WRY neck - restriction of head turning - mobile, non-tender nodule (felt within SCM) W

MSK Flashcards by Laura Lazzari

What is genu varum

Bow legs (knees far apart, legs bowed)

How well did you know this?

Not at all

Perfectly

What are pathological causes of gene varum

Rickets 
Blount disease (condition in black children, unilateral)

How well did you know this?

Not at all

Perfectly

What is genu valgum

knees close when standing, feet far apart

Intermalleolar distance >8cm

How well did you know this?

Not at all

Perfectly

What is flat feet

aka pes planes

flat medial longitudinal arch (normal before child walks, because of fat pad under foot)

How well did you know this?

Not at all

Perfectly

What are three main causes of intoning

Metatarsus varus (forefoot adduction)
Medial tibial torsion
Femoral anteversion

How well did you know this?

Not at all

Perfectly

What is the latin name for clubfoot

Talipes equinovarus

How well did you know this?

Not at all

Perfectly

What is the cause of clubfoot

oligohydramnios
deformity in utero, from intrauterine compression

OR malformation

OR neuromuscular disorder

How well did you know this?

Not at all

Perfectly

What is the foot like in clubfoot

inverted
supinated
in plantar flection

How well did you know this?

Not at all

Perfectly

How do you treat clubfoot

Ponseti method (plaster casing and bracing)

Surgery may be required if severe (Achilles tenotomy)

How well did you know this?

Not at all

Perfectly

What is vertical talus like

Foot is stiff

Rocker bottom foot

How well did you know this?

Not at all

Perfectly

What is pet cavus

High arched foot

Associated with neuromuscular disorder e.g. Friedrich Ataxia

How well did you know this?

Not at all

Perfectly

What is scoliosis

lateral curvature of the spine

How well did you know this?

Not at all

Perfectly

What is the dangerous complications scoliosis

cardiorespiratory failure

from distortion of the chest

How well did you know this?

Not at all

Perfectly

What is torticollis

WRY neck

restriction of head turning
mobile, non-tender nodule (felt within SCM)

How well did you know this?

Not at all

Perfectly

What is the most common cause of torticollis

SCM tumour

How well did you know this?

Not at all

Perfectly

What are chromosomal causes of hypermobility

Downs

Marfans, Ehler Danlos

How well did you know this?

Not at all

Perfectly

What is complex regional pain syndrome

Musculoskeletal pain of unknown origin

How well did you know this?

Not at all

Perfectly

Who does complex regional pain syndrome occur in

teenage females

How well did you know this?

Not at all

Perfectly

What kind of pain is experienced in complex regional pain syndrome

Extreme / incapacitating
may be locatlised on foot and ankle

Hyperanaestheisa
allodynia

How well did you know this?

Not at all

Perfectly

What is osteomyelitis

infection of metaphysis of long bones (e.g. femur, tibia)

How well did you know this?

Not at all

Perfectly

What does osteomyelitis arise from

Haematogeneous spread

Direct spread from infected wound

How well did you know this?

Not at all

Perfectly

What are pathogens causing osteomyelitis

S aureus
Streptococcus
H influenza

How well did you know this?

Not at all

Perfectly

What are features of osteomyelitis

painful, immobile limb
swelling and tenderness over site
movement cause s èpain
acute febrile illness

How well did you know this?

Not at all

Perfectly

What investigations do you do for osteomyelitis

Blood cultures (+ve)
WCC, CRP 
X rays (normal until 7-10 days, when you get new bone formation) 
MRI 
Radionucleotide bone scan

How well did you know this?

Not at all

Perfectly

What is management for acute osteomyelitis

high dose IV antibiotics | surgical debridement

What are the two most malignant types of bone tumour

Ostoegenic sarcoma | Ewing tumour

What is Osgood-Schattler Disease

Osteochondritis of patellar tendon insertion at the knee

Who does Osgood-Schattler Disease affect

Adolescent males who are very physically active

What are key symptoms of Osgood-Schattler Disease

knee pain after exercise localised tenderness swelling over tibial tuberosity

What is management for Osgood-Schattler Disease

Stop sporting activity Pain relief (NSAID, paracetamol, ice packs)

What is chondromalacia patellae

Softening of thew articular cartilage of the patella, affecting adolescent females

What is osteochondritis dissecans

avascular necrosis of subchondral bone

What is Perthes disease

Avascular necrosis of the capital femoral epiphysis due to interruption of blood supply Followed by revascularisation and reossification over next 2 years

What is reactive arthritis

Transient joint swelling following extra-articular infection

What causes reactive arthritis

``` Enteric bacteria (salmonella, shigella, campylobacter) STI (chlamydia, gonorrhoea) ```

How do you treat reactive arthtritis

You DON'T - SELF RESOLVING

What is septic arthritis

Serious infection of the joint that can lead to bone destruction

How do you treat septic arthritis

Prolonged course of antibiotics (IV 2 weeks, oral 4 weeks)

What is juvenile idiopathic arthritis

persistent joint swelling >6 weeks presenting before 16 years of age in absence of any other causes

How do you classify JIA

Polyarthritis >4 joints | Oligoarthritis <4 joints

What are clinical features of JIA

Gelling (stiffness after rest) Morning stiffness Joint pain, swelling Intermittent limp

What investigations should you consider for JIA

ANA

How do you manage JIA

Specialised paeds rheum clinic NSAIDS Corticosteroids DMARD (methotrexate PO/SC)

What is achondroplasia

short stature short limbs large head with frontal bossing pincer grip

What is thanatophoric dysplasia

results in stillbirth | large head, very short limbs

What is arthrogyposis

stiffness and contractor of joints

What is the difference in presentation between Osgood-Schattler and Chondromalacia Patellae

OSD: males, knee pain after lots of exercise chondromalacia patellae: females, anterior knee pain on rising from sitting, walking upstairs

What is another differential for knee pain after exercise

osteochondritis dissecans

What is the presentation of Perthes disease

``` 5-10 year olds limp / knee pain Pain worse after exercise Reduced range of movement stiffness One leg shorter than other ```

How do you investigate Perthes

Bilatera x ray (widening of joint space, m decrease in femoral head size) Bone scan, MRI

How do you manage Perthes disease

Acute pain with analgesia <5yo good prognosis from observation only >5yo consider surgery

what is pathophysiology of Slipped Capital Femoral Epiphtysis

fracture through growth palate of femur > slippage of femoral ahead epiphysis poster-inferiorly

what is classic person that will present with Slipped Capital Femoral Epiphysis

Obese teenager Other metabolic abnormality (hypothyroid, hypogonad) 10-15 year old

What is presentation of Slipped Capital Femoral Epiphysis

gradual onset limp hip or knee pain pain on abduction and internal rotation, restricted movements

How do you confirm Slipped Capital Femoral Epiphysis diagnosis

Bilateral hip X ray (AP + frog view)

How do you manage Slipped Capital Femoral Epiphysis

DONT LET THE PATIENT WALK analgesia immediate ORTHO REVIEW Surgical repair: internal fixation

What is pattern of inheritance for achondroplasia

AUTOSOMAL DOMINANT So in GoT one parent must've been a dwarf also !!

What children need to have an USS at 6 weeks to check for DDH?

``` Breech presentation at 36/40 (regardless of presentation at delivery) Breech delivery (incl <36/40) Family history of DDH ```

when do you change from USS to X ray for DDH

6 months

What DMARD is first line in JIA

Methotrexate

how do you manage patient with rickets

if vit D deficient: daily calcium + ergocalciferol / cholecalciferol

what X ray finding do you see in SCFE

Thethowan's sign: line of Klein does not interset superior femoral epiphysis

what is the most common cause of acute hip pain in children, and when does it occur

transient synovitis often with / after viral infection

what are symptoms of transient synovitis

sudden onset pain in the hip / limp no pain at rest decreased range of movement mild febrile / afebrile

What is still's disease?

Arthritis with SALMON PINK RASH + pyrexia, uveitis, anorexia, WL essentially a systemic form of JIA

what rash do you get in juvenile dermatomyositis

helkiotropid discoloration of eyelids erythema over bridge of nose

what are findings on X ray of Perthes

widening of joint space | then decreased femoral head size

what are findings on X ray of SCFE

Trethowan's sign: lines of klein does not intersect femoral head

what criteria can you use to differentiate septic arthritis from transient synovitiss

KOCHER's CRITERIA

What are Kocher's criteria

- Fever >38.5 - refusal to bear weight on affected side - Raised ESR/CRP - Raised WCC

MSK Flashcards

(70 cards)