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Pediatrics 3B > Applied Muscularskeletal > Flashcards

Applied Muscularskeletal Flashcards

0
Q

Clues for muscle disease in older infants and children (11)

A 
Floppy baby
Delayed milestones 
Trouble walking/running
Trouble climbing stairs/Getting up from sitting
Tripping and falling 
Fatigue
Double vision at the end of the day 
Muscle Pain 
Difficulty swallowing
Garbled speech after eating cold food (myotonia?)
Trouble letting go of objects
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1
Q

Perinatal clues for muscle disease (4)

A

Reduced Intra-uterine movement
Neonatal respiratory distress
Poor Suck
Reduced limb activity

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2
Q

Congenital absence of ____ is associated with _____

- Pectoralis major

A

Isolated

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3
Q

Congenital absence of ____ is associated with _____

- Depressor labii oris

A

Congenital heart disease

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4
Q

Congenital absence of ____ is associated with _____

- Pectoralis muscle

A

leukemia

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5
Q

Congenital absence of ____ is associated with _____

- Temporalis

A

Myotonia

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6
Q

Wasting 1’ muscle degeneration

A

Disuse

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7
Q

Wasting 2’ (2)

A

Anterior horn cell dse

Peripheral nerve dse

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8
Q

T/F Genital hemihypertrophy involves _____% of the body and is considered ________

A

50%

SERIOUS

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9
Q

Isolated hypertrophy of calf muscles

A

Duchenne Dystrophy

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10
Q

Type of hypertrophy seen in congenital adrenal hyperplasia

A

Generalized

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11
Q

Fasciculation of muscle bundles is seen in conditions associated with irritation of

A

Anterior horn cell

  • Polio
  • Werdnig-Hoffmann
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12
Q

Palpation of an induration over muscle is seen in (3)

A

Dermatomyositis
Infectious myositis
Pyomyositis

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13
Q

Tenderness on palpation of muscles is seen in

A

Dermatomyositis

Trichinosis

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14
Q

Percussion
Contraction on percussion + delayed relaxation

Best tested on _____ muscle

A

Myotonia congenita

Biceps

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15
Q

Testing Muscle strength

Ant neck flexors

A

Get up from supine

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16
Q

Testing Muscle strength

Trapezius

A

Shrug shoulders

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17
Q

Testing Muscle strength

Deltoids

A

Elevate arms over head

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18
Q

Testing Muscle strength

Biceps

A

Flex elbow

Palm facing upwards

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19
Q

Testing Muscle strength

Quadriceps

A

Sit on edge of table w/popliteal space flush

Extend knee

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20
Q

Testing Muscle strength

Gluteus medius

A

R lateral side
Flex knee
Abduct hip on L side

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21
Q

Testing Muscle strength

Gluteus maximus

A

Prone
Knees flexed
Lift hip off table

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22
Q

Testing Muscle strength

Gastrocnemius and soleus

A

Using sole of foot, push down on examiner’s palm

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23
Q

Pattern of weakness

Dermatomyositis

A

Proximal

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24
Q

Pattern of weakness

Peripheral neuritis

A

Distal extremity weakness

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25
Q

Pattern of weakness

One sided weakness

A

Unilateral cerebral insult

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26
Q

Pattern of weakness

Unequal lower limb weakness

A

Myelomeningocele

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27
Q

Pattern of weakness

Equal lower limb weakness

A

Paraplegia

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28
Q 
Activities of Daily living
I -
II - 
III - 
IV -
A

I Fully independent
II Most independent, minimal help required
III Wheelchair bound
IV Totally dependent

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29
Q

Clues in diagnosing muscle weakness

Myotonia

A

Mental retardation

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30
Q

Clues in diagnosing muscle weakness

Exaggerated reflexes

A

CNS dse

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31
Q

Clues in diagnosing muscle weakness

Fasciculations

A

Anterior horn cell disease

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32
Q

Clues in diagnosing muscle weakness

Rashes

A

Collagen vascular disease

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33
Q

Clues in diagnosing muscle weakness

Sensory changes

A

Peripheral nerve disease

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34
Q

Clues in diagnosing muscle weakness

Dark urine

A

Myoglobinuria

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35
Q

Gait

Waddling

A

Proximal muscle weakness around the hip

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36
Q

Gait

Toe walking

A

Duchenne or

Tight heel cord

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37
Q

Gait

Slapping gait

A

Peripheral neuropathy

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38
Q

Gait

High stepping gait

A

Posterior column lesion

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39
Q

History and PE
(+) Joint pain
(-) Swelling

A

Arthralgia

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40
Q

History and PE
(+) Joint Pain
(+) Swelling

A

Arthritis

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41
Q

History and PE: Etiology

Pain: Acute onset in 1 joint

A

Trauma or

Inflammation

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42
Q

History and PE: Etiology

Slow onset of pain

A

Collagen vascular disease

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43
Q

History and PE: Etiology

Generalized pain

A

Polyarticular

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44
Q

History and PE: Etiology

Pain in a joint for 1-2 days

A

Trauma

Infection

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45
Q

History and PE: Etiology

Pain in a joint for days or months

A

Collagen disease

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46
Q

History and PE:

Intense acute pain

A

Acute rheumatic fever or
Septic arthritis
(Acute onset could also be trauma or inflammation)

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47
Q

History and PE:

Extreme grades of pain

A

Vasomotor disease

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48
Q

History and PE:

Moderate pain

A

Juvenile Rheumatoid Arthritis

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49
Q

History and PE:

Arthritis w/no pain

A

Neuropathic joint

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50
Q

History and PE:

True migrating pain (Flitting-fleeting)

A

Acute rheumatic fever

Gonococcemia

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51
Q

History and PE:

Non-migrating pain

A

Collagen vascular disease

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52
Q

History and PE:

Pain worse on activity

A

Destructive joint dse

i.e. acute cartilaginous necrosis

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53
Q

History and PE:

Pain and stiffness early in the morning

A

Suggests JRA

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54
Q

History and PE:

Pain that interferes w/sleep

A

Vasomotor dse

Joint Bleeding

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55
Q

History and PE:

Growing pain

A

Septic arthritis
Osteomyelitis
Osteoid osteoma

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56
Q

Inspection

Involves 1 side of the joint

A

Peri-articular

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57
Q

Inspection

Swelling extends above and below joint

A

Cellulitis

Peri-articular swelling involves 1 side of joint

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58
Q

Inspection

True swelling w/_____ defined edges suggests __________

A

ill-defined

effusion in the joint

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59
Q

Inspection

___________ __________ = swelling of joint w/clear defined edges

A

Synovial thickening

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60
Q

Inspection
Sterno-clavicular swelling
- Acute: ?
- Chronic: ?

A

Acute - Gonococcemia

Chronic - Juvenile arthritis

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61
Q

Inspection: Etiology?

Obliteration of dimples of olecranon

A

Swelling of elbow

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62
Q

Inspection: Manifestation

Swelling of carpal joints

A

Limitation of wrist extension (seen dorsally)

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63
Q

Inspection: Etiology?

Clear, distal, oblique transverse edge

A

Swelling of extensor tendon sheath

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64
Q

Inspection: Etiology?

Diffuse swelling of dorsum of hand

A

Sickle cell disease

Tenosynovitis w/lymphedema or serum sickness

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65
Q

Inspection: Etiology?

Flexed, claw-like fingers

A

Flexor teno-synovitis

Clawhand - paralysis of ulnar nerve
Bifid Claw-like hand - Thalidomide

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66
Q

History and PE:

Swelling of plantar aspect w/tenderness

A

Ankylosing spondylitis

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67
Q

History and PE:
Swelling of sole and dorsum of feet
(-) Tenderness

A

Serum sickness

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68
Q

History and PE: Palpation

Heat and tenderness over the joint

A

Inflammatory arthritis

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69
Q

History and PE: Palpation

Flexor tendon tenderness upon percussion

A

Flexor tenosynovitis

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70
Q

History and PE: Palpation

Percussion of flexor aspect of wrist –> tingling sensation along outer 3 fingers

A

Carpal tunnel syndrome

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71
Q

T/F

Tenderness along femoral tibial edges of knee is a feature of arthritis

A

FALSE

NOT a feature

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72
Q

Most important point in testing for tenderness

A

Exclude tenderness of peri-articular structures

73
Q

History and PE:

Test to elicit tenderness of sacro-iliac joint

A

Prezel

Hold and cross one lower limb over the other while crossing the opposite upper limb across the trunk. Hold the shoulder and knee, and do quick spring-like stretching

74
Q

History and PE:

(+) Cashmere velvet feeling =

A

Hypertrophic synovium

75
Q

History and PE:
(+) Crepitus on auscultation
- Along flexor tendons =
- Over tempero-mandibular joint =

A

Flexor tendons - Teno-synovitis of scleroderma

TMJ - JRA

76
Q

Range of motion: How to test

Inferior cervical spine

A

Chin on chest

77
Q

Range of motion: How to test

Atlanto-axial joint

A

Look up

Side to side

78
Q

Range of motion: How to test

Lower cervical spine

A

Ear to shoulder

79
Q

Range of motion: How to test

Abduction and internal rotation of shoulder

A

Arms above shoulders

Touch palms

80
Q

Range of motion: How to test

Indian greeting tests what

A

Wrist ext

Elbow flexion

81
Q

Range of motion: How to test/What are you testing

Distal and proximal interphalangeal joints

A

Bend fingers (scratching)

82
Q

Range of motion: How to test/What are you testing

Metacarpo-phalangeal joints

A

Close the fist

83
Q

Range of motion: How to test/What are you testing

Hip and knee flexion

A

Squat DOWN

if rising from squatting, test of strength (DUH!)

84
Q

Range of motion: How to test/What are you testing
Trouble getting up? Suspect
Trouble sitting down? Suspect

A

Muscle

Joint

85
Q

Range of motion: Hip

At rest, flexion + external rotation =

A

Effusion into hip joint

86
Q

Range of motion: How to test/What are you testing

Hip rotation is best tested in what position

87
Q

Range of motion: Etiology

Limitation of internal rotation of hip

A

Slipped epiphysis

Legg-Perthes disease

88
Q

Range of motion:

Excessive external rotation of hip is normal up to _____

89
Q

Range of motion: Etiology/Manifestation

Loss of full extension of knee

A

Arthritides

90
Q

Range of motion: Etiology/Manifestation

Osgood-Schlatter disease

A

Pain below knee causing limitation of flexion

91
Q

Torsional deformities of lower limb: Hip
In-toeing:
Out-toeing:

A

Femoral anteversion

Physiologic (infancy)

92
Q

Torsional deformities of lower limb: Tibia
In-toeing:
Out-toeing:

A

Internal torsion

External torsion

93
Q

Torsional deformities of lower limb: Foot
In-toeing:
Out-toeing:

A

Metatarsus adductus

Flat-foot or curved foot

94
Q

Straight lateral border of foot =

95
Q

Convexity of the lateral border of the foot =

A

Metatarsus adductus

96
Q

Tibial torsion is best observed when child is in _____ position and thigh _________

A

Prone

Flexed to 90’

97
Q

Normal Thigh foot angle =

98
Q

Thigh foot angle =

A

Internal tibial torsion (normal first 2 years of life)

99
Q

Excessive external rotation and limitation of internal rotation is normal up to

A

18m of life

100
Q

Internal rotation normally:

101
Q

Internal rotation >70’

A

Femoral anteversion

102
Q 
Toddler gait: 
When child walks in straight line, feet make an angle of 
\_\_\_\_ in external rotation
\_\_\_\_ in-toeing 
\_\_\_\_ out-toeing
A

10’
>10’
>30’

103
Q

Testing genu varum, valgum, flat foot and pronated foot

With medial malleoli touching, there must be _________ space between medial condyles

104
Q

Testing genu varum, valgum, flat foot and pronated foot
Genu varum
Space between medial condyles:
Normal until

A

Bowleg
>2 inches
Physiologic until 2.5 years old

105
Q

Testing genu varum, valgum, flat foot and pronated foot
Genu valgum
Space between medial condyle:
Normal at what age

A

Knock knee

Normal betwee 2-5 years

106
Q

Testing genu varum, valgum, flat foot and pronated foot
Pronated feet: definition -
Where is weight

A

Outward curvature of tendo-achilles

Inside edge of sole

107
Q

Functional test for joint problems:

Duration of morning stiffness

A

Rheumatic dse

108
Q

Functional test for joint problems:

Grip strength of 6-10 y/o

109
Q

Spine: Inspection
Young child w/
Short neck or Elevated shoulder
+ Scholiosis

A

Hemi-vertebrae

110
Q

Spine: Inspection

Child walking extremely to avoid pain suggests

A

Intervertebral disc inflammation

111
Q

Spine: Inspection

Bunch of hair over lower end of spine suggests

A

Lipo-meningocele

Spina bifida occulta?

112
Q

Spine: Inspection

Dimple at lower end of spine (2)

A

Sacrococcygeal dimple

Pilonidal sinus

113
Q 
Spine: Inspection 
Curves 
- Cervical - 
- Thorax - 
- Lumbar
A

C curve
Convex
C Curve

114
Q

Loss of C curve in cervical spine = (2)

A

JRA

Tuberculosis of the spine

115
Q

Spine: Inspection

Prominent thoracic curve

A

Kyphosis

i.e. morquio disease

116
Q

Spine: Inspection
Distinct angle at apex of kyphosis =
Indicates:

A

Gibbus

Fracture/collapse of vertebrae

117
Q

Spine: Inspection

Loss of lumbar lordosis seen in

A

Ankylosing spondylitis

118
Q

Spine: Inspection

Prominent lordosis is d/t (3)

A

Familial
Developmental (N up to 7-8 yo)
Hip flexion

119
Q

Spine: Scoliosis

Five (5) physical clues

A 
Elevated shoulder on one side 
Unequal bra cup size 
Family history of scoliosis 
Prominent scapula 
Leg length discrepancy
120
Q

Spine: Scoliosis

How to perform Hump Test

121
Q

Spine: Scoliosis

Modified Schober’s tests for

A

Mobility of lumbar spine

Mark midline over spine 10cm above 1st point
Another mark 5cm below first point.
Patient bends forward and points should be at least 7cm apart

122
Q

Hand:
Handedness established at
What if earlier?

A

2.5-3 years old

Earlier suggests hemiplegia

123
Q

Hand:

Tremors at rest (2)

A

Essential

Wilson’s

124
Q

Hand:

Tremor in sustained posture (4)

A

Anxiety
Fatigue
Thyrotoxicosis
Cerebellar dse

125
Q 
Hand: 
Intention tremor (2)
A

Cerebellar dse

Stress

126
Q

Hand:

Inability to sustain grasp =

127
Q

Hand:

Writhing movements in distal part of body =

128
Q

Hand:
Flopping movement of outstretched hand =
Seen in

A

Asterixis (liver flap)

Seen in hepatic failure (Reye’s syndrome)

129
Q

Hand:

Loss of abduction and extension of thumb d/t

A

Radial nerve paralysis

130
Q

Hand:

Loss of ADduction of thumb

A

Ulnar nerve paralysis

131
Q

Hand:

Apposition of thumb d/t

A

Median nerve paralysis

132
Q

Hand: Size

Achondroplasia

133
Q

Hand: Size

Gigantism

134
Q

Hand: Size

Long hands w/spidery fingers (2)

A

Arachnodactyl

Homocystinuria

135
Q

Hand: Size

Hypoplasia of radial aspect of hand (2)

A

Holt-Oram syndrome

Fanconi Syndrome

136
Q

Hand: Shape

Mitten hand + Fused fingers

137
Q

Hand: Shape

Apert syndrome =

A

Mitten hand w/fused fingers

138
Q

Hand: Shape

Bifid claw-like hand

A

Thalidomide syndrome

139
Q

Hand: Position

Policeman receiving tip d/t

A

Brachial plexus paralysis

140
Q

Hand: Position

Wrist drop

A

Radial nerve paralysis

141
Q

Hand: Position

Claw hand

A

Ulnar nerve paralysis

Bifid clawlike = thalidomide
Claw-like fingers = flexor tenosynovitis

142
Q

Hand: Position
Ulnar deviation of hand +
Volar subluxation of the wrist

143
Q

Rashes and Nodules:

Vesicular lesions are seen in: (6)

A 
Scabies
Herpes simplex 
Chicken pox 
Epidermolysis bullosa 
Congenital Syphilis 
Gonococcemia
144
Q

Rashes and Nodules:

Pustules are seen in (2)

A

Impetigo

Infected scabies

145
Q

Rashes and Nodules:

Lesion in Rheumatoid arthritis

146
Q

Rashes and Nodules:

Purpuric (2)

A

Rocky Mountain spotted fever

Meningococcemia

147
Q

Rashes and Nodules:

Tips of fingers in scleroderma

A

Vasculitic

148
Q

Fingers:

Short fingers of equal length are seen in (2)

A

Hypothyroidism

Achondroplasia (banana bunch fingers)

149
Q

Fingers:

Trident sign

A

Acondroplasia

150
Q

Fingers:

Polydactyl is seen in (2)

A

Ellis-Van Creveld syndrome

Trisomy 13

151
Q

Fingers:

Syndactyl is seen in (3)

A

Apert Syndrome
de Lange syndrome
Prader Willi Syndrome

152
Q

Fingers:
Uniformly swollen
Slight flexion
Tender along tendon sheaths

A

Acute tenosynovitis

153
Q

Fingers:

Triggering (locking) of fingers suggests

A

Nodules along flexor tendons

154
Q

Fingers:
Flexion deformity of little finger
Seen in (3)
Inherited via

A

Camptodactyl

Down
Carpenter
Aarskog

Simple dominant gene

155
Q

Fingers:
Shortening of radial aspect of middle phalanx resulting to radial deflection of terminal phalanx

Seen in: M/F?
Normal: ?

A

Clindodactyl

Females

0.3% of normal population

156
Q

Fingers:

Hypoplasia of metacarpal bones of all fingers is seen in (2)

A

Coffin-siris syndrome

Cri-du-chat

157
Q

Fingers:

Hypoplasia of 4th metacarpal causes dimple. Seen in

A

Pseudo-hypo-parathyroidism

158
Q

Fingers:
Patient clenches fist w/thumb inside palm. Tip of thumb protrudes past ulnar border of palm.
(+) in
(-) in

A

THUMB SIGN
(+) Marfan
(-) Homocystunuria

159
Q

Thumb:
Abnormality: Triphalangeal thumb
Associated Syndrome:

160
Q

Thumb:
Abnormality: Thumb Aplasia
Associated Syndrome:

A

13q syndrome

161
Q

Thumb:
Abnormality: Broad thumb
Associated Syndrome:

A

Rubinstein-Taybi

162
Q

Thumb:
Abnormality: Proximal placement of thumb
Associated Syndrome:

A

18q syndrome

163
Q

Thumb:
Abnormality: Flexed thumb
Associated Syndrome:

A

Arthrogryposis

164
Q

Thumb:
Abnormality: Bifid thumb
Associated Syndrome:

A

Translocation 3/13

165
Q

Dermatoglyphics:

Three components

A

Flexion creases
Ridge arrangement of palms
Finger patterns

166
Q

Dermatoglyphics:
2 distal creases fuse and run as single crease along entire palm to ulnar border of palm =

Seen in

A

Simian crease

Down (NOT pathonomonic)

167
Q

Dermatoglyphics:
2 transverse creases
Proximal runs across entire palm

Seen in:

A

Sydney line

Congenital rubella syndrome

168
Q

Dermatoglyphics:
2-3 creases over proximal interphalangeal joints
1 over distal interphalangeal joints

169
Q

Dermatoglyphics:

2 creases over palmar aspect of distal interphalangeal joints are seen in

A

Sickle cell disease

170
Q 
Ankylosing Spondylitis: 
Arthritis of the \_\_\_\_\_\_
\_\_\_\_\_\_\_ disease
Early symptoms: (2) 
Age:
A 
Arthritis of spine 
Immune disease (auto?)
Early: Back pain + Stiffness
Late adolescence or early adulthood 
Fuse vertebrae together
171
Q

_______ ________ Disease

Idiopathic Osteo-necrosis of capital femoral epiphysis of femoral head

A

Legg Perthes Disease

172
Q

Legg Perthes

  • Cause
  • Location (2), referred to (1)
  • Pain (2)
  • Quality of pain (2)
  • History of trauma?
A

Idiopathic osteo-necrosis of capital femoral epiphysis of femoral head
Hip/Groin –> Thigh
Mild/Intermittent in Ant thigh or knee
NO history of trauma

173
Q

MC cause of knee pain in adolescent

Prognosis:

A

Osgood-Schlatter (Osteo-chondritis) Dis-ecans

Benign/Self limited

174
Q

Pain + Edema in tibial tubercle
Associated w/traction apophysitis of _____ tubercle
Due to __________ on the ___________ ossification center

A

Osgood-Schlatter (Osteo-chondritis)
Tibeal
Repetitive strain on 2’ ossification center of tibial tubercle

175
Q 
\_\_\_\_\_\_\_\_\_\_\_\_
Mucopolysaccharidosis type \_\_\_\_
INC clumsiness 
Mild coarsening of facial features
Corneal clouding
Hepatomegaly 
Odontoid hypoplasia 
Exercise intolerance
A

Morquio Disease

176
Q

_____________ Disease
Inheritance
Liver dse manifestations (jaundice, varices, spider angiomas, palmar erythema)
Neuro-psychiatric
___________ rings
Arthropathy ressembles premature osteo-arthritis
________ anemia

A

Wilson’s
Rare AR
Kayser-Fleischer rings
Hemolytic anemia

177
Q 
Fanconi Syndrome
\_\_\_\_\_\_\_\_ of kidneys excrete \_\_\_\_(3)\_\_\_\_\_ into urine 
Evidenced by 
\_\_\_(4)\_\_\_\_\_ in urine 
INC or DEC? Potassium
INC or DEC? in Vit. D
A 
Fanconi Syndrome 
Proximal tubules secrete \_\_\_\_\_\_ into urine 
- Glucose
- AA
- Phosphate

Evidenced by: Glucose, Citrate, AA, Phosphate in urine
Hypokalemia
Vit D deficiency

178
Q 
\_\_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_ Syndrome 
X-linked 
Ocular hyper-telorism
Anteverted nostrils 
Broad \_\_\_\_\_\_\_\_ lip
Scrotal "Shawl" \_\_\_\_\_\_\_ the penis 
\_\_\_\_\_\_\_\_ hands
A

Carpenter and Aarskog Syndrome
Broad upper lip
Shawl Above penis
Small hands

179
Q

______________ Syndrome

  • rare congenital
  • Sex predilection (?)
  • Delay: mental or developmental
  • Coarse facial features
  • Incompletely formed or absent ______
  • Absent 5th finger
A

Coffin-Siris Syndrome
Females
BOTH Mental and developmental
5th fingernails

180
Q

_____________ syndrome

  • Multisystem
  • Growth retardation & and delayed ______ age
  • Mental retardation
  • Craniofacial dysmorphism
  • Hyper-telorism
  • ___________ nose
  • ___________ thumbs and toes
  • Breathing and swallowing difficulties
A

Rubinstein-Taybi

  • Delayed bone age
  • Broad nasal bridge
  • Abnormally large or “beak-shaped” nose
  • Broad thumbs and toes
181
Q

__________________
Progressive or non-progressive?
Multiple joint contractions present at birth
Extremities are ________ or _________ in shape
Thin SQ Tissues and absent skin creases
Deformities are (symmetric or asymmetric?)
Severity increases (distally or proximally?)
_________ and ______ are most deformed
Joint rigidity and dislocation (esp ____ and _____)
Atrophy
Sensation (+/-? )
DTR (+/-?)

A
  • Arthrogryposis
  • Non-progressive
  • Extremities are fusiform or cylindrical
  • Deformities are symmetric
  • Severity increases distally
  • Hands and feet most deformed
  • Sensation intact
  • DtR diminished or absent

Pediatrics 3B (12 decks)

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