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Paediatric > Rheum/MSK > Flashcards

Rheum/MSK Flashcards

1
Q

What are the nail changes in psoriatic arthritis?

A

Pitting, Ridging, Onycholysis, Dactylitis (sausage fingers)

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2
Q

Urethritis, Conjunctivitis, peripheral arthritis

A

Reactive Arthritis

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3
Q

An active kid with a painful knee with patellar tenderness over the ball of the knee.

A

Osgood-Schlatter

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4
Q

How to differentiate between septic arthritis and osteomyelitis

A

Osteomyelitis may or may not present with fever. Localised pain in Osteomyelitis. Septic arthritis generally pain present at rest too

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5
Q

Most common causative of Osteomyeletis

A

Staph Aureus

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6
Q

What do you see on Xray in Osetomyelitis?

A

Lytic lesion with ring of sclerosis

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7
Q

Causative organism of Septic arthritis in a kid with sickle cell disease?

A

Salmonella

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8
Q

Transient Arthritis is generally preceded by ________

A

an acute viral infection

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9
Q

Which is the only male dominant Juvenile idiopathic arthritis?

A

Enthesitis related arthritis

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10
Q

What is craniosynostosis?

A

Premature fusion of the sutures

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11
Q

Osteonecrosis of subchondral bone (after damage to overlying articular cartilage) …

A

Osteochondritis dissecans

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12
Q

Gower’s sign, Calf hypertrophy, Waddling

A

Duchene’s Dystrophy

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13
Q

Common complaints include ‘having to mount stairs one at a time’ and running slower than peers

A

Duchene’s Muscular Dystrophy

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14
Q

How many types of Spinal Muscular Atrophy? And basic way to differentiate them?

A

4 types - and they get diagnosed at different ages

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15
Q

Flattened femoral head on XRAY

A

Perthe’s

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16
Q

What age is perthe’s most common at?

A

4-8 years

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17
Q

Growing pains generally present at _____ and where?

A

Night time ad in the calf shin and thigh. no functional limitation

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18
Q

How do you manage growing pains?

A

reassurance, supportive management (heat, massage and analgesia)

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19
Q

3% of kids with transient Synovitis develop ____

A

Perthe’s

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20
Q

Septic arthritis is most commonly caused by _____. And in a kid with sickle cell disease ____

A

Staph A and Strep. pneumonia. SCD - Salmonella

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21
Q

How do you Ix and manage Septic arthritis?

A
  1. Investigate - Joint aspirate. need 50,000 WBC for confirmed diagnosis. U/S, XRAY, Bone scan? Septic screen

Mx: Urgent aspiration +/- Arthrotomy and washout. Flucloxacillin IV

Elevate and immibolisise - plaster or split, repeat blood tests

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22
Q

In Neonates and Children Osteomyelitis occurs at the ______

A

Metaphysis

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23
Q

Osteomyelitis is subacute and hence takes about ______

A

6 weeks

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24
Q

A complication of Osteomyelitis is Brodie’s abscess which is _____

A

lytic centre with a ring of sclerosis

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25
Q

RF for Perthe’s disease?

A

Steroid use! Fam history, abnormal pregnancy, LBW

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26
Q

Painful hip, afebrile, tenderness of knee and anterior thigh - decreased internal rotation and abduction of the hip. Worse after exercise

A

Perthe’s disease

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27
Q

XRAY: Increased density of capital epiphysis, patchy osteolysis, new bone formation, remodeling and collapse or flattening of the femoral head
Remodeling and collapse or flattening of the femoral head

A

Perthe’s disease

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28
Q

Management of perthe’s disease?

A

Goal to preserve ROM and Femoral head.

  1. Physiotherapy
  2. Brace in flexion and abduction for 2-3 years
  3. pelvic or femoral osteotomy
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29
Q

Repetitive tensile stress on the insertion of patellar tendon over the tibial tuberosity causes minor avulsion at the site and subsequent inflammatory reaction

A

Osgood Schlatter disease

30
Q

Tender lump over the tibial tuberosity - pain on resisted led extension.

A

Osgood Schlatter disease

31
Q

What would you see on Knee XRAY with Osgood Schlatter disease?

A

Fragmentation of the tibial tubercle

32
Q

Management of Osgood Schlatter disease?

A

Benign, self limited condition - hence RICE. Restrict activities like cycling and basketball.

33
Q

Congenital Talipes Equinovarus has three points of deformity: Talipes, Equinus and Varus

A
  • Talus is inverted and internally rotated
  • Ankle is plantar flexed
  • Varus - heel and forefoot are varus (supinated)
34
Q

How to manage Club foot (Congenital talipes equinovarus)?

A

Correct deformity in the following order, forefoot adduction, ankle eversion and euqinar.
Use strapping and cast - which has to be changed every 1-2 weeks

35
Q

Scolios above and below the fixed primary curve to try and maintain normal position of head and pelvis - primary or secondary curve?

A

Secondary!

36
Q

When do you start treating scoliosis?

A

When the angle of deformity is more than 20 degrees.
>20 degree - brace (slow progression)
> 40 degrees - surgery

37
Q

Non-specifically poorly localised knee pain (can be over femoral condyles) with activity, mechanical sensation and loss of range of motion with advances lesions (with loose bodies)

A

Osteochondritis Dissecans

38
Q

Osteonecrosis of subchondral bone (after damage to overlying cartilage)

A

Osteochondritis dissecans

39
Q

Classic triad of Henoch Schonlein Purpura?

A

Palpable purpura
Abdominal pain and
Arthritis

40
Q

Features of (Systemic arthritis) Still’s disease?

A

Once or twice daily fever spikes for more than 2 weeks - children

Salmon coloured maculopapular rash, lymphadenopathy, hepatosplenomegaly

Arthritis may occur weeks to months later

41
Q

Fever - with Salmon coloured maculopapular rash, lymphadenopathy, hepatosplenomegaly. Arthritis occurs 4 months later

A

Still’s disease

42
Q

How do you manage Still’s disease?

A

Prednisolone

43
Q

Oligoarthritis is arthritis of ______ joints. And if extended?

A

1-4. if extended it affects more than 4 joints after the first 6 months

44
Q

Anterior Uveitis is related to ______

A

Juvenile idiopathic arthritis - Oligoarthritis

45
Q

ANA positive Juvenile Idiopathic arthritis?

A

Oligoarticular, Polycarticular and psoriatic

46
Q

Knee flexion contracture, quadriceps atrophy,leg length discrepancy and growth distrubances are complications seen with which arthritis?

A

Oligoarthritis

47
Q

RF positive in Juvenile Idiopathic arthritis. Most likely to be________

A

Polyarticular arthritis

48
Q

Ethesitis-related arthritis tends to affect which joints?

A

Weight bearing joints, especially hip and intertarsal joints

49
Q

Arthritis Affects Achilles tendon and plantar fascial attachment into the calcaneus, the poles of the patellae and the greater trochanters. In a male boy

A

Enthesistis related arthritis

50
Q

Which JIA is HLA-B27 positive?

A

Enthesitis related arthritis

51
Q

Enthesitis related arthritis in kids has a 50% risk of developing _____ in adulthood

A

Ankylosing spondylitis

52
Q

_________ presents with Reiter’s syndrome - can’t see, can’t pee, can’t Climb a tree

A

Reactive arthritis

53
Q 
Caused by spirochete Borrelia Burgdorferi, B. Garinii, B. afzelli
- Trasmitted by Ixodes Tick
Small rodents (mice) serve as primary reservoir Incidence highest amongst 5-10 year olds
A

Lyme Arthritis

54
Q

Arthritis related to Erythema Chronicum Migrans (Expanding, non-pruritic target lesions.

A

Lyme arthritis

55
Q

Features of Lyme Arthritis BAKE

A

Bell’s Palsy
Arthritis
Kardiac block
Erythema chronicum Migrans

56
Q

Extra-muscular features of Duchene Muscular dystrophy?

A

Dilated cardiomyopathy and ID

57
Q

Diagnosis of Duchene can be excluded by testing ____ which is always elevated

58
Q

Mx of Duchene dystrophy?

A

Steroids (Can slow progression)
Cardiac monitoring Step wise respiratory interventions
Physio, Allied health

59
Q

First months of life and most severe; hypotonia and weakness (affecting respiratory function, ‘paradoxical breathing’; death within first two years (usually from pneumonia)
♣ Weakness of the intercostal muscles, coupled with relatively normal diaphragmatic contractions, resulted in marked chest deformity
II (intermediate): 8-18mo; children cannot

A

Type 1 SMA

60
Q

Due to ligamentous laxity, muscular underdevelopment and abnormal shallow slope of acetabular roof —>

61
Q

What are the three pathophys features of DDH?

A
  1. Ligamentous laxity
  2. Muscular underdevelopment
  3. abnormal positioning of the acetabular roof
62
Q

DDH leads to Hip ______ and _____-

A

Hip subluxation and dislocation

63
Q

Test done with DDH - shows knees at unequal heights when hip’s flexed

A

Galeazzi Sign

64
Q

What investigations would you do for DDH?

A

U/S in first few months to view cartilage. Follow up radiography after 3mo

65
Q

SUFE is a Type I Salter Harris fracture since

A

it is straight through the Growth plate

66
Q 
SALTER HARRIS FRACTURE Classification:
S
A
L
T
R
A 
Straight (SUFE)
Above (Growth plate and metaphysis
Lower (Through growth plate and Epiphysis)
Through all three elements
RAM - Crush injury of growth plate
67
Q

In SUFE, Limited movement of hip (especially________________)

A

Internal rotation. Abduction, flexion

68
Q

Knee pain in a sporty teenager associated with intermittent swelling and locking?

A

Osteochondritis Dissecans

69
Q

Teenage girl with characteristic knee pain on walking up and down stairs and rising from prolonged sitting

A

Chrondomalacia patella

70
Q

Sporty teenager with pain, tenderness and swelling over the tibial tubercle

A

Osgood Schlatter disease

71
Q

Medial knee pain due to lateral sublaxation of the patella - knee may “give way”

A

Patellar Subuxation

72
Q

More common in athletic teenage boys - chronic anterior knee pain that worsens on running. Tender below the patella on examination

A

Patellar tendonitis

Paediatric (13 decks)

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