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Peds-Final > Ortho > Flashcards

Ortho Flashcards

1
Q

torticollis in infancy

A

wry (twisted) neck deformity

contracture of the sternocleidomastoid (forms an intramuscular fibroma)

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2
Q

torticollis is caused in newborns by

A 
uterine malposition (breech delivery)
birth trauma
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3
Q

DDx of torticollis in older CH

A 
neurogenic/CNS mass
inflammatory (local head & neck infxns)
traumatic
ocular strabismus
hysterical & psychiatric
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4
Q

Dx of torticollis often requires?

A

simple radiographs

consider CT of brain to uncover neurogenic causes

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5
Q

tx of torticollis

A

ROM exercises

occasionally surgically released

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6
Q

scoliosis is?

A

lateral curvature of the spine
often assoc. w/ rotation
idiopathic in 80% of cases

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7
Q

historical factors suggesting a pathologic cause

A

pain
left thoracic curves are more often associated w/ spinal pathology (syrinx or tumor)
stifness
midline skin lesion

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8
Q

screening exam for scoliosis should be performed when?

A

< 12 yrs
standing erect (plumb line) and toe-touch
leg length comparison (screeens for compensatory scoliosis)

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9
Q

radiographs for scoliosis indicated for?

A

5 degrees or more

higher risk of progression

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10
Q

DDx of pathologic scoliosis

A 
secondary
congenital
neuromuscular
constitutional
traumatic
neoplastic
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11
Q

secondary scoliosis

A

muscle spasm

leg length discrepancy

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12
Q

congenital scoliosis

A

d/o of spinal development

often w/ bone, renal, urogenital or neural abnormalities

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13
Q

neuromuscular scoliosis

A

cerebral palsy
polio
muscular dystrophy
spinal muscular atrophy

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14
Q

constitutional scoliosis

A

metabolic d/o’s

athritides

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15
Q

scoliosis curve severity

A 
0-15 degrees
15-25
25-45
45+
60+
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16
Q

mgnt of scoliosis

A 
unlikely to progress
monitor regularly
bracing vs. operative
operative intervention
may cause pulmonary compromise
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17
Q

CH & walking general info

A

infants bend their hips, knees & ankles more than adults to improve balance
their ft are externally rotated & widely spread
they walk at a faster cadence but a slower velocity b/c of shorter stride length

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18
Q

on avg, infants begin to crawl when

A

9 months

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19
Q

on avg kids begin to walk w/ assistance at

A

12-14 months

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20
Q

on avg. kids begin to walk independently when

A

15 months

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21
Q

on avg kids begin to run when?

A

@ 18 months

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22
Q

ch develop a nml adult gait pattern around what age?

A

3 yo

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23
Q

genu varum

A

tibial bowing

nml up to 6 mon-2yrs

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24
Q

genu valgum

A

knock knees

nml at ages 3-8 yrs

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25
Q

concerning features of a limp

A

nocturnal pain/limp
pain at rest
systemic findings: fever, wt loss, lymphadenopathy, HSM
pain out of proportion to exam findings

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26
Q

PE for limping

A 
general exam, inspect bilaterally
attention to contusions, erythema, edema, rashes & temp of affected area
ROM of affected & adjacent joints
neurovascular status & strength
gait: do your best
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27
Q

plain radiographs

A

fx, effusion, lytic lesions, osteoid osteoma
knee pain may be reflection of hip patho
in CH that lacks obvious focus of pain
limited in acute osteomylelits

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28
Q

why are plain radiographs limited in acute osteomyelitis?

A

appears on x-ray up to 1 wk after onset of pain

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29
Q

ULS for limping

A

effusion- esp. for hips

developmental dysplasia of hip

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30
Q

bone scan for limping

A

useful for eval of acute osteomyelitis & suble fx’s

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31
Q

MRI for limping

A

mores specific for osteomyelitis & neoplasm

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32
Q

labs for infxn & limping

A 
CBC
blood cx
ESR
CRP
consider Lyme titers
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33
Q

labs for muscle tenderness & limping

A

CK
renal fx if CK elevated
return to exam to ensure no necrotizing fasciitis

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34
Q

joint aspiration & limping

A

include Gram stain, cx, cell count, glucose & protein of fluid

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35
Q

DDx of limping- causes localized to the limb

A 
strain, sprain, contusion
fx
limp length inequality
transient (toxic) synovitis
septic arthritis
osteomyelitis
developmental dysplasia of hip (DDH)
slipped capital femoral epiphysis (SCFE)
Legg-Calve-Perthes dz (LCPD)
Osgood-Schlatter
patellofemoral syndrome
osteoid osteoma
neoplasm of bone, joint of soft tissue
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36
Q

DDx for limping trivial causes

A 
hair tourniquets (may NOT be trivial)
blisters
nail trauma
ill-fitting shoes
subcutaneous FBs
plantar warts
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37
Q

DDx for limping & systemic causes of arthritis

A 
Henoch-Schoenlein purpura (HSP)
rheumatologic dz
Kawasaki dz
serum sickness
Lyme dz
IBD
gonorrhea & meningococcemia
neoplasm
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38
Q

DDx limping and abdominal pathology

A

appendicitis

psoas muscle abscess

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39
Q

DDx limping and pelvic pathology

A

PID or abscess

ovarian torsion/cysts

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40
Q

DDx limping & genitourinary pathology

A

testicular torsion/ epididymitis
urolithiasis
inguinal hernia

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41
Q

DDx limping & back pathology

A

muscle strain
discitis, herniated disc
spondylysis/spondyloslisthesis

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42
Q

DDx limping & neurologic pathology

A

tumor: spinal/cerebral/cerebellar/retroperitoneal

stroke

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43
Q

A 0-2 yr old comes into the office with hip pain. What’s on your DDx?

A

DDH (developmental dysplasia of hip)

septic arthritis

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44
Q

A 3-5 yr old comes into the office w/ hip pain. What is on your DDx?

A

transient synovitis

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45
Q

A 4-7 yr old comes into the office w/ hip pain. What is your DDx?

A

Legg-Calve-Perthes

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46
Q

A 10-15 yr old comes into office w/ hip pain. DDx?

A

SCFE

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47
Q

A 0-2 yr old w/ knee pain. DDx?

A

septic arthritis

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48
Q

A 10-15 yr old w/ knee pain. DDx?

A

subluxing patella chondromalacia

Osgood Schlatter

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49
Q

Tibia pain in 0-2 yr old. DDx?

A

toddler fx

50
Q

tibia pain in 3-5 yr old. DDx?

A

“growing pains”

51
Q

tibia pain in 10-15 yr old. DDx?

A

stress fx

52
Q

spine pain in a 3-5 yr old. DDx?

A

discitis

53
Q

spine pain in 10-15 yr old. DDx?

A

spondylolisthesis

54
Q

0-5 yr old with any limb pain. DDx?

A

JRA
Leukemia
Cerebral Palsy
Osteomyelitis

55
Q

4-7 yr old with any limb pain. DDx?

A

osteomyelitis

56
Q

10-15 yr old with any limb pain. DDx?

A

bone tumor

osteomyelitis

57
Q

what is the MCC of limp in children?

A

trauma

58
Q

greenstick fxs reflect the unique ability of kids’ bones to ?

A

bend

59
Q

MC mechanism in toddler’s fractures

A

twisting or tripping

60
Q

what is more common? soft tissue or bone injury

A

soft tissue injury

61
Q

MC ID’d fx in preschool children (ages 9mo to 3 yrs) presenting w/ a limp

A

toddler’s fx

62
Q

what is a toddler’s fx

A

nondisplaced spiral or oblique fx of lower third of tibial shaft

63
Q

the MC presentation of toddler’s fx

A

child refuses to bear wt on affected leg

hx of minimal or no trauma

64
Q

what do you find on PE in toddler’s fx

A

possibly warmth & pain w/ palpation
usually no swelling
pain w/ gentle torsion of the foot

65
Q

pathophys of toddler’s fx

A

sudden twisting of tibia
fx more obvious 10-14 days after injury (callus formation)
generally heals w/ subperiosteal new bone formation running entire length of tibia (indicates fx more extensive & likely extends up the shaft through middle & proximal 1/3)

66
Q

tx of toddler’s fx

A

long leg cast immobilization

67
Q

what is developmental dysplasia of the hip

A

displacement of th efemoral head from its nml position in the acetabulum- affects nml development of both

68
Q

dislocation in DDH

A

femoral head completely outside of the acetabulum

69
Q

subluxable in DDH

A

femoral head can be displaced outside of acetabulum

70
Q

dysplasia in DDH

A

radiographic abnormality

71
Q

in DDH children often walk on what?

A

affected side’s toes to compensate for short limb

72
Q

risk factors in DDH

A 
female gender
breech malposition
FH of DDH
limited fetal mobility
clinical evidence of joint instability
significant persistent hip asymmetry
73
Q

hx in DDH

A 
prenatal hx (breech, gestation, birthweight)
MS abnormalities
FH of DDH
ethnic background
postnatal risk factors
74
Q

examination of DDH

A

screen on every well child visit
0-4 mo check hip instability via Ortolani maneuver, Barlow maneuver
4 mo leg length/abduction-Galeazzi sign
12 mo+- trendelenburg’s sign

75
Q

imaging of DDH

A

plain films- incrase inusefulness beyond 4 months of age; widened pelvic floor; decreased femoral head coverage; femoral ossific nucleus
ULS- requires static & dynamic images, trained

76
Q

Dx DDH

A

reg. well child visit screening- follow clics for 1st 2 wks, refer clunks (subluxation, dislocation on exam)
work up- ULS < 5 months, plain films > 4months

77
Q

tx of DDH < 6 mo old

A

Pavlik harness- prevent hip extension & abduction

78
Q

tx of DDH > 6 mo old

A

open or closed reduction

79
Q

what is Legg-Calve-Perthes dz

A

avascular necrosis of proximal femoral head

80
Q

Legg-Calve-Perthes dz is predominately?

A

unilateral
both hips are involved in less than 10% of cases
hips are involved successively, not simultaneously

81
Q

Legg-Calve-Perthes dz may have insidious onset or may occur after?

A

hip injury

coagulation or endocrine abnormalities may also contribute to cause

82
Q

pathophysiology of Legg-Calve-Perthes dz

A
  • rapid growth relative to blood supply development of secondary ossification centers in epiphysis
  • causes interruption of adequate blood flow & results in avascular necrosis (necrosis, removal of necrotic tissue, & replacement w/ new bone)
  • bone replacement may result in nml bone
83
Q

frequency of Legg-Calve-Perthes dz

A

4/100,00
usually bet 4-10 yr old (mean age 7 yo)
boys>girls 4:1
white children affected more

84
Q

sx’s of Legg-Calve-Perthes dz

A

antalgic limp, pain typically mild
pain often gradual onset, intermittent & referred to thigh or knee
pain usually worsens w/ activity

85
Q

exam of Legg-Calve-Perthes dz

A

loss of medial rotation

loss of abduction

86
Q

acute radiographic signs in Legg-Calve-Perthes dz

A
  • small femoral epiphysis (96%)
  • sclerosis of femoral head w/ sequestration & collapse (82%)
  • widening of joint space d/t thickening of cartilage, failure of epiphyseal growth, the presence of joint fluid, or joint laxity (60%)
  • fx line between avascular center of the femoral head & the subchondral bone
87
Q

what does a bone scan show in LCP dz

A

reduced uptake

88
Q

what does an MRI show in LCP dz

A

marrow necrosis
irregularity of the femoral head
loss of signal from affected side

89
Q

non-operative mgnt of LCP dz

A

prevent deformity & osteoarthritis

  • restoration/maint of ROM
  • prevention of subluxation
  • attainment of a spherical femoral head at healing
  • bed rest & NSAIDs
  • abduction bracing until lateral portion of femoral head has regenerated (12-18 mo)
  • surgery for sever dz
90
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

structural failure of the upper femoral physis that allows displacement of the femoral head on the neck

  • frequently misdiagnosed
  • early tx leads to better outcome but there are freq. delays in dx
91
Q

what is the MC hip abnormality presenting in school age or adolescence (age 7-15)?

A

slipped capital femoral epiphysis

92
Q

what is a primary cause of osteoarthritis?

A

SCFE

93
Q

what is the key predisposing factor in SCFE?

A

obesity

94
Q

almost exclusive incidence of SCFE during adolescent growth spurt suggest?

A

hormonal role

95
Q

pathophysiology of SCFE

A

Salter-Harris type 1fx thru proximal femoral physis

  • physeal cartilage weak
  • hip stress–>shear force at growth plate–>epiphysis to move posteriorly & medially
  • blood supply tenuous & frequently lost after fx
96
Q

manipulation of SCFE frequently results in what?

A

osteonecrosis & chondrolysis d/t tenuous blood supply

97
Q

frequency of SCFE

A 
m>f
>AA
typically occurs after onset of puberty
freq. in overwt, skeletally immature boys
slippage is bilateral in 20-37%
98
Q

sx’s of SCFE

A

hip & knee pain
insidious onset
antalgic limp
out-toeing (to avoid internal rotation)

99
Q

signs of SCFE

A
  • thigh may be shortened, externally rotated, and abducted
  • internal rotation & abduction limited by pain
  • tenderness on palpation of hip w/ discomfort often referred to hip, groin, or thigh
100
Q

early radiologic findings in SCFE

A

widening of growth plate & osteopenia of the involved femoral head & neck

101
Q

late radiologic findings of SCFE

A

displacement of the femoral neck relative to the femoral head
“ice cream scoop falling off the cone”

102
Q

acute signs of SCFE

A

widened physis
lateral frog leg readiograph- demonstrates slippage earliest, slippage begins w/ posterior displacement & prgresses w/ medial rotation

103
Q

line of Klein

A

line drawn along lateral aspect of femoral neck on AP view

line should intersect a portion of femoral head

104
Q

tx of SCFE

A

fixation: using a screw
osteotomy-attempts to change head alignment may predispose to avascular necrosis
goal- avoid chondrolysis, AVN, degenerative arthritis

105
Q

what is a common cause of knee pain in active adolescents?

A

osgood-schlatter dz

106
Q

how do you dx osgood-schlatter dz

A

characteristic localized pain at tibial tuberosity

*radiographs not needed for dx, but do confirm clinical suspicion & exclude other causes of knee pain

107
Q

pathophysiology of Osgood-Schlatter dz

A

most cases caused by micro trauma in deep fibers of patellar tendon at insertion on tibial tuberosity (avulsion mya be present)
usually d/t quadriceps femoris

108
Q

s/sx of Osgood-Schlatter dz

A 
pain
heat
tenderness
soft-tissue edema at tibial tuberosity
thickening & indistinct margins of patellar tendon
109
Q

cartilaginous tibial tuberosity in Osgood-Schlatter dz

A

no initial change

after 3-4 wks, fragmented ossification visible w/in tendon

110
Q

ossified tibial tuberosity in Osgood-Schlatter Dz

A

linear or nodular avulsed bony fragments

bony defect at donor site

111
Q

tx for Osgood-Schlatter Dz

A

conservative

  • NSAIDs
  • application of ice
  • avoid stress on knee caused by quads loading
  • possible brief period of inactivity
  • stretching of quads & hamstrings to reduce stress on tubercle
  • usually self-limited & resolves w/ skeletal maturity
112
Q

osteoid osteoma

A

benign skeletal tumor

113
Q

osteoid osteoma presents as?

A

severe pain, worse at night & with activity

114
Q

osteoid osteoma dramatically improves w/ what?

A

NSAIDs

115
Q

what will you see on x-ray in osteoid osteoma?

A

radiolucent nidus 2-3 mm diameter w/ large, dense reactive bone growth
CT can confirm

116
Q

osteochondroma

A

benign focal neoplasm

non-painful swelling, may be irritated by athletic activity

117
Q

osteosarcoma

A

malignant focal neoplasm
typically painful
common at metaphysis of long bone
“sunburst” pattern on x-ray

118
Q

Ewing’s sarcoma

A

malignant focal neoplasm

typically painful

119
Q

name some systemic neoplasms

A

leukemias & lymphomas

metastases from other sites

120
Q

pain from leukemia is often described as?

A

a deep, boring pain that awakens a child from sleep

*up to 25% of pts w/ leukemia present w/ limp, bone pain or refusal to walk as a primary complaint

Peds-Final (10 decks)

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