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paeds > musculosketal > Flashcards

musculosketal Flashcards

1
Q

causes of genu varum

A

rickets

blounts disease

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2
Q

causes of pes planus

A

normal in toddlers
tendo-achilles contracture
INF

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3
Q

What causes of toe-walking should be excluded

A

mild cerebral palsy
achilles tendinitis
inflammatory arthritis
in older people - duchenne’s

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4
Q

what is pes cavus and what’s it associated with

A 
high arched foot
neuromuscular disorder (ie friederich's ataxia
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5
Q

How does missed DDH present

A

Asymmetrical skin folds, abduction of hip, abnormal gait

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6
Q

what are the indications for DDH investigation

A

breech presentation at 36/40
breech delivery
FHx of DDH

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7
Q

Mx DDH

A

1st lie - if <6 months old monitor progress with US/X Ray
2nd line - put in pavlik harness if <6 months and follow up with x ray at 6 months
3rd line - surgery if nothing works

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8
Q

causes of scoliosis

A 
idiopathic (10-14 weeks)
congenital
secondary -
neuromusclar problems (CP)
bone disorders (neurofibromatosis)
connective tissue disorders (marfan's)
leg length discrepancy (arthritis of knee)
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9
Q

where does osteomyelitis occur

A

metaphysis of bone

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10
Q

features of osteomyelitis

A

painful immobile limb
illness
can see sterile effusion of adjacent limb

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11
Q

What does X-ray of osteomyelitis show

A

after 7-10 days you see new subperiosteal bone formation and localised bone rarefaction

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12
Q

mx of osteomyelitis

A

ACUTE

  1. immobilse
  2. blood cultures
  3. High dose empirical IV Abx (switch to oral when pt improved)
  4. surgical debridement

CHRONIC

  1. disease staging
  2. surgical debridement
  3. IV Abx
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13
Q

why do you assess hip when pt presents with knee pain

A

hip pain often referred to knee

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14
Q

what is osgood-schlatter disease

A

osteochondritis of patellar tendon insertin at knee

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15
Q

how does osgood schlatter present

A

knee pain
tibial swelling
hamstring tightness

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16
Q

mx osgood schlatter

A

pain relief
ice packs
reassure it will resolve over time
change sporting activity to less running and jumping (but don’t have to stop sport)

17
Q

what is osteochondritis dissecans

A

segmented avascular necrosis of subchondral bone

presents as persistent knee pain in active kids

18
Q

Why is transient synovitis significant clinically

A

most common cause of hip pain between 2-12 year olds
follows/accompanied by viral infection

hard to distinguish it from septic arthritis

19
Q

what is Perthes disease

A

avascular necrosis of femoral head due to interrupted blood supply
revascularises and reossifies after 18-36 months

20
Q

how does perthes’ present

A

insidious limp + hip pain

21
Q

mx Perthes’ disease

A

conservative:
supportive care for acute pain
activity continuation
physio - stretch hamstring and quads

surgical treatment if >6 and not responding

22
Q

What is a slipped capital femoral epiphysis and what is mx

A

femoral head slips postero-inferiorly
need to operate quickly to prevent avascular necrosis of femoral head

mx - immobilise, immediate ortho referral, screw fixation of growth plate

23
Q

what infections cause reactive arthritis

A

enteric bacteria - shigella, campylobacter, salmonella
STI - chlamydia, gonococcus
rheumatic fever + post streptococcal arthritis more common in low income countries

24
Q

what usually causes septic arthritis

A

s. aureus

if immunodeficient or with sickle cell can be others

25
Q

Ix for septic arthritis

A

US - shows joint effusion
X-Ray - exclude trauma (will normally be normal)
aspirate for diagnosis

26
Q

mx septic arthritis

A

2 weeks IV Abx followed by 4 weeks of oral
gram +ve - vancomycin
gram -ve - cefotaxime
joint aspiration whenever needed
surgical washing + drainage may also be needed

27
Q

what is the definition of juvenile idiopathic arthritis

A

persistent joint swelling (>6 weeks) in children <16 with no signs of infection

28
Q

how does JIA present

A

gelling
morning stiffness
joint pain
young children can have limp

29
Q

complications of JIA

A

bone deformities and subsequent asymmetry
chronic anterior uveitis (can lead to visual impairment)
flexure contraction of joint
growth failure
osteoporosis
amyloidosis

30
Q

mx JIA

A

mobility encouraged
NSAIDs for pain relief
can give adjunctive intra-articular steroids
DMARDs if nothing works

31
Q

How does osteochondritis dissecans present

A

persistent knee pain
localised tenderness over femoral condyles
complete separation of fragments can cause feeling of knee locking or giving way

32
Q

when do you US vs X ray for DDH

A

US before 6 months

X ray after 6 months

paeds (19 decks)

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