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Peds Flashcards

1
Q

physical fx

A

z of provisional calc in z of hypertrophy

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2
Q

physical arrest

A

bar resection if >2cm growth and <50% physeal involvement

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3
Q

Block to reduction proximal humerus fracture

A

biceps tendon, deltoid, periosteum

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4
Q

Acceptable reduction proximal humerus fx

A

<5 yo: 70° and 100% displacement
5-12yo:Upto40°to70°
>12 yo: 40° and 50% displacement

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5
Q

angulation tolerated humeral shaft fx

A

30 degrees

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6
Q

SCH fx
N injury for extension
N injury for flexion

A

AIN for extension type

ulnar nerve for flexion type

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7
Q

lateral condyle fx xray

A

internal oblique

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8
Q

lat condyle complication

A

avn - posterior blood supply

cubitus valgus - ulnar n palsy

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9
Q

transphyseal distal hum fx

A

child abuse

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10
Q

proximal radius fx

A

reduce if >30-45 degrees

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11
Q

forearm fx alignment

A 
– Bayonet OK
– Younger than 9
• 15° angulation
• 45° rotation
– Older than 9
• 10° angulation proximal • 15° angulation distal
• 30° rotation if distal
– Anatomic if approaching skeletal maturity
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12
Q

cast index

A

<0.8 thickness over width

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13
Q

femur fx

A 
• Up to 6 mo: Pavlik
• Up to 5 years:
– Spica Cast 
– Up to 2 cm shortening
– 0.5 to 2 cm overgrowth
>5 years Flexi nails if <11 yo or <45-50 kg, 80% fill
or rigid nail
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14
Q

tibial tubercle fx

A

type 3 involves the joint

if block to reduction it’s likely meniscus

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15
Q

tibial spine fx

A

type 1/2 - non displaced can treat in LLC in extension
Type 3/4 need arthroscopic or ORIF
complication is high rate of stiffness and late instability

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16
Q

late deformity for proximal tibia fx

A

valgus deformity 6 months after, usually corrects in 1-2 years

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17
Q

tibia fx operative

A

Consider operative
• >5° Posterior
• >5-10° Varus/Valgus

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18
Q

risk of growth arrest for distal tibia fx

A

post reduction gap of >3mm

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19
Q

tillaux fx

A

aitfl

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20
Q

triplane

A

SH2 on lat, SH3 on AP, is a SH4

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21
Q

kid halo pins

A

6-8 pins at 2-4 inch pounds

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22
Q

what bug needs blood culture medium

A

kingella kingae

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23
Q

involucrum

A

new bone formed by active periosteum

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24
Q

sequestrum

A

necrotic bone atet is avascular

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25
Q

gene for MRSA

A

PVL gene can cause septic emboli/DVT

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26
Q

joints w/intraarticular metaphysis

A

shoulder, elbow, hip, ankle

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27
Q

kosher criteria

A 
Kocher Criteria
– NWB
– ESR > 40
– Fever > 38.5
– WBC > 12K
• Kocher JBJS 1999
– 4=99%,3=93%,2=40%,1=3%
• Caird JBJS 1999
– Added CRP >2.0
– 5=98%,4=93%,3=83%
 Fever best predictor followed by CRP
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28
Q

Lyme disease tx

A

doxy if >8years, amoxicillin if younger

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29
Q

MRI for CP kid

A

periventricular leukomalacia

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30
Q

GMFCS

A

I – Speed, balance, coordination impaired
II – Hold railing, trouble with uneven surface
III – Rolling walker, self propelled wheelchair
IV – Operate powered wheelchair
V – Completely dependent

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31
Q

botox mechanism

A

inhibits presynaptic release of ACH

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32
Q

arthrogryposis hip

A

pavlik doesn’t work, needs open reduction, reduce if unilateral

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33
Q

spina bifida

A

maternal serum alpha fetoprotein

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34
Q

spina bifida based on lowest motor level so what is needed for community ambulation

A

L4

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35
Q

sacral agenesis associated w/

A

maternal diabetes

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36
Q

muscular dystrophy

A

duchess XLR, dystrophin protein
Becker less severe
20 degrees of curve is indication for fusion

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37
Q

Fascioscapulohumeral MD

A

can’t whistle, AD, scapular winging

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38
Q

treatment of CMT pes cavus

A

Lateral post with depression for 1st ray – PF release and 1st MT Osteotomy
– Post Tib Transfer if hindfoot flexible
– Calc Osteotomy if rigid
• Coleman block test

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39
Q

spinal muscle atrophy hip management

A

treated nonop

40
Q

infantile blounts

A

often unilateral, obese,

XRAY metaphyseal peaking, drennen angle >16

41
Q

adolescent blount

A

often unilateral, widening of prox medial physic

42
Q

asymmetric out toeing

A

may be a SCFE

43
Q

limb length growth

A

Amount of growth remaining
– Prox Femur – 3mm/year – Distal Femur – 9 mm/year – Prox Tibia – 6 mm/year
– Distal Tibia – 5mm/year
• Cessation of growth
– 14 years old for females – 16 years old for males

44
Q

LLD TREATMETN

A 
Treatment
– <2cm at maturity
• Observation/shoe lift
– 2-5cm
• Epiphysiodesis of long side
• Shortening vs. Lengthening
- > 5cm
- shortening vs. lengthening
45
Q

POSTEROMEDIAL BOWING

A

bowing will resolving, associated with calcaneovalgus foot, will develop LLD of 3-4 cm

46
Q

anterolateral bowing

A

NF, associated with pseuedarthrosis of tibia
brace to prevent fx
difficult to fix

47
Q

anteromedial bowing

A

fibular hemimimeila, tarsal coalition, ball/socket ankle joint

48
Q

fibular hemimelia gene

A

SHH

Ball and socket ankle

49
Q

club foot

A

related to PITX1 gene
CAVE
caves, adducts, varus, equines

50
Q

deficient artery in clubfoot

A

tibialis anterior

51
Q

hindfoot parrallelism

A

dorsiflexion lateral has talocalcaneal angle of <35

52
Q

congenital vertical talus

A

navicular doesn’t reduce on plantar flexion view, manipulation casting, pinning, tenotomy

53
Q

treatment calcaneovalgus foot

A

stretching, due to excessive dorsiflexion

54
Q

progression of scoliosis after maturity

A

thoracic curve >50 degrees
lumbar curve >30 degrees
typically 1-2 degrees per year

55
Q

treatment AIS

A

<25 obs
<40 obs
25-40 brace
>50 surgery

56
Q

what is early onset scoliosis

A

<10 years
usually left thoracic
RVAD >20 is high risk for progression

57
Q

treatment of infantile idiopathic

A

< 25°; RVAD < 20° = observation
25-45°; RVAD > 20° = cast / brace/MRI
> 50° = MRI, +/- surgery

58
Q

worst prognosis for congenital scoliosis

A

unilateral bar and contralateral hemivertebrae, nearly 100% progression

59
Q

treatment for congenital

A

MRI preop
Surgery for documented progression of 10 degrees
usually do insitu fusion UNLESS L4 or L5 hemivertebra then you do hemivertebrectomy
if <8 do growing rod type

60
Q

what type of spine deformity has highest risk fro neurologic compromise

A

congenital kyphosis

61
Q

what is  Vertebral scalloping
 Enlarged foramina
 Pencilling of ribs
 Short segmented, sharp curves  Kyphoscoliosis

A

NF with dystrophic type scoliosis needs ASF and PSF with instrumentation

62
Q

test to order when normal X-ray and concern for spondylolysis

A

SPECT, most sensitive

63
Q

atlantoaxial instability

A

More than 5mm
 Treatment: PSF
 Different indications for Down’s
Fusion if symptomatic or ADI > 10mm

64
Q

when does proximal femur ossific nucleus appear

A

6 months

65
Q

what do anterior/posterior straps do on pavlik harness

A

anterior - flexion

posterior - abduction

66
Q

what is superolateral filling defect on DDH arthrogram

A

inverted limbus

67
Q

when to leave DDH hips dislocated

A

Bilateral over age 6?? Leave alone

Unilateral over age 8?? Leave alone

68
Q

hip acetabular angle in a child

A

> 35 treat with abduction brace

69
Q

PAO unique in what way

A

posterior column remains intact

70
Q

shelf/chiari requires what?

A

requires metaplasia

71
Q

define congenital coxa vara

A

decreased neck/shaft angle

treatment is valgus osteotomy for neck-shaft angle 90 or less

72
Q

when can you use lateral pillar classificatin

A

end of fragmentation phase

73
Q

what drives prognosis in perthes

A

poor prognosis if onset 6 years old or later

and total head involvement

74
Q

outcome of perthes determined by

A

ROM and spherical head

75
Q

how does neck displace in SCFE

A

neck displaced anteriorly and externally rotates

76
Q

stable vs unstable scfe

A

stable you can walk on it. if unstable = AVN, less than 10% AVN risk in stable

77
Q

when pin bilateral scfe

A

endocrine workup if <10 yo, pin bilateral when endocrine etiology or open tri-radiate cartilage

78
Q

longitudinal femoral deficiency

A

sonic HH gene, limb bud

79
Q

congenital short femur presentation

A

bulky thigh, externally rotated femur, coxa vara, often absent ACL, can be lengthened if 30% or less shortening

80
Q

treatment for LLD

A

shoe lift if 1 inch or less
2.5-4.0 cm epiphysiodesis
4 cm or > lengthening
prosthesis w/or w/o conversion 30% or more shortening

81
Q

amputations

A

preserve heel pad, prevent overgrowth so do disarticulation if you can

82
Q

when is best time to do lower extremity amputation

A

when child starts to walk

83
Q

when is best time to do UE amputation

A

6 months

84
Q

how to treat congenital knee dislocation

A

frequently associated with ipsilateral dislocated hip

Treat knee dislocation first if both present, treatment is with casting

85
Q

treatment of osgood schlatters

A

activity modification

86
Q

how to treat popliteal cyst

A

observation

87
Q

groove of ranvier

A

contributes cells to resting zone

88
Q

ring of lacroix

A

fibrous/support structure

89
Q

rosebud hand

A

FGFR2

Aperts syndrome

90
Q

gene involved in MED

A

COMP

91
Q

hitchhiker thumb

cauliflower ear

A

DIASTROphic dysplasia

failure of DTD gene

92
Q

Trevors disease.dysplasia epiphyseal hemimlica

A

epiphyseal osteochondroma, often on talus

93
Q

osteochondroma

A

EXT gene defect, loss of hedgehog regulation

94
Q

filamin b mutatino

A

Larsen syndrome
accessory calcarea ossification center
multiple joint dislocations
cervical kyphosis

95
Q

Trevors disease

A

osteochondroma in the epiphysis
AKA dysplasia epiphyseal hemimelica
defect in groove of ranvier

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