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clinic sp5 2017 > paeds > Flashcards

paeds Flashcards

1
Q

lift head at

A

3-4 months

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2
Q

sitting without support

A

4-9 months

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3
Q

standing with assistance

A

5-11 months

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4
Q

crawling

A

5-13 months

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5
Q

standing alone

A

7-16 months

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6
Q

walking alone

A

9-18 months

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7
Q

walking with assistance

A

6-14 months

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8
Q

osgood schlatter lesion is an osteochondroses in the-

A

tibial tubercle

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9
Q

an osteochondroses in the tibial tubercle is called a

A

osgood schlatter lesion

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10
Q

sindig larsen johnson lesion is located in the

A

inferior pole of the patella

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11
Q

an osteochondroses in the inferior pole of the patella is called a

A

sindig larsen johnson

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12
Q

ddx of toe walking

A 
mm tightness
global developmental delay
tumour
ankylosing spondylitis
trauma e.g. #, burns
CMT
Angelmann's syndrome
tethered cord
transient focal dystonia
venous malfunction of soleus
cerebral palsy
spd
muscular dystrophy
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13
Q

antetorsion

A

medial twist of the distal end of the femur on the proximal end

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14
Q

anteversion

A

when the NOF and HOF are positioned towards the anterior asp of the body

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15
Q

retroversion

A

when the NOF and HOF are tilted away from the anterior aspect of the body

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16
Q

list off some OMs you could use on a 3 month old

A 
wong baker
AIMS up to 18 months old
DSM 5 for autism and shit
pirani score(TEV)
gallop
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17
Q

name some OMs you could use on a 8 year old

A

8+ use VAS
4-18 se FLACC
paediatric balance scale 5-15 years
MABC/BOT 2

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18
Q

list some OMs you could use on a 12 year old

A

paediatric balance scale (5-15)
gallop
p FFP

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19
Q

outline the rating of reflexes 1-5

A 
0= absent
1= hypo
2= normal
3= hyper reflexive 
4= clonus
5 = sustained clonus
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20
Q

5 determinants of mature gait

A

S: step length increases with age
C: cadence decreases with age
A: ankle spred: pelvic span to ankle spread ration increases with age
W: walking speed increases with age
D: duration of single limb stance increases with age

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21
Q

ddx for kohlers

A 
accessory navicular
tumour
#
RA
maybe tib post or TA tendinopathy
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22
Q

what manipulations are performed when casting

A

lateral shift of navicular, calc and cuboid.

do not move talus within aj

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23
Q

what are some potential causes of paediatric flat foot?

A

tarsal coalition
congenital vertical talus
peroneal spastic flat foot
tib post dysfunction

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24
Q

how would you rx growing pains

A

RCT for stretching quads, hamstrings, gastroc/sol

case series for in shoe wedging for pronated feet

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25
Q

is there a gender bias for kohlers?

A

yas there is a gender bias for kohlers: males 4:1

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26
Q

what is the normal age range for kohlers

A

2-9 years old

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27
Q

what is newborn STJN?

A

22 varus

STJ ROM = 45

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28
Q

newborn forefoot position

A

varus 12-15

metatarsus primus adductus

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29
Q

when is ossification complete in the whole body

A

25 yo

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30
Q

majority of acetabulm shape and depth is determined by …. what age

A

8 years old

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31
Q

what is the typical age range and gender ratio for osgood schlatters

A

boys 12-15

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32
Q

what is the treatment for osgood schlatters (tibial tubercle- bone builds up here)

A

address any mm strength/flexibility imbalances,
activity modification (directed by pain),
spontaneus resolution is common
NSAIDs
may need surgery

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33
Q

what is the typical age range and gender ratio for kohlers?

A

males > females 4:1

2-9 years old

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34
Q

what is the treatment for kohlers?

A

activity modification,
orthoses
short leg cast 6-8 weeks

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35
Q

what is the typical age range and gender ratio for friebergs

A

typically dancers 12-15 yo

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36
Q

what is the rx for friebergs

A 
activity modification
shoe wear modification
short leg cast
surgery
aspirin (over 12s)
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37
Q

what is the typical age range and gender ratio for perthes

A

boys > girls 4 or 5:1

4-10 yo

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38
Q

what is the rx for perthes

A

monitor + analgesics
slings and casting
surgical (to encourage spherical moulding of HOF)

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39
Q

what is the rx for sindig larsen johnson (inferior pole of patella)

A 
activity modification (directed by pain)
tightness of quads may predispose
40
Q

what is the typical age range and gender ratio for severs

A

boys 7-15
girls 5-13

** mostly boys aged 10-12

41
Q

what is the rx for severs

A

activity modification
shoe wear
heel raises
calf stretching/strenght

42
Q

what is the rx for iselins

A

offloading
orthoses
lateral wedging (?)

43
Q

what is the rx for sheuermann’s

A

joint mobilisation
soft tissue therapy
bracing
surgery

44
Q

osgood schlatters are typically seen in patients who play what kind of sports?

A

anything with running and jumping

45
Q

which osteochondroses has spontaneuous resolution of sx? (only 10 % of cases are sx into adulthood)

A

osgood schlatters spontaneous resolution

46
Q

ddx osgood schlatters

A

osteochondrosis dissecans (joint)
RA
meniscus injury

47
Q

severs- how often does it present bilaterally ?

A

60% of cases are bilateral

48
Q

severs- what are the limiting factors

A

the calcaneus has 2 ossifcation centres which fuse at around 16 years of age –> self limiting

49
Q

what is a clinical dx tool for severs?

A

pain localised to post heel –> “squeeze test”

50
Q

ddx of severs

A 
retrocalcaneal bursitis,
achilles tendinopathy
bone tumour
medial calc nerve entrapment
tarsal tunnel syndrome
RA
51
Q

what is a clinical tool you could use to dx a kohlers?

A

get them to go up on their toes (i.e. trigger some tib post contraction) and see if they get pain

52
Q

ddx of kohlers?

A

accessory navicular
#
RA

53
Q

ddx of iselins

A

styloid #
accessory
RA

54
Q

ddx friebergs

A 
stress #
march #
synovitis
neuroma
RA
55
Q

you have dx your pt with growing pains (using evans table). now what do you do?

A

implement a pain episode diary
mm stretching program : quads, hamstrings, triceps surae, 2 x 20-30 sec holds

if the pt doesn’t respond well then try shoe wedges

then try paracetamol, heat, massage, orthoses

if no response then pls consider red flags!

56
Q

ddx of growing pains

A 
juvenile arthritis
bone tumour
mm metabolism disorder
fibromyalgia
restless legs
57
Q

outline the 3 theories of growing pains

A

anatomical: orthopaedic factors e.g. flat feet, genu valgum

fatigue theory: crazy active kids –> overuse of mm

psychological or emotional theory: avoiding school, looking for special rx etc.

58
Q

3 Es for orthotics?

A

Efficacy
Expense
Ethics/justification

59
Q

what are some tests we can do on a kid with flat feet?

A 
tib post: see how many times they can do a single leg toe raise in 10 secs 
jacks test
FPI 6
FMM
flexible or rigid/
gait analysis
60
Q

it is common for kids to have flat feet until the age of about _____

A

10

61
Q

excessive lordosis is a red flag for ____

A

osteomalacia

TB of spine

62
Q

what is ehler’s danlos syndrome?

A

a big group of inherited connective tissue disorders involving jjoint hypermobility, skin hyperextensibility and tissue fragiliaty

63
Q

what are the most likely/take home characteristics/consequences of down syndrome - relevant to pods

A

hypotonia : when going from sit to stand they will typically go through a tripod position rather than squats - problematic because he will fall heaps more (discouraging) and doesn’t help with position + ROM at hips and knees

broad flat square foot –> arch profile wont emerge when going onto toes

probably won’t be walking at 2

64
Q

your pt has genu valgum and they are over 8 years. what pathologies could they have?

A

renal osteodystrophy
metaphyseal dysplasias
olliers disease (tumour like condition)

65
Q

your pt is over 8 and has a valgum. what do you do?

A

needs to be investigated
x rays if indicated
rx if pain with gait, cosmetic concern, knee pain

66
Q

when are x rays indicated in childhood genu valgum?

A 
over 8
hx trauma/infection
short stature
unilateral or asymmetryy
metabollic bone disease (mostly rickets)
67
Q

what are some reasons (i.e. underlying conditions) for pathologic genu varum

A

physeal disruption post trauma or infection
metabollic bone disease e.g. rickets
generalised skeletal dysplaisa
focal fibrocartilaginous dysplasia

68
Q

define pathologic genu varum

A

infantila and adolescent onset

physeal disruption post trauma or infection or metabolic bone disease (rickets) or dysplasias

69
Q

what are some of the complications of SUFE?

A 
very serious. you need to get them to hospy ASAP
osteonecrosis
chondrolysis (cartilage destroyed)
OA
impingement
70
Q

what is the typical presentation of SUFE?

A 
12-14 yo
maybe overweight
antalgic gait
out toeing
shortening of affected limb
obligatory lateral rotation of the thigh when you try to flex their hip (pt supine)

acute: # like pain, unable to WB
chronic: groin pain + radiating to anteromedial thigh + med knee, antalgic limp, pain for more than 3 weeks, no sudden exacerbation, 3 weeks after acute phase

71
Q

what is SUFE?

A

slipped upper femoral epiphysis. when the neck and shaft of the femur displace upwards and anteriorly

72
Q

what tests would you do on someone with suspected perthes?

A

medial rotation: will be decreased
abd: will be decreased
ROM: will be decreased
trendelenburg sign will be seen
telescope the knees –> there will be shortening of the limb
gait analysis: limp, exacerbated by activity

73
Q

what are the 3 stages of a perthes?

A

a) blood supply is disturbed
b) softening and collapse of bone
c) re-establishment of BS + repair + modelling of HOF

74
Q

define perthes and describe what it does to the shape of the HOF

A

idiopathic juvenile avascular necrosis of HOF

HOF widens and flattens

75
Q

what are the 3 main broad categories of etiology of DDH ?

A
  • lig lax; maternal relaxin crosses placenta? genetic predisposition
  • prenatal positioning: breech, big babies, 1st born, oligohydramnios
  • post natal positioning: swaddling in HJ extended position
76
Q

which hip is usually affected in DDH?

A

left hip because left goes under right in the foetal position

77
Q

when do the vertebrae parts fuse?

A

3-5 years of age

78
Q

ddx of back pain in kids

A 
neoplasm
infection
UTI
OM
diskitis
spondylosis
disk herniation
slipped or # vertebral apophysis
inflammatory bowel disease
hydronephrosis
ovarian cysts
79
Q

pt under 4 years with back pain. what is the most likely dx?

A

infection or neoplasm

80
Q

pt under 10 years with back pain. what is the most likely dx?

A

diskitis
vertebral OM
neoplasms

81
Q

pt over 10 with back pain. what is the most likely dx?

A

secondary to trauma or overuse

82
Q

yes/no: do the cuneiforms have ossification centres at birth?

A

no- the cuneiforms and navicular do not have ossification centres at birth?

83
Q

at what age do the 3 acetabulum epiphyseal centres fuse?

A

17-18 yo

84
Q

majority of acetabular shape and depth is determined by what age?

A

8

85
Q

what does a staheli arch index of over 1.15 in a child aged 6-10 mean?

A

anything over 1.15 in kids aged 6-10 is abnormal

86
Q

in mid childhood what position should the tibia be in?

A

10 external

87
Q

at age 1 what position should the tibia be in?

A

5 ext

88
Q

at birth what position should the tibia be in?

A

neutral/patallel or slightly internal

89
Q

what should the position of the tibia be for older children ?

A

14-20 ext

90
Q

how do you measure tibial torsion?

A

thigh foot angle

91
Q

your pt is 12 months old and has a banana shaped foot. what is your dx and list possible sub types

A

postural metatarsus adductus
simple metatarsus adductus
complex metatarsus adductus
skew foot: iatrogenic or acquired

92
Q

you have a pt with metatarsus adductus. what objective assessments would you do?

A

classify the type, severity and flexibility
put the little foot in your peace finger
stroke the medial and lateral borders to see if it spontaneously corrects
check rearfoot alignment
check frontal and transverse plane alignment of forefoot
x ray isn’t appropriate in mild cases but can be used to find the metatarsus adductus angle (between the midfoot and 2nd met bisection)

93
Q

ddx of metatarsus adductus

A 
calcaneovalgus
clubfoot (talipes equinovarus TEV)
forefoot adductus
skewfoot
supination of STJ
internal tibial torsion
femoral anteversion
(tumour, RA)
94
Q

why shouldnt you put the wrong she on a kid with metatarsus adductus?

A

because it causes too much forefoot abduction and promotes a pronated foot type

95
Q

what is the treatment for metatarsus adductus?

A

mild flexible: manipulations at every nappy change
mlld-moderate flexible: splinting
mod-severe: serial casting
rigid serial casting ( rays recommended and then maybe surgery)

clinic sp5 2017 (2 decks)

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