Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Pediatric Orthopedics > Flashcards

Pediatric Orthopedics Flashcards

1
Q

A true groin pull is actually what type of strain?

A

adductor strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

common injuries along with groin pain

A
  • Avulsion fractures of the pelvis are common in young adults
  • Stress fractures of the femoral neck is a common injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Refusal to bear weight at all
Refusal to move hip
Pain more than 24-48 hours

dx?
tx?

A

groin pain
PT, NSAIDs, rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3 types of knee pain

A
  1. acute
  2. chronic
  3. popping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

acute knee pain causes

A
  1. ligaments - torn ACL, MCL
  2. fx - tibial spine or osteochondral fx (MC), patellar sleeve
  3. PE:
    - Ballotment Test - effusion
    - Patellar Apprehension test - patellar dislocation
    - Lachman - ligamentous injury
    - Anterior Drawer - ligamentous injury
    - McMurray’s Test - meniscus tears
    - Varus and Valgus injuries - may be associated with popliteal artery injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

an important bony prominence that anchors the attachment of the ACL

A

Tibial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

an avulsion fracture of the ? is the equivalent of an ACL rupture in adults

A

tibial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tibial spine fx s/s

A

Hemarthrosis, joint pain, markedly decreased ROM, sudden pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

tx for tibial spine fx

A
  • Nondisplaced - immobilization in extension, ortho f/u; dx by radiographs, repeat in 2 weeks to check healing
  • Displaced - reduction and immediate ortho consult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Osteochondral fractures to the intra-articular portions of the femoral condyles or tibial plateau MC associated with what other injuries?

A
  1. frequently accompany patellar dislocation
  2. ligament tears
  3. meniscal injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what findng may arise from Osteochondral Fractures?
Results in mechanical sx (catching, locking)
If untreated, will develop in osteoarthritis
Will complain of continued pain, swelling, and mechanical

A

Osteochondral fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

screening of choice for Osteochondral Fracture

A

MRI
refer to peds ortho

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • Caused by an indirect force applied to the patella through sudden, forceful contraction of quadriceps to a flexed knee
  • someone lands on feet after jumping from moderate height or comes to sudden stop from full sprint
  • knee joint effusion or hemarthrosis and focal tenderness of patella
  • May not be able to extend knee against gravity

dx?
w/u?
tx?

A
  • Patellar Sleeve Avulsion Fracture
  • XR, MRI
  • immobilize knee with ortho referral for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Should the force generated by the quadriceps exceed the strength of the patella, what often results?

A

avulsion fracture - Separation between cartilage “sleeve” and main part of patella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F: patellar sleeve fx - hemarthrosis and PE findings are more predictive than XR findings

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is osteochhondritis dissecans

A
  1. Osteonecrosis of subchondral bone due to overuse
  2. Similar to AVN
  3. Localized lesion in which segment of subchondral bone and articular cartilage separates from underlying bone
    - necrotic bone is replaced by subchondral trabeculae or cartilage
  4. focal areas of demineralization and repeated shear forces = detachment of bone and overlying cartilage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

w/u and tx for osteochondritis dissecans

A
  • XR initially, MRI is dx of choice
  • PT/knee immobilization 4-6 weeks
  • Surgery for those who do not respond
  • Pain journal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

osteochondritis dissecans Can result in ? if not adequately treated .

A

premature arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

possible causes of popping knee pain?
tx?

A
  • Pain, Edema? after an injury ?
  • More and more loose / unstable?
  • Cartilage damage?
  • Abnormal meniscus?
  • Tx: bracing and PT; May need an MRI/ Ortho
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MC ankle sprain

A

Calcaneofibular ligament and anterior talofibular ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

s/s of sprain ankle?
tx?

A
  • Edema around the site, not ON the bone
  • Improves over a few days time
  • Tx: Brace, support, NSAIDS; Still need controlled ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ligament sprain grading

A
  • grade I - stretching, small tears
  • Grade II - larger, but incomplete tear
  • Grade III - complete tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

possible causes of a limp in child

A
  • INJURY / INFLAMMATION OR INFECTION
  • TUMOR OR CANCERS
  • CONGENITAL ANOMALIES
  • LCP DISEASE
  • SCFE
  • DISKITIS
  • CNS DISORDER
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  • MCC for inflammatory childhood limp
  • an inflammation of the joint- hips and knee affected MC
  • occurs after a recent URI
A

Toxic synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

a bacterial infection of the hip and far more dangerous

A

Septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

criteria for septic arthritis

A

Kosher Criteria: >101.3, ESR > 40 , WBC >12K, NO wt-bearing

  • Level 1 - 3% chance of SA
  • Level 2 - 40%
  • Levels 3 & 4 - almost definite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

w/u and tx for Transient Synovitis vs Septic Hip

A
  1. AP pelvis w/ frog leg views
    - Hip effusions, bony changes, soft tissue shadows - in both
    - U/S for effusions - both
    - MRI of pelvis (septic) - bone marrow destruction / bone erosion / cartilage destruction
  2. Labs - CBC, ESR, CRP, BMP
  3. I&D if needed - aspiration of joint fluid; abx - cover staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MCC of Intoeing in infants birth to < 1y/o

A

Metatarsus Adductus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  • Inward deviation of the forefoot in relation to the hind foot
  • Does not involve the ankle
  • Ventral crease in medial aspect of the arch
  • “C”-shaped foot or “kidney bean” shape
A

Metatarsus Adductus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Metatarsus Adductus is linked to ___ ___ and postion in the womb

A

intrauterine molding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

RF for metatarsus adductus

A

breech presentation, family history of MA, hip dysplasia, decreased amniotic fluid, first born, twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which foot is MC seen with metatarsus adductus?

A

Left - if unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

when does Metatarsus Adductus usually resolve?

A

MC 1st birthday
rest by 5-6 y/o w/o intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

category severity of metatarsus adductus

A
  • Mild – examiner can passively over-correct the deformity into abduction with little effort
  • Moderate – examiner can passively correct the deformity only into middle position
  • Severe – examiner is unable to correct the deformity to midline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

tx for metatarsus adducutus

A
  • mild-mod: Treatment - stretching, observation
  • severe: corrective casting before 8 months of age or surgery in severe cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q
  • Congenital deformity present at birth or on prenatal US
  • Foot points downward and inward and soles of feet face each other - foot appears internally rotated at ankle
  • Shortening of Achilles tendon, tendons of medial lower leg, unusual shape to talus bone
  • Idiopathic or isolated 80%
  • Males > females
A

Clubfoot (Talipes Equinovarus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
  • Calf muscles appear underdeveloped
  • Plantar flexion of the foot and ankle
  • Inversion of the heel
  • Medial deviation of the forefoot
A

Clubfoot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clubfoot associated conditions?

A
  • dec amniotic fluid, genetic factors, familial history, twins, spina bifida
  • smoking during pregnancy (20x avg risk), infection during pregnancy or illicit drug use while pregnant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

types of clubfoot

A
  • Congenital: Unknown etiology (MC)
  • Syndromic: Spina Bifida
  • Positional: Intrauterine crowding, Breech, Low amniotic fluid
40
Q

tx for clubfoot

A
  1. Ponseti Method - foot manipulation, casting
  2. Surgery - achilles tendon release
  3. French Functional Method - stretches and exercise, massage, immobilize and taping foot position, PT until 2 y/o
41
Q

Most common cause of intoeing and out-toeing in older children

A

Tibial Torsion - “Knock-knees” or “Pigeon-toes”

42
Q

MCC of intoeing in children aged 1 - 3

A

Internal Tibial Torsion

43
Q
  • Inward twisting of tibia (tibia rotated inward)
  • Usually noticed when toddlers start to walk
  • Medially deviated foot with patella facing forward
A

Internal Tibial Torsion

44
Q

Fastest runners are typically ? (sprinters and athletes)

A

in-toed

45
Q

Tibial Torsion usually resolves by what age when tibia rotates laterally

A

5 yrs

46
Q

mgmt for tibial torsion?

A
  • XR to R/O hip dysplasia
  • CT scan of hips and femur
  • No tx unless feet still turn inward by >15 degrees at age 5 – spontaneous correction unlikely at that point
  • Refer to orthopedics if > 8 y/o and activity is limited or cosmetic reasons
  • orthotics is ineffective
47
Q
  • MCC of out-toeing in toddlers and young children
  • identified when child begins to walk
  • Medial malleolus is anterior to lateral malleolus
  • Can be discovered later at 4-7 years old or early adolescence
  • Can worsen over time but doesn’t cause sx
  • Normal rotational variant due to intrauterine positioning
A

External Tibial Torsion

48
Q
  • Increased angle of rotation of femoral neck in relation to transcondylar axis of femur
  • Prefer sitting in “W” position
  • “Egg-beater” or “Windmill” pattern of walking and swimming
  • Familial
  • Refer if persists past 11 years of age
  • Femoral derotational osteotomy (child with severe dysfunction or deformity)
A

Femoral Anteversion

49
Q

MCC of intoeing after 3 y/o
Inward facing feet and patella

A

Femoral Anteversion

50
Q

definition of unstable hip?

A

hip loose in socket with abnormal movement

51
Q

definition of subluxation hip

A

partial dislocation (hip partly out of socket)

52
Q

definition of dislocated hip

A

hip completely out of socket

53
Q

definition of hip Dysplasia

A

wide spectrum term ranging from unstable to dysplastic to malformed

54
Q

definition of Newborn hip instability preferred term by AAP

A

hip noted to enter and exit socket
- Normally formed hip that becomes displaced in utero or at ≤ 1 yr of age in otherwise healthy child

55
Q

Instability or looseness of hip joint. Head of femur loose and may dislocate

A

DDH – Developmental Dysplasia of Hip

56
Q

RF for DDH

A
  • Familial link – 30x more likely
  • Girls
  • Breech, Twins, First born
  • Swaddling link
57
Q

which hip is MC affected with DDH?

A

left hip

58
Q
  • Asymmetrical buttock or thigh hip creases / skin folds
  • Hip clicks - may be normal
  • Difficulty diapering
  • Painless, but exaggerated waddling limp after learning to walk
  • Swayback
  • Limited abduction of the hip
  • Trendelenburg sign
A

DDH

59
Q

painless limp and lurch to one side with a dip in pelvis on opposite side when child stands on affected leg (secondary to weakness of gluteal muscle)

A

Trendelenburg

60
Q

barlow maneuver?

A
  • Thigh grasped loosely with examiner’s index and middle finger along the greater trochanter and thumb along inner thigh
  • Hip adducted and posteriorly directed pressure applied
  • “jerk” or “clunk”
61
Q

Ortolani Maneuver?

A
  • Thigh grasped loosely in same manner as the Barlow Maneuver
  • From an adducted position – the hip is abducted while lifting the trochanter anteriorly
  • “jerk” or “clunk”, even a sliding type sensation like a “ball moving in a bowl”
62
Q

types of DDH

A
  1. Subluxated: Head of femur loose in socket; Bone moved during physical exam but won’t dislocate
  2. Dislocatable: Head of femur is in acetabulum but easily pushed out during physical examination
  3. Dislocated: Most severe; Head of femur completely out of socket
63
Q

w/u for DDH

A
  • US – standard for diagnosis
  • XR – AP pelvis, bilateral hips and frog leg views
64
Q

when to US suspected DDH?

A
  • Any child w/ instability
  • born breech > 34 weeks gestation should be screened
  • FHx DDH
65
Q

when to XR for suspected DDH

A
  • Any child 4 - 6 months of age and older with instability
  • Any child with a limp or unstable gait when able to walk
66
Q

tx for DDH

A
  • MC resolve by 2 – 6 wks of age
  • Positive Ortolani at any age - refer
  • Positive Barlow - observe and follow
  • 0 – 6 mo – Pavlik Harness
  • 6 – 18 mo – closed reduction, Spica casting x 2-3 mo
  • 18 mo – 6 yrs – closed reduction vs. open reduction
  • > 6 yrs – no tx
67
Q
  • Inflammation of the patellar tendon
  • Growth spurts during puberty
  • Pain and tenderness to tibial tubercle +/- edema
  • Worsens with activity / Improves with rest
  • Tightness in surrounding muscles
  • Usually unilateral, BL 25 – 50%
  • Overuse injury caused by repetitive strain and chronic avulsion of ossification center of tibial tubercle
A

Osgood Schlatter Disease

68
Q

tx for OSD

A
  • RICE, stretching quads, PT if needed
  • Complete avoidance of PE not recommended – playing IS permitted. No crutches or knee immobilizers
69
Q

Most common chronic anterior knee pain in athletes
Degeneration of cartilage due to poor alignment of kneecap
Abnormal tracking allows patella to grate over the femur causing chronic inflammation

A

Patellofemoral Syndrome

70
Q

Patellofemoral Syndrome - who is at highest risk?

A

teenage females

71
Q
  • Aggravated by activity or prolonged sitting with bent knees – “theatre sign”
  • Vague discomfort inner front knee with running, climbing, jumping and stairs
  • Patient points to anterior knee or around entire patella as area of pain
  • Knock-knee, flat footed

dx?
w/u?
tx?

A
  • Patellofemoral Syndrome
  • Clinical, may see on x-ray or MRI
  • Ice, NSAIDS, DC activity causing the pain
72
Q

Ball of upper end of femur slips off in a backward direction secondary to weakness in the growth plate
One of the most common hip disorders in adolescents

A

Slipped Capital Femoral Epiphysis

73
Q

biggest RF for Slipped Capital Femoral Epiphysis

A

obesity

74
Q

Slipped Capital Femoral Epiphysis MC seen at which hip?

A

left hip

75
Q
  • Several weeks or months of hip or knee pain, intermittent limp. Pain during exam with limited internal hip rotation.
  • acute or chronic
  • Stable – can ambulate with assistance such as crutches; foot is gradually externally rotating
  • Unstable – cannot ambulate even with crutches. Non-weight bearing

dx?
w/u?

A

SCFE
X-ray, U/S, MRI

76
Q

tx for SCFE

A
  • Surgery – internal fixation with single cannulated screw placed in center of epiphysis
  • Post-op - Limited weight bearing and crutches
77
Q

how to categorize SCFE

A

Categorized by % displacement

  • Type 1 (mild) - < 33% displaced (epiphysis < 1/3 diameter of femoral head)
  • Type 2 (moderate) – 33 – 50% displaced
  • Type 3 (severe) - >50% displaced
78
Q

complications of SCFE

A
  • AVN of femoral head
  • Chondrolysis at hip joint (loss of cartilage); osteoarthritis
79
Q
  • Blood supply temporarily interrupted to femoral head
  • Bone dies and easily breaks
  • Idiopathic avascular necrosis of the hip
A

Legg-Calve Perthes Disease

80
Q

Legg-Calve Perthes Disease MC affects who?

A
  • boys
  • caucasians (AA very rare)
  • 3 – 12 years old, peak 5 – 7
81
Q

s/s LCPD

A
  • Limp
  • Pain or stiffness in hip, groin, thigh or knee
  • Limited ROM to hip joint
82
Q

w/u for LCPD

A
  • XR - May take 1-2 mo to show; Joint effusion with widening of joint space and periarticular swelling
  • MRI
  • Bone Scan
83
Q

tx LCPD

A
  • Protection of the joint by minimizing impact
  • PT
  • Avoid weight bearing
  • Traction
  • Casting
  • Home Therapy - Activity modification, Pain meds, Ice / Heat
  • Surgery controversial – tendon release, joint realignment, joint replacement
    Increased risk of arthritis in adulthood
84
Q

Any degree of curvature of the spine as described by the ?

A

Cobb’s angle

85
Q

scoliosis is Screened age 8 – 9 and older by ?

A

Adam’s forward bend test (AFB)

86
Q

how to dx scoliosis?

A

XR
Cobb’s angle

87
Q

tx for scoliosis

A
  • < 20 degrees – follow for progression
  • > 20 degrees or progression of ≥5 degrees – refer for bracing or surgery
88
Q

what is a Toddler’s Fracture?

A
  1. 9 – 36 months MC age
  2. Distal ½ of tibia
  3. Trivial injury common - Fall from low height, Tripping, Twisting ankle
  4. “CAST” – Childhood Accidental Spiral Tibial fracture
  5. Refuse to bear weight on extremity
  6. Screen for child abuse
89
Q
  • Genetic connective tissue disease
  • Multiple and recurrent fractures
  • Blue sclera
  • Thin skin
  • Hyperextensibility of ligaments
  • Otosclerosis w/ hearing loss
  • Deformed teeth
  • Osteoporosis / Osteopenia
A

Osteogenesis Imperfecta

90
Q

Genetic mutation causing short-limbed dwarfism - autosomal dominant w/ 80% cases from random mutation

A

Achondroplasia

91
Q
  • Short stature – usually around 4 feet tall max
  • Average-sized trunk
  • Short arms and legs w/ bowing
  • Waddling gait
  • Macrocephaly with prominent forehead
  • Normal Intelligence and sexual function

dx?
tx?

A
  • Achondroplasia
  • Endocrine - growth hormone in some cases; Genetics
92
Q
  • Birth defect causing the early growing together of two or more bones of the skull
  • Sutures close too early
  • Sporadic – occurs by chance
  • Asymmetrical head shape or appearance, hydrocephalus
A

Craniosynostosis

93
Q

what is Plagiocephaly?

A

abnml head from how a baby is laid

94
Q
  • Specifically referred to as X-linked hypophosphatemia (XLH)
  • 80% of all hypophosphatemia
  • Mutation of the phosphate-regulating gene
A

Familial Hypophosphatemic Rickets

95
Q

s/s of familial hypophosphatemic rickets

A
  • Impaired growth and rickets of the femur/tibia - short stature of the lower limbs
  • Dental abnormalities - delayed dentition and abscesses
  • Deafness
  • Chiari malformation of the brain
  • Calcification of tendons, ligaments and joints
  • Craniosynostosis
96
Q

w/u and tx for Familial Hypophosphatemic Rickets

A
  • XR - short, coarse long bones
  • Labs - severe hypophosphatemia (< 2.5), elevated serum alk phos, Ca normal to low
  • Tx: Calcitriol with Amiloride and HCTZ; GH possible option
97
Q

what is Nursemaid Elbow?
tx?

A
  • Subluxation of radial head
  • 1-4 years of age MC
  • Tug or pull injury
  • Holds arm by side - fully pronated, refuses to use
  • XR normal
  • Tx: closed reduction – supinate hand and flex elbow – “pop” over radial head

Pediatrics (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions