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pediatrics > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Congenital hip dysplasia - age / RF

A

infants

  1. breech positioning
  2. family history
  3. excessively tight swaddling
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2
Q

Congenital hip dysplasia - presentation

A

uusally found on newborn exam screening

- ASYMMETRIC GLUTEAL FOLDS

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3
Q

Congenital hip dysplasia - diagnosis

A

Ortolani and Barlow maneuver (click or clunk the hip)
- confirm:
with U/S if younger than 4 months
with X-ray if older

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4
Q

Congenital hip dysplasia - treatment

A

pelvic harness (abduction for 6 months)

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5
Q

Legg-Calve-Perthes disease (avascular necrosis of femoral head) - age

A

2-8 / (often males)

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6
Q

Legg-Calve-Perthes disease (avascular necrosis of femoral head) - presentation

A

painful limp
decreased motion (limited internal rotation and abduction)
+/- knee pain
thigh muscle atrophy

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7
Q

Legg-Calve-Perthes disease (avascular necrosis of femoral head) - diagnosis

A

flattened and fragmented femoral head

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8
Q

Legg-Calve-Perthes disease (avascular necrosis of femoral head) - treatment

A

Rest and NSAID –> follow with surgery on both hips –> if one necroses –> eventually so will the other

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9
Q

slipped captital femoral epiphysis - epidimiology

A

adolescence, esp in obese

additional RF: endocrinopathies, renal failure, radiation history

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10
Q

slipped captital femoral epiphysis - presentation

A
  • painful limb

- extenrally rotated leg

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11
Q

slipped captital femoral epiphysis - diagnosis

A

x-ray shows widening of joint space

- posterior displacement femoral head

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12
Q

slipped captital femoral epiphysis - treatment

A

internal fixation with pinning (urgent surgery to prevent avascular necrosis)

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13
Q

Vitamin D deficiency can cause

A

adults –> osteomalacia (defective mineralization of osteoid)
children –> rickets (defective mineralization of cartilaginous growth plates)

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14
Q

rickets - x-rays

A

epiphyseal widening and metaphyseal cupping/fraying

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15
Q

children with rickets - presentation

A

bow legs (genu varum). bead-like costochondral junctions (rachitic rosary), craniotabes (soft skull)

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16
Q

Osgood Schlatter disease (traction apophysitis) - definition

A

overuse injury caused by repetitive strain and chronic avulsion of 2ry ossification center of proximal tibial tibercle

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17
Q

Osgood Schlatter disease (traction apophysitis) - epidimiology

A

adolescents after growth spurt

common in running and jumping athletes

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18
Q

Osgood Schlatter disease (traction apophysitis) - presentation / radiology

A

anterior knee pain / reproduce pain when extend the knee against resistance / tenderness and edema on tubercle
- anterior soft tissue swelling, lifting of tubercle from the shaft, irregularity or fragmentation of the tubercle

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19
Q

Radial head subluxation (nursmaid’s elbow) - epidemiology / treatment / x-ray

A

children under 5
treatment: hyperpronation of the forearm, supiation of foram and flexion of the elbow
x-ray: normal

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20
Q

Radial head subluxation (nursmaid’s elbow) - mechanism

A

sudden pull on the arm –> immature annular ligament slips over head of radius –> injured arm held in flexed and pronated position

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21
Q

Kawasaki disease - criteria

A

fever for 5 or more days + 4/5: (CRASH mnemonic)

  1. Conjunctivitis: bilateral, nonexudative, spares limbus
  2. oral mucosal changes: erythema, fissured lis, strawberry tongue
  3. Rash
  4. Extremity changes: erythema, edema, desquamation of hands and feet
  5. Cervical lymphadenopathy: node larger than 1.5
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22
Q

Kawasaki disease - labs

A
  1. sterile pyuria
  2. thrombocytosis
  3. elevated CRP, ESR
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23
Q

Kawasaki - Echo

A

at the time of diagnosis and 6-8 weeks after

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24
Q

Kawasaki - treatment / epidimiology

A

aspirin and IVIG within 10 days after diagnosis to prevent complications

  • 90% in under 5 years old
  • East asia
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25
Q

Kawasaki - increased risk to develop aneuyrism if

A

delayed diagnosis
delayed treatment
younger than 1

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26
Q

transient synovitis of the hip

A

common cause of limp in young children
symptoms after a viral infection and last for less than 4 weeks
X-ray: normal or joint effusion

27
Q

MC late manifestation of Lyme

A

arthritis: infl monoarticular or asymmetric oligoaricular arthritis, MC in the knee

28
Q

Lyme arthrtis: synovial fluid

A

infl profile, but Gram and culture are (-)

PCR –> Lyme DNA

29
Q

bone pain worse at nights without relation to physical activity that improves with NSAID

A

osteoid osteoma: tenderness, deformity, swelling

30
Q

osteoid osteoma - MC site

A

proximal femur

31
Q

stress fracture - x-ray

A

linear fracture at the angle of the cortex

32
Q

osteoid osteoma - management

A

NSAID –> serial examination and X-ray to monitor every 5 months
if refractory –> surgery

33
Q

serum sickness-like reaction - etiology

A
  1. IC formation
  2. antibiotics (beta-lactam, sulfa)
  3. Acute HBV
34
Q

serum sickness like reaction - presentation

A

1-2 weeks after exposure

FEVER, SKIN RASH, POLYARTHRALGIA

35
Q

serum sickness like reaction treatment

A

remove offending agent
supportive cate
if severe steroids or plasmapheresis

36
Q

osteogenesis imperfecta

A

AD: frequent fractures, joint hypermobility, dentiogenesis imperfecta, blue scleare, hearing loss, short stature
type 2 is lethal due to Resp failure or fractures in utero)

37
Q

systemic-onset juvenile idioath arthritis - clinical presentation

A 
auto-inf disease in children: 
1. long stading daily fever
2. arthritis of 1 or more joints (more than 6 weeks)
3. pink macular rash
MORE THAN 6 WKS
38
Q

systemic-onset jevenile idiopathic arthritis - labs

A
  1. leukocytosis
  2. thrombocytosis
  3. elevated inf markers
  4. anemia
  5. high ferritin
39
Q

MCC of supracondylar elbow fracture / severe complication?

A

fall onto an outstretched arm with the elbow extended

- compartment syndrome

40
Q

Trendelemburg sign - weakness of

A

gluteus medius and gluteus minimus (superior gluteal nerve)

also maybe in Legg-Calve-Perthes

41
Q

DDX of lytic bone lesion in children

A
  1. infectious (Brodie abscess from osteomyelitis)
  2. endocrine (hyperparathyroid osteitis fibrosa cystica)
  3. neoplastic (Ewing, langerhans, metastasies)
  4. idiopathic (benign bone cyst, aneysmalbone cyst)
42
Q

Osgood - treatment

A

NSAID, avoid exercise, stretching

43
Q

prepatellar bursitis - clinical characteristics

A

pain with direct pressure and swelling over the patella

44
Q

patellar tendonitis - clinical characteristic

A

point tenderness at the inferior pole of patella

45
Q

Down patient with upper motor neuro finginds / treatment

A 
antlantoaxial instability (due to excessive laxity in the posterior transverse ligament --> compression of spinal cord --> behavioral changes, torticollis, urinary incontinence, verebrobasila symptoms, UMN symptoms 
treatment: surgical fusion of C1+C2
46
Q

congenital torticollis

A

postural neck DEFORMITY , presents with a sternocleidomastoid muscle mass, contralaterla chin deviation, ipsilateral head tilt
- limited range of motion of the neck increases the risk of positional plagiocepaly

47
Q

fibrillin 1 gene mutation - disease?

A

Marfan

48
Q

MC congenital foot deormity

A

Metatarsus adductus

49
Q

Metatarsus adductus?

A

congenital foot deformity in which the forefoot turns inward

foot is flexible and the condition resolves spontaneously

50
Q

Congenital clubfoot?

A

rigid positioning
medial/inward of forefoot and hindfoot
hyperplantar flexion of foot

51
Q

metatarsus adductus vs congenital clubfoot regarding treatment

A

metatarsus –> reassurance

clubfoot –> serial manipulation + casting (surgery if refractory)

52
Q

growing pains

A

bilateral, lower extremity pains that occur at night in children 2-12
no systemic symptoms, normal activitu
treatment: observation, reassurance, massage and over the counter pain medications

53
Q

tennis vs golf elbow

A

tennis –> lateral

golf –> medial

54
Q

spondylolisthesis is a developmental disorder characterized by

A

forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children
- back pain, neurologic dysfunction (eg. urinary incontinence), papable step-off at the lubosacral area present if the disease is severe

55
Q

juvenile idiopatic arthritis - presentation

A

different to systemic
symmetric arthritis (poly: 5 or more or oligo: less than 5) for 6 weeks
anemiia, high ferritin, inf markers, hypergammaglobulinemia, thrombocytosis

56
Q

Kawasaki - cervical nodes

A

1 or more Lymph nodes more than 1.5 cm in diameter

57
Q

acute rhematic arthritis

A

2-4 wks after untreated strep throat –> Jones criteria (2 major or 1 major and 2 minor)
(Minor criteria: fever, arthralgia, ESR/CRP, prolonged PR interval)

58
Q

osteogenesis imperfecta - another symptom

A

joint hypermobility

59
Q

Geleazzi test

A

leg-length discrepancy in developmental dysplasia of the hip

60
Q

Langerhans cell histiocytosis - clinical findings

A
  1. lytic bone lesions (skull, jaw, femur)
  2. skin lesions (papules, eczematous rash)
  3. lymphadenopahty
  4. hepatosplenomegaly
  5. pulm cysts/nodules
  6. CDI
61
Q

langerhans cell histiocytosis - diagnosis / treatment

A

diagnosis: Lang cells on bone/skin biopsy

62
Q

langerhans cell histiocytosis - treatment

A

chemo (prednisone +/- vinblastine)

desmopresin for CDI

63
Q

arthralgia in neoplasia - time in day

A

night

pediatrics (16 decks)

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