14578608
Description
Flashcards by Averil Tam, updated more than 1 year ago
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Created by Averil Tam
over 5 years ago
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| Question | Answer |
| 1. TRUE/FALSE - developmental dysplasia of the hip (DDH). a) Ultrasound is the investigation of choice in the first six months of life for suspected DDH. | True. It is a sensitive test if performed by an experienced ultrasonographer. Beyond six months of age X-ray is the investigation of choice. |
| 1. TRUE/FALSE - developmental dysplasia of the hip (DDH). b) A normal newborn examination rules out rules out the possibility of DDH. | False. Physical signs of DDH may be subtle. A hip examination should therefore be repeated at every opportunity in the first year of life. |
| 1. TRUE/FALSE - developmental dysplasia of the hip (DDH). c) Asymmetric skin folds on the thighs are a reliable sign of DDH in a baby. | False. Asymmetric skin folds may be present in babies with normal hips. A dislocated hip detected by the Ortolani’s manoeuvre or a dislocatable hip detected by the Barlow test are the most reliable clinical signs of DDH. Limitation of hip abduction is also a reliable feature where as leg length asymmetry is difficult to assess and therefore less reliable. |
| 1. TRUE/FALSE - developmental dysplasia of the hip (DDH). d) DDH is a benign self resolving condition. | False. Mild cases of DDH often resolve without treatment, however more severe cases if not managed appropriately may progress to an irreducible hip dislocation. Early detection is vital in order to prevent long term disability. Treatment includes splinting in Pavlik harness. In severe cases, or those detected late, plaster casting or surgical correction may be required. |
| 1. TRUE/FALSE - developmental dysplasia of the hip (DDH). e) A family history of DDH is an indication for hip ultrasound in a newborn even if the hips appear normal on clinical examination. | True. Signs of DDH may be subtle and may be missed on physical examination. Other indications for a hip ultrasound include: breech presentation, associated features such as sternomastoid tumour, metatarsus adductus and talipes calcaneovalgus and/or physical signs of DDH. |
| 2. TRUE/FALSE? a) Septic arthritis of the hip requires urgent management. | True. If not managed urgently, may lead to permanent damage to the femoral head. Any child/infant with an irritable hip who appears unwell should be urgently referred to a hospital emergency for specialist review and management. The child should be fasted as the management modality for septic arthritis involves arthrotomy and drainage of the joint under general anaesthetic. |
| 2. TRUE/FALSE? b) A three year old boy presents with a history of limp of a few days duration but otherwise looks well. The most likely diagnosis is Perthes disease. | False. Transient synovitis of the hip is the commonest cause of an antalgic gait in a preschooler who is afebrile, otherwise well and whose inflammatory markers are normal/mildly elevated. Do not miss septic arthritis which is more likely if the child appears unwell etc. If Dx of transient synovitis, need close follow up to check for symptom resolution which is usually 2-3 weeks. Perthes disease is more common in school aged children (5-10yo). However some children diagnosed with transient synovitis may subsequently present with radiological features of Perthes disease; therefore children with unresolved irritability of the hip require orthopaedic review. |
| 2. TRUE/FALSE? c) A 12 year old boy presents with knee pain of 3 weeks duration. The knee is normal on examination. The boy has been well, afebrile but the pain has been progressive and he is now unable to weight bear. There is a history of being bullied at school. In the setting of a normal knee examination, the knee pain is most likely to be of psychosomatic origin in this child. | False. The most likely cause of knee pain to be considered here is slipped capital femoral epiphysis (SCFE) which typically presents in adolescents, overweight is a predisposing factor. This requires urgent orthopaedic intervention. Hip pathology can often present with referred pain in the knee or anterior thigh and should always be considered in cases of knee pain. |
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