Ortho

Question 1

What is transient synovitis

Answer 1

• Irritable hip - inflammation in the synovial membrane of the joint
• most common cause of hip pain in kids - 3-8

Question 2

What causes transient synovitis

Answer 2

• Viral upper resp tract infection previously

Question 3

Sx of transient synovitis

Answer 3

• Sudden onset, limp, no weight bearing, hip pain, low grade temp

Question 4

Mx of transient synovitis

Answer 4

• Exclude septic arthritis
• conservative - usually resolve within 1-2 weeks

Question 5

What is Perthes disease

Answer 5

• Disruption of blood flow to the femoral head causing avascular necrosis
• kids aged 4-12

**Below age of 6 is reassurance and monitoring

Question 6

Complications of Perthes

Answer 6

• Early arthritis

Question 7

Sx of Perthes

Answer 7

• Pain, limp, restricted movement, referred pain to the knee

Question 8

Ix for Perthes

Answer 8

• Xray
• Bloods, DEXA, MRI

Question 9

Mx of Perthes

Answer 9

• conservative
• surgery if severe
  <6 - monitor and reassurance

Question 10

What is a slipper upper femoral epiphysis

Answer 10

• Head of the femur is displaced along the growth plate

Question 11

Cx of slipper upper femoral epiphysis

Answer 11

• Obese, trauma, growth spurt, Male

Question 12

Sx of slipped upper femoral epiphysis

Answer 12

• hip, groin, thigh, knee pain
• restricted range of movement
• painful limp

**limited in internal rotation - prefer to keep the hip externally rotated

• 10-16 years old

Question 13

Ix for slipped upper femoral epiphysis

Answer 13

• bloods
• X ray 1st line
• MRI or CT

Question 14

Mx of slipped upper femoral epiphysis

Answer 14

• Surgical pinning
• open reduction if serve

Question 15

Sx of an osteosarcoma

Answer 15

Bone cancer in adolescents 10-20

**Femur most common

• Persistent bone pain, worse at night time, may awake from sleep, palpable mass

Question 16

Ix for an osteosarcoma

Answer 16

• Urgent x ray - fluffy bone with sunburst appearance
• Bloods - ALP raised
• CT for staging

Question 17

Mx of an osteosarcoma

Answer 17

• Limb sparring surgery
• May need amputation
• Adjuvant chemotherapy

Question 18

What is talipes and Cx

Answer 18

• Fixed abnormal ankle position presenting at birth

Axs - other syndromes or occurs spontaneously

Question 19

Position of talipes equinovarus

Answer 19

• Ankle in plantar flexion and supination

Question 20

Position of Talipes calcaneovalgus

Answer 20

• Ankle in dorsiflexion and pronation

Question 21

Mx of talipes

Answer 21

• Ponseti method (hold foot in place with casts

Question 22

What is DDH

Answer 22

• Structural abnormality in the hips caused by abnormal development of bones in pregnancy

Question 23

Cx of DDH

Answer 23

• Breech, multiple pregnancies

Question 24

Sx of DDH

Answer 24

• Increased risk of subluxation and dislocation
• Asymmetry, reduced range of movement

Question 25

Ix of DDH

Answer 25

- Picked up on newborn check - US < 4-6months - X ray >4-6 months

Question 26

Mx of DDH

Answer 26

- Pavlov harness - Surgery if diagnosed > 6months or harness fails

Question 27

What is Rickets

Answer 27

- Softening of bone caused by a vitamin D deficiency

Question 28

RF for rickets

Answer 28

- Dark skin, poor sunlight exposure

Question 29

Cx of rickets

Answer 29

- IBD, CKD, low parathyroid

Question 30

Sx of rickets

Answer 30

- lethargy, bone pain, swelling, poor growth, muscle weakness, pathological fractures **Widening of joints due to excess non mineralised bone

Question 31

Ix for osteomalacia

Answer 31

- Vit D Levels low , Ca low , ALP high, PTH, high Po, low - X ray

Question 32

Mx of osteomalacia

Answer 32

- Vit D and Ca supplements

Question 33

What is achondroplasia and Cx

Answer 33

Most common cause of dwarfism Cx - FGFR3 gene on C4 dominant pattern - causing abnormal function of growth plates restricting growth

Question 34

Px of achondroplasia

Answer 34

- short stature - av height 4ft - reduced limb length - lower limb more affected - life expectancy and intelligence not affected - short digits and normal head size

Question 35

Axs of achondroplasia

Answer 35

- Recurrent otitis media, spinal stenosis

Question 36

Mx of achondroplasia

Answer 36

- Lengthening surgery - MDT

Question 37

what is Osgood schlatters and Cx

Answer 37

Inflammation at the tibial tuberosity where tendons insert * Common in adolescents

Question 38

Sx of osgood schlatters

Answer 38

- Hardened lump over time, painful tibial tuberosity - Worse on activity, extension of the knee

Question 39

Mx of osgood schlatters

Answer 39

- Reduce, Ice, NSAIDs

Question 40

Brittles bones disease cx

Answer 40

Brittles bone disease Cx - Autosomal dominant, abnormality in type 1 collagen

Question 41

Sx of Brittles bones disease

Answer 41

- Multiple bone fractures after minor trauma - Deafness due to otosclerosis, dental imperfections - Blue sclera

Question 42

Ix for Brittles bones disease

Answer 42

- Ca, Po, ALP, PTH all normal - X ray

Question 43

Mx for Brittles bones disease

Answer 43

- Bisphosphates, Ca, Vit D, Physio

Question 44

What is Duchennes

Answer 44

*X linked disorder causing progressive muscular weakness in kids u5 - mutation in dystrophin gene Axs with dilated cardiomyopathy

Question 45

Sx of duchennes

Answer 45

- Progressive proximal weakness, delayed, motor milestones, gait abnormalities, frequent falls, - Calf pseudohypertrophy - Gower's sign positive - Intellectual imapirment (30%)

Question 46

Ix for Duchennes

Answer 46

- CK raised - ALT, AST and LDH may also be raised - Genetic test to confirm

Question 47

Mx of Duchennes

Answer 47

- oral steroids - MDT *Long term steroid use

Question 48

Complications of duchennes

Answer 48

- Dilated cardiomyopathy - yearly echo - Resp failiure due to weakness