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MSK/Derm > SM 251/252: Peds MSK, Peds/Adult Sports Med > Flashcards

SM 251/252: Peds MSK, Peds/Adult Sports Med Flashcards

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Dermatology Board Prep flashcards
1
Q

How do you describe a fracture?

A

Location: Bone involved, area in the bone, and SH classification Fracture type or pattern Displacement

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2
Q

What is the treatment for Medial Epicondlyle Apophysitis?

A

Rest and PT to strengthen core/spine while improving baseball throwing abiliity

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3
Q

What is this?

A

Anterior Superior Iliac Spine Apophysis Avulsion Fracture

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4
Q

What’s the treatment for a muscle strain?

A

RICE and strengthening/stretching

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5
Q

What fracture pattern is this?

A

Comminuted fracture pattern

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6
Q

What are the main functions of bone?

A

Structure/skeletal support, mineral + electrolyte regulation, and hematopoiesis

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7
Q

What is Rotational displacement?

A

Rotational movement along the mid-axial line that can be difficult to detect Not the same as Angulation

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8
Q

How does Sever disease present?

A

Insidious onset heel pain with mild weakness in dorsiflexion and tight calf muscles - in an 8 - 11 y/o

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9
Q

What meds can cause tendinopathy?

A

Fluoroquinolones and NSAIDS

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10
Q

What is the treatment for Nursemaid’s elbow?

A

Supination and Flexion to pop the radius back into place

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11
Q

What is the most common SH injury pattern?

A

Salter II

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12
Q

How does mechanical overload lead to Tendinopathy in adults?

A

Mechanical overload involves repeated microdamage with a failed healing response, causing a rise in inflammatory markers like IL-1b

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13
Q

How are Muscle strains graded?

A

Grade I = no tear Grade II = partial tear Grade III = full tear

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14
Q

What is Osgood-Schlatter syndrome?

A

Inflammation of the patellar ligament at the Tibial Tuberosity in teenagers playing sports, that gets worse with running/jumping

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15
Q

What is Sever disease?

A

A calcaneal apophysitis that effects children 8 - 11y/o causing mild weakness in dorsiflexion and tight calf muscles

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16
Q

What fracture is this and why?

A

Toddler’s fracture - oblique, nondisplaced fracture of a Tibia, likely due to twisting motion while falling

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17
Q

What is an ankle sprain?

A

Athletic activity that leads to injured ligaments

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18
Q

How is Slipped Capital Femoral Epiphysis treated?

A

Immediate surgical fixation to prevent further slippage and avoid avascular necrosis of the head of the Femur

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19
Q

What injury predisposes Osgood-Schlatter?

A

None

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20
Q

Does a Type I SH injury effect growth?

A

Generally no

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21
Q

What is imaging used for in Achilles Tendinopathy?

A

Look for tear or calcification with Ultrasound or MRI

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22
Q

Where on the tendon does Achilles Tendinopathy occur?

A

Mid-tendon > Calcaneal insertion

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23
Q

What are the complications of Slipped Capital Femoral Epiphysis?

A

Avascular necrosis of the hip, which increases in likelihood the longer the slip is untreated and the larger the slip

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24
Q

What fracture pattern is this?

A

Transverse fractures

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25
Q

What unique effects does the different composition of pediatric bones have in comparison to adult bones?

A

Decreased mineral content allows them to absorb more energy without fracturing, creating incomplete fractures and unique fracture patterns

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26
Q

Should you consider a gradual onset muscle strain?

A

Nope, they’re acute; consider alternatives like stress fracture or tendinopathy and get imaging

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27
Q

What is fusiform swelling?

A

A form of swelling that can create nodules on inflammed areas, such as an Achilles Tendon nodule in a tendinopathy

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28
Q

How does a Toddler’s fracture present?

A

A child < 5y/o is limping or can’t put weight on a leg with minimal to no swelling Subtle line on Xray

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29
Q

What are the types of fractures?

A

Transverse fracture, Oblique fracture, Spiral fracture, Comminuted fracutre

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30
Q

What are the advantages of open Physes?

A

High potential for bone healing and remodeling as well as fractures often being easier to heal

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31
Q

What is a fracture pattern and why does it arise?

A

Bones fail in a predictable way to force, and the fracture pattern tells us how the bone was injured

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32
Q

Does a Type V SH injury effect growth?

A

Worst prognosis and may lead to growth arrest

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33
Q

How do fetal skeletons mature into adult skeletons?

A

As the fetus develops, the Cartiagenous skeleton is transformed into a bony skeleton via Endochondral ossification

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34
Q

What fracture this this?

A

Nursemaids elbow since the Annular ligament is dislocated and no longer holding the Radius in place

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35
Q

How should imaging be used for ankle sprains?

A

Imaging is not used to diagnose; assess for other pathologies/injuries and order an MRI if pain is not improving in a few weeks

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36
Q

What are the risk factors for Slipped Capital Femoral Epiphysis?

A

Males > Females, Obesity, Endocrinopathies

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37
Q

What occurs during Stage I of the healing response?

A

Inflammation; RBC’s and WBC’s infiltrate to remove necrotic material and begin angiogenesis

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38
Q

What are fetal skeletons made of?

A

Cartilage

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39
Q

What Type of fracture is this?

A

Salter Type II fracture because it’s above the Physis (the end of the distal end of the bone is treated as the bottom, so up is down)

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40
Q

What is this?

A

Calcaneal Apophysitis

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41
Q

How does a proinflammatory environment lead to Tendinopathy in adults?

A

Sedentary individuals have a high levels of pro-inflammatory cytokines at rest and low levels of COL-I

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42
Q

What is a Type IV SH injury?

A

A growth plate injury where the fracture is both above and below the growth plate, as well as the Metaphysis and Epiphysis

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43
Q

How can Medial Epicondyle Apophysitis be prevented?

A

Proper pitch progression and resting

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44
Q

Is remodeling extensive or limited in Pediatric bones?

A

Extensive; large degrees of angulation can be fixed and nonunion is rare

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45
Q

What is the term to describe irritation of a Physis or Apophysis?

A

Juvenile Epiphyseolysis or Apophysitis

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46
Q

How does Sinding-Larsen Johansson present?

A

Bilateral achy anterior knee pain with mild tenderness to palpation over the lower pole of the patella, with full ROM

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47
Q

How does Slipped Capital Femoral Epiphysis present?

A

A 10-16 y/o presents with pain in the groin/thigh/knee and a limp, with the leg externally rotated at the hip and pain/limitation with flexion and internal rotation

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48
Q

What is Slipped Capital Femoral Epiphysis?

A

A SH Type I fracture in the hip that occurs in adolescents due to slippage of the Epiphysis due to growth plate instability during periods of rapid growth

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49
Q

What are the risk factors for tendinopathy?

A

Age, Obesity, DIIM, HTN, Muscle weakness, Abnormal biomechanics, excessive mechanical load, training error, some medications

50
Q

What is this and what might it suggest?

A

Fusiform swelling near the Achilles Tendon = Achilles Tendonopathy

51
Q

How does a Type I SH injury present?

A

Radiograph mostly normal, dx based on hx of trauma, swelling, pain and tenderness with a repeat XR showing healing callus after 7 days

52
Q

How is Osgood-Schlatter treated?

A

Patellar strap + Physical Therapy + activity modification + NSAIDS

53
Q

How does Achilles Tedinopathy present?

A

No sudden injury, pain while performing activity but not at rest, not warm or erythematous and localized to mid-portion or insertion

54
Q

How does a Transverse fracture arise?

A

Force exerted perpendicular to the long axis of a bone, typically a higher force direct impact

55
Q

How does an Oblique fracture arise?

A

Caused by a bending force oblique to the long axis of the bone, and leads to significant displacement

56
Q

Are Buckle fractures stable or unstable, and how does that effect healing?

A

Buckle fractures are stable and heal with with simple immobilization

57
Q

What is Medial Epicondyle Apophysitis?

A

“Little league Elbow” = A type of Apophysitis with slow onset that effects the medial elbow and causes occasional swelling in people who play baseball

58
Q

What is a Type II SH injury?

A

A growth plate injury where the fracture is above the growth plate

59
Q

What is Proximal Humeral Epiphysiolysis?

A

“Little league Shoulder” = a type of Epiphysiolysis that presents with pain in the shoulder and full shoulder ROM

60
Q

What are common sites of injury in adults?

A

Tendons and ligaments more than bone itself, because the bone is harder and stronger

61
Q

What muscles are strained more often?

A

Two joint lower-limb muscles: hamstrings, calf, quadriceps

62
Q

What are the two broad ways to develop Tendinopathy in adults?

A

Mechanical overload and Proinflammatory involvement

63
Q

What occurs during Stage III of the healing response?

A

Remodeling; consolidation and maturation phase

64
Q

What is the physis?

A

The growth plate between two ossification centers

65
Q

How can Proximal Humeral Epiphysiolysis be treated and prevented?

A

Same as Medial Epicondyle Apophysitis - rest and PT

66
Q

What are the 3 stages of healing injured soft tissue?

A

Stage I = inflammatory response Stage II = proliferative phase Stage III = remodeling phase

67
Q

What’s strong in kids, a Ligament or a Bone?

A

Ligaments are stronger than bones in kids, meaning sprains are less likely than fracture

68
Q

What fracture pattern is this?

A

Oblique fracture

69
Q

What imaging should be ordered for Nursemaid’s elbow?

A

None - just supinate and flex the arm to fix it

70
Q

How does a muscle strain present?

A

Sudden onset pain, impairs function and tender to palpation at site of injury, often due to acceleration or deceleration injury

71
Q

What type of fracture is this?

A

Type IV of the Tibula, since it’s on both sides of the growth plate

72
Q

What is a Greenstick fracture?

A

A fracture due to compression or bending force that involves two bones, such as the forearm; the bone on the convex side fails but the fracture does not fully crack the bone on the other side

73
Q

What is Sinding-Larsen-Johansson?

A

An inferior patella apophysitis common in 11 - 12 year olds that presents with bilateral achy knee pain and mild tenderness to palpation over the bottom of the patella with full ROM

74
Q

Are Comminuted fractures common in children?

A

High force mechanism fracture, but rare in children and requires operative treatment

75
Q

Whats more likely in a kid, a Sprain or a fracture?

A

Fractures are more likely because Ligaments in kids are stronger than bones

76
Q

Describe the Periosteum in Pediatric bones?

A

Thick, strong, metabolically active and allows for better fracture reduction, healing, and remodeling

77
Q

How can a Spiral fracture arise?

A

A relatively low force twisting mechanism

78
Q

If an 11 y/o comes to you with a limp and this Xray, pain and normal ROM, what’s the dx?

A

Sinding Larsen Jensen Syndrome

79
Q

What are the risk factors for an ankle sprain?

A

Decreased strength and proprioception

80
Q

What is a Nursemaid’s Elbow?

A

A type of dislocation that arises when there is traction to the arm that dislocates the Annular ligament, and frees the Radius, resulting in not using the arm and no swelling, deformity or bone tenderness

81
Q

What is an ASIS Apophysis Avulsion Fracture?

A

A fracture that presents acutely with a “pop” and causes pain with full ROM and pain with hip extension

82
Q

What are the anatomic regions of a growing bone?

A

Diaphysis = shaft Metaphysis = Widening end Growth Plate = Physis (separates Metaphysis and Epiphysis) Epiphysis = end of bone

83
Q

Who does Sever disease effect?

A

8 - 11 year olds

84
Q

Describe the structure and function of a tendon?

A

Collagen Type I + Water, conects muscle to bone

85
Q

How is Toddler’s fracture treated?

A

Cast, no weight bearing on the effected leg

86
Q

What is Toddler’s fracture?

A

An oblique, non-displaced fracture of the distal Tibia that effects walking children < 5y/o due to a twist while running or falling

87
Q

What are common sites of injury in kids?

A

Physis and Apophysis more than tendons and ligaments, because they are still growing and not fully calcified

88
Q

What is a Type III SH injury?

A

A growth plate injury where the fracture is below the growth plate

89
Q

What is a fracture displacement?

A

A fracture fragment being moved out of normal bony alignment, due to Translation, Angulation, or Rotation

90
Q

What fracture is this?

A

Buckle fracture - increased distance between distal Ulna and Radius

91
Q

What is this showing?

A

A comparison showing the inflammed Achilles Tendon in Achilles Tendonapathy

92
Q

What is Angulation displacement?

A

Angular movement, measured in degrees, through the mid-axial line

93
Q

Does a Type II SH injury effect growth?

A

Generally no

94
Q

What is a Type I SH injury?

A

A growth plate injury involving separation through the growth plate

95
Q

How should ankle sprains be treated?

A

RICE, immobilization, taping/bracing, rehab

96
Q

What is a Type V SH injury?

A

A growth plate injury involving crush injury the to the growth plate

97
Q

Does a Type IV SH injury effect growth?

A

May interfere with growth

98
Q

What occurs during Stage II of the healing response?

A

Proliferation; myocytes infiltrate and Type III collagen is produced

99
Q

Where do muscle strains occur?

A

The myotendinous junction

100
Q

How is an ASIS Apophysis Avulsion fracture treated?

A

RICE, strengthening, slowly progressing Physical Therapy

101
Q

What is this and why?

A

Slipped Capital Femoral Epiphysis - Type I fracture at the head of the Femur

102
Q

How does an Ankle sprain present?

A

Sudden onset pain with impaired function and swelling, causes inversion and plantarflexion

103
Q

What fracture pattern is this?

A

Spiral fracture

104
Q

What is Achilles Tendinopathy?

A

A non-inflammatory condition of intratendinous collagen degeneration and scattered vascular ingrowth

105
Q

How do pediatric bones differ from adult bones, and why?

A

Pediatric bones are more porous and pliable due to decreased mineral content

106
Q

Where are primary ossification centers located, and how does that compare to secondary ossification centers?

A

Primary ossification center = long bone shaft Secondary ossification center = Epiphyses

107
Q

Do Type III SH injuries effect growth?

A

May interfere with growth

108
Q

How is Sinding-Larsen-Johansson treated?

A

Patellar strap + stretching and symptomatic treatment

109
Q

How does a Nursemaids elbow present?

A

Traction to the arm, pain initially and comfortable at rest, won’t use the arm No swelling, deformity, or bony tenderness but pain with movement of elbow

110
Q

What group is at risk for Achilles tendinopathy?

A

Runners

111
Q

How do bones grow?

A

Germinal cells on the Epiphyseal side of the growth plate proliferate and calcify on the Metaphyseal side

112
Q

What fracture is this and why?

A

Greenstick’s fracture because it’s effecting both bones - the side with the full crack was hit directly while the partial crack is showing bending

113
Q

How is Achilles Tendinopathy treated?

A

Physical Therapy, rest, heel lift if walking pain occurs - good prognosis overall

114
Q

What is a Buckle fracture, and what group is it common in?

A

A fracture that results from compression force on a bone, such as falling onto an outstretched hand Common forearm fracture in children, very stable

115
Q

What is the point of PT in Achilles Tendinopathy?

A

Address weakness and inflexibilities in the Kinetic Chain

116
Q

What scale is used to classify growth plate injuries?

A

Salter Harris classification: types I to V = SABTR I = Separation II = Above III = Below IV = Through V = cRush

117
Q

What are the disadvantages of open Physes?

A

Fracture through the physis can lead to growth arrest and irritation may occur at the Physis

118
Q

What is Translation dispalcement?

A

Lateral movement of a fracture fragment

119
Q

What is an Apophysis?

A

An accessory growth plate where muscles attach

120
Q

What are general risk factors for adult MSK injury?

A

Increase in activity, change in exercise, age, etc.

121
Q

What group is affected by Sinding-Larsen-Johansson?

A

11 - 12 year olds

MSK/Derm (46 decks)

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