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MSK > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Statistically, normal is defined as how many SDs from the mean?

A

Within 2

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2
Q

The growth plate of the bone is AKA the

A

Physis

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3
Q

Bones grow how (2)

A

1) Longituindally from the growth plate by enchondral ossification
2) By appositional growth from the periosteum (making bones thicker)

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4
Q

All physis contribute roughly the same growth to their respective bone. True/false?

A

False (the inferior femur physis contributes 70%, while the anterior contributes 12%)

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5
Q

Factors affecting bone growth and development (5)

A

1) Diet / nutritional status
2) Sunshine (vitamins D and A)
3) Injury
4) Illness
5) Hormones (e.g. GH lack)

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6
Q

What’s the 6-9 month motor milestone?

A

Sits alone, crawls

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7
Q

8-12 month motor milestone?

A

First steps

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8
Q

14-17 month motor milestone?

A

Walking

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9
Q

24 month motor milestone?

A

Jumping

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10
Q

3 years motor milestone?

A

Managing stairs alone

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11
Q

By which month should primitive reflexes have disappeared?

A

6 months

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12
Q

By which age should head control have been achieved?

A

2 months

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13
Q

Genu varum is AKA

A

Bow legs

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14
Q

Genu valgum is AKA

A

Knock knees

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15
Q

Valgus is always abnormal. True/false?

A

False (around 6 degrees is usually normal)

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16
Q

Genu varum is always abnormal. True/false?

A

False - it is normal aged <2 years old. Only abnormal if persisting or significant (>2SDs) or painful

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17
Q

Describe Blount’s Disease

A

Growth arrest of medial tibial physis of unknown cause

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18
Q

What’s the classical sign of Blount’s Disease on X-ray

A

Beak-like protrusion

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19
Q

Treatment option for Blount’s

A

Medical arrest of growth of tibial physis on other side to allow the lagging side to “catch up”

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20
Q

Intoeing is when the child…

A

Walks on the toes pointing in (pigeon toed). May be related to femoral neck anteversion.

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21
Q

Describe femoral neck anteversion

A

When the femoral neck has an increased internal rotation relative to the hip - patients will tend to sit in a “W position” (Britney Spears)

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22
Q

What’s the normal femoral neck rotation at maturity?

A

10-15 degrees

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23
Q

Treatment option for metatarsus abductus

A

Serial casting

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24
Q

In anterior knee pain, it is important to check which other site?

A

Hips

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25
Q

Barlow tests if the hip can be dislocated easily. Which anatomical movement is undertaken in this test?

A

Hip adduction with an anterior force to promote dislocation

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26
Q

Ortolani test is performed with which movements?

A

Flexion, adduction and anterior force onto the hip

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27
Q

Ortolani exacerbates/ reduces dislocation?

A

Reduces

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28
Q

Extra skin folds suggest a pathology with which site?

A

Hip

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29
Q

X-ray is useful in screening for abnormalities in young children. True/false?

A

False - hip is mostly cartilage and difficult to visualise

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30
Q

What is the preferred imaging modality for screening of joints in young?

A

Ultrasound

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31
Q

Early treatment of DDH is with which type of harness?

A

Pavlik -> gives around 90-95% normal hip function

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32
Q

A Pavlik harness maintains which movements of the hips?

A

Flexion and abduction to force the femur to grow back into the acetabulum

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33
Q

Later diagnosis in DDH is classed at diagnosis at which age?

A

> 2 years

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34
Q

Later diagnosis of DDH requires which treatment?

A

Open reduction and hip spiker

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35
Q

Which % of DDH cases will have NO risk factors?

A

60%

36
Q

DDH affects girls or boys more?

A

Girls

37
Q

DDH tends to affect both hips equally. True/false?

A

False - left hip more commonly involved

38
Q

Risk factors for DDH include (2)

A

1) 1st degree relative with DDH

2) Breach position birth

39
Q

Late presenting (>3 years) DDH generally never have a normal hip. True or false?

A

True

40
Q

DDH presenting symptoms (4)

A

1) Painless limp
2) Short limb
3) Asymmetric creases
4) Trendelenburg gait

41
Q

Perthes tends to affect which type of child?

A

“Dennis the Mennis” style boys, usually 4-8 years old.

42
Q

The underlying pathology in Perthes is…

A

Idiopathic AVN of the head of femur

43
Q

What are some signs of SUFE? (2)

A

1) Shortened limb

2) External rotation

44
Q

Trethowan’s Sign is what & useful in which condition?

A

Drawing a line up the neck of the femur it should hit the femoral head - will be used in diagnosing a SUFE

45
Q

What is needed to make a diagnosis of SUFE?

A

Lateral & AP X-rays

46
Q

SUFE is late diagnosed in which % of cases?

A

50%

47
Q

Transient synovitis tends to present at which age range

A

2-5 years

48
Q

SUFE tends to present at which age range?

A

11-15 years

49
Q

Short stature is commonly pathologic, T/F?

A

False - only 1 in 5 children less than 2SD below mean for age will have an underlying pathology

50
Q

Which people should you look at when assessing a child’s short stature?

A

Parents (for height)

51
Q

Genu varum/valgus is normal in <2 year olds?

A

Varum

52
Q

What are some features of genu varum that would make you want to refer an infant? (4)

A

Unilateral
Severe (>2SD from mean)
Short stature (>2SD)
Painful

53
Q

What are some pathologic causes for genu varum? (5)

A

1) Skeletal dysplasia
2) Rickets
3) Tumour
4) Blount’s Disease
5) Trauma

54
Q

What are some pathologic causes for genu valgum? (4)

A

1) Tumours
2) Rickets
3) Neurofibromatosis
4) Idiopathic

55
Q

Genu valgum/varum is normal at 3.5 years old?

A

Valgum

56
Q

What are some features for referral of genu valgum in a 3.5 year old?

A

Painful, asymmetric, severe >2SD, >8cm intermalleolar distance by 11-years old.

57
Q

Which conditions are associated with intoeing? (3)

A

1) Femoral Neck Anteversion
2) Internal Tibial Torsion
3) Metatarsus Adductus

58
Q

Patients with femoral neck anteversion tend to sit in which position?

A

W-position

59
Q

Femoral neck anteversion is always pathologic, T/F?

A

False - usually of no problems (except patellofemoral problems)

60
Q

Femoral neck anteversion needs to be corrected surgically, T/F?

A

False - little role for surgery (only if severely deformed)

61
Q

Internal tibial torsion is usually seen at which age?

A

Toddlers (1-3)

62
Q

Internal tibial torsion will not self-correct, T/F?

A

False - vast majority resolves by 6 years old.

63
Q

Is orthotics & bracing useful in treatment of internal tibial torsion?

A

No, these are ineffective. Surgery is very rarely used.

64
Q

Metatarsus adductus always needs correction, T/F?

A

False - usually self-resolving. Serial casting may be needed (6-12 months)

65
Q

Intoeing is generally treated surgically, T/F?

A

False - usually just needs definition of cause (e.g. femoral neck), reassurance and charting with review.

66
Q

T/F: Children are born with flat feet.

A

True (arch develops with tibialis posterior)

67
Q

How many adults have flat-feet?

A

1:5

68
Q

What test is done on flat-feet to check cause?

A

Flexion - if they are fixed it suggests a bony deformity (e.g. tarsal coalition), if they are flexible it suggests all ligaments are present but there may be other errors (e.g. ligamentous laxity or tight gastrosoleus).

69
Q

Orthotics are commonly used to treat flat feet, T/F?

A

False - only used if pain is present (as there is no consequences of having flat feet)

70
Q

A tight gastrocsoleus complex causing flat feet can be treated how?

A

Stretching

71
Q

Curly toes are treated with splintage/ taping. T/F?

A

False - ineffective. Rarely can be treated with flexor tenotomy.

72
Q

What knee alignment is present at 18 months?

A

Normally straight (minimal valgus)

73
Q

What knee alignment is present at 3.5 years?

A

Valgus

74
Q

What knee alignment is present at 7 months?

A

Straight

75
Q

A 2year,, 6 month old child will normally have which knee alignment?

A

Valgus

76
Q

Symptoms of a transient synovitis (4)

A

1) Insidious
2) Low-grade pyrexia (if any)
3) Reduced ROM/ slight pain only.
4) Normal blood tests. US shows an effusion.

77
Q

T/F: Perthes tends to be bilateral.

A

False - only bilateral in 10% of cases

78
Q

Is Perthes painful?

A

Yes

79
Q

What are options for treating Perthes? (4)

A

1) Maintain hip abduction (compliance very poor)
2) Rest and activity modification (vast majority)
3) Bracing (some cases)
4) Surgery (rare)

80
Q

Perthes has a much better prognosis if presenting/ diagnosed before which age?

A

7 years old

81
Q

Complication of Perthes

A

OA (early onset, 18 years old)

82
Q

SUFE Is more common in women/men?

A

Men

83
Q

What % of SUFE cases will be acute (unstable, sudden onset, rapidly progressive)?

A

10% (most are chronic and stable)

84
Q

Surgical option for stabilising the physis in SUFE?

A

Screws into femur

85
Q

What’s controversial about SUFE surgery in ONE hip joint?

A

25% of people will have a contralateral slip in the next 1-2 years. Some surgeons advocate to do both at same time even if unilateral.

86
Q

Adolescent unable to weight-bear is what until proven otherwise?

A

SUFE

87
Q

Acute unstable SUFE is a surgical emergency, T/F?

A

True

MSK (21 decks)

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