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DI3-Exam 3 new content > Peds > Flashcards

Peds Flashcards

1
Q

Infantile scolisos age?

A

0-3yrs

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2
Q

Juvenile scolisosis age?

A

4-10yrs

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3
Q

Adolescent scoliosis age?

A

11-18yrs

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4
Q

Indications for imaging a child?

A

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)

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5
Q

Causes of a limping child?

A

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

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6
Q

Causes of a limping child - 3 categories?

A

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

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7
Q

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

A

3 per 100,000

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8
Q

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

A

10 degrees

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9
Q

Most common cause of scoliosis?

A

Primary/Idiopathic (80%)

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10
Q

5 categories of scoliosis causes?

A

Idiopathic
Congenital
Developmental
Neuromuscular
Tumor-associated

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11
Q

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

A

Congenital scoliosis

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12
Q

Hueter-Volkmann law

A

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

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13
Q

4 things to report when imaging a scoliosis?

A

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

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14
Q

Scoliosis diurnal vriation?

A

+/- 5 degrees

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15
Q

Cobb method for measuring scoliosis?

A

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

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16
Q

Method for assessing vertebral rotation amount?

A

Nash-Moe (Grade 0-4)

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17
Q

Scoliosis progression is most likely when?

A

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

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18
Q

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

A

More than 5 degrees between 4-12mo followups

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19
Q

Do adult scolioses pogress?

A

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

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20
Q

How often do congenital scolioses progress?

A

75% of the time

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21
Q

How often does infantile idiopathic scoliosis progress?

A

typically self-limiting

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22
Q

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

A

only 5% progress past 30 degrees

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23
Q

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

A

Progress in 75-95% of kids

24
Q

2 best predictors of idiopathic curve progression?

A

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

25
Q

What curve magnitude may have associated back pain?

A

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

26
Q

When to order MRI for scoliosis?

A

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)

27
Q

How often to monitor curve progression in children?

A

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

28
Q

When to brace a scoliosis?

A

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

29
Q

Primary vs secondary goals of surgery in idiopathic scoliosis treatment?

A

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

30
Q

Primary goals of surgery in degenerative scoliosis treatment?

A

to decompress the spine and truncal balance correction

31
Q

Primary goals of surgery in neuromuscular scoliosis treatment?

A

Curvature correction, pain control and increase respiratory function

32
Q

Rate of child abuse in the US?

A

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

33
Q

What to look out for in potential abuse cases?

A

Unusual injuries, especially in women and children

34
Q

Suspicious injuries in children?

A

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

35
Q

High specificity injuries for child abuse?

A

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

36
Q

Moderate specificity injuries for child abuse?

A

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

37
Q

Low specificity injuries for child abuse?

A

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

38
Q

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

A

neurocentral synchondrosis

39
Q

C2 has ____ primary ossifications centers

A

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

40
Q

Dens fuses with C2 when?

A

3-6 years old

41
Q

How to detemine traumatic C2 subluxation versus pseudosubluxation?

A

Swischuk line
line tangential to the C1 & C3 spinolaminar lines

42
Q

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

A

3-6 years old

43
Q

List the 2ndary ossification centers of the spine

A

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

44
Q

Premature closure of skull sutures/agenesis of a suture?

A

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

45
Q

Salter-Harris types?

A

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

46
Q

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

A

Triplane fracture

47
Q

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

A

Little leaguer’s elbow

48
Q

Chronic physeal injury of the proximal humerus in trowing athletes?

A

Little leaguer’s shoulder

49
Q

Widening and irregularity of the margins of the proximal humeral physis

A

Little leaguer’s shoulder

50
Q

Sclerosis and/or fragmentation of the capitellum?

A

osteochondral lesion, usually associated with compression from pitching

51
Q

Adolescent tibia vara?

A

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

52
Q

Osgood-Schlatter findings?

A

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

53
Q

Adult version of Sinding-Larsen-Johansson disease?

A

Jumper’s knee

54
Q

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

A

Patellar sleeve avulsion

55
Q

Incomplete fractures only found in children?

A

Torus fx
Greensick fx
Plastic deformity

DI3-Exam 3 new content (6 decks)

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