Pediatric Musculoskeletal

Question 1

If a pediatric patient admits to the ER with a contusion, what is the therapeutic management of it?

Answer 1

RICE (rest, ice, compression, elevation)

Question 2

What is a sprain?

Answer 2

partial or complete tear of a ligament

Question 3

What is a strain?

Answer 3

tear to musculotendinous unit

Question 4

What are the two most common types of fractures?

Answer 4

distal forearm (radius, ulna, or both), clavicle

Question 5

How are growth plate injuries classified?

Answer 5

Salter-harris classification

Question 6

What is a complicated fracture?

Answer 6

Bone fragments have damaged other organs or tissues

Question 7

What is a comminuted fracture?

Answer 7

Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue

Question 8

What does a buckle or torus fracture look like?

Answer 8

raised or bulging projection at the fracture site

Question 9

What are the goals of fracture management?

Answer 9

To regain alignment and length of the bony fragments (reduction)
To retain alignment and length (immobilization)
To restore function to the injured parts
To prevent further injury and deformity

Question 10

What is the most useful diagnostic tool when looking for a fracture?

Answer 10

x-ray

Question 11

What is a spica?

Answer 11

hip or knee injury that requires a cast

Question 12

What are the 6 P’s?

Answer 12

Pain, pulselessness, pallor, paresthesia, paralysis, pressure

Question 13

What are 3 things seen with pallor?

Answer 13

Pale-appearing skin, poor perfusion, capillary refill greater than 3 seconds

Question 14

What is paresthesia?

Answer 14

tingling or burning sensation

Question 15

What is assessed when assessing pressure for a fracture/casted region?

Answer 15

Involved limb or digits may feel tense and warm; skin is tight, shiny; pressure within the compartment is elevated

Question 16

Why is a spica cast placed?

Answer 16

to immobilize the hip joint

Question 17

What pulses need to be checked in relation to a fracture?

Answer 17

distal

Question 18

What is the purpose of traction?

Answer 18

To fatigue the involved muscles and reduce muscle spasm so that bones can be realigned

Question 19

What are the three types of traction?

Answer 19

manual, skin, and skeletal

Question 20

What is an example of skeletal traction?

Answer 20

halo brace for cervical traction

Question 21

What is an example of skin traction?

Answer 21

Buck traction

Question 22

When is manual traction used?

Answer 22

closed reduction

Question 23

What are the two pathological groups of developmental dysplasia of the hip?

Answer 23

idiopathic (neurologically intact) and teratologic (neuromuscular defect)

Question 24

What is subluxation?

Answer 24

incomplete dislocation of a joint

Question 25

What are the two most common tests done to evaluate hip dysplasia?

Answer 25

Positive ortolani test and positive barlow test

Question 26

Can an x-ray be used to diagnose hip dysplasia of a newborn?

Answer 26

No, because the femoral head is not ossified yet

Question 27

When should DDH be fixed?

Answer 27

as early as possible

Question 28

What is a pavlik harness used for?

Answer 28

abduction of the hip

Question 29

How often does a Pavlik harness need to be worn?

Answer 29

22-24 hours a day

Question 30

What is osteogenesis imperfecta characterized by?

Answer 30

excessive fragility and bone defects

Question 31

What kind of medication would a child with osteogenesis imperfecta be given?

Answer 31

medications that promote bone density and prevent fractures

Question 32

what is the most common spinal deformity?

Answer 32

idiopathic scoliosis

Question 33

What are the three planes that spinal deformities are found?

Answer 33

lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis

Question 34

What technique is used to measure the angle of curvature for idiopathic scoliosis?

Answer 34

Cobb technique

Question 35

What angle would the spine have to be to consider operative management of scoliosis?

Answer 35

45-50 degrees

Question 36

What is osteomylitis?

Answer 36

infectious process in the bone

Question 37

What is the most common causative organism for osteomyelitis?

Answer 37

staphylococcus aureus

Question 38

How can osteomyelitis be diagnosed?

Answer 38

X-ray vs bone scans
Labs: leukocytosis, ESR, CRP, culture

Question 39

What is septic arthritis?

Answer 39

bacterial infection of the joint

Question 40

What is the most common causative agent of septic arthritis?

Answer 40

Depends on the age

Question 41

Where is septic arthritis most common?

Answer 41

hip, knee, ankle, elbow

Question 42

What are the clinical manifestations of septic arthritis?

Answer 42

Joint pain, swelling, warmth to area, erythema
Fever, malaise, headache, N/V, irritability

Question 43

How can juvenile idiopathic arthritis be diagnosed?

Answer 43

It is a diagnosis or exclusion and there are no definitive tests

Question 44

What is juvenile idopathic arthritis?

Answer 44

inflammation in joint synovium and surrounding tissue

Question 45

When is JIA diagnosed?

Answer 45

mid school aged years to teenage years

Question 46

What are the therapeutic management goals for JIA?

Answer 46

control pain, preserve joint ROM and function, minimize effects of inflammation, promote normal growth and development

Question 47

What medications are given to manage JIA?

Answer 47

NSAIDS, DMARDs, glucocorticoids