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Peds MSK Flashcards

1
Q

Salter-Harris classification?

A 
S: slipped
A: above
L: lower
T: thru
R: rammed
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2
Q

Salter-Harris type I –> XR appearance?

A
  • soft tissue swelling
  • normal physis
  • asymmetrically widened physis
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3
Q

pediatric elbow –> order of ossification? age ossify?

A

CRITOE:

  • capitellum 1yo
  • radial head 3
  • internal (med) epicondyle 5
  • trochlea 7
  • olecranon 9
  • external (lat) epicondyle 11
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4
Q

distal humerus –> capitellum vs trochlea?

A

articular surface of distal humerus:

  • capitellum –> articulate w radial head
  • trochlea –> olecranon
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5
Q

elbow alignment lines? (2)

A
  • ant humeral line

- radiocapitellar line

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6
Q

abnormal ant humeral line –> suggests what condition?

A

supracondylar fx

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7
Q

abnormal radiocapitellar line –> suggests what condition?

A

elbow dislocation

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8
Q

what is Toddler’s fx?

A

tibial metadiaphysis –> nondisplaced spiral fx

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9
Q

iliac crest apophysis –> muscle?

A

abd muscles

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10
Q

ASIS apophysis –> muscle?

A

sartorius

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11
Q

AIIS apophysis –> muscle?

A

rectus femoris

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12
Q

ischial tuberosity apophysis –> muscle?

A

hamstring

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13
Q

pubic symphysis apophysis –> muscle?

A

hip adductors & gracilis

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14
Q

grter trochanter apophysis –> muscle?

A

gluteus

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15
Q

lesser trochanter apophysis –> muscle?

A

iliopsoas

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16
Q

lesser trochanter fx –> diff bw adolescent vs adult?

A

adolescent: avulsion fx
adult: pathologic fx

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17
Q

nonaccidental trauma –> bone scintigraphy –> pros (1) vs cons (3) ?

A

pro:
- more sensitive for post rib fx

cons:
- higher radiation than XR
- insensitive for skull fx
- can’t eval fx age

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18
Q

fx age –> callus vs no callus?

A

no callus: <2wk

callus: at least 1wk

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19
Q

nonaccidental trauma –> highly specific fx? (5)

A
  • classic metaphyseal lesion
  • post rib
  • scapula
  • sternum
  • spinous process
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20
Q

nonaccidental trauma –> suspicious (but not highly specific) fx? (5)

A
  • > 1 fx
  • fx OOP to hx
  • infant –> digit
  • nonambu –> long bone
  • complex skull
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21
Q

what is bone dysplasia?

A

normal bone growth –> impair –> abnormal skeleton

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22
Q

achondroplasia –> key XR findings? (4)

A
  • narrow interpeduncular distance
  • post scalloping of vertebral bodies
  • “tombstone” iliac wings
  • flat acetabula, short femoral neck
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23
Q

MC lethal skeletal dysplasia

A

thanatophoric dysplasia

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24
Q

thanatophoric dysplasia –> key XR findings? (3)

A
  • H-shape vertebrae
  • narrow interpeduncular distance
  • telephone receiver femurs
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25
Q

prenatal fx –> dx?

A

osteogenesis imperfecta

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26
Q

osteogenesis imperfecta –> XR findings? (4)

A
  • osteopenia
  • mult fx
  • bowed long bones
  • Wormian bones
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27
Q

osteogenesis imperfecta –> rib appearance?

A

accordion ribs

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28
Q

what is asphyxiating thoracic dystrophy (Jeune synd)?

A

AR –> small thorax –> resp distress

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29
Q

asphyxiating thoracic dystrophy (Jeune synd) –> bone findings? (4)

A
  • small thorax
  • short ribs –> ant is bulbous
  • high “handlebar” clavicle
  • “trident” acetabulum
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30
Q

cleidocranial dysostosis –> XR findings? (4)

A
  • KEY finding: complete/partial absence of clavicles
  • wormian bones
  • delayed ossfication of skuls
  • wide pubic symphysis
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31
Q

what conditions can have stippled epiphyses? (4)

A
  • chondrodysplasia punctata
  • mult epiphyseal dysplasia
  • hypothyroid
  • maternal warfarin use
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32
Q

enchondromatosis is characterized by what?

A

asymm –> mult intra-osseous benign cartilaginous tumors

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33
Q

conditions w enchondromatosis? (2)

A
  • Ollier dz

- Maffucci synd

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34
Q

Ollier dz –> synd?

A
  • enchondromatosis

- no other abnormalities

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35
Q

Mafucci synd –> synd?

A
  • enchondromatosis

- venous malformation –> phlebolith

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36
Q

what is mult hereditary exostoses (osteochondromatosis)?

A

AD –> long bone –> metaphysis –> mult benign osteochondromas

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37
Q

mult hereditary exostoses (osteochondromatosis) –> complication?

A

malig transform –> chondrosarcoma

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38
Q

what is mult hereditary exostoses (osteochondromatosis) –> symm or asymm?

A

symm

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39
Q

mucopolysaccharidoses –> XR findings? (5)

A
  • ant vertebral body beaking
  • thick rib
  • undertubulated bones
  • Madelung deform
  • thick calvarium –> J-shape sella
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40
Q

mucopolysaccharidoses –> Hurlers vs Morquio –> XR findings?

A

ant beaking of vertebra body:

  • Hurlers: inf
  • Morquio: mid portion of vertebra
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41
Q

mucopolysaccharidoses –> Morquio –> other assoc findings? (2)

A
  • spinal stenosis

- atlantoaxial instability

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42
Q

septic arthritis –> MC MOA? MC org?

A

S. aureus –> hematogenous spread –> metaphyseal osteomyelitis –> brk thru periosteum –> infect jt capsule

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43
Q

hip effusion –> XR findings? (2)

A
  • displace gluteal/psoas fat plane

- widening of teardrop distance

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44
Q

hip effusion –> imaging modality of choice?

A

US

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45
Q

slipped capital femoral epiphysis –> epidemiology?

A

obese pre-adol (10-16yo)

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46
Q

slipped capital femoral epiphysis –> XR findings? (2)

A
  • wide proximal femoral physis

- Klein’s line –> not intersect femoral head

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47
Q

what is Klein’s line?

A

line –> lat margin of femoral neck –> should intersect femoral head

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48
Q

Klein’s line –> used on what view?

A

AP

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49
Q

slipped capital femoral epiphysis –> wide proximal femoral physis –> best seen on what view?

A

frog leg lat

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50
Q

what is Legg-Calve-Perthes dz?

A

avascular necrosis of capital femoral epiphysis ossification ctr

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51
Q

Legg-Calve-Perthes dz –> age range?

A

4-8yo

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52
Q

Legg-Calve-Perthes dz –> bilat –> assoc condition? (2)

A

systemic dz:

  • sickle cell
  • steroid
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53
Q

Legg-Calve-Perthes dz –> etiology?

A

unknown

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54
Q

early Legg-Calve-Perthes dz –> XR finding?

A

XR: femoral head –> subtle sclerosis

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55
Q

late Legg-Calve-Perthes dz –> XR findings? (2)

A
  • osteonecrosis: femoral head –> flat & distort

- OA

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56
Q

early Legg-Calve-Perthes dz –> bone scan finding?

A

bone scan: decreased uptake

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57
Q

late Legg-Calve-Perthes dz –> bone scan finding?

A

repair attempt –> increased uptake

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58
Q

MC primary pediatric bone tumor

A

osteosarcoma

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59
Q

osteosarcoma –> MC subtype?

A

75% –> conventional (intramedullary)

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60
Q

conventional (intramedullary) sarcoma –> MC location?

A

knee:
- distal femur
- prox tibia

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61
Q

conventional (intramedullary) sarcoma –> XR appearance?

A
  • destructive –> invade cortex

- osteoid matrix

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62
Q

2nd MC primary pediatric bone tumor

A

Ewing sarcoma

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63
Q

Ewing sarcoma –> MC location? 2nd MC?

A 
#1 --> femoral diaphysis
#2 --> pelvis --> flat bone
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64
Q

Ewing sarcoma –> mets –> MC location?

A

lung

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65
Q

Ewing sarcoma –> XR appearance?

A

soft tissue mass –> difficult to see on XR

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66
Q

what are Langerhans cells?

A

epidermis & LN –> dendritic cells (histiocytes) –> Ag-presenting cells

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67
Q

histiocytes –> microscopic finding?

A

Birbeck bodies

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68
Q

Langerhans cells histiocytosis –> 4 clinical subtypes?

A
  • eosinophiic granuloma (osseous LCH)
  • Hand-Schuller-Christian (multfocal unisystem)
  • Letterer-Siew (multifocal multisystem)
  • pulm LCH
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69
Q

pulm Langerhans cells histiocytosis –> epidemiology?

A

adult smoker

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70
Q

eosinophiic granuloma (osseous LCH) –> location?

A

skeleton only –> mono or poly-ostotic

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71
Q

LCH –> subtype –> Hand-Schuller-Christian (multfocal unisystem) –> clinical triad?

A
  • pituitary hypophysitis –> diabetes insipidus
  • exophthalmos
  • lytic bone lesions –> skull
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72
Q

eosinophiic granuloma (osseous LCH) –> epidemiology?

A

5-15yo

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73
Q

eosinophiic granuloma (osseous LCH) –> clinical presentation?

A

pain, tender, fever –> mimic osteomyelitis

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74
Q

eosinophiic granuloma (osseous LCH) –> skull –> XR appearance?

A

lytic lesion –> “beveled edge” (“hole within a hole)

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75
Q

eosinophiic granuloma (osseous LCH) –> flat bone (ie pelvis) –> XR appearance?

A

lytic lesion –> “hole within a hole”

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76
Q

eosinophiic granuloma (osseous LCH) –> long bone –> XR appearance? can look like what other condition? (2)

A

permeative destruction –> lytic lesion w faint sclerotic rim –> agg periosteal rxn

  • lymphoma
  • Ewing sarcoma
77
Q

eosinophiic granuloma (osseous LCH) –> spine–> XR appearance?

A

vertebra plana

78
Q

eosinophiic granuloma (osseous LCH) –> maxilla –> XR appearance?

A

“floating” teeth

79
Q

<30yo –> lytic bone lesion –> ddx? (2)

A
  • infx

- eosinophiic granuloma (osseous LCH)

80
Q

pediatric –> osteomyelitis –> MC location? MC MOA?

A

hematogenous spread –> metaphyseal marrow

81
Q

pediatric –> osteomyelitis –> metaphysis –> age range when common to have infection spread to epiphysis? why?

A

infant –> transphyseal vessels

older children –> capillaries NOT cross physis –> transphyseal extension uncommon

82
Q

pediatric –> osteomyelitis –> MC org?

83
Q

pediatric –> sickle cell –> osteomyelitis –> MC org?

A

Salmonella

84
Q

osteomyelitis –> when can be visualized by XR?

85
Q

osteomyelitis –> initial XR finding?

A

focal osteopenia (d/t hyperemia)

86
Q

early osteomyelitis –> which imaging modality is more sensitive than XR? (2)

A
  • MRI

- scintigraphy

87
Q

osteomyelitis –> XR appearance?

A

intramedullary lesion –> lucent –> erode cortex –> periosteal rxn

88
Q

isolated discitis –> occur in children or adult? why?

A

children only –> presence of blood vessels directly feeding disc –> infection begin in disc

adult –> infection can SPREAD to disc –> but not isolated discitis

89
Q

pediatric –> discitis –> classic age & presentation?

A
  • young child (up to 4yo)
  • preceding URI
  • back pain or refuse to sit
90
Q

pediatric –> discitis –> MC location?

91
Q

discitis –> XR appearance?

A
  • disc space narrow

- endplate irreg

92
Q

discitis –> MRI appearance?

A
  • disc space narrow
  • BM edema
  • vertebra –> may enhance
93
Q

what is chronic recurrent multifocal osteomyelitis (CRMO)?

A

nonpyogenic inflamm disorder –> mimic osteomyelitis

94
Q

chronic recurrent multifocal osteomyelitis (CRMO) –> key imaging finding?

A

lytic & sclerotic lesions –> migratory –> in time and space

95
Q

chronic recurrent multifocal osteomyelitis (CRMO) –> can be indistinguishable from infectious osteomyelitis –> but CRMO should NOT have these findings? (3)

A
  • soft tissue abscess
  • bony sequestra
  • fistula
96
Q

chronic recurrent multifocal osteomyelitis (CRMO) –> assoc synd?

A

SAPHO synd

97
Q

SAPHO synd –> synd?

A
  • synovitis
  • acne
  • pustulosis
  • hyperostosis
  • osteitis
98
Q

MC pediatric malig?

99
Q

leukemia –> XR findings? (3)

A
  • metaphyseal lucent band
  • osteopenia
  • permeative lytic lesions
100
Q

metaphyseal lucent band –> ddx? (4)

A
  • leukemia/lymphoma
  • severe illness
  • TORCH infx
  • scurvy
101
Q

what is rickets?

A

metabolic bone dz –> inadeq vitD –> zone of provisional calcification –> abnormal calcification –> abnormal physeal dev

102
Q

rickets –> XR findings? (4)

A
  • long bone –> metaphysis –> expand, fray, cupping –> periosteal rxn
  • leg bowing
  • osteopenia
  • fx
103
Q

rickets –> rib finding?

A

rachitic rosary: ant cupping of ribs –> wide rib epiphyseal cartilage

104
Q

what is oncogenic rickets?

A

variant of rickets

105
Q

leg bowing –> ddx? (3)

A
  • developmental/congenital
  • Blount dz
  • osteogenesis imperfecta
106
Q

metaphysis –> flare –> ddx? (5)

A
  • bone dysplasia
  • chronic lead poison
  • anemia
  • fibrous dysplasia
  • storage disorder
107
Q

TORCH infx –> syphilis –> what bone dz?

A

congenital syphilitc osteomyelitis

108
Q

Wimberger sign vs Wimberger ring sign?

A

Wimberger sign:

  • TORCH syphilis
  • prox tibia –> metaphysis –> med aspect –> erosion

Wimberger ring sign:

  • scurvy
  • ossification ctr –> increase density
109
Q

MC chronic arthopathy of childhood

A

juvenile idiopathic arthritis (JIA)

110
Q

juvenile idiopathic arthritis (JIA) –> age range by definition?

111
Q

juvenile idiopathic arthritis (JIA) –> MC subtype

A

pauciarticular

112
Q

juvenile idiopathic arthritis (JIA) –> pauciarticular subtype –> epidemiology?

A

young girls

113
Q

juvenile idiopathic arthritis (JIA) –> MC location?

114
Q

juvenile idiopathic arthritis (JIA) –> early imaging appearance? (3) later changes? (2)

A

early:
- osteopenia
- ST swelling
- jt eff

later:
- periosteal rxn
- erosion

115
Q

juvenile idiopathic arthritis (JIA) –> eventual endpt of dz?

A

jt ankylosis

116
Q

juvenile idiopathic arthritis (JIA) –> jt ankylosis –> MC sites? (3)

A
  • wrist
  • carpometacarpal jt
  • cervical spine
117
Q

cervical spine –> ankylosis –> ddx? (2) how to differeniate? (1)

A
  • juvenile idiopathic arthritis (JIA): no segmentation anomalies
  • Klippel-Feil: segmentation anomalies
118
Q

juvenile idiopathic arthritis (JIA) –> jt ankylosis –> MOA?

A

synovitis –> hyperemia –> accel bone growth & maturation –> abnormal bone growth, premature fusion of physes

119
Q

what is Still dz?

A

JIA subtype –> acute systemic

120
Q

Still dz –> epidemiology?

121
Q

Still dz –> clinical presentation? (5)

A
  • fever
  • anemia
  • leukocytosis
  • hepatosplenomeg
  • polyarthritis
122
Q

what is dev dysplasia of hip (DDH)?

A

femoral head - acetabulum relationship –> abn dev

123
Q

breech birth –> screen for DDH –> when?

A

few (4-6) wks after birth

124
Q

dev dysplasia of hip (DDH) –> screening US –> eval what? (2)

A
  • alpha angle (normal >60)

- acetabular covering (normal 50%)

125
Q

dev dysplasia of hip (DDH) –> when can screen w XR?

A

after 6mo (when femoral heads ossify)

126
Q

XR –> screen DDH –> Hilgenreiner & Perkins lines –> normal location of femoral heads?

A

inner low quad

127
Q

what is osteochondrosis?

A

group of disorders: bone necrosis –> affect the progress of bone growth

128
Q

osteochondrosis –> epidemiology?

A

children & adol who are still growing

129
Q

osteochondrosis –> what are 3 examples?

A
  • Legg-Calve-Perthes dz
  • Osgood-Schlatter dz
  • Sever dz
130
Q

osteochondrosis –> what is Blount dz?

A

osteochondrosis –> prox tib metaphysis –> tibia bowing (varus) & int rot –> progressive deform –> gait deviation, leg length discrepancy

131
Q

osteochondrosis –> Blount dz –> infantile form –> etiology?

A

early walking + obesity

132
Q

osteochondrosis –> Blount dz –> differentiate infantile vs adolescent form?

A

infantile:
- infant
- bilat

adol:
- >6yo
- unilat

133
Q

what is Madelung deformity?

A

osteochondrosis –> dysplasia of distal radius –> medial –> physis –> growth disturb –> medial sloping of distal radius

134
Q

what is Panner dz?

A

osteochondrosis –> capitellum

135
Q

what is little league elbow?

A

osteochondrosis –> med epicondyle

136
Q

what is Scheuermann kyphosis?

A

osteochondrosis –> mult thoracic vertebra –> avascular necrosis –> mult compression fx

137
Q

what is Kienbock dz?

A

osteochondrosis –> lunate

138
Q

what is Osgood-Schlatter dz?

A

osteochondrosis –> tibial tuberosity

139
Q

what is Freiberg infraction?

A

osteochondrosis –> 2nd metatarsal head

140
Q

what is Kohler dz?

A

osteochondrosis –> navicular

141
Q

what is Sever dz?

A

calcaneal apophysitis

142
Q

what is fibromatosis coli?

A

idiopathic sternocleidomastoid enlrg –> torticollis

143
Q

fibromatosis coli –> tx?

144
Q

tarsal/carpal coalition –> 3 types of coalition?

A
  • fibrous
  • cartilaginous
  • osseous
145
Q

what is tarsal/carpal coalition?

A

abnormal joining of 2 bones

146
Q

tarsal coalition –> 2 MC subtypes?

A
  • talocalcaneal

- calcaneonavicular

147
Q

carpal coalition –> MC subtype? 2nd MC?

A 
#1 lunotriquetral
#2 capitohamate
148
Q

physiologic periosteal reaction of the newborn –> age? why does it occur?

A

1-4mo

rapid bone growth & loosely adherent periosteum

149
Q

physiologic periosteal reaction of the newborn –> XR appearance?

A
  • long bone –> med or lat aspect (not both)

- smooth, thin

150
Q

infant/child –> periosteal rxn –> etiology? (7)

A
  • physiologic periosteal rxn of newborn
  • prostaglandin therapy
  • infx
  • neoplasm
  • trauma
  • metabolic
  • syndromic
151
Q

what is Caffey dz (infantile cortical hyperostosis)?

A

inflamm dz –> periostitis –> mandible, scapula, clavicle

152
Q

what is Tillaux fx?

A

Salter-harris III –> distal tibia

153
Q

MC pediatric idiopathic inflammatory myopathy

A

dermatomyositis

154
Q

dermatomyositis –> MC location?

A

proximal thigh musculature (particularly the anterior compartment) and pelvic musculature

155
Q

dermatomyositis –> chronic imaging findings? (2)

A
  • muscle fatty infiltration

- periarticular soft tissue calcifications

156
Q

clubfoot (talipes equinovarus) –> components? (4)

A
  • hindfoot equinus: plantarflex, tibiocalcaneal angle >90
  • hindfoot varus: talocalcaneal angle <20
  • metatarsus adductus (forefoot varus): talus to first metatarsal angle >15
  • talonavicular subluxation
157
Q

MC congenital foot abnormality

A

metatarsus adductus

158
Q

what is diastatic fx?

A

fracture of suture

159
Q

diastatic fx –> MC location?

A

lambdoid suture

160
Q

skull –> depressed fracture –>

  • “depressed” measurement?
  • what is compound?
  • what is penetrating?
A
  • depressed: >skull thickness
  • compound: + scalp lac
  • penetrating: + dural tear
161
Q

what is ping pong fx?

A

type of depressed fx –> greenstick/buckle type

162
Q

differentiate: depressed vs ping pong fx –> clinical outcome?

A
  • depressed: high morbidity

- ping pong: favorable/benign

163
Q

cause?

  • diastatic fx
  • depressed fx
  • ping pong fx
A
  • diastatic: sig blow
  • depressed: sig blow
  • ping pong: birth trauma
164
Q

depressed skull fx –> tx: surg –> indications? (5)

A
  • > 5mm depression –> assoc w dural tear
  • epidural bleed
  • superinfx
  • cosmetic correction
  • frontal sinus involved –> prevent mucocele formation
165
Q

what is leptomeningeal cyst?

A

growing skull fx

166
Q

leptomeningeal cyst –> MOA?

A

skull fx –> dural tear –> leptomeninges herniate thru –> CSF pulse –> widen fx –> brain herniate thru

167
Q

focal skull defect + assoc vasc malformation –> dx?

A

sinus pericranii

168
Q

CT –> focal skull defect –> overlying lesion –> suspect vasc malformation –> next step?

A

US/MRI to demonstrate vasc component

169
Q

sinus pericranii –> what kind of vasc malformation?

A

low flow vasc malformation –> bw dural venous sinus & extracranial vein

170
Q

retroclival hematoma –> above/below tectorial membrane –> subdural vs epidural?

A

above tectorial membrane –> subdural

below tectorial membrane –> epidural

171
Q

vertex –> thrombosed cortical V –> dx?

172
Q

retroclival hematoma –> dx?

173
Q

cervical soft tissue –> edema –> dx?

174
Q

benign enlrgmt of subarachnoid space in infancy (BESSI) –> etiology?

A

immature villa

175
Q

benign enlrgmt of subarachnoid space in infancy (BESSI) –> measuremt?

176
Q

differentiate: BESSI vs subdural hygroma (1)

A

BESSI: positive cortical V sign –> cortical V –> adj to inner table

subdural hygroma: neg cortical V sign –> cortical V –> displaced away from inner table & compressed –> not seen

177
Q

enlrg extra-axial spaces –> RF?

A

premature –> ECMO

178
Q

benign enlrgmt of subarachnoid space in infancy (BESSI) –> potential complication?

A

subdural bleed

179
Q

differentiate: BESSI-related vs NAT-related subdural hematoma

A

BESSI: same age blood

NAT: diff age blood

180
Q

macrocephaly –> MCC

A

benign enlrgmt of subarachnoid space in infancy (BESSI)

181
Q

benign enlrgmt of subarachnoid space in infancy (BESSI) –> epidemiology?

182
Q

periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) –> MOA?

A

ischemic/hemorrhagic injury –> typically during birth

183
Q

periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) –> RF? (2)

A
  • premature

- low birth weight

184
Q

periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) –> MC complication?

A

50% –> cerebral palsy

185
Q

periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) –> MC location?

A

watershed areas –> lateral ventricles –> dorsal & lat white matter

186
Q

periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) –> grade 4 –> subcortical cysts –> epidemiology?

187
Q

differentiate: periventricular blush vs periventricular flaring vs periventricular leukomalacia

A

periventricular blush: periventricular white matter –> physiologic bright –> symm

periventricular flaring: periventricular white matter –> bright –> may be PVL –> but go away in 1wk

periventricular leukomalacia: periventricular white matter –> bright –> persist >7days

188
Q

R-sided fibromatosis coli:

direction of:

  • head tilt?
  • look toward?
A

R-sided fibromatosis coli:

  • head tilt –> R
  • look toward –> L
189
Q

neck mass –> outside SCM –> calcifications –> dx?

A

neuroblastoma

CORE (33 decks)

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