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
Oblique Talus - flexible or rigid?
fully flexible triplane pronation foot
26
Congenital Convex Pes Valgus - other names
- rock-bottom flatfoot - persian slipper - vertical talus
27
Difference b/w CCPV and Talipes Calcaneovalgus
- CCPV - DISLOCATED STJ
28
Most common cause of CCPV
- Myelomeningocele
29
Bone/Joint Abnormalities of CCPV
- 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
Treatment of CCPV
- 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
Talipes Equinovarus (TEV) - 3 components
- ankle and foot equinus - STJ varus (STJ supinated) - FF adductus (and in some degree of cavus, 1st met PF)
32
Etiology of TEV
- idiopathic ** most common form - unknown, probably genetic - males > females (females get it wore when present)
33
Arterial abnormality seen in TEV
80-85% - anterior tibial artery abnormality - usually does not develop distal to lower 1/3 of leg
34
Pathological anatomy TEV
- 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
Gold standard of TEV correction
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
When to do surgery on TEV
- 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
Cincinnati incision
big incision - from 1st met base up to Tendo Achilles to cuboid/5th met base
38
Clinical Picture of Met Adductus
- 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
4 Findings that constitute the screening for met adductus
1. simple inspection 2. passive overcorrection 3. active overcorrection (note: response involutes after 1 yr) 4. evaluation standing (deformity usually worse)
40
Most common cause of met adductus
most likely intra-uterine packing | * also genetic component
41
Which is easier to fix met adductus type: flexible or rigid?
rigid
42
When should you definitively decide to treat met adductus
if it has not spontaneously corrected by 6-8 months
43
Gold standard treatment of met adductus
- manipulation and serial casting, change weekly (as long as
44
Indications for met adductus surgical intervention
- persistant hallux varus - age > 3 - recurrence - failure of non-op tx
45
Heyman, Herndon, and Strong Px
- TMTJ lig (only medial, dorsal, and plantar) release with 2nd met osteotomy * * for younger children
46
Fowler Px
- 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
Berman-Gartland Px
- 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
Stereotypical Blount's Dz Pt
- short, fat, early walker - African American - Female
49
is Blount's real AVN
no
50
Current theory on Pathophysiology of Blounts Dz
- 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
Xray findings Blounts
- beak on medial side w/ flattening | - tibiometaphyseal (Levine-Dennen's Angle) >16 = suggestive for Blounts (