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Pediatrics > BRS Rheumatology and Ortho > Flashcards

BRS Rheumatology and Ortho Flashcards

1
Q

URI –> skin, GI, renal, and joint manifestations

  • skin: petechiae and palpable purpura on buttocks and legs, edema of extremities and face
  • joint: arthritis, arthralgia
  • GI: colicky abd pain, GI bleeding, intussusception
  • renal: ranges from mild hematuria to ESRD
A

henoch Schönlein purpura- IgA mediated vasculitis

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2
Q

how to dx HSP

what are the plts like?

A

H&P
may see IgA immune complexes in serum or kidney
**note: plt counts are normal! this is a nonthrombocytopenic purpura

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3
Q

how to tx HSP

prognosis?

A

supportive care
steroids for abd pain and arthritis
most recover in 4 weeks- some might recur, morbidity depends on severity of nephritis

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4
Q

median age of HSP

A

age 5 years

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5
Q

______ is an acute febrile vasculitis of childhood
most common cause of acquired heart disease in kids in US
-mean age of presentation? MC ethnicity affected?

A

kawasaki disease (mucocutaneous lymph node syndrome)
mean age 18-24 months
Asian

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6
Q

diagnostic criteria of kawasaki disease

A
  1. fever for at least 5 days
    AND
  2. 4/5 of the following:
    -conjunctivitis- limbic sparing, no exudate
    -oropharyngeal changes- red cracked swollen lips, strawberry tongue
    -cervical adenopathy- unilateral, nonsuppurative
    -rash- trunk
    -changes in extremities- brawny edema, erythematous palms and soles –> peeling around nail beds
    AND
  3. it’s not caused by something else
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7
Q

other features of kawasaki disease

A 
coronary artery aneurysm in the subacute phase of the disease (days 7-14)
low grade myocarditis
CHF
urethritis (sterile pyuria)
aseptic meningitis
*hydrops of the gallbladder 
arthritis or arthralgias
anterior uveitis
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8
Q

3 phases of kawasaki disease

A
  1. acute phase (1-2 weeks): fever, conjunctivitis, oropharyngeal changes, cervical adenopathy, rash, swollen hands
    - increased ESR and CRP
  2. subacute phase (weeks to months): defervescence of inflammation, peeling from nail beds or distal extremities, *coronary artery aneurysms
    - decreasing ESR and CRP, increasing plt count
  3. convalescent phase (weeks to years): gradual resolution of aneurysms
    - normalization of labs
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9
Q

tx for kawasaki disease

A

acute phase: high dose IVIG, hight dose aspirin
subacute phase: low dose aspirin
convalescent phase: low dose aspirin only if aneurysms remain

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10
Q

prognosis of kawasaki disease

A

if coronary artery disease is absent, no long term sequelae occur

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11
Q

diagnostic criteria for JRA

A
  • age of onset < 16 years
  • arthritis in at least 1 joint (swelling or effusion OR limitation of motion, tenderness, increased warmth)
  • duration of disease > 6 weeks
  • exclusion of other causes of arthritis
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12
Q

mean age of onset of JRA

A

1-3 years

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13
Q

for the most part, JRA is more common in females except for the following two instances:

A
  1. M = F for systemic onset JRA

2. M > F for late-onset oligoarticular JRA

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14
Q

two types of oligoarticular JRA (less than or equal to 4 joints)

A
  1. early onset: females, majority are ANA+, high risk for developing chronic uveitis
  2. late onset: males, HLA-B27+, hips and SI joints involved
    - in both types, arthritis is usually not symmetric and involves knees and hips most commonly
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15
Q

two types of polyarticular JRA (>4 joints)

A
  1. RF negative: both early and late childhood
  2. RF positive: more in older children, more severe than RF (-) disease, higher risk of severe arthritis
    - symmetric polyarthritis of both small and large joints
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16
Q
  • high spiking fevers that are worse at night
  • transient salmon colored rash when fevers are present, nonpruritic
  • HSM
  • LAD
  • fatigue, anorexia, weight loss, FTT, serositis, CNS involvement, myositis, tenosynovitis
A

systemic onset JRA (Still’s disease)

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17
Q

what type of anemia do you see in JRA

A

microcytic and hypochromic- anemia of chronic dz

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18
Q

when is ANA+ with JRA

A

75% of early-onset oligoarticular

50% of polyarticular

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19
Q

unlike adult inflammatory arthritis, in JRA, RF is ____ in the majority of patients

A

negative

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20
Q

how to tx JRA

A
  • NSAIDs
  • immunomodulatory meds (steroids, methotrexate, etc) for more severe dz
  • PT and OT
  • surgery if joint issues are awful
  • psychosocial support
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21
Q

diagnostic criteria for SLE

A

4/11 of the following (SOAP BRAIN MD):

  1. Serositis (pleurites or pericardial inflammation)
  2. Oral or nasal mucocutaneous ulcers
  3. Arthritis, nonerosive
  4. Photosensitivity
  5. Blood cytopenias (leukopenia, hemolytic anemia, thrombocytopenia)
  6. Renal disease (hematuria, proteinuria, HTN)
  7. ANA positive
  8. Immunoserology- dsDNA, Smith, false + RPR or VDRL
  9. Neurologic sxs- seizures, psychosis, encephalopathy
  10. Malar rash
  11. Discoid lupus
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22
Q

demographic for SLE

A

teen girls

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23
Q

describe the arthritis in SLE

A

transient and migratory

rarely causes joint deformity or erosion (unlike JRA)

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24
Q

what are libman-sacks endocarditis?

A

sterile valvular vegetations

can be seen in SLE

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25
Q

neonates born to mothers with SLE might have this

A

congenital heart block

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26
Q

which rheum factors are often (+) in SLE but are not specific?

A

ANA

RF

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27
Q

_____ are specific for SLE and can be used as markers for active disease (esp nephritis)

A

anti-dsDNA

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28
Q

_______ are very very specific for SLE but are less prevalent

A

anti-Smith antibodies

these are NOT used as a measure of disease activity

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29
Q

_____ found in SLE predispose you to thrombotic events

A

antiphospholipid antibodies

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30
Q

these complement findings are present in lupus

A

decreased C3 and C4

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31
Q

how to tx SLE

A

-NSAIDs for myalgias and arthralgias
-steroids are the mainstay of therapy!!
+/- cyclophosphamide and other more potent immunomodulators

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32
Q

2 major complications of SLE

A
  • if there’s thrombosis and antiphospholipid antibodies –> LMWH or warfarin
  • renal failure –> tx like any other renal failure
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33
Q

prognosis of SLE

A

survival rate 90% at 5-10 years

major causes of mortality: infection, renal failure, CNS complications

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34
Q

demographic of dermatomyositis in kids

A

6 year old female

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35
Q
  • fatigue, malaise, weight loss
  • periorbital violaceous heliotrope rash
  • gottron’s papules
  • proximal muscle weakness with (+) Gower’s sign
A

dermatomyositis

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36
Q 
neck flexor weakness
calcinosis 
nail bed telangiectasias
constipation
dysphagia
cardiac involvement
A

dermatomyositis

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37
Q

how to dx dermatomyositis

A

H&P
abnormal EMG and muscle bx
increased muscle enzymes (CPK, LDH, aldolase)

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38
Q

how to tx dermatomyositis

A

steroids are the mainstay
vitamin D and Ca to prevent osteopenia
may need more intense immunosuppressants

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39
Q

3 complications of dermatomyositis

A

aspiration pneumonia 2/2 decreased gag reflex
intestinal perforation 2/2 GI vasculitis
osteopenia 2/2 steroids and muscle weakness

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40
Q

with pediatric dermatomyositis, you must look for a malignancy (T/F)

A

F

prognosis of dermatomyositis is in general better in kids

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41
Q

rheumatic fever is caused by _______

A

GABHS strains that cause pharyngitis (the skin infection strains don’t cause rheumatic fever)

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42
Q

Jones criteria for rheumatic fever

A

2 major or 1 major and 2 minor

major:
- joints
- carditis
- nodules
- erythema marginatum
- sydenham chorea
minor: fever, arthralgia, previous rheumatic fever, leukocytosis, elevated ESR, elevated CRP, prolonged PR interval

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43
Q

cardiac manifestations in rheumatic fever

A
  • endocarditis (most common) –> insufficiency of left sided valves
  • myocarditis- tachycardia out of proportion to extent of fever
  • pericarditis less common
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44
Q

describe the arthritis in rheumatic fever

A

migratory asymmetric and painful polyarthritis

-does not result in chronic joint disease

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45
Q

sydenham chorea caused by rheumatic fever is 2/2 involvement of these 2 brain structures

A

basal gnaglia and caudate nuclei

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46
Q

pink to red macules –> coalesce and spread centripetally with central clearing over the trunk and proximal limbs

A

erythema marginatum of rheumatic fever

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47
Q

how to look for GABHS infection in rheumatic fever

A

ASO
anti-DNase
anti-hyaluronidase

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48
Q

how to tx rheumatic fever

A
  • benzathine PCN (IM) one dose or PCN (PO) for 10 days
  • NSAIDs for joint pain and swelling, but only give these after the dx is for sure
  • steroids if severe cardiac involvement
  • tx the CHF if present, tx chorea if severe with haldol
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49
Q

what to do long term for rheumatic fever

A

long term antimicrobial ppx to prevent further episodes

watch out for heart valve dysfunction

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50
Q

Lyme disease is caused by _______, which is carried on ______

A

borrelia burgdorferi

deer ticks- ixodes scapularis

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51
Q

infected tick must be attached at least ______ for high chance of lyme transmission

A

36-48 hours

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52
Q

stages of Lyme disease

A

early disease (1-4 months)
-early localized
-early disseminated
late disease (5-12 months)

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53
Q

early localized Lyme disease

A

erythema migrans- annular and taret-like with variable central clearing
constitutional symptoms

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54
Q

early disseminated Lyme disease

A
  • multiple secondary erythema migrans
  • constitutional sxs
  • neuro: aseptic meningitis, facial nerve palsy (uni and bilateral), encephalitis
  • carditis is rare but could cause heart block
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55
Q

late disease of Lyme disease

A

5-12 months after transmisssion

hallmark is arthritis

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56
Q

how to dx lyme

A

classic rash

serology- ELISA then confirm with Western blot

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57
Q

how to tx Lyme disease

prognosis

A
  • early localized or late disease with arthritis only: doxycycline (age >9 years) or amoxicillin
  • carditis and meningitis require IV ceftriaxone or PCN

prognosis is excellent if treated, even if it’s late tx

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58
Q

triad of arthritis, urethritis, and conjunctivitis

what is it and what precedes it

A

reiter’s disease (a type of reactive arthritis)

usually preceded by chalmydia trachomatis infection

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59
Q

arthritis of small and large joints
scaly skin plaques
nail pitting
onycholysis (separation of nail from nailbed)

A

psoriatic arthritis

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60
Q

characterized by enthesitis

males with late onset oligoarticular JRA are at high risk for this later on

A

ankylosing spondylitis (HLA B27)

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61
Q

IBD pts may have this type of arthritis

A

HLA B27 positive, involvement of axial skeleton that looks exactly like ankylosing spondylitis

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62
Q

large vessel vasculitis affecting young Asian females

-aneurysmal dilation or thrombosis of the aorta, carotid, or subclavian arteries

A

takayasu’s arteritis

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63
Q

aneurysms and thrombosis of the small and medium sized vessels
a type of vasculitis

A

polyarteritis nodosa (PAN)

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64
Q

necrotizing granulomas in multiple organs

-severe sinusitis, hemoptysis, and glomerulonephritis

A

wegener’s granulomatosis

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65
Q

what is crest syndrome

A 
calcinosis 
Raynaud's phenomenon
esophageal involvement 
sclerosis of the skin 
telangiectasias
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66
Q

skin thickening (tightened skin), loss of dermal ridges everywhere in the body

A

systemic sclerosis

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67
Q

most brachial plexus injuries are during ______

A

the birthing process

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68
Q

_____ is a brachial plexus palsy affecting the ___ and _____ roots
it is the most common brachial plexus injury
what are some clinical features?

A

erb’s palsy, C5 and C6 roots
flaccid arm and asymmetric moro reflex
waiter’s tip

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69
Q

_____ is due to injury to nerve roots C7 and C8

what are the clinical features

A

klumpke’s palsy
claw hand- unopposed finger flexion and decreased ability to extend the elbow and flex the wrist
Horner’s syndrome may be present

70
Q

what to do when you suspect brachial plexus injury: dx and tx

A

H&P
may possibly get xray, EMG, nerve conduction studies…
observation and ROM PT and monitor for improvement

71
Q

nursemaid’s elbow is _________

it is caused by ________

A

subluxation of the radial head

pulling a toddler upward by the hand

72
Q

clinical features of nursemaid’s elbow

how to tx it?

A
  • sudden onset of pain, elbow is held flexed, no swelling, normal hand function
  • reduce it by flexing the elbow and supinating the hand simultaneously
73
Q

how to dx and tx anterior shoulder dislocation

A

dx based on xrays
tx by closed reduction then immobilization
**note: in teens, recurrence of dislocation approaches 90%

74
Q

congenital vs. acquired torticollis

which is more common and what is it caused by

A

congenital is way more common and is usually 2/2 uterine constraint or birth trauma causing SCM contracture

75
Q

head is tilted to affected side

A

torticolli

76
Q

how to dx and tx torticollis
prognosis?
complications

A

dx with physical exam
tx with stretching exercises +/- helmet therapy if head asymmetry is present
prognosis is good- 90% resolution at 6 months
complications- skull deformity, facial asymmetry

77
Q

what is atlantoaxial instability

what’s the issue here?

A
  • unstable joint between occiput and first cervical vertebrae or between C1 and C2 vertebrae
  • most ppl are asymptomatic but if they get injured, they could easily have a bad spinal cord injury
78
Q

how to dx and tx atlantoaxial instability

A

dx with flex-ex films

tx with fusion of C1 and C2 if instability is severe

79
Q

failure of normal vertebral segmentation that results in relative fusion of the involved vertebrae

A

klippel-feil syndrome

80
Q

sprengel’s deformity

A

congenital scapula problem in which the scapula is rotated laterally –> shoulder asymmetry and diminished shoulder motion
-can be seen with klippel-feil syndrome

81
Q

when can you see abnormal C1 and C2 vertebrae?

A

Down syndrome
skeletal dysplasia
klippel-feil syndrome

82
Q

lateral curvature of the spine

most cases are _______

A

scoliosis

idiopathic

83
Q

how to screen and dx scoliosis

A

adam’s forward bending test for screen

dx with PA and lateral xrays –> calculate Cobb angle

84
Q

how to tx scoliosis

A

before and during growth spurt:

  • 10-20: get f/u scoliosis film in 4-6 months
  • 20-40: bracing
  • greater than 40: surgery

after growth has concluded: surgery if > 50

85
Q

bracing and surgery for scoliosis

A

bracing prevents progression of curvature
surgery is for very severe curves or to stop progression
progression of scoliosis occurs only during growth or if curve > 50
note: almost all growth in females ceases within 6 months of menarche

86
Q

most adolescents with kyphosis have ________

A

flexible kyphosis- they can voluntarily correct the rounded area

87
Q

scheuermann’s kyphosis

A

stiff idiopathic kyphosis in which 3 or more vertebrae are wedged
-develops in previously normal teens

88
Q

you need to take back pain seriously in kids (T/F)

A

T

b/c it’s an infrequent peds complaint

89
Q

_____ is the MCC back pain in children

A

back strain

tx with rest and analgesics

90
Q

stress fracture of pars interarticularis 2/2 repetitive ______ of the spine (gymnastics, tennis, diving)

A

spondylolysis
hyperextension
pain increases with hyperextension

91
Q

how to dx spondylolysis and spondylolisthesis

A

lumbar xrays- broken scottie dog neck in spondylolysis

may need bone scan or SPECT to be more sensitive

92
Q

how to tx spondylolysis and spondylolisthesis

A

rest and analgesics for pain
casting, bracing may be necessary if pain persists
if neuro sxs in spondylolisthesis, may need surgery

93
Q

body of the vertebra involved in spondylolysis slips anteriorly (subluxation of the vertebra)

A

spondylolisthesis

this may cause impingement on nerve roots

94
Q

infection or inflammation of the intervertebral disk

if infectious, what’s the most common organism

A

diskitis

staph aureus is most common

95
Q

clinical feature of diskitis

A

typically begins with signs of URI or mild trauma
back pain with tenderness over the involved disk
+/- fever
children refuse to flex the spine

96
Q

how to dx diskitis

A

elevated ESR

confirm with MRI and bone scan

97
Q

how to tx diskitis

A

bed rest

abx against staph if you think it’s infectious

98
Q

cause of herniated disk in teens

what’s the tx

A

repetitive activity > trauma

tx is conservative

99
Q

what is developmental dysplasia of the hip (DDH)

A

acetabulum is abnormally flat –> easy dislocation of the head of the femur

100
Q

risk factors for DDH

A

first born girl, breech presentation, fhx, oligohydramnios

101
Q

DDH physical exam

A
  • barlow (dislocate)
  • ortolani (reduce)
  • galeazzi (affected femur is posteriorly shifted)
  • asymmetric abduction of the hips and asymmetric thigh or buttock folds in older infants
102
Q

how to confirm DDH dx

A

young infants (6 months): AP xrays

103
Q

how to tx DDH

A
  • if caught early (<6 weeks), pavlik harness

- if caught later, hips are bilaterally displaced, hips are not reducible, or pavlik harness fails, then surgery

104
Q

complications of DDH

A

AVN of the femoral head

limb length discrepancy, painful abnormal gait, osteoarthritis

105
Q

septic arthritis usually affects the _____ in younger children and the _____ in older children

A

hip

knee

106
Q

peak age of septic arthritis

A

age 1-3 years

107
Q

common organisms of septic arthritis

A

staph aureus and strep pyogenes… in teens also meningococcus

108
Q

how do kids hold their hips in septic arthritis

A

fexion, abduction, external rotation to relieve the pressure in the joint

109
Q

labs in septic arthritis

A

elevated WBC, ESR, CRP

-bcx, cx and gram stain of synovial fluid

110
Q

imaging and treatment for septic arthritis

A

ultrasound can show fluid collection

tx with surgical decompression and empiric IV abx for 4-6 weeks

111
Q

complications of septic arthritis

A

AVN and cartilaginous damage

112
Q

______ is a common self limited, post infectious (URI, diarrhea) response of the hip joint
it is a dx of exclusion but the MCC of painful limp in toddlers
what are some clinical features

A 
transient synovitis (toxic synovitis)
-low grade fever, limp, mild irritability but mostly well appearing, hip pain
113
Q

how to dx and tx transient synovitis

A

WBC and ESR can be normal or mildly high
if there is an effusion in the hip, aspirate it to r/o septic arthritis
tx with NSAIDs, bed rest, observation
prognosis is great!

114
Q

_______ is idiopathic AVN of the femoral head
it’s peak age of onset is ______
typical person this happens to

A

legg-calve-perthes
4-9 years
active thin boys who are small for their age

115
Q

dx of legg-calve-perthes

A

PE: decreased internal rotation and abduction of the hip (log roll them) with referred pain to groin or knee
crescent sign on xrays

116
Q

how to tx legg-calve-perthes

A

PT and restriction of vigorous exercise (may include traction, casting, crutches, etc)
surgery if > 50% damage to femoral head or femoral head moves out of the acetabulum

117
Q

prognosis of legg-calve-perthes

A 
complete resolution in younger patients
older kids (>9 years) will probably get OA of the hips as adults
118
Q

obese adolescent boy with a limp

A

SCFE- slipping of the femoral head off the femoral neck

119
Q

patients with _____ are especially prone to develop bilateral SCFE

A

hypothyroidism

120
Q

how to dx SCFE

A

Klein line is abnormal

121
Q

how to tx SCFE

A

pin the femoral head to the femoral neck

don’t force it back into place 2/2 risk of avascular necrosis

122
Q

complications of SCFE

A

AVN
chondrolysis
limb length discrepancy
OA

123
Q

MCC of osteomyelitis
what if someone has SS disease
what if it’s due to someone stepping on a nail

A

staph aureus and strep pyogenes
salmonella
pseudomonas

124
Q

MC way children get osteomyelitis

A

hematogenous spread

125
Q

lab studies in osteomyelitis

A

increased WBC, CRP, ESR

bcx positive, aspirated fluid cx positive

126
Q

imaging for osteomyelitis

A

bone scan or MRI

plainfilm is not useful/sensitive

127
Q

how to manage osteomyelitis

A

abx for 6 weeks
once ESR is decreasing, switch to oral abx
may need surgery if fever and swelling persist for 48 hours after abx

128
Q

complications of osteomyelitis

A
  • spread of infection
  • chronic osteomyelitis- sequestrum (focus of necrotic bone), involucrum (formation of new bone or fibrosis surrounding the necrotic infected bone)
  • pathologic fx
  • angular deformity or limb length discrepancy if it involves the growth plate
129
Q

you need to intervene if a kid has in-toeing

A

F

most is normal and will correct with growth

130
Q

metatarsus adductus

A

medial curvature of the mid-foot (metatarsals)
C shaped foot
dorsiflexion is intact

131
Q

how to manage metatarsus adductus

prognosis

A
  • flexible foot that can over-correct with passive motion- obs only
  • flexible foot that can correct with passive motion but will not overcorrect- stretching exercises
  • stiff foot that cannot be straightened- ortho consult, cast for 3-6 wks
    prognosis: resolution in all patients
132
Q

fixed foot in inversion with no flexibility

ankle is held in plantarfelxion and inversion… there is also metatarsus adductus

A

talipes equinovarus (clubfoot)

133
Q

risk factor for clubfoot

A

FHx

134
Q

how to tx clubfoot

A

casting within first week of life

if deformity is severe or if there’s no improvement with casting, then surgery

135
Q

medial rotation of the tibia causing the foot to point inward
MCC in-toeing in kids younger than 2 years
what is it called, clinical features, management

A

internal tibial torsion

  • foot points medially but patella faces forward
  • obs only with excellent prognosis (resolution by age 5 years)
136
Q

inward angulation of the femur
MCC in-toeing in kids > 2 yars
what is it called, clinical features, management

A

femoral anteversion/medial femoral torsion

  • both feet and patella point medially
  • hips internally rotate more –> child likes sitting in W position
  • obs only with resolution by age 8 years
137
Q

MCC out-toeing in kids
what causes it
clinical features

A 
calcaneovalgus foot (flexible foot held in a lateral position)
caused by uterine constraint 
restricted plantar flexion, excessive dorsiflexion
138
Q

how to tx calcaneovalgus foot (out-toed foot)

A

stretching +/- rarely casting

prognosis is excellent

139
Q

symmetric bowing of the legs in children younger than 2 years of age
clinical features
dx
management

A

bowed legs (genu varum)
cowboy stance with normal gait
dx with PE
prognosis is good with no intervention; will resolve by age 2 years

140
Q

progressive angulation at the proximal tibia in obese AA boy

clinical features

A

blount’s disease (tibia vara)

angulation just below the knee with lateral thrust with gait

141
Q

how to dx and tx blount disease

A
  • dx: suspect it in any child with progressive bowing, unilateral bowing, or persistent bowing after 2 years of age –> get standing AP film
  • treatment is bracing (age 2-3 years) or surgical osteotomy (no improvement with bracing, > 4 years of age, etc)
142
Q

complications of blount’s disease

A

OA

recurrence of angulation esp in obese children or if tx is started after age 4 yars

143
Q

______ is idiopathic angulation of the knees toward the midline
age of onset
clinical features

A

knock knees (genu valgum)
3-5 years
knock kneed with swinging of legs laterally when walking

144
Q

how to dx, tx, and prognosis of knock knees

A
  • dx with PE
  • tx is observation; only do surgery if it persists past 10 years or causes knee pain
  • prognosis: excellent with spontaneous resolution, if it doesn’t resolve then risk for OA
145
Q

inflammation or microfx of the tibial tuberosity caused by overuse injury

A

osgood-schlatter disease

146
Q

osgood schlatter age of onset

what causes it

A

10-17 years

repetitive jumping like basketball or soccer

147
Q

apophysitis

A

inflammation of a tuberosity (ex. osgood schlatter)

148
Q

osgood schlatter
clinical features
dx
management

A
  • swelling of the tibial tuberosity, knee pain with point tenderness over tibial tubercle, pain with extension of knee against resistance
  • dx based on H&P, no xrays
  • manage with rest, stretching, analgesics
149
Q

slight malalignment of the patella that causes knee pain

A

patellofemoral syndrome

150
Q

patellofemoral syndrome:

  • demographic
  • clinical features
  • dx
  • management
A
  • teen girls
  • knee pain directly under or around patella, pain with walking up and down stairs, patella in lateral position
  • dx with H&P +/- sunrise view xray
  • tx with rest, stretching and strengthening
151
Q

growing pains can interfere with play

A

F

152
Q

_______ occurs if the soft bony cortex buckles under a compressive force
what is it, where does it most commonly occur, how to tx

A 
compression fx (torus or buckle fx) 
most often in the metaphysis
tx with 3-4 weeks of splinting
153
Q

_____ occurs if only one side of the cortex is fractured with the other side intact

A 
incomplete fx (greenstick fx) 
*reduction may involve fracturing the other side of cortex to prevent angulation
154
Q

when you see this type of fx, suspect child abuse

A

spiral fx

155
Q

Salter Harris classification

which ones might affect bone growth

A

looking at the distal femur…SALTR
I: Same- in the physis
II: Above- physis and above into the metaphysis
III: Low- physis and below into the epiphysis
IV: Through and through- through physis, epiphysis, and metaphysis
V: Crushing of the physis

II-III may affect bone growth
IV-V definitely affect bone growth

156
Q

clavicular fxs usually caused by ______ in older kids and ______ in neonates

A

falling onto the shoulder

birth injury

157
Q

infant with asymmetric moro or pseudoparalysis

kid holding affected limb with the opposite hand, head tilted toward affected side

A

clavicular fx

158
Q

how to dx and manage clavicular fxs

what part of the clavicle is most often affected in trauma

A
  • dx with plain xray
  • middle and lateral aspects are most often affected in trauma
  • tx with sling for 4-6 weeks +/- figure 8 bandage
  • for neonates, you may not need tx
159
Q

______ occur when child falls onto outstretched arm or elbow… esp kids < 10 years

A

supracondylar fxs- fi displaced and angulated, this is an ortho emergency!!!

160
Q

how to assess supracondylar fx
if there is pain with passive extension of the fingers, think _______
what imaging would you use?

A

look for point tenderness, swelling, deformity of the elbow
assess neurovascular function
think comparment syndrome
xrays

161
Q

posterior fat pad sign on elbow xray suggests ______

A

supracondylar fx

162
Q

how to manage supracondylar fx

A

never passively move the arm b/c you might damage nerves/vessels more!

  • nondisplaced and nonangulated –> casting
  • displaced or angulated –> surgical reduction and pinning
163
Q

compartment syndrome might lead to ______ in the UE

A

volkmann’s contracture (flexion deformity of the fingers and wrist)

164
Q

nerve injury in supracondylar fx usually resolves (T/F)

what is cubitus varus

A

T

decreased or absent carrying angle as a result of poor positioning of the distal fragment

165
Q

fx of distal radius

A

colles fx

166
Q

fx of proximal ulna with dislocation of the radial head

A

monteggia fx

167
Q

fx of radius with distal radioulnar joint dislocation

A

galeazzi fx

168
Q

how to manage colles, monteggia, and galeazzi fxs

A

reduction and splinting –> cast replaces splint in a week after swelling goes down

169
Q

femur fxs require _____ of casting

A

8 weeks

170
Q

toddler’s fx
where is it and what causes it
clinical features
how to tx

A

spiral fx of the tibia after very mild or no trauma, fibula is intact

  • often age 9 months to 3 years when kids are tripping and falling
  • refuses to bear weight but will crawl
  • long leg cast 3-4 weeks
171
Q

which fxs make you suspicious for child abuse

what do you do?

A

-metaphyseal fxs (corner or bucket handle fxs)
-posterior or first rib fxs
-multiple fxs at various stages of healing
-complex skull fxs
-scapular, sternal, vertebral spinous process fxs
-mechanism doesn’t fit history
do a skeletal survey!!

Pediatrics (14 decks)

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