Paeds Written - MSK

Question 1

Criteria to manage a case of Transient Synovitis in primary care

Answer 1

Has to be all of these:

Aged 3-9 
Afebrile
Well child
Mobile but limping
Had Sx for <72 hours

Question 2

Septic arthritis Tx

Answer 2

Joint aspirate
THEN start empirical Abx
- 4-6 weeks
- can swap to oral after 2 weeks if improving

+ Arthroscopic washout?

Question 3

Definitive Tx for DDH

Answer 3

Pavlik harness if <4-5 months

Older = surgery

Question 4

Pathophysiology of Perthes’ disease

Answer 4

Impaired blood supply to femoral head

Results in avascular necrosis of femoral epiphysis

Question 5

When is limb shortening observed in Osteosarcoma (of femur)?

Answer 5

If pathological fracture occurs

Otherwise, not seen.

Question 6

Pathophysiology of SUFE

Answer 6

Displacement of femoral head postero-inferiorly

Acute or chronic, persistent

Question 7

RF for SUFE

Answer 7

Obesity!!
Family Hx
Endo: Hypothyroidism, pituitary tumour, renal osteodystrophy
Down's syndrome
Trauma

Question 8

Diagnostic findings on imaging in SUFE

Answer 8

Displaced femoral head - infero-laterally
Klein’s line (superior edge of femoral neck) intersects less of femoral head

Southwick angle - gives indication of severity

Question 9

Criteria for assessing likelihood of septic arthritis in child?

Answer 9

Kocher’s criteria

Non weight bearing
Fever >38.5
WCC >12
ESR > 40

1 point = 3%, 4 points = 99%

Question 10

Common sites of osteomyelitis

Answer 10

Distal femur

Proximal tibia

Question 11

Osteomyelitis Tx

Answer 11

2-4 weeks IV Abx

• 1st line = Flucloxacillin
• penicillin allergic = clindamycin
• MRSA = vancomycin

Switch to oral once CRP normal

+ surgical debridement if evidence of dead bone or biofilm

Question 12

Ottawa rule for X-Raying ankle

Answer 12

Pain in malleolar zone and

• bone tenderness at posterior edge or tip of lateral malleolus OR
• bone tenderness at posterior edge or tip of medial malleolus OR
• inability to bear weight immediately AND in ED for 4 steps

Pain in mid-foot zone and

• bone tenderness at base of 5th metatarsal OR
• bone tenderness at navicular OR
• inability to bear weight immediately AND in ED for 4 steps

Question 13

Ottawa rule for X-Raying knee

Answer 13

Any of:

Age 55+
Isolated patellar tenderness
Cannot flex to 90 degrees
Inability to weight bear immediately AND in ED for 4 steps

Question 14

Sedation for manipulation of fracture

Answer 14

1st line = intranasal / oral midazolam OR Nitrous oxide
2nd line (or severe) = intranasal ketamine

Question 15

XR changes in Perthes’ disease

Answer 15

Joint space widening (early)
Decreased femoral head size / flattening (late)
Femoral head fragmentation (very late)

Question 16

Perthes’ disease Tx options

Answer 16

Cast, braces - to keep femoral head within acetabulum

<6 years = observation
Older = surgery

+ Physiotherapy

Question 17

Pathophysiology of Osgood-Sclatter disease

Answer 17

Multiple small avulsion fractures from quadriceps’ contraction at their insertion into proximal tibial apophysis

Causes inflammation of cartilage/bone

Question 18

Clinical features of Osgood-Schlatter disease

Answer 18

Localised tenderness/swelling over tibial tuberosity

Gradual onset pain worse AFTER exercise - relieved by rest

Question 19

Chondromalacia patellae Clinical features

Answer 19

Anterior knee pain
Exacerbated by running, climbing stairs, getting up after prolonged sitting

O/E:
Painless passive movement
Repeated extension –> pain, Grating sensation

Question 20

Osteochondritis dissecans clinical features

Answer 20

Pain after exercise

Catching, locking, giving way

Question 21

Indications for USS Screening of DDH:

Answer 21

Breech presentation at any time after 36/40 (even if not born breech)

First degree family member with early life hip problems

Multiple pregnancy

Question 22

Tests for DDH at 6-8 week baby check

Answer 22

Barlow = attempt to dislocate
Ortolani = attempt to relocate

Question 23

Features of benign idiopathic nocturnal limb pains of childhood (growing pains)

Answer 23

NOT present at start of day / after waking
Intermittent
Worse after day of vigorous activity
No limp or limitation on activity
Systemically well
Normal examination
Normal motor milestones