Paediatric MSK Flashcards Preview

Olivia MD3 2nd semester > Paediatric MSK > Flashcards

Flashcards in Paediatric MSK Deck (29):
1

What are your differentials for a child with an acute limp?

Need to exclude:
Septic arthritis
Osteomyelitis
SUFE
Perthes
DDH
Fracture/trauma
Malignancy

Other:
Transient synovitis of hip
Functional limp
JIA/reactive arthritis

2

a child presents with a limp. what are some key questions you need to ask?

Acute or chronic/insidious onset?
Able to weightbear/walk at all?
Any previous trauma?
Any recent illnesses? (particularly gastro etc)
Any other illnesses such as IBD etc?
Do they have a fever or any other infective symptoms?
Any deformity/swelling noticed?
Pain with certain movements?
Morning stiffness or history of 'gelling' after long car rides?
Birth history--> risk factors for DDH
Systemic constitutional symptoms of malignancy?
FMH of rheumatoid arthritis/SLE/autoimmunity

3

what are some key investigations all children with suspected bone/joint infections get?

blood culture
FBE
blood film
plain x-rays
CRP

then +/- joint aspirate; bone scan/MRI according to clinical judgement

4

what are the three clinical presentations of JIA?

oligoarticular JIA
polyarticular JIA
systemic JIA (still's disease)

5

what are some complications of untreated JIA?

overgrowth of limb and subsequent deformity
erosive disease

6

what is the most common cause of intoeing in children?

internal femoral torsion

7

what does talipes equinovarus mean?

clubfoot deformity- can either be postural or fixed

8

what is osgood schlatter's syndrome

this is when there is pain and swelling of the tibial tuberosity due to inflammation of the patellar ligament.

often clinically seen as a tender bump/lump on the tibial tuberosity in active 10-14 yr olds.

self resolving over many months with physiotherapy to strengthen quadriceps/hamstring muscles.

some may require surgical excision of lump

9

what is a good way of seeing whether there is any hip involvement in a child who presents with joint pain?

as the child to 'squat and walk like a duck'. if they are able to do so; then unlikely to involve the hip

10

what must you exclude in a child you suspect might have systemic JIA?

septic arthritis
malignancy
osteomyelitis

11

where often does SUFE pain present?

can present as thigh/knee pain, hence always assess the hip joint

12

what is the treatment of SUFE?

surgical correction with screws

13

a child presents with dactylitis. what condition must you think of?

psoriatic arthritis

14

what is the technical name for 'banana shaped feet'?

metatarsus adductus

15

up to which age is bowed legs considered normal?

up to 2 yrs; it is common for toddlers to appear bowed legged

16

what is a ddx for osgood schlatter disease?

enthesitis, particularly if both knees are affected

17

a child complains of leg pain at night. what are your differentials?

growing pains (especially if bilateral)- most common

benign osteoma (if unilateral)- rare

18

what are the common malignant causes of bone pain in children?

leukaemia
neuroblastoma
lymphoma

19

what are the two most common primary bony malignancies in children?

osteosarcoma
ewings sarcoma

20

what is the difference between osteomalacia and rickets?

no difference; both mean a disorder in bone mineralisation often due to vitamin D deficiency or calcium deficiency.

rickets is the condition in kids and osteomalacia is the condition in adults

21

what are some causes of rickets in a child?

vitamin D deficiency due to little vitamin D exposure, malabsorption disorders, severe liver disease, prolonged anticonvulsant therapy

22

a child comes in with a confirmed elbow fracture. how might you manage their pain in ED?

Pharmacological
- Simple analgesia= panadol up to 20mg/kg
-Intranasal fentanyl
-IV morphine if required
-ketamine if manipulating fracture

Non-pharmacological
-distraction techniques, play therapy
-immobilisation, bracing

23

a young child falls on her outstretched hand. What type of fractures is she at risk of?

1. buckle fracture of the distal radius
2. greenstick fracture of the distal radius
3. complete fracture of the distal radius
4. supracondylar fracture of the elbow
5. scaphoid fracture
6. proximal humeral fracture
7. lateral condylar fracture

24

what is a quick way of assessing neurological involvement in child with an upper limb fracture?

Ask them to:
Make a fist- median nerve
Make a star with their hands- testing ulnar nerve
Give you the thumbs up- radial nerve

25

how do we classify supracondylar fractures and which is more common?

flexion - distal fragment displaced anteriorly

extension- more common; distal fragment displaced posteriorly

26

what are the complications of a supracondylar fracture?

Deformity due to malunion

Neuropraxia

Vascular compromise- radial or brachial artery

-->compartment syndrome

27

what is the peak age group for a supracondylar fracture in children?

5-8 yrs old

28

a child presents with a fracture of the shaft of the humerus. what must you consider?

non-accidental injury

29

a boy presents with a sore elbow after falling on an outstretched hand. on examination the elbow has reduced ROM, is tender and there is swelling, more markedly on the lateral side. what are you worried about and how could you confirm this?

ix= AP and lateral x-rays of elbow

looking for lateral condylar fracture

--> always requires an urgent orthopaedic review due to known poor outcomes