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Lectures Flashcards

1
Q

What is Dupytren’s contracture?

A

Progressive, painless thickening of the palmar fascia that can eventually cause the finger to be locked in flexion

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2
Q

What joint is mainly affected by Dupytrens contracture?

A

MCP

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3
Q

What are the risk factors associated with developing Dupytren’s contracture?

A

Alcohol
Epilepsy
Diabetes

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4
Q

Name some of the treatments offered for Dupytren’s contracture

A

Percutaneous needle fasciotomy
Partial fasciectomy
Dermo-fasciectomy

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5
Q

What is trigger finger?

A

Swelling in the flexor tendon or tightening of sheath around tendon

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6
Q

What are the risk factors for developing trigger finger?

A

Women in 40s-60s
T1DM
Gout
RA

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7
Q

What are the signs of trigger finger?

A

Pain in base of fingers
Lump in palm
Catching of digit and clicking on movement

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8
Q

What are the classical symptoms of De-Quervian’s tenovaginitis?

A

Pain in base of thumb which is aggrevated by moving thumb

Localised tenderness over extensor tunnel

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9
Q

Who often suffers from De-Quervian’s tenovaginitis?

A

Post-partum women

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10
Q

What test can be done to diagnose De-Quervian’s tenovaginitis?

A

Finklestein’s test

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11
Q

What management is indicated for De-Quervian’s tenovaginitis?

A

NSAIDs + rest
Consider steroid injections
Consider decompression surgery

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12
Q

What treatment is indicated for soft tissue ganglia?

A

None if not problematic
Aspiration
Excision (less risk of recurrence)

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13
Q

What are the signs associated with base of thumb OA?

A

Pain at base of thumb (when pinching/opening jars)
Stiffness
Swelling
Deformity

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14
Q

What is the management of base of thumb OA?

A

Non-operative:
Lifestyle modifications
NSAIDs + splints
Steroid injections

Operative:
Trapeziectomy (gold standard)

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15
Q

What does a trapeziectomy involve?

A

Removal of bone at base of thumb

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16
Q

How does a scaphoid fracture most commonly occur?

A

Falling on outstretched hands

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17
Q

How can a scaphoid fracture be imaged?

A

Scaphoid series xray

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18
Q

If you suspect someone has a scaphoid fracture, but it cannot be seen on a scaphoid series xray, what are the next steps of management

A

MRI

or cast and xray again in 2 weeks

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19
Q

What are the signs of a scaphoid fracture?

A

Tenderness over anatomical snuff box

Pain on ulnar deviation of pronated hand

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20
Q

What is the most common type of shoulder dislocation?

A

Anterior

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21
Q

What nerve is at risk of damage during shoulder dislocation?

A

Axillary nerve

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22
Q

What events may lead to posterior shoulder dislocation?

A

Epileptic fit

Electrocution

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23
Q

What is a bankart tear?

A

Labral injury due to anterior shoulder dislocation which leads to a pocket in front of the glenoid cavity that the humeral head can slip into
Increases dislocation recurrence

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24
Q

What is the treatment for a shoulder dislocation?

A 
Ensure no axillary nerve damage
Manipulation 
Immobilisation
Physiotherapy
Surgery for bankart tear
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25
Q

What is the main sign of a subacromial impingement?

A

Painful arc (painful abduction)

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26
Q

How is a subacromial impingement managed?

A

Subacromial steroid injections if bursitis
Physiotherapy if rotator cuff dysfunction
Arthroscopic subacromial decompression surgery

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27
Q

What are the 3 classic presentation stages of a frozen shoulder?

A 
Painful stage (up to 1 year)
Frozen stage (6 months to 1 year)
Thawing stage
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28
Q

How does a frozen shoulder usually present?

A

As an acutely painful shoulder which over time develops into a stiff shoulder

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29
Q

Name 2 secondary causes for a frozen shoulder

A

Diabetes

Thyroid disease

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30
Q

What tests should always be carried out when investigating a frozen shoulder?

A

Clinical examination
Radiography to exclude OA
Fasting blood glucose (diabetes)
TFTs

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31
Q

What 2 tests are gold standard for diagnosing a frozen shoulder?

A

Decreased passive movement on clinical examination

+ Radiography to rule out OA

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32
Q

What is the management for a frozen shoulder?

A 
Treat underlying cause (if any)
Steroid injections (early presentation)
NSAIDs
Physiotherapy
Surgery (late presentation)
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33
Q

What is the common name given to medial epicondylitis?

A

Golfer’s elbow

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34
Q

What is the most common clinical sign for tennis elbow?

A

Tenderness over lateral epicondyle

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35
Q

What is the recommended management for lateral and medial epicondylitis?

A

Modify activity to restrict overloading tendon
Physiotherapy
Tendon release surgery

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36
Q

What complication can be caused by medial epicondylitis?

A

Ulnar neuropathy

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37
Q

What are some of the changes that happen in the spine as we age?

A

Decreased water content of intervertebral discs
Disc space narrowing
Degenerative changes on xray
Degenerative changes in facet joints

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38
Q

What accelerates normal spinal ageing?

A

Smoking

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39
Q

In which region of the spine do intervertebral discs most commonly prolapse?

A

Lumbar region

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40
Q

What is one major complication of lumbar disc prolapse?

A

Cauda equina syndrome

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41
Q

Name some of the causes of cauda equina syndrome

A 
Lumbar disc prolapse
Trauma
Spinal surgery
Spinal tumour
Epidural
Epidural abscess
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42
Q

What are the signs of cauda equina syndrome?

A 
Back pain
Loss of sensation over inner thighs, buttocks and perineum (saddle anaesthesia)
Loss of anal tone
Loss of bladder or bowel control
Urinary retention
Leg pain
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43
Q

If you suspect someone may have cauda equina syndrome what test would you order?

A

MRI

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44
Q

What is the management for cauda equina syndrome?

A

Urgent surgery within 48 hours

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45
Q

What can be the long term complications of cauda equina syndrome?

A

Permanent loss of bladder/bowel function
Permanent loss of sexual function
Permanent loss of motor power
Permanent sensory loss

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46
Q

What is the main sign of spinal stenosis?

A

Spinal claudication

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47
Q

What are the signs of spinal claudication?

A

Pain when walking downhill
Bilateral pain in both legs
Possible weakness (footdrop)
Sensory loss

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48
Q

How is spinal stenosis managed?

A

Steroid injections into nerve root

Decompression surgery

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49
Q

What is the definition of a complete spinal cord injury?

A

No motor or sensory function distal to lesion

No anal squeeze

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50
Q

What is the definition of an incomplete spinal cord injury?

A

Some motor or sensory function distal to lesion

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51
Q

What are the signs of neurogenic shock?

A

Low BP
Low HR
Hypothermia
Loss of sympathetic tone

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52
Q

Fractures above which spinal level can cause neurogenic shock?

A

Above T6

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53
Q

What are the signs of spinal shock?

A

Transient depression below level of lesion
Flaccid paralysis
Arreflexia
Will start to improve hours to days after injury

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54
Q

What is the definition of tetra/quadriplegia?

A

Partial or total loss of sensory and motor function in all 4 limbs and trunk

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55
Q

What segment of the spinal cord is damaged in a tetraplegic individual?

A

Cervical

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56
Q

What is the definition of paraplegia?

A

Partial or total loss of function in the lower limbs

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57
Q

What segments of the spinal cord are affected in someone who is paraplegic?

A

Thoracic, lumbar or sacral

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58
Q

What kind of injury can lead to paraplegia?

A

Chest or abdominal injury leading to thoracic or lumbar fracture/injury

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59
Q

What are the signs of central cord syndrome?

A

Loss of motor power in upper extremities
Varying loss of sensation in arms
Lower limbs less affected

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60
Q

Lesions in which segment of the spinal cord cause central cord syndrome?

A

Cervical

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61
Q

In particular, what material in the spinal cord is affected in central cord syndrome?

A

Grey matter

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62
Q

What is anterior cord syndrome?

A

Infarction of the anterior spinal artery

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63
Q

What are the signs of anterior cord syndrome?

A

Loss of motor function below level of lesion

Loss of pain or temperature sensation below level of lesion

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64
Q

What sensory functions are spared in anterior cord syndrome?

A

Vibration sense

Proprioception

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65
Q

What are the signs of Brown Sequard syndrome?

A

Loss of motor function on ipsilateral side
Loss of vibration sense, proprioception and fine touch on ipsilateral side
Loss of pain and temperature sensation on contralateral side

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66
Q

What are the signs of Erb’s palsy?

A 
Waiter's tip sign:
Adduction of shoulder
Extension of elbow
Pronation of forearm
Flexion of wrist
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67
Q

What levels of the brachial plexus are damaged in Erb’s palsy?

A

C5-6

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68
Q

What is the main sign of lower brachial plexus injury?

A

Claw hand

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69
Q

What levels of the brachial plexus are damaged in Klumpke’s palsy?

A

C8-T1

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70
Q

What are the clinical signs of axillary nerve palsy?

A

Deltoid muscle wasting

Loss of sensation over badge area

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71
Q

During which fracture, is the axillary nerve prone to damage?

A

Fracture of surgical neck of humerus

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72
Q

What are the axillary nerve roots?

A

C5-6

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73
Q

What are the roots of the musculocutaneous nerve?

A

C5,6,7

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74
Q

What is the most common injury that causes radial nerve entrapment?

A

Fracture of humeral shaft

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75
Q

What is the most common injury that leads to radial nerve compression?

A

Saturday night palsy

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76
Q

What are the root values of the radial nerve?

A

C5-T1

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77
Q

What muscles does the radial nerve supply?

A

Triceps brachii
Brachioradialis
Extensor compartment of forearm

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78
Q

Radial nerve injury in axilla will lead to what clinical signs?

A

Loss of elbow extension
Loss of wrist extension (wrist drop)
Loss of sensation over dorsal thumb

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79
Q

Radial nerve injury in arm will lead to what clinical signs?

A

Loss of wrist extension (wrist drop)

Loss of sensation over dorsal thumb

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80
Q

Radial nerve injury in arm will lead to what clinical signs?

A

Loss of sensation over dorsal thumb

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81
Q

What are the median nerve roots?

A

C5,C6,C8,T1

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82
Q

What artery is closely associated to the median nerve in the arm?

A

Brachial artery

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83
Q

What muscles does the median nerve supply?

A 
All forearm flexors except FCU and lateral 2 tendons of FDP
Lumbricals 1 and 2
Opponens longus
Abductor pollicis brevis
Flexor pollicis brevis
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84
Q

Where does the median nerve supply sensation?

A

First 3.5 digits on palmar aspect of hand

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85
Q

Name some of the causes of carpal tunnel syndrome

A

Trauma
Metabolic: pregnancy, hypothyroid
Inflammatory: gout, RA

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86
Q

What are the signs of carpal tunnel syndrome?

A

Noctoural pain and paraesthesia in median nerve distribution
Wasting of thenar muscles

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87
Q

How is carpal tunnel syndrome diagnosed?

A

Clinical examination
Phalen’s test
Tinel’s test
If unsure nerve conduction studies can be carried out

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88
Q

How is carpal tunnel syndrome managed?

A

Splinting
Steroid injections
Nerve decompression surgery (release of flexor retinaculum)

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89
Q

What are the ulnar nerve roots?

A

C8-T1

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90
Q

What muscles does the ulnar nerve supply?

A

FCU

Medial 2 tendons of FDP

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91
Q

What are the 2 main causes of ulnar nerve palsy?

A

Cubital tunnel syndrome

Guyon’s canal syndrome

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92
Q

What are the signs of cubital tunnel syndrome?

A

Loss of sensation over ulnar aspect of hand

Difficulty with fine tasks

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93
Q

What are the signs of ulnar nerve damage at the wrist?

A 
Loss of sensation over ulnar aspect
Claw hand (loss of use of intrinsic hand muscles) - ulnar paradox
94
Q

During which injury is the common fibular nerve most commonly damaged?

A

Fibula fracture

95
Q

What is the main clinical sign of common fibular nerve damage?

A

Foot drop

96
Q

What are the criteria for diagnosing JIA?

A

Age <16
History >6 weeks

Presence of joint swelling or 2 of:
Limited ROM
Pain
Tenderness 
Warmth
97
Q

What are the common presentations of JIA?

A 
Arthritis >6 weeks
Morning stiffness
Irritability or refusal to walk
Fatigue
Poor appetite/weight loss
Delayed growth/puberty
98
Q

What are the clinical signs of JIA?

A

Swelling
Pain
Joint held in position of maximum comfort (often flexion)
Limited ROM

99
Q

What differential diagnoses must be ruled out before making a JIA diagnosis?

A

Septic arthritis
Malignancy
Transient synovitis
Recurrent hemiarthrosis (haemophilia)

100
Q

What is the typical history seen in septic arthritis?

A

Hot swollen red joint
Unable to move joint
Child systemically unwell with high fever

101
Q

What is the typical history seen in transient synovitis?

A

Child will be systemically well

Short history of joint inflammation

102
Q

What are the main types of JIA? How are they distinguished from one another?

A 
Pauciarticular (<5 joints affected)
Polyarticular (5 or more joints affected)
Systemic JIA (extra-articular features)
103
Q

What are the subtypes of Pauciarticular JIA?

A

Type I
Type II
Type III

104
Q

What are the subtypes of Polyarticular JIA?

A

RF +

RF -

105
Q

What are the clinical signs of systemic JIA?

A 
Child systemically unwell
Fever spikes
Salmon rash
Hepatosplenomegaly
Lymphadenopathy
106
Q

What subtype of JIA is most commonly associated with uveitis?

A

Pauciarticular type I ANA +

107
Q

What is the common presentation of type I pauciarticular JIA?

A

Limp

Lower limbs affected more than upper limbs

108
Q

What is the common presentation of type III pauciarticular JIA?

A

Upper and lower limbs affected

Nail pitting

109
Q

What condition is linked to type III pauciarticular JIA?

A

Psoriasis

110
Q

What are the risk factors for developing JIA?

A

Female sex
Family history of autoimmune disease
HLA polymorphism

111
Q

How is JIA diagnosed?

A

History (6 weeks)
Clinical examination
Labs: FBC, ESR, CRP, ANA, RF
USS joint if diagnostic doubt

112
Q

What is the first line treatment for pauciarticular JIA affecting less than 4 joints?

A

Intra-articular steroid injections

113
Q

What is the first line treatment for polyarticular JIA?

A

Methotrexate (traditional DMARD)

114
Q

What is the second line treatment for polyarticular JIA?

A

Biologics e.g. anti-TNF

115
Q

When are oral steroids suitable to use in JIA?

A

To bridge the gap while waiting for Methotrexate to start working

116
Q

What are the side effects of oral steroid use in children?

A

Osteoporosis
Growth retardation
Infection

117
Q

What is the common presentation of RA?

A

Symmetrical, swollen, painful, stiff small joints of the hands and feet
Often worse in morning

118
Q

What autoantibodies are specific for RA?

A

Anti-CCP

119
Q

How is RA diagnosed?

A

Bloods: Anti-CCP, RF

Plain xray

120
Q

You wish to monitor a patient’s rheumatoid arthritis improvement since being started on Methotrexate, what can be used to analyse this?

A

Disease Activity Score (DAS 28)

121
Q

What DAS score represents eligibility for biological therapy in RA patients?

A

> 5.1

122
Q

What DAS score represents clinical remission in RA patients?

A

<2.4

123
Q

Name 2 traditional DMARD drugs used in the management of RA

A

Methotrexate

Sulfasalazine

124
Q

Name some examples of biological DMARDs used in the management of RA

A

TNF inhibitor (Inflixumab)
IL-1 inhibitor (Anakinra)
Anti B cell therapy (Rituximab)

125
Q

What are some of the clinical signs of ankylosing spondylitis?

A

Low back pain for more than 3 months that is improved by exercise and NOT improved by rest
Limitation of lumbar spine movement
Limitation of chest expansion
Sacroilitis on xray (or MRI)

126
Q

How is AS managed?

A 
Physiotherapy
NSAIDs
DMARDs (Sulfasalazine)
Anti-TNF
Bisphosphonates for osteoporosis
Surgery - joint replacement
127
Q

What x-ray deformity can be seen in psoriatic arthritis?

A

‘Pencil in cup’

128
Q

How is psoriatic arthritis treated?

A

Traditional DMARDs
Biologics
Axial disease treated same as AS

129
Q

What is reactive arthritis?

A

Sterile synovitis after a distant infection

130
Q

What classical triad of symptoms describes Reiter’s syndrome?

A

Urethritis
Uveitis
Arthritis

131
Q

What particular infection can cause recurrent reactive arthritis attacks?

A

Chlamydia

132
Q

What do all the spondyloarthropathies have in common?

A

They are all RF-

They all have an association with HLA-B27

133
Q

What type of crystal deposits are associated with gout?

A

Monosodium urate

134
Q

What type of crystal deposits are associated with pseudogout?

A

Calcium pyrophosphate dehydrate (CPPD)

135
Q

What are the signs of an acute gout flare-up?

A

Redness
Pain
Swelling
Often in one joint (big toe)

136
Q

How is gout diagnosed?

A

History
Examination
Aspiration of fluid from swollen joint and microscopy

137
Q

What events may precipitate a flare-up of gout?

A

Trauma
Surgery
Infection
Diuretic use

138
Q

How is an acute flare of gout managed?

A

Strong NSAIDs (Indocin)
Colchichine
Steroids

139
Q

Who is most at risk of polymyalgia rheumatica?

A

Elderly females

140
Q

What are the common presenting symptoms of polymyalgia rhumatica?

A

Sudden onset symmetrical aching tenderness
Morning stiffness in shoulders, pelvic girdle and proximal limb muscles
May have systemic features e.g. fever

141
Q

How is polymyalgia rheumatica confirmed?

A

History
Age >50
ESR >50
Dramatic response to steroids

142
Q

How is polymyalgia rheumatica treated?

A

15mg Prednisolone daily

143
Q

When is the most common age onset of SLE?

A

15-50 (especially women)

144
Q

What criteria can help diagnose SLE?

A

Any 4 of the following:

Arthritis (at least 2 joints)
Renal (proteinuria)
ANA +
Serositis
Haematological (low platelets, low WCC)
Photosensitivity
Oral ulcers
Immunological (anti-ds DNA)
Neurological (seizures, psychosis)
ts
an
Malar rash (butterfly rash on cheeks)
Discoid rash (alopecia)
145
Q

What are the clinical signs of limited scleroderma?

A 
Calcinosis
Reynaud's phenomena
Eosophageal dysmotility
Sclerodactyly
Telangiectasia
146
Q

What are the common presenting symptoms of GCA?

A

New onset headache
Scalp tenderness
Jaw claudication
Sudden blindness in one eye

147
Q

What are the classification criteria for diagnosing GCA?

A

3 of the following:

Onset >50 years of age
New headache
Temporal artery tenderness
ESR >50
Abnormal temporal artery biopsy
148
Q

How is GCA managed?

A

Start prednisolone

149
Q

How is osteomalacia diagnosed?

A

Bloods: serum calcium (low), serum vitamin D (low), serum PTH (high)
Radiography: plain xray

150
Q

How is osteomalacia treated?

A

Calcium with vitamin D

151
Q

How is osteomalacia treated in a patient with renal disease?

A

Calcitriol

152
Q

How is paget’s disease normally picked up?

A

High alk phos in an asymptomatic individual

153
Q

If you suspect someone may have paget’s disease, what investigations would you order?

A

Plain x-ray of bone
Bone scan
Total serum alk phos
Bone specific alk phos

154
Q

What areas of the body are most commonly affected by paget’s disease?

A

Long bones
Axial skeleton
Skull

155
Q

What bone mass density is required to diagnose a patient with osteoporosis?

A

-2.5

156
Q

What is the definition of osteoporosis?

A

Metabolic bone disease characterised by low bone mass which leads to increased fragility and increased fracture risk

157
Q

What factors increase the likelihood of someone sustaining a fracture?

A

Low BMD
Age
Falls risk

158
Q

A 55 year old woman comes to you concerned that she may have osteoporosis as her mother has recently been diagnosed with it, what is the first investigation you should consider?

A

Fracture risk assessment

159
Q

A 55 year old woman comes to you concerned that she may have osteoporosis as her mother has recently been diagnosed with it, you conduct a fracture risk assessment and it comes back as 30% likelihood in the next 10 years, what is the next step?

A

DEXA bone scanning

160
Q

A 55 year old woman is referred for a DEXA bone scan, the results come back and her T score is -1.5, what advice should she be given?

A

She has osteopenia

Give lifestyle advice

161
Q

A 55 year old woman is diagnosed with osteoporosis, what medications should be considered?

A

Bisphosphonates (Alendroic acid)
HRT if going through the menopause
Monoclonal antibodies against RANKL (Denosumab)

162
Q

What is the most common causative organism of acute osteomyelitis?

A

Staph aureus

163
Q

What are the risk factors for developing osteomyelitis?

A

Diabetes
Immunocompromised
RA
Sickle cell disease

164
Q

What are the most common causative organisms of acute osteomyelitis in neonates?

A

Staph aureus
Group B strep
E.coli

165
Q

What are the most common causative organisms of acute osteomyelitis in children?

A

Staph aureus
Strep pyogenes
H.influenzae

166
Q

What are the most common causative organisms of acute osteomyelitis in adults?

A

Staph aureus

Coagulase negative staphlococci

167
Q

What are the clinical features of osteomyelitis in neonates?

A

Irritability/drowsiness
Swelling
Decreased range of movement

168
Q

What are the clinical features of osteomyelitis in children?

A

Severe pain
Swinging pyrexia and tachycardia
Malaise/fatigue

169
Q

How is acute osteomyelitis treated?

A 
Rest and splint
Analgesia
Antibiotics 
Aspiration of pus
Drainage of abscesses
170
Q

What is subacute osteomyelitis?

A

Chronic low grade bone infection characterised by lack of systemic manifestations

171
Q

What type of osteomyelitis is associated with Brodie’s abscess

A

Subacute

172
Q

What organisms are mainly responsible for septic arthritis?

A

S.aureus
H.influenzae
Strep pyogenes
E.coli

173
Q

What causes damage to articular cartilage in septic arthritis?

A

Bacterial toxins

Cellular enzymes

174
Q

What is the key diagnostic test for septic arthritis?

A

Aspiration and culture of synovial fluid

175
Q

What are the differential diagnoses for an acute, painful, inflamed knee?

A 
Septic arthritis
Pseudogout
Trauma
Acute osteomyelitis
Haemophilia
176
Q

What is the most common cause of septic arthritis in adults?

A

Joint replacement infected with S.aureus

177
Q

How do neonates with septic arthritis generally present?

A

Picture of septicaemia

Irritability

178
Q

How do children with septic arthritis generally present?

A

Acute pain in large joint
Reluctance to move joint
Increased temperature
Increased pulse

179
Q

How is septic arthritis treated?

A

Immediate antibiotics

Immediate drainage and lavage (washout)

180
Q

What are the drugs used in the treatment of TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

181
Q

What is the commonest primary bone tumour in young people?

A

Osteosarcoma

182
Q

What is the commonest primary bone tumour in older people?

A

Myeloma

183
Q

What are the cardinal features of malignant bone tumours?

A

Pain (worse at night)
Pathological fractures
Deep seated mass
Loss of function

184
Q

What is the key investigation for diagnosing primary malignant bone tumours?

A

Plain radiograph

185
Q

What are the cardinal features of malignant soft tissue tumours?

A 
Fast growing
Non-painful (but can ache at night)
Non-tender on palpation
Hard, craggy mass
>5cm
186
Q

What 2 investigations are carried out to diagnose a soft tissue malignancy?

A

MRI

Needle biopsy

187
Q

How are soft tissue tumours treated?

A

Excision
Radiotherapy
Sometimes adjuvant chemotherapy

188
Q

What are the 4 stages of fracture healing?

A

Inflammation
Soft callous formation
Hard callous formation
Bone remodelling

189
Q

Name the clinical features of peripheral nerve injury

A

Sensory:
Paraesthesia
Anaesthesia
Dysthesia

Motor:
Paralysis
Paresis +/- muscle wasting

Absent/diminished reflexes

190
Q

What is the first type of sensation to return upon peripheral nerve healing?

A

Pain

191
Q

Name 2 methods of assessing peripheral nerve healing

A

Nerve conduction studies

Tinnel’s test

192
Q

Considering an open fracture, what factors would make it necessary to perform surgery within 6 hours of injury?

A

Polytraumatised patient
Marine/farmland environment
Gross contamination
Neurovascular compromise

193
Q

What nerve is affected in Morton’s neuroma?

A

Common digital nerve

194
Q

What type of achilles tendonitis most commonly affects athletes?

A

Paratendinopathy

195
Q

What are the symptoms of achilles tendinopathy?

A

Pain during exercise
Pain following exercise
Recurrent episodes
Difficulty fitting shoes

196
Q

What triad of tests is used to diagnose a ruptured achilles tendon?

A

Simmonds triad

197
Q

What are the risk factors for developing DDH?

A 
1st born
Female
Breech delivery
Family history 
Other lower limb pathology
Oligohydramnios
High BMI
198
Q

What are the typical presenting features of a child with DDH?

A

Started walking but never confidently
Awkward gait
Limb length discrepancy

199
Q

How is DDH diagnosed?

A

Clinical examination
USS
Plain xray

200
Q

What 2 clinical examinations can be used to test for DDH?

A

Barlow’s test

Ortolani’s test

201
Q

What is Perthe’s disease?

A

A childhood condition that causes temporarily loss of vascularity to the femoral head, this results in avascular necrosis of the bone

202
Q

What are the typical presenting features of perthe’s disease?

A 
Primary school age boy
Short stature
Low social class
Limp
Knee pain on exercise
Systemically well
203
Q

What are the 4 radiological stages of Perthe’s disease?

A

Initial stage of AVN
Fragmentation stage
Reossification stage
Healed stage

204
Q

What are the typical presenting features of a slipped upper femoral epiphysis?

A

Boy aged 9-14
Obese
Hip or knee pain
Externally rotated hip

205
Q

How is SUFE diagnosed?

A 
High index of suspicion clinically if teenage boy with external rotation of hip 
Plain radiograph (lateral view)
206
Q

What complications are associated with SUFE?

A 
AVN
Early onset OA
Chondrolysis
Deformity
Limb length discrepancy
207
Q

What are the main causes of a limping child aged 0-5 years?

A 
Trauma
Septic arthritis
JIA
Transient synovitis
DDH
Osteomalacia
208
Q

What are the main causes of a limping child aged 5-10 years?

A 
Trauma
Septic arthritis
Transient synovitis
Perthe's disease
Osteomalacia
209
Q

What are the main causes of a limping child aged 10-15 years?

A 
Septic arthritis
SUFE
Osteomalacia
Trauma
Neoplasm
210
Q

What muscle is affected by torticollis?

A

Sternocleidomastoid

211
Q

What other conditions are associated with torticollis?

A

DDH

Metatarsus adductus

212
Q

What are the clinical signs of torticollis?

A

Lump in muscle belly

Head tilted to side

213
Q

What is the treatment for torticollis?

A

Physiotherapy

214
Q

What is metatarsus adductus?

A

Congenital problem where forefoot is turned inwards

215
Q

How is metatarsus adductus assessed?

A

Clinically - hold had in heel and try to move foot to midline position, note if it is flexible, semi-flexible or rigid

216
Q

How is calcaneovalgus managed?

A

Parental stretching

217
Q

What are the causes of clubfoot?

A 
Oligohydramnios
Placental insufficiency
Toxins
Drugs
Chromosomal abnormality
218
Q

What are the 2 types of clubfoot?

A

Positional - can be passively corrected

Structural - true club foot, foot cannot be passively corrected

219
Q

Positional clubfoot is also associated with which other condition?

A

DDH

220
Q

How is club foot treated?

A

Positional - reassure
Structural - Ponsetti serial casting for 8 weeks
Achilles tenotomy to correct equinus

221
Q

What is scoliosis?

A

Deviation of the spine in the coronal plane

222
Q

Name some of the causes of scoliosis

A 
Idiopathic
Neuromuscular conditions e.g. CP
Trauma
Infection
Neoplasm
223
Q

How is scoliosis investigated?

A

Clinical examination
Plain radiograph (AP erect)
MRI
Bone scan if pain

224
Q

How is scoliosis managed?

A

Bracing

Surgery in severe cases

225
Q

What are some of the complications of severe scoliosis?

A

Cardiorespiratory compromise
Seating issues
Surgical challenges

226
Q

Name the 4 main types of spina bifida and give a brief description of each

A

Occulta - bengin
Meningocele - passage of dura and arachnoid matter out of spinal opening
Myelomeningocele - passage of meninges and spinal cord from spinal opening
Encephalocele - part of brain pushed through opening of skull

227
Q

How is Duchenne’s muscular dystrophy diagnosed?

A

Elevated creatinine kinase
Muscle biopsy
DNA analysis

228
Q

What are some of the complications associated with duchenne’s muscular dystrophy?

A

Scolosis
Respiratory failure
Cardiomyopathy
Infections

229
Q

When does DMD usually present?

A

Young childhood

230
Q

When does Becker’s Muscular Dystrophy usually present?

A

Adolescence

MSK (1 decks)

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