Paeds MSK

Question 1

What is Osgood-Schlatter disease

Answer 1

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

Question 2

What is Osteochondritis dissecans

Answer 2

Pain after exercise
Intermittent swelling and locking

Question 3

What is Patellar tendonitis

Answer 3

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

Question 4

Growth plate fractures

Answer 4

Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush

Question 5

Undisplaced spiral fracture of the tibia

Answer 5

toddlers fracture

Question 6

Presentation transient synovitis

Answer 6

limp/refusal to weight bear
groin or hip pain
a low-grade fever is present in a minority of patients
after respiratory illness

Question 7

Management transient synovitis

Answer 7

Transient synovitis is self-limiting, requiring only rest and analgesia.

Question 8

Investigations ?septic arthritis

Answer 8

USS, if shows effusion and with corroborating history, treat as septic arthritis

joint aspiration: for culture.

Will show a raised WBC
raised inflammatory markers

blood cultures

Question 9

Most common causative organism septic arthritis

Answer 9

Staphylococcus aureus is the most common causative organism

Question 10

If you were going to get septic arthritis from an STI, what would it be?

Answer 10

neisseria gonorrhoea

Question 11

what is the kocher criteria

Answer 11

fever >38.5 degrees C
non-weight bearing
raised ESR > 40
raised WCC >12

Question 12

Best imaging for osteomyelitis

Answer 12

MRI

Question 13

Most common organism osteomyelitis

Answer 13

staph aureus

Question 14

Management osteomyelitis

Answer 14

sepsis 6 and local protocol

adult and over 5 1. fluclox 2. vancomycin if pen allergic
<5 1. ceftriaxone

Question 15

How does perthes present

Answer 15

Pain in the hip or groin
Limp
Restricted hip movements
There may be referred pain to the knee
no trauma!!

Question 16

investigations perthes

Answer 16

plain x-ray

technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist

Question 17

Management perthes

Answer 17

rest
cruches
analgesia
physio

Question 18

Age typical SUFE

Answer 18

typically presents aged 8 – 15 years, with the average age of 12 in boys

Question 19

Presentation SUFE

Answer 19

Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted movement in the hip
Minor trauma history

Question 20

Investigations SUFE

Answer 20

1. X-ray

Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
Technetium bone scan
CT scan
MRI scan

Question 21

Management SUFE

Answer 21

surgery

Question 22

Inheritance osteogenesis imperfecta

Answer 22

autosomal dominant
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides

Question 23

Features of osteogenesis imperfecta

Answer 23

fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common

Question 24

Blood tests osteogenesis imperfecta

Answer 24

adjusted calcium, phosphate, parathyroid hormone and ALP results are usually normal in osteogenesis imperfecta

Question 25

manaagement osteogenesis imperfecta

Answer 25

Bisphosphates to increase bone density Vitamin D supplementation to prevent deficiency

Question 26

Investigatons rickets

Answer 26

Serum 25-hydroxyvitamin D is the laboratory investigation for vitamin D. A result of less than 25 nmol/L establishes a diagnosis vitamin D deficiency, which can lead to rickets. Xray is required to diagnose rickets.

Question 27

Dosage vitamin D for kids whoa re deficient

Answer 27

6 months and 12 years is 6,000 IU per day for 8 – 12 weeks.

Question 28

Whos at more risk of vitamin D deficiency - breast fed babies or bottle fed

Answer 28

breast fed

Question 29

Management kawasaki disease

Answer 29

High dose aspirin to reduce the risk of thrombosis IV immunoglobulins to reduce the risk of coronary artery aneurysms

Question 30

Features of kawasaki/ criteria

Answer 30

Conjunctivitis (non-exudative, bilateral) Rash (nonvesicular) Adenopathy Strawberry tounge Hands (peeling, redness) and burn (5 days of fever) 4 of 5 symptoms WITH fever > 5 days fever (above 39 degrees)

Question 31

What is rheumatic fever?

Answer 31

Acute rheumatic fever is an autoimmune condition triggered by streptococcus bacteria. It is caused by antibodies created against the streptococcus bacteria that also target tissues in the body.

Question 32

Criteria for rheumatic fever

Answer 32

A diagnosis of rheumatic fever can be made when there is evidence of recent streptococcal infection, plus: Two major criteria OR One major criteria plus two minor criteria The mnemonic for the Jones criteria is JONES – FEAR. Major Criteria: J – Joint arthritis O – Organ inflammation, such as carditis N – Nodules E – Erythema marginatum rash S – Sydenham chorea Minor Criteria: Fever ECG Changes (prolonged PR interval) without carditis Arthralgia without arthritis Raised inflammatory markers (CRP and ESR)

Question 33

Investigations for rheumatic fever

Answer 33

Throat swab for bacterial culture ASO antibody titres Echocardiogram, ECG and chest xray can assess the heart involvement

Question 34

What causes rheumatic fever

Answer 34

Group A strep - strep pyogenes

Question 35

How does stills disease present?

Answer 35

salmon pink rash, high swinging fevers, arthritis

Question 36

How does polyarticular arthritis present?

Answer 36

5 or more joints, symmetrical

Question 37

How does oligoarticular/pauciarticular arthritis

Answer 37

4 joints or less Larger joints 60% of JIA Girls under 6 years Anterior uveitis

Question 38

How does enthesitis present?

Answer 38

Boys over 6 years Tender entheses

Question 39

How do psoriatic arthritis present?

Answer 39

symmetrical polyarthritis affecting the small joints similar to rheumatoid, or an asymmetrical arthritis affecting the large joints in the lower limb. Pitting Dactylitis Psoriatic plaques enthesitis

Question 40

Most common juvenile arthritis

Answer 40

Oligoarticular/pauarticular

Question 41

Which JIA do you get raised inflammatory markers

Answer 41

systemic/stills

Question 42

Which JIA is associated with HLA-B27

Answer 42

enthesitis

Question 43

What arthtitis is ANA positve

Answer 43

oligoarticular/pauarticualr

Question 44

What JIA may be RF positive

Answer 44

polyarticualr in older children

Question 45

Acute inflammation JIA

Answer 45

NSAIDs Steroid injections or oral

Question 46

Long term management JIA

Answer 46

1. DMARDs methotrexate or IM sulfasalazine 2. Biologics: adalimubab

Question 47

Kids and methotrexate

Answer 47

upset stomach

Question 48

Symptoms of reactive arthritis

Answer 48

'Can't see, pee or climb a tree'

Question 49

What pathogens causes reactive arthritis

Answer 49

Chlamydia Shigella Salmonella Yersinia Campylobacter

Question 50

Management reactive arthritis

Answer 50

symptomatic: analgesia, NSAIDS, intra-articular steroids sulfasalazine and methotrexate are sometimes used for persistent disease symptoms rarely last more than 12 months

Question 51

Associations reactive arthritis

Answer 51

Bilateral conjunctivitis (non-infective) Anterior uveitis Circinate balanitis is dermatitis of the head of the penis

Question 52

What rheumatological condition is POTS associated with

Answer 52

ehlers danlos

Question 53

features of growing pains

Answer 53

never present at the start of the day after the child has woken no limp no limitation of physical activity systemically well normal physical examination motor milestones normal symptoms are often intermittent and worse after a day of vigorous activity

Question 54

features of rickets

Answer 54

Rickety rosary I pigeon chest (pectus carinatum) Craniotabes (soft skull bones) Knock knees (older), bowed legs (toddler) End of long bones --> wide Teeth hypoplasia Skull frontal bossing and delayed closure of fontanelles aching bones and joints Genu varum (bow legs) Genu valgum (knock knees) - stuck together with gum 'rickety rosary' - swelling at the costochondral junction kyphoscoliosis craniotabes - soft skull bones in early life Harrison's sulcus widening of joints on imaging

Question 55

What collagen is implicated in osteogenesis imperfecta?

Answer 55

type 1

Question 56

genetics achondroplasia

Answer 56

The achondroplasia gene, fibroblast growth factor receptor 3 (FGFR3), is on chromosome 4. Achondroplasia results from either a sporadic mutation or inheritance of an abnormal copy of this gene. The condition is inherited in an autosomal dominant pattern. Homozygous gene mutations, meaning two abnormal gene copies with one from each parent, is fatal in the neonatal period. Therefore, patients with achondroplasia have one normal gene and one abnormal gene. Mutations in the FGFR3 gene causes abnormal function of the epiphyseal plates (growth plates). This restricts the bone growth in length, leading to short bones and short stature.