MSK

Question 1

What is transient synovitis and what is the common age range it presents in?

Answer 1

Transient inflammation of the synovial membrane (commonly

hip), commonest reason for limp in children 3-8 y/o

Question 2

Clinical features of transient synovitis

Answer 2

• history of recent URTI (1-2 weeks)
• child is afebrile
• sudden onset hip pain
• can walk but limp
• mild-mod increase in ROM esp internal rotation
• peaks on day 2-3, subsides by 5-6

Question 3

What is Osgood Schlatter Disrase and who does it affect?

Answer 3

Osteochondritis of the patellar tendon insertion at the tibial tuberosity

Adolescent males who are active, athlete

Question 4

Clinical features of osgood-schlatter

Answer 4

• knee pain after exercise
• painful lump below knee
• localized tenderness +/- swelling over tibial tuberosity
• hamstring tightness

Question 5

How to manage osgood-schlatter

Answer 5

Rest, it’s usually self-limiting

Physio for quad strengthening and hamstring stretches

Question 6

What is Perthes disease and who does it present in?

Answer 6

Idiopathic avascular necrosis of the capital femoral epiphysis, commonly 4-8 y/o

Question 7

Clinical features of perthes disease and how to manage

Answer 7

• progressively worsening pain and limp
• restricted hip motion (ext rotation)
• rest, analgesia, traction, surgery

Question 8

What do you see on X-Ray for Perthes disease

Answer 8

Flattened femoral head, increased density in femoral head, fragmented and irregular ossification

Question 9

What is slipped upper femoral epiphysis and who does it present in

Answer 9

Fracture through the growth plate which results in slippage of the overlying end of the femur (metaphysis) and it displaces postero-inferiorly

10-14 y/o male, overweight

Question 10

Clinical features of SUFE and management

Answer 10

• painful limp, knee pain
• limb shortened and externally rotated
• restricted ROM esp internal rotation
• surgically put screw in

Question 11

What do you see on X-Ray of SUFE

Answer 11

ice cream sign on frog-lateral view

Question 12

How to manage JIA

Answer 12

NSAIDS 
Low dose methotrexate 
Corticosteroids for systemic JIA 
Intra-articular CS in early stage
Biologics like TNF-alpha and inhibitors 
Splinting to avoid flex ion contractures
Physiotherapy

Question 13

Tests for osteomyelitis

Answer 13

FBC, ESR/CRP, blood culture
X-Ray: negative initially but will show subperiosteal bone formation in 7-10 days
MRI/radionuclide bone scan to show infection
Bone aspirate with Gram Stain and culture

Question 14

Managing osteomyelitis

Answer 14

IV antibiotics for 4-6 weeks: clindamycin + cipro or ampicillin
Surgical drainage if unresponsive
Surgical debridement of necrotic parts

Question 15

Features of osteomyelitis

Answer 15

Fever, localized bone pain, extreme tenderness on moving, erythematous, swelling, warm, limited movement of adjacent joint

Question 16

Tests for septic arthritis

Answer 16

FBC, ESR, CRP, blood culture
X-Ray - might show widening of joint space and soft tissue swelling
Joint aspiration with U/S guidance for WBC, gram stain, C&S