Ortho and Rheumatic Diseases Flashcards
1
Q
toeing in
A
Metatarsus Varus
Tibial Torsion
Femoral Anteversion
2
Q
out toeing
A
Less common, lateral rotation of hips
3
Q
common congenital foot deformity, inward deviation of the forefoot
A
metatarsus varus/adductus
4
Q
check for this when you have metatarsus varus/adductus
A
hip dysplasia
5
Q
most common cause of toeing in <2 years
A
tibial torsion
6
Q
internal rotation of leg between knee and ankle
A
tibial torsion
7
Q
toeing in beyond 2-3 years old, mostly girls
A
femoral anteversion
8
Q
“w” sitters, internal rotation of the hip is greater than external rotation
A
femoral anteversion
9
Q
club foot; hypoplastic tarsal bones (esp talus) and hypoplastic muscles
A
talipes equinovarus
10
Q
Diagnosis requires: plantar flexion of foot at the ankle joint (equinus)
Inversion deformity or heel (varus)
Medial deviation of the forefoot (varus)
A
talipes equinovarus
11
Q
3 categories of talipes equinovarus
A
congenital (MOST COMMON), teratogenic, positional
12
Q
treat talipes equinovarus
A
manipulation of foot, stretching tissues, splinting . Some require surgical tendon release
13
Q
bowleg
A
genu varum
14
Q
genu valgum
A
knock kneed
15
Q
when do you worry about genu varum or valgum?
A
persistant beyond 2 years or 8 years- refer
bowing of only 1 leg or asymmetric knocknee
worsening
16
Q
unilateral bowleg resulting in a progressive deformity. males, overweight, AA
A
Blount’s
17
Q
Anterior knee pain that is worse with activity, stairs, prolonged sitting. F more than M, athletes, strength imbalance
A
patellofemoral pain syndrome
18
Q
treat patellofemoral pain syndrome
A
complex, RICE, PT eval
19
Q
knee problem unique to kids (11-15 year old). young athletes, mostly males, due to fast growth and open growth plates
A
osgood schlatter disease
20
Q
knee pain during and after activity. Fragmentation and microfractures of the tibial tuberosity can occur
A
osgood schlatter disease
21
Q
kid points directly to the tibial tuberosity when you ask where it hurts. Has tight quads. No pain at rest
A
osgood schlatter
22
Q
treat osgood schlatter
A
Rest + activity . NSAIDs, ice, stretching quads and hamstrings
23
Q
Abnormal relationship between acetabulum and proximal femur
A
hip dysplasia
24
Q
this is dislocateable or subluxable. becomes worse with growth is not corrected
A
hip dysplasia (congenital)
25
common in first born females who were breech presentation
developmental hip dysplasia
26
PE hip dysplasia
Ortolani and Barlow
Asymmetric Skin Creases +/-
Galeazzi
check for asymmetric hip abduction
27
treatment hip dysplasia
hip held in flexion and abduction. Use a Pavlik harness in first 4-6 months. After 6 months, surgery and splinting
28
The most common cause of limping and pain in the hip in children in US
transient synovitis of the hip
29
acute inflammatory reaction usually in 3-8 year olds, often follows URI. Not associated with elevated ESR, WBC, or temp elevation
transient synovitis of the hip
30
treat transient synovitis of the hip
rest, anti-inflammatory, traction and slight flexion of hip
31
PE shows limitation of internal hip rotation and pain in the groin and hip area
transient synovitis of the hip
32
complication of transient synovitis of the hip
AVN, Perthe's
33
most common organism septic arthritis
staph aureus
34
Fever, irritability, refusal to walk, hip held in flexion and external rotation
Labs show elevated ESR, WBC
septic arthritis of the hip
35
treat septic arthritis of the hip
Aspirate (if pus- send to surgery for irrigation)
| May use abx alone in first 24 hours (send to surgery if no improvement)
36
Idiopathic Avascular Necrosis of Proximal Femoral Head
Legg-Calve-Perthes
37
6 year old boy comes in pain and limp, no fever, worse with activity. Decreases internal rotation and abduction
Perthe's
38
treat Perthe's
protect joint, dont splint. Course is for replacement of epiphysis as living bone replaces necrotic bone (creeping substitution)
39
ortho emergency. Displacement of proximal femoral epiphysis due to disruption of growth plate. Male adolescents
Slipped capital femoral epiphysis
40
Vague symptoms over time of pain and limp. Pain in hip, MEDIAL KNEE, and anterior thigh
SCFE
41
X ray: Earliest sign is widening of the physis without slippage. Femoral head is displaced medially and inferiorly with slip
SCFE
42
treat SCFE
Immediate non weight bearing
Orthopedic referral
surgical realignment (variable)
43
Complications of SCFE
AVN, high incidence of premature degenerative arthritis
44
Lateral curvature of spine, with internal rotation of involved vertebrae
scoliosis
45
common cause of scoliosis
idiopathic
46
when does scoliosis usually occur
older than 11... if younger, increased chance of congenital
47
pain in spine with scoliosis
look for underlying disorder like a tumor
48
vertebral anomalies that can result in congenital scoliosis
wedge vertebra, hemivertebra, congenital bar, block vertebra
49
diseases associated with scoliosis
NF, Marfans, CP, MD, poliomyelitis
50
treat scoliosis
(if less than 20 degrees- NONE)
20-50 degrees bracing
> 40 degrees may need spinal surgery
> 60 degrees correlated to poor pulmonary function as adult
51
wryneck- injury to SCM during delivery
torticollis
52
Head twisted away from affected side
Palpable mass in muscle = fibrous (not tumor)
Treatment with passive stretching, massage
torticollis
53
Child younger than 5 yrs of age, arm is held in flexion with hand pronated (“My arm” position)
There may be tenderness over the radial head
pulled (nursemailds) elbow
| radial head subluxation
54
FRACTURE: Buckling of cortex
Usually distal ulna or radius
Usually at metaphyseal / diaphyseal junction
Immobilize x 3 weeks
torus fracture
55
FRACTURE: Disruption of cortex on one side of bone
Angulated but not displaced
External reduction and cast
greenstick fracture
56
both sides of bony cortex. Most common frx
complete fracture
57
oblique fracture of the distal tibia without a fibula fracture, limping and pain with weight bearing, minimal swelling and pain (usually in 1-3 year olds)
toddler's fracture
58
Growth disturbance/arrest potentially related to location of fracture within physeal zones, joints, disruption of vascularity
epiphyseal fractures
59
transverse fracture through the physis, growth disturbance is unusual
SH Type I
60
fracture through a portion of the physis and metaphysis, most common type of Salter-Harris fracture (75%)
SH Type II
61
fracture through a portion of the physis and epiphysis into the joint that may result in complication because of intra-articular component and because of disruption of the growing or hypertrophic zone of the physis
SH Type III
62
fracture through the metaphysis, physis, and epiphysis with a high risk of complication
SH Type IV
63
a crush injury to the physis with a poor functional prognosis
SH Type V
64
treat SH type I and II
closed reduction, immobilization Exceptions = proximal femur, distal femur
65
treat SH type III and IV
intraarticular and physeal step-off needs anatomic reduction, ORIF if necessary
66
most common bone tumor in children
pain free mass
Not malignant
can interfere with function
osteochondroma
67
pain in a long bone, pathologic fracture common
Malignant
Femur, tibia, humerus and other long bones
osteosarcoma
68
pain and tenderness
| Tumor that destroys cortex. Fever, leukocytosis. Present like osteomyelitis
Ewing sarcoma
69
CT disorder- affects the long fingers and toes, hypermobility of joints, subluxation of ocular lenses (cataracts, colobomas strabismus) tendency for scoliosis, perctus carinatum (or excavatum), Thoracic aortic aneurysms due to weakness of media of the vessels
Marfan
70
Rare genetic connective tissue disease
| Multiple and recurrent fractures (in utero if severe), wormian bones in skull, blue sclera, thin skin
osteogenesis imperfecta
70
Rare genetic connective tissue disease
| Multiple and recurrent fractures (in utero if severe), wormian bones in skull, blue sclera, thin skin
osteogenesis imperfecta
71
treat ostogenesis imperfecta
bisphosphonates
71
treat ostogenesis imperfecta
bisphosphonates
72
Most common form of short limbed dwarfism.
| Upper arms and thighs proportionally shorter than forearms and legs. AD
achondroplasia
72
Most common form of short limbed dwarfism.
| Upper arms and thighs proportionally shorter than forearms and legs. AD
achondroplasia
73
Pain, Fever, conjunctivitis/uveitis , rash , malaise, anorexia, weight loss, fatigue
Patterns (ie fever; erratic vs reg spikes once/twice per day) or patterns of joint involvement
Usually chronic conditions
Rheumatic disorders
73
Pain, Fever, conjunctivitis/uveitis , rash , malaise, anorexia, weight loss, fatigue
Patterns (ie fever; erratic vs reg spikes once/twice per day) or patterns of joint involvement
Usually chronic conditions
Rheumatic disorders
74
inflammation of the synovium
arthritis
74
inflammation of the serosal lining
serositis
74
inflammation of the muscle
myositis
74
inflammation of the blood vessels
vasculitis
74
Most common chronic Rheumatic Disease of children. Involves chronic synovitis
Juvenile idiopathic (rheumatoid) arthritis
74
types of JRA
Pauciarticular- <5 joints, especially associated with uveitis (most common form )
Polyarticular- 5 or more joints
Systemic: fever, rash, hepatosplenomegaly, lymphadenopathy, anemia
Spondyloarthropathy (spine and lower extremity)
74
worry about this in JRA. Especially in young girls with a positive ANA
uveitis
74
```
JRA:
Chronic , 4 or less joints
Medium to Large weight bearing joints (KNEE)
Asymmetric
Synovitis milder, less pain
```
pauciarticular
74
this type of JRA has a high association with uveitis
pauciarticular
74
```
JRA:
Chronic pain with swelling of many joints, 5 or more
Symmetric pattern
Large and small joints (hands and feet)
Rheumatoid nodules
```
polyarticular JRA
74
JRA:
“Acute febrile form” – classic feature 39-40C once or twice per day.
Salmon-pink macular rash
Arthritis any # of joints, large and small
HSM
Polyserositis ; pleuritis, pericarditis
systemic JRA
89
rash is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged, and scarring often occurs in older lesions
lupus
90
lupus antibodies
ANA (antinuclear)
91
Multisystem inflammatory disease of joints, serous linings, skin, kidneys, and CNS
SLE
92
most common presenting feature of SLE
joints: myalgia, myositis, muscle weakness, muscle fatigue
93
leading cause of death from SLE
renal failure (nephritis, nephrosis, uremia)
94
treatment lupus
steroids are the mainstay
95
Rare inflammatory disease of muscles and skin
Peak incidence 4-10 yr
Girls>boys
dermatomyositis
96
kid comes in with rash on face and hands, scaley red plaques on knuckles and extensor surfaces. Also complains of muscle pain, proximal symmetrical weakness (pelvic and shoulder girdle muscles)
dermatomyositis
97
labs for dermatomyositis
abnormal muscle enzymes (CK, LDH, ALT, AST)
| WBC, ESR, CRP often normal
98
treat dermatomyositis
methotrexate
methylprednisone
prednisone
99
most common vasculitis in childhood
HSP
100
post strep polyarthritis, generally migratory
Rheumatic fever
