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MSK Flashcards

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1
Q

risk factors for DDH

A

girls
breech
multiple pregnancy
oligohydramnios
1st degree FH
1st born
spina bifida
fixed foot deformities

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2
Q

presentation of DDH at new born

A

newborn screening - Barlows and ortolani
leg length discrepancy
limitation of abduction < 60 degrees
left hip more common

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3
Q

presentation fo DDH older children

A
  1. affected leg shorter than other
  2. waddling gait or tip toe walking
  3. limitation of hip abduction
  4. Galeazzi sign - femoral shortening when hips flexed
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4
Q

investigations for DDH

A

USS hip within 6 weeks if < 4 months old (should be 38-40 corrected gestational age)

if present over >4 months old -> x ray hip

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5
Q

management of DDH

A
  1. splinting using Pavlik harness, fit if less than 6 weeks old for 6 weeks then wean for 6 weeks
  2. if late diagnosis , surgical reduction >6 months
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6
Q

complications of pavlik harness

A

avascular necrosis of femoral head
accessory nerve palsies
irreducible hip dislocation

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7
Q

definition of JIA

A

joint inflammation in under 16 y/o for longer than 6 weeks with no other cause found

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8
Q

describe systemic JIA

A

fever, salmon pink rash with the fever, symmetrical joint pain, hepatosplenomegaly

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9
Q

describe oligoarticular arthritis

A

MOST COMMON FORM - < 6 y/o, girls

involves < 4 joints (usually lower limb)
uveitis common with ANA +VE (can be asymptomatic and present before joint pain)

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10
Q

describe polyarticular arthritis

A

> 5 joints involved (smaller joints)
if RF +ve, predicts poorer disease

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11
Q

describe enthesitis arthritis

A

arthritis plus:
1. sacro-iliac / lumbrosacral pain
2. heel pain
3. acute anterior uveitis
4. lower limbs

HLA-B27 usually +ve

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12
Q

describe juvenile psoriatic arthritis

A

affects small and large joints asymmetrically
dactylitis
nail pitting
oncholytis

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13
Q

diagnosis of JIA

A
  1. raised ESR
  2. USS - joint fluid and synovial hypertrophy
  3. ANA +VE in polyarticular, oligoarticular and psoriatic - most important test to predict for blindness
  4. RF +ve in polyarticular
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14
Q

management of JIA

A
  1. physiotherapy
  2. pain relief
  3. exercise
  4. NSAIDs
  5. steroids (intra-articular 1st line for oligoarticular JIA)
  6. methotrexate
  7. biologics
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15
Q

cause of septic arthritis

A
  1. staph aureus *
  2. group A strep
  3. haemophilus
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16
Q

presentation of septic arthritis

A

red hot painful swollen joint - usually knee or hip
restricted movement/ non weight bearing
fever

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17
Q

investigations of septic artrhitis

A
  1. bloods - raised WCC, raised ESR/CRP, cultures
  2. joint aspiration for culture
  3. x ray - widened joint space
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18
Q

management of septic arthritis

A
  1. IV antibiotics (cefuroxime) for 4-6 weeks IV
  2. pain control
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19
Q

cause of osteomyelitis in neonates

A

group B strep
staph aureus
e.coli

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20
Q

cause of osteomyelitis in children

A

staph aureus
strep pneumoniae
H.influezna
K.kingae (chronic)

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21
Q

cause of osteomyelitis in children with sickle cell disease

A

salmonella
affects diaphysis

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22
Q

location of osteomyelitis in neonates vs children

A

neonates - femur or humerus + destruction of growth plates

children- long bone metaphysis (distal femur)

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23
Q

presentation of osteomyelitis

A

ACUTE - fever, unwell, limp, red swollen painful limb, limited movement within 1 week

CHRONIC - months of infection, unusual organism (mycobacteria), brodies abscess deep in bone of metaphysis and deep boring pain

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24
Q

diagnosis of osteomyelitis

A

MRI ** - detects early changes

X ray - late changes
periosteal elevation, radiolucent metaphyseal lesions

Bloods - high WCC, high CRP, high ESR, culture

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25
describe slipper capital femoral epiphysis
displacement or slipping of the proximal femoral epiphysis at the neck defect in hypertrophic zone on growth plate
26
risk factors for slipper capital femoral epiphysis
- BOYS and OBESITY - trauma - hypothyroidism, hypopituitarism, vit d deficiency, short stature - contralateral SCFE
27
presentation of SCFE
pain in hip , groin, medial thigh on walking limp limited internal rotation and abduction Drehmanns sign - external hip rotation
28
xray findings on SCFE
widened epiphyseal line or femoral head displacement globular swelling of joint capsule decalcification of epiphyseal border
29
management of SCFE
NEED URGENT MANAGEMENT TO PREVENT AVASCULAR NECROSIS OF FEMORAL HEAD 1. pain relief 2. rest 3. surgery - screw fixation across growth plate goal is to prevent femoro-acetabular impingement, avascular necrosis, recurrence, osteoarthritis
30
inheritance of ehlers danlos
autosomal dominant mutation in COL5A12 gene in defective collagen V
31
presentation of ehlers danlos syndrome
1. hypermobile 2. hyper extensible skin 3. poor wound healing 4. blue sclera 5. developmental delay 6. aortic regurg/ dissection of aorta
32
describe mucopolysaccharidoses and diagnosis
group of inheritable lysosomal enzyme disorders autosomal recessive lead to accumulation of GAGs (glycosaminoglycans) -> detected in urine
33
cause of rickets
1. low vitamin D and calcium - dietary **, malnutrition 2. lack of sunlight 3. liver disease 4. renal tubular loss 5. mccune albright syndrome 6. X linked dominant hypophosphatemic rickets - 80% inherited forms of ricket (give phosphate to treat) + 50% deelop nephrocalcinosis
34
vitamin D metabolsim
1. UV lights absorbed through skin and turned into vitamin D3 2. Converted in the LIVER to 25-VITAMIN- D (calcidiol) 3. converted in the KIDNEY to 1,25-VITAMIN D (calcitriol)
35
presentation of rickets
wrist, knee, costochondral joint swelling, tender delayed walking, delayed gross motor development genu varum (bow legs) skull bossing poor growth enamel hypoplasia dilated cardiomyopathy abdominal pain hypotonia irritable
36
x ray changes of rickets
cupping, splaying and fraying of metaphysis costochondral swelling looosers zones (areas of weajness)
37
blood tests of nutritional rickets
low vit d Low calcium low phosphate high ALP and PTH
38
diagnosis and presentation of SLE
>4/11 of the following S - serositis O - oral ulcers A - arthritis - symmetrical P - photosensitivity B - blood disorder e.g. thrombocytopenia, haemolytic anaemia R - renal e.g. lupus nephritis A - ANA +ve 95% I - immunological - anti DsDNA, anti smooth muscle, anti phospholipid disease N - neurological disease e.g. seizures, psychosis M - malar rash 'butterfly facial rash" D - discoid rash "sun exposed areas, scaling"
39
which is the most specific blood test for SLE
anti Ds DNA * + anti- smith indicates more severe disease
40
management of SLE
1. sun protection, exercise 2. NSAIDs 3. glucocorticoids 4. hydroxychloroquine 5. azathioprine or methotrexate 6. biological therapies
41
maternal spread of lupus to baby by...
anti Ro and anti La antibodies cause heart block in 5% babies + 70% have skin lesions + thrombocytopenia
42
describe type 1 osteogenesis imperfecta inheritance
autosomal dominant mutation in COL1A1 gene - abnormal production of alpha chain in type 1 collagen
43
presentation of osteogenesis imperfecta type 1
blue sclera easy bruising fractures hearing loss
44
list properties of bone in children
- more porous - low mineral content - wider haversian canals - increased incidence of bucule and greenstick fractures - periosteal sleeve thick
45
what is perthes disease
avascular necrosis of femoral head interruption of blood supply causing asvascular necrosis of capital femoral epiphysis of the femoral head - followed by revascularisation and reossification over 18-36 months
46
presentation of perthes disease
boys 4-11 y/o pain limitation of movement on internal rotation and abduction small for age afebrile
47
management of perthes disease
containment - by abduction bracing and osteostomy
48
describe osgood schlatter disease
inflammation of patellar ligment at the tibial tuberosity prominent in boys and sport
49
describe ankylosing spondylitis
common in boys linked to HLA-B27 seronegative spondyloarthropathy
50
presentation of ank spon
low back pain , radiating to back of legs stiffness - worse in morning, relieved by exercise aortic regurg pulmonary fibrosis IBD nephrotic syndrome
51
x ray signs in ank spon
1st sign = loss of costal margins/blurring of verterbal and thoracolumbar junction, widening of joint space, anterior squaring of the vertebra late signs = marginal sclerosis, narrowing and fusion
52
presentation of achondroplasia
marked short stature large head with frontal bossing depression of nasal bridge delayed motor milestones and hypotonia complications: OSA, hydrocepahlus, otitis media
53
presentation of reactive arthritis
preceded by gonorrhoea/ chlamydia 1. arthritis 2. conjunctivitis 3. urethritis + keratoderma, blennorhagica balanitis
54
associated hLA with reactive arthritis
HLA B27
55
associated hLA with behcets disease
HLA B5
56
presentation of behcets disease
1. uveitis 2. oral and genital ulcers 3. eryethma nodosum + Thrombophlebitis, neuropathy, psychiatric
57
describe scheurmanns disease
13-16 y/o deep notches on anterior corner of vertebra causes kyphosis
58
most common form of scoliosis
idopathic late onsent/ adolescent scoliosis painless in 70%, 20% have FH
59
signs of tuberculous arthritis
hip * x ray - rarefaction of bone, narrowing of joint spaces
60
x ray of perthes disease
flattened femoral head
61
presentation of drug induced lupus
sudden onset after onset of drug e.g. anti fungal, antibiotics (rifampicin), valproate, biologics
62
investigations of drug induced lupus
anti single stranded DNA (instead of double stranded DNA in SLE) anti histone antibodies normal complement
63
signs of hypocalcaemia
brisk tendon reflexes tetany paraesthesia prolonged QT -> arrthymias petechiae larynospasm - complication
64
bloods of hypophosphataemic rickets
low phosphate normal/ low Ca high ALP normal PTH
65
bloods of vitamin D dependent rickets type 2
AR alopecia, tooth decay low calcium and phosphate high ALP high PTH high vitamin D
66
how does sjogren present
bilateral painless salivary gland enlargement dry skin
67
role of vitamin D
increase calcium reabsorption and increase phosphate reabsorption from gut
68
describe colles fracture
distal radius fracture damages median nerve 'dinner fork' deformity'

FOP/TAS (12 decks)

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