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Y5 Paediatrics > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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1
Q

What is the most common sarcoma causing acute limp in paediatrics and over what age does it occur?

A

Osteosarcoma - 10 plus

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2
Q

3 infections that can cause acute paediatric limp?

A

Septic arthritis
Osteoarthritis
Discitis

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3
Q

3 ways in which sickle cell disease can contribute to acute limp?

A

Avascular necrosis
Stroke
Increased infection risk

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4
Q

What is the most common cause of paediatric acute limp?

A

Trauma

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5
Q

At what age do growth plates tend to fuse in girls vs boys? Why?

A

12-14 girls, 14-16 boys

Due to oestrogen

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6
Q

What should be considered as an alternative injury a suspected sprain in a child?

A

Growth plate injury as these are more susceptible to injury than ligaments

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7
Q

What is a Toddler’s Fracture?

A

A subtle undisplaced spiral fracture of tibia, often seen in preschool children due to twist or unwitnessed fall

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8
Q

6 risk factors for developmental dysplasia of hip DDH?

A 
Family history
Being a girl
Oligohydramnios
High birth weight over 4kg
First born baby
Breech presentation
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9
Q

What are the 2 manoeuvres used to screen for DDH at birth?

A

Barlow - posterior force on adducted legs to try to posteriorly dislocate hips
Ortolani - anterior force on bent and abducted legs to relocate and confirm posterior dislocation

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10
Q

Why do many kids ‘grow out of’ DDH?

A

Ligaments and soft tissue strengthen over time

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11
Q

If DDH is found or suspected at birth, what should you do? What if it persists?

A

Recheck at 6-8 weeks
If still there can do hip USS if less than 4-6 months
Or hip XR if older

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12
Q

What screening takes place for breech babies for DDH?

A

Hip USS at 2 weeks

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13
Q

What is first line management of DDH in a child under 6m old?

A

Pavlik harness

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14
Q

How long should you try a Pavlik harness for?

A

At least 6 weeks full time

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15
Q

What is there a risk of with use of Pavlek harness?

A

Avascular necrosis

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16
Q

What is first line management of DDH for child over 6m or after tried Pavlik harness?

A

Closed reduction and hip spica (cast)

Manipulation under anaesthesia then cast stays on for at least 12 weeks

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17
Q

What is a further option if closed reduction for DDH fails?

A

Open reduction

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18
Q

What age and sex of child is commonly affected by transient synovitis?

A

Boys aged 4-10

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19
Q

How long does transient synovitis normally last?

A

3-10 days

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20
Q

What does transient synovitis follow in 50% of cases?

A

Viral URTI

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21
Q

What findings on exam, bloods and US would be reassuring for transient synovitis?

A

Limited range of movement
Mild inflammatory blood picture, low grade CRP
Effusion on USS

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22
Q

Management of transient synovitis?

A

NSAIDs and non-weight-bearing rest

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23
Q

What is Perthes disease/Legg-Calve-Perthes disease?

Study These Flashcards
A

Idiopathic AVN of femoral head

24
Q

In what age and sex of child does Perthes disease typically affect?

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A

Boys aged 4-10 plus

25
Over how long does Perthes disease tend to resolve?
Months - couple of years, physio may hope and surgery may be needed
26
2 long term consequences of healed Perthes disease?
Stiffness of joint | Osteoarthritis
27
What is SUFE?
Slipped Upper Femoral Epiphysis - capital femoral epiphysis displaces relative to metaphysis leading to hip, knee or thigh pain
28
What is a common RF for SUFE? 3 other associations?
Being overweight | Also hypothyroidism or previous radiotherapy/growth hormone therapy
29
Over what age does SUFE tend to occur?
Over 10
30
Movement restricted classically early in SUFE?
Internal rotation
31
2 management options for SUFE?
External in situ pinning | Open reduction and pinning
32
What needs to be done quickly for SUFE and why?
Orthopaedic assessment - risk of AVN
33
What is Osgood-Schlatter disease?
Multiple small avulsion fractures of anterior tibial tuberosity apophysis leading to anterior knee pain in sporty adolescents
34
When does pain associated with Osgood-Schlatter disease tend to resolve?
Either after reducing activity or end of growth spurt
35
What is the definition of JIA?
Autoimmune inflammatory joint disease lasting for over 6 weeks in under 16s (commonly 7-12)
36
What growth anomalies can occur related to JIA?
Overall growth rate may fall but affected joints may be large due to inflammation
37
What are the 4 major subtypes of JIA?
Oligo/pauciarticular Systemic (Still's disease) Polyarticular (juvenile RA) Seronegative spondylarthritis/juvenile AS
38
What is oligo/pauciarticular JIA and what blood finding is usually positive?
Less than 4 affected joints in first 6m | ANA positive
39
What joints are typically affected in oligo/pauciarticular JIA?
Larger joints but not hips, asymmetrical pattern
40
What rash is classical of systemic JIA/Stills disease?
Salmon pink macular rash that migrates around trunk, associated with systemic malaise
41
What is the most common subtype of JIA?
Oligo/pauciarticular
42
What is polyarticular JIA?
Juvenile RA - 5 or more joints affected in first 6 months, often very symmetrical with worse prognosis
43
What is Farber disease?
Lysosomal storage disorder caused by ceraminidase deficiency Looks like JIA plus subcut nodules plus hoarse/weak voice (vocal cord nodules)
44
What is Severs disease?
Apophysitis of the calcaneus leading to heel pain
45
What is thought to be the cause of Severs disease?
Pull of Achilles' tendon on unossified apophysis causing repeated microtrauma
46
3 diseases causing limp more associated with active adolescent males?
Osgood-Schlatter disease Severs disease Osteochondritis dissecans
47
What is osteochondritis dissecans? Where is it most common?
Most common cause of loose body in joint space - typically in knee joint medial femoral condyle
48
How does osteochondritis dissecans present?
OA-like symptoms, mild pain and effusion that can present in adolescence or adulthood
49
What is chondromalacia patellae?
Anterior knee pain typically felt ascending or descending stairs, more common in females than males aged 10-19
50
Cause of anterior knee pain in adolescent girl worse on ascending or descending stairs?
Chondromalacia patellae
51
What is apophysitis of the calcaneus and resultant heel pain called?
Severs disease
52
What is bony fragment within joint space, often near medial femoral condyle, called?
Osteochondritis dissecans
53
What might acute limp following trauma plus extreme pain, anxiety and agitation suggest?
Compartment syndrome
54
What swift assessment should be done if querying compartment syndrome?
Neurovascular assessment
55
7 red flags for acute paediatric limp?
Pain waking from sleep Bone pain Red swollen joints Bruises or rashes Constitutional Sx incl fever, weight loss, anorexia etc. Early morning worsening Sx suggestive of evolving compartment syndrome
56
What should a child over 9 presenting with acute limp with limited or painful hip movement be rapidly assessed for?
SUFE
57
3 cancers that may present with acute limp?
Leukaemia Lymphoma Sarcoma

Y5 Paediatrics (13 decks)

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