Ortho & Rheum Flashcards
Developmental Dysplasia of the Hip
RFs: family hx, female, firstborn, breech, oligo, multiple gestation
PEx: Barlow, Ortolani
Imaging
- -before 4m?
- -after 4m?
Tx
–Pavlik harness, then surgery
Developmental Dysplasia of the Hip
Imaging
- -before 4m: ultrasound
- -after 4m: frog lateral xray
hip and/or knee pain; insidious onset; greater than 1m duration; limping; decreased internal rotation and abduction at hip; xray shows deformity of femoral head
–boys, age 4-10y
Dx?
Adolescent with insidious onset of dull hip or (referred) knee pain; exacerbated by trauma; obese; underlying endocrine disorder
–complications: osteonecrosis, chrondrolysis
Dx?
Legg-Calve-Perthes Disease
–idiopathic avascular necrosis of the capital femoral epiphysis
Slipped Capital Femoral Epiphysis
- -adolescent hip disorder (obese)
- -displacement of capital femoral epiphysis from femoral neck
- -insidious onset of dull hip or knee pain; limp
- -tx: urgent surgical fixation
Slowly developing back pain in pre-adolescent; neurologic dysfunction (eg, urinary incontinence, decreased sensation); palpable “step off” in lumbrosacral area
Dx?
Spondylolisthesis
–forward slip of vertebrae (usually L5 over S1)
- -fever, not improved with ibuprofen or acetaminophen
- -non-exudative conjunctivitis
- -strawberry tongue
- -dry, cracked lips
- -cervical lymphadenitis
- -erythema and swelling of hands and feet
- -rash
- -cardiac: myocarditis, pericarditis
- -high ESR, platelets
Dx?
Most important test?
Tx? (2)
Kawasaki Disease
- -2D echochardiogram
- -IVIG, high-dose aspirin
Trendelenburg Sign
- -when standing on one foot, the contralateral hip tilts downwards
- -lesion is contralateral to the side of the hip that drops
Injury to what three nerve roots?
That comprise what nerve?
That innervate what two muscles?
Trendelenburg Sign
- -injury to L4-S1
- -superior gluteal nerve
- -gluteus medius and minimus
- -often due to posterior hip dislocation
Sickle Cell Dz –> vaso-occlusion –> aseptic necrosis of the femoral head
Femoral head: 2 blood supplies
- -ascending arteries
- -foveal artery (patent at birth, then closes)
In what structure do these blood supplies run?
Sickle Cell –> vaso-occlusion –> aseptic necrosis of the femoral head
Femoral head blood supplies
- -ascending arteries
- -foveal artery (patent at birth, then closes)
- -both lie within ligamentum teres
Osteogenesis Imperfecta
–recurrent fractures, blue sclera, hearing loss, opalescent teeth
Mode of inheritance?
Defect in what type of collagen?
Osteogenesis Imperfecta
- -AD; defect in type 1 collagen
- -recurrent fractures
- -blue sclera
- -hearing loss
- -opalescent teeth
Vitamin D deficiency – Rickets
–inadequate intake, inadequate synthesis
Labs
- -Ca2+ is normal/low
- -Phosphorous is normal/low
- -PTH, Alk Phos?
Vitamin D deficiency rickets
- -poor intake, inadequate synthesis
- -fractures
- -costochondral joint hypertrophy (rachitic rosary)
- -genu varum
- -craniotabes (ping pong ball skull)
- -enlarged skull, frontal bossing
Labs
- -Ca2+, P are normal/low
- -PTH, alk phos are elevated
Xray
–cupping and fraying of metaphyses of long bones
Henoch-Schonlein Purpura
Pathophys: IgA-mediated vasculitis of small vessels
Features
- -usually follows URI
- -pink rash that develops into palpable purpura
- -GI: colicky abdominal pain, intussusception
- -arthritis
- -hematuria
Biopsy
–mesangial IgA deposition
Tx
–supportive: hydration, NSAIDs
Complications
–renal insufficiency
Where is the rash located?
What is the tx for GI s/s?
What is a potential GI complication?
Henoch-Schonlein Purpura
Pathophys: IgA-mediated vasculitis of small vessels
Features
- -usually follows URI
- -rash: palpable purpura distributed symmetrically over lower extremities, buttocks (pink rash develops into purpura)
- -GI: colicky abdominal pain, intussusception
- -arthritis
- -glomerulonephritis
Biopsy
–IgA mesangial deposition
Tx
- -supportive: hydration, NSAIDs
- -corticosteroids for GI s/s
Complications
- -renal insufficiency
- -bowel perforation
bone or joint (eg, hip, knee) pain in context of viral URI; restricted ROM; able to bear weight; normal X-rays
Dx?
Transient Synovitis
Presentation
–7-14d post-URI; acute mild pain in hip, anterior thigh or knee with limp; restriction of motion
X-Rays
–normal
Tx: rest, ibuprofen
DDx: intoeing
- front half of foot is turned inward; heel can touch flat on surface
- one foot is smaller than other; medial rotation of foot and heel; heel can’t touch flat on surface
- entire leg rotated inwardly at hip during gait; secondary to W-sitting
- -most common cause of intoeing at age 2y and up - internal twisting of the tibia; examination with knee caps straight shows medial rotation of the feet
- -most common cause of intoeing at age less than 2y
DDx: intoeing
- Metatarsus Adductus
- -front half of foot is turned inward; heel can touch flat - Talipes Equinovarus (Clubfoot)
- -one foot is smaller than other; medial rotation of foot and heel; heel can’t touch flat on surface
* NB: tx begins immediately! - Internal Femoral Torsion (Femoral Anteversion)
- -entire leg rotated inwardly at high during gait; secondary to W-sitting
- -most common cause of intoeing at age 2y and up - Internal Tibial Torsion
- -internal twisting of tibia; examination with knee caps straight shows medial rotation of the feet
- -most common cause of intoeing at age less than 2y
knee problem in an adolescent athlete
- -swelling, tenderness of tibial tubercle
- -pain reproduced by knee extension against resistance
- -due to “traction apophysitis”
Dx?
Osgood-Schlatter Disease
*during periods of rapid growth, the quadriceps tendon puts traction on the apophysis of the tibial tubercle where the patellar tendon inserts
Tx: rest, stretching, NSAIDs
Serum Sickness-Like Reaction
–fever, urticaria, and joint pain approx 1 wk after beginning abx
What type of hypersensitivity reaction?
Type III Hypersensitivity Reaction
*Immune Complex Hypersensitivity
NB:
Type 1 - Immediate Hypersensitivity
–IgE cX-linking
–asthma, bee sting, anaphylaxis
Type 2 - Cytotoxic Ab-Mediated Hypersensitivity
- -Ag-Ab complexes activate complement
- -penicillin allergy, erythroblastosis fetalis, rheumatic fever
Type 3 - Immune Complex Hypersensitivity
- -Ag-Ab complexes deposit in tissues –> inflammation
- -serum sickness, post-strep GN, vasculitis
Type 4 - T Cell-mediated Delayed Hypersensitivity
- -sensitized T cells encounter Ag and activate macrophages
- -PPD, contact dermatitis
