Pediatric orthopedic disorders (obj 28)

Question 1

3 risk factors for congenital hip dysplasia, in order of most to least risk

Answer 1

family history
breech position
female

Question 2

How do you interpret the results of a hip abduction test on a baby?

Answer 2

suspect hip disease if asymmetric or if abduction > 60 degrees is possible

Question 3

Testing a baby for hip DISLOCATABILITY (grasp knees, adduct legs, push down and back - dislocation is palpable as femur head slips out of acetabulum)

Answer 3

Barlow test

Question 4

Testing a baby for hip DISLOCATION (start with knees together, abduct and externally rotate - clunk = reduction and is a positive finding)

Answer 4

Ortolani test

Question 5

Allis sign

Answer 5

when hips and knees are flexed, the knees are at unequal heights, with dislocated side lower

Question 6

On a 2 month old baby, xrays are the most useful way to look at hip dysplasia.
T/F

Answer 6

FALSE - up until 5-6 months of age, xrays are NOT useful because of lack of ossification centers - do ULTRASOUND

Question 7

avascular hip necrosis caused by impairment of blood supply to the developing femoral head - cause unknown

Answer 7

Legg-Calve-Perthes disease

Question 8

Parents bring their 12 year old son to your office - he is limping and complaining of pain on walking.
You see that he is overweight.
You observe his gait and see that his right thigh is externally rotated.
You obtain an xray, and see that Klein’s line does not pass through the right femoral head.
Diagnosis? Treatment?

Answer 8

Diagnosis: SCFE
Slipped Capital Femoral Epiphysis

Treatment: surgical fixation of femoral head

Question 9

SCFE and Legg-Calve-Perthes disease are both known for affecting boys around the age of 10. What’s one way you can differentiate them?

Answer 9

SCFE has PAINFUL limp

Legg-Calve-Perthes has PAINLESS limp

Question 10

The treatment for Legg-Calve-Perthes disease:

Answer 10

Legg-Calve-Perthes USUALLY RESOLVES ON ITS OWN!

Question 11

Fancy term for clubfoot

Answer 11

talipes equinovarus

Question 12

Treatment options for clubfoot:

Answer 12

mild clubfoot: serial plaster casting

severe clubfoot: surgery

Question 13

“toeing-in”

Answer 13

tibial torsion

Question 14

treatment for tibial torsion

Answer 14

usually resolves spontaneously

Question 15

baby’s head is turned to one side due to anomalies of SCM

Answer 15

torticollis

Question 16

torticollis can be associated with _____ so be sure to do a thorough full-body musculoskeletal exam

Answer 16

hip dysplasia

Question 17

two possible treatments for torticollis

Answer 17

stretching/passive ROM

surgery if necessary

Question 18

greater than 10 degree curve by Cobb angle = ______

Answer 18

scoliosis

Question 19

What physical exam test can be done to check for scoliosis?

Answer 19

Adams forward bend

Question 20

What xray views do you want to get for scoliosis?

Answer 20

STANDING full column AP and lateral

Question 21

What are three treatment options for scoliosis?

Answer 21

observation
bracing
surgical spinal fusion

Question 22

genu _____ is normal from 0 - 2 yrs old, then switches to genu _____, after which adult alignment is usually obtained.

Answer 22

genu varum is normal from 0 - 2 yrs old

genu valgus is normal from 2 - 8 yrs old

Question 23

most common foot deformity in newborns

Answer 23

metatarsus varus/metatarsus adductus

two names for the same thing

Question 24

metatarsus varus/adductus usually _________ by age _____________

Answer 24

usually spontaneously resolves by age 1-2

Question 25

treatment for femoral anteversion:

Answer 25

femoral anteversion is a variant of normal and requires NO treatment

Question 26

subluxation of the radial head = ________

and is caused by ________

Answer 26

nursemaid’s elbow; caused by pulling child’s arm or lifting by pulling on hand

Question 27

treatment for nursemaid’s elbow:

Answer 27

place elbow in full supination; slowly move from full extension to full flexion; palpate for click at radial head; this should provide immediate pain relief

Question 28

~6+ weeks of joint swelling
~no other cause of childhood arthritis
~diagnosis?

Answer 28

Juvenile Idiopathic Arthritis
aka
Juvenile Rheumatoid Arthritis

Question 29

Treatment for Juvenile Idiopathic Arthritis?

Answer 29

1. NSAIDs
2. glucocorticoids
3. DMARDs

Question 30

Acute onset of hip or knee monoarticular joint swelling, redness, & pain = _____, most likely caused by _____ (or ______)

Answer 30

septic arthritis

most likely caused by MSSA or N. gonorrhoeae

Question 31

Synovial fluid findings in septic arthritis:

Answer 31

WBC count > 50,000
PMN > 80%
positive culture