MSK

Question 1

What is osteogenesis imperfecta?

Answer 1

Genetic cdtn that results in brittle bones that are prone to fractures (brittle bone syndrome). This happens due to mutations that affect collagen formation.

Question 2

Sx of osteogenesis imperfecta?

Answer 2

• Blue/grey sclera
• Hypermobility
• Triangular face
• Short stature
• Joint + bone pain
• Bone deformaties (bowed legs + scoliosis)

Question 3

Ix for osteogenesis imperfecta?

Answer 3

• Clinical diagnosis
• Xrays
• Genetic testing

Question 4

Mx of osteogenesis imperfecta?

Answer 4

No cure but can be mx by:
* Bisphosphonates - inc. bone density
* Vit D supplementation - prevent deficiency
* Physio

Question 5

What is rickets?

Answer 5

Defective bone mineralisation causing “soft” + deformed bones

Question 6

Causes of rickets?

Answer 6

MC - Deficiency in vit. D or calcium
Rarely - Genetic (hereditary hypophosphataemic rickets - x-linked dominant)

Question 7

What are bone deformities that can occur in rickets?

Answer 7

• Bowing of legs (leg curve outwards)
• Knock knees (leg curve inwards)
• Rachitic rosary (ribs expand at costochondral junctions causing lumps along chest)
• Craniotabes (soft skull)
• Delayed teeth (enamel underdevelopment)

Question 8

Vit D deficiency/rickets sx?

Answer 8

• Lethargy
• Bone pain
• Swollen wrists
• Bone deformity
• Dental problems
• Muscle weakness

Question 9

Ix for rickets?

Answer 9

• Serum 25-hydroxy vitamin D
• Xray
• Serum calcium, phosphate, PTH, alkaline phosphatase
• Bloods - FBC, ESR, CRP, LFTs

Question 10

Mx of rickets?

Answer 10

Vit D supplement:
* 400 IU per day for children + young people

If vit D deficiency - Vitamin D (ergocalciferol):
* If between 6 mths and 12 yrs give 6000 IU per day for 8-12 wks

Question 11

What is transient synovitis?

Answer 11

Temporary (transient) irritation + inflammation in synovial membrane of joint (synovitis).

Sometimes referred to as irritable hip + often associated with recent viral URTI but typically do not have a fever.

Question 12

Sx of transient synovitis?

Answer 12

Often occurs within a few wks of viral illness:
* Limp
* Refusal to wgt bear
* Groin or hip pain
* Mild low grade temp

Question 13

Mx of transient synovitis?

Answer 13

Simple analgesia + safety net if sx get worse i.e. worsen or develop fever to attend A&E immediately

Question 14

What is septic arthritis?

Answer 14

Infx inside a joint leading to systemic illness.

Question 15

What are the common bacteria that causes septic arthritis?

Answer 15

MC - staph aureus
Other:
* N. gonorrhoea
* Group A strep
* H. influenza
* E.coli

Question 16

Sx of septic arthritis?

Answer 16

Usually only affects a single joint (often knee or hip). Presents with:
* Hot, red, swollen and painful joint
* Refusing to weight bear
* Stiffness + reduced ROM
* Systemic sx i.e. fever, lethargy and sepsis

Question 17

Ix for septic arthritis?

Answer 17

Joint aspiration for gram staining, crystal microscopy and culture

Question 18

Tx of septic arthritis?

Answer 18

Empirical IV antibiotics
If severe - sugical drainage + joint washout

Question 19

What is osteomyelitis?

Answer 19

Infx in bone + bone marrow typically in metaphysis of long bones. The infx may be introduced directly into the bone i.e. during open frax or travel to bone through blood.

Question 20

What is the MC bacteria that causes osteomyelitis?

Answer 20

Staph aureus

Question 21

RF for osteomyelitis?

Answer 21

• Open bone frax
• Ortho surgery
• Immunocompromised
• Sickle cell anaemia
• HIV
• TB

Question 22

Sx of osteomyelitis?

Answer 22

• Refusing to use limb or weight bear
• Pain
• Swelling
• Tenderness

Question 23

Ix for osteomyelitis?

Answer 23

• 1st line - Xrays
• GS - MRI
• Bloods - CRP + ESR + WBCs
• Bone marrow aspiration

Question 24

Mx of osteomyelitis?

Answer 24

Abx
Surgery if severe - drainage

Question 25

What is Perthes disease?

Answer 25

Disruption of blood flow to the femoral head causing avascular necrosis of bone. This affects epiphysis of femur. ## Footnote * Avascular necrosis = the death of bone tissue due to a lack of blood supply. * Epiphysis of femur = the end of the femur that connects with the hip consists of a “ball”

Question 26

Sx of Perthes disease?

Answer 26

Slow onset of: * Pain in hip or groin * Limp * Restricted hip movements * Knee pain ## Footnote Note - there will be no history of trauma.

Question 27

Ix for Perthes disease?

Answer 27

* 1st line - Xray * Bloods * Technetium bone scan * MRI scan

Question 28

Mx of Perthes disease?

Answer 28

* Initial - conservative (bed rest, crutches, analgesia) * Physiotherapy * If severe - surgery

Question 29

What is slipped upper femoral epiphysis (SUFE)?

Answer 29

When head of femur is displaced (slips) along the growth plate. It's MC in obese children.

Question 30

Sx of slipped upper femoral epiphysis?

Answer 30

* Hip, groin, thigh or knee pain * Restricted hip ROM * Painful limp * Pts prefer to keep hip in external rotation Typical exam presentation - adolescent, obese boy undergoing growth spurt

Question 31

Ix for slipped upper femoral epiphysis?

Answer 31

* 1st line - xray * Bloods - infl. markers * CT/MRI * Technetium bone scan

Question 32

Mx of slipped upper femoral epiphysis?

Answer 32

Surgery - return femoral head to correct position + fix it in place to prevent further slipping.

Question 33

What is osgood-schlatter?

Answer 33

Infl. at tibial tuberosity where patella ligament inserts

Question 34

What causes osgood-schlatter?

Answer 34

Stress from running, jumping and other movements at same time as growth in epiphyseal plate.

Question 35

Sx of Osgood-Schlatter?

Answer 35

* Visible or palpable hard + tender lump at tibial tuberosity * Pain at anterior aspect of knee * Pain exacerbated by physical activity, kneeling + on knee extension

Question 36

Mx of Osgood-Schlatter?

Answer 36

* Ice * NSAIDs * Reduce physical activity * Physio + stretching once sx settle

Question 37

What is juvenile idiopathic arthritis?

Answer 37

Arthritis that affects children and young individuals under 16 yrs where the aetiology is unknown.

Question 38

Sx of juvenile idiopathic arthritis?

Answer 38

* Arthritis lasting for 6 wks or more * Can affect single or multiple joints * Joint swelling + pain * Morning stiffness * Limited ROM

Question 39

Ix for juvenile idiopathic arthritis?

Answer 39

* Primarily clinical dx * Bloods - exclude causes * USS/MRI of affected joints * Joint aspiration - rule out infx or malignancy

Question 40

Mx of JIA?

Answer 40

* NSAIDs * Steroids - control infl. * Steroid-sparing agents - methotrexate or biological agents

Question 41

What is discoid meniscus?

Answer 41

Abnormality in knee joint where meniscus is shaped more like a disc than crescent shape

Question 42

Sx of discoid meniscus?

Answer 42

* Popping knee sounds * Knee pain + swelling * Limited ROM * Instability

Question 43

What is scoliosis?

Answer 43

When spine curves abnormally to the side forming "S" or "C" shape. Usually appears during growth spurt just before puberty.

Question 44

Sx of scoliosis?

Answer 44

* Visible curvature of spine * Uneven shoulders or hips * Protruding shoulder blade * Back pain * Restricted ROM

Question 45

Ix of scoliosis?

Answer 45

* Forward bend test * Xrays * MRI/CT scans

Question 46

What is torticollis?

Answer 46

Cdtn where neck muscles contract involuntarily causing head to twist or tilt to one side