MSK Flashcards
(72 cards)
1
Q
Define Slipped upper femoral epiphysis - SUFE
A
The head of the proximal femur epiphysis is displaced (“slips”) along the growth plate
2
Q
SUFE imaging Ix
A
Bilateral X-ray: Anteropost and ‘frog leg’ lateral position
3
Q
Septic arthritis gold standard Ix
A
Aspiration of the joint: Gram staining, cell count, glucose level, crystal analysis cultures
4
Q
Osteomyelitis Risk Factors
A
- Trauma from injury
- bones growing more blood supply easier for bacteria to travel into the bone
- Open bone fracture
- Orthopaedic surgery
- Immunocompromised
- Sickle cell anaemia
- HIV
- Tuberculosis
5
Q
Osteomyelitis Sx
A
- Fever
- Tiredness
- Erythema
- Oedema
- Fussiness / irritability
- Lethargy
6
Q
Vit D deficiency Loading dose in Age 1–5 months
A
3000 IU daily for 8–12 weeks.
7
Q
Current guidance on vitamin d supplements in children under 5
A
- 0-1 year Vit. D RDI:
8.5-10mcg - 1-4 years RDI Vit D RDI: 10 mcg
8
Q
When is vit D supplement not indicated for children
A
- > 500ml of infant formula a day
Fortified with vit D
9
Q
Vit D deficieny risk factors
A
- Low / no exposure to the sun
- Dark skin tone
- Exclusively breastfed babies
- GI / malabsorption disorders: Coeliac, lactose intolerance, Cystic fibrosis
- Insufficient maternal vit D
- Premature baby
10
Q
Define Osgood-Schlatter Disease
A
An inflammation at the tibial tuberosity where the patella ligament inserts
11
Q
Oliogoarticular JIA
A
- affecting 1-4 joints in the first 6/12
- commonly affects the knee and ankle
- assoc with other inflammation (uveitis)
12
Q
late stages of arthiriris
A
joint spaces narrowed and spaces fuse together
13
Q
RED FLAGS in children
A
Fever: Septic arthritis,
WL
14
Q
Osgood-Schlatter Disease presentation
A
- Ant. knee pain
- Pain is exacerbated by physical activity; running, jumping, and on extension of the knee
- Visible or palpable hard and tender lump at the tibial tuberosity
- Usually unilateral
15
Q
OSD pathophysiology
A
There are multiple small avulsion fractures, where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially this bump is tender due to the inflammation, but has the bone heals and the inflammation settles it becomes hard and non-tender.
16
Q
OSD Risk factors
A
- Male > Female
Growth spurt age: - Boys 12-15 years
- Grils 8-12 years
- Active in sports which include running, jumping, and repetitive bending of the knee are at greater risk of developing the condition.
17
Q
OSD complications
A
- Full avulsion fracture
- Ossicles (bony fragments) formation in the knee - may impinge on the patellar tendon, causing pain and limiting activity
18
Q
OSD Sx
A
- Gradual onset of pain
- Swelling below the knee
- Pain relived on resting
- Pain exacerbate by activities
19
Q
OSD Dx
A
- Tenderness over the tibial tuberosity that is provoked by knee extension against resistance
- Firm or bony enlargement of the tibial tuberosity
20
Q
OSD Mx
A
- Rest
- Ice
- Analgesia / NSAIDs
- Physios
- Avoid aggrevating activities
- Refer Paeds ortho for persistent Sx
21
Q
SUFE X-ray findings
A
- Widening of epiphyseal line or displacement of the femoral head
- Klein’s line does not intersect the femoral head
22
Q
SUFE Acute presentation
A
- < 3/52 of Sx onset
- Painful limp
- External rotation of the hip joint
- length discrepency
- unable to weight bear
23
Q
SUFE examination findings
A
- External rotation of the hip
- Leg length discrepency
- Limited ROM on internal rotation and abduction of the hip
24
Q
SUFE Risk Factors
A
- Obesity
- Endocrine disorders
- Puberty: Girls 11-12 years
Boys 12-13 years
25
SUFE Mx
- Refer to paeds ortho **stat**
- Avoid excessive movements / weight bear on the affected hip
- Analgesia
- **Surgically:** In situ single-screw fixation of the epiphysis
26
SUFE complications
Avascaular necrosis AKA Osteonecrosis
27
Septic arthritis diagnostic criteria in aspiration
WBC > 50,000
28
Septic arthritis diagnostic criteria for **prosthetic** in aspiration
WBC > 1100
29
Paed Septic arthritis presentations
- Acute presentation
- unable to weight bear
- Hot, swollen, painful, restricted joint
- Fever (60% of cases)
- Erythema
- Swelling
30
Septic Arthritis examination findings
- Erythema
- Effusion
- Hot to touch
- Pain on palpation
- Fever
- Systemically unwell
31
Septic arthritis aspiration fluid characteristics
- Purulent
- Cloudy
32
Septic arthritis common causative organism
- Staph aureus
33
Septic arthritis Mx
- Empirical Abx until sensitivities
- Abx for 6/52 from diagnosis
- Surgical drainage and washout of the joint to clear the infection in severe cases
34
Osteomyelitis epidemiology
- < 5 years
- long bones: arms / legs
35
Paeds Osteomyelitis common site
metaphysis of the long bones
36
Paeds Osteomyelitis common causative organism
Staph aureus
37
Acute Paeds osteomyelitis
Infection in the bone - over 2/52
38
Paeds osteomyelitis Ix
- **Bloods:** FBC, ESR, CRP
- Blood culture: Before commencing Abx
- X-rays
- MRI
- Bone scan
39
Paeds osteomyelitis Mx
1. **Admit**
2. Blood culture
3. Think **Sepsis**: IV Abx after blood culture / within 1h of presenting for high risk sepsis patient
40
Paeds osteomyelitis complications
- Sepsis
- Osteonecrosis AKA AVN
- Bone abscess
- Septic arthritis
- Chronic osteomyelitis
41
Paeds Septic arthritis complications
**Joint damage:** Septic arthritis can cause permanent damage to joints, including joint degeneration, stiffness, and dysfunction.
**Osteomyelitis:** An infection of the bone itself
**Osteonecrosis:** Bone tissue dies due to lack of blood flow
**Sepsis:** A widespread inflammation in the body
**Death:** In severe cases, septic arthritis can lead to death
**Limb length discrepancy:** A difference in the length of one leg compared to the other
42
Vit D deficiency serum level in children
Serum 25-hydroxyvitamin D (25[OH]D) levels < 25 nmol/L
43
Vit D sufficient serum level in children
Serum 25-hydroxyvitamin D (25[OH]D) levels > 50 nmol/L
44
Vit D deficiency in children complications
- Rickets
- Osteomalacia and muscle weakness
- Hypocalcaemia: seizures
- Dilated cardiomyopathy
45
Vit D deficiency Loading dose in Age 6-11 months
6000 IU daily for 8–12 weeks.
46
Vit D deficiency Loading dose in Age 12–18 years
- 10,000 IU daily for 8–12 weeks.
- A single or divided oral dose totalling 300,000 IU can be considered if there is concern about compliance with treatment.
47
Vit D deficiancy daily maintenance dose in children post loading dose regime
400–600 IU daily for 1/12
48
Define Juvenile Idiopathic Arthritis (JIA)
A collective term used to describe arthritis that affects children and young individuals under the age of 16
49
Systemic JIA Sx
- Muscle / joint pain
- High swinging fever 37-39
- WL
- Salmon-pink rash
50
Systemic JIA presentations
- Lymphadenopathy
- Serositis: inflammation to the serous membranes (pericarditis, pleuritis, peeritonistis)
- Hepato / SPlenomeagly
- Salmon-pink rash
- High Temp
51
Systemic JIA ANA, RF findings
-ve
52
Systemic JIA inflammatory marker findings
Raised for CRP, ESR, PLTs, Ferritin
53
Systemic JIA complication
Macrophage activation syndrome (MAS)
## Footnote
disseminated intravascular coagulation
54
Define Oligoarticular JIA AKA Pauciarticular JIA
Arthritis involving < 4 joints
55
Oligoarticular JIA Risk factors
- Female > Male
- Age < 6years
56
Oligoarticular JIA extrarticular complication
Ant. uveitis
57
Oligoarticular JIA Sx
- Pain in joints
- Swelling in joints
- Morning stiffness
**NO Systemic Sx**
58
Oligoarticular JIA auto-antibodies findings
- RF -ve
- ANA +ve
59
Oligoarticular JIA Mx
- Refer to paed Rheum
- **Intra-articular steroid injection**
60
Oligoarticular JIA commonly affects which joints
Large joints: knee and ankle
61
Define Polyarticular JIA
Idiopathic inflammatory arthritis in > 5 joints
62
Polyarticular JIA presentations
- can be Symmetrical inflammation
- affects smaller joints e.g. hands
- **Minimal** systemic Sx
63
Polyarticular JIA subtypes
- Seronegative: RF -ve
- Seropositive: RF +ve
64
Polyarticular JIA seronegative prevalence
toddler - preschool age
Female > Male
65
Polyarticular JIA seropositive prevalence
older children and adolescents
66
Define Juvenile Psoriatic Arthritis
seronegative (RF -ve) inflammatory arthritis associated with psoriasis
67
Juvenile Psoriatic Arthritis presentations
- **Plaques of psoriasis**on the skin
- **Pitting of the nails** (nail pitting)
- **Onycholysis**, separation of the nail from the nail bed
- **Dactylitis** inflammation of the full finger
- **Enthesitis**, inflammation of the entheses, which are the points of insertion of tendons into bone
68
Systemic JIA Mx
- Refer to paeds rheum
- Physical activities
- Physio
- Oral steroid
69
JIA bloods Ix
- FBC, CRP, ESR, ANA, RF
70
JIA imaging Ix
- **X-rays:** to exclude trauma, osteomyelitis or malignancy
- **Ultrasound:** can show joint fluid, synovial hypertrophy and erosions if present
- **MRI:** delineates any bony changes, joint damage and extent of synovitis
71
JIA X-ray findings
- Bone erosion
- Narrowing of joint space
- Fusion of bones
72
Chronic JIA complications
- Growth failure or abnormality
- Osteoporosis
- Delayed puberty
