Paeds MSK

Question 1

What’s the most common cause of hip pain in children aged 3-10?

Answer 1

Transient synovitis

Question 2

What is transient synovitis often associated with?

Answer 2

A recent viral URTI

Question 3

True/false - Perthes disease is more common in boys

Answer 3

True

Question 4

What happens in Perthes disease

Answer 4

Disruption of blood supply to the femoral head leading to avascular necrosis of the bone

Question 5

Will there be a history of trauma in Perthes disease?

Answer 5

No

Question 6

What is the initial management in Perthes disease?

Answer 6

Conservative - maintain a healthy position and alignment in the joint to promote healing and prevent damage

Question 7

What happens in slipped upper femoral epiphysis?

Answer 7

The femoral head is displaced along the growth plate

Question 8

What is the typical profile of a child with SUFE?

Answer 8

Adolescent (ages 8-15), obese male undergoing a growth spurt

Question 9

What condition is indicated by a history of hip pain/restricted ROM and trauma

Answer 9

Slipped upper femoral epiphysis

Question 10

How will a patient with SUFE typically hold their hip?

Answer 10

Externally rotated

Question 11

What is the management of SUFE?

Answer 11

Surgery to fix the femoral head in the correct place

Question 12

What happens in Osgood-Schlatter disease?

Answer 12

Inflammation at the tibial tuberosity where the patella ligament inserts

Question 13

Is Osgood-Schlatter disease usually unilateral or bilateral?

Answer 13

Usually unilateral

Question 14

What is the typical profile of a child with Osgood-Schlatter disease?

Answer 14

Sporty male between ages of 10-15

Question 15

What the the 3 most common causes of joint pain in patients aged 0-3?

Answer 15

• Septic arthritis
• Developmental dysplasia of the hip
• Transient synovitis

Question 16

What are the 3 most common causes of joint pain in patients aged 5-10?

Answer 16

• Septic arthritis
• Transient synovitis
• Perthes disease

Question 17

What the the 3 most common causes of joint pain in patients aged 10-16?

Answer 17

• Septic arthritis
• Slipped upper femoral epiphysis
• JIA

Question 18

What is osteomyelitis and what’s the most common cause?

Answer 18

• Infection in the bone and bone marrow
• Staph aureus

Question 19

How is septic arthritis different to osteomyelitis?

Answer 19

Septic arthritis is infection of a joint

Question 20

What’s the best investigation for diagnosing osteomyelitis?

Answer 20

MRI

Question 21

What is the management of osteomyelitis?

Answer 21

• Long term antibiotic therapy
• May need surgery to drain and remove the infected bone

Question 22

Osteosarcoma:
1. Age typically affected
2. Which bone is mos commonly affected
3. What is the main presenting feature

Answer 22

1. 10-20
2. Femur
3. Persistent bone pain

Question 23

Osteosarcoma diagnosis:
1. What will XR show
2. What blood test may be raised

Answer 23

1. A poorly defined lesion in the bone, with destruction of the normal bone and a “fluffy” appearance
2. ALP

Question 24

What is talipes

Answer 24

A fixed abnormal ankle position, present at birth

Question 25

What are the two different types of talipes?

Answer 25

- Talipes equinovagus - ankle in plantar flexion and supination - Talipes calcaneovalgus - ankle in dorsiflexion and pronation

Question 26

What is the management of talipes?

Answer 26

Ponseti method - non surgical correction with physio and casts

Question 27

Give 3 risk factors for developmental dysplasia of the hips

Answer 27

- 1st degree FHx - Breech presentation - Multiple pregnancy

Question 28

What is the preferred investigation in developmental dysplasia of the hips?

Answer 28

USS

Question 29

DDH management: 1. What is first line treatment? 2. How does this keep the hips? 3. How long does it stay on for?

Answer 29

1. Pavlik harness 2. Flexed and abducted 3. 6-8 wks

Question 30

When is surgery indicated in DDH?

Answer 30

If the pavlik harness fails or the baby is >6months

Question 31

Vitamin D deficiency investigations: 1. What blood test is measured? 2. What value indicates vitamin D deficiency? 3. What investigation is required to diagnose rickets? 4. What might it show?

Answer 31

1. 25-hydroxyvitamin D 2. <25 mol/L 3. XR 4. More radiolucent bones

Question 32

Vitamin D deficiency management: 1. What is the treatment for Vitamin D deficiency 2. What else needs to be replaced in rickets

Answer 32

1. Ergocalciferol 2. Calcium

Question 33

What's the likely diagnosis? What differential requires excluding? - Young child - Unusual and recurrent fractures - Blue discolouration to sclera

Answer 33

- Osteogenesis imperfecta - NAI

Question 34

What medications are used in osteogenesis imperfecta?

Answer 34

- Bisphosphonates - increase bone density - Vit D supplements - prevent deficiency

Question 35

Do you get a painless limb in Perthe's or SUFE?

Answer 35

Perthe's

Question 36

What is irritable hip?

Answer 36

Transient synovitis with joint effusion

Question 37

What do Barlows and Ortolanis tests look for?

Answer 37

- Ortalani - does the hip dislocate anteriorly - Barlow - does the femoral head displace posteriorly

Question 38

What is the investigation for hip dysplasia in... 1. Child <4 months 2. Child >4 months

Answer 38

1. USS 2. XR

Question 39

Give two investigations for Perthes disease

Answer 39

- Roll test - will evoke guarding/spasm - XR - joint space widening, crescent sign

Question 40

What criteria can be used for septic arthritis? What is included?

Answer 40

Kocher criteria - Can't weight bear - Temp >38.5 - ESR > 40 - WCC > 12