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CPNP EXAM PREP > MSK > Flashcards

MSK Flashcards

1
Q

SELF LIMITING inflammation of HIP most likely viral or immune etiology, Occurs 1-15 years

A

Toxic synovits

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2
Q

Is toxic synovitis unilateral or bilateral?

A

Unilateral

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3
Q

Kocher’s criteria elevates what ?

A

If toxic synovitis VS septic arthritis

  1. NOn weight bearing
  2. Fever
  3. Increased ESR
  4. Increased WBC

If so = septic

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4
Q

Toxic synovitis is acute or insidious painful limp?

A

Insidious

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5
Q

Internal rotation of hip causes spasm

A

Toxic synovitis

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6
Q

Toxic synovitis Tx

A

Naproxen x 4 weeks / bed rest , Motrin//Tylenol

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7
Q

Septic arthritis is a inflammation of joint due to_____?

A

Bacterial infection of staph or strep most common

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8
Q

Both septic arthritis and transient (toxic) synovitis are common in ____.

A

Males

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9
Q

Septic arthritis has ____ onset of _____ or _____ pain. May be red, swollen, warm. Fever is ______. May refuses to bear weight or present _____.

A 
Acute onset
Knee or hip pain
Fever present 
May limp 
Anorexia/ ill appearing
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10
Q

Diagnostics for septic arthritis

A

ESR elevated
WBC elevated
DX confirmed CT of US guided aspiration
Kocher criteria

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11
Q

TX for Septic arthritis

A

IV abx

Emergent referral surgical drainage of joint

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12
Q

Solid tumor of bone

A

Osteoscarcoma

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13
Q

Osteosarcoma common in ages _____to_____.

A

15-19 years

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14
Q

Local UNILATERAL BONE pain, swelling , tenderness ; increased pain with activity , LIMP, fever, decreased ROM, mass at end of long bone

A

Osteosarcoma s/s

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15
Q

Dx for osteosarcoma includes:___, ___, ___. Management is chemo and surgery.

A

CT, MRI

Biopsy

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16
Q

Interruption of blood to femoral head (spiphysis) leading to partial or complete Aseptic or a vascular necrosis of femoral head

A

LCPD

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17
Q

In leg calve Perthes disease (LCPD) their is a _____ onset of limp with ____ slight pain , and pain may also migrate to ____.

A

Insidious limp
Limp is with knee pain migrates to groin/lateral hip
More PAINLESS limp

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18
Q

In LCPD is the patient febrile?

A

No

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19
Q

There is _____ passive INTERNAL ROTATION and abduction of ____ joint in LCPD.

A

Limited; hip

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20
Q

AP and Lateral radiograph shows ________ in LCPD.

A

Crescent

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21
Q

LCPD common in ___. Ages ___ to ___.

A

Males; 4-9

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22
Q

General Treatment for LCPD

A

Non weight bearing
Bed rest
Observe if full ROM

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23
Q

Aggressive treatment for LCPD is indicated when?

A

More than 1.5 of femoral head involved ; children >6 years ; poor ROM—- ortho

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24
Q

SCFE has acute pain in knee or hip that is severe and present with inability to ambulated or with limping that may be referred to ____ or ______.

A

Thigh or knee

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25
Q

Ages for SCFE

A

12-15

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26
Q

SCFE is common in …..

A

> Boys

OBESE!!!

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27
Q

Spontaneous dislocation of femoral head (epiphysis) downward and back displacing femoral neck .

A

Slipped Capital femoral epiphysis (SCFE)

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28
Q

DX of SCFE is radiograph of which view___?

A

AP pelvis and frog leg lateral

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29
Q

TX of SCFE

A

Ortho refer

No ambulation —-crutches/wheelchair

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30
Q

Passive internal rotation of hip is limited

A

LCPD

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31
Q

Inability to flex hip

A

SCFE

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32
Q

Genu Varum

A

Bow leg

RUM MAKES KNEES OPEN

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33
Q

Genu varum is normal until what age

A

2 years

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34
Q

Genu Valgum

A

“KNees stuck together with GUM”

Knock knees

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35
Q

Genu Valgum is normal until what age ?

A

7 year olds chew GUM

Normal till 7 — then refer to ORTHO

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36
Q

Genu Valgum has distance between medial malleoli (ankles) of ___.

A

3 in

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37
Q

What test is used to identify scoliosis ?

A

Adams forward bend test

Asymmetry of hips, ribs , shoulders and waist

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38
Q

When do you refer for scoliosis?

A

Pain or curvature >25 degrees

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39
Q

When do you do radiograph for scoliosis?

A

Cobb angle > 10 degrees

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40
Q

Muscular Dystrophy Duchenne is what?

A

Progressive INHERITED genetic disorder began in lower extremities and progresses to upper extremities/torso

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41
Q

Muscular Dystrophy Duchenne affects who?

A

ONLY MALES; 3-5 years

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42
Q

Abnormal gait and posture, inability to keep up with peers, clumsy, firm WOODy calves are symptoms of

A

Muscular Dystrophy Duchenne— leads to decreased muscle strength and wheelchair dependent by 12 years —- death from cardiopulmonary failure ; intelligence intact

43
Q

Mom reports her son has started to get up like a crab and walks his hand up his legs to stand this shows what sign?

A

Gowers sign ; Muscular Dystrophy Duchenne

44
Q

What labs are indicated for Muscular Dystrophy Duchenne?

A

CREATINE KINASE — elevated (shows degree of muscle wasting) ; ECG; muscle biopsy ; DNA analysis of gene —dx made

45
Q

Stretch or tear in ligament

A

SPrain

46
Q

Stretch or tear in muscle/tendon

A

Strain

47
Q

Ligaments attach to ____ to Bone, ____ attach muscles to bone.

A

Bone to bone ; tendons

48
Q

Sprains are graded ___ to ___.

A

1-3

Remember sprain is ligament tear.

49
Q

Sprain grade 1 symptoms

A

STRETCHING no TEAR

Kid is like I sprained my ankle no biggie…

Local tenderness
Edema minimal 
Bruising absent or barley their 
FULL ROM
Can weight bear
50
Q

Sprain grade 2 symptoms

A

PARTIAL TEAR

Pain immediately, localized swelling, bruising , ROM limited

51
Q

Sprain grade 3 symptoms

A

COMPLETE TEAR

Severe pain
Edema significant and bruising —- all the colors
No weight bearing
NO ROM

52
Q

OTTAWA ankle rule

A

Ankle sprain rule

is pain near ankle (malleoli) + bone tenderness+ unable to bear weight 4 steps at time of injury —-then X-RAY

Decreases amount of X-ray in kids

53
Q

Ankle sprain Mangement

A

RICE + NSAID

Rest, ice compression (min edema and stabilize) , elevate

54
Q

Pain, POINT TENDERNESS, swelling, bruising/ erythema

A

S/s fracture

55
Q

Diagnostics for fracture

A

AP/L X-ray, CT, MRI complex injury

56
Q

Fracture occurs in growth plate of long bone during development during traumatic injury

A

Salter Harris fracture —- unique to Peds

BOYS >GIRLS

57
Q

SALTER Harris fracture classification

S
A
L
T/T
R
A

Slipped

Above

Lower

Through/transverse

Rammed/ruined

58
Q

Salter Harris fracture Tx

A 
X-ray, CT 
Pain meds
RIE —no compression
Closed reduction 1-2 casting/splint 
Open reduction 3-4
59
Q

Child refuses to use arm after brother was playing tug of war and pulled on her arm hard. She now holds arm across body.

A

Radial head subluxation —-NURSE MAID ELBOW

60
Q

Is nurse maid elbow a fracture?

A

No popped ligament over bone wrong way ( ligement bone-bone)

61
Q

What age group for nurse maid elbow

A

1-4

62
Q

TX nurse maid elbow

A

Reduction makeup—hyperpronation or supination/flex \ion

63
Q

Point tenderness at costal cartilages along eternal boarder , sharp dull pain that exacerbates with cough, sneeze, or deep inspiration.

A

Costochondritis

Acute or gradual onset
Chest pain

64
Q

Crowing rooster or horizontal traction can be done to reproduce this pain

A

Chest pain in Costochondritis

65
Q

Costochondritis Mangement

A

NSAIDS

66
Q

Bilateral lower extremity pain

A

Growing pains

Can be INTERMITTENT and Increases and NIGHT

67
Q

Growing pain occur at what age?

A

3-5 years and 8-12 during rapid growth

68
Q

Growing pain TX

A

NSAID, massage, heat/cold rest

69
Q

Mild aching pain , joint stiffness, swelling of joint, warmth, loss rom (may limp)

A

JIA symptoms

Can have fever salmon colored skin rashes, increased WBCs, adenopathy

70
Q

Joint stiffness in JIA is worst when

A

In morning after rest

71
Q

JIA is more common in ____.

A

Girls

72
Q

Poly arthritis

A

> 5 joints inflamed

73
Q

Oligoartheritis

A

<5 joints inflamed

74
Q

JIA diagnosis requires arthritis that is _____ for more than ____weeks in a patient ages ____.

A

Persistant; 6; <16 years

75
Q

Juvenile idiopathic artheritis (JIA) Tx

A

No diagnostics test — useful labs (CBC, ESR, CRP, LFTs, Lyme , ANA+ = opthmology refer)

Refer Peds rheum 
NSAIDS
Corticosteroids 
PT
Methotrexate —anti rheum drug
76
Q

In developmental hip dysplasia

You concur that a child has a positive Galeazzi finding what is the treatment

A

Identify during the newborn period
High incidence of spontaneous improvement
Treat before six months of age Pavlik harness
Restore contact between the femoral head and acetabulum if devices not affective then surgery

77
Q

Metatarsus adductuctus / Varus

Pigeon toed treatment

A

Adductus —- parents stretch 4 foot with each diaper change for 4 to 6 months

Varus —-foot adducted and inverted ; limited rom
Serial casting are bracing first year of life; straight laced fitted shoes for daytime; surgery if child older than four years

78
Q

Which of the following disorders is usually associated with adduction of the forefoot?

Internal femoral torsion

Genu valgum

Talipes equinox arid congenita

Internal tibial torsion

A

Talipes equinox arid congenita ___club foot

79
Q

Radiographic findings of disease progression and sphericity of the femoral head is helpful in the diagnosis and follow up of

leg calve perches disease

Or Slipped capital femoral epiphysis??

A

LCPD

80
Q

Does toxic synovitis have fever?

A

low grade

81
Q

What would be the most appropriate initial management of a newborn diagnosed with developmental dysplasia of the hip?

Observant examined at two week well child visit
Triple diapering in nursery
Pavlik harness
Surgical reduction

A

The Pavlik harness is an appropriate initial management for subluxation and reduction of hip dislocation

82
Q

Club foot findings

A 
The ankle is in the Equinus (foot is an pointed toe position)
Forefoot adduction
Deep crease on medial border a foot
Small foot with limited dorsiflexion
Atrophy of calf muscles

Iliotibial bands not involved!!!

83
Q

Diagnostic marker for juvenile idiopathic arthritis

A

Anti-nuclear antibody’s(ANA) Sero positivity for Antibodies

Consist of immunoglobulins directed against structures within the cell found in various autoimmune diseases

84
Q

Dislocation in the hip of a child six months or older may typically present with

A

Positive Galeazzi sign—-Candis picked a leg length discrepancy and children with dislocated her hips

85
Q

Duchenne muscular dystrophy is characterized by which of the following signs and symptoms?

At birth infants are notably hypotonic floppy babies

Earlier symptoms refusal to bear weight

Unable to keep up with their peers when running at school-age

Abnormalities of gate and posture become evident during preschool years and during gross motor development

A

Abnormalities of gate And posture become evident during preschool years and during gross motor development

86
Q

Most children with Duchenne muscular dystrophy become wheelchair dependent by what age?

A

7 to 12

87
Q

Obese 13-year-old male with two days of right knee pain without trauma illness has exam of significant pain upon right hip motion he maintains his leg in an external rotation and adduction. Based on these findings the most likely diagnosis is

A

SCFE

88
Q

Osteomyelitis management

A

Antibiotic treatment for identified pathogen’s 4-6 weeks is recommended

Aspiration usually indicated

Surgery if abscess is present

89
Q

The most common symptom is persistent pain that may be referred to the medial aspect of the ipsilateral me or to the lateral thigh

A

Leg calf perthe‘s disease

90
Q

Tibial torsion involves twisting of the long bone along its long axis, resulting in an increased internal rotation. Treatment is:

A

Observation

91
Q

Contracture of the sternocleidomastoid muscle

A

Torticollis

92
Q

A 14 years diagnosed with JIA , he is not up-to-date on his immunizations it is currently on methotrexate. What vaccinations would be cautioned in this cause?

A

Vericella, risk for developing serious complications from the varicella zoster infection and JIA patients receiving antirheumatic drugs. Varicella zoster immune status should be checked before starting such therapy

93
Q

Systemic onset JIA is most commonly associated with

A

Highly daily intermittent spiking fevers and rash

94
Q

Referred to an orthopedist as early as possible ideally in the newborn nursery because joints are most flexible in the first hours and days of life in this disorder

A

Equinovarus of feet—- club foot

95
Q

An injury at this part of the bone that will most likely result in a bone length discrepancy

A

Epiphysis

Bone length occurs at the epiphyseal plates where blood supply enters

96
Q

Torticollis symptoms

A

Irritability when lifted, asymmetrical moro reflex, spasm along the right sternocleidomastoid muscle

97
Q

Enlarged anterior fontanelle with delayed closing, enlarged costochondral junction or architecture sign
Are classic signs of what

A

Rickets

98
Q

After one year of conservative treatment for torticollis a child still experiences limited neck rotation what is the PNP‘s next step?

A

Referral for surgery

Torticollis should resolve by one year

99
Q

While completing a hip exam on a newborn infant you are able to just locate the infants right hip. The appropriate management plan would be to

A

Refer to orthopedic specialist for pavlik harness

Swaddling in the prone position and triple diapering or not I thought to be effective

100
Q

Galeazzi/Allis sign

A

Shows Unequal height of legs confirming hip dysplasia

101
Q

Ortolani maneuver is not an appropriate indicator for hip dysplasia after what age

A

6 months

102
Q

Elevated white blood cells fever and refusal to bear weight are common in both osteomyelitis and transient toxic Synovitis.
What is a differentiating factor between these two

A

Osteomyelitis is associated with local trauma where is toxic Synovitis is commonly associated with recent respiratory illness

103
Q

Nurse maid elbow ____pronation method or _____/______ method.

A

Hyperpronation or supination/flexion

CPNP EXAM PREP (17 decks)

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