MSK disorders Flashcards

Question

What are the complications of osteomyelitis?

Answer 1

``` Chronic osteomyelitis with sinus discharge Bone necrosis Limb deformity Amyloidosis Joint destruction Septic arthritis Subperiosteal abscess Sepsis ```

Answer 2

Blood cultures and FBC with CRP and Xray/USS IV Abx until CRP drops and clinical recovery Continue PO Abx for several weeks Aspirate if very grave Surgical drainage if no response Splint the limb and mobilise later

Answer 3

Referred from hip Local knee -Osteochondritis of patellar tendon insertion -Chondromalacia of patellar articular cartilage -Avascular necrosis of femoral condyles -Patella subluxation and dislocation

Answer 4

``` #1-3 years -Septic arthritis/osteomyelitis -Transient synovitis -Trauma -ALL/Neuroblastoma #3-10 years -Transient synovitis -Septic arthritis/osteomyelitis -Trauma/overuse -Acute Perthes disease -JIA -ALL -CRPS #11-16 years -Mechanical -Acute slipped capital femoral epiphysis -AVN of femoral head -Reactive arthritis -JIA -Septic arthritis/osteomyelitis -AVN of femoral condyles -Bone tutors/malignancy CRPS ```

Answer 5

``` #1-3 years DDH CTEV CP JIA #3-10 years Chronic Perthes disease DMD JIA Tarsal coalition #11-16 years Chronic slipped capital femoral epiphysis JIA Tarsal coalition ```

Answer 6

Onset - acute limp, non weight bearing, follows viral infection Fever - mild/absent Appearance - Clinically well, 2-12 year olds Hip movement - Painful on moving, limited internal rotation, no pain at rest WBC - normal CRP/ESR - normal, slightly high USS - effusion Xray - normal Management - rest, analgesia Follow up - resolves within a week 3% may get Perthes' disease

Answer 7

Onset - acute limp, non weight bearing Fever - high Appearance - Clinically ill looking Hip movement - held in flexion, pain at rest, worsens on moving WBC - high CRP/ESR - high USS - effusion Xray - widened joint space Management - aspiration, antibiotics, rest, analgesia, blood cultures Follow up - joint destruction if untreated

Answer 8

Transient synovitis

Answer 9

Avascular necrosis of the capital femoral epiphysis of the femoral head due to interruption of blood supply Followed by revascularisation and reossification over 18-36 months M>F 5:1 20% bilateral Insidious limp, hip or knee pain Xray both hips, can do MRI, bone scan Prognosis good if <6 years and <50% epiphysis affected Complications - femoral head deformity, degenerative arthritis

Answer 10

Early (hyper dense femoral head) -bed rest and traction Late (fragmented irregular femoral head) -maintain hip in abduction

Answer 11

Displacement of the epiphysis of the femoral head postero-inferiorly which can lead to avascular necrosis Restricted abduction and internal rotation 10-15 years of age Mostly in obese boys 20% bilateral Associated with hypothyroidism, hypogonadism Mx = pin fixation in situ

Answer 12

Infection - bacterial, TB, viral, atypical, reactive, RF IBD - CD, UC Vasculitis - HSP, Kawasaki disease Haematological - Hemophilia, SCD Malignancy - ALL, neuroblastoma CTD - JIA, SLE, dermatomyositis, MCTD, PAN Genetic - cystic fibrosis

Answer 13

``` Rubella Mumps Adenovirus Coxsackie B Herpes Hepatitis Parvovirus ```

Answer 14

Reactive arthritis (GI infection, strep infection, RF) Transient joint swelling < 6 weeks Ankles or knees, low grade fever NSAIDs only Salmonella, Shigella, Capylobacter, Yersinia Chlamydia, Gonococcus, Mycoplasma, Borrelia

Answer 15

``` Most common in <2 years old Acutely unwell child with a joint with acute inflammation Can cause bone destruction Staph aureus (single joint), Hib (multiple joints) Pseudoparesis with hip in flexion, abduction and external rotation ```

Answer 16

Young pubertal girls Malaise, arthralgia, malar rash Kidney, CNS, lung involvement

Answer 17

JDMS is rare Malaise, proximal myopathy Facial malar rash over nasal bridge Heliotrope rash of eyelids

Answer 18

``` Most common vasculitis of children Purpuric rash over lower legs and buttocks Ankle or knee arthritis Abdominal pain Hematuria Proteinuria ```

Answer 19

``` FBC, CRP, BCx, Aspiration and USS Bone scan and MRI IV Abx, joint drainage Immobilize then mobilise Analgesia ```

Answer 20

Most common chronic inflammatory joint disease in children Persistent joint swelling > 6 weeks Before 16 years of age In the absence of infection or other causes 95% of cases are different from Rheumatoid arthritis Affects 1:1000 7 subtypes based of number of affected joints in the first 6 months of the disease

Answer 21

Polyarthritis (>4 joints) - poor prognosis Oligoarthritis (4 or less joints) - most common, best prognosis Systemic (with fever and salmon pink rash) - poor prognosis Psoriatic Enthesitis Undifferentiated

Answer 22

Gelling (stiffness after rest) Morning stiffness Pain Intermittent limp Behavioural change and avoidance behaviour Joint swelling (fluid, inflammation, proliferation) Bone overgrowth (deformities)

Answer 23

``` Chronic anterior uveitis and blindness Flexion contractures in joints Growth failure Anemia of chronic disease Delayed puberty Osteoporosis Amyloidosis and proteinuria with CKD ```

Answer 24

Calcium and vit D supplements Regular weight bearing exercises Minimise corticosteroid therapy Bisphosphonates

Answer 25

``` Goals are to induce remission and prevent deformity and disability Refer to Paed Rheumatology Education and support for child and family Physiotherapy to protect joint function Eye referral Avoid contact sports in active flares NSAIDs during flares IA steroid injections Weekly SC MTX with FBC, LFT monitoring IV Methylprednisolone pulses Biologics in severe cases Joint Xrays ANA and RF and HLAB27 ```

Answer 26

``` 1:3 will have active disease as adults Joint replacement surgery Vision loss Fractures from osteoporosis Psychosocial effects ```

Answer 27

``` Fever, salmon pink macular rash LN and HSM Serositis Oligo or poly arthritis Poor prognosis 1:1 male female ```

Answer 28

``` Either RF + or - Females 5 times more likely Symmetrical large and small joints and fingers Rheumatoid nodules in RF + C spine and TMJ joints in RF - ```

MSK disorders Flashcards

(52 cards)