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MSK Paed Flashcards

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1
Q
A
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2
Q

What is the difference in the onset of infection between paediatric and adult discitis?

A

Paediatric discitis starts in the disc itself due to direct blood supply, while adult discitis starts at the endplate and extends into the disc.

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3
Q

What is the abnormal measurement for scoliosis?

A

Cobb angle >10 degrees

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4
Q

What are some causes of scoliosis?

A
  • Neuromuscular (CP, Chari, syrinx, muscular dystrophy)
  • Hemivertebrae
  • Skeletal dysplasia
  • Tumours
  • Infection
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5
Q

What are the risk factors for cerebral palsy?

A
  • Premature
  • Low birthweight
  • Infection/meningitis
  • Head injury (PVL, HIE, stroke)
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6
Q

What are the clinical subtypes of cerebral palsy?

A
  • Spastic (80%)
  • Ataxic
  • Dyskinetic
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7
Q

What are the differential diagnoses for vertebral fusion in Klippel Feil?

A
  • Congenital segmental anomaly
  • JIA
  • Ankylosing spondylitis
  • Discitis
  • Post-traumatic
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8
Q

What are the diagnostic criteria for Scheuermann disease?

A

Sorensen criteria: kyphosis >40 degrees + 3 adjacent vertebrae with >5 degrees wedging

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9
Q

What is the differential diagnosis for developmental dysplasia of the hip (DDH)?

A

Physiologically immature hip - usually resolves by 3 months

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10
Q

What is the typical age group for DDH?

A

Newborn to 12 months

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11
Q

What are the risk factors for DDH?

A
  • Female
  • Firstborn
  • Breech delivery
  • Oligohydramnios
  • Spinal dysraphism
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12
Q

What are the normal acetabular and alpha angles in DDH?

A
  • Acetabular angle (<30 at birth, <22 at 1 year)
  • Alpha angle >60 (Graf method)
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13
Q

When would you stop following up on ultrasound for DDH?

A

Ultrasound <6 months while femoral head is not ossified, then AP x-ray after for more accuracy.

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14
Q

What is the differential diagnosis for septic arthritis?

A

Transient synovitis (3-8 years old, related to recent viral infection, self-limiting)

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15
Q

What is the management for septic arthritis?

A

Orthopaedic referral, likely require ultrasound-guided aspiration (mid-sagittal plane)

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16
Q

What is the epidemiology of Perthes disease?

A

5-6 year old boys

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17
Q

What is the pathology of Perthes disease?

A

Osteonecrosis - deficient blood supply to femoral epiphysis leading to fragmentation, bone loss, collapse

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18
Q

What is the age group for slipped capital femoral epiphysis (SCFE)?

A

10-17 year old boys, 8-15 year old girls

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19
Q

What is the management for SCFE?

A

Surgical pinning and consider prophylactic pinning on contralateral side (but controversial) to prevent osteonecrosis

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20
Q

What is the epidemiology of Osgood Schlatter disease?

A

10-15 year old boys

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21
Q

What are the ossification centers of the knee?

A
  • Tibial shaft
  • Femoral/fibular shaft
  • Distal femur
  • Tibial plateau
  • Patella
  • Tibial tuberosity
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22
Q

What is the epidemiology of Sinding-Larsen-Johansson disease?

A

10-14 year old active adolescents

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23
Q

What are the differential diagnoses for tibial bowing in Blount disease?

A
  • NF1
  • Foot deformities
  • Physiologic bowing
  • Hypophosphatasia
  • Rickets
  • Osteogenesis imperfecta
  • Achondroplasia
  • Paget disease
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24
Q

What is the pathology of Blount disease?

A

Increased compressive forces on the medial proximal tibial physis from excessive overload causes relative lack of growth and tibia vara (infantile, juvenile, and adolescent forms)

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25
What is the next step for non-accidental injury (NAI) with skull/rib/corner fractures?
Discuss with referring team, keep child in department, need CPS involved, further investigation with skeletal survey, CT/MRI brain, bone scan
26
How would you perform a skeletal survey for NAI?
* AP/lateral skull * Lateral whole spine * AP chest * Oblique ribs * AP abdomen/pelvis * AP upper and lower limbs * Lateral elbow/wrist/knee/ankle
27
What is the classification for supracondylar fractures?
Gartland: 1 - undisplaced, 2 - displaced with intact cortex, 3 - completely displaced
28
What are the ossification centers of the elbow?
* Capitellum (1) * Radial head (3) * Internal epicondyle (5) * Trochlea (7) * Olecranon (9) * External epicondyle (11)
29
What are the ossification centers of the hand/wrist?
* MC * Phalanges * Capitate * Hamate * Triquetral * Lunate * Scaphoid/trapezium/trapezoid * Pisiform
30
What causes the pattern of injury in Tillaux/triplane fractures?
Physis closes from medial to lateral between 12-15 years of age
31
What is the Salter Harris classification for Tillaux and triplane fractures?
Tillaux (3), triplane (4)
32
What are the ossification centers of the feet?
* MT * Phalanges * Calcaneus * Talus * Cuboid * Lateral cuneiform * Medial cuneiform * Intermediate cuneiform * Navicular (completed by 4th year)
33
What attaches to all the pelvic/hip apophyses?
* Iliac crest (abdominal wall muscles) * ASIS (sartorius) * AIIS (rectus femoris) * GT (gluteus medius/minimus) * LT (iliopsoas) * Ischial tuberosity (hamstrings) * Pubis (adductors, gracilis)
34
What is the age group for Ewing sarcoma?
11-14 years
35
What are the common locations for Ewing sarcoma?
* Diaphysis/metadiaphysis of long bones * Flat bones (ilium, scapula) * Chest wall
36
What is the genetic characteristic of Ewing sarcoma?
t(11,22) translocation
37
What are differential diagnoses for vertebra plana?
* LCH * Lymphoma * Metastasis (including neuroblastoma) * Myeloma * Trauma * TB
38
What are the musculoskeletal manifestations of Langerhans cell histiocytosis (LCH)?
* Punched out lytic skull lesions (beveled edge) * Floating tooth * Aggressive lytic lesion in long bones * Vertebra plana
39
What is the pathology of LCH?
Uncontrolled monoclonal proliferation of Langerhans cells (monocyte/macrophage lineage)
40
What is the prognosis for LCH?
EG 95% survival (most spontaneously resolve and fibrose), HSC intermediate prognosis, LS (multiorgan) fulminant and poor prognosis
41
What are the treatments available for LCH?
* Excision/curettage * Steroids * RFA * Chemo * RTx (spinal lesion)
42
What is the treatment for chronic recurrent multifocal osteitis (CRMO)?
Rheumatology review, NSAIDs, immunosuppression, may need long-term whole body MRI follow-up
43
What attaches to the cortical desmoid?
Medial head of gastrocnemius or adductor magnus
44
What is the management for a cortical desmoid?
Don't touch lesion, will look like osteosarcoma if you biopsy
45
What are some differential diagnoses for symmetrical periosteal reaction?
* JIA * Leukaemia * Rickets * Caffey disease * Scurvy * Prostaglandin E therapy * Syphilis * Osteomyelitis
46
When should physiologic periostitis resolve?
By 6 months (never occurs before 1 month)
47
What are the differential diagnoses for diffuse hypointense T1 marrow signal in leukaemia?
* Diffuse sclerosis: leukaemia/lymphoma * Mets * Sickle cell * Hyperthyroidism * Hypoparathyroidism * Renal osteodystrophy (in adults) * Myelofibrosis * Mastocytosis * Fluorosis
48
What is the pathology of acute lymphoblastic leukaemia (ALL)?
Lymphoid progenitor cells don't mature, leading to proliferation that crowds marrow space, decreasing normal blood cell production, causing marrow failure.
49
What is the management for leukaemia?
Bone marrow biopsy, CT CAP, treatment depends on B or T cell and BCR-ABL1 positive or negative
50
What are some differential diagnoses for Erlenmeyer flask deformities?
* Osteopetrosis * Achondroplasia * Ollier disease * Multiple hereditary exostoses * Fibrous dysplasia * Gaucher disease * Thalassemia * Sickle cell
51
What are the subtypes of osteopetrosis?
* Infantile (AR, 70% fatal) * Adult (AD, good prognosis)
52
What are the subtypes of juvenile idiopathic arthritis (JIA)?
* Oligoarticular (1-6 years, medium/large joints) * Polyarticular (1-4 and 7-10 years, small/medium joints) * Systemic (Still disease, fevers, migratory rash)
53
What are the differential diagnoses for lucent metaphyseal bands?
* Rickets * Scurvy * TORCH * Neuroblastoma metastasis * Leukaemia/lymphoma * Growth arrest lines
54
What are the differential diagnoses for dense metaphyseal bands?
* Healed rickets * Treated leukaemia * Chemo * Sickle cell * Thalassemia * Growth arrest lines * Lead poisoning * Renal osteodystrophy
55
What is the pathology of rickets?
Abnormal mineralization of growth plates leading to deformity
56
What are the findings associated with scurvy?
* Generalized osteopenia * Cortical thinning * Periosteal reaction (due to subperiosteal hemorrhage) * Expansion of costochondral junctions (scorbutic rosary) * Haemarthrosis * Wimberger ring sign * Frankel line (dense calcification) * Trummerfeld zone (lucent metaphyseal band) * Pelkin spur (metaphyseal spur)
57
What are the musculoskeletal findings in mucopolysaccharidosis?
* Shortened widened long bones * Pointed proximal metacarpals * Widening of anterior ribs (oar shaped) and clavicles * Thoracolumbar kyphosis * Hip dysplasia * Anterior vertebral body beaking * Platyspondyly * Goblet shaped flared iliac wings * Metaphyseal flaring
58
What are some differential diagnoses for platyspondyly?
* Gaucher disease * Osteogenesis imperfecta * Thanatophoric dysplasia * Acromegaly * Scheuermann's disease
59
What are some differential diagnoses for posterior vertebral scalloping?
* Spinal cord tumour * Achondroplasia * Mucopolysaccharidosis * Osteogenesis imperfecta * NF1
60
What is the prognosis for thanatophoric dysplasia?
Lethal, results in death from hours to days after birth due to respiratory insufficiency
61
What are the main subtypes of osteogenesis imperfecta?
* 1 - mild (80%, fragile with minimal deformity, blue sclera, hearing loss) * 2 - perinatal lethal (10%, due to pulmonary hypoplasia, IUGR) * 3 - progressive deforming (multiple fractures, short stature, blue sclera, hearing loss) * 4 - moderate/severe (ranges from 1 to 3, no blue sclera)
62
What is the genetics behind osteogenesis imperfecta?
Mutation in COL1A1 and COL1A2 genes (that make type 1 collagen), usually AD (>95%)
63
What are the findings associated with cleidocranial dysostosis?
* Wormian bones * Absent clavicles * Supernumerary ribs * Hypoplasia of iliac bones * Absent ossification of pubic bone (pseudo-widening of symphysis pubis) * Short/absent fibula/radius * Coxa vara
64
What is the pathology of cleidocranial dysostosis?
Incomplete intramembranous ossification of midline skeletal structures (including clavicle) & defective development of pubic bones, vertebral column, and long bones
65
What further testing is required for cleidocranial dysostosis?
Genetic testing for mutation in the RUNX2 gene (autosomal dominant)
66
What are some differential diagnoses for Wormian bones?
* Pyknodysostosis * Osteogenesis imperfecta * Rickets * Hypothyroidism * Down syndrome (T21)
67
What is the prognosis for fibrodysplasia ossificans progressiva?
Progressive, median survival 45 years

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