Pediatric musculoskeletal Flashcards
What causes developmental dysplasia of the hip?
Poor development of acetabulum in utero
An infant comes in for a well child check and has positive Barlow and Ortolani maneuvers. What is going on? What other sign could be positive? Child is less than four months old, what should be done?
Developmental dysplasia of the hip
Galeazzi sign (uneven knees when hips and knees are flexed)
Ultrasound the hip
An obese black 12yo comes limping in with knee and thigh pain. On exam, she has limited internal rotation and abduction of the hip and hip flexion produces an obligatory external hip rotation. What is going on? What are the concerns?
Slipped capital femoral epiphysis
Avascular necrosis
Premature osteoarthritis
SCFE on contralateral side if hypothyroid
A kid is brought in due to delayed walking and bowed legs. On labs, he has increased alk phos, decreased phosphorus, decreased calcium, decreased vitamin D, and increased PTH. What is going on?
Rickets due to hypocalcemia…secondary to deficient intake, absorption, or metabolism of vitamin D
A kid comes in with significant upper arm pain after bumping into the wall; x-ray shows a fracture. On exam, she is found to have kyphoscoliosis and proximal limb weakness. Labs show increased alk phos, decreased phosphorus, and increased vitamin D and PTH. What is going on?
Rickets due to impaired phosphate absorption
A 2-3yo has morning stiffness and swelling in the same 2-3 large joints and eye pain for the last 3+ months. What is likely going on? Treatment? What is the biggest concern?
Pauciarticular JIA (weakly positive ANA)
NSAIDs; methotrexate for chronic (rare)
Blindness from iridocyclitis…leg length discrepancy can also happen
A patient (2-5yo or 10-14yo) comes in with symmetric joint stiffness, back stiffness, hand deformities, fever, and decreased growth. What is likely going on? Treatment? What is the prognosis?
Polyarticular JIA (increased ESR, decreased Hgb, ANA [young] or RF [older])
NSAIDs, methotrexate, sulfasalazine, or etanercept
60% remission within 15yrs…worse with older onset
A child (less than 17yo) comes in with any number of joints that have acute significant pain that follows fevers (often includes neck/jaw involvement), a maculopapular rash, and on exam found to have organomegaly, lymphadenopathy and a friction rub on chest auscultation. What is likely going on? Treatment? Prognosis?
Systemic JIA (increased WBC, decreased Hgb, increased ESR)
NSAIDs, methotrexate, corticosteroids, cytotoxic drugs
50% remission at some point
Amyloidosis is a possible complication
How can the Salter-Harris physeal fracture classification be remembered?
SALTE
I- S: Same II- A: Above (proximal) III- L: Lower (distal) IV- T: Through V- E: Everything (crush)
A young child comes in with a sore, immobile elbow after mom pulled him out of the road. What happened? How is it fixed?
Nursemaid’s elbow…radial head subluxation
Manual reduction via supination of the arm with flexion of the elbow from 0-90 degrees of flexion
What has to be done for Legg-Calve-Perthes disease? What are the likely outcomes?
Contain the hip within acetabulum (brace or surgery)
Acetabular reconstruction performed in cases of permanent hip dysplasia
50% completely recover w/o treatment
Hip issues later in life
A 2-6yo comes in with progressive clumsiness, difficulty getting up and walking (Gower maneuver…pushes on thighs with hands to help stand up). What could be going on? What is seen on biopsy? What is the prognosis?
Duchenne muscular dystrophy (x-linked deficiency of dystrophin)
Fiber degeneration and fibrosis; basophilic fibers; absent dystrophin on immunostaining is diagnostic
Progresses to cardiac issues, scoliosis, and flexion contractures
Death by 20yo…respiratory issues
What is difference between Duchenne and Becker muscular dystrophies?
Becker has less severe symptoms and progresses slower
