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Pediatrics > Pediatrics Ortho > Flashcards

Pediatrics Ortho Flashcards

1
Q

You see a pt w/ deformity from scoliosis confirmed w/ x-ray, discrepancy in leg lengths, and Adam’s test. What should you consider?

A 
level of curvature (Cobb angle)
age of pt/skeletal maturity (Risser score) 
age of menarche
duration
family hx
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2
Q

what should be done for pts w/ scoliosis and Cobb angle of 0-20 degrees?

A

look at age, re-xray pt in 6 months

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3
Q

what should be done for pts w/ scoliosis and Cobb angle of 20-30 degrees?

A

Thoracal Lumbar Sacral Orthosis brace (TLSO) 18-20 hrs/day and ortho referral

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4
Q

what should be done for pts w/ scoliosis and Cobb angle of 40+ degrees?

A

ortho referral

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5
Q

if you see a left sided curve in scoliosis, what should you do?

A

refer pt

left sided curves have high association w/ interspinal anomalies even if no pain

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6
Q

what is postural roundback?

A

flexible deformity not associated w/ vertebral wedging

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7
Q

what is Pre-Scheuermann’s Kyphosis?

A

initially flexible roundback loses its flexibility and pt develops hamstring tightness (occurs in ages 9-12 yrs.).x-ray shows kyphosis w/out wedging

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8
Q

what is Scheuermann’s Kyphosis?

A

associated w/ wedged thoracic vertebra

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9
Q

What is the tx for postural roundback?

A

postural and PT early

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10
Q

what is the tx for pre-scheuermann and scheuermann’s kyphosis?

A

refer for eval and bracing

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11
Q

what is a common cause of low back pain in young people?

A

spondylolysis/listhesis

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12
Q

how is spondylolithesis graded?

A 
by how much slide
grade 1: <25% diameter
grade 2: 25-50%
gade 3: 50-75%
grade 4: 75-100%
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13
Q

what is spondylolithesis?

A

A lumbar spinal disorder in which a bone (vertebra) slips forward onto the bone below it

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14
Q

what causes spondylolithesis?

A

repeated stress in hyperflexion and/or rotation

more common in gymnasts, athletes, divers, dancers

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15
Q

pt presents with restricted motion, hamstring tightness, decreased walking tolerance (one leg bearing more weight and other leg is hyperextending) and LOW BACK PAIN W/ ROTATION. You notice the pt tends to rotate towards the affected side. what do you suspect?

A

spondylolysis/lithesis

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16
Q

What is Spondylolysis?

A

Spondylolysis is a stress fracture through the pars interarticularis of the lumbar vertebrae

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17
Q

What should be physically examined in spondylolithesis?

A

lumbar spine exam, distal dermatomes and myotomes

one leg weight bearing w/ rotation

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18
Q

What imaging should be ordered in Spondylolithesis?

A

lumbar spine x-rays (scotty dog film + flexion/extension laterals)
CT, MRI and bone scans can be ordered if dx still questionable

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19
Q

what is the treatment for Spondylolithesis?

A

activity modification
analgesics (avoid opiates)
bracing and PT
surgery in severe cases

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20
Q

what is discitis?

A

bacterial infection of vertebral disc seen w/ vertebral osteomyelitis

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21
Q

2-9 yr old pt presents w/ sudden onset of severe back pain, refusal to walk, and irritability. pt is febrile w/ limited back motion. Upon PE, there is localized tenderness over the area along w/ paraspinal muscle spasm. What do you suspect?

A

discitis

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22
Q

what will be seen in the workup for discitis?

A

ESR (80-100), elevated WBC and CRP, + blood culture

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23
Q

what imaging is preferred for discitis?

A

CT is good, but MRI is better (x-ray not helpful)

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24
Q

what is the tx for discitis?

A

referral to pediatric ID specialist

broad spectrum abx if no organism isolated (IV route for 6-8 wks)

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25
Q

what is Legg-Calve-Perthes disease?

A

avascular necrosis of the femoral head

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26
Q

5-10 yr old Caucasian boy is limping and has pain in/slightly above the knee. Upon PE, there is decreased external hip ROM. what do you suspect?

A

Legg-Calve-Perthes disease

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27
Q

what is the tx for Legg-Calve-Perthes disease?

A

refer to ortho

28
Q

what is slipped capital epiphysis?

A

common orthopedic condition in 12-17 yr old boys w/ obesity caused by weakening of physis leading to a slip (femoral head falls off femoral neck)

29
Q

overweight teenage boy w/ knee pain walking w/ the limb externally rotated. Upon PE, there is almost no external rotation of the hip. what do you suspect?

A

slipped capital epiphysis

30
Q

what should be examined in slipped capital epiphysis?

A 
X-ray (hip film) if >6 months old 
hip ROM (little/no external rotation of the hip will be present)
31
Q

what is the tx for slipped capital epiphysis?

A

refer to ortho (surgery)

32
Q

how is congenital hip dysplasia identified?

A

Ortolani and Barlow maneuver (palpable clunk when hip is reduced in and out of acetabulum)

33
Q

what is the best imaging choice for congenital hip dysplasia?

A

ultrasound

34
Q

child has palpable clunk with the ortalani maneuver; however, imaging is normal. What should you do?

A

tx w/ Pavlik harness

have ortho f/u

35
Q

pt has knee pain w/ bending, squatting and kneeling. Upon palpation of the patella, there is tenderness and pain w/ quad flexion. what do you suspect?

A

chondromalacia

36
Q

what should you do if you suspect chondromalacia?

A

knee exam, x-ray w/ sunrise view

tx w/ NSAIDs, quad strengthening, PFO brace, occasionally patellar realignment

37
Q

adolescent presents w/ anterior knee pain and has a bump located over the tibial tuberosity. what do you suspect?

A

osgood schlatters disease

38
Q

what are causes of osteomyelitis?

A

S. Aureus (most common)
Newborns can acquire Neisseria gonorrhoeae from infected birth canal
Gonoccocal arthritis in sexually active teens, or younger children w/ sexual abuse

39
Q

infant presents w/ fever, focal swelling, redness and is guarding the affected body part. they are unable to support weight and asymmetric movement of the extremities is noted. what do you suspect?

A

osteomyelitis

40
Q

what should be ordered if you suspect osteomyelitis?

A

labs: CBC-WBC (elevated in 50%), ESR and sed rate elevated, CRP
X-ray
bone scan
MRI (best option)

41
Q

child looks ill, is febrile, and refuses to walk/move affected joint. there is effusion and erythema in the joint. the child is holding the joint in a position of least pain. what do you suspect?

A

septic joint disease

42
Q

what should be ordered if you suspect septic joint disease?

A

labs: CBC, sed rate, CRP, blood cx, joint aspiration w/ gram stain and cell count
x-ray

43
Q

what is the tx for septic joint?

A

immediate referral (delay can result in irreversible damage), joint wash-out, adequate antibiotic coverage for sufficient period of time

44
Q

what is the most common cause of heel pain in children?

A

calcaneal apophysitis (inflammation of posterior calcaneal growth plate)

45
Q

child who just started an organized sport complains of heel tenderness. what do you suspect?

A

calcaneal apophysitis

46
Q

how do you treat calcaneal apophysitis?

A

NSAIDs, gel heel cup, limit extensive activity (will resolve on its own)

47
Q

child complains of medial foot/calf pain w/ prolonged weight bearing. The child relies on arms to sit up and you note inversion. what do you suspect?

A

pes planus

48
Q

how do you check for pes planus?

A

Gower’s sign to rule out neuromuscular condition
subtalar ROM to rule out tarsal coalition
heel cord tightness

49
Q

what is the tx for pes planus?

A

supportive shoes, orthotics in severe cases and lots of reassurance

50
Q

what is calcaneovalgus?

A

dorsiflexed and everted foot (EXTERNALLY rotated) due to “packaging defect”

51
Q

what is metatarsus adductus?

A

kidney shaped foot deviates MEDIALLY with vagus heel d/t “packaging defect”
foot sits on ground while holding baby up, sole is pointed in the right direction

52
Q

what is club foot?

A

congenital condition where pt is unable to dorsiflex
foot is kidney shaped w/ heel varus
food is adducted and sole is INVERTED almost upward
usually accompanied by other abnormalities

53
Q

how is calcaneovalgus treated?

A

spontaneously resolves on its own

54
Q

how is metatarsus adductus treated?

A

correct to neutral manually

55
Q

how is clubfoot treated?

A

needs intervention, can’t be corrected manually

56
Q

child complains of pain in the wrist/proximal forearm. they are holding their forearm and won’t supinate the hand. you feel a “winding up” sensation when you supinate the hand. what do you suspect?

A

nursemaids elbow

57
Q

how should a nursemaids elbow be treated?

A

reduction, arm held straight, lower arm-traction applied, arm is supinated and flexed to 90 degrees. you will feel a pop over the radial head.

58
Q

what are factors associated w/ brachial plexus injuries?

A

large birth weight, breech delivery (born bottom first), shoulder dystocia, gestational DM

59
Q

baby is born w/ arm internally rotated and pronated w/ no movement at the shoulder or elbow w/ hand/wrist flexion. what do you suspect?

A

brachial plexus injury

60
Q

what is the tx for brachial plexus injury?

A

most will resolve over several weeks

may protect joints if appropriate

61
Q

what is ewing sarcoma?

A

bony tumor

62
Q

pt presents with pain and has a palpable mass close to the bone. you notice Codman’s triangle on x-ray. what do you suspect?

A

ewing sarcoma

63
Q

what is the tx for ewing sarcoma?

A

surgical- immediate referral!

64
Q

what should be examined if you suspect ewing sarcoma?

A
  • careful inspection of painful sites w/ palpation
  • comprehensive neurologic examination to evaluate asymmetric weakness, numbness, or pain (tumors can push on nerve)
  • lungs (asymmetric breath sounds, pleural signs, rales)
  • skin- petechiae, purpura
  • fever and wt loss indicates metastatic disease
65
Q

what is osteochondroma?

A

benign and asymptomatic cartilaginous tumor of bone most frequently see in the hand (no tx necessary)

66
Q

what are fibromas?

A

Fibrous cortical defect that can occur anywhere in the body.
§ On x-ray, it will have a regular, sclerotic border.
§ Main problem is pathological fractures.

Pediatrics (7 decks)

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