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OITE Prep Fredericks > Peds > Flashcards

Peds Flashcards

1
Q

Osteogenesis Imperfecta decrease is amout of?

A 
Normal Type I collagen
- COLA1a1, 
- Glycine substitution 
AR form is more severe 
SABER Shin, Bisphosphonates
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2
Q

Prophylactic slip indiations?

A
  • Hypothyroidsm
    . Girls Les than 10, boys less 12
  • obesity
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3
Q

Mutation of Marfan/s syndrome?

A

Fibrillin-1

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4
Q

Best Prognostic indicator for good outcome after LCP?

A

<6 years old

- Fragmentation phase is 6months after initial. this is when lateral pillar classification determined

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5
Q

Bowed legs at 2 years, knocked knees at 3 yeaers

A

valugs until normal at 7 years

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6
Q

Angle of drennan (blounts) line from metaphyseal beaks perpendicular to axis of tibia?

A

> 16d has greater than 95* progression
- Operative is grter than 4 in ALL stages
NEED to correct to 10-15d of VALGUS

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7
Q

Distal Clavicle Physeal fractures pathoanatomy?

A

The clavicle displaces away from physis and periosteal sleeve, physis and sleeve stay attached to AC/CC ligaments

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8
Q

Clubfoot correction

A
  • Cavus
  • Adductus
  • Varus
  • equinus ( Achilles tenotomy)
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9
Q

Calcaneonavicular coalition Tx

A
  • immobilization/ rest
  • resection with EDB interposition
  • No supple- arthrodesis
    If talocalcaneal >50% arthrodesis/<50% resection
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10
Q

C1-C2 fusion for downs syndrome AAI

A

ADI
>5mm and myelopathic
or >10m

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11
Q

Neurmofibromatosis phenotype

A 
-ANTERIOR LATERAL BOWING tibia
(posterior medial- packaging problems)
- Café-AuLait- SMOOTH (California)
- Short SHarp Dytrophic Scoliosis
- AD, Cutaneous neuromas
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12
Q

Progression of Thorcacolumbar kyphosis in Achondroplasia?

A

Will improve by 12-18 months when child ambulates

FGFR-3 mutation

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13
Q

FGFr2 mutation ?

A

Aperts

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14
Q

Klippel-feil syndrome and scapular deformity?

A

Sprengels deformity- difficulty in shoulder abduction

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15
Q

What is the cut-off age for AI to be less than 25d?

A

6months
Normal Alpha Angle (>60)
Normal Beta Angle <55

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16
Q

What to do if pavlik harness has failed after 3 weeks in child <6months old?

A

Convert to semi-rigid abduction orthosis

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17
Q

When do you do closed reduction and spica casting in DDH?

A

6-18months old

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18
Q

When do you do open reduction and spica casting of DDH?

A

> 18months old

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19
Q

Open reduction with femoral or acetabular osteotomies in children greater than?

A

2years old

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20
Q

What does vancomycin bind to?

A

D-Ala-D-Ala moieties in bacterial cell wall

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21
Q

What other work-up does Juvenile idiopathic Arthritis need (JIA?

A

Optho for anterior uveitis

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22
Q

Infantile tibia var indications for operative treatment?

A
  • needs to have osteotomy by age of 4
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23
Q

When are barlow and Ortaloni maneuvers useless?

A

After the age of 6mo.

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24
Q

Breakdown of femoral shaft fracture treatment in kids?

A

<6months- Pavlick versus spica cast
7m-5 years- <2/3cm shortening- spica
>2cm short: ORIF/Flex Nails
6-11y: length stable- flexible nail
unstable- ORIF, ExFix
>11 year: Flex nails ,10lbs, Troch lateral entry

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25
Q

Coxa Vara Surgery angle?

A

Hilgrenrieners epiphyseal angle
Line thorugh physis adn H line
<45d can observe, >60d Valgus osteotomy

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26
Q

30s subunit on ribosome

A

Aminoglycoside(gentamicin, tobramicin)

Tetracycline (doxycycline)

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27
Q

50s ribosomal subunit acotrs

A

Macrolides (azithromycin, erythromycine)

Clindamycin

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28
Q

Pseudoachondroplasia gene and differences?

A
  • NO frontal bossing, No spinal stenosis

- COMP on chromosome 19

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29
Q

What is the rash associated with LYME disease?

A

Erythema Migrans

  • Amoxicillin/Doxycycline
  • Borrelia Burgdorferi
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30
Q

Elbow fracture associated with dislocation?

A

ME fracture- Plan for dissection? Brachialis (MCTN), Triceps (Rad. N. )

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31
Q

Excessive supination during SWING phase of gait after ponsetti castin? What Tendon to transfer and where?

A

TA

  • LATERAL Cuneiform 1
  • Cuboid 2
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32
Q

Rugger Jersey Spine pathonogmonic?

Erlemeyer Flask of distal femur

A

Osteopetrosis

- Defect in Carbonic Anhydrse (hearing los, anemia

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33
Q

Duchene’s Muscular dystrophy

  • Inheritance pattern
  • gene/protien
A
  • XLR
  • Gowers sign
  • Scoliosis in 90-95%
  • Dystrophin
  • Bewckers is less severe form (some dystrophin)
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34
Q

Tibial Torsion test ?

A

Thigh-Foot angle (normal between -5–>20

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35
Q

Increase femoral anteversion signs?

A
  • In towing gate
  • Knee IN LINE with foot
    Increase interrotaiton
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36
Q

Normal Heel bisector line?

A

Between the 2nd/3rd

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37
Q

When should physiologic genu Varum resolve?

A

2 years, especiialy b3

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38
Q

Jump gait conctractures?- Hip flexion, Knee Flexion, Plantar flexion
Crouch Gain Contractures?

A

Hip Flexion, kne Flexion, Ankle Dorsiflexxion (calcaneous on floor during entire stance phse)

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39
Q

Iselin’s Disease is ?

A

traction apophysitis of base of 5th metatarsal

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40
Q

Which artery is HYPOPLASTIC in clubfoot?

A

Anterior tibial artery

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41
Q

LDFA Normal?
MPTA Normal
F-T Angle Normal

A

85-90
85-90
5-10

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42
Q

hallmarks of marfans?

A 
AD
Fibrillin-1
Dolichostenomelia
Scoliosis
Dural ectasia
Cardiac problems
acetabular protrussio
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43
Q

Uper Cervical problem in achondroplasia

A

Foramen Magnum stenosis

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44
Q

What iw gene for Spinal Muscular Atrophy?

A

Survival Motor Neuron II (SMN2)

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45
Q

Arthrogyrposis hip reduction? Open or closed?

A

Probably not going to be able to do it with CLosed, will be open and with MEDIAL approach
- No elbow flexion, wrist flexed , internally rotated shoulder

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46
Q

What is common etiologic bacterial agent following varicella injection/infection?

A

Group A- beta hemolytic strep

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47
Q

What muccopolysaccaraidosis is odontoid hypoplasia associated with?

A

Moroqiuo Syndrome

Accumulation of Keratan sulfate

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48
Q

Bilateral Flattening of the femoral epiphsysis?

Unilateral Flattending of Femoral Epiphysis?

A
  • Bilateral - Multiple Epiphyseal Dysplsia- Survey

- Unilateral- Legg-Cathe Perthes

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49
Q

?Which Zone does SCFE usually happen in

A

Zone of Hypertrophy

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50
Q

Growth plate zone associated with achondroplasia?

A

Proliferative Zone

- also gigantism

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51
Q

Hypertrophic Zone pathology?

A

SCFE
SH Fractures
Rickets

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52
Q

Gauchers and Diastrophic Dysplsia Chondral zone?

A

Resting Zone

53
Q

Most Likely strucutre that is trapped under tibial eminience fractures?

A

Medial meniscus

54
Q

Erbs Palsy with Favorable recovery if what is seen early?

A

Biceps function/ elbow flexion

55
Q

Tibial Bowin

  • Anterior Lateral?
  • Anterior Medial?
A
  • AL- NF-1

- AM- Fibular Hemimelia (no ACL, Absent Lateral Ray

56
Q

Fibrilin-1 is on what chromosome?

A

15

57
Q

Packing problems in utero

A

DDH, MT adductus, Torticollis

58
Q

Calcaneal Valgus AND and PM bowing? What should you expect?

A

LLD 4-6 cm

59
Q

Salter and Triple (Steele)

A
  • rotational osteotomies (think if them like PAOs with pubis/triradiates)
  • Salter is ONE cut
  • Triple is obviously 3
  • Rotate through the pubis
60
Q

Pemberton and DEGA Osteotomy are what type of osteotomies?

A

Volumetric reducing osteotomies

61
Q

Where is the hip volume loss in CP kids?

A

Posterior superior- need to graft in the back

- DDH is most anterior lateral

62
Q

What is the most common position of the chile in utero?

A

Head own, LEFT hip towards sacrum

- Left hip more common in DDH

63
Q

What is the grey Zone in infantile blounts angle of Drennen?

A

11-16d

64
Q

When does the the proximal femoral epiphysis form or show up

A
  • 6 months
65
Q

When does closed reduction of hip probably not work?

A

Definitely over 18 months WONT work

66
Q

What does fibrous dysplasia on histology

A

Scattered calcification- Chinese Letters

67
Q

Fibular Hemimelia things ?

A
  • ACL out
  • Lack of lateral rays of foot
  • Ball and Socket joint
  • Anterior Medial Tibial bowing
  • Sonic Hedgehog
68
Q

What are the muccopolysaccharidosis?

All are AR except HUNTER ( Xlinked)

A
  • Moroqio- Keratan Sulfate
  • Hunters
  • Hurlers- Dermatan Sulfate
  • San Fellipo
69
Q

Larsens Syndrome ?

A

Fixed dislocations that are STIFF
Wide set eyes
Club feet

70
Q

What mother factor is associated with sacral agenesis?

A

Maternal Diabetes

71
Q

NF-1

A
  • Lisch nodules - needs six
  • Coast of California- smooth
  • dural extasia
  • PENCILLING of ribs (three)
  • Short, sharp, diastropic curves
72
Q

NF-1

What chromosome ?

A

-Lisch nodules - needs six
-Coast of California- smooth
- dural extasia
- PENCILLING of ribs (three)
- Short, sharp, diastropic curves
CHromosome 17

73
Q

What is the LLD asssocaited with Posterior medial tibial bowing?

A

BOWINR RESOLVES

4CM Tibial descrepancy

74
Q

What limb length decrepancy is ok at maturation?

A

2cm

75
Q

Lengthening with fixitor and osteotomy?

A

1 month/CM of needed length to remain on
100% complication rate
95% efficacy rate

76
Q

Varus normal Until When 2 years
Valgus Normal 2-6 years
Nomrmal Alignment 7 years

A

See other

77
Q

Blounts Treatment? <4yo , >4yo

A

<4yo: Brace as Toddler
>4yo: Surgery
If >4yo and Langenskoild classification you used Surgical OVER CORRECTION
OVER CORRECTION

78
Q

Blunts Disease Angle?

A

<11d normal
111-15 Monitor
>16 d- treat with braces or surgeryBrce if less thn 4yo, Surgery if Class IV or over 4

79
Q

Tibial Deficiencies
Extensor mechanism; NONE?
Extensor MEchanism intact?

A

NONE: Knee disarticularion

Present- BKA, Syme

80
Q

Bowing
Anteriorlateral Bowing?
Posterior Medial?
Anterior Medial

A

AL: “ A-L Bad”, Neurofibromatosis, Ch 17, pseuodarthrosis

PM: Calcaneoolavugs foot association, Bowing improves, residual limb length deficiency is 4CM

AM: Fibular hemelia (

81
Q

Anterior lateral tibia bowing without fracture Tx?

A

AL Bad, But you treat the bowing with orthosis UNLESS there is actual fracture

82
Q

Fibular hemilelia associations:

A 
Criciate defieciency
Coxa Vara
Lateral rays absent
Lateral femoral condyle hypoplasia
Ball and socket ankle ( unstable ankle- Syme amputation)
83
Q

What side is the discoid meniscus ?

A

Lateral side

3 consecutive cuts on the saggitals show menisceal body

84
Q

Congenital dislocations of hte knee asssociation

A

Larsens Syndrome, arthrogryposis, myelomenigoceole

Rule out Hip dysplasia ( need U?S or exrays of the hip)

85
Q

AER ( apical ectodermal ridge)?

A

Proximal to distal
Inter-digital apoptosis

THALIDOMIDE NHIBITS

86
Q

Zone of Polarizing activity ( ZPA)

A

Radial to ulnar development

Sonic Hedghog

87
Q

Wnt

A

Dorsal to volar developement

88
Q

Ectoderm

A

Responsible for neural crest, skin, spinal cord

89
Q

Endoderm

A

Notochord—nucleus pulposis

90
Q

THALIDOMIDE INHIBITS WHAT?

A

AER ( proximal to distal)

91
Q

Notochord (endoderm) induces the ectooderm to form the spinal cord. when does notchod go away

A

After somoites form vertebra from mesoderm ( nulceus pulposis is remnant of notochord)
Chordoma is Notochord remnant

92
Q

Vertebral Body Growth ends:

Neural Arch growth ends:

A

Body Growth ends at 16-18

Arch growth at 8 years- canald diameter fixed at 8 yeras

93
Q

Where does the epiphyseal vessels STOP in the growth plate?

A

Goes through reserve zone and proliferative zone ( high o2)but NOT hypertrophic ZONE (low o2 tension)

94
Q

Groove on Ranvier does what?

A

Anchors to pericondrium and BONE formation wthout latitudnal growth

95
Q

Perichondral ring of LaCroix

A

Give mechanical support to the epiphysis and growth plate

96
Q

C-R_I_T_O_E

A

6months, 3, 5, 7, 9, 11

97
Q

Autosomal Dominant?

A
  1. Achodonroplastia
  2. SED
  3. Jansen and Smid Metaphyseal Dysplasia
98
Q

Autosomal Recessive

A

Morquios
Distrphic Dysplasia
Often SINGLE enzyme disorder

99
Q

Partial deletions in Chromosome 15

A

Prader Willi- Paternal deletion

Angelmann- Materal deletion

100
Q

Intraarticular metaphysis?

A

Hip
Shoulder
Elbow
Ankle

NOT KNEE

101
Q

Most common acute hematogenous infections in Kids?

A

S. Aureus
PVL Strains: more complex, multisystem organ failure

CLINDAMYCIN

102
Q

Kocher Criteria

A

Fever
Inability to bear weight
WBC >12
ESR>40

4/4 99% septic hip

CRP >2 independent risk factor for septic hip

103
Q

XLD condition

A

XL Hypophosphatemic ricketts

104
Q

Parellelism of the Talus and calcaneus on AP AND LATERAL?

A

Pediatric Clubfoot

105
Q

What is needed after Ponsetti Casting for Clubfoot

A

Foot External rotation orthosis (70d)

Full Time for 3 months then night tim until 3-4 years

106
Q

Most common reason for clubfoot recurrance?

A

lack of bracing compliance

Need for early recasting

107
Q

Last Portion of Ponsetti Casting?

A 
Equinus release (tenotomy)
CAVE
108
Q

Long term seqeula of Clubfoot?

A

Lateral forefoot overload
Have to transfer Anterior TIb. tendon to Lateral cunieform
They have dynamic supination with gait

109
Q

Metatarsus Adductus

A

Packaging Disorder
85% resolve
Medial devaited forefoot with convex lateral border

110
Q

Type of foot does CVT have?

A

Dorsal dislocation of navicular on talus
Rocker botttom foot
50% due to neuromuscular or genetic causes

111
Q

What view do you want to get with CVT suspected?

A

Lateral XR of foot in PLANTAR FLEXION
Axis of first metarsal is ABOVE the talus
(navicular does not ossify until 3 yers

112
Q

What is most common Tarsal Colalition?

A
  1. Calcaneonavicular (45d oblique view) 8-12yo

2. Talo Navicular 12-15 yo,

113
Q

What is weak/strong in CMT?

A

Posterior Tib Strong
Peroneus Longus strong
Peroneus Brevis Wekan,
Anteriro Tib Weak

114
Q

COL1A1 or COL1A2 disease and anethesia risk?

A

Osteogensis imperfecta
BLue sclera
Malignant Hyperthermia Risk
olecranon apophysis avulsion fractures

115
Q

Bisphosphonates for OI?

A

Decrease fracture incidence and

PARK HARISS lines on Xray

116
Q

Fibrillin 1 defect?

A

Marfans Syndrome
Aortic Roo dilation, SUPERIOR Lends dislocation
AUTOSOMAL DOMINANT
Acetbular Proturssio

117
Q

Achondroplastia Spinal Findings ?

A 
FGFR3
Decreasing  interpedicular Length from L1-L5
autsomal Dominant ( but much are random and with advnaced paternal age)

PROLIFERATIVE ZONE OF PHYSIS

118
Q

Spinal Pathology in Achondroplasia

A
  1. Foramen magnum stenosos ( Sleep apnea and death)
  2. Thoracolumbar Kyphosis ( most resolve when walking begings)
  3. Lumbar Spinal Stenosis ( usually later)
119
Q

Keratin Sulfate Accumulation Disorder?

A

Moroquio Syndrome
Abnormal Beta Galatosidase enzyme
ODONTOID HYPOLASIA- C1-C2 instabiliity

120
Q

What do you have to due prior to surgery for

  1. Mucopolysaccaradosis
  2. Pseudochondroplastia
  3. SED
A

Get flexion extension veiws of C-Spine

121
Q

DDH Timeline Treatment

A

0-6mo- Pavlik Harness
6-18mo- Spica casting, closed reduction ( placed for 3months- adductor tenotomy
>18monts_ OPEN reduction +/- Pelvic and femoral osteotomies

122
Q

What are looking for on medial die pool on arthrogram in DDH

A

<5mm for reduction

123
Q

Approaches for Open reduction in DDH

A

Medial- Risk of AVN

Anterior lateral- can do capsuloraphy and pelvic osteotomies through same approach

124
Q

What pelvic osteotomies hinge on Triradiates?

A

Dega
Pemberton
San Diego

125
Q

Types of pelvic Osteotomies ?

A

Redirectional( Salter, Ganz, Triple)

ReContourning ( Dega, Pemberton, Sandiego)

Salvage; Chiari and Shelf

126
Q

Herring Classification of LCP

A

a: no loss of laterl 1/3 height
B: <50% loss
B/C: 50% loss of hiehg
C: >50% loss of height

127
Q

Gage Sign?

A

Osteopenic “V” lateral aspect of physis

128
Q

Bracket Phalanx or Metatarsal in kid- what is treatment ?

A

PHysiolysis - break it up

OITE Prep Fredericks (15 decks)

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