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Clerkships > Peds > Flashcards

Peds Flashcards

1
Q

Staheli’s Test

A
  • Child placed prone, legs hanging over the table. Examiner extends one limb at a time trying to get limb to neutral.
  • If child can’t get to neutral, may be fixed flexion contracture.
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2
Q

Thomas’s Test

A
  • Tests for flexion contracture (illiopspoas)

- Child supine, with knees to chest. Allow one leg to extend.

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3
Q

Ober’s Test

A

Tests for hip abduction contracture

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4
Q

Ely’s Test

A

Tests for Rectus Femoris contracture

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5
Q

Ryder’s Test

A
  • Measures femoral antetorsion
  • Normal is 10˚ internally rotated
  • If femur is ext rotated, there is retrotorsion
  • If femur is int rotated, there is antetorsion
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6
Q

APGAR score

A

Skin Color:
0 - blue
1 - body pink, extrem blue
2 - completely pink

HR:
0 - asystole
1 - 100 bpm

RR:
0 - absent
1 - slow/irregular
2 - good (>60 bpm)

Stimulation Response
0 - no response
1 - facial grimace
2 - sneeze/cough

Muscle Tone
0 - limp/no tone
1 - some flexion of extrems
2 - active motion

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6
Q

What APGAR score indicates extreme distress

A

1-2 (highest score = 10)

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7
Q

Barlow’s Test

A

To identify a hip that is fully located (or subluxed), but which can be additionally subluxed or fully dislocated

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9
Q

When to take APGAR score

A

@ 1 min, 5 min, then q 5 min until normalize

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10
Q

Ortoloni’s Test

A

To identify a hip that is doslocated but reducible

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11
Q

Palmen’s Sign

A

A finding of subluxation

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12
Q

Telescoping Sign

A

To identify a dislocated mobile proximal femur

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13
Q

Galeazzi’s Sign

A

To identify an apparently short femur in hip dislocation

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14
Q

Allis’ Sign

A

Tests for shortening in the limb

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15
Q

Trendelenberg’s Test

A

Tests for weakness of the hip abductors (especially gluteus medius)

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16
Q

Gower’s Sign

A

Identifies weak hip extensors

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17
Q

Confusion Sign

A
  • Have pt do maneuver unrelated to ankle dorsiflexion, but it will produce reflex ankle
  • Seen in children that are neurologically abnormal, with spasticity
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18
Q

Calcaneovarus deformities

A 
ankle = calcaneus
FF = supinated (adducted/varus)
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19
Q

Causes of Calcaneovarus

A
    • NM in nature
  • tibialis anterior = only muscle really working well (adducted/varus)
  • weakness in posterior, lateral, and other anterior muscle groups
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20
Q

Difference b/w calcaneovarus and calcaneus deformity

A

calcaneus deformity = no forefoot malposition (all anterior muscle groups functioning)

Similarities:

  • also NM in nature
  • neither are talipes (congenital) deformities
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21
Q

Triad of Talipes Calcaneovalgus

A
  • Ankle Calcaneus
  • STJ pronation
  • TN subluxation (NOT dislocated – i.e., how to differentiate from vertical talus, in which TNJ is dislocated!)
    • note: ankle in calcaneus with PF to neutral only until ~6 mo… after 6mo, ankle in equinus and PF 20 deg (OBLIQUE TALUS AND TALIPES CALCANEOVALGUS = ONE IN THE SAME AFTE 6 MONTHS)
  • i.e., ankle equinus, STJ pronated/subluxed, FF abducted
22
Q

Etiology of Talipes Calcaneovalgus

A
  • congenital (in utero positioning - packaging defect) **most common
  • neurological (paralysis below L5)
23
Q

Tx of Talipes Calcaneovalgus

A
  • serial casting followed by orthotics (UCBL or Type C Heel Stabilizers)
24
Q

Causes of rigid pediatric flatfoot

A
  • Congenital Convex Pes Valgus (Vertical Talus)
  • Tarsal Coalition
  • Severe Talipes Calcaneovalgus (more common than CCPV*)
25
Q

Oblique Talus - flexible or rigid?

A

fully flexible triplane pronation foot

26
Q

Congenital Convex Pes Valgus - other names

A
  • rock-bottom flatfoot
  • persian slipper
  • vertical talus
27
Q

Difference b/w CCPV and Talipes Calcaneovalgus

A
  • CCPV - DISLOCATED STJ
28
Q

Most common cause of CCPV

A
  • Myelomeningocele
29
Q

Bone/Joint Abnormalities of CCPV

A
  • TNJ dislocation (navicular wedged b/w dorsal talar neck and anterior tibia)
  • ankle in equinus, but foot in calcaneus (b/c talus extremely PF, but foot looks DF on AJ)
  • talar neck hypoplastic (“Washington monument”), small talus
  • calcaneus in equinus
  • elongated spring ligament
  • tight anterior compartment tendons, triceps surae, and peroneals
30
Q

Treatment of CCPV

A
  • Dobb’s Technique = serial casting based on reversal of Ponsetti technique
  • do serial casting and then limited midfoot release if necessary
  • late initiation of tx worsens prognosis
31
Q

Talipes Equinovarus (TEV) - 3 components

A
  • ankle and foot equinus
  • STJ varus (STJ supinated)
  • FF adductus (and in some degree of cavus, 1st met PF)
32
Q

Etiology of TEV

A
  • idiopathic ** most common form
  • unknown, probably genetic
  • males > females (females get it wore when present)
33
Q

Arterial abnormality seen in TEV

A

80-85% - anterior tibial artery abnormality - usually does not develop distal to lower 1/3 of leg

34
Q

Pathological anatomy TEV

A
  • ankle/foot equinus
  • STJ varus
  • talar neck short & deviated medially/plantarly
  • navicular is down, medial, and proximal on the talar head (SUBLUXED) and 2/3 the size of normal - follows abnormal position of talus and may be so medial that forms false articulation with anterior aspect of medial mall
  • can’t palpate the talar head medially b/c of navicular covg
  • calcanus in varus and rotated so that distal portion almost directly inferior to talar head (medially and downward)
  • severe capsular/ligamentous contractures
  • invoved foot is smaller involved leg is smaller (look at calf musculature)
  • no sinus tarsi (talar head fills it)
  • redundant skin over talar head, thin and hyperpigmented – caused by the uncovering of the dorsolateral aspect of talar head (long standing pressure of head against skin)
35
Q

Gold standard of TEV correction

A

PONSETTI TECHIQUE = manipulation and serial casting (MUST BE ABOVE THE KNEE)

  • supinate the FF to remove the 1st ray cavus and get FF parallel to RF
  • correct FF and STJ as unit
  • correct AJ equinus only after (PQ AT tenotomy! not lengthening)

** long term shoe/bar splinting - Dobb’s brace = what is used today (or can use Filauer bar if non-ambulatory or when sleeping/resting)

36
Q

When to do surgery on TEV

A
  • salvage px
  • wait until at least 9 mo of age (so they can tolerate)
  • if pt not corrected by serial casting/manipulation before 1 year - want to consider sx before start standing on the deformity
  • usually need to d posterio-medio-latero-plantar release
37
Q

Cincinnati incision

A

big incision - from 1st met base up to Tendo Achilles to cuboid/5th met base

38
Q

Clinical Picture of Met Adductus

A
  • mets 2-5 adducted due to bowing of prox shaft; vs. distal medial cuneiform is malaligned so that it directs medially (not 1st met)
  • concave medially w/ apex at 1st TMTJ and deep vertical skin crease
  • convex laterally w/ apex at 5th met base (prominent)
  • regular hindfoot
  • hallux varus may be present
  • wide 1st interdigital space
  • contracted abductor hallucis
39
Q

4 Findings that constitute the screening for met adductus

A
  1. simple inspection
  2. passive overcorrection
  3. active overcorrection (note: response involutes after 1 yr)
  4. evaluation standing (deformity usually worse)
40
Q

Most common cause of met adductus

A

most likely intra-uterine packing

* also genetic component

41
Q

Which is easier to fix met adductus type: flexible or rigid?

A

rigid

42
Q

When should you definitively decide to treat met adductus

A

if it has not spontaneously corrected by 6-8 months

43
Q

Gold standard treatment of met adductus

A
  • manipulation and serial casting, change weekly (as long as
44
Q

Indications for met adductus surgical intervention

A
  • persistant hallux varus
  • age > 3
  • recurrence
  • failure of non-op tx
45
Q

Heyman, Herndon, and Strong Px

A
  • TMTJ lig (only medial, dorsal, and plantar) release with 2nd met osteotomy
    • for younger children
46
Q

Fowler Px

A
  • used mostly for skewfoot when need deformity correction in all three planes
  • includes: 1. opening wedge osteotomy of medial cuneiform, 2. abducting osteotomies of lesser mets, 3. possible lateral column lengthening, 4. possible varus osteotomy of calcaneus
47
Q

Berman-Gartland Px

A
  • crescentic osteotomies to abduct metatarsals (base osteotomies)
  • older children (b/c ca no longer remodel cartilage as you can w/ HHS) with persisting deformity
    • be careful w/ 1st met – need to make 1.5 distal to base due to open physis
48
Q

Stereotypical Blount’s Dz Pt

A
  • short, fat, early walker
  • African American
  • Female
49
Q

is Blount’s real AVN

A

no

50
Q

Current theory on Pathophysiology of Blounts Dz

A
  • progressive upper medial tibial physeal dysfunction (may be due to early loading / walking of someone already in varoid position)
  • decrease growth medial side, cntnd growth laterally
51
Q

Xray findings Blounts

A
  • beak on medial side w/ flattening

- tibiometaphyseal (Levine-Dennen’s Angle) >16 = suggestive for Blounts (

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