Peds

Question 1

Infantile scolisos age?

Answer 1

0-3yrs

Question 2

Juvenile scolisosis age?

Answer 2

4-10yrs

Question 3

Adolescent scoliosis age?

Answer 3

11-18yrs

Question 4

Indications for imaging a child?

Answer 4

Pain or limited ROM
Trauma
Surgical planning.
Previous surgery.
Suspected malignancy.
Congenital anomalies.
Previously detected spinal abnormality.
Alignment abnormalities, including scoliosis and kyphosis.

(American College of Radiology Guidelines)

Question 5

Causes of a limping child?

Answer 5

Soft-tissue or bone injury
Infection of bone, soft tissues or joints (osteomyelitis, cellulitis/myositis/abscess, septic arthritis)
Neuromuscular disease
Congenital disease
Developmental disease
Ischemia
Neoplasm

Question 6

Causes of a limping child - 3 categories?

Answer 6

Pain (injury, infection, tumor, AVN)
Structure abnormality (developmental dysplasia, other congenital deformities)
Neuromuscular control (muscular dystrophy, cerebral palsy, etc)

Question 7

Annual incidence of a brain tumor in children (often presenting as a headache)?

Answer 7

3 per 100,000

Question 8

Scoliosis in a child is defined as a curvature greater than _____

Answer 8

10 degrees

Question 9

Most common cause of scoliosis?

Answer 9

Primary/Idiopathic (80%)

Question 10

5 categories of scoliosis causes?

Answer 10

Idiopathic
Congenital
Developmental
Neuromuscular
Tumor-associated

Question 11

A nonincarcerated hemivertebra causing scoliosis is an example of an)…

Answer 11

Congenital scoliosis

Question 12

Hueter-Volkmann law

Answer 12

Scoliosis progression occurs due to compression on the concave side of the curvature, and tension on the convex side

Question 13

4 things to report when imaging a scoliosis?

Answer 13

Levels involved
Apex level
Direction (convex side)
Vertebral body rotation

Question 14

Scoliosis diurnal vriation?

Answer 14

+/- 5 degrees

Question 15

Cobb method for measuring scoliosis?

Answer 15

Measure between the MOST ANGELED vertbrae at the top and bottom of the curve

Question 16

Method for assessing vertebral rotation amount?

Answer 16

Nash-Moe (Grade 0-4)

Question 17

Scoliosis progression is most likely when?

Answer 17

Most likely during periods of rapid growth: >2cm/year height change

Question 18

How many degrees of curve progression in a scoliosis requires management?

Answer 18

More than 5 degrees between 4-12mo followups

Question 19

Do adult scolioses pogress?

Answer 19

No, especially if less than 30 degrees.
May progress 30-50 degrees- can progress 10-15 degrees throughout life. 50-75 degree curves progresses ~1 degree per year

Question 20

How often do congenital scolioses progress?

Answer 20

75% of the time

Question 21

How often does infantile idiopathic scoliosis progress?

Answer 21

typically self-limiting

Question 22

How often does adolescent (11-18yrs) idiopathic scoliosis progress?

Answer 22

only 5% progress past 30 degrees

Question 23

How often does juvenile (4-10yrs) idiopathic scoliosis progress?

Answer 23

Progress in 75-95% of kids

Question 24

2 best predictors of idiopathic curve progression?

Answer 24

Velocity of spinal growth (>2cm/year)
Curve magnitude at initial presentation

Question 25

What curve magnitude may have associated back pain?

Answer 25

Patients who have a curve with a Cobb angle of more than 50°

Question 26

When to order MRI for scoliosis?

Answer 26

Neuro symptoms or pain Rapid progression Foot deformity Left thoracic curve Triple major curve Short-segment curve Curve after skeletal maturity Concerning radiographic features (wide canal, wide IVF, etc)

Question 27

How often to monitor curve progression in children?

Answer 27

Every 4-12 months depending on rate of progression/symptoms No monitoring in adults typically, at most every 5 years if over 30 degrees

Question 28

When to brace a scoliosis?

Answer 28

Only in children with cobb angle of 20°–45° Goal is to reverse Hueter-Volkmann law in the growing spine Should be done by a pediatric orthopedist

Question 29

Primary vs secondary goals of surgery in idiopathic scoliosis treatment?

Answer 29

Primary: prevent curve progression Secondary: curve correction, trunk balance restoration, sagittal contour preservation, while leaving as many mobile segments as possible

Question 30

Primary goals of surgery in degenerative scoliosis treatment?

Answer 30

to decompress the spine and truncal balance correction

Question 31

Primary goals of surgery in neuromuscular scoliosis treatment?

Answer 31

Curvature correction, pain control and increase respiratory function

Question 32

Rate of child abuse in the US?

Answer 32

roughly 1 of every 100 children is subjected to some form of neglect or abuse, responsible for approximately 1,200 deaths per year

Question 33

What to look out for in potential abuse cases?

Answer 33

Unusual injuries, especially in women and children

Question 34

Suspicious injuries in children?

Answer 34

rib fracture metaphyseal fractures (corner, bucket handle) skull fracture interhemispheric extra-axial hemorrhage shear-type brain injury vertebral compression fracture small bowel hematoma and laceration Subperiosteal new bone formation multiple fractures, especially if at different stages of healing

Question 35

High specificity injuries for child abuse?

Answer 35

Classic metaphyseal lesions Rib fractures, especially posteriorly Unusual fractures, e.g. spine, acromion

Question 36

Moderate specificity injuries for child abuse?

Answer 36

Multiple fractures, especially bilateral Fractures of different ages Digital fractures, especially in a non-ambulatory child Complex skull fractures

Question 37

Low specificity injuries for child abuse?

Answer 37

Subperiosteal new bone formation Clavicle fractures Long bone shaft fractures Linear skull fractures

Question 38

The non-ossified region at the junction of the vertebral body and neural arches

Answer 38

neurocentral synchondrosis

Question 39

C2 has ____ primary ossifications centers

Answer 39

4 (Vertebral Body, Odontoid Process, 2 Neural Arches)

Question 40

Dens fuses with C2 when?

Answer 40

3-6 years old

Question 41

How to detemine traumatic C2 subluxation versus pseudosubluxation?

Answer 41

Swischuk line line tangential to the C1 & C3 spinolaminar lines

Question 42

In lower cervical vertebrae, the body and neural arches fuse when?

Answer 42

3-6 years old

Question 43

List the 2ndary ossification centers of the spine

Answer 43

Transverse processes Spinous process Ring apophyses (in the T&L regions: superior and inferior articular facets as well)

Question 44

Premature closure of skull sutures/agenesis of a suture?

Answer 44

Craniosynostosis Results in mis-shapen skull, may be associated with various syndromes in some cases

Question 45

Salter-Harris types?

Answer 45

1-physis 2-physis+metaphysis 3-physis+epiphysis 4-physis+metaphysis+epipysis 5- crushed physis

Question 46

A unique pattern of Type 4 Salter-Harris fracture found in the ankle that may be mistaken as a type 2 or 3?

Answer 46

Triplane fracture

Question 47

Chronic traction injury of the medial epicondyle 2ndary ossification center?

Answer 47

Little leaguer's elbow

Question 48

Chronic physeal injury of the proximal humerus in trowing athletes?

Answer 48

Little leaguer's shoulder

Question 49

Widening and irregularity of the margins of the proximal humeral physis

Answer 49

Little leaguer's shoulder

Question 50

Sclerosis and/or fragmentation of the capitellum?

Answer 50

osteochondral lesion, usually associated with compression from pitching

Question 51

Adolescent tibia vara?

Answer 51

Blount disease metaphyseal-diaphyseal angle more than 11 degrees Often associated with obesity

Question 52

Osgood-Schlatter findings?

Answer 52

Mainly a clinical diagnosis May see associated fragmentation, swelling on XR

Question 53

Adult version of Sinding-Larsen-Johansson disease?

Answer 53

Jumper's knee

Question 54

Acute injury of the inferior pole of the patella in children?

Answer 54

Patellar sleeve avulsion

Question 55

Incomplete fractures only found in children?

Answer 55

Torus fx Greensick fx Plastic deformity