Orthopedic/Rheumatology (5%) Flashcards
____% of osteosarcomas occur in the metaphysis of long bones (i.e. femur, tibia, humerus)
90%
What is the most common cause of chronic knee pain in young, active adolescents?
Osgood schlatter dz
Slipped capital femoral epiphysis occurs most commonly in patients who are ___-___ y/o, (underweight/normal BMI/obese), (AA/Caucasian), (male/female) during their growth spurt.
If seen in children before puberty, suspect what kind of d/o?
7-16 y/o
Obese
AA
Males
hormonal/systemic d/o (i.e. hypothyroidism, hypopituitarism)
What will be seen on XR of pt’s hips with slipped capital femoral epiphysis?
Posterior and inferior slip at growth plate (seen here on L side)
What is the recommended course of management for a patient with nursemaid’s elbow?
Reduction
pressure on the radial head with supination and flexion
What condition are the phrases “hair on end” or “sun ray/burst” appearance on XR associated with?
Osteosarcoma
What is Codman’s triangle?
What two conditions is this finding associated with?
Ossification of raised periosteum
Osteosarcoma and Ewing’s Sarcoma
What are examples of malignant bone tumors?
Benign?
Malignant: Osteosarcoma, Ewing Sarcoma, Chondrosarcoma
Benign: Osteochondroma
Which of the three types of JIRA is described below?
<5 joint involvement in the 1st 6 mo, MC large joints, ± small joints
Type I associated w/ iridocyclitis (anterior uveitis), often iridocyclitis is asymptomatic (but may cause blindness if not tx)
Joint involvement is usually asymmetric
Type II associated with increased incidence of ankylosing spondylitis
Pauci-articular (oligoarticular)
What is the recommended course of tx for a pt with chondrosarcoma?
Surgical resection
Chemo in advanced cases
What type of JIRA is described below?
Arthritis >/= 5 small joints w/in the 1st 6 months (usually symmetric). Most similar to adult rheumatoid arthritis. Hip involvement is common (may present as a limp)
Increased risk of iridocyclitis, may have low-grade fever
Systemic sx not as common
Rheumatoid factor (-) dz associated w/ better prognosis than RF (+) pts
Polyarticular
What is the most common bone malignancy?
Osteosarcoma
What is the recommended course of management for a pt with osteochondroma?
Observation
Resection if becomes painful or located in pelvis
What is seen on XR of the knee in a pt with Osgood-schlatter dz?
prominence or heterotopic ossification at the tibial tuberosity
Is chondrosarcoma more common in adults or adolescents?
Adults (40-75 y/o)
What are common complaints of a pt with Ewing Sarcoma?
Bone pain, +/- palpable mass, may have joint swelling, +/- fever
Where is the most common site of metastasis in a pt with Ewing Sarcoma?
Bone
What type of fx is described below?
Incomplete fx w/ cortical disruption & periosteal tearing on the convex side of the fx (intact periosteum on the concave side) “_bowing_”
Greenstick fx
How is a dignosis of scoliosis made?
Adam’s forward bend test (most sensitive)
Cobb’s Angle measured on XR (AP/Lateral)
What condition is described beow?
Osteochondritis of the patellar tendon at the tibial tuberosity from overuse (repetitive stress) or small avulsions (due to quadriceps contraction on the patellar tendon insertion into the tibia)
Osgood schlatter dz
What is the most common age for legg calve perthes dz to present?
4-10 y/o
What is the recommended course of management for osgood schlatter dz?
RICE (rest ice compression elevation), NSAIDs, and quadriceps stretching
Surgery only in refractory cases, usually performed after the growth plate has closed
What are the three types of juvenile idiopathic/rheumatoid arthritis?
What % of cases fall into each?
Pauci-articular (oligoarticular): 50%
Polyarticular: 30%
Systemic/acute febrile (Still’s disease): 20%
T/F: JIRA is usually a clinical dx
TRUE
Osteochondromas are often described as ______ and grow (away from/toward) the growth plate, and involve _____ tissue
PEDUNCULATED
GROWS AWAY FROM GROWTH PLATE
medullary tissue (directly contiguous with marrow space)
Slipped Capital Femoral Epiphysis: Occurs when the epiphysis (femoral _____) slips (posterior/anterior) and (inferior/superior) at the growth plate
Femoral head
Posterior
Inferior
Legg calve perthes is 4x more common in (boys/girls) with a low incidence in what race?
boys
AA low incidence
What is legg calve perthes dz?
Idiopathic AVASCULAR OSTEONECROSIS OF THE FEMORALHEAD IN CHILDREN due to ischemia of capitalfemoral epiphysis in children
What is another name for a radial head subluxation?
Nursemaid’s elbow
What is produced by an osteosarcoma?
Immature bone
What serious condition is a pt with slipped capital femoral epiphysis at risk for developing?
What can be done to prevent this from developing?
Avascular necrosis
Open reduction and internal fixation (ORIF), also non-weight bearing on crutches
Which of the three types of JIRA is described below
Daily arthritis, DIURNAL HIGH FEVER w/in the 1st 6months
Both small & large joints
SALMON-COLORED/PINK MIGRATORY RASH: often accompanies the fever (±Koebner phenomenon)
No iridocyclitis, but associated w/ hepatosplenomegaly, hepatitis, lymphadenopathy and serositis (pericardial & pleural effusions)
Systemic/acute febrile (still’s dz)
Scoliosis is associated with both kyphosis and lordosis. Describe the presentation of each.
Kyphosis: humpback (upper back)
Lordosis: Sway back (lower back)
In a pt with slipped capital femoral epiphysis, one would expect to observe hip, thigh, or knee pain with _____, and (internal/external) rotation of the affected leg
Limp
External
What is the recommended course of managment for a pt with osteosarcoma?
Limb sparing resection (if not neovascular)
Radical amputation (if neovascular)
Chemotherapy as adjuvant tx
What is usually the cause of death in a pt with osteosarcoma?
Lung metastasis
Is there usually swelling associated with nursemaids elbow?
No
What is the recommended course of management for a pt with legg calve perthes dz?
OBSERVATION
self-limiting with revascularization w/in 2 years
initial tx in most cases is non weight bearing with movement restriction and orthopedic f/u
PT
Pelvic osteotomy may be indicated in some children > 8 y/o
What are options for tx in a pt with Ewing Sarcoma?
Chemo, surgery, and radiation
What is the most common benign bone tumor?
Osteochondroma
Scoliosis is most commonly noted started in what age range?
More common in boys or girls?
8-10 y/o
Girls (+ FHx)
In what age group is osteochondroma most commonly seen in?
More common in males or females?
What may their presence precede?
10-20 y/o, begins in childhood and grows until skeletal maturity
Males
chondrosarcoma
What is the recommended course of management for a pt with JIRA?
NSAIDs &/or corticosteroids
Methotrexate or Leflunomide
Frequent eye exams to detect iridocyclitis
What will be seen on XR of a pt with Ewing Sarcoma?
lytic lesion, layered periosteal reaction “ONION SKIN”* appearance on radiographs
± Codman’s triangle
What is chondrosarcoma a cancer of?
The cartilage
What is the mechanism of injury for a nursemaid’s elbow?
In what age group is this injury most commonly seen?
Lifting, swinging, pulling a child while the forearm in pronated and extended, which leads to the radial head wedging into the stretched annular ligament
MC 2-5 y/o
How does a child with nursemaid’s elbow typically present?
With arm slightly flexed and with refusal to use the arm
Where is the most common anatomical site of an osteochondroma that will eventually undergo malignant transformation?
Pelvis
There is restricted ROM with legg calve perthes dz, what abilities are lost?
LOSS OF ABDUCTION & INTERNAL ROTATION
At what Cobbs angle is bracing recommended for tx?
Surgical intervention?
20-40 degrees = bracing
>40 degrees = surgery
What will be seen on XR of a pt with chondrosarcoma?
Punctate or ring and arc appearance pattern of calcification
Mineralized chondroid matrix
What dz is characterized by the following description?
PAINLESS LIMPING for weeks (worsen w/ continued activity especially at the end of the day)
Legg calve perthes dz
In what age group is osteosarcoma most commonly dx’d in?
Adolescents (80% occur <20 y/o)
What will be seen on hip XR in a pt with legg calve perhtes dz (early vs advanced dz)?
early: increased density of the femoral head, widening of the cartilage space
advanced: deformity, CRESCENT SIGN (microfractures w/ collapse of the bone)
Juvenile idiopathic rheumatoid arthritis is an autoimmune mono or polyarthritis in children < ____ y/o, that often resolves by ______
<16 y/o
puberty
What are the most important risk factors for the development of congenital hip dysplasia?
Female sex
Breech positioning at ≥34 weeks gestation (whether or not external cephalic version is successful)
FHx
Tight lower extremity swaddling
What type of fx is described below?
Incomplete fx w/ “wrinkling or bump” of the metaphyseal-diaphyseal junction where the dense bone meets the more porous bone due to axial loading
Torus/buckle fx
Osgood schlatter dz is most common in (males/females) of (what age range) during growth spurts
males
10-15 y/o athletes
What condition is described below?
Giant cell tumor MC in males 5-25 y/o
Ewing Sarcoma
Scoliosis is defined as a lateral curvature of the spine greater than how many degrees?
> 10 degrees
What is the most common complaint of a pt with osteosarcoma?
Bone pain/joint swelling
Palpable soft tissue mass
How to test for congenital hip dysplasia?
Barlow and Ortolani maneuvers
