Pedi musculoskeletal

Question 1

Long bones grow in ______
Increase in width by _______
Lengthening occurs at the _______ or ________
Growth plates are ______ located at the ends of _______
Longitudinal growth occurs until _____

Answer 1

Long bones grow in two dimension
Increase in width by- new bony tissue around shaft
Lengthening occurs at the epiphyses or growth plates
Growth plates are transverse located at the ends of long bone
Longitudinal growth occurs until 20

Question 2

Children bones description

children injury considerations

Answer 2

• porous
• less dense
• buckle, splint or fracture
• ligaments and bones are stronger than bones prior to puberty
• trauma frequently result in injuries to ligaments
• fracture to epiphyseal plate- angulation and shortening of limb

Question 3

Assessment of hip

Answer 3

inside or outside hip

isolated problem or systemic condition

Question 4

Labs

Answer 4

C-reactive protein
ESR
CBC
Blood culture

Question 5

Infectious

Diagnostic

Answer 5

MRI is necessary septic arthritis, skeletal injry, tumor

U/S- ID joint effusions, if radiograph normal but septic hip is suspected

Question 6

Infectious joint presentation
PE

Labs

Answer 6

acute, localized, severe
refuse to bear weight

fever, elevated WBC, elevated ESR + C-reactive protein

Question 7

Inflammatory pain

Answer 7

chronic 
insidious (except transient synovitis) 
-other findings: rash 
-can bear weight but hurts 
-think juvenile arthritis

Question 8

Oshgood-Schlatter 
define
presentation
age
occurs during

Answer 8

-osteochondritis of tibial tubercle (below knee)
-pain and swelling at this point (exacerbated by direct trauma, relieved by rest- pain increases over time)
9-14 years of age or on
occurs during rapid growth spurt 20% who are active in sports, more common in boys

Question 9

Treatment Oscgood-Schlatter

Answer 9

• ice
• decrease swelling
• NSAIDs
• complete avoidance of activity is uneccessary
• no follow up
• subsides with closure at around 18-20 years of age

Question 10

most common hip pain nontraumatic

Answer 10

Transient synovitis

Question 11

Transient synovitis
ask about what?
presentation?

Answer 11

History of Upper respiratory tract infection, pharyngitis, bronchitis, vomiting, diarrhea- more than 50%

• pain LROM
• no fever
• appear okay
• antalgic gait
• hip abduction and external rotation

Question 12

TS treatment

Answer 12

• NSAIDS
• activity as tolerated
• full recovery in 1-4 weeks expected

Question 13

TS typical presentation

Answer 13

3-8 
M>F 
Fall/winter 
Afebrile well appearing 
no ^WBC, ESR, CrP
Unilateral or bilateral

Question 14

fever, hip pain

Answer 14

septic hip order labs send out

Question 15

Scoliosis
Neuromuscular
Congenital
Idiopathic

Answer 15

neuromuscular- cerebral palsy, marfans, neurofibromatosis
congential- secondary to congenital anomalies
Idiopathic- no definite etiology, most common

Question 16

Clinical manifestations scoliosis

Answer 16

assymetry shoulder heights
scapular prominence
unequal hip height
leg length discrepancy

Question 17

Adams forward bend test

Answer 17

scoliosis

Question 18

scoliometer

Answer 18

determine degree of curve of scoliosis

curve 10 degree or greater- referral to orthopedics

Question 19

Management scoliosis 
Goal: 
10-20 degrees 
20-40 degrees 
40-50 degrees

Answer 19

limit stop progression
10-20: exercises
20-40: boston brace 23 hours a day
40-50: surgery

Question 20

Slipped capital femoral epiphysis prsentation

Answer 20

• most common developmental condition of hip joints
• teens and preteens
• antalgic gait- limp fixed knee, walking on one side of foot
• obese
• dull ache hip groin thigh knee
• decreased interal rotation, abduction and flexion
• MRI, refer