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CORE--Peds > Pediatric MSK > Flashcards

Pediatric MSK Flashcards

1
Q

Name the histological zone closest to the metaphysis within the growth plate/physis

A

zone of provisional calcification

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2
Q

What cells make up the zone of provisional calcification?

A

chondrocytes underrgo apoptosis to make matrix for calcification

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3
Q

Describe Salter Harris classification

A 
Physeal fractures; SALTR, SMETC
I. physis
II. physis, metaphysis
III: epiphysis, physis
IV: metaphysis, epiphysis
V: physis crushed
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4
Q

Example of type 1 SH injury

A

SCFE, gymnast’ wrist

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5
Q

Example of type 2 SH injury

A

nondisplaced fracture of the base of the phalynx

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6
Q

Example of type 3 SH injury

A

juvenile tillaux fracture; distal tibial epiphyseal fracture

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7
Q

Example of type 4 SH injury

A

triplane fracture

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8
Q

Example of type 5 SH injury

A

physis crushed

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9
Q

Name ossification centers of elbow and age

A

CRITOE

Capitellum, radial head, internal/medial epicondyle, trochlear, olecranon, external/lateral epidcondyle

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10
Q

Pitfall with 3 yr old elbows

A

make sure trochlear and internal/medial epicondyle are not confused for avulsion fracture

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11
Q

pediatric elbow effusion – think?

A

pathognomic for fracture; rx xr in 7-14 days

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12
Q

Elbow alignment lines and associated abnormality?

A

anterior humeral line (supracondylar fracture); radiocapitellar line (elbow dislocation)

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13
Q

most common pediatric fx

A

supracondylar fx, 2nd is lateral condyle fx

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14
Q

most common adult fracture

A

radial head

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15
Q

what is a toddler’s fx

A

nondisplaced spiral fx through tibial metadiaphysis; rotational; faint sclerotic line

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16
Q

radial buckle fx

A

focal cortical irregularity

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17
Q

what is an apophysis?

A

growth plate that does not contriute to logitudinal growth

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18
Q

name the 5 pelvic apophysis

A 
iliac crest
ASIS
AIIS
ischial tuberosity
pubic rami
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19
Q

name muscular attachments to pelvic apophysis

A 
iliac crest: abdominal muscles
ASIS: sartorious
AIIS: rectus femoris
ischial tuberosity: hamstrings
pubic ramus: adductors, gracilis
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20
Q

when do apophyses fuse?

A

arise in puberty, fuse by 3rd decade

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21
Q

what SH injury are apophyseal avulsion injuries?

A

type 1

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22
Q

name 2 femoral apophyses

A

greater trochanter, lesser trochanter

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23
Q

name muscular attacments to femoral apophyses

A

greater trochanter: gluteus medius/minimus

lesser trochnater: iliopsoas (suspicious for pathologic fx in adult)

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24
Q

bone scintigraphy has high sensitivity for what type of fx? low sensitivity for what type of fx?

A

posterior rib, low sensitivity for skull fx

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25
Q

specific fx for child abuse

A

metaphyseal corner fx, posterior rib fx, scapula, sternum fx, spinous process fx

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26
Q

suspicious fx for child abuse

A

polyfracture, fracture out of proportion to history, digital fracture, long bone fx in nonambulatory child, complex skull fx

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27
Q

nonspecific fx concerning for child abuse

A

long one fx in ambulatory child, linear skull fx

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28
Q

NM study for child abuse

A

Tc99 MDP, HMDP, DPD

Several 99mTc-labelled radiopharmaceuticals are available
for bone scintigraphy:
Medronate (methylene diphosphonate, MDP)
Oxidronate (hydroxymethylene diphosphonate, HMDP
or HDP)
Diphosphonopropanedicarboxylic acid (DPD)

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29
Q

Define these terms: rhizomelia, mesomelia, acromelia, micromelia, amelia

A

proximal limb shortening, middle limb shortening, distal limb shortening, entire limb shortening, limb absent

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30
Q

most common cause of dwarfism

A

achondroplasia

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31
Q

key XR findings in achondroplasia

A

frontal bossing of skull, narrowing of interpeduncular distance in the lower spine, posterior scalloping of vertebral bodies, tombstone iliac wings, flat acetabula, short femoral neck

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32
Q

Most common lethal skeletal dysplasia

A

thanotorphoric dysplasia

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33
Q

inheritance of thanotorphoric dysplasia

A

AD

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34
Q

Key findings in thanotorphoric dysplasia

A

platyspondyly, flattening of veretebral bodies (H shaped); curved telephone receiver femurs

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35
Q

Cause for osteogenesis imperfecta

A

abnormal type I collagen

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36
Q

Key indings in OI

A

multiple rib, vertebral body, long bone fx (accordian ribs), ; bowed long bones, osteopenia, wormian bones in skull

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37
Q

What is Jeune syndrome

A

asphyxiating thoracic dystrophy; small thorax causing respiratory distress; AR

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38
Q

XR findings of asphyxiating thoracic dystrophy

A

short ribs (bulbous anteriorly), high riding handlebar clavicle, trident acetabulum

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39
Q

What is cleidocranial dysostosis?

A

abnormalities with clavicles; short or partial absent; also associated with wormian bones

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40
Q

Wormian bones associated with?

A

OI, hypothyroidism, healing rickets, cleidocranial dysostosis, Down syndrome

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41
Q

Key XR findings in cleidocranial dysostosis

A

wormian bones, delayed ossification of skull, widened pubic symphsyis (seen later), clavicular anomalies, supernumary eeth

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42
Q

What skeletal dysplasia and metabolic bone disease cause stippling of epiphyses?

A

chondrodysplasia punctata, multiple epiphyseal dysplasia, hypothyroidism, complications of maternal warfin use

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43
Q

What is chondrodysplasia puncata?

A

rhizomelic, short limbed dwarfism

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44
Q

What is multiple epiphyseal dypslasia

A

Fairbank disease; mildly short limbed AD skeletal dysplasia that manifests in late childhood/adolescense

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45
Q

What is enchondromatoses?

A

syndromes; multiple intra-osseous benign cartilaginous tumors in an asymmetric distribution

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46
Q

Types of enchondromatoses

A

Maffuci ; Ollier

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47
Q

Maffuci syndrome

A

enchondromatosis with venous malformations/hemangioma, lots of phleboliths

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48
Q

Ollier syndrome

A

mostly enchondromatosis with associated limb shortening

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49
Q

enchondromatoses can have malignant transformation into?

A

chondrosarcoma; maffucci > ollier

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50
Q

Multiple hereditary exostoses inheritance pattern? distribution?

A

AD; symmetric, long bone metaphyses

51
Q

Multiple benign osteochondromas syndrome?

A

MHE, osteochondromatosis; usually long bones metaphyses

52
Q

malignant degeneration of osteochondromas?

A

chondrosarcoma

53
Q

What are mucoplysaccharidoses?

A

lysosomal storage disorders – hurlers, morquio, hunters

54
Q

XR findings of mucopolysaccharidoses

A

anterior vertebral beaking, thick ribs, undertubulated bones, Madelung deformity of wrists, J shaped sella/thickened calarium, hypoplastic dens

55
Q

Hurlers XR findings

A

anterior beaking of vertebral bodies, mostly inferiorly

56
Q

Morquio XR findings

A

anterior beaking of middle potion of vertebral body, spinal stenosis, atlantoaxial instability

57
Q

Ddx for child with a limp

A

trauma, septic arthritis, fracture, avascular necrosis, lymphoma

58
Q

Ddx for septic arthritis

A

aseptic toxic synovitis, hemarthrosis in trauma, hemophilia

59
Q

Most common cause of septic arthritis?

A

S aureus

60
Q

XR findings for hip effusion

A

displacement of gluteal/psoas fat planes

widening of teardrop distance

61
Q

What muscles insert on greater trochanter? lesser trochanter?

A

gluteus medius/minimus; psoas

62
Q

best modality of choice to evaluate for hip effusion?

A

ultrasound

63
Q

What type of SH is SCFE?

A

Salter Harris 1

64
Q

What is SCFE?

A

fracture of the proximal femoral epiphysis in obese preadolescents 10-16yo

65
Q

XR findings of SCFE

A

asymmetric widening of proximal femoral growth plate, lack of intersection of Klein’s line

66
Q

What is the Klein’s line?

A

line along lateral margin of femoral neck

67
Q

Bests view to evaluate physeal widening/displacement for SCFE?

A

frog leg lateral projection

68
Q

Is SCFE bilateral or asymmetric usually?

A

asymmetric, but evaluate both sides still

69
Q

Age of presentation for LCP?

A

4-8yo

70
Q

What is LCP?

A

avascular necrosis of the capital femoral epiphysis ossification center

71
Q

XR and NM findings of LCP?

A

XR: subtle sclerosis –> osteonecrosis and distortion of femoral head
NM: Tc99 MDP; decreased uptake and then increased uptake with attempted repair

72
Q

Most common pediatric bone tumor? most common site?

A

osteosarcoma, most common intramedullary type and mostly by the knee (distal femur/proximal tibia)

73
Q

XR of osteosarcoma

A

destructive lesion invading cortex; extensive osteoid matrix

74
Q

second most common primary pediatric bone tumor

A

ewing sarcoma

75
Q

cell type for ewing

A

aggressive small round blue cell tumor; neuroectodermal differentiation

76
Q

Common locations for Ewing

A

femoral diaphysis, flat bones of pelvis, tibia, humerus, ribs

77
Q

common met site of Ewing

A

lung

78
Q

XR appearance of Ewing

A

permeative lesion within the medullary; wide zone of transition; aggressive lammelated/onion skin or spiculated periosteal reaction ; may also have soft tissue mass component

79
Q

What is langerhans cell histiocytosis?

A

abnormal proliferation of LCH (dendritic cells/histiocytes) that live in the epidermis/lymph nodes; Birbeck bodies on electron microscopy

80
Q

Presentation for LCH

A

age 5-15; pain/tenderness/fever; similar to osteomyelitis

81
Q

most common variant of LCH

A

eosinophilic granuloma

82
Q

XR findings of LCH

A 
skull: beveled edge lytic lesion
flat bones: hole in a hole lytic lesion
long bones: diaphysis commonly, permeative destruction with lysis and faint rim of sclerosis
spine: vertebra plana
maxilla: floating tooth
83
Q

Ddx for lytic lesions in undre 30 yos

A

LCH, infection, eosinophilic granuloma

84
Q

Common site for osteomyelitis in bones

A

metaphysis marrow; transphyseal vessels in infants supply the epiphysis; transphyseal infection in older children rare

85
Q

Common organisms for osteomyelitis

A

S aureus, Salmonella in sickle cell

86
Q

XR, NM, MR findings of osteomyelitis

A

XR: irregular lucencies/periosteal reaction
NM: Tc 99m MDP scan with increased uptake on all 3 phases (angio, bone, blood pool phases)
MR: increased T2 weighted sequences, marrow edema

87
Q

Disciitis in kids vs adults

A

infections begins in disk in kids, spread through disk in adults; blood vessels feed intervertebral discs directly in kids

88
Q

Presentation for disciitis

A

young child <4 with preceding URI, new onset back pain/refusal to sit

89
Q

Cmmon location for discitis

A

lumbar spine (young children), thoracic spine (preteen)

90
Q

XR , MR findings of discitis

A

XR: disc space narrowing and vertebral end plate irregularity
MR: narrowing of disc space, bone marrow edema

91
Q

What is CRMO

A

chronic recurrent multifocal osteomyelitis; nonpyogenic inflammatory disorder that mimics osteomyelitis

92
Q

Key imaging findings of CRMO

A

lytic/sclerotic lesions migratory separateed by time and space; no soft tissue abscess, bony sequestra, fistula

93
Q

Associations with CRMO

A

SAPHO: synovitis, acne, pustulosis, hyperostosis, osteoitis

94
Q

XR finding with luekemia

A

metaphyseal lucent band; osteopenia, permeative lytic lesions

95
Q

Causes of metaphyseal lucent band

A

leukemia, severe illness, scurvy, TORCH infections, lymphoma

96
Q

XR rickets findngs

A

fraying/cupping of metaphyses, rachitic rosary, bowing legs, osteopenia, fractures

97
Q

What is oncogenic rickets

A

associated with hemangiopericytoma, NOF due to tumor metabolits that derange vitamin D metabolism

98
Q

Organism for sphilis

A

spirochete Treponema pallidum; can cross placenta

99
Q

What is the Wimberger sign

A

destructive erosion of medial aspect of proximal tibial metaphysis (different from scurvy Wimberger ring sign)

100
Q

XR findings of syphilis in peds

A

symmetric periosteal reaction, Wimberger sign

101
Q

Most common arthropathy in kids

A

JIA: 6+ weeks in pt under 16; RF negative

102
Q

XR findings

A

early: synotitis like; joint effusion, soft tissue swelling, osteopenia
later: periostitis, erosions
chronic: joint ankylosis (wrist, CMC, cervical sign)

103
Q

XR findings of Klippel Feil syndrome

A

segmentation anomalies

104
Q

What is still dx

A

subtype of JIA affecting kids <5yo; fever, anemia, leukocytosis, hepatosplenomegaly, polyarthritis

105
Q

DDH first US performed?

A

4-6w due to normal neonatal ligamentous laxity after birth (perinatal maternal hormones)

106
Q

How to measure DDH on US

A

coronal US

alpha angle: bony ileum/acetabular roof; normal >60 degrees and covers 50% of cartilagenous femoral head

107
Q

DDH XR performed?

A

6 mo when femoral head ossification centers appear

108
Q

Describe Hilgrenreiner line and Perkins line

A

Hilgrereiner: horizontal line through triradiate cartilage

Perkins line: perpendicular through lateral acetabulm perpendicular to Hilgrenreiner line

109
Q

Kids who get DDH

A

breech births

110
Q

Blount disease XR findings

A

oxteochondrosis of tibial metaphysis; usually males <6 unilateral
XR: tibia varus/bowing, internal rotation –> limb length discrepancy/gait deviations

111
Q

Madelung deformity

A

medial sloping of distal radius; dysplasia of medial distal radial diaphysis

112
Q

Panner disease

A

osteochondrosis of capitellum

113
Q

Little league elbow

A

osteochondrosis of medial epicondyle

114
Q

Scheurmann kyphosis

A

AVN of thoracic vertebral bodies; compression fx

115
Q

LCG

A

osteochondrosis of capital femoral epiphysis

116
Q

Kienbock dx

A

osteochondrosis of carpal lunate

117
Q

Osgood Sclater

A

osteochondrosis of tibial tuberosity

118
Q

Freiberg infarction

A

osteochondrosis of 2nd metatarsal head

119
Q

Kohler dx

A

self limited osteochondrosis of navicular bone

120
Q

Sever disease

A

calcaneal apophysitis; heel pain

121
Q

What is torticollis?

A

fibromatosis coli/idiopathic SCM enlargmenet; can’t straighten neck

122
Q

Tarsal coalition

A

abnormal fusion of tarsus bones – osseous, cartilaginous, fibrous
Talocalcaneal/calcaneonavicular

123
Q

Carpal coalition

A

joining of carpal bones; most common lunotriquetral then capitohamate

124
Q

Types of periosteal rx in peds

A

physiologic periosteal rx in newborn, prostaglandid therapy, infectious, syphilis, neoplastic, trauma, metabolic (rickets/scurvy, hypervit A), syndromic (Caffey disease)

CORE--Peds (7 decks)

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