing
Therapy to increase range of movement

20
Q

What are the complications of a slipped capital femoral epiphysis?

A

Avascular necrosis of the femoral head - Perthes disease

Chondrolysis - degeneration of the articular cartilage

21
Q

What is Perthes disease?

A

Avascular necrosis of the capital femoral epiphysis

22
Q

What are the symptoms associated with Perthes disease?

A

Gradual worsening hip / knee / pain, limp, stiffness

Decreased range of movement

23
Q

What are the X ray changes associated with Perthes disease?

A

Fragmentation of the femoral head
Early = joint space widening
Later = increased femoral head density

24
Q

How would you treat a patient with Perthes disease?

A

Rest
Physio
Plaster cast / surgery

25
Q

What are the complications of Perthes disease?

A

Osteoarthritis

Premature fusion of growth plates

26
Q

What are the differentials for a swollen joint in a child?

A

If septic signs / pain - septic arthritis
If after a different infection - reactive arthritis
If stiffness (especially in the morning) - JIA
If associated with long bone symptoms / signs - osteomyelitis

27
Q

How do you differentiate between reactive arthritis and JIA?

A 
Reactive = <6 weeks joint swelling
JIA = >6 weeks joint swelling
28
Q

Which joints are most commonly affected in reactive arthritis?

A

Ankles

Knees

29
Q

Which infections is reactive arthritis associated with?

A

Enteric - shigella, salmonella, campylobacter

In adolescents - Chlamydia, gonorrhoea, mycoplasma

30
Q

How would you investigate a child with suspected reactive arthritis?

A

CRP (may be raised)

X ray - would be normal

31
Q

How would you treat a child with reactive arthritis?

A

NSAIDs
Intra-articular steroids

If persistent - sulfasalazine, methotrexate

32
Q

What is a slipped capital femoral epiphysis?

A

Postero-inferior displacement of the femoral head epiphysis

33
Q

What is septic arthritis?

A

Infection of the joint space

34
Q

Which organism usually causes septic arthritis?

+ what is the route of entry

A

Staph aureus
by blood - SEPTIC
or through a puncture wound

35
Q

How would a child with septic arthritis present?

A

Red, warm, tender joint
Unwell, febrile child
Decreased range of movement of joint
Joint effusion at peripheral joints

36
Q

How would you investigate a child with suspected septic arthritis?

A

Bloods:

  • FBC - raised WCC
  • Raised CRP

USS
X ray - normal or widened joint space and swelling
US guided joint aspiration

37
Q

How would you treat a child with septic arthritis?

A

Flucloxacillin (or if penicillin allergic, Clindamycin, if MRSA - vancomycin)
If gonococcus - cephalosporin
If persists - drainage / washout of joint

38
Q

Outline the types of JIA

A 
Oligoarthritis (persistent <4 joints, extended >4 joints)
Polyarthritis (RF positive or negative)
Systemic arthritis
Psoriatic arthritis
Enthesitis-related arthritis
39
Q

How would you manage a patient with JIA? (overall)

A 
Education and support
Physical therapy
Monitor complications
Social stuff - school, social worker
Medical
40
Q

What are the complications of JIA?

A

Uveitis

Osteoporosis

41
Q

What medical treatments would you use in a patient with JIA?

A 
NSAIDs
Intra-articular steriods - triamcinolone
Methotrexate
Anti-TNF - Etanercept
If really bad - systemic corticosteroids

Phase 3a (11 decks)

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