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Clinical Disciplines > Peds 2 > Flashcards

Peds 2 Flashcards

1
Q

Esophageal Atresia

A

Blind esophageal pouch w/ out w/out fistulous connection between proximal or distal esophagus and trachea

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2
Q

Autism spectrum disorder

A

Includes autism, Asperger syndrome, pervasive developmental disorder
Lack of interest in others, delayed language, resistant to change, behavior disturbances

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3
Q

Red flags of Autism spectrum disorder

A

Parental concerns of: deficits in social/language/behavior skills, frequent tantrums, intolerance to change
Not meeting milestones (not babbling/knowing words etc)
Loss of language or social skills at any age

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4
Q

Social Attention vs Joint Attention

A

Social: absent/limited interest, no eye contact/spacial awareness
Joint: don’t show/bring things to parents, can play alone

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5
Q

Universal screening for ASD

A

18 and 24 months, or earlier if needed: MCHAT-R/F testing (identifies at risk, not a diagnosis, NO’s are significant) score over 8 refer

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6
Q

ASD Treatment

A

Early intervention; meds for targeted symptoms (anxiety, oct, etc), vitamins, diets, hyperbaric oxygen
Behavioral and educational interventions

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7
Q

Asperger Syndrome

A

Symptoms not including significant language or intellectual impairment “high functioning” autism
Treat with symptom reduction

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8
Q

ADD/ADHD categories (2)

A

Hyperactive/impulsive: apparent by 4, peak by 7-8, hyperactive wanes after 8 but impulsivity persists
Inattention: apparent around 8-9, persists into adulthood

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9
Q

ADHD Hyperactivity Symptoms

A

Fidgety, “perpetual motion”, excessive talking, interruption, acts without considering consequences, difficulty staying seated

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10
Q

ADHD Inattention Symptoms

A

Reduced ability to focus, decreased speed of cognitive processing (daydream, “off task”)
Common in premies
Seems to not listen, difficulty organizing, loses thing, forgetful, easily distracted

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11
Q

ADHD Diagnosis (DSM5)

A

At least 6 symptoms for 6 months that must impair function academically, socially or occupationally
Symptoms present before 12 years and don’t occur during psychosis
No exclusion criteria for pts with ASD

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12
Q

ADHD Assessment Tools

A

Conners comprehensive behavior rating
ADHD rating scale
Vanderbilt assessment scales (only >4 years)

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13
Q

ADHD Management (not medications)

A

Eating and sleeping patterns, cardiac exam (BP, HR, auscultation, Marfan check) BEFORE meds
<6: behavioral therapy +/- meds
>6: meds +/- behavioral therapy

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14
Q

ADHD Medications

A

First line: stimulants

Second line: atomoxetine (strattera), alpha-2-adrenergic agonists

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15
Q

Oppositional Defiant Disorder Categories (3)

A

1-angry/irritable mood
2- argumentative/defiant behavior
3-vindictiveness

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16
Q

Oppositional Defiant Disorder Diagnosis

A

At least 4 symptoms from any category occurs for at least 6 months, exhibited during interaction with at least one person thats NOT a sibling
Interferes with social or academic functioning, doesn’t occur during psychotic episode

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17
Q

Oppositional Defiant Disorder Symptoms

A

Loses temper often, argues with adults, actively defies, deliberately annoys, blames other for mistakes/behavior, angry, resentful, spiteful, vindictive

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18
Q

Oppositional Defiant Disorder Management

A

Refer to psych for psychometric testing

CBT, psychotherapy, family therapy, anger management, etc

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19
Q

Conduct Disorder Categories (4)

A

Aggressive (harm others)
Property loss/damage
Deceitful or theft
Violation of rule/laws

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20
Q

Conduct disorder Diagnosis

A

At least 3 occur in last year with one in last 6 months

Changes to antisocial anxiety disorder if >18

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21
Q

Conduct Disorder Management

A

Refer to psych
Psychotherapy, CBT, fam therapy, anger management
treat other disorders

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22
Q

Esophageal Atresia Presentation

A

Only symptomatic within hours of birth (excess saliva, choking, cyanosis and respiratory distress)
Presents slower with tracheoesophageal fistulas

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23
Q

Esophageal Atresia Diagnostics

A

Prenatal US>MRI

Post-natal: NG tube and chest xray-tube in blind pouch, if gas is present theres a TE fistula distal o esophagus

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24
Q

Esophageal Atresia Treatment

A

NG tube in proximal pouch w/ low suction
Elevate head of bed
IV glucose, fluids, O2
Surgery

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25
Q

Coin Ingestion Diagnostics/Treatment

A

see round coin if in esophagus, just edge if in trachea

Retrieve if button battery (emergency), multiple magnets, or if it doesn’t move to stomach

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26
Q

GER

A

if no secondary symptoms just GER, resolves spontaneously; supportive care, avoid overfeeding

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27
Q

GERD

A

If failure to thrive, pneumonia, GI bleed, etc is GERD, usually resolves by 12 months, can thicken food with cereal or milk free for 2 weeks
PPIs but can increase infection risk
Nissen fundoplication

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28
Q

Eosinophilic Esophagitis Symptoms and complications

A

Feeding dysfunction similar to Gerd, long meal times, avoidance of textured food, no response to Gerd treatment
Causes esophageal food impactions and strictures

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29
Q

Eosinophilic Esophagitis Diagnosis

A

EGD: esophagus sprinkled w/ pinpoint white exudates (eosinophils) like candida
thickening, mucosal fissures, strictures and rings

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30
Q

Eosinophilic Esophagitis Treatment

A

Elimination of food allergens

Steroids (2 puffs of fluticasone BID 30 mins before food, without rinsing after)

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31
Q

Pica

A

Eating feces, clay, dirt, hair, ice, etc for at least 1 month
Zinc and iron deficiencies, ^lead
Treat with behavioral therapy and address deficiencies/possible lead poisoning

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32
Q

Rumination

A

Repeated regurg and rechewing of food for at least 1 month, MC in young kids
Causes cavities, malnutrition, weight loss, failure to thrive

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33
Q

Malabsorption associated with cystic fibrosis

A

Carbs (lactase deficiency), fat and protein (milk protein allergy)

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34
Q

Presentation of malabsorption

A

weight loss, malnutrition, diarrhea/steatorrhea, N/V, abdominal pain

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35
Q

Diagnostics of malbsorption

A

stool sample, dietary testing (removals), celiac and cystic fibrosis workups

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36
Q

Phenylketonuria (PKU)

A

most common inborn error of amino acid metabolism, decreased activity of phenylalanine hydroxylase

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37
Q

PKU Presentation

A

Intellectual disability (MC), fair hair and skin, atopic dermatitis, hyperactive, seizures, musty/mousy body and urine odor, epilepsy

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38
Q

PKU Diagnosis and Treatment

A

Newborn screening
Dietary restriction of phenylalanine (<6mg/dL/day) and aspartame
(restrict starches, proteins; supplements aminos, vitamins and minerals)

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39
Q

Common food allergies

A

Cow milk, fruit (citrus, strawberry), veggies (tomato), egg, fish, nuts, cereals

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40
Q

Presentation of food allergies

A

urticaria and angioedema MC

Rhinitis, swelling, asthma, anaphylaxis, N/V, abdominal pain, cramping, diarrhea

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41
Q

Food allergy diagnosis and treatment

A

IgE testing

epinephrine and H1 blockers

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42
Q

Celiac Disease

A

malabsorption of gluten causing abd pain, diarrhea, vomiting, bloating, constipattion
associated w/ diabetes, thyroiditis, downs, turner syndrome

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43
Q

Non-GI Celiac disease manifestations

A

delayed puberty, short stature, iron deficiency anemia

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44
Q

Celiac disease diagnosis/treatment

A

serology, duodenal biopsy (villous atrophy)

Gluten restriction improves intestinal mucosa within 6-12 months

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45
Q

Gastroschisis and Omphalocele

A

Abdominal wall defect causing GERD, volvulus, malabsorption
Discovered prenatally on US and elevated alpha-veto protein
Delivered c-section with surgical correction

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46
Q

Omphalacele

A

Membrane covered herniation of abdominal contents into base of umbilical cord

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47
Q

Gastroschisis

A

Uncovered intestine through small abdominal wall defect to right of umbilical cord
Increasing incidence bc of meth, coke, young mothers and ibuprofen use

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48
Q

Diaphragmatic Hernia

A

usually left sided, diagnosed on prenatal ultrasound around 8-10weeks
Can be associated with chromosomal abnormalities and dysmorphisms (craniofacial and extremity)

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49
Q

Diaphragmatic hernia presentation

A

Respiratory distress in first minutes-hours of life, may require aggressive resuscitation; scaphoid abdomen, barrel-shaped chest, bowel loops in chest with mediastinal shift on xray
signs of pneumothorax with decreased breath sounds

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50
Q

Diaphragmatic hernia treatment/complications

A

mechanical ventilation and decompression of GI tract with OG tube or surgical reduction
Can cause pulmonary hypertension, GERD, behavior problems

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51
Q

Indirect inguinal hernia

A

Most common in kids, more common than direct
passes lateral to epigastric vessels through inguinal canal (into testicle)
M>F, mostly right sided

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52
Q

Direct inguinal hernia

A

Passes medial and inferior to epigastric vessels, goes through Hesselbach triangle (not inguinal canal)
More common in older men

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53
Q

Hesselbach Triangle Borders

A

Fascia surrounded by: rectus abdominis muscle, inferior epigastric artery and inguinal ligament

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54
Q

Femoral inguinal hernia

A

follows tract below inguinal ligament through femora canal, medial femoral vein lateral to lacunar ligament
Often incarcerated or strangulated
F>M

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55
Q

Umbilical Hernias

A

More common in full term black babies, regress spontaneously; repaired if still there at 4 years old

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56
Q

Pyloric Stenosis*

A

Postnatal muscular hypertrophy of pylorus causing progressive gastric outlet obstruction
M>F, common in first born kids, whites

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57
Q

Pyloric Stenosis Symptoms

A

Projectile postprandial vomiting, Olive mass in RUQ is hallmark* (esp after vomiting)
upper abdominal distention, visible gastric peristaltic waves
Usually starts at 3-6 weeks

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58
Q

Pyloric stenosis diagnosis

A

Pyloric ultrasound: hypo echoic muscle ring >4mm thick w/ hyper dense center and >15mm pyloric channel length
Barium swallow: String sign in long pyloric channel

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59
Q

Pyloric stenosis treatment

A

Surgical repair (pyloromyotomy), high risk of chronic abdominal pain in childhood

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60
Q

Duodenal Atresia

A

Associated with trisomy 21
Blind pouch or stenosis
“double-bubble sign” on abdominal xray (dilated stomach and proximal duodenum)
Bilious (green) vomiting hours after birth
Surgically corrected

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61
Q

Short bowel syndrome

A

reduced intestinal absorptive surface typically after resection of intestine
Leads to alternation in intestinal function

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62
Q

Symptoms of short bowel syndrome

A

Diarrhea, dehydration, electrolyte/micronutrient deficiency, excessive gas, foul smelling stool

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63
Q

Treatment of short bowel status

A

Diet, TPN (total parenteral nutrition), enteral nutrition (g-tube), antacids, PPIs, antibiotics, surgery
last resort-intestine transplant

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64
Q

Intussusception

A

Most common bowel obstruction in first 2 years of life, most commonly proximal to ileocecal valve
M>F

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65
Q

Causes of intussusception

A

85% idiopathic

viral (rotavirus), carcinoma (lymphoma MC >6), henoch-schonlein purpura

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66
Q

Symptoms of intussusception

A

Red currant jelly stools* (pathognomonic), healthy baby develops recurrent severe, crampy belly pain, vomiting, diarrhea
Palpable right-sided sausage shaped mass

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67
Q

Intussusception diagnostics

A

Barium + air enema-diagnostic and therapeutic
Ultrasound most sensitive/specific
Xray: target sign

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68
Q

Intussusception Treatment

A

Air enema is best if stable
Non-operative (contrast enema, hydrostatic or pneumatic pressure)
Successful reduction likelihood decreases after 24 hours

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69
Q

Hirschsprung Disease

A

Congenital aganglionic megacolon- no neurons in anal sphincter causing functional obstruction>dilation with gas and feces

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70
Q

MC chromosomal abnormality associated with hirschsprung disease?

A

Down syndrome

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71
Q

Presentation of Hirschsprung disease

A

Usually in infants: Failure to pass meconium followed by vomiting, abdominal distention and reluctance to feed, bilious emesis
Explosive expulsion of gas and stool after DRE

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72
Q

Hirschsprung disease in older kids

A

Constipation alone-foul smelling ribbonlike stools, no visible stool on anal and rectal exam

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73
Q

Hirschsprung diagnosis

A

Rectal biopsy: lack of neurons
X-ray-dilated proximal colon w/out gas in pelvic colon
Barium enema: dilated colon, narrow distal segment with sharp transition to normal colon

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74
Q

Hirschsprung treatment

A

Surgical removal of aganglionic bowel, reconstruction

Leads to fecal incontinence, retention, constipation and enterocolitis

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75
Q

Meckel’s Diverticulum

A

Bulge in small intestine containing cells from stomach and pancreas
rule of 2’s: 2 inches long, 2 feet from ileocecal valve, occurs after 2 years old

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76
Q

Whats the most common congenital anomaly of the GI tract?

A

Meckels diverticulum

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77
Q

Presentation of Meckels diverticulum

A

Usually asymptomatic

PAINLESS lower GI bleed, can mimic appendicitis, recurrent/atypical intussusception, obstruction

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78
Q

Diagnosis/treatment of Meckel’s Diverticulum

A

CT angio or arteriography
Meckel’s scan (radionuclide)
Surgical resection IF symptomatic

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79
Q

Newborn Jaundice complications/treatment

A

Brain injury if high bili persists (kernicterus)

Treat with phototherapy, may need transfusion

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80
Q

Gilbert’s Syndrome

A

Autosomal dominant hyperbilirubinemia

Jaundice without increased bili levels (usually <3-6), normal biopsy and LFTs

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81
Q

Diagnosis/Treatment of Gilberts syndrome

A

Increase of 1.4mg unconj bili after 2 day fast

No treatment

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82
Q

What 4 areas does cystic fibrosis affect?

A

Lung, pancreas, intestine and liver

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83
Q

Symptoms of cystic fibrosis

A

Pancreas: fat soluble vitamin deficiency, diarrhea, steatorrhea
Intestine: intussusception, carb intolerance
Liver: steatosis, cirrhosis, neonatal jaundice

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84
Q

When to suspect cystic fibrosis?

A

Any child with meconium ileus, cholestasis, recurrent URI/lung disease or malabsorption

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85
Q

Diagnosis/treatment of cystic fibrosis

A

Newborn screening, sweat chloride test

Oral supplement of pancreatic enzymes, ours for cholestasis

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86
Q

Biliary/choledochal cysts (presentation, diagnosis, treatment)

A

Recurrent RUQ pain, fever, vomiting, obstructive jaundice, pancreatitis or R abdominal mass
US or MRI to diagnose
Surgery once stable

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87
Q

Biliary atresia

A

Progressive fibroinflammatory obliteration of lumen of extra hepatic biliary tree

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88
Q

Presentation of biliary atresia

A

Urine stains diaper and stools pale yellow, gray or echoic
Firm hepatomegaly common
failure to thrive by 6 months
Asians, blacks, premies in 1st 3 months

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89
Q

Diagnosis and treatment of biliary atresia

A 
Ultrasound to rule out choledochal cyst
Kasai procedure (hepatoportoenterostomy)
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90
Q

Imperforate anus

A

Congenital defect when opening of anus is absent or blocked

develops within 5-7 weeks of pregnancy

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91
Q

Presentation and treatment of imperforate anus

A

Infant fails to pass meconium, greenish bulging membrane obstructing anal aperture
Surgery

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92
Q

Pilonidal Cyst risk factors/treatment

A

overweight, deep cleft

Surgical opening and draining of sinus, sitz bath

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93
Q

Enterobiasis (pinworms)

A

intense ana pruritis
Scotch tape test
Pyrantel pamoate for whole family

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94
Q

Encopresis

A

repeated pooping in inappropriate places for 3 months >4 years of age
Behavioral-educational therapy
If meds needed, miralax, laxatives

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95
Q

Causes of chronic constipation

A

dehydration, excessive milk intake, lack of fiber
meds (antihistamines, narcotics)
thyroid disease, cerebral palsy
Treat with P fruits, miralax

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96
Q

UTI Presentation

A

Newborns/infants: high fever, vomiting, jaundice, cloudy foul smelling urine
preschool kids: abd/flank pain, vomiting, fever, frequency, dysuria, enuresis; CVA tenderness unusual
School aged: frequency, dysuria and urgency; pyelonephritis with fever, vomiting, flank pain, CVA tenderness

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97
Q

UTI Diagnosis

A

Urine culture of midstream clean catch, may need catheter

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98
Q

UTI Treatment

A

<3 months, dehydrated or septic: admit for IV antibiotics

Older: empiric amoxicillin, bactrim, reflex for 7-10 days

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99
Q

Vesicoureteral reflux

A

reflux of urine from bladder into upper urinary tract
common in kids with febrile UTI <2 years old
Short ureters is MC form, then blockage

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100
Q

Diagnosis of vesicoureteral reflux

A

hydronephrosis on prenatal US-repeat at 1 week; if bilateral also do VCUG
Postnatal: Renal/bladder US, if febrile-VCUG

101
Q

VCUG Reflux grades

A

Grade I – reflux into the ureter no dilation
Grade II – Reflux to the kidneys
Grade III – Reflux to the kidneys w/ dilation of ureter only
Grade IV – Reflux w/ dilation of ureter and mild blunting of renal calyces
Grade V –Reflux w/ dilation of ureter & blunting of reflux calyces

102
Q

VUR Treatment

A

Monitor grades 1/2, consider antibiotics

Grades 3-5: bactrim or nitro regardless of age

103
Q

Posterior urethral valve (PUV)

A

MC etiology of urinary tract obstruction in newborn male

104
Q

Diagnosis of PUV

A

prenatal US: bilateral hydronephrosis, distended thickened bladder; possible oligohydramnios
Post natal: VCUG

105
Q

PUV Treatment

A

Prenatal surgery-vesicoamniotic shunt

Postnatal: correct electrolyte abnormalities, foley cath, transurethral catheter ablation

106
Q

Enuresis

A

urinating in clothes >5 at least 2x/week for 3 months

secondary: after at least 6 moths of dryness

107
Q

Nocturnal enuresis

A

Associated with constipation, sleepapnea
limit liquids before bed, bedwetting alarms
meds: desmopressin acetate (limit fluids to avoid hyponatremia) or imipramine

108
Q

Diurnal (daytime) enuresis

A

accident 1 every 2 weeks

more common in females, UTI, encopresis, nocturnal enuresis

109
Q

Urinary incontinence causes

A

overactive bladder, voiding postponement, underachieve bladder, dysfunctional voiding

110
Q

Exstrophy of bladder

A

open, inside-out bladder

M>F, more common in first born whites

111
Q

Presentation of exstrophy of bladder

A

open bladder, exposed urethra, low bellybutton, anterior anus, outward rotation of pelvic bones, genital defects (esp in males)

112
Q

diagnosis/treatment of exstrophy of bladder

A

prenatal US, confirmed with MRI, otherwise at birth

Treatment: induced delivery/planned c-section, surgery within 72 hours

113
Q

Imperforate hymen

A

one of MC obstructive lesions of female GU tract

treated surgically

114
Q

Presentation of imperforate hymen

A

neonate: bulging introitus at birth/asymptomatic
Adolescent: amenorrhea, cyclic abdominal or pelvic pain, hematocolpos (bluish color of hymen membrane)

115
Q

Hypospadias

A

Ventral placement of urethral opening
Associated with cryptorchidism
DO NOT CIRCUMSIZE!

116
Q

Hypospadias treatment

A

repair before 18 months

With cryptorchidism: pelvic US, karyotype, serum electrolytes

117
Q

Cryptorchidism

A

hidden/undescended testes (by 4 months)
risk of infertility and testicular malignancy
surgery (orchiopexy) if descent hasn’t happened by 6 months

118
Q

MC congenital abnormality of GU tract?

A

cryptorchidism

119
Q

Cryptorchidism testing

A

LH, FSH, inhibit B and testosterone to make sure testes are present

120
Q

Testicular torsion

A

Twisted cord
“bell clapper” deformity, abrupt onset of severe pain, N/V, swelling, absent cremasteric reflex, negative phren sign
Doppler
Detorsion/fixation ASAP (4-6 hours)

121
Q

Hydrocele

A

Fluid filled sac between parietal and visceral layers of tunica vaginalis, NO pain
common in newborns
resolve spontaneously by 1 year-surgery if not

122
Q

Communicating vs non-communicating hydrocele

A

communicating: failure of vaginalis to close, fluid is peritoneal fluid, comes and goes
non-communicating: fluid comes from mesothelial lining, stays same size, needs further workup

123
Q

Varicocele

A

dilated veins surrounding spermatic cord, more common on the left
may be asymptomatic, dull ache
“Bag of worms”
Manage conservatively- tight underwear

124
Q

Androgen Insensitivity

A

Male resistant to androgens showing physical traits of a woman
Complete-looks like a girl at birth but no uterus, breasts but infertile and no menses
Partial- male and female characteristics; vagina with no cervix or uterus, inguinal hernia w/ testes

125
Q

Varus vs Valgus

A

Valgus knock knees (aka genu valgum)

varus is bowed legs (aka gene varum)

126
Q

Salter Harris 1

A

transverse physical fracture with widening

127
Q

Salter Harris 2

A

Fracture through metaphysis and physis

128
Q

Salter Harris 3

A

Fracture through physis and epiphysis

129
Q

Salter Harris 4

A

Fracture through metaphysis, physis, and epiphysis

130
Q

Salter Harris 5

A

Physical compression or crush fracture

131
Q

what are the three most common fractures in kids?

A

Bowing, torus/buckle, greenstick

132
Q

What ages do elbow bones present? (critoe)

A 
Capitellum 1 year
radial head 3 years
internal/medial epicondyle 5 years
Trochlea 7 years
Olecranon 9 years
External/lateral epicondyle 11 years
133
Q

What is the most common pediatric elbow fracture?

A

Supracondylar fracture

134
Q

Supracondylar fracture (MOI and diagnostics)

A

FOOSH from height with hyperextension
swelling and deformity
CHECK MEDIAN NERVE!
AP, lateral (90*) and oblique xrays

135
Q

Supracondylar fracture management

A

Type1/2 posterior splint with wrap, sling, ibuprofen, elevation
Type 3 emergent ortho consult, NV concerns

136
Q

Lateral Condylar Fracture presentation and diagnostics

A

Soft tissue swelling only laterally, tender to palpation on lat condyle
Xray AP, lateral oblique, MRI if needed

137
Q

Lateral condylar management

A

Emergent referral if displaced >2mm

Splint, sling, NSAIDs, cast vs surgery

138
Q

Lateral condyle complications

A

Nonunion, fish tail deformity, cubits valgus/varus deformities

139
Q

Medial epicondyle fracture of distal humerus

A

Pitchers, dislocations
Xray: ap, lat, oblique
rule out incarceration of fragment joint

140
Q

Medial epicondyl fracture of distal humerus Management

A

Emergent if entrapped fragment present

Splint including wrist, sling, NSAIDs, short term immobilization vs open fixation

141
Q

Medial epicondyl fracture of distal humerus complications

A

ulnar nerve palsy, nonunion, angular deformity, decreased ROM

142
Q

Radial neck fracture MOI and presentation

A

FOOSH w/ valgus stress, dislocation/relocation of elbow

TTP over radial head/neck, pain with supination/pronation, wrist pain in young kids

143
Q

Radial neck fracture diagnostics and management

A

Xray: AP, lat, external oblique

Immobilize to wrist, Sling, NSAIDs, Cast vs surgery

144
Q

Radial neck fracture complications

A

loss of ROM, nonunion, premature physeal closure

145
Q

Nursemaids elbow

A

Subluxation of radial head, mostly from 1-3 years from sudden pull of pronated arm (swing while walking)

146
Q

Nursemaids elbow presentation

A

Arm fully extended or slightly flexed/pronated, refusal to move arm (may use fingers), pain over radial head, increases with supination
No imaging required

147
Q

Nursemaids elbow management

A

reduction by hyperpronation w/ radial head pressure or supination/flexion with radial head pressure
lollipop test to check if it worked

148
Q

Capitellar osteochondrosis “panner disease” presentation

A

irregular articular surface of capitellum
Males 5-10, throwing arm, baseball, gymnastics
rapid onset of deep lateral pain, limited extension and no locking
NOT TTP, pain/gaurding with passive extension, lateral pain with values stress

149
Q

Capitellar osteochondrosis management

A

Ice, NSAIDs, rest
+/-PT with gradual return to play
avoid elbow stress until symptom free, unremarkable exam, xray healing

150
Q

Monteggia fracture

A

Ulnar (or radial + ulnar) shaft fracture WITH dislocation of radial head
Xray of arm and elbow to rule out isolated ulnar fx

151
Q

Wrist Fracture causes

A

Direct fall/FOOSH, direct trauma

152
Q

Common types/presentation of wrist fractures

A

Distal radius typically at metaphysis, +/- ulnar involvement

Point tenderness, swelling, ecchymosis

153
Q

Wrist fracture management

A

emergent with significant deformity/NV compromise
Splint and NSAIDs
Cast, +/- reduction vs surgery

154
Q

What do we need to rule out in femur fractures?

A

Child abuse! esp <1 year

155
Q

Femur fracture presentation

A

Pain in groin/buttock, unable to bear weight

leg slightly adducted with external rotation if proximal

156
Q

Femur fracture diagnostics and management

A

MUST XRAY ENTIRE FEMUR!
Hip spica cast vs surgery
Can cause shortening/lengthening or angulation

157
Q

Patellar sleeve fracture

A

MC patella fracture <13
Caused by forced extension with knee flexed, happens at superior or inferior poles
Knee mobilizer, non-weight bearing, elevation, NSAIDs

158
Q

Toddler’s fracture

A

Commonly kid falling while running/twisting, diagnosed clinically or xray
Splint or boot, non-weight bearing, elevate

159
Q

Ankle fracture xrays

A

AP, mortise, lateral, internal and external oblique

160
Q

Triplane Fracture of ankle

A

Often caused by external rotation
Salter Harris 3 on AP and 2 on lateral view>SH4
Must get CT to assess displacement
Surgical fixation vs closed reduction

161
Q

Torticollis

A

Sternocleidomastoid contracted and shortened causing head tilt with chin rotation; rule out plagiocephaly
Stretch, PT

162
Q

Scoliosis imaging and treatment

A 
Cobb angle, AP/PA standing X-rays
TLSO brace (boston, Milwaukee,charleston bending), 25*
Surgery with internal rod fixation if 45*
163
Q

Osteochondritis Dissecans (OCD)

A

Idiopathic osteonecrosis of subchondral bone, 10-20 years, usually from repetitive trauma/stress, vascular disruption, ischemia, genetics

164
Q

OCD Locations

A

Elbow (chronic valgus stress, teens, throwing, gymnastics)
Knee (repetitive axial loading, preteens; MC LOCATION)
Other more likely in adults

165
Q

OCD Presentation

A

Gradual onset poorly localized pain (lateral w/ decreased ROM in elbow)
swelling
Popping, locking, catching

166
Q

OCD Diagnostics

A

flattened articular surface on xray, MRI if needed

Elbow: guarding, knee: gait disturbance

167
Q

OCD Treatment

A

Stages 1-3 avoid running/jumping, may need immobilization, +/- PT
Surgery if loose intra-articular body (stage 4) or skeletally mature patients-drilling (for vascularity) and fixation

168
Q

Septic Hip vs Transient synovitis*

A

Present similar- leg flexed, abducted and ext rotated, refusal to bear weight
Septic often febrile and ill appearing, transient often after viral illness

169
Q

Kocher Criteria*

A 
Diagnostic of septic hip
WBC>12,000
ESR>40
Fever >101.3
Nonweight bearing on affected side
2/4=joint aspiration
4/4=septic
170
Q

Management of septic/transient Hip

A

High dose NSAIDs, rest-if they help its transient!

Septic: admit to hospital with emergent ortho referal-drainage and IV antibiotics

171
Q

Leg-calve-perthes disease

A

Idiopathic avascular necrosis of femoral head

MC in thin, active white boys 4-8

172
Q

Presentation of Leg-calve-perthes disease

A

Limp by end of day, occasional pain in knee/hip, limped internal rotation/abduction of hip

173
Q

Diagnosis/treatment of Leg-calve-perthes disease

A

May be diagnosed clinically, confirm with xray

Observation, PT for ROM, surgical realignment if needed

174
Q

Slipped capital femoral epiphysis (SCFE) presentation

A

Obesity is significant risk factor, minorities 10-16
Limp or non-weight bearing w/ dull/achy hip or knee pain
Restricted abduction and internal rotation

175
Q

Slipped capital femoral epiphysis (SCFE) Diagnostics/treatment

A

Xray: AP pelvis an frog lat both hips, MRI if negative xrays
URGENT surgical consult for screw fixation
if non weight bearing>admit to hospital

176
Q

Developmental hip dysplasia risk factors

A

first born female/twins, breech pregnancy, fam history

177
Q

What is the most common orthopedic condition in newborns?

A

developmental hip dysplasia

178
Q

Exams for hip dysplasia

A

Galeazzi: limb length difference w/ supine and legs at 90
Barlow: flex, adduct and push back
Ortolani: flex, abduct, push back/out to lift trochanter

179
Q

Management of hip dysplasia

A 
Pavlik harness (95% success if started by 6 weeks)
avoid swaddling/tight clothes
180
Q

Osgood-Schlatters disease

A

Inflammation and irritation of patellar tendon insertion on tibia tubercle, traction at tibial tubercle apophysis
Common in jumpers (flares in girls 10-11, boys 13-14)

181
Q

Osgood-schlatters presentation

A

Enlargement or bony protrusion of tibial tubercle with focal tenderness

182
Q

Diagnostics and management of osgood-schlatters disease

A

Lateral xrays to rule out avulsion
rest, ice, NSAIDs
quad/hammy exercises
Chopat strap

183
Q

Calcaneal apophysitis “Sever’s disease”

A

Irritation and inflammation of calcanea apophysis; overuse syndrome, pull of achilles
kids 6-12
Treated with stretching, ice, NSAIDs

184
Q

Clubfoot (congenital talipes equinovarus)

A

CAVE: mid foot caves, forefoot adducts, hind foot varus and equinus
Smaller foot and calf with shortened tibia

185
Q

Clubfoot risk factors and treatment

A 
maternal smoking, fam history
Ponsetti method (takes years) or casting (weeks) both multiple stages
186
Q

Adolescent age range

A

starts 10-12 ends 18-21

Period of physical, social and emotional development

187
Q

Top 5 causes of teen deaths

A

accidents (cars) #1, homicide, suicide, cancer, heart disease

188
Q

Puberty

A

biologic process of child turning not adult (reproductive, adult size)
Girls usually done 11.5-12 years, boys 13.5-14 years

189
Q

Early adolescence

A

10-13 years
Cognitive :interested in NOW, deeper moral thinking, abstract thought
social emotional: awkward about self/body, increased conflict with parents, desire for independence, want privacy, moody

190
Q

Middle adolescence

A

14-16 years
Cognitive: greater capacity for goal setting, meaning of life
Social emotional: self-involved, drive for independence, love and passion (safe sex talk), worries about being normal

191
Q

Late adolescence

A

> 17 years
cognitive: ability to think ideas through, increased concern for the future
Social emotional: firmer sense of self identity, develop more serious relationships

192
Q

Menarche

A

2-2.5 years after pubarche (during stages 3-4)
first period often only from effect of estradiol, not ovulation
first year usually irregular

193
Q

When is the first visible sign of puberty in boys?

A

9-10; enlarged scrotum, pink and altered texture (tanner stage 2)

194
Q

When is first sperm production (spermarche)?

A

14-15, stage 4-5

195
Q

What is the MC reasons adolescents don’t seek care?

A

don’t want to tell parents

196
Q

When can minors consent without parent? (in AZ)

A

emancipated, married, homeless
Care relates to: STI, alcoholism, HIV testing
if 12+: rape, substance abuse (parents notified once admitted for treatment)

197
Q

adolescent pregnancy consent

A

If considered “mature minor” can consent

in Az: can consent for Childs care but not her own

198
Q

Mental Health adolescent consent

A

Inpatient treatment requires parental consent unless emergent situation, outpatient requires consent

199
Q

Minor consent on abortion

A

Minors can not consent unless: emancipated, judicial bypass, pregnancy result of incest, pregnancy harmful to patient

200
Q

When is disclosure required by law?

A

Abuse, suicidal ideation, homicidal ideation, reportable STIs

201
Q

When do we start dyslipidemia screening?

A

19-21, earlier (11-14) if risk factors like high BMI, fam history

202
Q

Whats the largest preventable and most costly public health problem in US?

A

Adolescent substance abuse (alcohol most common, then cigarettes, then marijuana)

203
Q

What regions of brain are impacted by adolescent substance use?

A

Judgment, attention, memory, reward seeking

204
Q

Adolescent presentation of depression

A

boredom, hopeless, weight changes substance use, suicide attempts
parents report irritability

205
Q

Adolescent depression treatment

A

refer to pets behavioral health
meds: fluoxetine (prozac) only one approved in kids 8+ for a min of 8 months
monitor for suicidality (combination with psychotherapy is most effective)

206
Q

3rd MC chronic illness in adolescent girls?

A 
eating disorder (obesity and asthma 1 and 2)
F>M 10:1
207
Q

Presentation of anorexia nervosa

A

Decreased body temp, bradycardia, dizzy, decreased peripheral circulation, thin hair/nails, dry skin, early satiety, depression

208
Q

Bulimia nervosa presentation

A

abdominal pain, early satiety, diarrhea/constipation, depression, dehydration, orthostatic hypotension, enamel loss, cavities, bruising/thickening of finger joints, parotid pain/enlargement
Usually average height weight or overweight

209
Q

Diabulimia

A

Diabetic patients skipping insulin dose to lose weight

210
Q

Binge eating

A

eating more rapidly than normal, until uncomfortably full
1/week for 3 months with no compensatory behaviors
50% are obese

211
Q

What are the types of genetic testing?

A

fetal (ultrasound, amniocentesis, carrier screening)
newborn screen
chromosome test (karyotype, FISH, genomic hybridization)
Specific gene or enzyme testing

212
Q

Fragile X syndrome

A

X-linked, M>F, many meet autism criteria
Decreased/absent “fragile x mental retardation protein FMPR” due to loss of function of FMR1 gene (200->1000 repeats of CGG)
Female carriers exhibits mild-severe symtoms

213
Q

Most common inherited cause of intellectual disability?

A

Fragile x syndrome

214
Q

Presentation of fragile X syndrome

A

Intellectual disability, oblong facies, large ears/testicles, hyper mobile joints, mitral valve prolapse
+/- macrocephaly

215
Q

Diagnosis of fragile X

A

Direct DNA analysis: abnormal DNA amplification

Test in developmental delay, mental retardation, autism diagnosis

216
Q

Management of fragile X

A

Speech/language therapy, occupational therapy, behavioral psychologist
meds for ADHD, aggression, anxiety, mood instability

217
Q

Angelman syndrome cause

A

Inactivation or deletion of UBE3A gene on maternal chromosome 15
very rare

218
Q

Angelman syndrome presentation

A

Happy, excitable, frequently smile/laugh

Microcephaly, seizures, tongue thrusting, autism, intellectual disability, poor language development

219
Q

Angelman syndrome management

A

No cure; epilepsy drugs, PT, speech therapy

Most develop <10 words in lifetime

220
Q

Prader-willi syndrome

A

Characterized by childhood obesity due to hyperphagia
Lack of expression of genes on paternal chromosome 15 with inactive copy on maternal chromosome 15
Loss of OCA2 gene in some>light skin and hair

221
Q

Presentation of Prader-willi

A

Hypotonia in infancy (feeding tube)
Insatiable appetite leading to obsessive chronic hyperphagia
almond shaped eyes, strabismus, sleep apnea, short, small hands/feet, hypogonadism

222
Q

Diagnosis and treatment of prader-willi

A

Genetic testing recommended in newborns with hypotonia

Treat: GH injections, speech therapy, PT, OT

223
Q

Congenital adrenal hyperplasia

A

Autosomal recessive disorder of CYP21A2 gene causing 21-hydroxylase enzyme deficiency causing virilization (too many androgens), increased ACTH secretion (impaired cortisol synthesis) and salt loss (impaired aldosterone synthesis)

224
Q

Congenital adrenal hyperplasia Presentation

A

Females: ambiguous genitalia, adrenal insufficiency in 2-3rd week of life, early pubic hair (age 2), excessive acne/pigmentation, deep voice, short
Males: normal at birth, salt loss in 2-4 weeks of life, enlarged penis, hyperpigmentation

225
Q

Diagnosis and treatment of congenital adrenal hyperplasia

A 
Newborn screen
Hormone studies (elevated 17-hydroxyprogesterone)
Treat with steroid replacement (small dose of glucocorticoid and mineralocorticoid)
genital reconstruction for females
226
Q

Maple syrup urine disease

A

Psychomotor retardation, feeding problems, maple syrup odor in urine
Autosomal recessive amino acid disorder-deficiency of enzyme that breaks down leucine, isoleucine and valine (milk, eggs, meat) resulting in elevated keto acids

227
Q

Maple syrup urine disease presentation

A

Normal at birth

by 1 week: poor feeding, vomiting, lethargy; results in seizures, coma, encephalopathy, death if untreated

228
Q

Maple syrup urine disease Diagnosis and treatment

A

Newborn screening panel, amino acid analysis
Dietary restriction of eggs, meat and milk, fluids and diuresis in episodes of decomposition
If started in first 10 days can develop/grow normally

229
Q

Osteogenesis Imperfecta

A

Rare genetic connective tissue disease, “brittle bone”

Mutation of type 1 collagen (COL1A1), most due to spontaneous mutation

230
Q

Type 1 Osteogenesis Imperfecta

A

mildest- bone fragility without deformity and blue sclera

231
Q

Type 2 Osteogenesis Imperfecta

A

lethal, usually stillbirth, intrauterine fractures

232
Q

Type 3 Osteogenesis Imperfecta

A

Moderately severe, bony deformities due to multiple fractures, blue sclera, extremely short, lung disease, wheelchair by teens

233
Q

Type 4 Osteogenesis Imperfecta

A

mild, increased fractures after birth, bowing of long bones

234
Q

Presentation of Osteogenesis Imperfecta

A

Accessory skull bones (wormian bones), blue sclera, hypo plastic/deformed teeth, thin skin, hearing loss

235
Q

Diagnosis/treatment of Osteogenesis Imperfecta

A

Clinical
biochem tests (collagen biopsy), DNA analysis
No cure; bisphosphonates! swimming for exercise, hearing checks

236
Q

Prognosis in Osteogenesis Imperfecta

A

respiratory failure is most common cause of death in adults

237
Q

Tay-sachs disease

A

autosomal recessive, neurogenerative disease
Enzyme deficiency causing buildup of glycolipid in lysosomes (“storage disease”)
Common in European (Ashkenazi) jews
1/25!

238
Q

Tay-sachs presentation

A

Normal until 2-6 months>progressive weakness, loss of motor skills (hypotonia/reflexia), cherry red macula, hyperacusis (exaggerated startle response), intellectual disability, seizures, vision loss
Long, narrow head, broad ribs, hook-shaped vertebrae, enlarged sella turcica

239
Q

Diagnosis/treatment of Tay-sachs

A

Enzyme assay

Feeding tubes, enzyme infusions, death usually by 4 years

240
Q

Trisomy 21

A

Prenatal testing: quad screen, nuchal translucency
3 copies of chromosome 21
Cardiac defects, hearing loss, visual problems, characteristic facies, GI defects

241
Q

Most common chromosomal abnormality in live births?

A

trisomy 21/down syndrome

242
Q

Trisomy 18/Edward syndrome

A

3 copies of 18 or translocation
Many die before birth-1 month
Club foot/rocker bottom, low set ears, small jaw, clenched hand, kidney/heart defects

243
Q

Trisomy 13/Patau Syndrome

A

3 copies of chromosome 13
Cleft lip/palate, polydactyly, secures, small jaw, heart defects, brain/spinal cord abnormalities
Many die within first days-weeks

244
Q

Cri-du-chat syndrome

A

Deletion of part of short arm of chromosome 5

Cat-like cry, wide set eyes

245
Q

Turner Syndrome

A

45X, affects female development

Short, broad chest, webbed neck, amenorrhea, infertility (nonfunctional ovaries), CV abnormalities

246
Q

Klinefelter syndrome

A

Extra X, 47XXY
Affects male development
Hypogonadism, infertility, gynecomastia, reduced hair
Many first trimester losses

247
Q

Fetal alcohol syndrome

A

growth retardation, CNS dysfunction, facial dysmorphology (small eyes, smooth philtrum, thin upper lip)
heart and joint defects, failure to thrive, mental deficiency, ADHD, sensory impairment, cerebral palsy, epilepsy

248
Q

Fetal alcohol syndrome management

A

Assess family for addiction

Learning support, social/employment skills programs, OT, PT, ST, etc

Clinical Disciplines (4 decks)

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