Goldstien Peds Flashcards
Risk factors for acute hematogenous osteomyelitis (6)
- Diabetes
- Chronic renal disease
- Hemoglobinopathies
- Rheumatoid arthritis
- Concurrent varicella infection
- Immunocompromise
Osteomyelitis differential diagnosis (11)
- Thrombophlebitis
- Bone infarction
- Sickle cell crisis
- Cellulitis
- Rheumatic fever
- Septic arthritis
- Fracture
- Toxic synovitis
- Caffey’s disease
- Gaucher’s disease
- Malignancy (including leukemia)
(V.I.T.I.M.N. – vascular, infectious, trauma, inflammatory, metabolic, neoplastic)
Indications for surgical treatment of osteomyelitis (3)
- Aspiration of pus
- Imaging findings of an abscess or sequestrum
- Failure of non-surgical management
Indications for step-down from parenteral to oral antibiotics in osteomyelitis treatment (5)
- No fever
- Normal use of the limb
- Local inflammation subsided
- Able to tolerate oral antibiotics
- Improving serologic markers
Complications of pediatric osteomyelitis (9)
- Meningitis
- Chronic osteomyelitis
- Septic arthritis
- Septicaemia
- Limb-length discrepancy
- Angular deformity
- Pathologic fracture
- Gait abnormality
- Venous thromboembolism
Factors leading to subacute presentation of osteomyelitis (3)
- Increased host resistance
- Less virulent organism
- Prior antibiotic exposure
Classification of subacute osteomyelitis (6)
- IA/B: bony lucency
- II: metaphyseal with cortical bone loss
- III: diaphyseal
- IV: presence of onion skinning
- V: epiphyseal
- VI: spine
Classification of cerebral palsy (2)
- Physiologic
o Spastic – increased muscle tone, hyperreflexia (#1)
o Athetoid – slow, writing involuntary movements
o Ataxic – inability to coordinate muscles for voluntary movement
o Mixed- A
-anatomic
Hemiplegic – unilateral UE/LE
o Diplegic – LE > UE, strabismus, IQ may be normal
o Quadriplegic – all 4 extremities, low IQ
Predictors of walking in CP (5)
- Positive
o Sitting by age 2
o Pulling to stand by age 2
- Negative
o Persistence of ≥ 2 primitive reflexes by age 1
o Not sitting by 5 years
o Not walking by 8 years
Grading of CP with the Gross Motor Function Classification System (5)
- Level I: walks and runs, does stairs independently
- Level II: walks with no aids, stairs with railing
- Level III: walks with aids as a primary method of travel
- Level IV: stands, uses wheelchair independently (manual/motor)
- Level V: wheelchair powered by caregiver
Treatment options for cerebral palsy (4)
- Physiotherapy (ROM, stretching, strengthening)
- Tone reduction (medications for spasticity control, Botox)
- Bracing/orthotics
- Serial casting
- Surgery
Surgical options for elbow flexion contracture in CP (3)
- Musculocutaneous neurectomy
- Biceps lengthening
- Brachialis lengthening
- lacertus fibrosis release
- brachioradialis origin release
- pronator teres release
- transfer of the FCU to the ECRB
Goals of surgical treatment of GMFCS I-III CP (4)
- Optimize gait efficiency
o Decrease energy expenditure
o Increase physical function
o Increase activity participation
- Improve gait cosmesis
- Requirements for successful ambulation in children with CP (5)
- Stability in stance phase
- Clearance in swing phase
- Preposition of foot at initial contact
- Adequate step length
- Optimal energy consumptions
Classification of scoliosis in cerebral palsy (4)
Weinstein classification
Group I - double curves with thoracic and lumbar component and minimal pelvic obliquity
Group II - large lumbar or thoracolumbar curves with marked pelvic obliquity
Indications for surgery for scoliosis in CP (3)
- Progressive deformity (> 45-50°)
- Sitting imbalance
- Pelvic obliquity
Principles of surgery for scoliosis in CP (4)
- Pre-op nutrition assessment ± g-tube
- Posterior spinal fusion
- Segmental instrumentation
- Include the pelvis (if non-ambulatory)
Classification of hip disorders in CP (3)
- Hip at risk – abduction < 45° with partial uncovering
reimers index <30
- Hip subluxation - reimers index >30
- Spastic dislocation - RI >100
- windswept
Gait problems in CP (3)
- Equinus gait
- Jump gait
- Crouched gait
- Stiff-knee gait
Risk factors for myelodysplasia (4)
- Maternal hyperthermia
- Maternal diabetes
- Valproic acid/carbamazepine
- Maternal folate deficiency
Classification of myelodysplasia (4)
- Spina bifida occulta
- Meningocele
- Myelomeningocele
- Rachischisis
Things to remember about scoliosis in myelodysplasia (6)
- Bracing ineffective
- May need anterior spinal fusion due to deficient posterior elements (pre-op 3D CT)
- Check shunt prior to surgery
- Pre-op MRI to rule out Chiari II malformation/tethered cord
- Latex allergy
- Higher risk of pseudarthrosis/infection
Classification of spinal muscular atrophy (3)
- Type I
o Acute Werdnig-Hoffman
o < 6 months
o Death by 2 years
- Type II
o Chronic Werdnig-Hoffman
o 6-24 months
o May live into 40’s
- Type III
o Kugelberg-Welander disease
o 2-10 years
o Best prognosis
Classification of osteogenesis imperfecta (Sillence) (4)
- Type I:
o Autosomal dominant
o Blue sclera
o Hearing loss
A – teeth involved
B – teeth normal
- Type II:
o Autosomal recessive
o Blue sclera
o Lethal in utero
- Type III:
o Autosomal recessive
o Normal sclera
o # at birth with progressive short stature
- Type IV:
o Autosomal dominant
o Blue sclera
A – teeth involved
B – teeth normal
Histologic findings of osteogenesis imperfecta (6)
- Increased diameter of haversian canals
- Increased size of osteocyte lacunae
- Increased number of cells
- Replicated cement lines
- Decreased number of trabeculae
- Decreased cortical thickness
Outcomes of bisphosphonate treatment of osteogenesis imperfecta (3)
- Increased cortical thickness
- Decreased fracture rates
- Decreased pain
Methods of classifying skeletal dysplasias (5)
- Proportionate vs. disproportionate
- By bone segment involved
o Rhizomelic – proximal
o Mesomelic – middle
o Acromelic – distal
- By bone involved
- By causative gene defect
- By presence or absence of spine involvement
Disorders of the primary ossification centre (3)
- Cleidocranial dysplasia
- Apert’s syndrome
- Proximal femoral focal deficiency
- (C.A.P.)
Disorders of the secondary ossification centre (4)
- Diastrophic dysplasia
- Spondyloepiphyseal dysplasia congenital
- Spondyloepiphyseal dysplasia tarda
- Multiple epiphyseal dysplasia
- (D.S.M.)
Disorders of hypertrophic zone
- psudoachondroplasia
- Mucopolysaccharidoses
o Morquio’s
o Hurler’s
o Hunter’s
o San Filippo’s
- Enchondroma
- Rickets
- SCFE
Types of Rickets (5)
- Vitamin D dependent
- Vitamin D resistant (hypophosphatemic)
- Vitamin D deficient (nutritional)
- Renal
- Gastrointestinal
Disorders of osteoid production (2)
- Osteogenesis imperfecta
- Scurvy
Disorders of bone remodeling (7)
- Metaphyseal dysplasia(s)
- Osteopetrosis
- Gaucher’s disease
- Osteopathia striata
- Pyknodysostosis
- Melorrheostosis
- Osteopoikilosis
Disorders of FGFR3 (3)
- Hypochondroplasia
- Achondroplasia (#1)
- Thanatophoric dysplasia
- (H.A.T. – there are “3” disorders of FGFR3)
Functions of fibroblast growth factors (5)
- Cell induction/differentiation
- Cell growth/migration
- Bone growth
- Angiogenesis
- Wound healing
Disorders of collagen oligomeric matrix protein (COMP) (2)
- Pseudoachondroplasia
- Multiple epiphyseal dysplasia
Disorder of parathyroid hormone-related peptide (1)
- Jansen’s metaphyseal chondrodysplasia
- (“Dwarves of stone (↑ Ca2+) stand alone”)
Differential diagnosis of Caffey’s disease (infantile cortical hyperostosis) (4)
- Child abuse/trauma
- Infection
- Scurvy
- Progressive diaphyseal dysplasia
Disorders of collagen (9)
- Osteogenesis imperfecta (COL1)
- Ehlers-Danlos syndrome (COL1/3/5)
- Achondrogenesis (COL2)
- Spondyloepiphyseal dysplasia congenital (COL2)
- Spondyloepiphyseal dysplasia tarda (SEDL/TRAPPC2)
- Kniest dysplasia (COL2)
- Precocious arthritis (COL2)
- Stickler syndrome (COL2/11)
- Schmidt metaphyseal chondrodysplasia (COL10)
Disorders associated with structural protein deficits (9)
- Achondroplasia
- Pseudoachondroplasia
- Multiple epiphyseal dysplasia
- Spondyloepiphyseal dysplasia congenital
- Kniest dysplasia
- Stickler syndrome
- Schmidt’s metaphyseal chondrodysplasia
- Ehler’s Danlos syndrome
- Marfan’s syndrome
- Osteogenesis imperfecta
