Peds Flashcards
TORCHES infections are what?
Toxoplasmosis, Other agents (varicella, parvovirus), Rubella, Cytomegalovirus, Herpes/HIV, Syphilis)
What chromosomes are associated with Down’s, Edward’s, Patau, Turner’s, and Klinefelter’s?
21; 18; 13; 45X; 47XXY
When does the greatest change in bone mass occur in boys and girls?
Boys: 14-17;
Girls 12-15
When can baby keep head midline? When can they sit and transfer objects? When can they cruise with pincer grasp?
4 mos;
7 mos;
10 mos;
When can a kid pile two cubes and use single words? When does hand dominance emerge? When can they go up and down stairs, use two-word phrases, and build eight-cube towers?
14 mos;
18 mos;
24 mos (2 yrs)
When can a kid pedal a tricycle, go up stairs with alternating feet, copy a circle? What about going down stairs alternating feet and copying a cross? What about drawing a triangle?
3 yrs;
4 yrs;
5 yrs;
What specific anomalies are associated with limb deficiencies?
Craniofacial anomalies
What is the most common congenital limb deficiency? When should prosthetic fitting first occur for kids?
Terminal transradial;
6-7 months
What is the Krukenberg procedure?
Reconstructs the forearm and creates a sensate prehensile surface for children with absent hands by separating the ulna and radius in the forearm
The most common congenital lower limb deficiency is
fibular longitudinal deficiency
70-80% of patients with partial proximal femoral focal deficiency (PFFD) also present with
associated fibular deficiencies
What is the most common prosthetic foot prescribed for the child amputee?
Solid ankle cushion heel (SACH); energy-storing feet becoming more popular
Most common cause of pediatric acquired amputation? What about disease-related amputation?
Trauma;
tumor
Most common complication of amputation in the immature child? Where most likely to occur?
Terminal overgrowth at transected end of long bone; occurs most frequently at humerus, then fibula, then tibia, then femur (HFTF)
When are motorized wheelchairs classically introduced to kids?
Age 5-6 years old
Children with congenital limb deficiency do/do not develop phantom sensation or pain
DO NOT;
if ACQUIRED, some kids retain some awareness of the amputated part
Nmemonic for club foot deformity?
CAVE: midfoot CAVUS forefoot ADDUCTUS hindfoot VARUS hindfoot EQUINUS
How to manage clubfoot?
Start with Ponseti method of serial casting and manipulation; try to initiate in first month of life;
Can do PT and bracing, and last line of treatment is surgical correction
What is Blount’s disease? In whom is it more common? How to treat?
Abnormal fxn of medial portion of prox tibial growth plate with bowing in prox tibia;
AA’s;
osteotomy of prox tibia and fibula
Most common cause of congenital torticollis? Where is head tilted and rotated?
SCM fibrosis;
Tilted to ipsilateral side, rotated to contralateral side
Mainstay of treatment of congenital torticollis?
Stretching by tilting head to contralateral side and rotating to the ipsilateral side of fibrosis
What is nursemaid’s elbow, and how to manage it?
Subluxation of radial head;
Supination, extension of forearm
What is pathology behind medial epicondylar apophysitis?
Repetitive traction stress on apophysis of medial epicondylar ossification center of humerus
Most common cause of limping and pain in child’s hips?
Transient (toxic) synovitis of hip
Treatment for LCP vs. SCFE?
LCP: abduction brace, rest, may need varus osteotomy if need surg;
SCFE: surgical pinning preferred
Most common cause of structural scoliosis?
Idiopathic
When is neuromuscular disease most commonly seen?
CP, muscular dystrophy, spinal muscular atrophy, spina bifida
When to brace for scoliosis? When is surg needed?
20-40 degrees;
Over 40 degrees
How is Scheuermann’s disease diagnosed radiographically?
Having 3 or more consecutive vertebrae with greater than 5 degrees anterior wedging
Most common type of spondylolisthesis? Most common in adults? In kids, where is the spondylolisthesis most common? When do you need surgery?
Isthmic;
degenerative;
L5-S1, followed by L4-5;
usually over 50% slippage (i.e. grade 3)
Most common connective tissue disease in kids?
Juvenile idiopathic arthritis
Type of JIA most likely to develop chronic iridocyclitis? Acute iridocyclitis?
Oligoarticular;
systemic
Juvenile dermatomyositis is associated with
histologic presence of vasculitis, onset of calcinosis, lack of association with childhood malignancy
Jones Criteria to diagnose rheumatic fever?
Major: JONES Joints (polyarthritis) Heart (carditis) Nodules (subcutaneous nodules) Erythema marginatum Chorea; minor include fever, arthralgia, elevated CRP/ESR, prolonged PR interval
What is the hallmark of hemophilia?
Hemarthrosis
Most common cause of pediatric burn injury?
Scald burns
Of all the burn-related contractures in kids, which is most commonly involved?
Axilla
Reasons to hospitalize kids with burns?
Over 5% full thickness injury, over 10% total BSA in kids or elderly, or over 20% in general;
inhalation injuries, electrical burns, trauma; HEENT, hands, feet, genitalia
Most common type of tumor in kids? Most common type of malignant bone tumors in kids?
ALL;
osteosarcoma, followed by Ewing’s sarcoma
Leading cause of TBI in kids?
Transportation-related
Hypopituitarism presents with
growth failure and delayed or arrested puberty;
see GH, LH, and FSH most deficient
Which has better prognosis classically, TBI or anoxic brain injury?
Traumatic
CP is a disorder primarily of ________ and _____, but is also associated with
movement control; posture;
cognitive and sensory associated problems resulting from non-progressive lesion to immature brain
When do majority of CP cases occur? Some risk factors?
Prenatal;
prenatal ICH, placental complications, gestational toxins, gestational teratogenic agents
What is most common antecedent of CP?
Prematurity
Most common type of CP?
Spastic diplegia
Which type of CP has highest incidence of significant disability? Which has high incidence of sensorineural deafness?
Tetraplegic;
dyskinetic
What is common cause of spastic diplegia, and what can be seen on MRI?
History of IVH;
can see peri-ventricular leukomalacia
For ataxic CP, what is this classically associated with?
Sensorineural hearing loss, hyperbilirubinemia, neonatal jaundice
GMFCS descriptors
Level 1: Walking without restrictions
2: Walking without assistive devices;
3: Walks with assistive mobility devices;
4: Self-mobility with limitations;
5: Self-mobility severely limited even with use of assistive devices
Prognosis for ambulation in kid with CP is good if
independent sitting occurs by age 2
Predictors of successful and unsuccessful employment include
IQ level, ambulation level, speech, and degree of hand function
What are positions for asymmetric vs symmetric tonic neck reflex? When are they suppressed?
For asym, turn neck to side and see extension on that side with flexion on occiput side;
for symm, neck flexion and neck extension lead to arms flexing and extended, respectively, while legs do the opposite;
6-7 months
Which geographic regions have highest incidence of myelodysplasia? Lowest?
British Isles, Ireland, Wales, Scotland;
Japan
For spina bifida, when does defect of neural tube closure typically occur?
Day 26
What is myelomeningocele classically associated with?
Arnold-Chiari malformation type 2 with hydrocephalus
Most frequent single cause of death in spina bifida?
Central respiratory dysfunction (stridor, central apnea, aspiration)
Proteus UTI’s associated with
calcinosis
Presence of ________ or _______ reflex associated with greater chance of bowel continence
bulbocavernosus;
anocavernosus
In spina bifida, what is the relationship of intellectual function with level of spinal cord dysfunction?
Inversely proportion, ie higher the lesion, lower the score
In spina bifida, among verbal, math, written, or visual perceptual skills, what is usually greatest?
Verbal
For spina bifida, when to achieve independent self-cath?
Age 5-6 years; boys learn easier than girls due to anatomic differences
What are kids with spina bifida at increased risk for reaction wise?
Anaphylaxis (latex allergy)
For spina bifida thoracic lesions, what is ambulation ability?
Assistive devices for passive standing: parapodium, swivel walker, HKAFOs with spinal extensions, walker or Lofstrand crutches
For spina bifida lower thoracic and lumbar lesions, how to ambulate?
RGO;
can use AFO if L3 spared
Functional community ambulation in spina bifida by level?
Thoracic: 0 to 33%;
High lumbar: 31% can achieve some degree;
Low lumbar: 38% get there under age 15, 95% if age 15-31;
Sacral: All can achieve
Employment rate among those with spina bifida?
25-50%
Why does Gower’s sign happen?
Proximal (pelvic girdle) muscle weakness; can’t rise from sitting position on floor
Muscle biopsy findings for Duchenne?
Degenerating fibers often observed in clusters, with necrotic fibers surrounded by macrophages and lymphocytes
In DMD, where is earliest weakness seen? At ankle, knee, and hip, what muscle groups are stronger?
Neck flexors; pelvic girdle weakness precedes shoulder weakness; Ankle DF weaker than PF; Ankle evertors weaker than inverters; knee extensors weaker than flexors; hip extensors weaker than flexors; hip abductors weaker than adductors
Emery-Dreifuss muscular dystrophy inheritance, protein involved, and contractures of what?
X-linked recessive;
emerin;
elbow flexors
Central core myopathy with high incidence of
malignant hyperthermia
Another name for SMA type III, and what is characteristic prognosis-wise?
Kukelberg-Welander syndrome;
good long-term survival, depending on respiratory function
Number one cause of mortality in childhood neuromuscular diseases?
Pulm complications
