MSK

Question 1

14 yo boy presents to GP with anterior kneee pain which is worse when playing football. on examination he is tender when palpating the tibial tuberosity

Answer 1

Osgood-schlatter disease

Question 2

Risk factors for osgood Schlatter disease

Answer 2

Male - usually in their growth spurt (9-14 yo) when bones, tendons etc are still growing
Sporty children

Question 3

Prognosis of Osgood schlatter disease

Answer 3

self-limiting> usually gets better within 1 to 2 years when person reaches puberty ( only 10% can go into adulthood)

Question 4

Major RF for slipped upper femoral epiphysis

Answer 4

1. Obesity (80% of diagnosed children are obese)

2. 91% will be below the 10th percentile for height

Question 5

Diagnostic method for slipped upper/capital femoral epiphysis
? findings

Answer 5

X- ray (gold standard) - anteroposterior and frog leg lateral xray to be specific

Finding = widening of epiphyseal line or displacement of femoral head

Question 6

Management of Slipped upper femoral epiphysis

Answer 6

Provide analgesia + immediate referral for ortho for surgery

Question 7

Gold standard treatment for Slipped upper femoral epiphysis

Answer 7

Surgery - Single in situ screw fixation (across growth plate)

Question 8

Common cause of septic arthritis + acute osteomyelitis

Answer 8

Bacterial - mainly staphy aureus

Question 9

Investigation for septic arthritis

Answer 9

1. Bloods - FBC + ESR/CRP
2. Aspiration of joint***
   - if WCC > 50,000 (diagnostic) * if prosthetic joint then > 1100
   - fluid tends to be purulent/cloudy

Question 10

Management and Treatment for septic arthritis

Answer 10

Medical emergency > hospital admission

IV abx ( then prescribed abx for 6 months after) + urgent washout (incision in knee then flush with saline)

Question 11

the common cause of acute osteomyelitis and why

Answer 11

Bacterial - Staph aureus
*Children have an increased blood supply to their bones as the child is growing, therefore, making it easier for bacteria to get to the bone

Question 12

Gold standard for diagnosing Acute osteomyelitis

Answer 12

• Bone biopsy/culture

Other include FBC, inflammatory markers, blood culture , imagine or bone scan

Question 13

Treatment of acute osteomyelitis

Answer 13

Admit to hospital - extensive surgical cleaning + IV antibiotics

Question 14

Best indicator of Vit D exposure from both sun and diet

Answer 14

25 (OH)D

Question 15

RF of vitamin D deficiency

Answer 15

1. lack of sun exposure or spend little time outdoors
2. dark skin
3. vegans or poor diet
4. exclusively breastfed babies from birth (especially if mother had low vi D during pregnancy)
5. Obesity
6. Fhx

Question 16

You can diagnose Vitamin D deficiency in children if there 25(OH)D levels are

Answer 16

Less than 25 nmol/l

Question 17

age 1- 6 months require ? Vit D supplement doses

Answer 17

3000IU dailyfor 8-12 weeks

Question 18

age 6 months to 12 years require ? Vit D supplement doses

Answer 18

6000 IU daily for 8- 12 weeks

• 10,000 UI for 12 to 18 years

Question 19

Diagnostic procedure for rickets

Answer 19

X-ray

• also check 25OHD for vitamin D deficiency which is a cause of Rickets

Question 20

Juvenile idiopathic arthiritis

Answer 20

joint inflammation
presenting in children < 16
and persisting for at least 6 weeks
with other causes excluded

Question 21

most common type of juvenile idiopathic arthritis

Answer 21

Oligoarticular JIA followed by polyarticular JIA (RF -ve)