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PCM IV Exam I > MSK The limping child (Pitcher- CCP 4 questions) > Flashcards

MSK The limping child (Pitcher- CCP 4 questions) Flashcards

1
Q

when does the adult gait pattern occur ?

A

by 8-10 years old

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2
Q

normal gait has what 5 key maneuvers

A 
cadence
stride length 
walking velocity 
single limb support time
support base width
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3
Q

antalgic gait

A

usually from pain

less time in stance phase

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4
Q

trendelenburg limp

A

Trendelenburg limp—stance phase body sway away from the weak hip abductor & swing phase droop of the weak side

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5
Q

waddling gait

A

seen in b/l hip involvement or neurologic dz

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6
Q

stiff legged gait

A

knee extension & circumduction w/ pelvic elevation on affected side

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7
Q

toe walking

A

Toe walking—habitual or due to muscle contractures, spasticity or (puncture wound on heel)

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8
Q

steppage gait

A

Steppage—difficulties w/ dorsiflexion of foot usu. Assoc. w/ peroneal neuropathies

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9
Q

stooped gait

A

abdominal pathology

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10
Q

limping DDx in a 0-4 year old

A 
hip dysplasia
toddler' fx
physeal fx
puncture wound
sprain
contusion
osteomyelitis
septic arthritis
transient/toxic synovitis ***

discitis
neoplasm

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11
Q

limping DDx in 4-10 year old

A 
physeal fx
puncture wound
sprain
contusion
transient/toxic synovitis
septic arthritis
osteomyelitis
Legg-Calve Perthes disease
Leukemia
Juvenile idiopathic arthritis
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12
Q

DDx limping in 10-18 year old

A 
Slipped capital femoral epiphysis
fx
sprain
contusion
osteomyelitis
septic arthritis
lymp disease
gonococcal arthritis 
stress fx
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13
Q

developmental hip dysplasia

A

age- 0-4 years
abnormal formation of hip joint
more common in females**

  • femoral head unstable within acetabulum- don’t stick together
  • may be loose in socket or completely dislocated
  • may occur during fetal development, at delivery or after birth
  • risk factors-genetic component, anything causing crowding of the fetus—large birth, oligohydraminos; female, first born, breech (esp. feet up)
  • 5-9X more common in females
  • left hip> right
  • more common with other ortho problems (torticollis, metatarusadductus, clubfoot) or connective tissue d/o (Larsen syn)
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14
Q

Barlow

Ortolani

A

Barlow- move femoral head posterior

Ortolani- move femoral head anteriorly

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15
Q

what is galeazzi sign

A

flex infants knees when lying down so that feet touch the surface and the ankles touch the buttocks

if the knees are not level then the test is positive

congential hip malformation

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16
Q

toddler’s fx?

A

Def: Spiral fracture of tibia under age of 5 years

Common childhood fx

Sudden twisting of tibia
Often difficult to visualize on x-ray

Sx: pain, refusal to walk, minor swelling/warmth over site, pain with palpation

Tx: long-leg cast; heal within 3-4 wks

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17
Q

physeal fracture

A

Growth plate injuries are fractures

Age: 0-16 yrs girls; 0-18 yrs boys
Weakest area of growing bone
15% of all childhood fractures

Boys>girls

Salter-Harris classification

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18
Q

stress fracture?

A

Small crack in bone
Often from overuse, high impact sports
Weight bearing bones
2nd/3rd metatarsal most common
Age: 10-18 years
Sx: pain that increases with weight bearing activities, reduced with rest, tenderness to touch
Tx: rest, possible surgery depending on site

NOTE:
When muscles are overtired, they are no longer able to lessen the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones. This can create small cracks or fractures

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19
Q

salter type I

A

Salter 1: epiphysis separate from shaft & metaphysis—-through physis—most common in newborns/young children—excellent prognosis

slip (epiphysis separated from shaft)

20
Q

salter type II

A

Salter 2: like type 1 through physis separation of physis from metaphysis but with a small metaphysis triangle—most common epiphyseal fx—excellent prognosis

21
Q

salter type III

A

Salter 3: intraarticular fx through epiphysis—uncommon—ORIF needed

22
Q

salter type IV

A

Salter 4: intraarticular fx through epipysis, physis & metaphysis—poor prognosis—needs perfect reduction

23
Q

salter V

A

Salter 5: Crush of physis—poor prognosis, early x-ray negative, rarely occurs

24
Q

osteomyelitis

A

Inflammation of bone marrow & adjacent bone (long bone). painful

Age: all
Children: hematogenous spread
Location: metaphysis of long bones

Sx: local inflammation & fever, irritability, lethargy, bone tenderness & dec. ROM

Adults: subacute/chronic forms, secondary to open wounds

Tx: IV antibiotics (4-6 wks min.)

NOTE:Staphlococcus aureus implicated in most pts with hematogenous spread

25
Q

septic arthritis

A

Infection with the joint space
hot, red, swollen join

Age: all
Causes:
injury?

Bacterial, viral, (fungi or parasite)
Intense synovitis is the result of the inflammatory response

Sx: monoarticular, erythema, swelling, pain, dec. ROM

Knee most common***
can stick a needle in and aspirate- culture

Tx: IV/PO antibiotics (4-6 wks)

26
Q

what is transient toxic synovitis

A

Sx: “irritable hip syndrome”

acute hip pain*** , dec. ROM
Hip in flexion/abduction & ext. rotation

Age 0-10 yrs

Dx of exclusion

Cause: ? Infectious —> preceding URI

Tx: self limited*** (5-7 days), NSAIDS

27
Q

what is legg-calve-perthes disease

A

aka Perthes disease or idiopathic osteonecrosis of the femoral head

Age 4-10 years

Lack of blood flow to femoral head=necrosis
Bone collapses—flattens
Blood supply returns after several months
New bone replaces old

Boy>girls–4:1 ***
Typically thin, active boys

Sx: slight limp, pain in knee, thigh or groin, limited ROM, leg length discrepancy

Tx: meds/reduce activity to dec. pain (children under 6);
splinting or surgery to keep hip stable

28
Q

slipped capital femoral epiphysis (SCFE)

A

Noninflammatory condition; femoral head displaced from femoral neck (femoral neck is moving not head)

Initially bilateral 20-40%, if unilateral, the other side slips in 30-60%

Age: 10-14 years

Typically overweight boys: shear stress

Association with endocrine disorders

  • 1° hypothyroid
  • HGH deficiency (growth hormone)

Sx: insidious, complaint of pain in hip and limp

Tx: surgical stabilization

29
Q

Juvenile Idiopathic Arthritis (JIA)

A

Chronic joint pain for min. of 6 wks & age onset <16 yrs

Sx: joint effusion, pain, limited ROM, warmth over the joint
Morning stiffness; hip involvement unusual

Prevalence: 16-150 per 100,000

Cause: unknown (?immune/environment)
7 subtypes

elevated CRP and sed rate

30
Q

Lyme arthritis

A

2nd most frequent presenting sx (rash #1; erythema migrans)

May occur months or years after infection

Sx: Episodic initially
2/3 monoarthritis of knee

Age: 10-18 yrs.

Cause: Borrelia burgdorferi transmitted by tick
Prevalence: US–northeast, midwest, south & west costal areas

Boys=girls

Tx: IV/PO antibiotics, NSAIDs

31
Q

Gonococcal arthritis

A

only going to be found unless they are sexually active

Septic arthritis of the joint caused by gonococcus

Age: 10-18 yrs (sexually active)

Sx: same as septic arthritis

Dx/Tx: aspiration of joint fluid

IV/PO antibiotics (at least 1 week)

32
Q

growing pains

A

Intermittent non-articular pains in childhood

Diagnosis of exclusion

Sx: Typically pain at night & limited to calf, thigh or shin

  • -pain is short-lived and resolved with heat, massage, or mild analgesics
  • –Pain free during the day

Cause: unknown

Tx: reassurance to parents/child

33
Q

what is the most common organism involved in septic arthritis/osteomyelitis

A

staph aureus

THEN nongroup A beta-hemolytic streptococci

34
Q

most common organism causing septic arthritis in neonates

A

Group B Streptococcus, Staphlococcus aureus, gram-negative bacilli

35
Q

most common organism causing septic arthritis infant (1-3 months)

A

strep
staph
haemophilus influenza

36
Q

most common organism causing septic arthritis in child

A

s. aureus
strep pneumoniae

group A strep

37
Q

most common organism causing septic arthritis in adolescent

A

S. aureus, S. pneumoniae, group A Streptococcus

plus neisseria gonorrhea

38
Q

most common organism causing septic arthritis in sickle cell disease

A

salmonella

staph aureus, strep pneumonia, group A strep

39
Q

puncture wound cause of septic arthritis

A

pseudomonas

40
Q

if a pt has septic arthritis of the hip, what else are they at risk for

A

Septic arthritis of hip associated with highest risk of avascular necrosis
Due to increased joint pressure on blood vessels supplying cartilage & femoral head

41
Q

how is the diagnosis of septic arthritis made

A

Definitive diagnosis by aspiration and culture of synovial fluid
Radiology not diagnostic but supportive-may not be apparent until 10 days into illness

42
Q

treatment of septic arthritis

A

Treatment
Most important prognostic factor for good outcome is early antibiotic treatment
Cefotaxime IV (Claforan)
Due to the high incidence of MRSA in the United States (62% of all skin infections), ID should be consulted for most appropriate regional antibiotic (guided by local resistance pattern)
With clinical improvement, change to PO abx
Total treatment 4-6 wks
Low dose steroids have been shown to reduce residual joint sx with hematogenous spread

43
Q

what is the treatment for SCFE

A

Non-weight bearing until assessed by ortho
Tx: surgical fixation with central screw or bone graft epiphysiodesis
Most patient have good prognosis
Risk for acute chondrolysis or avascular necrosis

44
Q

what are the risk factors for development of hip dysplasia

A

female
breech
first born (nulliparous)
oligohydramnios

45
Q

presentation of acute lymphocytic leukemia in kid

A

CBC reveals elevated WBC and low HgB and plts

If infectious cause (septic arthritis/toxic synovitis) would see elevated WBC but not low Hgb and plts
This is picture of WBC crowding out the other cell lines

Likely to see blasts on differential

Patient:
2 weeks of low grade fevers, malaise & hip pain. Her temp. is 38.4 C. She refuses to bear weight on her right leg. no joint inflammation. spleen tip palpable

PCM IV Exam I (5 decks)

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