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Surg > Pestana2 Ortho (Peds, Back pain) > Flashcards

Pestana2 Ortho (Peds, Back pain) Flashcards

1
Q

Two most common primary malignant bone tumors in pediatric patients

A
  • Osteogenic sarcoma (mc)

- Ewing’s sarcoma

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2
Q

Osteogenic sarcoma (age, location, xray)

A
  • 10-25yo
  • Around knee (lower femur/upper tibia)
  • “Sunburst” pattern
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3
Q

Ewing sarcoma (age, location, xray)

A
  • 5-15yo
  • Diaphyses of long bones
  • “Onion skinning”
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4
Q

Common sx w/ primary malignant bone tumor

A

Persistent low-grade pain

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5
Q

Two types of fractures in pediatric pts that can cause problems

A
  • Supracondylar fractures of the humerus

- Fractures that involve the growth plate

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6
Q

Bone remodeling after frx in pediatric pts (2 advantages)

A
  • Wider degree of acceptable angulations after reduction

- Faster healing

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7
Q

Supracondylar frx’s of humerus (injury)

A

Hyperextension of elbow 2/2 fall on hand w/ outstretched arm

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8
Q

Supracondylar frx’s of humerus (complication x2)

A
  • Vascular/nerve injury (can lead to Volkmann contracture)

- Compartment syndrome

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9
Q

Supracondylar frx’s of humerus (mgmt)

A

Casting/traction

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10
Q

Fractures that involve the growth plate (mgmt x2 based on mechanism)

A
  • Closed reduction: epiphysis+growth plate are in the same piece; frx doesn’t cross epiphysis or growth plate; frx doesn’t involve joint
  • Open reduction, internal fixation: growth plate is in 2 pieces
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11
Q

Soliosis (demographic and abnormality)

A
  • Adolescent girls

- Thoracic spine curves to the right

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12
Q

Scoliosis (dx and tx)

A
  • Inspect from behind as she bends down: hump over r.thorax

- Bracing; surgery

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13
Q

Club foot (aka, demographic)

A
  • Talipes equinovarus

- At birth

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14
Q

Club foot (abnormalities x5)

A
  • Both feet turned inward
  • Plantar flexion of ankle
  • Inversion of foot
  • Adduction of forefoot
  • Internal rotation of tibia
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15
Q

Club foot (mgmt)

A
  • Serial plaster casts from neonatal period (50%)

- Surgery: > 6-8mo, <1-2yrs (50%)

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16
Q

Osgood-Schlatter disease (aka, demographic)

A
  • Osteochondrosis of the tibial tubercle

- Teenagers

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17
Q

Osgood-Schlatter disease (sx)

A
  • Pain over tibial tubercle, aggravated by quadricep contraction
  • No swelling
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18
Q

Osgood-Schlatter disease (mgmt)

A
  • Conservative (ice, rest, compression, elevation), then:
  • Immobilization of the knee in an extension, or
  • Cylinder casts for 4-6wks
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19
Q

Genu x2 by age

A
  • Genu varum (bow-legs): NL up to 3yo

- Genu valgus (knock-knee): NL 4-8yo

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20
Q

Persistent varus (dx)

A
  • After age 3

- Blount disease (disturbance of medial proximal tibial growth plate)

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21
Q

Acute hematogenous osteomyelitis (sxs 2, dx, tx)

A
  • Fever; Severe localized pain
  • MRI
  • ABXs
22
Q

Hip pathology (sx localization)

A

Pain maybe in hip or knee

23
Q

Hip disorders (x4)

A
  • Developmental dysplasia of the hip
  • Legg-Perthes disease
  • Slipped capital femoral epiphysis
  • Septic hip
24
Q

Developmental dysplasia of the hip (demographic, sxs 2)

A
  • Dx’d at birth
  • Uneven gluteal folds
  • Hips easily dislocated posteriorly with a “click” and returned with a “snap”
25
Q

Developmental dysplasia of the hip (dx)

A

Sono

26
Q

Developmental dysplasia of the hip (mgmt)

A

Abduction splinting w/ Pavlik harness (6mo)

27
Q

Legg-Perthes disease (aka, demographic)

A
  • AVN of the capital femoral epiphysis)

- 6yo

28
Q

Legg-Perthes disease (sxs 5)

A
  • Hip/knee pain
  • Limping
  • Antalgic gait
  • Decreased hip motion
  • Guarded passive motion of hip
29
Q

Legg-Perthes disease (dx)

A

AP/lateral XRAY

30
Q

Legg-Perthes disease (tx)

A

Contain femoral head w/in acetabulum by casting and crutches

31
Q

Slipped capital femoral epiphysis (demographic)

A

-Chubby 13yo boy

32
Q

Slipped capital femoral epiphysis (sxs 5)

A
  • Groin/knee pain
  • Limping
  • Sole of dangling affected foot points toward other foot
  • Limited hip motion
  • As hip is flexed, thigh goes into external rotation+cannot be internally rotated
33
Q

Slipped capital femoral epiphysis (dx, tx)

A
  • XRAY

- Pins

34
Q

Septic hip (demographic)

A

-Toddlers

35
Q

Septic hip (sxs)

A
  • Fever
  • Decreased hip motion
  • Hip flexed in slight abduction and external rotation
  • Guarded passive motion
36
Q

Septic hip (dx 2)

A
  • Elevated ESR

- Dx: Aspiration of hip

37
Q

Disk herniation (mc locations)

A

L4-L5

L5-S1

38
Q

Disk herniations (types of pain)

A

Discogenic pain followed by neurogenic pain

39
Q

Discogenic vs. Neurogenic Pain

A
  • Discogenic: vague, aching pain (ant.spinal ligament)

- Neurogenic: extremely severe, electric pain, exacerbated by coughing, sneezing, or defecating

40
Q

Disk herniations (sxs 3)

A
  • positive straight leg-raising test
  • cannot ambulate
  • hold affected leg flexed
41
Q

Disk herniations (dx)

A

MRI

42
Q

Disk herniations (mgmt)

A
  • Pain control, bed rest
  • Surgical w/ progressive neurological deficits: weakness
  • Immediate decompression w/ cauda equina syndrome
43
Q

Cuada equina syndrome

A
  • Bladder incontinence
  • Flaccid rectal sphincter
  • Perineal saddle anesthesia
44
Q

Ankylosing spondylitis (demographic)

A
  • Young men in their 30s, 40s

- HLA-B27

45
Q

Ankylosing spondylitis (presentation x2)

A
  • Chronic back pain w/ morning stiffness

- Worse at rest, improves w/ activity

46
Q

Ankylosing spondylitis (dx)

A

XRAY: bamboo spine

47
Q

Ankylosing spondylitis (mgmt)

A
  • Anti-inflammatory agents

- PT

48
Q

Metastatic malignancy to vertebrae (demographic)

A

Elderly

49
Q

Metastatic malignancy to vertebrae (presentation x4)

A
  • Progressive back pain
  • Worse at nt
  • Unrelieved by rest or positional changes
  • Wt loss
50
Q

Metastatic malignancy to vertebrae (dx)

A

XRAY: lytic breast cancer (women); blastic prostate cancer (men)
MRI: best dx’c tool

Surg (7 decks)

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