Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > paeds ortho > Flashcards

paeds ortho Flashcards

1
Q

how are fractures to the growth plate graded?

A

Salter-Harris classification (SALTR)

type 1 = Straight across
type 2 = Above
type 3 = beLow
type 4 = Through
type 5 = cRush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pain management in childrens fractures

A
  1. paracetamol or ibuprofen
  2. morphine

**codeine + tramadol are NOT used in kids, aspirin contraindicated in U16s (except Kawasaki)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk factors for DDH

A 
1st degree fam history
breech presentation from 28 weeks (feet first)
multiple pregnancy (twins)
female 
down syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

presentation of DDH

A

different leg lengths
restricted hip abduction on one/both sides
difference in knee level when hips are flexed (positive Galeazzi sign)
clunking of hips on Ortolani + Barlow test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ortolani test

A

DDH

starts dislocated will reduce - push from behind will pop upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Barlow test

A

DDH
starts reduced - will dislocate
pushing down so hip pops back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

diagnosis of DDH

A 
<3months = US
>3months = x-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

management of DDH

A

<6months = Pavlik harness - keeps hips flexxed + abducted, 6-8weeks

> 6months or harness fails = surgery - hip spica cast post-surgey

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Slipped upper femoral epiphysis (SUFE)

A

head of femur is displaced (slips) along growth plate

  • boys aged 8-15 + obese
  • suspected if pain is disportionate to minor trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SUFE presentation

A

hip, groin, thigh, or knee pain (knee pain = examine hip)
restricted range of hip movement - esp. internal rotation
painful limp
patient will prefer to keep hip externally rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

management of SUFE

A

surgery - pin femoral head in correct position + fix it preventing further slipping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

transient synovitis

A

“irritable hip”
commonest cause of hip pain aged 3-10
associated with recent viral upper respiratory tract infection

NO fever if fever + joint pain urgent for septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

transient synovitis presentation

A

limp
refusal to weight bear
groin or hip pain

previous viral URT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of transient synovitis

A

analgesia
safety net - attend A&E if develop fever
usually resolve 1-2weeks

follow up at 48hrs + 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pethes disease

A

disruption of blood flow to femoral head causing AVN
affects epiphysis of femur
idiopathic, severity varies

overtime there’s revascularisation of femoral head - remodelling of bone as it heals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what age and gender is Perthes disease more common in?

A

boys aged 4-12 yrs - particularly 5-8yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

presentation of Perthes disease

A

slow onset of -

  • pain in hip or groin
  • limp
  • restricted hip movements
  • referred pain to knee

**no history of trauma - if trauma think SUFE (esp. in older kids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

complications of Perthes

A

soft + deformed femoral head (from remodelling as it heals)

leads to -

  • early hip OA
  • artificial total hip replacement in 5% of patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Perthes investigations

A

x-ray

  • femoral head deformity
  • widening of femoral neck (coxa magna)
  • sclerotic lie running across femoral neck

MRI if x-ray normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

management of Perthes

A

depends on severity

  • bed rest, analgesia, traction/crutches, physio
  • regular x-rays to assess healing
  • surgery in v severe cases, older kids or those not healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

foot position in talipes equinovarus

A

plantar flexion + supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

foot position in talipes calcaneovalgus

A

dorsiflexion + pronantion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

treatment of talipes (clubfoot)

A

Ponseti method
- repeated casts until in correct position - may require Achilles tenotomy

  • after cast brace is used when not walking until kid 4ish y/o (“boots + bars”)
24
Q

tarsal coalition

A

abnormal brige between talus + calcaneus
- painful fixed flat foot

Mx = splintage, orthotics, surgery to remove abnormal connection

25
Q

spondylolithesis

A

slippage of one vertebra over another
– usually L4/5 or L5/S1

presents usually adolescence
developmental or recurrent stress fracture that fails to heal

26
Q

presentation of spondylolisthesis

A

low back pain

radiculopathy (pinching of nerve root in spinal column) with sever slippage

“flat back” - due to muscle spasm

27
Q

management of spondylolisthesis

A

minor = rest + physio

severe = stabilisation + possibly reduction (risk of neurological injury)

28
Q

osteogenesis imperfecta

A

genetic mutations that affect maturation + organisation of type 1 collagen

brittle bones prone to fractures

8 types - vary in severity

29
Q

presentation of osteogenesis imperfecta

A 
*blue/grey sclera*
reccurent + inappropriate fractures
hypermobility
triangular face
short stature
deafness from early adulthood
dental problems
bone deformities - scoliosis, varus

diagnosis = clinical

30
Q

management of osteogenesis imperfecta

A

biphosphonates - to increase bone density
vit D supplementation

MDT - physio, occ., paeds, social workers

31
Q

achondroplasia

A

(short stature/dwrfism)

  • autosomal dominent or sporadic
  • prominent forehead + widened nose
  • recurrent otis media due to cranial abnormalities
32
Q

Ehlers-Danlos syndrome

A

abnormal elastin + collagen

joint hypermobility, vascular fragility, scoliosis

33
Q

Duchenne muscular dystrophy

A

boy starts to walk with difficulty standing (Gower’s sign)

can’t walk by age 20, progressive cardiac + resp failure in early 20s

34
Q

how do you diagnose + treat Duchenne muscular dystrophy?

A

diagnosis = raised serum creatinine phosphokinase + abnormalities on biopsy

Mx = spplintage, physio

35
Q

cerebral palsy

A

due to an insult to immature brain before, during, or after birth
onset before 2-3 yrs

expression + severity variable depending on where it is in the brain

36
Q

causes of cerebral palsy

A 
more often no identifiable cause
genetic problems
brain malformation, intracranial haemorrhage
infection during early pregnancy
prematurity
hypoxia during birth
meningitis
37
Q

cerebral palsy presentation

A

failure to meet milestones
increased/decreased tone generally or specific limbs
hand preference <18months
problems with speech, coordination or walking
learning difficulties

38
Q

types of spina bifida

A

2 halves of posterior vertebral arch fail to fuse - first 6 weeks gestation

occulta = mildest, dimple over area, high arched foot/clawing of toes

meningocele = herniation of meninges alone

myelomeningocele = herniation of meninges + cauda equina

39
Q

treatment spina bifida

A

defect usually closed within 48hrs of birth

40
Q

obstetric brachial palsy

A

brachial plexus injury during vaginal delivery
common in - large babies, twins, shoulder dystocia (shoulder stuck during birth)

Erb’s palsy (upper)
Klumpke’s palsy (lower) - prognosis WORSE than Erb’s (no treatment)

41
Q

what part of the brachial plexus is injured in Erb’s palsy?

A

C5 + C6

42
Q

Erbs palsy presentation

A

loss of motor innervation of arm muscle (biceps)

leads to internal rotation of humerus - may lead to waiters tip posture

43
Q

management of Erbs palsy

A

(C5 + C6)

physio
surgical release of contracture + tendon transfers if no recovery

->prognosis is based on return of biceps function by 6 months

44
Q

what part of the brachial plexus is injured in Klumpke’s palsy?

A

C8 + T1

45
Q

Klumpke’s palsy

A

C8 + T1 injury
paralysis of intrinsic hand muscle +/- fingers+ wrist
possible horners syndrome

NO treatment

46
Q

risk factors for rickets

A

breastfed babies - formula fed is fortified with vit D

darker skin, low exposure to sunlight, colder climate, lots of time indoors

47
Q

presentation of rickets

A 
may not have any symtpoms
lethargy
bone pain
swollen wrists
varus, valgus
rachitic rosary
soft skull
delayed teeth
abnormal fractures
48
Q

what is rachitic rosary + craniotabes?

A

rachitic rosary = ribs expand at costochondral junc, causing lumps along chest

craniotabes = soft skull, delayed closure of sutures + frontal bussing

–> both signs of rickets

49
Q

rickets investigations

A

serum 25-hydroxyvitamin D (<25 = deficient)
x-ray required to diagnose = translucent bones

serum ca + phosphate = low
serum alkaline phosphatase = high
parathyroid hormone = high

50
Q

what would serum alkaline phosphatase + parathyroid hormone levels be like in rickets?

A

both HIGH

51
Q

serum calcium + phosphate levels in rickets?

A

LOOOOW

52
Q

management of rickets

A

breastfeeding women should take vit D supplement

ergocalciferol (vit D for kids) - dose dependents on age
calcium supplementation

53
Q

what is Jacks test used for

A

flat feet

mobile/flexible = flattened medial arch forms with dorsiflexion of great toe

rigid = remain flat regardless of load or dorsiflexion - underlying tarsal coalition or inflammatory or neurological disorder

54
Q

angulation of the distal segment of bone away from midline

A

valgus

55
Q

angulation of distal segment of bone towards midline

A

varus

MSK (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions