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PEDS > Ortho and Rheumatology > Flashcards

Ortho and Rheumatology Flashcards

1
Q

Three main causes of toeing IN

A

metatarsus Varus
Tibial Torsion
Femoral anteversion

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2
Q

inward deviation of the forefoot due to intrauterine positioning. Most resolve spontaneously. Can usually move the foot back to midline

A

Metatarsus Varus/ adducutus

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3
Q

if metatarsus varus/ adductus is rigid what can you do?

A

Use serial casting

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4
Q

there is a small percentage of kids with metatarsus varus/ adductus that also have what?

A

Hip dysplasia

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5
Q

Rotation of leg between knee and ankle

most common cause of in-toeing <2 years

A

Tibial torsion

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6
Q

when will the tibia rotate itself back out by

A

16 months

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7
Q

what can exacerbate tibial torsion

A

Sit with feet behind them

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8
Q

tx for tibial torsion

A

splints if needed, most get better by age 2

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9
Q

what causes toeing in beyond 2-3 years?

A

Femoral Anteversion

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10
Q

when is femoral anteversion the worst?

A

4-6 years

more common in girls

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11
Q

Tx for femoral anteversion

A

Bicycling and skating/ exercises

stop sitting in “w” position

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12
Q

what is there the foot is bent very far towards the shin? (dorsiflexion and eversion)

A

Calcaneovalgus

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13
Q

Tx for calcaneovalgus

A

Resolves sponteaneously

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14
Q

Complete disruption in the bones, not just positional. Tarsal bones espeically Talus are hypoplastic

A

Talipes equinovarus

Club feet

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15
Q

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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16
Q

3 cateogires of talipes equinovarus

A

congenital
teratologic (meningomyelocele or arthrogryposis)
positional

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17
Q

Tx for talipes equinovarus

A

Manipulation of foot
stretching, splinting
may need surgical tendon release
best to start early

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18
Q

when is bowleg (varum) normal?

A

infancy to 2-3 years

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19
Q

what is the term for knock knee’d?

A

valgum

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20
Q

when should valgum straighten out?

A

by 8 years old

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21
Q

when do you refer for genus varum?

A

bowing of only one leg

worsening bowlegs

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22
Q

abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus deformity. unilateral
typically affects overweight AA males

A

Blout’s disease

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23
Q

tx for blout’s dz before age 4

A

orthotics

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24
Q

tx for blout’s dz after 4 years

A

surgery

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25
Q

anterior knee pain that is worse with activity, stairs, and prolonged sitting. more common in female athletes

A

Patellofemoral pain sydomre (chrondomalacia patella)

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26
Q

tx for patellofemoral pain syndrome

A

RICE
PT eval
complex

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27
Q

Found in young athletes, more common males. Age of 11-15 during fast growth and open growth plates. WIll have knee pain during and activity and will limp, stop playing.

A

Osgood Schlatter Dz

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28
Q

What will you see on x-ray with osgood schlatter dz

A

fragmentation

microfractures of tibial tuberosity

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29
Q

Tx for osgood-schlatter

A

rest + activity

NSAIDs, ice, stretching quads and hamstrings

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30
Q

how long can symptoms of osgood-schlatter last for?

A

1-2 years

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31
Q

Will there be pain on rest with osgood-schlatter

A

no pain at rest

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32
Q

Abnormal relationship between acetabulum and proximal femur

A

hip dysplasia

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33
Q

first factors for developmental hip dysplasia

A

first born
female
breech
family hx

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34
Q

if an infant has positive hip dysplasia tests on PE when should they get an US?

A

4-6 weeks

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35
Q

when should an infant get an AP pelvis for suspicion of hip dysplasia on PE

A

> 4 months old

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36
Q

how may hip dysplasia present in a walking child?

A

Limb length discrepancy

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37
Q

are asymmetric skin fold diagnostic of hip dysplasia

A

No, need them with a positive barlow or ortalani or pertinent hx.

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38
Q

what is the most useful initial evaluation of DDH?

A

Ultrasound

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39
Q

tx of hip dysplasia

A

Pavlik harness in first 4-6 months in flexion and abduction

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40
Q

The most common cause of limping and pain in the hip in children in US.
Acute inflammatory reaction that often follows an URI
generally self limiting

A

Transient Synovitis of the Hip

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41
Q

will transient synovitis have elevated ESR, WBC or temp >38.3 C?

A

No

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42
Q

what age group is transient synovitis common in ? and sex

A

boys aged 3-8 years old

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43
Q

what limitations will a child with transient synovitis of the hip have?

A

Limitations in internal rotation of hip

pain in groin/ hip

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44
Q

Tx for transient synovitis of teh hip

A

Rest
anti-inflammatory
traction
slight flexion of the hip

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45
Q

what is a possible complication of transient synovitis

A

avascular necrosis

F/U with xrays

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46
Q

what will labs show with septic arthritis of hip?

A

elevated ESR, WBC

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47
Q

most common organism for septic arthritis of hip

A

Staph aureus

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48
Q

tx for septic arthritis

A

First 24-72 hours may use ABX alone

aspirate joint to determine if sx is needed

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49
Q

Idiopathic Avascular Necrosis of Proximal Femoral Head

Highest incidence 4-8 years, boys 4x girls

A

Legg-Calve-Perthes Dz

50
Q

Symptoms of Legg-Calve-Perthes Dz

A

pain and limp, no fever
worse w/ activity
decreased internal rotation and abduction

51
Q

Tx for legg-calve-perthes dz

A

protect joint, not splinting
track through x-rays
eventually bone will regrow

52
Q

what hip problem is a surgical emergency

A

Slipped Capital Femoral Epiphysis (SCFE)

53
Q

Displacement of proximal femoral epiphysis due to disruption of growth plate
Ice cream off the cone
Head displaced medially and posteriorly

A

Slipped Capital Femoral Epiphysis

54
Q

who is SCFE common in?

A

Adolescents ages 10-16 yaers old, obses males

55
Q

Symptoms of SCFE

A

vague over time

pain in hip, medial knee, anterior thigh

56
Q

tx for SCFE

A

immediate non weight bearing

ortho referral- need sx

57
Q

Lateral curvature of spine, with internal rotation of involved vertebrae. Usually idiopathic.

A

scoliosis

58
Q

do children get joint infections as much as adults

A

no

59
Q

who is scoliosis more common in?

A

Girls

60
Q

if scoliosis is painful what should you look for?

A

underlying disorder ie tumor

61
Q

Testing for scoliosis

A

have pt bend forward 90 degrees with hands held in midline.

Asymmetry of scapula, ribs, paravertebral muscles.

62
Q

When do you tx for scoliosis

A

Over 20 degrees

63
Q

when do you use bracing for scoliosis

A

20-50 degrees

64
Q

when may someone with scoliosis need spinal sx

A

> 40 degrees

65
Q

Greater than what degree for scoliosis will have poor pulmonary function as adults

A

> 60 degrees

66
Q

Injury to sternocleidomastoid (during delivery)
Head twisted away from affected side
Palpable mass in muscle = fibrous ( not tumor)

A

Torticollis

67
Q

Tx of torticollis

A

passive stretching, massage

68
Q

causes of torticollis in older children

A

muscular spasm

ENT infections

69
Q

diagnostics to do with troticollis?

A

xrays to r/o cervical deformity

70
Q

No using arm, held in flexion with hand pronated, tenderness over radial head. may have some swelling.

A

Nursemaid’s elbow

radial head subluxation

71
Q

tx for radial head subluxation

A

pressure on radial head
grasp wrist and provide slight traction
suprine wrist while flexing elbow to 90 degrees

72
Q

what should you watch out with radial head subluxation

A

supracondylar fractures

compartment syndrome

73
Q

Buckling of cortex
Usually distal ulna or radius
Usually at metaphyseal / diaphyseal junction

A

Torus fracture (stable)

74
Q

tx for torus fractures

A

immobilize x 3 weeks

75
Q

Disruption of cortex on one side of bone

Angulated but not displaced

A

Greenstick fracture

76
Q

tx for greenstick fracture

A

external reduction and cast

77
Q

Fracture of the distal tibia without a fibula fracture. Often no significant trauma, and initial radiographs don’t always show fracture.

A

Toddlers fracture

78
Q

transverse fracture through the physis, growth disturbance is unusual

A

Type I SH

79
Q

most common type of SH fracture

A

Type II

80
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

Type III SH

81
Q

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

A

Type IV SH

82
Q

fracture through a portion of the physis and metaphysis

A

Type II SH

83
Q

a crush injury to the physis with a poor functional prognosis

A

Type V SH

84
Q

Benign, pain free bony growth

most common bone tumor in children

A

osteochondroma

85
Q

pain in a long bone, pathologic fracture common

Malignant

A

osteosarcoma

86
Q

tx for osteosarcoma

A

surgical excision or amputation (after chemo)

87
Q

Tumor that destroys cortex, pain and tenderness. Will have fever, leukocytosis. inflammatory type presentation

A

Ewing Sarcoma

88
Q

Tx for ewing sarcoma

A

chemo
radiation
sx

89
Q

Connective tissue disorder

can have subluxation of ocular lenses (cataracts, colobomas strabismus)

A

Marfan syndrome

90
Q

multiple and recurrent fractures

blue sclera

A

osteogenesis imperfecta

91
Q

tx for osteogensis imperfecta

A

bisphosphonates to help w/ pain

92
Q

Upper arms and thighs proportionally shorter than forearms and legs.
Extreme lumbar lordosis

A

achondroplasia

93
Q

infection in the synovium

A

synovitis

94
Q

inflammation of the insertion of a ligament

A

enthesitis

95
Q

labs for rheumatic dz

A

CBC with diff
ANA
RF
ESR

96
Q

what type of JRA is associated w/ uveitis

A

pauciarticular

97
Q

to have polyarticular JRA what must you have

A

5 or more joints involved

98
Q

type of JRA that is in spine and lower extremity

A

spondyloarthropathy

99
Q

who are at highest risk of uveitis with JRA

A

young girls, with pauciarticular JRA and a positive antinuclear antibody are at highest

100
Q

most common form, most commonly asymmetric, in kneed, weight bearing joints can occur with uveitis

A

Pauciarticular

101
Q

symmetric pattern large and small joints. can have nodules, may start to have low grade fevers

A

polyarticular JA

102
Q

high spike in fevers a couple times a day. salmon-pink macular rash will have arthritis after systemic sx. can be any joint large or small. Will have pleurisy and pain

A

systemic form JA

103
Q

what does the lupus rash look like?

A

is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales.

104
Q

What is ANA?

A

Antinuclear antibody

test for lupus

105
Q

what sex does lupus affect more?

A

girls

106
Q

what is the most common presenting symptom of lupus?

A

joint pain

107
Q

what skin effects does lupus have?

A

butterfly rash
purpura
alopecia
Raynauds phenomenon

108
Q

What can happen in the pleural lining with lupus?

A

Pleurisy with effusion
peritonitis
pericarditis

109
Q

What happens to the GI system with lupus?

A

HSM
lymphadenopathy
acute pancreatitis (uncommon)

110
Q

what is the reading cause of death from lupus?

A

diffuse proliferative nephritis… nephrosis and uremia

111
Q

what is the treatment for lupus?

A

steroids
NSAID from pleuritic pain
hydroxycholorquin for skin, arthritis, fatigue

112
Q

what other antibody (besides ANA) is found in lupus

A

anticardiolipin antibody

lupus coagulant

113
Q

Rare inflammatory dz of muscles and skin. - face and hands, scaley red plaques on knuckles or extensor surfaces, proximal muscle pain.

A

Dermatomyositis

114
Q

what sex is affected more by dermatomyositis?

A

females

115
Q

What muscles does dermatomyositis affect?

A

pelvic and should girdle muscles

symmetric

116
Q

what labs will be abnormal with deramtomyositis?

A

abnormal muscle enzymes (CK, LDH, ALT, AST)
+/- ANA
WBC, ESR and CRP often normal

117
Q

Treatment for dermatomyositis

A

steroids

usually induces remission

118
Q

what is the most most common vasculitis in childhood?

A

henoch schonlein purpura

119
Q

what sex does HSP affect more?

A

boys

120
Q

what time of year is HSP more common?

A

winter

121
Q

where is palpable purpura most often found with HSP?

A

below waist

knees and ankles most common

122
Q

what labs will be elevated with HSP?

A

ESR
WBC
CRP

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