Paediatrics Flashcards by Kieran Ruthven

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

Within 2

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The growth plate of the bone is AKA the

Physis

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Bones grow how (2)

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

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

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

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Factors affecting bone growth and development (5)

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

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What’s the 6-9 month motor milestone?

Sits alone, crawls

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8-12 month motor milestone?

First steps

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14-17 month motor milestone?

Walking

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24 month motor milestone?

Jumping

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3 years motor milestone?

Managing stairs alone

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By which month should primitive reflexes have disappeared?

6 months

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By which age should head control have been achieved?

2 months

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Genu varum is AKA

Bow legs

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Genu valgum is AKA

Knock knees

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Valgus is always abnormal. True/false?

False (around 6 degrees is usually normal)

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Genu varum is always abnormal. True/false?

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

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Describe Blount’s Disease

Growth arrest of medial tibial physis of unknown cause

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

Beak-like protrusion

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Treatment option for Blount’s

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

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Intoeing is when the child…

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

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Describe femoral neck anteversion

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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What’s the normal femoral neck rotation at maturity?

10-15 degrees

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Treatment option for metatarsus abductus

Serial casting

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

Hips

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

Hip adduction with an anterior force to promote dislocation

Ortolani test is performed with which movements?

Flexion, adduction and anterior force onto the hip

Ortolani exacerbates/ reduces dislocation?

Reduces

Extra skin folds suggest a pathology with which site?

Hip

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

False - hip is mostly cartilage and difficult to visualise

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

Ultrasound

Early treatment of DDH is with which type of harness?

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

A Pavlik harness maintains which movements of the hips?

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

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

>2 years

Later diagnosis of DDH requires which treatment?

Open reduction and hip spiker

Which % of DDH cases will have NO risk factors?

60%

DDH affects girls or boys more?

Girls

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

False - left hip more commonly involved

Risk factors for DDH include (2)

1) 1st degree relative with DDH | 2) Breach position birth

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

True

DDH presenting symptoms (4)

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

Perthes tends to affect which type of child?

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

The underlying pathology in Perthes is...

Idiopathic AVN of the head of femur

What are some signs of SUFE? (2)

1) Shortened limb | 2) External rotation

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

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

What is needed to make a diagnosis of SUFE?

Lateral & AP X-rays

SUFE is late diagnosed in which % of cases?

50%

Transient synovitis tends to present at which age range

2-5 years

SUFE tends to present at which age range?

11-15 years

Short stature is commonly pathologic, T/F?

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

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

Parents (for height)

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

Varum

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

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

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

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

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

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

Genu valgum/varum is normal at 3.5 years old?

Valgum

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

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

Which conditions are associated with intoeing? (3)

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

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

W-position

Femoral neck anteversion is always pathologic, T/F?

False - usually of no problems (except patellofemoral problems)

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

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

Internal tibial torsion is usually seen at which age?

Toddlers (1-3)

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

False - vast majority resolves by 6 years old.

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

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

Metatarsus adductus always needs correction, T/F?

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

Intoeing is generally treated surgically, T/F?

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

T/F: Children are born with flat feet.

True (arch develops with tibialis posterior)

How many adults have flat-feet?

1:5

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

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).

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

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

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

Stretching

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

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

What knee alignment is present at 18 months?

Normally straight (minimal valgus)

What knee alignment is present at 3.5 years?

Valgus

What knee alignment is present at 7 months?

Straight

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

Valgus

Symptoms of a transient synovitis (4)

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

T/F: Perthes tends to be bilateral.

False - only bilateral in 10% of cases

Is Perthes painful?

Yes

What are options for treating Perthes? (4)

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

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

7 years old

Complication of Perthes

OA (early onset, 18 years old)

SUFE Is more common in women/men?

Men

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

10% (most are chronic and stable)

Surgical option for stabilising the physis in SUFE?

Screws into femur

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

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.

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

SUFE

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

True