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Phase 3a > Paeds - MSK > Flashcards

Paeds - MSK Flashcards

1
Q

what is osteogenesis imperfecta?

A

brittle bone disease
inherited AD
it is a group of disorder where defective collagen metabolism causes bone fragility, bowing and frequent fractures

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2
Q

what are the two types of osteogenesis imperfecta?

A

type 1 - collagen normal quality insufficient quantities (most common)
type 2 - collagen is not of sufficient quality or quantity - severe - many are still born

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3
Q

how do you treat osteogenesis imperfecta

A

bisphosphonates - reduces fracture rates

calcium supplements

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4
Q

what are the features of osteogenesis imperfecta?

A 
presents in childhood 
fractures following minor trauma 
blue sclera 
deafness secondary to otosclerosis 
dental imperfections are common.
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5
Q

what id the pathology of rickets?

A

changes caused by deficient mineralisation at the growth plates of long bones.
(osteomalacia in adults is the impaired bone mineralisation of the bone matrix)
Rickets and osteomalacia usually occur together whilst the growth plates are open

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6
Q

what are the risk factors/causes of rickets?

A

Vitamin D deficiency (malabsorption, lack of sunlight, diet)
Renal failure
drug induced - anticonvulsants - phenytoin
liver disease
end organ resistance (very rare AR disorder)
phosphate deficiency
calcium deficiency

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7
Q

what are the clinical features of rickets?

A

bone pain
growth retardation
delayed achievements of motor milestones
body deformities
muscle weakness
bow legs
numbness or parenthesis - seen with hypocalcaemia

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8
Q

what investigations would you perform for rickets? what would they show?

A

X-ray a long bone - cupped, ragged metaphysal surfaces
serum calcium - may be decreased in hypocalaemic rickets
serum phosphate - low
serum alkaline phosphatase - raised
Parathyroid hormone levels
25-dihydroxyvitamin D levels will be low

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9
Q

how do you treat rickets?

A

calcium and vitamin D (ergocalciferol) supplementation

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10
Q

what is transient synovitis?

A

a self limiting disorder of the hip that commonly affects young children between 2 and 12 years
usually associated with a viral infection

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11
Q

what is the most important differential diagnosis for transient synovitis?

A

septic arthritis

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12
Q

what are the features of transient synovitis?

A 
limited movement 
pain 
limp
positive leg roll 
fever
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13
Q

what investigations would you perform for suspected transient synovitis?

A

FBC
ESR and CRP - to rule out septic arthritis
X-ray

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14
Q

how is transient synovitis managed?

A

symptomatic relief

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15
Q

what is septic arthritis?

A

infection of 1 or more joints caused by pathogenic inoculation of microbes or via haematogenous spread

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16
Q

what are the common causes of septic arthritis?

A

the most common cause is staphylococcus aureus

can be from osteomyelitis spreading into joints

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17
Q

what are the clinical features of septic arthritis?

A

hot
swollen
restricted joint
fever

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18
Q

what is the most common place for septic arthritis in children?

A

the hip

can also be in knee

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19
Q

what investigations would you perform for septic arthritis?

A 
synovial fluid gram stain and culture 
synovial fluid white cell count 
blood culture 
WCC
ESR and CRP
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20
Q

what criteria can be used to differentiate between transient synovitis and septic arthritis?

A 
Kocher criteria 
fever >38.5
non weight bearing 
raised ESR 
raised WCC
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21
Q

how do you manage septic arthritis?

A

synovial fluid should be obtained before starting treatment
Vancomycin or clindamycin for gram positive
ceftriaxone if gram negative

22
Q

what is osteomyelitis?

A

an inflammatory condition of the bone caused by an infecting organism, most common staphylococcus aureus

23
Q

what are the common causes of osteomyelitis in infants, children up to 4 years and older children?

A

Infants:

  • s aureus
  • group B streptococci
  • aerobic gram negative bacilli

Children up to 4:

  • s aureus
  • streptococcus pyogenes
  • Haemophilus influenzae
  • kingella kingae

older children
- s aureus

24
Q

what is a common cause of septic arthritis in patients with sickle cell anaemia?

A

salmonella species

25
Q

what are the common features of osteomyelitis?

A

pain at the site of infection
malaise and fatigue
local inflammation, erythema or swelling
low grade fever

26
Q

what investigations would you perform if you suspected osteomyelitis ?

A

WBC count - may be raised
ESR and CRP- usually raised
USS
MRI

27
Q

how would you treat osteomyelitis

A

flucloxacillin for 6 weeks

clindamycin if penicillin allergic

28
Q

what is perthe’s disease?

A

a degenerative condition affecting the hip joints of children between the ages of 4-8 years
it is due to the blood supply to the head of the femur being disrupted - avascular necrosis of the femoral head which causes bone infarction

Typically self-resolves and normal functioning is regained

5 times more common in boys and 10% of cases are bilateral.

29
Q

what are the symptoms of perthe’s disease ?

A

limp
limited range of movement at the hip joint
hip pain: develops progressively over a few weeks
they may have short stature - however, normal height is attained by their mid teens

30
Q

what investigations would you perform and what would they show in perthe’s disease?

A

bilateral hip x-rays - will show femoral head collapse and fragmentation, subchondral fracture

FBC, ESR, CRP- to exclude other conditions

31
Q

what are some complications of perthes disease?

A

osteoarthritis
limb length inequality
stiffness and loss of rotation

32
Q

what classification can be used to assess the severity of perthes disease?

A

Catterall classification - severity based on the epiphyseal involvement

33
Q

how do you manage perthe’s disease?

A

identify early
under 5 - mobilisation plus monitoring

5-7 years - less than 50% epiphyseal involovment - mobilisation and monitoring, if greater than 50% surgical containment

7-12 years - stage 1 or 2 - surgical containment, stage 3 or 4 - salvage procedure

over 12 - salvage procedure

34
Q

what is slipped capital femoral epiphysis?

A

SCFE is the most common hip disorder in the adolescent age group
it occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis
may present acutley following trauma or more commonly with chronic persistent symtoms

35
Q

what are the risk factors for slipped capital femoral epiphysis?

A

puberty
obestiy
endocrine disorder
male

36
Q

what are the clinical features of slipped capital femoral epiphysis?

A

hip, groin, medial thigh or knee pain

loss of internal rotation of the leg in flexion

37
Q

what investigations would you perform for slipped capital femoral epiphysis?

A

observational gait analysis - leg externally rotated

X-ray

38
Q

how would you treat slipped femoral epiphysis?

A

surgical rapir - internal fixation

prophylatic fixation of the contralateral hip

39
Q

what is osgood schlatter disease and how is it managed?

A

Osgood-Schlatter disease (tibial apophysitis) is a type of osteochondrosis characterised by inflammation at the tibial tuberosity. It is a traction apophysitis thought to be caused by repeated avulsion of the apophysis into which the patellar tendon is inserted

Management is supportive

40
Q

what is DDH?

A

Developmental dysplasia of the hip (DDH) is gradually replacing the old term ‘congenital dislocation of the hip’ (CDH). It affects around 1-3% of newborns.

41
Q

what are the risk factors for DDH?

A 
Risk factors
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
  • DDH is slightly more common in the left hip. Around 20% of cases are bilateral
42
Q

what would you see on clinical examination of an infant with DDH?
what would confirm the diagnosis

A

Barlow test: attempts to dislocate an articulated femoral head
Ortolani test: attempts to relocate a dislocated femoral head

USS will confirm diagnosis if clinically suspected

43
Q

how is DDH managed?

A

most unstable hips will spontaneously stabilise by 3-6 weeks of age
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
older children may require surgery

44
Q

what is JIA?

A

Juvenile idiopathic arthritis (JIA), now preferred to the older term juvenile chronic arthritis, describes arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks. Systemic onset JIA is a type of JIA which is also known as Still’s disease

45
Q

what are the symptoms of JIA?

A 
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
46
Q

what investigations would you perform for JIA?

how is it managed?

A

ANA may be positive, especially in oligoarticular JIA
rheumatoid factor is usually negative

NSAIDs, such as ibuprofen
Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine and leflunomide
Biologic therapy, such as the tumour necrosis factor inhibitors etanercept, infliximab and adalimumab

47
Q

what are some causes of limping child?

A

Septic arthritis/osteomyelitis - unwell child with high fever

JIA - limp may be painless

Trauma

DDH - usually in neonates

Perthes - more common in 4-8 years - avascular necrosis of femoral head

Slipped upper femoral epiphysis - 10-15 years - displacement of the femoral head epiphysis posters-inferiorly

48
Q

what is Kohlers disease?

A

s a rare bone disorder of the foot found in children between six and nine years of age. The disease typically affects boys, but it can also affect girls. … It is caused when the navicular bone temporarily loses its blood supply.

49
Q

how does Kohler’s disease present?

A

a unilateral antalgic gait

local tenderness of the medial aspect of the poor

50
Q

what investigations would you perform for Kohler’s disease?

A

Cray

MRI/CT

51
Q

how is Kohler’s disease managed?

A

rest
avoidance of weight baring exercise
analgesia
immobilisation in a short leg cast can speed recovery

Phase 3a (41 decks)

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