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Clin med sem 2 > Ortho- peds > Flashcards

Ortho- peds Flashcards

1
Q

Transient Synovitis- epidemiology

A

3-8 yr
B>G
Antalgic gait - hips abducted and externally rotated, pain with internal rotation

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2
Q

Transient Synovitis- S/S & PE

A

No fever
Not toxic
Hurt, not tender

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3
Q

Septic Arthritis- S/S & PE

A 
Acute onset fever
joint pain 
loss of function in joint
Swelling 
limited ROM
Malaise
Irritable

Joint effusion
warm/tender

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4
Q

Septic Arthritis- diagnosis

A

U/S

Xray

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5
Q

Septic Arthritis - labs & imaging

A

CBC - left sift
APR - inc
BC

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6
Q

Septic Arthritis - treatment

A

IV abx
Surgery/drainage
REFER

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7
Q

Osteomyelitis- pathophysiology

A

Infection localized in bone

Infection in metaphysis -> cellulitis of BM -> exudate under pressure forced into cortex -> lifts periosteum

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8
Q

Osteomyelitis- cause

A

Direct inoculation

Hematogenous spread - more common

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9
Q

Osteomyelitis- epidemiology

A

Uncommon

<5

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10
Q

Osteomyelitis- S/S & PE

A

Tubular bones

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11
Q

Osteomyelitis- labs & imaging

A

Gram pos - Staph

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12
Q

Osteoid Osteoma- pathophysiology

A

Bone forming non-malignant lesion

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13
Q

Osteoid Osteoma- epidemiology

A

B>G

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14
Q

Osteoid Osteoma- S/S & PE

A 
LE - proximal femur
Prog pain - worse at night 
- affected by activity?
Limp, swelling, muscular atrophy 
Leg length, bone deformities
Local point tenderness
Relief w/ NSAIDs
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15
Q

Osteoid Osteoma- diagnosis

A

Xray - small radiolucent nidus <1-1.5cm

Might need CT

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16
Q

Osteoblastoma- pathophysiology

A

Bone forming non-malignant lesion

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17
Q

Osteoblastoma - epidemiology

A

Rare

B>G

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18
Q

Osteoblastoma- S/S & PE

A

Posterior column spine
Chronic pain
- less response to NSAIDs
Expansive bony lesion

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19
Q

Osteoblastoma - diagnosis

A

CT, MRI - larger >2cm

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20
Q

Osteoblastoma - treatment

A

Curettage and bone grafting

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21
Q

Osteochondroma- pathophysiology

A

Cartilage forming non-malignant lesion

Cartilage-capped bony spur arising on external surface of bone

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22
Q

Osteochondroma - epidemiology

A

B>G

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23
Q

Osteochondroma - S/S & PE

A

Distal femur - most common

Knee, proximal humerus

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24
Q

Osteochondroma - diagnosis

A

Xray - osseus spur - cauliflower head

MRI - eval adjacent tissue swelling

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25
Q

Osteochondroma - treatment

A

Observe w/out treatment

Xray yearly

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26
Q

Osteosarcoma- pathophysiology

A

Malignant lesion

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27
Q

Osteosarcoma- epidemiology

A

Most common malignant bone lesion

13-16 yo

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28
Q

Osteosarcoma- S/S & PE

A

Metaphysis of long bones - femur
Localized pain for months
- after injury, waxes and wanes

Larger, tender soft tissue mass

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29
Q

Osteosarcoma- diagnosis

A

Xray - SUNBURST

Biopsy

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30
Q

Osteosarcoma- labs & imaging

A

Labs - nl
alk phos
LDH

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31
Q

Osteosarcoma- treatment

A

Chemo

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32
Q

Ewings Sarcoma- S/S & PE

A

Long bones - Femur, tib/fib, humerus

Local pain and swelling
- aggravated w/ exercise, worse at night

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33
Q

Ewings Sarcoma- diagnosis

A

Xray - moth eaten, Codman’s triangle, Onion peal

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34
Q

Salter-Harris Classification- pathophysiology

A

I-II - well w/ little complication
III-V - require percutaneous pinning or open reduction and internal fixation
- higher rate of growth disturbance
V - immediate growth plate closure -> shortening of extremity

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35
Q

Buckle Fractures- pathophysiology

A

Compression force

- FOOSH

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36
Q

Buckle Fractures- S/S & PE

A

Radius, Ulna

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37
Q

Buckle Fractures- treatment

A

Don’t need reduction

Heal w/ immobilization

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38
Q

Bowing Fractures- pathophysiology

A

Longitudinal force on shaft of long bone

- exceeds bone ability to recoil back to normal position

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39
Q

Bowing Fractures- S/S & PE

A

Ulna, radius

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40
Q

Bowing Fractures- treatment

A

<20deg or <4yo - self corrects

REFER -> reduction

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41
Q

Greenstick Fracture- pathophysiology

A

Bone bent w/ a fracture line that does not extend completely through width of bone

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42
Q

Greenstick Fracture- diagnosis

A

Xray -

  • Tension side - fracture
  • Plastic side - buckling
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43
Q

Greenstick Fracture- treatment

A

High risk for repeat
Immobilization
Refer

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44
Q

Supracondylar fracture- cause

A

Fall on an out-stretched arm w/ elbow extension

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45
Q

Supracondylar fracture- epidemiology

A

Most common elbow injury

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46
Q

Supracondylar fracture- S/S & PE

A 
Concern for NV compromise!!
Elbow pain
Swelling
Guarding 
NO ROM
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47
Q

Supracondylar fracture- diagnosis

A

Xray - FAT PAD SIGN

48
Q

Clavicle fracture- cause

A

Direct blow or fall

49
Q

Clavicle fracture - epidemiology

A

Common in athletes

50
Q

Clavicle fracture - treatment

A

Pre-pubescent fracture - heal conservatively

Adolescent - may need surgery

51
Q

Scaphoid Fractures- cause

52
Q

Scaphoid Fractures- S/S & PE

A

Distal radial fractures too

Pain in snuffbox

53
Q

Scaphoid Fractures - diagnosis

A

Xray - can be missed initially

54
Q

Scaphoid Fractures- treatment

A

Cast immobilization

55
Q

Boxer’s fracture- cause

A

Punching mechanism

56
Q

Boxer’s fracture- epidemiology

A

Head/neck of 5th metacarpal

Angulated

57
Q

Boxer’s fracture tx

A

Percutaneous pinning

Surgical reduction

58
Q

Non accidental Trauma (NAT)- pathophysiology

A

Injury/finding is inconsistent w/ hx

59
Q

Non accidental Trauma (NAT) - S/S & PE

A

Long bone fractures in non-ambulatory children
Rib
Sternum, scapula, spinous processes, vertebral body fractures
Multi fract in various stages of healing
Distal fract in <3yr of age
Complex skull fract in <18m

60
Q

Craniosynostosis - pathophysiology

A

Premature closure of any sutures in isolation

Posterior - 2m
Anterior lateral - 3m
Posterior lateral - 1y
Anterior - 2y

61
Q

Craniosynostosis - cause

A

Plagiocephaly
- premature closure of unilateral coronal sutures

Scaphocephaly
- premature fusion of sagittal suture

62
Q

Craniosynostosis - S/S & PE

A

Plagiocephaly
- Flattening of forehead and elevation of eyebrow on affected side

Scaphocephaly
- dec width and elongation of Ap axis of cranium

63
Q

Torticollis- pathophysiology

A

Sternocleidomastoid muscle

64
Q

Torticollis- S/S & PE

A

Head tilt toward affected side
Chin away from affected side
Flattening of head on affected side

65
Q

Torticollis- treatment

A

Stretching - 1 year

Surgery - if no improvement

66
Q

Back Pain- pathophysiology

A

NOT A COMMON COMPLAINT - suspect pathology

Common in adolescence and teens in sports

67
Q

Scoliosis- pathophysiology

A

Lateral curvature of spine

68
Q

Scoliosis- cause

A

Genetics

Progression - growing remaining and severity of curve

69
Q

Scoliosis- epidemiology

A

G>B

Idiopathic

70
Q

Scoliosis- S/S & PE

A

Rotational deformity of vertebrae
Right thoracic
Left Lumbar

asymptomatic
Posture - crooked back
Mild pain

71
Q

Scoliosis - labs & imaging

A

Measure Cobb angle

72
Q

Scoliosis- treatment

A

Adolescent >10y

  • 0-25 - observe
  • 25-40 - brace
  • > 40 surgery
73
Q

Scoliosis- prognosis

A

Small can be tolerated
Cosmetic concerns
Larg - shorten life span, arthritis and pain

74
Q

Spondylolysis- pathophysiology

A

Fracture of arch in lower lumbar spine

75
Q

Spondylolysis- diagnosis

A

Scotty dog sign

76
Q

Spondylolisthesis- pathophysiology

A

Defect/fracture - posterior arch -> anterior displacement of vertebral body

77
Q

Dysplasia of Hip- pathophysiology

A

Femoral head has abnormal relationship with acetabulum

78
Q

Dysplasia of Hip- epidemiology

A

1st born
Breech
Female
Fmhx

79
Q

Dysplasia of Hip- S/S & PE

A 
Asymmetric thigh folds
Asymmetric inguinal folds - should not be beyond aperture
Limited abduction
Positive Ortolani - out and around
Positive Barlow - push down
80
Q

Dysplasia of Hip- treatment

A

0-6m

  • Pavlik Harness
  • Hip flexed to 100-120
  • No adduction

6-12m

  • closed reduction
  • hip spica cast - 3-4m
  • abduction night splint
  • Open reduction - if unsuccessful closed
  • > 12m often surgical procedures req
81
Q

Dysplasia of Hip- prognosis

A

Complications

  • Avascular necrosis
  • Deformed femoral head
  • leg length discrepancy
  • Early onset arthritis
82
Q

Slipped Capital Femoral Epiphysis - pathophysiology

A

Femoral head displaces off the physis - ice cream falling off the cone

83
Q

Slipped Capital Femoral Epiphysis - epidemiology

A

M>F
11-16y
AA
Overweight

84
Q

Slipped Capital Femoral Epiphysis - S/S & PE

A

Sudden or gradual
Vague knee, groin, or thigh pain - w/o hx of trauma
Limp?
Pain w/ weightbearing activity
Limited ROM - Adduction, internal rotation

85
Q

Slipped Capital Femoral Epiphysis - treatment

A

Non- weight bearing for >8weeks

Percutaneous pinning in situ

86
Q

Slipped Capital Femoral Epiphysis - prognosis

A

Avascular necrosis - not treated correctly
Systemic disease
High incidence of degenerative arthritis

87
Q

Legg-Calve-Perthes Disease- pathophysiology

A

Osteonecrosis necrosis of femoral head

88
Q

Legg-Calve-Perthes Disease- cause

A

Idiopathic
Traumatic
Infectious

89
Q

Legg-Calve-Perthes Disease- S/S & PE

A

Limp
Pain
loss ROM

90
Q

Legg-Calve-Perthes Disease- treatment

A 
Avoid severe degenerative arthritis!
Crutches
PT
Bracing
Traction 
Surgery
91
Q

Osgood-Schlatter Disease- pathophysiology

A

Traction apophysitis of the insertion of the patella tendon at the tibial tubercle

92
Q

Osgood-Schlatter Disease- epidemiology

A

M>F

Bilateral

93
Q

Osgood-Schlatter Disease- S/S & PE

A

Bony growth on anterior aspect of knee - tibial tuberosity

Pain w/ running, jumping, squatting

94
Q

Osgood-Schlatter Disease- treatment

A

Resolves - growth plates close

Rest, ice, NSAIDs, PT

95
Q

Sever’s Apophysitis- pathophysiology

A

Calcaneal apophysitis

96
Q

Sever’s Apophysitis- cause

A

Traction - induced inflammation at calcaneal apophysis from achilles tendon

97
Q

Sever’s Apophysitis- S/S & PE

98
Q

Sever’s Apophysitis- treatment

A

Resolves with closure

Rest, ice, NSAIDs, heel pads

99
Q

Clubfoot- cause

A

Idiopathic

Neurogenic

100
Q

Clubfoot- epidemiology

101
Q

Clubfoot- S/S & PE

A

Ankly equinus
Heel vargus
Metarsus adductus

102
Q

Clubfoot- treatment

A

Start early
Conservative - Ponseti Method and French Method
- stretch medial/posterior elements
- Serial casting/splinting to hold correction
- Percutaneous heel-cord lengthening
- After correction - will need nighttime brace

Surgery - 10%

103
Q

Epiphysiolysis Proximal Humeral Epiphysis - pathophysiology

A

Little Leagure shoulder
Excessive torsional stress across the physis
- widening of proximal humeral physis

104
Q

Epiphysiolysis Proximal Humeral Epiphysis - cause

A

Throwing athletes

Overuse of shoulder

105
Q

Epiphysiolysis Proximal Humeral Epiphysis - S/S & PE

A

Shoulder pain

106
Q

Medial Epicondylitis- pathophysiology

A

Overuse of elbow

Traction-induced inflammation at medial epicondyle apophysis

107
Q

Medial Epicondylitis - cause

A

Lateral compression of radial head and capitellum

108
Q

Medial Epicondylitis - diagnosis

A

Xray - nl to widening of medial epicondyle

- can have avulsion fracture

109
Q

Medial Epicondylitis - treatment

A

Ice, rest, stretching,

Not treated - ulnar collateral ligament can rupture

110
Q

Nursemaid’s Elbow- pathophysiology

A

Slippage of radial head under the annular ligament

111
Q

Nursemaid’s Elbow- cause

A

Lifting, pulling, tugging

Arm at side pronated w/ slight elbow flexion

112
Q

Nursemaid’s Elbow- epidemiology

113
Q

Nursemaid’s Elbow- treatment

A

Reduce - supinate and flex

114
Q

Syndactyly- pathophysiology

A

Most common hand anomaly

Congenital webbing of fingers

115
Q

Syndactyly - epidemiology

116
Q

Syndactyly - S/S & PE

A

Normal bony architecture w/ simple skin fusion

Fusion of phalanges

117
Q

Syndactyly - treatment

A

Surgical reconstruction

Skin grafting

Clin med sem 2 (30 decks)

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