Rheumatology and Orthopaedics

Question 1

Question text
A 1 week old baby has some apparent movement and clunking in the hips on your neonatal hip exam.

What is the best screening investigation for developmental dysplasia of the hip at this age?

Question 1Select one:

a.
CT scan of hips

b.
MRI scan of hips

c.
ultrasound hips

d.
X-ray of hips

Answer 1

ultrasound hips

Question 2

A midwife asks you about the feet of this newborn girl, shown in the photograph.

WHICH ONE of the following is the BEST assessment of the problem and the recommended next steps?

turned severely inwards

Answer 2

Congenital foot deformity: refer to orthopaedics

Question 3

A 3-year-old boy, Marcus, presents to your general practice with a one day history of limp and swelling of his left knee. He is otherwise well. Examination reveals a swollen and hot and exquisitely tender left knee with limitation of flexion. His temperature is 39.5°C. WHICH ONE of the following is the MOST APPROPRIATE management plan for Marcus?

Question 3Select one:

a.
Refer to orthopaedic outpatients for x-ray

b.
Refer urgently for joint aspiration

c.
Treat with ibuprofen and review next day

d.
Commence oral antibiotic treatment

Answer 3

Refer urgently for joint aspiration

Question 4

A 3-year-old boy, Marcus, presents to your general practice with a 7-month history of variable limp and swelling of his left knee. He is otherwise well. Examination reveals a swollen and hot and exquisitely tender left knee with limitation of flexion. His temperature is 37.4°C. Investigations show a normal full blood count, and ESR of 40 mm/hr and knee radiograph changes of soft-tissue swelling without fracture.

What is the most likely diagnosis?

Question 4Select one:

a.
Staphylococcal osteomyelitis

b.
Bucket-handle tear of medial meniscus

c.
Parvovirus infection with arthritis

d.
A form of chronic childhood arthritis

Answer 4

A form of chronic childhood arthritis

Question 5

A 5-year old girl, Stacey has had spiking fevers to 39oC every afternoon for the last 6 weeks. On examination she has generalized moderate lympadenopathy and an enlarged liver and spleen. She has an irregular salmon-coloured patch over the abdomen.

What diagnosis does this presentation suggest?

Question 5Select one:

a.
Hodgkin’s disease

b.
Kawasaki’s disease

c.
Still’s disease

d.
West’s disease

Answer 5

Still’s disease

Systemic JIA

Question 6

An 8 year old Samoan boy has been complaining of severe pain in varying large joints during the last week. He has had fever, tiredness and anorexia. Examination reveals a distressed boy with a temperature of 39oC. He has signs of arthritis in both ankle joints and his right knee. Systemic examination is normal. Initial investigations are as follows: Hb 95 g/l, WBC 25 x 109/l, polymorphs 23 x 109/l, Platelets 450 109/l, ESR 95 mm/hr, CRP 300 mg/l . WHICH ONE of the following is the MOST LIKELY diagnosis?

Question 6Select one:

a.
Acute rheumatic fever

b.
Systemic onset arthritis

c.
Reactive polyarthritis

d.
Acute child leukaemia

Answer 6

Acute rheumatic feve

Question 7

All of the following are known to be associated with arthritis in children except for one. WHICH ONE?

Question 7Select one:

a.
Psoriatic disease

b.
RSV infection

c.
Parvovirus infection

d.
Regional ileitis

Answer 7

RSV infection