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MSK Flashcards

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1
Q

What is osteogenesis imperfecta?

A

AD genetic condition leading to bone weakness, brittle bones and fractures

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2
Q

What causes osteogenesis imperfecta?

A

Mutation affecting type I collagen

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3
Q

What is the presentation of osteogenesis imperfecta?

A

Recurrent fractures, hypermobility, blue/ grey sclera, triangular face, short stature, dental problems, bone deformities, bone pain

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4
Q

What is rickets?

A

Defective bone mineralisation causing soft and deformed bones

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5
Q

Give 4 risk factors for rickets

A

Darker skin, low exposure to sunlight, colder climates, long time indoors

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6
Q

What are some causes of rickets?

A

Deficiency in vitamin D or calcium, dark skin, northern latitudes, vegan diets, coeliac disease, cystic fibrosis, fanconi syndrome

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7
Q

What is vitamin D?

A

A hormone created from cholesterol in the skin in response to UV radiation

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8
Q

What is vitamin D essential in?

A

Calcium and phosphate absorption from the intestines and kidneys
Regulating bone turnover
Promoting bone reabsorption to boost calcium

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9
Q

What is the presentation of rickets?

A

Lethargy, bone pain, bone deformity, poor growth, dental problems, muscle weakness, swollen wrists

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10
Q

What are some bone deformities of rickets?

A

Bowing of legs
Knock knees
Rachitis rosary - end of ribs expand causing chest lumps
Kyphoscoliosis
Craniotabes

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11
Q

What is craniotabes in rickets?

A

Soft skull with delayed closure of the sutures and frontal bossing

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12
Q

What is gold standard diagnosis for rickets?

A

X-ray

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13
Q

What are the two investigations that are high in rickets?

A

PTH and alkaline phosphatase

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14
Q

What is transient synovitis?

A

Irritable hip - temporary irritation and inflammation in the synovial membrane of the hip
Associated with a recent viral URTI

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15
Q

What is the presentation of transient synovitis?

A

No fever, limp, hip pain, refusal to weight bear

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16
Q

What is septic arthritis?

A

Infection inside the joint usually from haematogenous spread

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17
Q

What are the causes of septic arthritis?

A

Staph aureus - most common
Neisseria gonorrhoea - sexually active teens
Strep pyogenes
Hib
Staph epidermis - prosthetic joints

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18
Q

What is the presentation of septic arthritis?

A

Single joint, hot, swollen, red and painful
Stiffness and reduced range of motion
Refusal to weight bear
Fever, lethargy and sepsis

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19
Q

What is the management of septic arthritis?

A

Aspirate and send for crystal microscopy, gram staining and culture
Blood cultures
Empirical antibiotics
Surgical drainage and clearance

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20
Q

What is osteomyelitis?

A

Infection in the bone and bone marrow typically metaphysis of long bones

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21
Q

What is the most common site of osteomyelitis?

A

Distal femur and proximal tibia

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22
Q

What is the most common cause of osteomyelitis?

A

Staph aureus

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23
Q

What is the presentation of osteomyelitis?

A

Painful, immobile limb, swelling, tenderness, hot, refusal to weight bear, fever

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24
Q

What is the 1st line and gold standard diagnosis for osteomyelitis?

A

X-ray and MRI

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25
What is the treatment for osteomyelitis?
6 weeks IV flucloxacilin and Rifampicin for first 2 weeks
26
What is Perthes Disease?
Disruption in blood flow to the femoral head causing avascular necrosis of the bone followed by revascularisation and reossification
27
What are the risk factors for Perthes Disease?
ADHD, deprivation, passive smoking, low birth weight
28
What does Perthes Disease affect?
Epiphysis of the femur
29
What is the main complication of Perthes Disease?
Soft and deformed femoral head leading to early hip osteoarthritis
30
What is the presentation of Perthes Disease?
Slow onset Pain in hip or groin Limp Reduced ROM of hip
31
What are some investigations for Perthes Disease?
X-ray Blood tests Technetium bone scan MRI
32
What is discoid meniscus?
Developmental abnormality of the meniscus It can be complete where the tibia is completely covered by the meniscus
33
What is the presentation of discoid meniscus?
Visible or audible palpable snap on terminal extension Pain Swelling Locking Meniscal tear Click during movement
34
What is the diagnosis for discoid meniscus?
MRI
35
What is the treatment for discoid meniscus?
Arthroscopic partial menisectomy
36
What is slipped capital femoral epiphysis?
The head of the femur slips along the growth plate from a fracture through the growth plate
37
Who is slipped capital femoral epiphysis most common in?
Boys, 8-15 years during a growth spurt Also obese children
38
What is the presentation of slipped capital femoral epiphysis?
History of minor trauma triggering onset Hip, groin, thigh or knee pain Painful lump Reduced hip ROM
39
What are the investigations for slipped capital femoral epiphysis?
X-ray (lateral frog view) Bloods Technectium bone scan MRI and CT
40
What is Osgood Schlatters?
Inflammation at the tibial tuberosity where the patella ligament inserts.
41
What is the presentation of osgood schlatters?
Visible or palpable hard lump on tibial tuberosity Pain in anterior aspect of knee
42
What is a rare complication of osgood schlatters?
Full avulsion fracture where tibial tuberosity is separated from the rest of the tibia requiring surgery
43
What is developmental dysplasia of the hip?
Structural abnormality in the hips caused by abnormal development of foetal bones in pregnancy Instability in hips with tendency for subluxation or discloation
44
What are some risk factors for developmental dysplasia of the hip?
Family history Breech presentation Multiple pregnancy Females First child
45
When is developmental dysplasia of the hip screened for?
NIPE
46
What are the special tests for developmental dysplasia of the hip?
Barlow (dislocate) and Ortolani (relocate)
47
What are the investigations for developmental dysplasia of the hip?
USS, X-ray
48
What is the management of developmental dysplasia of the hip?
Pavlik harness Surgery
49
What is JIA?
Autoimmune mediated inflammation which occurs within the joints
50
What are some features of systemic JIA/ Stills?
Systemic illness, salmon-pink rash, high fevers, weight loss, joint inflammation and pain, splenomegaly, muscle pain, pericarditis
51
What are the investigations for systemic JIA?
ANA and RF negative Raised CRP, ESR, platelets and ferritin
52
What is a complication of systemic JIA?
Macrophage Activation Syndrome - massive inflammatory response causing DIC and low ESR
53
What are features of oligoarticular JIA?
4 or less joints, usually large More in girls under 6 Anterior uveitis is classic
54
What are some features of polyarticular JIA?
5 or more joints usually hands and feet Symmetrical RA in children basically
55
What is torticollis?
Neck muscles spasm and your neck twists to the side
56
What is the most common cause of congenital torticollis?
Sternocleidomastoid tumour
57
Name some causes of acquired torticollis
JIA, meningitis, osteomyelitis, discitis, URTI, otitis media, CNS or bone tumours
58
What are some investigations for torticollis?
Cervical spine plain x-ray USS CT or MRI neck
59
List some causes of limp in a child under 4
Toddlers fracture NAI Osteomyelitis Septic arthritis Developmental dysplasia of the hip
60
List some causes of a limp in a child 4-10 years
Trauma Transient synovitis Osteomyelitis Septic arthritis Perthes Disease
61
What is the treatment for transient synovitis?
Rest Physio NSAIDs
62
What investigations should you do if you suspect Septic Arthritis? What would these investigations show?
Blood cultures positive Raised WCC and CRP X-ray shows delayed bony changes not evident for 14-21 days
63
Which criteria is used to identify a child with septic arthritis?
Kocher's criteria Fever over 38.5 Cannot weight bear ESR over 40 in 1st hour WCC over 12
64
What test can be used to identify Perthes Disease?
Roll test
65
What are the signs of DDH?
Unequal leg length Asymmetrical skin creases in thigh or buttock

3a Child Health (14 decks)

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