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Pediatrics > Ortho and Rheumatic Diseases > Flashcards

Ortho and Rheumatic Diseases Flashcards

1
Q

toeing in

A

Metatarsus Varus
Tibial Torsion
Femoral Anteversion

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2
Q

out toeing

A

Less common, lateral rotation of hips

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3
Q

common congenital foot deformity, inward deviation of the forefoot

A

metatarsus varus/adductus

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4
Q

check for this when you have metatarsus varus/adductus

A

hip dysplasia

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5
Q

most common cause of toeing in <2 years

A

tibial torsion

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6
Q

internal rotation of leg between knee and ankle

A

tibial torsion

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7
Q

toeing in beyond 2-3 years old, mostly girls

A

femoral anteversion

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8
Q

“w” sitters, internal rotation of the hip is greater than external rotation

A

femoral anteversion

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9
Q

club foot; hypoplastic tarsal bones (esp talus) and hypoplastic muscles

A

talipes equinovarus

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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

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11
Q

3 categories of talipes equinovarus

A

congenital (MOST COMMON), teratogenic, positional

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12
Q

treat talipes equinovarus

A

manipulation of foot, stretching tissues, splinting . Some require surgical tendon release

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13
Q

bowleg

A

genu varum

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14
Q

genu valgum

A

knock kneed

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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

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16
Q

unilateral bowleg resulting in a progressive deformity. males, overweight, AA

A

Blount’s

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17
Q

Anterior knee pain that is worse with activity, stairs, prolonged sitting. F more than M, athletes, strength imbalance

A

patellofemoral pain syndrome

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18
Q

treat patellofemoral pain syndrome

A

complex, RICE, PT eval

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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

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20
Q

knee pain during and after activity. Fragmentation and microfractures of the tibial tuberosity can occur

A

osgood schlatter disease

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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

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22
Q

treat osgood schlatter

A

Rest + activity . NSAIDs, ice, stretching quads and hamstrings

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23
Q

Abnormal relationship between acetabulum and proximal femur

A

hip dysplasia

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24
Q

this is dislocateable or subluxable. becomes worse with growth is not corrected

A

hip dysplasia (congenital)

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25
Q

common in first born females who were breech presentation

A

developmental hip dysplasia

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26
Q

PE hip dysplasia

A

Ortolani and Barlow
Asymmetric Skin Creases +/-
Galeazzi
check for asymmetric hip abduction

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27
Q

treatment hip dysplasia

A

hip held in flexion and abduction. Use a Pavlik harness in first 4-6 months. After 6 months, surgery and splinting

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28
Q

The most common cause of limping and pain in the hip in children in US

A

transient synovitis of the hip

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29
Q

acute inflammatory reaction usually in 3-8 year olds, often follows URI. Not associated with elevated ESR, WBC, or temp elevation

A

transient synovitis of the hip

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30
Q

treat transient synovitis of the hip

A

rest, anti-inflammatory, traction and slight flexion of hip

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31
Q

PE shows limitation of internal hip rotation and pain in the groin and hip area

A

transient synovitis of the hip

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32
Q

complication of transient synovitis of the hip

A

AVN, Perthe’s

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33
Q

most common organism septic arthritis

A

staph aureus

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34
Q

Fever, irritability, refusal to walk, hip held in flexion and external rotation
Labs show elevated ESR, WBC

A

septic arthritis of the hip

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35
Q

treat septic arthritis of the hip

A

Aspirate (if pus- send to surgery for irrigation)

May use abx alone in first 24 hours (send to surgery if no improvement)

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36
Q

Idiopathic Avascular Necrosis of Proximal Femoral Head

A

Legg-Calve-Perthes

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37
Q

6 year old boy comes in pain and limp, no fever, worse with activity. Decreases internal rotation and abduction

A

Perthe’s

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38
Q

treat Perthe’s

A

protect joint, dont splint. Course is for replacement of epiphysis as living bone replaces necrotic bone (creeping substitution)

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39
Q

ortho emergency. Displacement of proximal femoral epiphysis due to disruption of growth plate. Male adolescents

A

Slipped capital femoral epiphysis

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40
Q

Vague symptoms over time of pain and limp. Pain in hip, MEDIAL KNEE, and anterior thigh

A

SCFE

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41
Q

X ray: Earliest sign is widening of the physis without slippage. Femoral head is displaced medially and inferiorly with slip

42
Q

treat SCFE

A

Immediate non weight bearing
Orthopedic referral
surgical realignment (variable)

43
Q

Complications of SCFE

A

AVN, high incidence of premature degenerative arthritis

44
Q

Lateral curvature of spine, with internal rotation of involved vertebrae

45
Q

common cause of scoliosis

A

idiopathic

46
Q

when does scoliosis usually occur

A

older than 11… if younger, increased chance of congenital

47
Q

pain in spine with scoliosis

A

look for underlying disorder like a tumor

48
Q

vertebral anomalies that can result in congenital scoliosis

A

wedge vertebra, hemivertebra, congenital bar, block vertebra

49
Q

diseases associated with scoliosis

A

NF, Marfans, CP, MD, poliomyelitis

50
Q

treat scoliosis

A

(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
Q

wryneck- injury to SCM during delivery

A

torticollis

52
Q

Head twisted away from affected side
Palpable mass in muscle = fibrous (not tumor)
Treatment with passive stretching, massage

A

torticollis

53
Q

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

A

pulled (nursemailds) elbow

radial head subluxation

54
Q

FRACTURE: Buckling of cortex
Usually distal ulna or radius
Usually at metaphyseal / diaphyseal junction
Immobilize x 3 weeks

A

torus fracture

55
Q

FRACTURE: Disruption of cortex on one side of bone
Angulated but not displaced
External reduction and cast

A

greenstick fracture

56
Q

both sides of bony cortex. Most common frx

A

complete fracture

57
Q

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)

A

toddler’s fracture

58
Q

Growth disturbance/arrest potentially related to location of fracture within physeal zones, joints, disruption of vascularity

A

epiphyseal fractures

59
Q

transverse fracture through the physis, growth disturbance is unusual

60
Q

fracture through a portion of the physis and metaphysis, most common type of Salter-Harris fracture (75%)

A

SH Type II

61
Q

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

A

SH Type III

62
Q

fracture through the metaphysis, physis, and epiphysis with a high risk of complication

A

SH Type IV

63
Q

a crush injury to the physis with a poor functional prognosis

64
Q

treat SH type I and II

A

closed reduction, immobilization Exceptions = proximal femur, distal femur

65
Q

treat SH type III and IV

A

intraarticular and physeal step-off needs anatomic reduction, ORIF if necessary

66
Q

most common bone tumor in children
pain free mass
Not malignant
can interfere with function

A

osteochondroma

67
Q

pain in a long bone, pathologic fracture common
Malignant
Femur, tibia, humerus and other long bones

A

osteosarcoma

68
Q

pain and tenderness

Tumor that destroys cortex. Fever, leukocytosis. Present like osteomyelitis

A

Ewing sarcoma

69
Q

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

70
Q

Rare genetic connective tissue disease

Multiple and recurrent fractures (in utero if severe), wormian bones in skull, blue sclera, thin skin

A

osteogenesis imperfecta

70
Q

Rare genetic connective tissue disease

Multiple and recurrent fractures (in utero if severe), wormian bones in skull, blue sclera, thin skin

A

osteogenesis imperfecta

71
Q

treat ostogenesis imperfecta

A

bisphosphonates

71
Q

treat ostogenesis imperfecta

A

bisphosphonates

72
Q

Most common form of short limbed dwarfism.

Upper arms and thighs proportionally shorter than forearms and legs. AD

A

achondroplasia

72
Q

Most common form of short limbed dwarfism.

Upper arms and thighs proportionally shorter than forearms and legs. AD

A

achondroplasia

73
Q

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

A

Rheumatic disorders

73
Q

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

A

Rheumatic disorders

74
Q

inflammation of the synovium

74
Q

inflammation of the serosal lining

74
Q

inflammation of the muscle

74
Q

inflammation of the blood vessels

A

vasculitis

74
Q

Most common chronic Rheumatic Disease of children. Involves chronic synovitis

A

Juvenile idiopathic (rheumatoid) arthritis

74
Q

types of JRA

A

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
Q

worry about this in JRA. Especially in young girls with a positive ANA

74
Q 
JRA:
Chronic , 4 or less joints
Medium to Large weight bearing joints (KNEE)
Asymmetric
Synovitis milder, less pain
A

pauciarticular

74
Q

this type of JRA has a high association with uveitis

A

pauciarticular

74
Q 
JRA: 
Chronic pain with swelling of many joints, 5 or more
Symmetric  pattern
Large and small joints (hands and feet)
Rheumatoid nodules
A

polyarticular JRA

74
Q

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

A

systemic JRA

89
Q

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

90
Q

lupus antibodies

A

ANA (antinuclear)

91
Q

Multisystem inflammatory disease of joints, serous linings, skin, kidneys, and CNS

92
Q

most common presenting feature of SLE

A

joints: myalgia, myositis, muscle weakness, muscle fatigue

93
Q

leading cause of death from SLE

A

renal failure (nephritis, nephrosis, uremia)

94
Q

treatment lupus

A

steroids are the mainstay

95
Q

Rare inflammatory disease of muscles and skin
Peak incidence 4-10 yr
Girls>boys

A

dermatomyositis

96
Q

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)

A

dermatomyositis

97
Q

labs for dermatomyositis

A

abnormal muscle enzymes (CK, LDH, ALT, AST)

WBC, ESR, CRP often normal

98
Q

treat dermatomyositis

A

methotrexate
methylprednisone
prednisone

99
Q

most common vasculitis in childhood

100
Q

post strep polyarthritis, generally migratory

A

Rheumatic fever

Pediatrics (15 decks)

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