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Musculoskeletal System II > 24- Pediatric Patients > Flashcards

24- Pediatric Patients Flashcards

1
Q

What are the 2 types of rotational foot deformities in kids?

A

Intoeing and outtoeing are the common MSK disorders, intoeing being more common

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2
Q

What is “pigeon toed” a rotational deformity of?

A

An intoeing

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3
Q

Where are the 3 possible locations for the origin of intoeing?

A

: the foot, the leg between the knee and the ankle, and the thigh, between the hip and the knee

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4
Q

What happens in metatarsus adductus?

A

Forefoot is angled towards the midline of the body. It is a packaging deformity, so the position of the baby inside the mother’s womb caused the deformity to occur

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5
Q

What is the actively correctable nature of the metatarsus adductus?

A

the infant straightens the foot in response to tickling.

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6
Q

What is the passively correctable nature of the metatarsus adductus?

A

does not correct when foot is tickled, but can correct with lateral pressure on the first metatarsal head.

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7
Q

What is it called when the foot cannot be corrected with active or passive methods in metatarsus adductus?

A

Rigid deformities

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8
Q

What is club foot?

A

complex foot disorder that involves three separate deformities, including metatarsus adductus, equinus (plantar flexion resembling a horse that walks on its toes), and heel varus, although Developmental dysplasia of the hip is linked as well. Also the foot looks like a golf club

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9
Q

What is genu varum?

A

bow legs (varying legs that don’t like each other)

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10
Q

What is genu valgum?

A

knock knees (think gum sticks together)

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11
Q

All children are born bow-legged and begins to improve around what year of age?

A

2-3 y/o

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12
Q

What is the criteria for pathological angular deformities?

A

An angular deformity must be asymmetric, unilateral, or painful, until it can be deemed pathological.

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13
Q

What is Blount’s disease?

A

medial proximal tibial physis stops working and then the lateral side of the tibia grows too much, producing tibia curving and genu varum

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14
Q

What population is Blount’s disease most common in?

A

African American children, girls, children who are large for their age, and early walkers ( <11 months walking age).

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15
Q

What is the incidence of club foot deformities as well as the male to female ratio of occurrence?

A

1 in 1000 live births, 2.5:1 M to F ratio

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16
Q

What are the three separate deformities of club foot?

A

Metatarsus addcutus, equinus, and heel varus.

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17
Q

Are congenital club foot and development dysplasia of the hip associated?

A

Yes so kids with clubfoot need to be screened for DDH

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18
Q

What is the Tx for clubfoot?

A

Club foot treatment consists of manipulation of the foot (casts), surgery, or both. Casting is done first, then surgery if it is unsuccessful.

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19
Q

What is the etiology of pes planus?

A

flat feet with no arch while standing but reappears with standing on toes. Comes from an autosomal dominant condition with generalized ligamentous laxity

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20
Q

How do you manage flat feet?

A

Only when pain presents itself does the physician prescribe shoe inserts. Shoes with built in arch support will help. Telling the family it is not a serious or dangerous condition will also allay fears.

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21
Q

What are rigid flat feet?

A

flat feet where the arch does not reform while standing on toes, and where the subtalar joint has limited motion on examination

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22
Q

What causes rigid flat feet?

A

tarsal caolition - some of the tarsal bones are fused, so the lack of motion from fusion can put stress on nearby joints and manifest pain.

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23
Q

Which type of radiographs are the best diagnostic imaging study for tarsal conditions?

A

CT

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24
Q

What is developmental dysplasia of the hip?

A

spectrum of abnormalities of the developing hip joint, includes shallowness of the acetabulum (hip socket), capsular laxity and instability, or frank dislocation

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25
Q

What are the rates of occurance for DDH?

A

DDH occurs 1 out of 1000 births

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26
Q

What are the risk factors for DDH?

A

female, firstborn, carried/delivered in the breech position, and family history of hip dysplasia or ligamentous laxity

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27
Q

How can you screen for DDH?

A

Screening consists of looking for asymmetries in the number of skin folds in the high, and the height of the affected knee (Allis/Galeazzi sign), and range of abduction

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28
Q

What are the provocative tests for DDH?

A

The provocative tests (Ortolani and Barlow maneuvers) are designed to elicit clunks when the dislocated femur in and out of the acetabulum.

29
Q

What happens in the Ortolani and Barlow tests?

A

For both tests a “clunk” will occur if there is a positive test and a femoral head dislocation.
Ortolani – abduction of the legs
Barlow – adduction of legs

30
Q

Which radiological test should you use for suspected DDH in a neonate?

A

Ultrasound is used until the 4th to 6th month old infant.

31
Q

What happens to the hip with DDH if it’s untreated?

A

DDH leads to severe early osteoarthritis of the hip if left untreated.

32
Q

What is slipped capital femoral epiphysis (SFCE)?

A

displacement or slipping of part of the femoral head (epiphysis) through the growth plate.

33
Q

When does SCFE occur?

A

It occurs during adolescence, when the growth plate is very active, and the typiiical patient is the child going through adolescence (11 to 13 in girls and 13 to 15 in boys)

34
Q

Where is the pain in SCFE?

A

The pain localizes in the groin, and also pain in the knee and thigh.

35
Q

What % of SCFE cases are bilateral?

A

20%

36
Q

How does a SCFE patient present on physical exam?

A

Limp, external rotation of the hip, and limited or painful internal hip rotation.

37
Q

What is the Tx of SCFE?

A

Surgical treatment is necessary with pinning of the femoral head.

38
Q

What is Legg-Calve’-Perthes Disease (LCP)?

A

idiopathic osteonecrosis of the femoral head, multifactorial, with a genetic/hormonal predisposition and also an external traumatic event

39
Q

What is a typical patient for LCP?

A

4-8 year old boy who is small for his age, very active, and has a very quick onset of pain and limp. Patient presents with limited abduction and internal rotation of the hip

40
Q

What shows on Xrays for LCP?

A

Findings will show sclerosis, flattening, and fragmentation of the femoral head. It is a long disease (2 years) with the femoral head fragmenting, subsiding, and slowly reforming

41
Q

How do you treat LCP?

A

the goal is maintaining the femoral head position in the acetabulum, range of motion, and preserving roundness in the head during regrowth, these goals are done through physical therapy, bracing and surgery.

42
Q

The Salter Harris classification is a system to classify fractures of what part of the bone?

A

growth plate (physis)

43
Q

What is a type I Salter Harris Fx?

A

normal radiograph due to the fracture going across, management is with immobilization

44
Q

What is a type II Salter Harris Fx?

A

wedge shaped fragment, common fracture and good prognosis

45
Q

What is a type III Salter Harris Fx?

A

go through physis and epiphysis, require surgical correction, and can lead to osteoarthritis, growth arrest, resulting in angular/longitudinal deformities of the bone

46
Q

What is a type IV Salter Harris Fx?

A

crosses the epiphysis and metaphysis, surgical treatment and high possibility of growth arrest.

47
Q

What is a type V Salter Harris Fx?

A

mpressional injury, rare and always result in growth arrest.

48
Q

What is cerebral palsy?

A

nonprogressive neurologic condition caused by a brain lesion, can be from mild to severe. Brain injury is unchanging, and the hallmark is abnormal muscle control.

49
Q

What causes cerebral palsy?

A

Brain malformation, vascular insult, trauma, toxins, fetal/maternal metabolic disease, and infection

50
Q

What might cause cerebral palsy during pregnancy?

A

Prematurity, low birth weight, and perinatal hypoxia are associated with CP as well

51
Q

What are the 3 functional classifications of cerebral palsy?

A

Manner of which the involvement is expressed, and are described as quadriplegic (four extremities are involved), diplegic (lower extremities are more involved), or hemiplegic (one side of the body).

52
Q

What causes spina bifida?

A

genetic, environmental, and nutritional factors all play a role.

53
Q

What is the embryological origin for spina bifida?

A

Dorsal thickening of ectoderm forms, within that thickening, neural groove develops, and then the neural folds develop from those and then fuse together to make the neural tube. When the neural folds don’t fuse or a rupture occurs after fusion, then spina bifida occurs

54
Q

What day does spina bifida occur?

A

21

55
Q

What is meningocele?

A

vertebral arches are unfused and meningeal sac is visible at birth

56
Q

What is myelomeningocele?

A

neural elements are visible within the sac

57
Q

What is rachischisis?

A

neural elements are exposed to the outside without a sac

58
Q

What are factors associated with neural tube defects?

A

Must have adequate levels of folate (400 to 800 ug/day) and avoid hot baths, saunas, and steam rooms, which have been associated with neural tube defects

59
Q

What is the difference between thoracic and lumbar presentation for meningocele?

A

Thoracic level defects have spine and hip problems

Lumbar/sacral level defects have more defects with the knee and foot.

60
Q

What is the level that the meningocele has to be in order to ambulate effectively?

A

Patients need quadriceps function to walk, so if there is a defect at or below L4, then they will not be able to walk.

61
Q

What are the complications of decreased sensation in spina-bifida?

A

Decreased sensation leads to the patient being prone to lower extremity wounds, skin breakdown, and fractures, since they don’t feel it, and must be carefully monitored

62
Q

What are the three categories of scoliosis?

A

Idiopathic (spontaneous/unknown), congenital (existing at birth), and neuromuscular (with a lot of other disorders)

63
Q

When is idiopathic scoliosis is typically detected and in what gender it is most common?

A

Idiopathic scoliosis is usually detected between 10 and 12 years old. Girls are more likely to have this deformity.

64
Q

What is the “rib hump” and how is it used to clinically detect scoliosis?

A

Remember OPP and how we detect scoliosis, this is pretty much the same thing: the patient forwardly bends and then rotates to see if there is a rib hump, which is a sign of scoliosis

65
Q

What is the criteria for conservative brace and surgical management of scoliosis?

A

Curvature of less than 25 degrees are left alone, and 25 to 45 degrees should be braced, greater than 45 degrees need surgery. For surgery, they insert metal rods and then fuse the spine into position.

66
Q

Which view of the X ray is best for scoliosis?

A

Best viewed anterior posterior, but also includes a rotational component. AP radiograph allows measurement of the degree of spinal curvature

67
Q

What is the association of congenital scoliosis with kidney or heart abnormalities?

A

Kidneys and heart development occurs at the same time of that of the spine, so these organs are affected in 15-20 percent of the congenital scoliosis children

68
Q

What are the types of disorders associated with neuromuscular scoliosis?

A

Disorders include CP, spina bifida, muscular dystrophy, and spinal cord injuries

Musculoskeletal System II (24 decks)

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