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EOR pediatrics > orthopedics/rheumatology > Flashcards

orthopedics/rheumatology Flashcards

1
Q

a 6-year-old who comes to the clinic with limp and left knee pain. He is notably short for his age. The pain is worse after soccer practice and exacerbated by internal rotation of his hip. At times the pain is severe enough that he refuses to walk. His temperature is 37.1°C (98.8°F), pulse is 102/min, respirations are 24/min, and blood pressure is 102/74 mm Hg. A hip radiograph is obtained and shows the left proximal femoral epiphysis to be misshapen and more horizontal compared to the unaffected right hip, the femoral head appears collapsed.

What is the likely Dx?

A

Avascular necrosis of the proximal femur

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2
Q

Avascular necrosis usually presents with?

A

insidious onset of a dull ache or throbbing localized to the groin, lateral hip or buttocks

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3
Q

Are both hips affected or just one side in Avascular necrosis of femoral head?

A

usually just one

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4
Q

If a pt presents with avascualr necrosis of femoral head, what should you suspect as causes?

A
  1. traume
  2. sickle cell
  3. steroid use
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5
Q

What is AVN known as in children?

A

in children it is Legg-Calve perthes disease

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6
Q

What is the diagnostic study of choice for AVN?

A

an MRI

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7
Q

What will a hip X-ray of AVN show?

A

they will demonstrate necrosis effusions and joint space widening with negative aspirate

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8
Q

a 4-month old female with asymmetric thigh creases during a routine checkup. Physical exam reveals that the left lower limb is shorter than the right and lay externally rotated. Hip abduction is limited to 30 degrees. Ortolani’s test is positive producing a soft “clunk” with anterior relation of the femoral head into the acetabulum. Radiographs reveal a superiorly displaced left proximal femoral metaphysis and a shallow, hypoplastic left acetabulum

What is likely Dx?

A

Congenital hip dysplasia

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9
Q

What is the issue with congenital hip dysplasia?

A

there is a problem where the socket or acetabulum and the femoral head are misaligned which results in unstable joint.

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10
Q

How will children with congenital hip dysplasia present?

A
  1. legs of unequal length asymmetric skin folds around the groin
  2. Limping or waddling gait
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11
Q

up until what age should a child get a hip exam at every well child visit?

A

up until 2 years old

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12
Q

What are the two techniques used to evaluate the childs hip for congenital hip dysplasia?

A
  1. Barlow maneuver

2. Ortolani maneuver

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13
Q

How do you perform the barlow manuver?

A

adducting the hip while holding the knee straight, and when this pops the femoral head out of the socket it raises suspicion for hip dysplasia

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14
Q

To confirm a dislocation what maneuver is done? and how?

A

the ortolani maneuver

you flex the babys hips at 90 degrees and then gently abducting it

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15
Q

Are radiographs reliable for looking at hip dysplasia when the child is 5 months old

A

yep, they are unreliable before 4 months of age

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16
Q

What is the Tx for hip dysplasia?

A

<6 months old: Pavlik harness (abduction bracing)

6-15 months old: hip spica cast

15-24 months old: open reduction followed by hip spica cast

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17
Q

a 14-year-old with complaints of morning stiffness and fatigue for the past 3 months. She complains of worsening stiffness after periods of inactivity and finds it difficult to participate in sports, especially PE. Her mom is particularly concerned because her daughter has been missing school and this has begun to affect her academic performance. They are requesting a medical note to be dismissed from physical education.

What is likely Dx?

A

juvenile idiopathic arthritis

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18
Q

What are the three types of JIA?

A
  1. Oligoarticular
  2. Polyarticular
  3. Systemic
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19
Q

Out of the 3 kinds of JIA which is most common?

A

Oligoarticular- characterized by involvement of less than 4 joints

more common in females

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20
Q

What two types of polyarticular JIA are there?

A

RF negative and RF positive

in both types the arthritis is symmetrical and frequently involves small joints

21
Q

What should be considered if a child has signs of iridocyclitis, generalized adenopathy, splenomegaly, or unexplained rash or prolonged fever

A

JIA

22
Q

What test should you do if you suspect a Pt to have JIA?

A
  1. RF
  2. ANA
  3. HLA-B27
23
Q

What is the treatment of JIA?

A

NSAIDs and intra-articular corticosteroids

possibly DMARDs

24
Q

An xray shows sun ray/burst or hair on end appearance in a kid 10-14 years old. What is the likely issue?

A

osteosarcoma

25
Q

What is the most common site of metastasis for osteosarcoma?

A

the lungs

26
Q

What are signs and symptoms of osteosarcoma?

A

Progressively worsening night pain, bone pain/joint swelling – may look similar to growing pains and can be easily missed

27
Q

You get an X-ray on an individual in the age range of 5-25 due to a trauma. The X-ray shows lytic lesions with an onion-skin appearance of the periosteum. What did you just discover?

A

Ewings sarcoma

28
Q

What are the signs and symptoms of ewings sarcoma?

A

Pain often accompanied by fever, often mimics an infection. May have palpable mass, swelling, and local tenderness

29
Q

Its been a brutal day in the office and you say fuck it we will X-ray everyone. You X-ray a patient in the age range of 10-20 and it shows a sessile, pedunculated (narrow Stalk) found on the surface of bone. What did you discover?

A

osteochondroma

30
Q

a 3-year-old boy is brought to the clinic because of left elbow pain. The father of the patient says that after picking up the boy from daycare, he noticed his son was not moving his elbow and complained of pain. Patient is holding his left elbow flexed and pronated. Physical examination shows tenderness over the lateral aspect of the left elbow joint on palpation

Whats going on?

A

nurse maids elbow

31
Q

Describe a nurse maids elbow?

A

this is a dislocation of the elbow joint caused by a sudden pull on the extended pronated forearm.

The technical term is radial head subluxation

32
Q

How do you Tx nursemaids elbow?

A

you apply pressure to the radial head, supinate and flex the forearm. Should pop back in.

33
Q

a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension

What is the likely Dx?

A

Osgood schlatters

34
Q

Painful swelling just below the knee in a 14 year old after running and also shows a lump are sugns of what?

A

osgood schlatters

35
Q

a 13-year-old girl who is being seen in your office for a routine well-child exam. She denies back pain and states she began her menses 3 months ago. On Adams forward bending asymmetry in scapular height is noted. She has 5 of 5 motor strength in all muscle groups in her lower extremities and symmetric patellar and Achilles reflexes. You obtain standing PA and lateral radiographs.

What are you looking at?

A

Scoliosis

36
Q

What is the criteria for scoliosis?

A

a lateral spine curvature with Cobb angle of 10 degrees or more

37
Q

What test can you do to check for scoliosis?

A

Adams test

38
Q

What other body part can scoliosis affect?

A

The lungs, should do PFTs

39
Q

Treatment of scoliosis with 10-15 degrees?

A

6-12 month follow-up with clinical evaluation and possible x-ray

40
Q

Tx for scoliosis with curve of 15-20 degrees?

A

need serial AP radiographic follow-up every 3-4 months for larger curves and every 6-8 months for small curves or for patients near the end of growth

41
Q

Tx for scoliosis with curve of 20 degrees or greater?

A

need a referral to an orthopaedist for continuous monitoring and management

42
Q

At what degree of curvature for scoliosis is surgery indicated?

A

greater than 40 degrees

43
Q

a 7-16 y/o obese male during a growth spurt with a limp and knee pain with external rotation of affected the leg

What is likely Dx?

A

Slipped capital femoral epiphysis

44
Q

How will a pt with Slipped capital femoral epiphysis present?

A

likely obese with a antalgic or waddling gait with an externally rotated leg on the affected side

45
Q

You are evaluating a pt and while supine their hip externally rotates and abducts with passive hip flexion. What is the name of this sign?

A

Drehmann sign

46
Q

How do you Dx Slipped capital femoral epiphysis ?

A

X-ray for all patients

Get AP and frog-leg lateral or right and left hip

47
Q

You xray someones hip and see double density from the superimposition of epiphysis and metaphysis. Whats this called?

A

Steel sign

48
Q

If Xray for Slipped capital femoral epiphysis come negative but you still have a suspicion what is the next test?

A

an MRI

49
Q

Tx for Slipped capital femoral epiphysis ?

A

surgical fixation with screws for all Pts

EOR pediatrics (9 decks)

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