orthopaedics

Question 1

perthes disease what is it

Answer 1

avascualr necrosis of femoral head for know known reason

Question 2

perthes disease presentation

Answer 2

limp
pain in hip
limited abduction and internal rotation

Question 3

perthes disease investigations and findings

Answer 3

x ray - joint space widening due to lack f blood supply

Question 4

perthes disease management

Answer 4

younger <6 the better prognosis - can remodel
bed rest and NSAIDS <1/2 femoral head effected (herring A/B)
surgery if older >1/2 femoral head effected (herring BC/C)

Question 5

slipped upper femoral epiphysis what is it

Answer 5

10-16yr obese males

displacement through growth plate with epiphysis slipping down and back

Question 6

slipped upper femoral epiphysis presentation

Answer 6

limp
flexion, abduction, medial rotation limited
risk early OA if missed
symptoms usually present for weeks to several months before diagnosis

Question 7

slipped upper femoral epiphysis management

Answer 7

surgical

Question 8

septic arthritis cause

Answer 8

s.aureus (most common)
h.influenza (if unvaccinated)
assume in all limping children

Question 9

septic arthritis presentation

Answer 9

spetic signs - low BP, high HR/RR/lactate
warm tender joint
reduced ROM
usually one joint infected

Question 10

septic arthritis investigations

Answer 10

joint aspiration

mc+s

Question 11

kocher criteria for septic arthritis

Answer 11

WCC >12,000
Inability to bear weight
Fever >38.5
ESR >40

all 4 99% septic arthritis

Question 12

hip septic arthritis causes

Answer 12

Group B streptococcus – neonates
Staph aureus – common in children > 2 years of age
Neisseria gonorhoeae – most common in adolescents

Question 13

transient synovitis of the hip cause

Answer 13

most common casue of hip pain in children

diagnosis is by exclusion of others

Question 14

transient synovitis of the hip aetiology

Answer 14

viral illness preceded by recent viral URTI

Question 15

transient synovitis of the hip management

Answer 15

NSAIDS

Question 16

development dysplasia of the hip risk factors

Answer 16

female
breech
family Hx
first born

Question 17

development dysplasia of the hip investigations

Answer 17

barlow and ortolani manoeuves

observe asymmetry, leg length, skin folds

Question 18

development dysplasia of the hip diagnosis

Answer 18

US

important to diagnose early as risk OA

Question 19

development dysplasia of the hip management

Answer 19

<6 months - long term splinting, pavlik harness
6-18 months - immobalise, examine under anaesthetic
>18 months - surgical correction

Question 20

osteogenesis imperfecta what is it

Answer 20

inherited disorder of type 1 collagen

joint laxity, fragile low density bones

Question 21

osteogenesis imperfecta presentation Sillence classification (4 types)

Answer 21

type 1 - mild, most common. many fractures, blue sclera, hearing loss
type 2 - lethal perinatal. many fractures, blue sclera, dwarfism
type 3 - severe. many fractures, spine limb deformity, transparent teeth
type 4 - moderate

Question 22

osteogenesis imperfecta diagnosis

Answer 22

x ray - low bone density, bowing of longer bones

Question 23

osteogenesis imperfecta management

Answer 23

bisphosphonates - alendronate

always think of non accidental injury

Question 24

rickets what is it

Answer 24

low bone mineral content

Question 25

rickets presentation
(presentation of symptomatic vitamin D deficiency)

Answer 25

growth retardation, hypotonia, bow legged, hypocalcaemic convultions, fractures

Question 26

ricketts causes

Answer 26

vit d deficiency - malabsorption, poor diet
drug induced - anticonvulsants
renal osteodystrophy

Question 27

ricketts investigations

Answer 27

low PO43-
raised ALP
raised PTH
low active (25-hydroxy) vitamin D

Question 28

ricketts management

Answer 28

vit d and calcium

Question 29

osteomyelitis common organisms

Answer 29

staph aureus
pseudomonas
e.coli
h.influenza

Question 30

osteomyelitis presentation

Answer 30

gradual onset
unwillingness to move
tender, warm, erythema

Question 31

osteomyelitis management

Answer 31

vancomycin and cefotaxime until organism known

Question 32

osteomyelitis investigations

Answer 32

raised esr,crp,wcc
mc+s
bone biopsy

Question 33

juvenile idiopathic arthritis diagnosis

Answer 33

normocytic anaemia
raised platelets WBC ESR/CRP
ANA RF HLA B27

Question 34

juvenile idiopathic arthritis managment

Answer 34

paracetamol and NSAIDS
methotrexate (dmard)
tocilizumab - il6 receptor blocker decrease inflammatory cytokine production

Question 35

juvenile SLE features SOAP BRAIN MD

Answer 35

mainly adolescent females. relapsing and remitting

serositis
oral ulcers
arthritis
photosensitivity

bloods - anaemia, thrombocytopenia, leucopenia, low c3/c4
renal - proteinuria
ANA
Immune - double stranded DNA
neurological - seizures, psychosis

malar rash
discoid rash

Question 36

juvenile SLE management

Answer 36

hydroxychloroquine and NSAIDS

Question 37

juvenile idiopathic arthritis presentation

Answer 37

fever spikes with salmon pink rash and joint Pain
Swelling - persistent
Joint stiffness (morning)
Loss of range of movement
Joint deformity
Warmth 
Colour change

Question 38

juvenile idiopathic arthritis - oligoarticular

Answer 38

less than 4 joints

knee and ankle are common

Question 39

juvenile idiopathic arthritis - polyarticular

Answer 39

more than 4 joints

Question 40

septic arthritis management

Answer 40

staph areus - IV Cefuroxime