CP2 PAEDS > MSK > Flashcards

MSK Flashcards

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1
Q

What does the GALS in Pgals stand for

A

Gait
Arms
Leg
Spine

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2
Q

Other name for Bow legs

A

Varus deformit

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3
Q

What is Bow leg due to?

A

Rickets

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4
Q

Other name for Knock Knees

A

Valgus deformity

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5
Q

What age gets Valgus deformity

A

2-7

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6
Q

What is the intramalleolar distance in valgus deformity?

A

> 8cm

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7
Q

Prognosis knock-knees

A

Resolves

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8
Q

Incidence of Developmental Hip Dysplasia (DDH)

A

1-3%

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9
Q

In DDH, where is the abnormality? (3)

A

Either:
Shape of head of femur
shape of acetabulum
Supporting structures

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10
Q

RF DDH (8)

A 
FHX
F 
Oligohydramnios 
Breech presentation 
First born 
Multiple pregnancy 
Premature 
NM - CP
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11
Q

What % of children w. DDH are female

A

80%

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12
Q

Screening for DDH

A

Barlow
Ortolani
Repeat test at 6-8w

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13
Q

Late presentation of DDH (2)

A

Usually abnormal gait or limp Short limp or asymmetric skin folds

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14
Q

If DDH is found, what is the next step?

A

USS to give detailed assessment of hip/degree of dysplasia

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15
Q

Mx DDH if <6 months

A

Bracing = 1st line

Or Palvik Harness - maintains hip flexion + abduction

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16
Q

When do most DDH resolve by ?

A

2-6 weeks

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17
Q

If other Tx fail for DDH, what is the final resort + what age must the child be?

A

Surgery

> 5 months

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18
Q

Other name for flat feet

A

Pes planus

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19
Q

Anatomically, what is flat feet

A

Absence in medial longitudinal arch

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20
Q

What condition could flat feet be part of?

A

Ehlers Danlos

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21
Q

Mx flatfeet

A

If Sx - footwear advice + arch support

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22
Q

Another name for forefoot

A

Talipes

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23
Q

What is Positional Talipes due to?

A

Intrauterine compression

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24
Q

Mx Positional Talipes

A

Passive manipulation/exercises by physio

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25
What is Talipes equinovarus?
Entire foot = inverted + supinated, heel rotated inwards | Foot = shorter, calf mm thinner
26
Mx Talipes equinovarus
Plaster cast + bracing Surgery if severe
27
What is scoliosis?
Lateral curvature of frontal plane of spine
28
What can scoliosis cause in servere cases?
Chest distortions --> cardioresp failure
29
causes of scoliosis (6)
``` Idiopathic Congenital - spina bifida NM - CP or MD NFM Marfans Leg length discrepancy ```
30
Mx severe scoliosis
Specialist Tx Bracing Surgery
31
What is Torticollis
Wry and twisted neck
32
Why does torticollis occur?
SCM tumour - mobile, non-tender nodule
33
Later presentatations of torticollis may be due to: (4)
Mm spasm ENT infection Spinal tumour Cervical spine arthritis
34
How long does torticollis due to mm spasm tend to resolve in?
1-2 weeks
35
Mx of torticollis caused by URTI/soft tissue infection
Passive stretching | Usually resolves 2-6 months
36
What is osteomyelitis
Infection of the metaphysis of long bones
37
Which 2 bones does osteomyelitis usually occur in>
Distal femur | Proximal tibia
38
Features osteomyelitis (7)
``` Acute onset Painful limb Immobile Acute febrile illness Over infected site - swelling, tenderness, erythema, warm Vertebral? Back pain Pelvic? Groin pain/limp ```
39
Causes osteomyelitis (4)
S. aureus Strep H influ TB if immunocom
40
Ix osteomyelitis (3)
Bloods Xray MRI
41
What would you see on an oestomyelitis MRI?
Boen infection | Subperiosteal pus + purulent debris in bone
42
Mx osteomyelitis (5)
``` IV ABx several weeks Then PO ABx Aspiration/decompression if atypical Surgical drainage if no response Limb in splint - mobilise ```
43
What is subacute osteomyelitis?
Bone pain + radiographic changes with no systemic symptoms
44
Risks of osteomyelitis is left untreated (4)
``` Widespread infection --> Cellulitis Sepsis Death Amputation ```
45
Who is septic arthritis common in?
<2 y/o
46
Causes of septic arthritis (2)
Following puncture wound/infected skin lesions | From adjacent osteomyelitis
47
Most common causative organism septic arthritis
Staph aureus
48
Features septic arthritis (7)
``` Erythemataous/warm Tender Decr ROM Acutely unwell/febrile Pseudoparesis Joint effusion Limp/pain ```
49
Ix septic arthritis (4)
Bloods - WCC, acute phase proteins, culture USS - effusion Xray - norm MRI
50
Mx septic arthritis
Prolonged IV ABx | Surgical drain/wash out
51
Fractures in what bones would make you think of NAI? (4)
Ribs Humerus Skull Multiple
52
Define Juveinile Idiopathic Arthritis
Persistent joint swelling >6w | Present before 16 y/o w/ no infection/other cause
53
What is the most common type of juvenile idiopathic arthritis?
Persistent oligoarthritis
54
Age Persistent oligoarthritis
1-6
55
Artiucular pattern Persistent oligoarthritis
<4 joints | Knees, ankle, wrist
56
Other features Persistent oligoarthritis
Uveitis | Leg-length discrepancy
57
Prognosis Persistent oligoarthritis
Good
58
Lab features Persistent oligoarthritis
ANA +/-
59
Age range Extended oligoarthritis
1-6
60
Joint pattern Extended oligoarthritis
> 4 joints
61
Other features Extended oligoarthritis
Uveitis | Asymmetrical growth
62
Lab features Extended oligoarthritis
ANA +/-
63
Age range polyarthritis RF -ve
1-6
64
Joint pattern polyarthritis RF -ve
Symmetrical large + small joints Fingers TMJ/Spine
65
Other features polyarthritis RF -ve
Low grade fever Uveitis Decr growth
66
Prognosis polyarthritis RF -ve
Moderate prognosis
67
Age range polyarthritis RF +ve
10-16
68
Joint pattern polyarthritis RF +ve
Symmetrical large + small joints Fingers TMJ/Spine
69
Prognosis polyarthritis RF +ve
Poor
70
Lab feature polyarthritis RF +ve
RF +
71
Age range Systemic Juvenile Arthritis
1-10
72
Joint pattern Systemic Juvenile Arthritis
Arthralgia/myalgia | Originally no arthritis
73
Other features Systemic Juvenile Arthritis
Illness/fever/Malaise | Rash
74
Prognosis Systemic Juvenile Arthritis
Poor
75
Lab features Systemic Juvenile Arthritis
Anaemia Neutrophilia Thrombophilia
76
Age range Psoriatic Juvenile Arthritis
1-16
77
Joint pattern Psoriatic Juvenile Arthritis
Asymmetrical | Large + small joints
78
Other features Psoriatic Juvenile Arthritis
Psoriasis Nail dystrophy Uveitis
79
Associated conditions Juvenile Idiopathic Arthritis (7)
``` Chronic ant uveitis Flexion contractures joints Growth failure Anaemia Chronic disease Delayed puberty OP Amyloidosis ```
80
Tx Juvenile Idiopathic Arthritis (4)
NSAIDs Joint injections Methotrexate Corticosteroids
81
What must be monitored for methotrexate (2)
LFTs | FBC
82
What is the most common form of arthritis in childhood?
Reactive arthritis
83
What is reactive arthritis
Transient joint swelling for <6w
84
Causes of Reactive arthritis (4)
Enteric bacteria - salmonella, campy, shigella Viral infection STI - chlamydia, gonorrhoea Mycoplasma
85
PS Reactive arthritis (3)
Low grade fever Norm APP Norm xray
86
Mx Reactive arthritis (5)
``` No 'Tx' needed NSAIDs Rest Avoid using joint Graded exercise ```
87
What is Perthe's
Disrupted blood supply to capital femoral epiphysis --> Avascular necrosis Revascularisation Re-ossification
88
What are the 3 stages of Perthe's
1 - avascular necrosis 2 - Fragmentation/resorption 3 - Re-ossification
89
Who does Perthe's mainly affect?
Males | Aged 5-10
90
PS Perthe's (2)
Insidious onset limp | Hip/knee pain
91
What % Perthe's is bilateral
20%
92
What would you see on a Perthe's xray
Incr density femoral head | Fragmented/irreg or flattened
93
Mx Perthe's - early detection
Bed rest + traction
94
Mx Perthe's - late/severe (2)
Need to maintain hip in abduction so Plaster cast Pelvic/femoral osteotomy
95
Indicators for good prognosis Perthe's
<6 y/o | < 1/2 head affected
96
What is slipped upper femoral epiphysis
Displacement of epiphysis of femoral head postero-inferiorly
97
RF Slipper upper femoral epiphysis (3)
10-15 y/o during GROWTH spurt Obese/males Metabolic/endocrine abnormalities
98
PS Slipper upper femoral epiphysis (4)
Limp Hip --> knee pain Acute onset Restricted abduction + int rotation hip
99
How to confirm slipped upper femoral epiphysis
Xray
100
Mx slipped upper femoral epiphysis (3)
Pin fixation - surgery NSAIDS Crutches 6-8w
101
What is the most common cause of acute hip pain?
Transient synovitis
102
Cause transient synovitis
Following/accomp viral infection
103
PS transient synovitis (4)
Sudden onset hip pain NO pain @ rest Limp + Decr ROM Afebrile
104
DDx painful limps - aged 1-3 (4)
Septic arthritis Osteomyelitis Transient synovitis Trauma
105
DDx painful limps - aged 3-10 (6)
``` Transient synovitis Septic arthritis Osteomyelitis JIA Perthe's Malignancy ```
106
DDx painful limps - aged 11-16 (5)
``` SUFE JIA Trauma Septic Arthritis ```
107
DDx painless limp - aged 1-3 (4)
DDH Neuromuscular - CP Unequal length JIA
108
DDx painless limp - aged 3-10 (4)
Perthe's - chronic DDH Neuromuscular JIA
109
DDx painless limp - aged 11-16 (3)
SUFE (chronic) JIA Dysplastic hip
110
Mx transient synovitis (3)
Bed rest Analgesia Skin traction (rare)
111
What is Rickets
Failure in mineralisation of growing bone/osteoid tissue
112
Causes of Rickets (6)
``` Decr sun absorption Decr dietary intake Malabsorption; coeliac, CF, cholestatic liver disease CLD Incr metabolism of 25(OH)D Defective 1,25(OH)2D3 ```
113
PS Rickets (9)
``` FTT Ping pong ball in head Delayed dentition Delayed closure of ant fontanelle Costochondral jct palpable Widened wrists/ankles Harrison sulcus Bowed legs/VARUS Hypotonia ```
114
Ix rickets (4)
Bloods Urine microscopy - CKD Wrist x-ray initially Long bone xray
115
Features on long bone xray rickets (5)
``` Cupping, splaying metaphysis Deformities - bowing Wide gap betw shaft + epiphyseal centre Coarse appearance Poorly ossified (greyer in centre) ```
116
Mx Rickets (4)
Dietary advice PO Calciferol Ca supplement Monitor serum Ca, vit D, PTH
117
Sources of Vit D (4)
Sunlight Fish liver oil Fatty fish Egg yolk
118
What is Osteogenesis imperfecta
Inherited condition that causes incr fragility in bones
119
Type 1 Osteogenesis imperfecta (4)
Mild Decr amount of bone AD Fractures in childhood + blue appearance
120
Type 2 Osteogenesis imperfecta (3)
Lethal Multiple fractures + short limbs Infants die immediatetly
121
Type 3 Osteogenesis imperfecta (3)
Severely progressive incr w/ age Short stature - repeated fracture
122
CF Osteogenesis Imperfecta (8)
``` Easily fractured bones Teeth gross Blue sclera Cardiac effects Hypermobility joints Hearing impaired Deformed skull Scoliosis ```
123
Ix Osteogenesis Imperfecta (3)
Xray Bone density Genetics
124
Mx Osteogenesis imperfecta (3)
Physio/bracing Surgery Bisphosphates
125
What is Polydactyly?
>5 digits
126
What conditions is Polydactyly associated with? (3)
Downs Turners Tibial hemimelia
127
What is Syndactylyl>
Abnormal joining of fingers
128
Which conditions is Syndactylyl associated with? (3)
Apert syndrome | Polert syndrome
129
Mx skeletal dysplasia (5)
``` Bone lengthening Braces + splints Physiotherapy OT Bone marrow transplants?? ```
130
Clinical features SLE (3)
Malaise Arthralgia Malar + photosensitive rash
CP2 PAEDS
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