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PC Paediatric > PC Peds > Flashcards

PC Peds Flashcards

1
Q

Treatment of patellar sleeve fx

A

Open reduciton and suture repair or tension band

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2
Q

Treatment of proximal tibia fx

A

nonop

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3
Q

Complicatoin of proximal tibial fx

A

Late valgus deformity; corrects over 12-24 mos

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4
Q

Accpetable alignment of tibial shaft fxs

A

< 5 deg posterior

5-10 deg varus/valgus

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5
Q

Distal tibial physeal fx at highest risk of growth arrest

A

Post reduction gap of >3mm

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6
Q

Workup tillaux fx

A

CT to assess displacement (2mm)

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7
Q

Order of closure of distal tibial physis

A

Central –> medial –> lateral

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8
Q

Treatment of tillaux fxs

A

ORPP if > 2mm displacement; otherwise, cast

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9
Q

Halo for peds c spine — _____ pins at ______in-lbs

A

6-8 pins at 2-4 inlbs

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10
Q

Age at dentocentral syndchondrosis fuses

A

6

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11
Q

Treatment of odontoid fxs in peds

A

CR + halo

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12
Q

Association of TL spine injuries

A

50% intraabdominal

15% paraplegia

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13
Q

Most common mechanism of osteo in peds

A

hematogenous

metaphysis

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14
Q

Most common organisms for osteo in peds

A

Staph aureus

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15
Q

What type of culture is needed for kingella kingae

A

Blood culture medium

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16
Q

Pediatric osteomyelitis with delayed presentation

A

Kingella kingae — blood culture medium

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17
Q

Sequestrum

A

necrotic bone that is avascular and can be nidus for chronic infxn

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18
Q

What lab peaks fastestand and normalies more quickly in osteo

A

CRP

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19
Q

Complications of osteomyelitis

A 
– Can be fatal if untreated
– Growth arrest and LLD
– Deformity
– Chronic infection
– DVT (MRSA with PVL gene)
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20
Q

Kocher criteria

A

– NWB
– ESR > 40
– Fever > 38.5
– WBC > 12K

4 = 99%, 3 = 93%, 2 = 40%, 1 = 3%

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21
Q

Best predictor of septic hip

A

Fever followed by CRP

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22
Q

Treatment of lyme disease (>8)

A

Doxycylcine

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23
Q

Treatment of lyme disease (<8)

A

Amoxicillin

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24
Q

Treatment of diskitis in peds

A

Abx

if fail –> look for TB

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25
Q

Treatment of chronic recurrent multifocal osteomyelitis

A

NSAIDs

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26
Q

Most common cause of sepitc hip in sickle cell pt

A

Staph aureus

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27
Q

MRI brain in CP

A

periventricular leukomalacia

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28
Q

Hemiplegic CP

A

one side

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29
Q

Diplegic

A

Lower > upper body involvment

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30
Q

GMFCS classification of CP

A

I – Speed, balance, coordination impaired
II – Hold railing, trouble with uneven surface
III – Rolling walker, self propelled wheelchair
IV – Operate powered wheelchair
V – Completely dependent

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31
Q

Botox mechanicsm

A

Inhibits presynaptic release of Acetylcholine

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32
Q

Treatment of stif kneed gait

A

hamstring lengthening and rectus transfer

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33
Q

Indications for scoliosis surgery in CP

A

– Progressive deformity with
– Sitting imbalance
– AND manageable comorbidities

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34
Q

Indication to treat dysplastic hips in CP

A

Early: adductor and IP release
Late: VDRO & pelvic osteotomy

Late dislocaiton: leave untreated

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35
Q

Treatment of equinovalgus foot in CP

A

Cause: spastic peroneals

TAL, PB Length, Lat Column Length, Calc osteotomy

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36
Q

Treatment of equinovarus foot in CP

A

Cause: spastic PT +/- AT

  • SPTT to peroneals – flexible varus with weak peroneals
  • SATT to cuboid – flexible varus with overactive tib ant
  • Rancho Procedure – combined with Post Tib length
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37
Q

Etiology of arthrogryposis

A

decreased anterior horn cells

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38
Q

Risk factors for spinal bifida

A 
– Low Folic Acid
– Valproic Acid
– Carbamazepine
– Maternal hyperthermia
– Maternal IDDM
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39
Q

Level of spina bifida needed for walking

A

L4

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40
Q

Type of allergy in spina bifida to latex

A

IgE

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41
Q

Functional status change in spina bifida

A

Need to get brain/spine MRI to eval for shunt malformation, hydrocephalus, arnold chiari, tethered cord

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42
Q

Associatoin in sacral agenesis

A

Maternal diabetes

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43
Q

Duchenne’s protein

A

Dystrophin

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44
Q

Duchenne’s inheritance

A

XLR

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45
Q

Indications to fuse scoliosis in Duchenne’s

A

Fuse > 20 deg

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46
Q

Fascioscapulohumeral muscular dystrophy - inheritance

A

Autosomal dominant

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47
Q

Fascioscapulohumeral muscular dystrophy - exam

A

– Scapular winging
– Weakness involving muscles of facial expression and proximal UE
– Inability to whistle

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48
Q

Treamtent of polymyosistis/dermatomyositis

A

Anti-TNF

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49
Q

AIS MRI indications

A 
Left thoracic curves
Pain
Apical Kyphosis
Rapid curve progression
Neurologic signs
Congenital anomalies
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50
Q

Peak growth velocity timeing

A

Occurs prior to menarche

Occurs prior to Risser1

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51
Q

AIS progression after maturity

A

Thoracic curves >50°
Lumbar curves >30°
Typically 1-2 degrees per year
This data guides treatment!!

52
Q

Bracing number hours per day needed

A

14

53
Q

AIS < 25 deg and skeletally immature

A

Observe

54
Q

AIS < 40 and skeletally mature

A

Observe

55
Q

AIS 25-40 and skeletally immature

A

Brace

56
Q

AIS > 50 and skeletally immature

A

Surgery

57
Q

AIS > 50 and skeletally mature

A

Surgery

58
Q

Bracing for AIS with apex T7 or higher

A

CTLSO or Milwaukee brace

59
Q

Bracing for AIS with apex T78 or lower

A

TLSO

60
Q

Indication for ASF and PSF in AIS

A

Skeletal immaturity (crankshaft)
less than 10 y.o.
Severe curves ( over 75 degrees)

61
Q

Early onset scoliosis - curve type

A

Usually left thoracic

62
Q

Early onset scoliosis - RVAD — who prorgresses

A

RVAD= (concave –convex) at apical vertebra

RVAD > 20 = high risk of progression

63
Q

Treatement of early onset scoliosis

A

< 25°; RVAD < 20°= observation
25-45°; RVAD > 20°= cast / brace/MRI
> 50°= MRI, +/-surgery

64
Q

Surgical treatment of congenital scoliosis

A

ASF/PSF without instrumentation

65
Q

Most sensitive test for spondylolysis

A

SPECT scan

66
Q

First line treatment for spondylolysis

A

Antilordotic bracing, PT, activiy restriction for 3 mos

67
Q

Treatment L5 spondylolysis that failed nonop

A

l5/S1 fusion

68
Q

Treatment of L3 spondy that has failed nonop

A

Repair

69
Q

Indication for surgical treatment of spondylolisthesis

A

Grade III or higher (>50%)
Progression of deformity
Failure of nonop tx

70
Q

Bracing indications for Scheuermann’s

A

65-80 deg

71
Q

Surgical indications for Scheuermann’s

A

> 80 deg

72
Q

Who to consider atlantoaxial instability

A

Down’s syndrome (fuse if ADI > 10)
Juvenile rheumatoid arthritis
Skeletal dysplasias

73
Q

Treatment C1-C2 rotatory subluxation that fails traction

A

C1-C2 fusion

74
Q

Position of elbow during CRPP of flexion type SCH fx

A

extensoin

75
Q

Associated anomalies with Klippel-Feil

A

Screen for:

    • Sprengel
    • deafness
    • GU abnls
    • CV abnls
76
Q

Indications to keep a child out from contact sports with Klippel Feil

A
    • Massive fusion of cervical spine
    • any involvement of C2
    • Limited cervical motion
77
Q

Factors most associated with nonaccidental trauma

A
    • nonambulatory pts
    • suspicious histories
    • associated injuries
    • metaphyseal fxs
78
Q

Study of choice for workup of suspected talocalcaneal coalition

A

CT scan

If nondiagnostic then MRI

79
Q

Initial treatment of congenital dislocation of the knee

A

Casting with the knee in flexion if able to achieve 30 degrees flexion (GI or GII)

If not able to achieve 30 degrees flexion (GIII) or recurrent case –> then need to do a quadricepsplasty of some sort

80
Q

Incidence of multilevel spine injury when there is ONE pediatric spine fx identified

A

30-55%

Therefore, entire spine should be imaged in these cases

81
Q

Treatment of 5 yo with vertcial shear pelvic ring injury displaced 2 cm and symphysis widening

A

Closed reduction and spica cast for 2 months

82
Q

Cause of Poland syndrome

A

Interruptoin of embryonic sublavian blood supply

83
Q

Cause of Sprengel deformity

A

Interruption of embryonic subclavian, internal thoracic, or suprascapular artery

84
Q

Cause of fibular hemimelia

A

No known genetic or environmental factor

85
Q

Cause of distal arthrogryposis

A

MYH3 gene mutation encoding for myosin heavy chain 3

86
Q

Cause of NF1

A

NF1 gene on chromosome 17 coding for neuofibromin (a tumor suppressor)

87
Q

Cause of Beckwith-Wiedemann syndomre

A

Chromosome 11 mutation near the IGF gene

Characterized by:
major criteria: 
-- overgrowth 
-- abdominal wall defects, incl. omphalocele
-- macroglossia or large tongue
minor criteria 
-- hemihypertrophy (10-20%)
-- ear anomalies
-- neonatal hypoglycemia
-- nephromegaly
88
Q

Genetic defect of the _____ protein in marfan syndrome

A

Fibrillin-1

FBN-1

89
Q

Genetic defect of the _____ protein in Ehlers-Danlos

A

Type III collagen

90
Q

Trewatment of adolescent Blount’s with open physes

A

Lateral tibial epiphysiodesis

91
Q

Treatment of adolescent Blount’s near/after skeletal maturity

A

Proximal tibial osteotomies

92
Q

DVT association in peds

A

Osteomyelitis caused by MRSA

93
Q

Bacterial gene that predisposes to DVT

A

Panton-Valentine leukocidin gene

PVL gene

94
Q

Treatment of Ortolani positive hip that has failed to reduce in Pavlik for 3 wks (remains Ortolani positive)

A

Apply semi-rigid hip abduction orthosis

95
Q

Fusion sequence of ossification centers of the elbow

A

CTE-R-O-I

96
Q

Rate of motor recovery after total brachial plexus birth palsy with associated Horner’s

A

<10%

97
Q

Disorders with COMP gene mutation

A

Multiple Epiphyseal Dysplasia

Pseudoachondroplasia

98
Q

Normal femoral head coverage, alpha angle, and beta angle on ultrasound

A

50% coverage

alpha angle > 60

beta angle < 50

99
Q

Comparison of treatment of both bone FA fxs with flexible IMN and ORIF
OR time, blood loss, radial bow magnitude, forearm rotation and union

A

IMN shorter surgical time and less blood loss

Similar union, radial bow magnitude and forearm rotation

100
Q

Larsen’s syndrome

A

Multiple joint dislocations and abnl facial features

101
Q

Additional workup needed in pt with multiple congenital joint dislocaoitns

A

Larsen’s syndrome

XR and/or MRI of the cervical spine prior to any sort of surgery or manipulation of the spine due to risk of cevial kyphosis and instability

102
Q

Workup Toddler with genu varum > 20 degrees

A

Blood work, calcium, phosphorus, alk phos, vit D, and renal function tests

DDx: Blounts, skeletal dysplasias, rickets

103
Q

Alpha angle on ultrasound measures what anatomic structure

A

Degree of horizontalization of the acetabular sourcil

104
Q

Preferred position that patients with SCFE hold their hip in

A

external rotation

105
Q

Treatment of osteoid osteoma of the spine

A

Excision if within 1 cm of neurovascular structures; otherwise RFA

106
Q

Deficient protein in Larsen syndrome

A

Filamin B

107
Q

First line treatment for pt with NF-1 with tibial fx

A

Long leg cast; if goes onto nonunion, can address with surgery

108
Q

For a patient with achondroplasia, the thoracolumbar kyphosis seen in infancy will most likely

A

Resolve with independent walking

109
Q

Consideration if not walking by 18 months of age

A

Evaluate for neurologic or developmental condition

Orthopaedic conditions should not delay amubulation

110
Q

Treatment of 2 year old presenting with dislocated hip

A

Open reduction and +/- acetabular +/- femoral osteotomy

Key point is that you have to do an OPEN reduction; can’t get closed

111
Q

MSK manisfestations associated with fibular deficiency

A

ACL deficiency
Ball and socked ankle joint
Tarsal coalition

112
Q

Complication after tibial spine fx

A

Arthrofibrosis

113
Q

Intraoperative neurophysiologic monitoring for pediatric spine surgery entails:

A

Motor cortex to the corticospinal tract –> spinal cord interneuron –> anterior horn cells –> peripheral nerve –> skeletal muscle in an efferent direction

114
Q

Risk factors for spinal agenesis

A

Maternal diabetes

115
Q

Genetic association with clubfoot

A

PITX1-TBX4 translocation

116
Q

Weakest zone of the physis - and therein most susceptible to fracture:

A

Zone of hypertrophy

117
Q

Genetic defect in fibrous dysplsia

A

GNAS1 on chromosome 20

118
Q

Pediatric septic joint with delayed presentation

A

Kingella kingae — blood culture medium or PCR

119
Q

What portends greatest risk of physeal arrest after fracture?

A

Amount of post-reduction displacement

120
Q

Lowest possible FVC of a pulmonary function testin in a pt with Duchenne’s that you can reasonably expect to wean from vent

A

35%

121
Q

Best method to reduce a native pediatric hip dislocatoin

A

Closed reduction under GENERAL anesthetic with fluoroscopy

122
Q

Timing to act on “physiologic” genu valgum

A

8 yrs

123
Q

Bacteria associated with increased risk of pathologic fx after subperiosteal abscess in kids

A

USA300-0114 pulsotype MRSA

124
Q

Presurgical testing for pt with Morquio’s should include ________

A

cervical spine XR

intability common at C1/C2

125
Q

Risk factor for arthrofibrosis after fixation of tibial spine fx

A

Surgical time > 120 min
Surgery > 7 days afer injury
Prolonged immobilization with delay of ROM rehab

PC Paediatric (8 decks)

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