Musculoskeletal Flashcards

Question

Features Sternomastoid tumour

Answer 1

``` Occur in first few weeks of life Mobile, non tender nodule Felt within body of sternocleidomastiod Restriction of head turning and tilting of head Resolves by 2-6m ```

Answer 2

``` Generalised pains in lower limbs Typically 3-12y Pain in night, waking from sleep Resolves with massage/comforting Symmetrical in lower limbs No limitation of physical activity ```

Answer 3

``` MSK pain confined to lower limbs Pain worse on exercise Symmetrical hyperextension -thumbs and fingers to forearm -elbows and knees >10' -flat feet with normal arch on tiptoe -hyperextensibility of knee Recurrent mechanical joint and muscle pain Associated with: Down's syndrome, Ehler-Danlos, Marfans ```

Answer 4

Most dramatic musculoskeletal pain Usually adolescent females Typically with distraction movement is normal Localised forms typically foot and ankle Triggered by minor trauma Hyperasthesia, allodynia, cool, sweollen, mottled, flexed Diffuse forms are widespread pain with disturbed sleep Extreme exhaustion

Answer 5

``` NAI Trauma Osteomyelitis Bone Tumours Septic Arthritis ```

Answer 6

Infection of metaphysis Most common sites distal femur and proximal tibia Haematogenous spread/direct spread from wound Usually staph aureus In sickle cells likely staph or salmonella Non-immunised possibly strep or H.influenzae

Answer 7

``` Markedly painful immobile limb Acute febrile illness Swelling and tenderness over site Movement causes severe pain Sterile effusion of adjacent joint More insidious presentation in infants Pelvic infection- limp or groin pain Vertebral infection- back pain Multiple foci in disseminated infection ```

Answer 8

Positive blood cultures WCC and acute phase reactants raised Initially normal Xray w soft tissue swelling Xray at 7d subperiosteal new bone formation and localised bone rarefaction US periosteal elevation MRI subperiosteal pus and purulent debris in bone Redionucleotide bone scan can localise site Xray chronic changes- periosteal reaction along lateral shaft

Answer 9

Parenteral Antibiotics for several weeks IV until clinical recovery and acute phase reactants return to normal Oral therapy for several weeks Aspiration or surgical decompression of subperiosteal space (atypical or immunodeficiency) Surgical draining if no response to Abx Resting in splint

Answer 10

Bone necrosis Chronic infection with discharging sinus Limb Deformity Amyloidosis

Answer 11

ALL (primarily at night) Neuroblastoma (systemic arthritis or met bone pain) Osteogenic sarcoma Ewing tumour

Answer 12

Pain or swelling | Pathological fracture

Answer 13

``` Pain more severe at night Improves with NSAIDs Affects boys Involves femur, tibia or spine Localised soft tissue swelling/joint effusion ```

Answer 14

Usually diagnostic Sharply demarcated radiolucent nidus of osteoid tissue Surrounding sclerotic bone

Answer 15

``` Osgood Schlatter Chondromalacia Patellae Osteochondritis Dissecans Subluxation and dislocation of patella Trauma ```

Answer 16

Sporty teens esp. football Pain and tenderness over tibial tuberosity Hamstring tightness

Answer 17

Softening oif patella cartilage common in teenage girls Characteristically pain walking up stairs and rising from sitting Associated with hypermobility and flat feet

Answer 18

Pain after exercise | Intermittent swelling and locking

Answer 19

Medial knee pain due to lateral subluxation Instability or giving way Associated with hypermobility Dislocation may occur (laterally with severe pain)

Answer 20

Young age High fever- infection Night pain/waking- osteoid osteoma Painful scoliosis- infection/malignancy Focal neurology- nerve root/cord compression Weight loss, systemic malaise- malignancy

Answer 21

Mechanical- spasm or soft tissue pain Tumours- spin in osteoid osteoma Vertebral osteomyeltitis/discitis- localised tenderness Spinal cord/root entrapment- tumour/prolapsed disc Scheuermann disease- osteochondosis of vertebral body (fixed thoracic kyphosis) Spondylolysis- stress fracture of pars interarticularis Complex region pain syndrome

Answer 22

Toddlers: - infection - transient synovitis - trauma - malignant .e.g. leukaemia, neuroblastoma

Answer 23

Child: - transient synovitis - Septic arthritis/osteomyeltitis - Trauma/overuse injury - Perthes - Juvenile idiopathic arthritis - Malignancy .e.g. leukaemia - Complex region pain syndrome

Answer 24

Teens: - Mechanical .e.g. overuse, trauma - SUFE - Avascular necrosis of femoral head - Reactive arthritis - Juvenile idiopathic arthritis - Septic arthritis - Osteochondritis dissecans - Bone tumour and malignancy - Complex regional pain syndrome

Answer 25

Children aged 2-12y Follows viral infection Sudden onset pain in hip or a limp No pain at rest Decreased range of movement , esp. internal rotation Afebrile or mild fever, but generally well

Answer 26

Mainly affects boys 5-10y Insidious presentation Onset of limp or hip/knee pain

Answer 27

Xray both hips lateral and frog leg Increased density in femoral head Repeat if normal Xray but persisting symptoms Bone/MRI scan

Answer 28

Rest Physiotherapy to optimise hip movement Traction, plaster casts and surgery

Answer 29

<6y good prognosis Older children poor prognosis Cx: deformity of femoral head, metaphyseal damage, degenerative arthritis

Answer 30

Displacement of epiphysis of femoral head posterior-inferiorly. Progresses to avascular necrosis

Answer 31

10-15y during puberty/adolescent growth spurt Typically obese boys Association with metabolic endocrine abnormality Limp or hip pain referred to knee Restricted abduction and internal rotation of the hip

Answer 32

Internal fixation: typically a single cannulated screw placed in the center of the epiphysis

Answer 33

``` Infection .e.g. sepsis, TB, virus Reactive; strep infection Inflammatory bowel disease: UC, Chron's Vasculitis: HSP, Kawasaki Haematological: Haemophilia, sickle cell Malignancy: neuroblastoma, leukaemia Connective tissue disorder: JIA, SLE, dermatomyositis, PAN, MCTD Cystic fibrosis ```

Answer 34

``` Transient joint swelling Usually <6w Often knee/ankle Follows extrarticular infection esp. enteric bacteria and STIs, rheumtic fever, Lyme Low grade fever Normal acute phase reactants ```

Answer 35

``` Children <2y Single joint affected Particularly hip Staph (HiB in non-immunised) Erythematous, warm, tender joint Reduced range of movement Acutely unwell child Limb held still Peripheral joint effusion ```

Answer 36

Leg held flexed, abducted, externally rotated Pseudoparalysis Marked tenderness over head of femur Movement resisted

Answer 37

``` WCC and acute phase reactants raised Blood cultures US deep joints identifies effusion Xray excludes trauma and bony lesions - initially normal with some joint widening Aspiration under US for culture ```

Answer 38

Immediate IV antibiotics Wash out of joint or surgical drainage Immobilisation

Answer 39

``` Joint swelling >6w Gelling (stiffness following rest) Morning joint stiffness Pain Intermittent limp Activity avoidance Prliferation of synovium ```

Answer 40

Usually normal | ANA positive but not specific

Answer 41

Bone expansion from overgrowth - Leg lengthening - Valgus deformity - digit length discrepancy - advancement of wrist bone age

Answer 42

``` Chronic anterior uveitis Flexion contractures of joints Growth failure Constitutional .e.g. anaemia, delayed puberty Osteoporosis Amyloidosis ```

Answer 43

Oligoarthritis (persistent): 1-4 joints Oligoarthritis (extended): >4 joints after 6m Polyarthritis (RF +ve): symmetrical large and small joints Polyarthritis (RF-ve) Systemic Arthritis: acute illness and inflamamtory marker Psoriatric arthritis: psoriasis and dactylitis Enthesitis-related arthritis: Lower large joints HLAB27+ Undifferentuated: >2 subtype feature

Answer 44

Induction of remission NSAIDs and analgesia Joint injection under US, with sedation Methotraxate: weekly dose and regular bloods Systemic corticosteroids: pulsed IV prednisolone -life saving in macrophage activation syndrome Cytokine modulation .e.g. anti-TNF, IL-1, CTLA-4, IL-6

Answer 45

``` AD inheritance Short stature Marked limb shortening Large head and frontal bossing Depression of nasal bridge Short and broad hands Lumbar lordosis ```

Answer 46

``` Results in still birth Large head Short limbs Small chest Xray- characteristically curved femurs Sporadic inheritance ```

Answer 47

``` AD inheritance Absence of clavicles Delay in closure of anterior fontanelle Delayed ossificatrion of skull Child can touch shoulders at the front of the chest Short stature ```

Answer 48

Stiffness and contractures of the joints Associated with oligohydramnios, chromosomal abnormalities, and widespread abnormalities Usually sporadic Marked flexion contractures of the knees, elbows, and wrists Dislocation of the hips Talipes Equinovarus and socliosis common Thin skin with reduced subcut tissue Marked muscle atrophy around affected joints Impaired walking in severe forms

Answer 49

``` Phsyiotherapy Correction of deformities -splints -plaster casting -surgery ```

Answer 50

``` Bone fragility: bowing and fractures Fractures in childhood Blue sclerae Development of hearing loss Type 2: fatal, multiple fractures before birth ```

Answer 51

Bisphosphonates to reduce fractures | Splinting of fractures to reduce deformity

Answer 52

``` RARE Dense but brittle bones Faltering growth Recurrent infection Hypocalcaemia Anaemia Thrombocytopenia Poor prognosis ```

Answer 53

Bone marrow transplantation can be curative

Answer 54

``` Tall stature Long thin digits (arachnodactyly) Hyperextensive joints High arched palate Dislocation of lenses of eyes (usually upwards) Severe myopia Altered body proportion (lower>>upper) -lower segment (pubis to soles) -upper segment (crown to pubis) Arm span greater than height Chest deformity Scoliosis ```

Answer 55

``` Cardiovascular: -degeneration of media of vessel walls Dilated incompetent aortic root -valvular incompetence -mitral valve prolapse and regurgitation -aneurysm of aorta (risk dissection/rupture) Monitor by echo ```

Musculoskeletal Flashcards

(79 cards)