peds

Question 1

Your young patient c/o deep nagging pain in the LLE. You are worried about a sarcoma. What characteristics are true for Osteosarcoma?

Answer 1

sunburst pattern, attacks the metaphysis, has a lacy pattern on histology

Question 2

Your young patient c/o deep nagging pain in the LLE. You are worried about a sarcoma. What characteristics are true for Ewing’s sarcoma?

Answer 2

attacks the diaphysis and pelvis. Has small round cell tumors on histology

Question 3

Dx of scoliosis requires a curve > ____ degrees, of which curve to the ____are most common.

Answer 3

> 10 degrees….right

Question 4

at what age can you dx adolescent idiopathic scoliosis?

Answer 4

10

Question 5

tx of adolescent idiopathic scoliosis:

Answer 5

1) observe for curve < 20
2) brace for curve 20 - 45
3) spinal fusion for > 45

Question 6

risk factors for hip dysplasia

Answer 6

first born female, breech presentation, with FHx and OLIGOHYDRAMNIOS

Question 7

What maneuver reveals a clunk when posterior force is placed on the hips in adduction?

Answer 7

Barlow

Question 8

What maneuver reveals a palpable clunk when hip is abducted, returning femoral head into the acetabulum?

Answer 8

Ortolani (a reduction technique)

Question 9

This test measures height of baby’s knees if they are on their back with knees up, discrepancy indicates posterior femur displacement

Answer 9

Galeazzi test

Question 10

what imaging do you use for dx of hip dysplasia?

Answer 10

US

Question 11

First line tx for hip dysplasia if reducable?

Answer 11

Pavlik Harness x 6 weeks (non-reducable = sx)

Question 12

12 month old seems to have pain in the leg. Holding hip out like butterfly. May have fever. What is high on DDx?

Answer 12

Septic hip joint

Question 13

How do you tx septic arthritis of the hip?

Answer 13

SURGICAL IRRIGATION, debridement and decompression, IV abx

Question 14

Septic hip caused by what pathogens?

Answer 14

Neonates–GBS, staph
1 mo-3 yrs–staph, strep, strep
3-13 yrs–staph, strep, h.flu
>13 yrs–staph, GC

Question 15

Young child with knee pain, limping, leg stiffness, Trendelenburg gait, LLD, normal knee PE

Answer 15

think HIP! Perthes Dz

Question 16

What is perthes dz?

Answer 16

idiopathic osteonecrosis of hip

Question 17

Who gets Perthe’s?

Answer 17

males b/t 5-7 years, ADHD risk

Question 18

What are poor prognostic indicators for Perthe’s patients?

Answer 18

1) bone age > 8 years
2) LROM
3) females
4) loss of femoral head sphericity

Question 19

tx of perthe’s?

Answer 19

restrict activity for bone age < 8 years….Sx for older (takes 12 mo for re-ossification)

Question 20

Can Perthe’s affect both hips at the same time

Answer 20

no

Question 21

obese kids (males) are at risk for:

Answer 21

SCFE (slipped capital femoral epiphysis)

Question 22

How often does SCFE/ice cream happen in both hips?

Answer 22

17-50%

Question 23

What are some additional risk factors for development of SCFE?

Answer 23

radiation, metabolic disorder

Question 24

tx for SCFE?

Answer 24

stop bearing wt!! Ortho RFL for Sx (risk for AVN)

Question 25

3 causes of in-toeing

Answer 25

Turning in of

1) femur
2) tibia
3) feet

Question 26

W position, often resolves with age:

Answer 26

Excessive femoral anteversion

Question 27

C-shaped foot

Answer 27

metatarsus adductus

Question 28

causes for Genu Varum:

Answer 28

rickett’s, skeletal dysplasia, blounts dz

Question 29

causes for Genu Valgum:

Answer 29

rickett’s, skeletal dysplasia, physeal injury, tumor

Question 30

clubfoot nmeumonic:

Answer 30

CAVE
Cavus = high arch
Adductus = C-shape
Varus = inturned heel
Equinus = hoof

Question 31

tx of clubfoot:

Answer 31

serial casting x 5 years

Question 32

These problems come from rapid bone growth, soft tissues cannot keep up

Answer 32

apophyseal issues

Question 33

apophyseal issue w/ tibial tubercle

Answer 33

Osgood schlatter

Question 34

apophyseal issue with calcaneus

Answer 34

Sever’s dz

Question 35

Subluxation of radial head from traction or roation

Answer 35

nursemaid’s elbow

Question 36

Tx of nursemaid?

Answer 36

1) pressure on radial head
2) traction on wrist
3) supination

Question 37

SCM contraction a/w intrauterine compartment syndrome

Answer 37

congenital muscular torticolis

Question 38

What condition necessitates ortho RFL?

Answer 38

SCFE

Question 39

What is the most likely problem in kids with knee pain?

Answer 39

hip path