Pediatric and Adolescent Patient

Question 1

Female Athlete Triad

Answer 1

Decreased Bone mineral density
Eating disorder
Amenorrhea (hormones with menstrual cycle)

Question 2

CV and pulmonary screen

Answer 2

40% 6-12yo have at least 1 factor for heart disease

Obesity

Physical inactivity

DM

Environmental stress

Aerobic metabolism

65-70% aerobic capacity to that of adults

Question 3

Cancer

Answer 3

Avg of children with cancer is 6 yo

60% of children who survive cancer suffer late effects: infertility, heart failure, secondary cancers

Most common: leukemia, brain + spinal cord tumors, neuroblastoma, bone cancer, lymphoma, rhabdosarcoma, retinoblastoma

Question 4

Cancer screening signs

Answer 4

Unusal llump or swelling,

Unexplained pallor and lethargy

Easy bruising

An ongoing pain in one area of the body

Sudden unexplained weight loss

Limping

Unexplained fever or illness

Frequent headache with vomiting

Sudden eye/vision changes

Question 5

Neoplasms

Answer 5

Tumors of skeletal system are less common in children

located in long bones

Symptoms: constant pain for malignant tumors, transient pain for benign tumors, local swelling, tenderness and joint pain

Red flag = onset of pain in absence of trauma

Question 6

Osteochondrosis

Answer 6

Developmental derangement of normal bone growth, primarily involving the centers of ossification in epiphysis
- repetitive trauma, synovitis, infection, granulation tissue disrupting blood flow

Question 7

4 stages of health osteochondrosis

Answer 7

Avascularity phase
Revascularization phase
Bone healing phase
Residual deformity phase

Question 8

Panner’s Disease

Answer 8

Osteochondrosis of the capitulum (elbow)
Pain swelling and ROM limitations
Differential dx: tendon injury, ligament injury at elbow

Now full ROM due to pain
If not trauma = possible bone condition

Question 9

Keinbocks Diease

Answer 9

Osteochondrosis of lunate bone, repetitive microtrauma

pain with end range wrist extension

Question 10

Legg-Calve Perthes

Answer 10

Clinical examination
Painful PROM (typically asymptomatic) 
ROM restrictions with hip IR
Terendelmburg gait

Question 11

Freibergs diease

Answer 11

Osteocondrosis of distal epeiphys 2nd or 3rd metatarsal

Pain at MTP, increases with WB and toe extension during gait

Question 12

Scheuermann’s diease

Answer 12

different growth rate in vertebra, post > Ant
Resultant kyphosis
Resolved with approp exercise
Brace can be used

Question 13

Osteochondritis dessicans

Answer 13

fragment of epiphysis comes separated then avascular
Medial femoral condyle
posterior surface of patella
Femoral head
Dome of talus
Capital of humerus 

Conservative treatment: fragment will be reabsorbed

Surgical - necrotic segment of bone can be removed or repaired

Question 14

Scoliosis

Answer 14

Epiphyseal disorder
Observation Curve < 25

Bracing curve 25-30 degrees

Surgery - curve 45-50, signs of instability or risk to CV/pulm systems