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Musculoskeletal + Rheumatology Flashcards

1
Q

Acquired toritcolis

A

Common causes:

  • URI
  • minor trauma
  • cervical lymphadenitis

Serious:

  • retropharyngeal abscess
  • atlantoaxial subluxation

Get Cervical spine radiographs!

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2
Q

Legg Calve Perthes

A

Avascular necrosis of femoral head

Mostly boys

Limping painless –> pain in groin, hip, thigh, knee

Will persist for > 1 month if no tx

Dx - radiographs show wide articular space, then necrosis

Tx

  • self healing
  • maintain joint mobility via containment (maintain hip in acetabulum)

Complications - osteoarthritis

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3
Q

How long can developmental dysplasia of hip be considered

A

birth –> 3 yo

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4
Q

Slipped capital femoral epiphysis

A

Adolescents

Displacement of femoral head from neck because of stress fracture through femoral capital epiphyseal plate

Most pts obese, possible endocrine basis

Tx

  • pinning
  • external fixation
  • bone grafts
  • casting
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5
Q

Scoliosis

A

Abnormal curvature of spine caused by misalignment in frontal plane

Dx w/ Adams test (forward bending)

Tx

  • bracing to slow down progression
  • surgery if curve > 45 degrees
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6
Q

Primary neoplasms of bone in children

A

Osteosarcoma

Ewing sarcoma

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7
Q

Association with osteosarcoma

A

Retinoblastoma

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8
Q

Osteosarcoma

A
  • Common in long bones at metaphysis
  • Pain at tumor site
  • Sites of mets - lung + bone
  • pelvic tumors present worse prognosis

Radiographs - “sunburst” appearance

Dx - biopsy

Tx - surgery + chemo

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9
Q

Ewing sarcoma

A

Ages 10-20

  • Mets to lung and LN
  • worse prognosis if primary is in pelvis or if mets at time of dx

Radiograph - onion skin periosteal r
eaction

Dx - biopsy

Tx - surgery, radiation, chemo

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10
Q

Pes planus

A

Flat feet

Variant of normal

Usually in kids > 6 yo

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11
Q

Popliteal cyst

A

Arise from capsule or tendon sheaths

Painless
Nonpulsatile swelling
Posterior aspect of knee

More prominent on knee extension

Tx - none, will resolve spontaneously

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12
Q

Osgood Schlatter disease

A

Traction apophysitis of tibial tubercle caused by overuse

Localized tenderness
swelling over tibial tubercle

Pain exacerbated by running and jumping
relieved by rest

Radiograph - soft tissue swelling over tubercle

Tx - resolution in 12 - 24 mos; NSAIDs no help

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13
Q

Radial head subluxation

A

2/2 sudden traction on arm, usually in kids < 4 yo

Child cries immediately, won’t move arm

Arm held partially flexed at elbow + supinated

Radiographs - normal

Tx - reduction by gentle supination with pressure overa radial head

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14
Q

Most common fx in pediatric population

- associated complication?

A

Supracondylar fractures

Complication = entrapment of brachial artery –> loss radial artery pulse

ALWAYS check radial pulse

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15
Q

Axillary N injured in..

A

proximal humerus fractures

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16
Q

Myotonic dystrophy

A

AD

Presents as teen

Skeletal muscle weakness
Myotonia (delayed muscle relaxation)
Cataracts
Cardiac conduction abnormalities

Most affected muscles:

  • facial
  • intrinsic hand
  • ankle dorsiflexors
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17
Q

Juvenile dermatomyositis

A

Presents 5-10 yo

Symmetrical proximal muscle weakness
Gottron papules
heliotrope rash
arthralgias
dysphagia
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18
Q

Panner disease

A

osteochondrosis of capitellum

Adolescents, active in sports and throwing

Pain
Crepitation
Loss of motion of arm (pronation and supination, esp_

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19
Q

Most common elbow dislocation

A

posterior dislocation 2/2 falling backward on outstretched arm

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20
Q

Developmental dysplasia of hip

  • charac
  • tx
A

Developmental dysplasia of the hip encompasses both subluxation and dislocation of the newborn hip, as well as anatomic abnormalities.

It is more common in firstborns, females, breech presentations, oligohydramnios, and patients with a family history of developmental dysplasia.

1st step:
- refer to ortho

Tx: Closed reduction and immobilization in a Pavlik harness, with ultrasonography of the hip to ensure proper positioning, is the treatment of choice until 6 months of age

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21
Q

Meniscal vs ligamentous presentation

A

Rupture of ligament = Rapid onset of effusion

Meniscal injury / ligament sprain = slower onset (24 to 36 hours) of a mild to moderate effusion

Meniscal injury = Recurrent knee effusion after activity

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22
Q

Anterior knee pain localized to tibial tuberosity

Young kid who recent went through growth spurt

A

Osgood-Schlatter lesion

  • stress on patellar tendon –> microavulsions of growth plate on tibial tubercle where patellar tendon inserts

Pain reproduced by extending knee against resistance

Can see on xray lifting of tubercle from shaft of tibia

Tx w/ activity restrict, stretching, NSAIDs

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23
Q

When does anterior fontanelle close? What if it closes early?

A

13.5 months on average

Serial head measurement circumference

The patient needs to be monitored for craniosynostosis (premature closure of one or more sutures) and for abnormal brain development

When craniosynostosis is suspected, a skull radiograph is useful for initial evaluation. If craniosynostosis is seen on the film, a CT scan should be obtained

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24
Q

Patellofemoral pain syndrome

A

is a common overuse injury observed in adolescent girls.

The condition is characterized by anterior knee pain associated with activity.

The pain is exacerbated by going up or down stairs or running in hilly terrain. Can also c/o pain w/ sitting due to sustained flexion

It is associated with inadequate hip abductor and core strength;

Patients complain of popping, catching, stiffness, and giving way.
- EXAM: + J sign = patella moving from a medial to a lateral location when the knee is fully extended from the 90° position.

therefore, a prescription for a rehabilitation program is recommended

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25
Causes of Reactive arthritis
Chlamydia GI pathogens NOT gonorrhea
26
Juvenile Rheumatoid arthritis | - What is it
Chronic Nonsuppurative Inflammation of joints Joint effusions + Destruction of joint cartilage + bone deformity, destruction, fusion Triggers: - Borrelia - Mycoplasma
27
Juvenile Rheumatoid arthritis | - presentation
``` AM stiffness Joint pain Swelling Decreased ROM Joint is warm ``` Polyarticular i - knees - ankles - elbows - -> SPARES HIPS! - small joints = bad prognosis vs Pauciarticular (oligoarthritis) in fewer but larger joints - asymmetric distribution vs Systemic (extraarticular manifestations)
28
JRA - Polyarticular involvement
Subdivide into: RF+ - older age onset - assoc w/ nodules, erosions - more in hands and wrists - fem > males ANA + - females - younger onset - good prognosis - higher risk of eye disease Seronegative
29
JRA - Pauciarticular (oligoarthritis) involvement
Asymmetric Subdivide into: ANA+ - most common - < 4 yo start - knees, ankles, elbows - girls > boys - assoc w/ eye path like iridocyclitis RF+ - erosions - polyarthritis - poor prognosis HLA B27+ - males > females - high risk for ankylosing spondylitis Seronegative
30
JRA - systemic
Extraarticular manifestations ``` Fever rash HSM pleuritis pericarditis ```
31
Tx JRA
#1 - NSAIDs #2 - Methotrexate Antimalarials PT Ophtho f/u Some: Steroids
32
Systemic lupus erythermatosus | - presentation
Great mimicker! ``` Fever Malaise Arthritis Arthralgia Butterfly rash Photosensitive Serositis Libman Sacks endocarditis Seizures Stroke Raynauds ```
33
SLE - dx
4 of the criteria must be present at some time: MD SOAP N HAIR Malar rash Discoid rash Serositis Oral ulcers Arthritis Photosensitivity Neuro - seizures Heme - anemia, leukopenia, lymphopenia ANA + Immuno - LE prep, anti DNA ab Renal - proteinuria, casts
34
Anti ds DNA
Very specific for SLE poor prognosis
35
Anti-histone antibodies
More sensitive for drug induced lupus
36
What is death from SLE usually 2/2 to?
Nephritis CNS complications Infections
37
Neonatal lupus
Can occur in newborns w/ moms who have lupus Transfer IgG anti-Ro at 12-16 wks gestation All manifestations usually resolve except for congenital heart block
38
Albinism
Congenital deficiency of: - tyrosinase (converts tyrosine --> melanin, Autosomal recessive) - defective tyrosine transporters (dec amts of tyrosine, therfore melanin) Can also result from lack of migration of neural crest cells Variable inheritance due to locus heterogeneity (vs ocular albinism is X linked)
39
Acne vulgaris
``` 2/2 to: P. acnes infection Abnormal keratinization of follicular epithelium Increased production of sebum Inflammation ``` Tx: - no special diet - benzoyl peroxide - Retin A - Adapalene - topical abx (clinda, erythromycin) - PO tetracycline - hormonal therapy
40
Achondroplasia
AD But 90% fresh mutations Short stature Large head Lumbar lordosis Short limbs Normal intelligence Hydrocephalus 2/2 narrow foramen magnum
41
most common reason for septic joint in kids
Staph aureus
42
Septic joint suspected in kids...what do you do first?
Arthrocentesis to dx and tx DO NOT do empiric abx as can interfere w/ isolation of offending organism
43
Tx for septic arthritis - birth-3 mo - > 3mo
Birth-3 mo - Staph, group B strep, Gm- bacilli, Kingella** - Abx: Nafcillin or vanco for staph + gentamicin or cefotaxime > 3 mo - Staph, group A strep, Strep pneumo - Abx: Nafcillin, clindamycin, cefazolin or vancomycin
44
Top causes of osteo in sickle cell kids
Salmonella Staph aureus
45
+ limp Following viral infection or mild trauma Hip flexed, slightly abducted, externally rotated What do you suspect?
Transient synovitis #1 cause of hip pain in children Usually in boys 3-10yo Resolves in 1-4 weeks (at most 1 month!!!) Synovial inflammation --> pain, decreased ROM, limping Flex + abduct + externally rotate maximized joint space providing some relief Will NOT have fever or significant lab abnormalities (vs septic arthritis having leukocytosis, increased ESR and CRP If sx persist or worsen, consider legg calve perthes and may need MRI if xrays were normal Tx: - rest - NSAIDs - NOT REYE
46
#1 cause of osteomyelitis in infants an dchildren
Staph aureus other common: - group B strep + ecoli in infants - strep pyogenes in children
47
greatest risk factors for cerebral palsy
Premature birth Spastic diplegia is most commonly seen in preterms - hypertonia - hyperreflexia - both feet pointing down and inward (equinovarus deformity) - clasp knife rigidity
48
Tx impetigo
Topical mupirocin Oral erythromycin Usually caused by - GABS - S aureus
49
Eczema herpeticum
Form of primary herpes simplex virus infeciton assoc w/ atopic dermatitis Usually superimposed on healing atopic dermatitis lesions after epxosure to herpes simplex virus Numerous umbilicated vesicles over area of healing atopic dermatitis is typical
50
Complications of shoulder dystocia
Fx clavicle Fx humerus Erb-Duchenne palsy Klumpke palsy Perinatal asphyxia
51
Fractured clavicle 2/2 shoulder dystocia findings
Clavicular creipitus/bony irregularity Dec MOro 2/2 pain on affected side Intact biceps + grasp reflexes
52
Fx humerus 2/2 shoulder dystocia findings
Upper arm crepitus / bony irregularity Decreased Moro 2/2 pain on affected side Intact biceps + grasp reflexes
53
Erb Duchenne palsy
Decreased Moro + biceps reflex on affected side Waiter's tip = extended elbow + pronated forear m+ flexed wrist and fingers C4/C5-C6 affected Results 2/2 increased distance between head and shoulder Tx - usually spontaneously recover. Surgery if no improvement age 3-6 mo
54
Klumpke paralysis
"Claw Hand" - extended wrist - hyperextended MCP joints - flexed IP joints - No grasp reflex Horner syndrome Intact moro + biceps reflexes C7-T1 Paralysis of hand
55
Vitamin D deficiency rickets - risks - clinical signs
Risks - increased skin pigmentation - only breastfeeding - mom vit D def Clinical - Craniotabes - delayed fontanel closure - Enlarged skull, costochondral joints, long bone joints - Genu varum
56
Vitamin D deficiency rickets - Xray - Labs
Xray - osteopenia - metaphyseal cupping + fraying - epiphyseal widening ``` Labs Decreased - Ca - PO4 - 25-OH vit D ``` Increased - ALP - PTH
57
Metatarsus adductus
Congenital foot deformity More common in 1st born infants 2/2 molding effect of primigravid uterus Type 1 - feet that OVERCORRECT passively and actively into abduction - spontaneous resolution, no tx needed Type 2 - feet that correct to neutral w/ passive and active mvmts - tx w/ orthosis or corrective shoes Type 3 - rigid feet that do not correct - tx w/ serial casts
58
How do you tell if baby has hip dysplasia just by looking?
inguinal skin folds | - if they are asymmetric or extend beyond the anal aperture, this suggests developmental dysplasia of hip
59
If baby has asymmetric inguinal skin folds but negative Barlow and Ortolani, what do you do?
2wk - 6 mo --> Hip US >4-6 mo --> Hip Xray Xray is not helpful until age 4-6 mo because femoral head and acetabulum not yet ossified
60
When paralysis of upper extremity from injury to brachial plexus is found in a neonate injury, injury to what N should also be suspected?
Phrenic The nerve roots are close together! Will have impaired inspiration and the negative pressure from the OK diaphragm will pull mediastinum toward normal side impairing ventilation further
61
Fifth finger (postaxial polydactyly) more common in..
Blacks If find in white child, careful exam of cardiac system is warranted Assoc syndromes; - trisomy 13 - rubinstein-taybi - meckel gruber - ellis van creveld
62
Harlequin syndrome
transient change in skin color of otherwise asymptomatic newborn usually premies dependent side of the body turns red while the upper side remains pale
63
Why is aseptic necrosis of femur head uncommon kids?
Femoral head has 2 main sources - ascending A - foveal A Foveal A can become obliterated in older kids so increase risk of avascular necrosis

Pediatrics (17 decks)

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