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Peds > MSK > Flashcards

MSK Flashcards

1
Q

Traumatic clavicular fractures in older children (not neonates) are treated how?

A

Nondisplaced: Figure-of-8 splint

Displaced: surgically reduced

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2
Q

What is important to ask for monoarticular arthritis?

A

Rashes - indicative of several pathologies, including:
Lyme
Juvenile arthritis (evanescent, macular, salmon-colored rash)
Serum sickness (pruritic rash)

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3
Q

What are oligoarticular and polyarticular juvenile idiopathic arthritis both characterized by?

A

May be complicated by uveitis
Sex ratio F > M

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4
Q

What is a typical sign of oligoarticular JIA?

A

Pain worse in the morning in a toddler (age <5), with joint swelling most commonly of large joints

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5
Q

What muscle weakness does Trendelenburg sign indicate?

A

Gluteal muscle of the contralateral side to hip drop

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6
Q

Slipped capital femoral epiphysis results in what position of leg?

A

Externally rotated foot - due to decreased abduction and internal rotation

Quadriceps and gluteus muscle disuse –> atrophy

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7
Q

Which direction is the femoral head in SCFE?

A

Femoral head (epiphysis) posteriorly displaced from metaphysis

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8
Q

Where is pain in patellar tendinitis?

A

Inferior pole of patella

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9
Q

How does patellofemoral pain feel?

A

Patella - sensation of instability or buckling at the knee
Overuse injury from running, squatting

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10
Q

Where is pain of Osgood-Schlatter disease? How is it diagnosed and treated?

A

Apophysitis of tibial tubercle
Traction apophysitis from quadriceps muscle pulling –> elevation and chronic avulsion of tibial tubercle
Pain is reproduced by knee extension against resistance or squatting
Diagnosis is clinical, treatment is supportive

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11
Q

Why does hypothyroidism predispose to SCFE?

A

Thyroid hormone normally promotes ossification of growth plate
These kids would have SCFE at earlier age (<10) and more likely bilateral

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12
Q

What is diagnostic for SCFE?

A

Frog-leg lateral hip x-ray

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13
Q

What is transient synovitis?

A

Inflammatory hip condition in children age 3-8 yo with hip pain and limp following viral illness

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14
Q

Legg-Calve-Perthes disease treatment

A

Conservative - bracing/splinting
Surgery - if femoral head is not well contained within acetabulum

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15
Q

Transient synovitis hip is held in which position to relieve pain?

A

Flexed and everted to maximize the joint space
US may show small, unilateral or bilateral hip effusions

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16
Q

Myositis ossificans cause and location

A

Trauma or neurologic events (TBI, stroke)
Quadriceps, brachialis

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17
Q

Myositis ossificans labs and imaging

A

Alk phos and inflammatory markers
Eggshell calcification representing heterotopic ossification

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18
Q

What are the prenatal positioning disorders related to intrauterine crowding?

A

Congenital muscular torticollis
Developmental dysplasia of the hip
Metatarsus adductus
Clubfoot

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19
Q

X-linked hypophosphatemic rickets presents with what on x-ray?

A

Metaphyseal fraying with widened physes
Beaking of the proximal tibial metaphyses

20
Q

What does a metaphyseal corner fracture suggest?

A

Child abuse - forcible pulling or twisting of an extremity

21
Q

What is Blount disease? What are signs/symptoms?

A

Pathologic cause of bowlegs due to abnormal cartilage growth

Leg length discrepancy, asymmetrical bowing, lateral thrust with ambulation

22
Q

How would developmental dysplasia of hip affect skin fold?

A

Asymmetric; extra skin fold on affected side

23
Q

Down syndrome atlantoaxial instability diagnosis and treatment

A

Diagnosis - lateral cervical x-rays showing compression of spinal cord due to increased mobility between C1 (atlas) and C2 (axis) (due to excessive laxity in posterior transverse ligament)

Treatment - surgical fusion of C1 to C2

24
Q

Treatment for osteoid osteoma

A

NSAIDs

25
Q

Spondylolysis pain worsens with what movement?

A

Lumbar extension of lower back

26
Q

What inheritance is Duchenne muscular dystrophy? What is the mutation?

A

X-linked recessive - markedly reduced or absent dystrophin in muscle fibers

27
Q

What is congenital myotonic dystrophy?

A

CTG repeat in myotonia dystrophy protein kinase (DMPK)

Big sign is sustained muscle contraction with inability to relax (myotonia)

28
Q

Myotonic dystrophy signs if presenting in childhood (by age 10); shows earlier than muscular signs

A

Cognitive (intellectual impairment)
Behavioral (ADHD, mood disorder)
Sleep disturbances (excessive daytime sleepiness)

29
Q

Which neoplasm is in epiphysis, lytic area with “soap bubble” appearance?

A

Giant cell tumor of bone - benign

30
Q

What is a unicameral bone cyst?

A

Proximal femur/humerus fluid-filled lesion with well-defined margins
Presents as pathologic fracture most commonly

31
Q

Describe clubfoot. What to do?

A

Forefoot adduction + internal rotation
Fixed plantarflexion
Underdeveloped calf

Serial molding cast application to feet to gently manipulate and stretch, followed by long-term bracing
Surgical correction for refractory or recurrent cases

32
Q

Achondroplasia signs

A

Limb shortening, tibial bowing, frontal bossing
Gross motor delay

33
Q

Rickets - what signs at metaphysis?

A

Concavity (cupping)
Indistinct margins (fraying)

Excess non-mineralized osteoid alters diameters, stability, and organization of physis and metaphysis

34
Q

Palpable click with manipulation of the hip

A

Iliopsoas bursitis

35
Q

Where is a branchial cleft cyst located?

A

Anterior to sternocleidomastoid muscle
Tract may extend to tonsillar fossa (2nd branchial arch) or pyriform recess (3rd branchial arch)

36
Q

Klumpke palsy is associated with what syndrome?

A

Horner syndrome (ptosis, miosis)

37
Q

What are the two benign neonatal rashes that can be treated if severe?

A

Miliaria rubra - not present at birth - erythematous, papular rash on occluded and intertriginous areas - topical steroids if severe

Neonatal cephalic pustulosis - age 3 weeks - erythematous papules and pustules on face/scalp only - topical steroids or ketoconazole if severe

38
Q

Systemic JIA vs polyarticular/oligoarticular

A

Systemic JIA has macular rash with quotidian fever (daily fever)

Oligo often ANA+
Polyarticular RF- but sometimes RF+
Systemic has no ANA or RF

39
Q

Scheuermann kyphosis

A

Due to abnormal anterior vertebral wedging
Diagnose with lateral x-rays showing >40 degree curvature and >5 degree anterior wedging in at least 3 vertebrae

Pain worse with flexion, activity; better after rest

40
Q

Constitutional growth delay vs familial short stature

A

Delayed bone age (vs normal bone age) until 11 girls or 13 boys, after which ideal height is achieved

41
Q

Ewing sarcoma translocation

A

t(11;22)

42
Q

Osteosarcoma vs Ewing - which more likely to have systemic symptoms?

A

Ewing - fever, anorexia, fatigue

43
Q

Duchenne vs Becker muscular dystrophy

A

Becker is qualitative dystrophin protein abnormality, later age of onset and better life expectancy, CK only 5x normal (vs 10-20x)

44
Q

Developmental dysplasia of hip - treatment based on age

A

<6 mo: rigid brace, Pavlik harness splint
6-18 mo: spica cast
>18 mo: open reduction followed by spica cast

45
Q

Legg-Calve-Perthes vs SCFE

A

LCP is painless, SCFE is painful

LCP may resolve on own or can consider bracing/cast/osteotomy if extensive necrosis or decreased ROM; SCFE should have immediate surgical screw fixation and no weight-bearing until stabilized

Peds (25 decks)

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