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Paed:MSK Flashcards

1
Q

What is the definition of Juvenile Idiopathic Arthritis?

A

Persistent joint swelling (>6weeks) presenting before the age of 16 and in the absence of infection or any other defined cause.

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2
Q

What are the seven different subtypes?

A

Persistent oligoarthritis - 1-4joints involved.
Extended oligoarthritis - <4joints involved >6months
Polyarthritis RF-ve
Polyartrtiis RF+ve
Systemic arthritis
Psoriatic arthritis
Enthesistis related

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3
Q

Features of JIA?

A 
Gelling (stiffness after rest)
Morning stiffness
Pain
Swelling
Loss or ROM
Warmth
Systemic arthritis: Malaise, fever, salmon-pink rash, lymohadenopathy
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4
Q

Complications of JIA?

A 
Uveitis
Flexion cotnractures of joints
Growth failure
Anaemia of chronic disase
Osteoporosis
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5
Q

Differentials of JIA?

A

Spetic arthritis
Reactive arthritis
Non-accidental injury
malignanccy

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6
Q

Management of JIA?

A 
NSAIDS + analgesics
Joint injections
Methotrexate
Systemic corticosteroids
Cytokine modulators + other immunotherapies
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7
Q

Diagnosing psoriatic arthritis?

A

Psoriasis and Arthritis
or
Arthritis w/ 2 of: FH of psoriasis, Nail changes, Dactylitis

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8
Q

What is reactive arthritis?

A

Transient joint swelling <6weeks often of ankles or knees, usually following extra-articular infection. Most common form of arthritis in childhood.

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9
Q

What causes reactive arthritis?

A

Enteric bacteria often (Salmonella, shigella, campylobacter)

Also: Viruses and STIs (chlamydia, mycoplasma, borellia burgoferi)

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10
Q

Presentation of reactive arthrtitis

A

Joint swelling with low grade fever.
acute phase reactants normal or slightly elevated
x rays normal

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11
Q

Management of reactive arthritis?

A

NSAIDs

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12
Q

What is septic arthritis?

A

Serious infection of joint space, can lead to bone destruction.

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13
Q

Presentation of septic arthritis?

A 
Erythematous, warm, acutely tender joint. acute in onset
Decreased ROM
Acutely unwell, febrile child
pseudoparesis
joint effusion
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14
Q

Causative organisms of septic arthritis?

A

Neonate: Group B strep
>2yrs: S. Aureus
adolescents: Neisseria Gonorrhoea

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15
Q

How does septic arthritis happen?

A

Haematogenous spread
Puncture wound
Infecred skin lesions (chicken pox)
Adjacent bone extension

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16
Q

Investigations of septic arthritis?

A 
raised WCC and acute phase reactants
Blood cultures
US if deep joints if effusion
X ray to exclude trauma
Bone scan
MRI
Aspiration of joint space - culture
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17
Q

Risk factors for septic arthritis?

A

Prematurity
C section
Pt treated on NICU
Invasive procedures

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18
Q

What is Kocher criteria for?

A

Differentiation of septic arthritis from transient synovitis in the child with a painful hip.

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19
Q

What are the Kocher criteria?

A 
WCC>12,000
Inability to weight bear
Fever >38.5
ESR>40
1= 3% chance of SA
2=40% chance of SA
3=93% chance of SA
4= 99% chance of SA
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20
Q

Management of SepticArthritis?

A

IV Abx
Surgical drainage
Immobilisation then mobilisation

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21
Q

Complications of septic arthritis:

A 
Femoral head destruction
Deformity
Joint contracture
Limb-length discrepancy
Gait abnormalities
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22
Q

What is osteomyelitis?

A

Infection of the metaphysis of long bones. Most commonly femur and proximal tibia

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23
Q

What methods of cause of osteomyelitis?

A

Haematogenous spread from a pathogen

Direct spread from an infected wound

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24
Q

Causative pathogens of osteomyelitis?

A

Staph. Aureus, strep, h.influenzae

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25
Presentation of osteomyelitis?
``` Painful, immobilised limb acute febrile illness swelling and tenderness warm and erythematous movement causes pain sterile effusion of adjacent joint ```
26
Investigations for osteomyelitis?
``` Positive blood cultures Raised WCC, CRP, ESR Xrays: normal but soft tissue swelling us: Periosteal elevation MRI: Subperiosteal pus + purulent debris in bone Radionuclide bone scan ```
27
Treatment of osteomyelitis?
IV abx aspiration or surgical decompression of the subperiosteal space splint
28
What is Perthes disease?
Idiopathic avascular necrosis of the proximal femoral epiphysis in children.
29
clinical features of perthes disease?
gradual onset painless limp intermittent hip, knee, groin or thigh pain
30
Examination findings on Perthes disease?
Hip stiffness - loss of IR and abduction gait disturbance - antalgic, trendelenburg gait limb length discrepancy
31
Treatment of perthes disease?
Sx relief: NSAIDs, traction, crutch Restore ROM: physio, muscle lengthening Containment of hip: osteotomy Operative
32
Pathophysiology of perthes disease?
- OSteonecrosis occurs secondary to disruption of blood supply to femoral head. Followed by revascularisation with subsequent resorption, and later collapse. May be ass w/ abnormal clotting factors Repeated subclincial trauma and mechanical overload lead to bone collapse and repair
33
What is SUFE?
``` Slipped upper (capital) femoral epiphysis. Leads to slippage of the metaphysis relative to the epiphysis. ```
34
What conditions are associated with SUFE?
Endocrine disorders: Hypothyroidism(^TSH), renal dystrophy, GH deficiency, panhypopituitarism
35
Presentation of SUFE?
Groin and thigh pain Limp Knee pain
36
Examination findings SUFE?
Decreased hip ROM - ER happens during passive flexion | Loss of hip IR, abduction, +flexion
37
Treatment of SUFE?
Percutaneous pinning in situ Fixation of contralateral hip Surgical hip dislocation and capital realignment
38
What is transient synovitis
Inflammation if the synovium causing hip pain
39
Risk factors for transient synovitis?
Viral infection Bacterial infection (eg post strep toxic synovitis) Trauma Allergic reaction
40
Clinical features of transient synovitis?
``` Recent URTI Mild/absent fever acute/gradual onset of groin/thigh pain refusal to weight bear improves during day ```
41
Examination findings of Transient Synovitis?
Mild/moderate restriction of hip IR | painless arc of motion
42
Treatment of Transient Synovitis?
NSAIDs
43
Define osteoporosis?
A disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to advanced bone fragility and a consequent increase in fracture risk.
44
Diagnosing osteoporosis in children?
``` 1 or more vertebral crush fractures OR Size adjusted bone density <2SD's either: - 2 or more long bone # by 10 - 3 or more long bone # by 19 ```
45
Congenital causes of Osteoporosis?
OSteogenesis imperfecta Inborn errors eg. galctosaemia Haematological problems Idiopathic
46
Acquired causes of osteoporosis?
``` Drug induced (esp steroids!) Major endocrinopathies Malabsorption Immobilisation Inflammation ```
47
Wha is osteogenesis imperfecta?
AD Mostly caused by defects in Type 1 collagen genes. Bone is brittle and fragile.
48
Clinical features of Osteogenesis Imperfecta
``` Bone fragility, fractures, deformity Bone pain Impaired mobility poor growth deafness, hernias, valvular prolapse ```
49
Types of Osteogenesis Imperfecta?
1: Mild 2: Lethal 3: progressively deforming, severe 4: Moderate
50
Treatment of osteogenesis imperfecta?
Bisphosphonates Surgery Physiotherapy Education
51
What is rickets?
Failure in mineralisation of the growing bone or osteoid tissue.
52
What is osteomalacia?
Failure of mature bone to mineralise.
53
Causes of Rickets?
Nutritional (1) rickets: Dark skin, poor sunlight exposure, low calcium/vit D diet Intestinal malabsorrption; Small bowel enteropathy(coeliacs), pancreatic insuffiency (CF), chlolestatic liver disease Defective production of vit D: Fanconi syndrome, chronic renal disease, familial hypophosphataemia rickets Increased metabolism of vit D: anticonvulsants induce enzymes - pheonobarbitals Defective production: Chronic liver disease
54
Clinical features of rickets
``` Earliest sign: Craniotabes (thinning of skull/softenign) Frontal bossing of skull Misery FtT/Short stature Delayed closure of anterior fontanelle Rickets rosary harrison sulcus bowing of knees seizures (late) Resp distress ```
55
diagnosis of rickets
``` Dietary hx if vitamins and calcium intake Bloods: - Decreased serum calcium - Decreased phosphate - Increased plasma alkaline phosphatase - Decreased 25-hydroxy vit D - increased PTH Wrist X-ray: - Cupping and fraying of metaphyses -widened epiphyseal plate ```
56
Management of rickets?
Dietary advice Correction of predisposing risk factors Daily vit D calcium
57
What is Kohlers disease?
Infarction of the navicular bone presenting as medial mid foot pain and a limp in younger children, esp with load bearing sports.
58
Treatment of Kohlers?
Rest. nowt else
59
What is osgood schlatters disease?
Failure of the tibial tubercle apophysis due to repetitive traction and stress from extensor mechanism.
60
Presentation of osgood schlatters?
Painful swelling over a prominent tibial tubercle Usually unilateral ass w/ running and jumping

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