Pediatric Pathologies

Question 0

Four phases of pathophysiology of Osteochondrosis.

Answer 0

1. Phase of avascularity
2. Phase of revascularization
3. Phase of bone healing
4. Phase of residual deformity.

Question 1

Osteochondrosis

Answer 1

Idiopathic

Avascular necrosis of epiphysis
May cause permanent deformity
Self limiting.

Most common 3-10; boys >girls

Question 2

Osteochondrosis: phase of avascularity

Answer 2

First Stage

Obliteration of blood vessels to epiphysis

Asymptomatic

Osteocytes and marrow die. Bone remains unchanged.

Months, years

Question 3

Osteochondrosis: phase of revascularization …

Answer 3

… With bone deposition and resorption

Revascularization of dead epiphysis
Months later

May lead to pathological fracture, subluxation, deformity.
Pain.

Synovial effusion and hypertrophy
Fibrous and granulation tissue rxn results in excessive resorption

Question 4

Osteochondrosis: phase of bone healing

Answer 4

Third phase

Resorption ceases. Deposition continues.

Granulation tissue replaced by new bone.

Question 5

Osteochondrosis: phase of residual deformity

Answer 5

Fourth phase

Once bony healing of epiphysis is complete, contours unchanged

Residual deformity may lead to premature degenerative changes

Question 6

Scheuerman’s disease

Answer 6

Osteochondrosis of thoracic spine

Question 7

Kohler’s disease

Answer 7

Osteochondrosis of navicular

Question 8

Panners disease

Answer 8

Osteochondrosis of capitulum

Question 9

Freiburg infraction

Answer 9

Osteochondrosis of second/third metatarsal

Question 10

Keinbock’s disease

Answer 10

Osteochondrosis of lunate

Question 11

Osgood Schlatter disease

Answer 11

Osteochondrosis of tibial tuberosity

Occurs during period of growth, most commonly in active boys.

Pain, inflammation that goes away with rest.

No necrosis.

Question 12

Leg-Calves Perthes

Answer 12

Osteochondrosis of femoral head

Inadequate blood supply; typically affects one hip

Most common among boys 2-12.

Can cause permanent deformity, increased risk of OA

Question 13

Chandlers disease

Answer 13

Osteochondrosis of hip; Legg-Calves Perthes in adults.

Spontaneous; idiopathic

Pain, collapse of femoral head.

Hip reacement surgery.

Question 14

Sever’s disease

Answer 14

Osteochondrosis of the calcaneus

“Calcaneal apophysitis”
Inflammation in growth plate in heel.

At Achilles’ tendon attachment.

Active children during growth spurt. Mostly boys.

Question 15

Nursemaids elbow

Answer 15

Subluxation of radial head from annular ligament.

Question 16

Osteogenesis imperfecta

Answer 16

Brittle bone disease
Congenital

Deficient or poor Type I collagen

Autosomal dominant. Or recessive. Or de novo (8 types).

Blue sclera. Hearing loss. Loose joints. Hypotoned muscles. Growth retardation. Barrel chest. Bad teeth.

No cure.

Question 17

Rickets

Answer 17

Softening of bones in children

Potentially leading to fractures and deformity.

Breastfed, dark skin, indoors, malnourished.

Related to Vitamin D deficiency; also calcium and/or phosphorus deficiency.

Question 18

Gigantism/Giantism

Answer 18

Overgrowth of long bones due to excessive HGH secretion BEFORE growth plate closes.

Hyperpituitarism – most commonly pituitary adenoma

Question 19

Acromegaly

Answer 19

Excessive HGH production AFTER epiphyseal plate has closed.

Most common cause pituitary adenoma

Headaches, DM,CV problems, kidney failure, frontal bossing

Question 20

Achondroplasia

Answer 20

Dwarfism of short limb type. Most common.

Autosomal dominant or mutation (double dominant = die in infancy)

Failure of longitudinal growth in cartilage of epiphyseal plate.

Thick bones. Hydrocephaly. Genu valgum or varum.

Question 21

Arthrogryposis Multiplex Congenita.

Answer 21

Congenital contractures (“bent joints”) in two or more joints

Caused by anything that limits fetal joint movement in utero.

– oligohydramnios, CT disorders, neuro disorders.

Aplasia/hypoplasia of muscle groups in utero.
Fat and fibrous tissue invade muscle.

Question 22

Still’s disease

Answer 22

Systemic juvenile arthritis

Idiopathic

Characterized by high spiking fevers and transient rashes.

Lymphadenopathy
Hepatosplenomegaly
Hepatitis
Serositis

50% remission rate

Question 23

Spina bifida

Answer 23

Most common congenital abnormality of the spine

Incomplete closure of neural tube, most commonly lumbo-sacral region.

Question 24

3 forms of spina bifida

Answer 24

1. Spina bifida occulta (most common, least severe)
2. Meningocele
3. Myelomeningocele

Question 25

Hemivertebrae

Answer 25

Congenital deformity of the body of the vertebrae. Usually upper L and lower T spine.

Usually other vertebral anomies

Can lead to structural scoliosis.

Idiopathic

Question 26

Syndactyly

Answer 26

Most common congenital abnormally of the hand. Can also affect feet.

Lack of apoptosis. Fusion of digits.

Most common in white males

Question 27

Polydactyly

Answer 27

Congenital. Extra digit on hands or feet.

Inherited or multifactorial.

Question 28

Clubfoot

Answer 28

Congenital talipes equinovarus

Most common congenital foot deformity.

Inversion of foot.

Idiopathic. 50% bilateral.
Boys>girls.

Question 29

Aplasia

Answer 29

Congenital absence of an organ, tissue or part

Question 30

Hypoplasia

Answer 30

Congenital underdevelopment of an organ, tissue or part.

Question 31

Hyperplasia

Answer 31

Congenital overdevelopment of an organ, tissue or part.

Question 32

Pott’s disease

Answer 32

Infectious arthritis of the spine caused by mycobacterium tuberculosis.

Isidious. Develops 2-3 years after infection.

Infection starts in vertebral body and spreads to IVD and adjacent vertebrae

Can lead to vertebral collapse and Potts paraplegia. .

Question 33

Scoliosis.

Answer 33

Abnormal lateral curvature of the spine.

L spine – left more common
T spine – right more common.

Idiopathic (80%)
Osteopathic – due to bony abnormalities
Myopathic – due to muscle weakness
Neurologic