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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
Kawasaki - increased risk to develop aneuyrism if
delayed diagnosis delayed treatment younger than 1
26
transient synovitis of the hip
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
MC late manifestation of Lyme
arthritis: infl monoarticular or asymmetric oligoaricular arthritis, MC in the knee
28
Lyme arthrtis: synovial fluid
infl profile, but Gram and culture are (-) | PCR --> Lyme DNA
29
bone pain worse at nights without relation to physical activity that improves with NSAID
osteoid osteoma: tenderness, deformity, swelling
30
osteoid osteoma - MC site
proximal femur
31
stress fracture - x-ray
linear fracture at the angle of the cortex
32
osteoid osteoma - management
NSAID --> serial examination and X-ray to monitor every 5 months if refractory --> surgery
33
serum sickness-like reaction - etiology
1. IC formation 2. antibiotics (beta-lactam, sulfa) 3. Acute HBV
34
serum sickness like reaction - presentation
1-2 weeks after exposure | FEVER, SKIN RASH, POLYARTHRALGIA
35
serum sickness like reaction treatment
remove offending agent supportive cate if severe steroids or plasmapheresis
36
osteogenesis imperfecta
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
systemic-onset juvenile idioath arthritis - clinical presentation
``` 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
systemic-onset jevenile idiopathic arthritis - labs
1. leukocytosis 2. thrombocytosis 3. elevated inf markers 4. anemia 5. high ferritin
39
MCC of supracondylar elbow fracture / severe complication?
fall onto an outstretched arm with the elbow extended | - compartment syndrome
40
Trendelemburg sign - weakness of
gluteus medius and gluteus minimus (superior gluteal nerve) | also maybe in Legg-Calve-Perthes
41
DDX of lytic bone lesion in children
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
Osgood - treatment
NSAID, avoid exercise, stretching
43
prepatellar bursitis - clinical characteristics
pain with direct pressure and swelling over the patella
44
patellar tendonitis - clinical characteristic
point tenderness at the inferior pole of patella
45
Down patient with upper motor neuro finginds / treatment
``` 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
congenital torticollis
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
fibrillin 1 gene mutation - disease?
Marfan
48
MC congenital foot deormity
Metatarsus adductus
49
Metatarsus adductus?
congenital foot deformity in which the forefoot turns inward | foot is flexible and the condition resolves spontaneously
50
Congenital clubfoot?
rigid positioning medial/inward of forefoot and hindfoot hyperplantar flexion of foot
51
metatarsus adductus vs congenital clubfoot regarding treatment
metatarsus --> reassurance | clubfoot --> serial manipulation + casting (surgery if refractory)
52
growing pains
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
tennis vs golf elbow
tennis --> lateral | golf --> medial
54
spondylolisthesis is a developmental disorder characterized by
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
juvenile idiopatic arthritis - presentation
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
Kawasaki - cervical nodes
1 or more Lymph nodes more than 1.5 cm in diameter
57
acute rhematic arthritis
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
osteogenesis imperfecta - another symptom
joint hypermobility
59
Geleazzi test
leg-length discrepancy in developmental dysplasia of the hip
60
Langerhans cell histiocytosis - clinical findings
1. lytic bone lesions (skull, jaw, femur) 2. skin lesions (papules, eczematous rash) 3. lymphadenopahty 4. hepatosplenomegaly 5. pulm cysts/nodules 6. CDI
61
langerhans cell histiocytosis - diagnosis / treatment
diagnosis: Lang cells on bone/skin biopsy
62
langerhans cell histiocytosis - treatment
chemo (prednisone +/- vinblastine) | desmopresin for CDI
63
arthralgia in neoplasia - time in day
night

pediatrics (16 decks)

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