Joints

Question 1

Risk Factors of developmental dysplasia of the hip

Answer 1

female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity

Question 2

what does the Barlow test do

Answer 2

attempts to dislocate an articulated femoral head

Question 3

What does the Ortolani test do

Answer 3

attempts to relocate a dislocated femoral head

Question 4

How is developmental dysplasia of the hip investiated

Answer 4

USS of the hip

Question 5

Management of DDH

Answer 5

• 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

Question 6

Normal RR age 0-6 months

Answer 6

30-60

Question 7

Normal RR 6-12 months

Answer 7

24-30

Question 8

Normal RR >12 mo

Answer 8

20-30

Question 9

Signs of increased resp effort in an infant

Answer 9

crackles in the chest.
nasal flaring.
chest indrawing.
cyanosis.
oxygen saturation of 95% or less when breathing air.

Question 10

Features of growing pains

Answer 10

• never at the start of the day after the child has woken
• no limp
• no limitation of physical activity
• systemically well
• normal physical examination
• motor milestones normal
• symptoms are often intermittent and worse after a day of - vigorous activity

Question 11

what are growing pains also known as

Answer 11

‘benign idiopathic nocturnal limb pains of childhood’

Question 12

what age range do growing pains occur

Answer 12

3-12 years

equal in boys and girls

Question 13

Features of Slipped capital femoral epiphysis

Answer 13

hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
bilateral slip in 20% of cases

Question 14

Investigations for ? Slipped capital femoral epiphysis

Answer 14

AP and lateral (typically frog-leg) views are diagnostic

Question 15

Management of Slipped capital femoral epiphysis

Answer 15

Internal fixation: typically a single cannulated screw placed in the center of the epiphysis

Question 16

What is the triad of Henoch-Schnlein Purpura

Answer 16

• Purpura: legs, buttocks, arms
• Arthralgia: ankles and knees
• Abdo pain

Question 17

What often triggers HSP

Answer 17

• Follows group A strep URTI

Question 18

What must you ALWAYS rule out in Henoch-Schnlein Purpura

Answer 18

• Testicular torsion

- Intussuception

Question 19

Who get’s neonatal Jaundice

Answer 19

• 50% babies
• Not worrying unless >2 weeks
• Boys > girls
• Check baby is well

Question 20

Neonatal jaundice history

Answer 20

• When did it start
• Incompatability: Maternal/fetal blood group, Anti-D?
• Sepsis: Fever, maternal infectons, Abx at labour etc

Question 21

When is neonatal jaundice always pathological

Answer 21

<24 hours old

Question 22

What are the symptoms of neonatal jaundince

Answer 22

• 2-3 days old (5-7 if prem)
• more common in breast fed
• Head, face then chest an stomach
• Itchy
• Poor feeding
• Sleepiness
• Dark urine/pale stools

Question 23

What are the features of hypermobility of the spine

Answer 23

back pain if parspinal muscles are weak and sore stability is poor

Question 24

What is the management of hypermobility

Answer 24

physiotherapy to built muscle strength around the joints

Question 25

At what age is hypermobility a normal variant

Answer 25

5-8years

Question 26

Features of marfans syndrome

Answer 26

``` tall archynodactyly pectus excavatum high arched palate can be myopic ```

Question 27

Which further assessments should be done with a diagnosis of Marfans

Answer 27

cardiac review with echo Family history of sudden early death from aortic aneurysmal dissection/rupture opthalmology

Question 28

Features of Ehlers Danlos

Answer 28

hyperextensibility of skin poor wound healing blue sclera

Question 29

What cardiac risk are associated with Ehlers Danlos

Answer 29

aortic regurgitation | Dissection of the Aorta

Question 30

What inheritence pattern do both Ehlers Danlos and Marfans syndrome have

Answer 30

autosomal dominant

Question 31

Causes of scoliosis

Answer 31

- postural - weak muscles due to hypermobility - growth in puberty - congenital - Heavy school bag!! - muscular dystrophies - cerebral palsy - neurofibromatosis

Question 32

What features lead you away from a structural cause of scoliosis

Answer 32

asymmetrical skin creases | correction of scoliosis on bending forward

Question 33

What is the first line imaging of scoliosis

Answer 33

1. spinal anteriorposterior (AP) and lateral spines | 2. MRI - if red flags or painful scoliosis

Question 34

What is the management of a true structural scoliosis

Answer 34

1. referral to spinal team 2. physiotherapy 3. spinal bracing 4. corrective surgery if necessary

Question 35

What are the investigations for a toddler/young child presenting with back pain

Answer 35

- low threshold for MRI imaging | - urinary catecholamines and catecholamine metabolities to rule out spinal/bone tumour or neuroblastoma.

Question 36

What is enthesitis related arthritis

Answer 36

- Subgroup of juvenile idiopathic arthritis - Boys >10 - Can be HLAB27 positive - autoimmine

Question 37

What are the features of enthesitis related arthritis

Answer 37

- long term lower back pain - hip and buttock pain while walking - tenderness on palpation of achilles tendon - can get skin/intestinal and opthalmalogical symptoms

Question 38

What is the management of enthesitis related arthritis

Answer 38

- referral to rheum - anti-inflam - may require biologics

Question 39

Causes of chronic back pain in children

Answer 39

- hypermobility - biomechanical - chronic pain - spondylosis - inflammatory arthritis - ERA - Disc degeneration - tumuours - osteoporosis

Question 40

Which joints do you mainly assess for hypermobility

Answer 40

Beighton score - thumb + fingers - elbows - knees - lumbar spine flexion

Question 41

features of Alport syndrome

Answer 41

- glomerulonephritis - hearing loss - eye abnormalaties

Question 42

how does systemic juvenile idiopathic arthritis usually present

Answer 42

- high intermittent fever - widespread lace like rash (levido reticularis) resolves when fever - joint pain - hepatoplenomegaly - lyphadenopthy - weight loss

Question 43

What do investigations of ystemic juvenile idiopathic arthritis usually show

Answer 43

- Very high CRP and ESR - thrombocytosis - RF and ANA negative

Question 44

Features of psoriatic arhtritis

Answer 44

- psoraitic rash - nail pitting - dactlytis - FH of psoraisis - joint pain - RF negative

Question 45

What is oligarticular arthritis

Answer 45

- less than 4 joints affected - Onset usually 2-5 - 50% of al juvenile idiopathic arthritis

Question 46

What are the blood results of oligoarticular arthritis

Answer 46

- RF ngative | - ANA positve

Question 47

Features of Kawasaki

Answer 47

``` fever >5 days + - bilateral conjunctivitis - polymorphous exthanma (rash) - mucosal changes of mouth and lips - oedema/erythema to hands and feet - lymphadenopathy (Induration of BCG scar) ```

Question 48

What it the management of kawasaki

Answer 48

- aspirin - immunoglobulins - follow up Echo