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Osha 3a > Paeds MSK > Flashcards

Paeds MSK Flashcards

1
Q

What is osteogenesis imperfecta?

A
  • autosomal dominant
  • brittle bones susceptible to fracture
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2
Q

What is the pathophysiology of osteogenesis imperfecta?

A
  • genetic mutation
  • affects formation of collagen
  • needed for structure and function of bone, skin, tendons, connective tissue
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3
Q

How does osteogenesis imperfecta present?

A
  • recurrent and inappropriate fractures
  • hypermobility
  • blue/grey sclera
  • triangular face
  • dental problems
  • bone deformities
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4
Q

How is osteogenesis imperfecta investigated?

A
  • clinical diagnosis
  • X-Rays for fractures
  • normal bloods
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5
Q

How is osteogenesis imperfecta managed medically?

A
  • bisphosphonates
  • Vit D
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6
Q

How is osteogenesis imperfecta managed by the MDT?

A
  • physio and OT
  • ortho surgeons
  • specialist nurses
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7
Q

What is rickets?

A
  • defective bone mineralisation causes ‘soft’ and deformed bones
  • called osteomalacia in adults
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8
Q

What is the aetiology of rickets?

A
  • vit D deficiency (lack of sunlight or food)
  • calcium deficiency (dairy + green veg)
  • hereditary hypophosphataemic rickets
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9
Q

What are risk factors for rickets?

A
  • darker skin
  • low exposure to sunlight
  • cold climates
  • time indoors
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10
Q

How does rickets present?

A
  • lethargy
  • bone pain
  • poor growth
  • dental problems
  • muscle weakness
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11
Q

What bone deformities does rickets present with?

A
  • bowed legs
  • knock knees
  • rachitic rosary (costochondral junction swelling)
  • craniotabes (soft skull)
  • delayed teeth
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12
Q

How is rickets investigated?

A
  • serum 250hydroxyvitamin D >25nmol/L
  • raised ALP and PTH
  • low calcium and phosphate
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13
Q

What is the management of rickets?

A
  • Prevention (more likely if breastfed)
  • oral Vit D 400IU supplements for breastfeeding women and all children
  • ergocalciferol (vit D) if deficient
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14
Q

What is transient synovitis?

A
  • irritable hip
  • temporary irritation and inflammation in the synovial membrane
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15
Q

What is the epidemiology and aetiology of transient synovitis?

A
  • MC cause of hip pain in children aged 3-10
  • often associated with viral URTI: symptoms occur within a few weeks
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16
Q

What is the presentation of transient synovitis?

A
  • refusal to weight bear
  • limp
  • groin or hip pain
  • mild low grade temp
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17
Q

What is the management of transient synovitis?

A
  • exclude septic arthritis
  • symptomatic management
  • recovery within 1-2 weeks without long term effects
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18
Q

When should children be admitted to hospital with transient synovitis?

A
  • under 3: septic arthritis is more common
  • fever
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19
Q

What is septic arthritis and what is the epidemiology?

A
  • infection inside a joint
  • MC in children <4 years
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20
Q

What bacteria cause septic arthritis?

A
  • S. aureus is MC
  • N. gonorrhoea (sexually active teens)
  • Group A strep (S. pyogenes)
  • H. influenzae
  • E. coli
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21
Q

What is the presentation of septic arthritis?

A
  • hot, red, swollen, painful joint
  • refusal to weight bear
  • affects single joint e.g. hip or knee
  • stiffness and reduced ROM
  • systemic symptoms: fever, lethargy, sepsis
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22
Q

What are the Kocher criteria?

A
  • fever >38.5
  • non-weight bearing
  • raised ESR
  • raised WCC
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23
Q

What is the management for septic arthritis?

A
  • admit to hospital
  • joint aspiration before Abx: gram staining, MC&S
  • empirical IV Abx followed by specific Abx
  • surgical drainage and washout
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24
Q

What is osteomyelitis?

A
  • infection of the bone and bone marrow
  • typically in metaphysis of long bones
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25
How can infection be introduced to bone in osteomyelitis?
- open fracture or from blood - chronic osteomyelitis is slow growing and deep seated
26
What are risk factors for osteomyelitis?
- males <10 - open bone fracture - orthopaedic surgery - immunocompromised - sickle cell anaemia - HIV/TB
27
How does osteomyelitis present?
- refusal to use limb or weight bear - pain - swelling - tenderness - systemic symptoms: fever
28
How is osteomyelitis investigated?
- first line: X-Ray - GOLD: MRI - bloods + cultures - Bone marrow aspirate
29
How is osteomyelitis managed?
- extensive and prolonged Abx therapy - surgery for draining and debridement
30
What is Perthes Disease?
- disruption of blood flow to femoral head causing - avascular necrosis of bone - revascularisation and bone remodelling as it heals
31
What is the aetiology and epidemiology of Perthes disease?
- idiopathic - MC boys 5-8y but can affect all children from 4-12
32
What is the presentation of Perthes disease?
- slow onset of pain in hip or groin - limp - restricted hip movement - referred knee pain - no history of trauma
33
How is Perthes disease investigated?
- X-Ray (may be normal) - bloods - technetium bone scan - MRI
34
How is Perthes disease managed?
- conservative to maintain position and alignment - reduce risk of damage or deformity to femoral head - bed rest, analgesia, crutches, traction - physio, X-Ray, surgery
35
What is slipped femoral epiphysis?
- head of femur dislocated along growth plate
36
What is the epidemiology of slipped femoral epiphysis?
- mc in males - aged 8-15 - obese children
37
How does slipped femoral epiphysis present?
- adolescent, obese male undergoing growth spurt - painful limp - wanting to keep hip in external rotation with restricted internal rotation on flexion - hip, groin, knee or thigh pain
38
How is slipped femoral epiphysis investigated?
- 1st line: X-Ray - bloods normal - CT/MRI
39
How is slipped femoral epiphysis managed?
- surgery to return femoral head to correct position and fix in place - internal fixation with cannulated screw
40
What is osgood-schlatter disease?
- inflammation at tibial tuberosity where patellar ligament inserts - usually unilateral
41
What is the epidemiology of osgood-schlatter disease?
- males aged 10-15 - common cause of anterior knee pain in adolescents
42
What is the pathophysiology of osgood-schlatter disease?
- patella tendon inserts into tibial tuberosity - stress from movement during growth causes inflammation - ligament pulls away tiny pieces of bone > new bone formation and calcification in response to injury - leads to tender bump > hard, non-tender as it heals
43
How does osgood-schlatter disease present?
- pain exacerbated by physical activity, kneeling and on extension - gradual onset of symptoms - palpable lump at tibial tuberosity
44
How is osgood-schlatter disease managed?
- NSAIDs - reduce physical activity - ice - stretching
45
What is DDH?
- structural abnormality in hips caused by abnormal development of fetal bones - leads to instability in hips and tendency for dislocation
46
How is DDH recognised?
- in newborn exam - child presents with hip asymmetry - reduced ROM in hip or limp
47
What are risk factors for DDH?
- 1º FHx - breech presentation from 36 weeks onwards - female - first born - oligohydramnios
48
How is DDH screened for after birth? (what is seen)
- NIPE - different leg lengths - restricted hip abduction on one side - significant bilateral restriction in abduction - difference in knee level when hips flexed - clunking of hips on special testing
49
What are the special tests for DDH?
- Ortolani - Barlow
50
What is the Barlow test?
- attempts to dislocate an articulated femoral head
51
What is the ortolani test?
attempts to relocate a dislocated femoral head
52
What are other signs of DDH?
- asymmetrical skin folds - different leg lengths - limited abduction of hip
53
How is DDH investigated?
- USS - X-Ray
54
How is DDH managed?
- Pavlik harness if <6 mo - keeps femoral head in correct position - keeps hips flexed and abducted - may need surgery if harness fails or diagnosis >6 mo
55
What is JIA?
- autoimmune inflammation in joints - arthritis without any other cause - lasts more than 6 weeks in patient under 16
56
What is the presentation of systemic JIA?
- idiopathic inflammatory condition - subtle salmon pink rash - enlarged lymph nodes - high swinging fever - joint pain and inflammation - splenomegaly - muscle pain
57
What are the results of investigations of systemic JIA?
- ANA and RF negative - raised CRP, ESR, platelets
58
What is a key complication of systemic JIA?
- macrophage activation syndrome - massive inflammatory response - DIC, anaemia, bleeding, non-blanching rash - low ESR
59
How does polyarticular JIA present?
- 5 joints or more - symmetrical - affects small/large joints - minimal systemic symptoms: mild fever, anaemia, reduced growth
60
What results are found in investigation of polyarticular JIA?
- mostly negative for RF - seropositive are older children and adolescents
61
What is oligoarticular JIA?
- involves 4 or less joints - aka pauciarticular JIA
62
How does oligoarticular JIA present?
- 4 or less joints (usually monoarthritis) - large joints e.g. knee or ankle - anterior uveitis
63
What is seen on investigation of oligoarticular JIA?
- no systemic symptoms - normal/mildly elevated inflammatory markers - ANA positive - RF negative
64
What is juvenile psoriatic arthritis?
- seronegative inflammatory arthritis - symmetrical polyarthritis affecting small joints OR - asymmetrical arthritis affecting large joints
65
How does juvenile psoriatic arthritis present?
- plaques of psoriasis - pitting and onycholysis - dactylitis - enthesitis
66
What is the epidemiology of enthesitis-related arthritis?
- more common in male children over 6 years - paeds version of seronegative spondyloarthropathies - most have HLA-B27 gene
67
What is enthesitis?
- inflammation at point where muscle inserts into bone - caused by trauma or autoimmune
68
How does enthesitis-related arthritis present?
- signs and symptoms of psoriasis and IBD - prone to anterior uveitis
69
How is JIA managed?
- NSAIDs - steroids - oral, IM or intra-articular - DMARDs e.g. methotrexate - biologics e.g. adalimumab

Osha 3a (15 decks)

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