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PCM 4 midterm > MSK peds > Flashcards

MSK peds Flashcards

1
Q

questions to ask during hx

A
  1. age
  2. pain or weakness (night pain pattern/worsening often seen in neoplasm)
  3. trauma
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2
Q

PE

A
  1. gait
  2. inspection/palpation - abdomen, pelvis, back and extremities
  3. ROM
  4. neurovascular status - strength, sensation, reflexes
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3
Q

normal gait development

A
  1. walk w/o support by 12-15mos
  2. coordination with reciprocal arm swing by 2yrs
  3. req MSK development of lower back, pelvis, and LE
  4. neurologic growth - coordination/balance (myelinization in cephalocaudal pattern)
  5. adult gait pattern attained by 8-10yrs
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4
Q

normal gait phases

A
  1. stance - weight-bearing phase; heel strike -> plantar flex -> toe-off
  2. swing - toe-off -> heel strike; rotation and tilting of pelvis and stability of lumbar spine and abdomen
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5
Q

abnormal gait and cause

A
  1. antalgic
  2. trendelenburg limp - problem with glut medius of standing leg
  3. waddling - b/l hip involvement or neurologic disease
  4. stiff-legged
  5. toe walking - habitual or due to mm contractures, spasticity, or puncture wound to heal
  6. steppage - peroneal neuropathies
  7. stooped - abdominal pathology
  8. generalized mm weakness - muscular atrophy or metabolic cause
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6
Q

developmental hip dysplasia:

age

A

0-4 yrs

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7
Q

developmental hip dysplasia:

pathology

A

abnormal formation of hip joint -> femoral head unstable within acetabolum

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8
Q

developmental hip dysplasia:

cause

A

unknown

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9
Q

developmental hip dysplasia:

risk factors

A
  1. female
  2. breech
  3. FMH
  4. first born
  5. oligohydramnios
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10
Q

developmental hip dysplasia:

location

A

L hip more common

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11
Q

developmental hip dysplasia: assoc with

A
  1. other ortho problems (torticollis, metatarusadductus, clubfoot)
  2. connective tissue disorders (Larsen syndrome)
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12
Q

developmental hip dysplasia:

PE

A
  1. Barlow and ortolani

2. Galeazzi sign

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13
Q

developmental hip dysplasia:

treatment

A

pavlik harness up to 6 months, surgical consideration after if bracing fails

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14
Q

developmental hip dysplasia:

labs and exams

A

ultrasound

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15
Q

Toddler’s fracture:

definition

A

spiral fracture of tibia under 5y/o

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16
Q

Toddler’s fracture:

cause

A

sudden twisting of tibia

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17
Q

toddler’s fracture:

symptoms

A
  1. pain
  2. refusal to walk
  3. minor swelling/warmth over site
  4. pain with palpation
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18
Q

toddler’s fracture:

treatment

A

long-leg cast; heal within 3-4 weeks

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19
Q

toddler’s fracture:

labs and exams

A

X-ray but often difficult to visualize

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20
Q

physeal fracture:

definition

A

fracture growth plate

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21
Q

physeal fracture:

age

A
  1. girls: 0-16y/o

2. boys: 0-18y/o (more common in boys)

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22
Q

physeal fracture:

location

A

weakest area of growing bone

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23
Q

physeal fracture:

type of fracture

A

salter-harris I classification

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24
Q

stress fracture:

definition

A

small crack in bone, often from overuse and high impact sports

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25
Q

stress fracture:

location

A

weight bearing bones, often 2nd/3rd metatarsal

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26
Q

stress fracture:

age

A

10-18y/o

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27
Q

stress fracture:

symptoms

A
  1. pain that increases with weight bearing activities
  2. reduced with rest
  3. tenderness to touch
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28
Q

stress fracture:

labs and exams

A

x-ray: callus around fracture

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29
Q

stress fracture:

treatment

A
  1. rest

2. possible surgery, depending on site

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30
Q

osteomyelitis:

definition

A

inflammation of bone marrow and adjacent bone

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31
Q

osteomyelitis:

age

A

all age

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32
Q

osteomyelitis:

cause

A
  1. children: hematogenous spread by staph aureus

2. adult: subacte/chronic forms, secondary to open wounds

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33
Q

osteomyelitis:

location

A

metaphysis of long bones

34
Q

osteomyelitis:

symptoms

A
  1. local inflammation and fever
  2. irritability
  3. lethargy
  4. bone tenderness and decrease ROM
  5. systemic symptoms
35
Q

osteomyelitis:

treatment

A

IV abx (4-6wks)

36
Q

septic arthritis:

definition

A

infection with the joint space -> inflammatory response -> intense synovitis

37
Q

septic arthritis:

age

38
Q

septic arthritis:

cause

A

bacterial, viral, fungi or parasite

39
Q

septic arthritis:

symptoms

A
  1. monoarticular
  2. erythema
  3. swelling
  4. pain
  5. decreased ROM
  6. inability to bear weight
40
Q

septic arthritis:

locaiton

41
Q

septic arthritis:

treatment

A

IV/PO abx 4-6 wks

42
Q

gonococcal arthritis:

definition

A

septic arthritis of the joint caused by gonococcus

43
Q

gonococcal arthritis:

age

A

10-18y/o (sexually active)

44
Q

gonococcal arthritis:

dx/tx

A
  1. dx: aspiration of joint fluid and send fluid for culture and sensitivity
  2. tx: IV/PO abx for at least 1wk
45
Q

transient/toxic synovitis:

symptoms

A
  1. irritable hip/knee syndrome
  2. acute hip pain
  3. decrease ROM
46
Q

transient/toxic synovitis:

age

A

0-10y/o, more often in boys

47
Q

transient/toxic synovitis:

dx

A

dx of exclusion

48
Q

transient/toxic synovitis:

definition

A

hip in flexion/abduction and external rotation

49
Q

transient/toxic synovitis:

cuase

A

unk, maybe due to infection (often seen post URI)

50
Q

transient/toxic synovitis:

exams and labs

A
  1. WBC normal

2. pos effusion

51
Q

transient/toxic synovitis:

tx

A
  1. self-limited (5-7 days)

2. NSAIDS

52
Q

slipped capital femoral epiphysis:

definition

A
  1. noninflammatory condition

2. epiphysis weak -> femoral head displaced from femoral neck

53
Q

slipped capital femoral epiphysis:

location

A

initially b/l

if u/l, high chance of other side slip

54
Q

slipped capital femoral epiphysis:

age

A

10-14y/o, more common in overweight boys

55
Q

slipped capital femoral epiphysis:

association

A

endocrine disorders - primary hypothyroid, HGH/pituitary deficiency

56
Q

slipped capital femoral epiphysis:

symptoms

A
  1. insidious or acute

2. complaint of pain in hip and limp

57
Q

slipped capital femoral epiphysis:

dx

58
Q

slipped capital femoral epiphysis:

tx

A
  1. immediate non-wt bearing
  2. surgical stabilization
  3. px good
59
Q

legg-calve-perthes disease:

age

A

4-10y/o, more common in thin, active boys

60
Q

legg-calve-perthes disease:

cause

A
  1. trauma
  2. inflammation
  3. coag abn -protein C/S def, Leiden factor V defect
61
Q

legg-calve-perthes disease:

definition

A

lack of blood flow to femoral head -> bone necrosis -> bone collapses (flattens)

62
Q

legg-calve-perthes disease:

symptoms

A
  1. slight limp
  2. pain in knee, thigh, or groin
  3. limited ROM
  4. leg length discrepancy
63
Q

legg-calve-perthes disease:

dx

A

MRI > X-ray

64
Q

legg-calve-perthes disease:

tx

A
  1. meds
  2. reduce activity to decrease pain
  3. splinting or surgery to keep hip stable (ROM impt)
65
Q

legg-calve-perthes disease:

px

66
Q

juvenile idiopathic arthritis:

definition

A

chronic joint pain for min 6wks and

67
Q

juvenile idiopathic arthritis:

location

A

mono or polyarticular

68
Q

juvenile idiopathic arthritis:

symptoms

A
  1. joint effusion
  2. pain
  3. limited ROM
  4. warmth over the joint
  5. morning stiff - hip involvement unusual
  6. spiking fever
  7. macular rash
69
Q

juvenile idiopathic arthritis:

exams and labs

A
  1. CBC - no WBC spike
  2. inflammatory markers - elevated CRP
  3. ANA
  4. RF
  5. X-rays
70
Q

juvenile idiopathic arthritis:

tx

A
  1. NSAIDS
  2. steroids
  3. DMARDS
71
Q

lyme arthritis:

symptoms

A
  1. episodic initially - 2/3 monoarthritis of knee

2. occur months or years after infection

72
Q

lyme arthritis:

age

73
Q

lyme arthritis:

cause

A

Borrelia burgdorferi transmitted by tick

74
Q

lyme arthritis:

prevalence

A

US - NE, MW, S, W costal areas

75
Q

lyme arthritis:

tx

A
  1. IV rocephin/PO Amox or doxy for 4 wks

2. NSAIDS

76
Q

growing pains:

definition

A

intermittent nonarticular pains (vague pain) in childhood (

77
Q

growing pains:

dx

A

dx of exclusion

78
Q

growing pains:

symptoms

A
  1. typically pain at night and limited to calf, thigh, or shin
  2. pain is short-lived and resolved with heat, massage or mild analgesics
  3. pain free during the day
79
Q

growing pains:

cause

80
Q

growing pains:

tx

A

reassurance to parents and child

PCM 4 midterm (6 decks)

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