Rheum/MSK Flashcards by Nalin Choudhary

What are the nail changes in psoriatic arthritis?

Pitting, Ridging, Onycholysis, Dactylitis (sausage fingers)

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Urethritis, Conjunctivitis, peripheral arthritis

Reactive Arthritis

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An active kid with a painful knee with patellar tenderness over the ball of the knee.

Osgood-Schlatter

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How to differentiate between septic arthritis and osteomyelitis

Osteomyelitis may or may not present with fever. Localised pain in Osteomyelitis. Septic arthritis generally pain present at rest too

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Most common causative of Osteomyeletis

Staph Aureus

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What do you see on Xray in Osetomyelitis?

Lytic lesion with ring of sclerosis

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Causative organism of Septic arthritis in a kid with sickle cell disease?

Salmonella

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Transient Arthritis is generally preceded by ________

an acute viral infection

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Which is the only male dominant Juvenile idiopathic arthritis?

Enthesitis related arthritis

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What is craniosynostosis?

Premature fusion of the sutures

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Osteonecrosis of subchondral bone (after damage to overlying articular cartilage) …

Osteochondritis dissecans

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Gower’s sign, Calf hypertrophy, Waddling

Duchene’s Dystrophy

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Common complaints include ‘having to mount stairs one at a time’ and running slower than peers

Duchene’s Muscular Dystrophy

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How many types of Spinal Muscular Atrophy? And basic way to differentiate them?

4 types - and they get diagnosed at different ages

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Flattened femoral head on XRAY

Perthe’s

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What age is perthe’s most common at?

4-8 years

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Growing pains generally present at _____ and where?

Night time ad in the calf shin and thigh. no functional limitation

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How do you manage growing pains?

reassurance, supportive management (heat, massage and analgesia)

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3% of kids with transient Synovitis develop ____

Perthe’s

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Septic arthritis is most commonly caused by _____. And in a kid with sickle cell disease ____

Staph A and Strep. pneumonia. SCD - Salmonella

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How do you Ix and manage Septic arthritis?

Investigate - Joint aspirate. need 50,000 WBC for confirmed diagnosis. U/S, XRAY, Bone scan? Septic screen

Mx: Urgent aspiration +/- Arthrotomy and washout. Flucloxacillin IV

Elevate and immibolisise - plaster or split, repeat blood tests

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In Neonates and Children Osteomyelitis occurs at the ______

Metaphysis

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Osteomyelitis is subacute and hence takes about ______

6 weeks

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A complication of Osteomyelitis is Brodie’s abscess which is _____

lytic centre with a ring of sclerosis

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RF for Perthe's disease?

Steroid use! Fam history, abnormal pregnancy, LBW

Painful hip, afebrile, tenderness of knee and anterior thigh - decreased internal rotation and abduction of the hip. Worse after exercise

Perthe's disease

XRAY: Increased density of capital epiphysis, patchy osteolysis, new bone formation, remodeling and collapse or flattening of the femoral head Remodeling and collapse or flattening of the femoral head

Perthe's disease

Management of perthe's disease?

Goal to preserve ROM and Femoral head. 1. Physiotherapy 2. Brace in flexion and abduction for 2-3 years 3. pelvic or femoral osteotomy

Repetitive tensile stress on the insertion of patellar tendon over the tibial tuberosity causes minor avulsion at the site and subsequent inflammatory reaction

Osgood Schlatter disease

Tender lump over the tibial tuberosity - pain on resisted led extension.

Osgood Schlatter disease

What would you see on Knee XRAY with Osgood Schlatter disease?

Fragmentation of the tibial tubercle

Management of Osgood Schlatter disease?

Benign, self limited condition - hence RICE. Restrict activities like cycling and basketball.

Congenital Talipes Equinovarus has three points of deformity: Talipes, Equinus and Varus

- Talus is inverted and internally rotated - Ankle is plantar flexed - Varus - heel and forefoot are varus (supinated)

How to manage Club foot (Congenital talipes equinovarus)?

Correct deformity in the following order, forefoot adduction, ankle eversion and euqinar. Use strapping and cast - which has to be changed every 1-2 weeks

Scolios above and below the fixed primary curve to try and maintain normal position of head and pelvis - primary or secondary curve?

Secondary!

When do you start treating scoliosis?

When the angle of deformity is more than 20 degrees. >20 degree - brace (slow progression) > 40 degrees - surgery

Non-specifically poorly localised knee pain (can be over femoral condyles) with activity, mechanical sensation and loss of range of motion with advances lesions (with loose bodies)

Osteochondritis Dissecans

Osteonecrosis of subchondral bone (after damage to overlying cartilage)

Osteochondritis dissecans

Classic triad of Henoch Schonlein Purpura?

Palpable purpura Abdominal pain and Arthritis

Features of (Systemic arthritis) Still's disease?

Once or twice daily fever spikes for more than 2 weeks - children Salmon coloured maculopapular rash, lymphadenopathy, hepatosplenomegaly Arthritis may occur weeks to months later

Fever - with Salmon coloured maculopapular rash, lymphadenopathy, hepatosplenomegaly. Arthritis occurs 4 months later

Still's disease

How do you manage Still's disease?

Prednisolone

Oligoarthritis is arthritis of ______ joints. And if extended?

1-4. if extended it affects more than 4 joints after the first 6 months

Anterior Uveitis is related to ______

Juvenile idiopathic arthritis - Oligoarthritis

ANA positive Juvenile Idiopathic arthritis?

Oligoarticular, Polycarticular and psoriatic

Knee flexion contracture, quadriceps atrophy,leg length discrepancy and growth distrubances are complications seen with which arthritis?

Oligoarthritis

RF positive in Juvenile Idiopathic arthritis. Most likely to be________

Polyarticular arthritis

Ethesitis-related arthritis tends to affect which joints?

Weight bearing joints, especially hip and intertarsal joints

Arthritis Affects Achilles tendon and plantar fascial attachment into the calcaneus, the poles of the patellae and the greater trochanters. In a male boy

Enthesistis related arthritis

Which JIA is HLA-B27 positive?

Enthesitis related arthritis

Enthesitis related arthritis in kids has a 50% risk of developing _____ in adulthood

Ankylosing spondylitis

_________ presents with Reiter's syndrome - can't see, can't pee, can't Climb a tree

Reactive arthritis

``` Caused by spirochete Borrelia Burgdorferi, B. Garinii, B. afzelli - Trasmitted by Ixodes Tick Small rodents (mice) serve as primary reservoir Incidence highest amongst 5-10 year olds ```

Lyme Arthritis

Arthritis related to Erythema Chronicum Migrans (Expanding, non-pruritic target lesions.

Lyme arthritis

Features of Lyme Arthritis BAKE

Bell's Palsy Arthritis Kardiac block Erythema chronicum Migrans

Extra-muscular features of Duchene Muscular dystrophy?

Dilated cardiomyopathy and ID

Diagnosis of Duchene can be excluded by testing ____ which is always elevated

Mx of Duchene dystrophy?

Steroids (Can slow progression) Cardiac monitoring Step wise respiratory interventions Physio, Allied health

First months of life and most severe; hypotonia and weakness (affecting respiratory function, ‘paradoxical breathing’; death within first two years (usually from pneumonia) ♣ Weakness of the intercostal muscles, coupled with relatively normal diaphragmatic contractions, resulted in marked chest deformity II (intermediate): 8-18mo; children cannot

Type 1 SMA

Due to ligamentous laxity, muscular underdevelopment and abnormal shallow slope of acetabular roof --->

DDH

What are the three pathophys features of DDH?

1. Ligamentous laxity 2. Muscular underdevelopment 3. abnormal positioning of the acetabular roof

DDH leads to Hip ______ and _____-

Hip subluxation and dislocation

Test done with DDH - shows knees at unequal heights when hip's flexed

Galeazzi Sign

What investigations would you do for DDH?

U/S in first few months to view cartilage. Follow up radiography after 3mo

SUFE is a Type I Salter Harris fracture since

it is straight through the Growth plate

``` SALTER HARRIS FRACTURE Classification: S A L T R ```

``` Straight (SUFE) Above (Growth plate and metaphysis Lower (Through growth plate and Epiphysis) Through all three elements RAM - Crush injury of growth plate ```

In SUFE, Limited movement of hip (especially________________)

Internal rotation. Abduction, flexion

Knee pain in a sporty teenager associated with intermittent swelling and locking?

Osteochondritis Dissecans

Teenage girl with characteristic knee pain on walking up and down stairs and rising from prolonged sitting

Chrondomalacia patella

Sporty teenager with pain, tenderness and swelling over the tibial tubercle

Osgood Schlatter disease

Medial knee pain due to lateral sublaxation of the patella - knee may "give way"

Patellar Subuxation

More common in athletic teenage boys - chronic anterior knee pain that worsens on running. Tender below the patella on examination

Patellar tendonitis

Rheum/MSK Flashcards

(72 cards)