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PEDS UWORLD > The Little People: MSK issues > Flashcards

The Little People: MSK issues Flashcards

1
Q

C/P of kid with Ewing’s Sarcoma

A

Pain and swelling for wks/months
mc in metaphysis and diaphysis of femur, tibia or humerus
intermittent fevers, leukocytosis, anemia, Increased ESR

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2
Q

Ewing’s on xray

A

lamellated or onion skin periosteal reaction
lesion: lystic, central and accompanied by endosteal scalloping
mottled appearance extension into soft tissue

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3
Q

Osteomyelitis on xray

A

central cystic bone defect w/ surrounding sclerosis termed Brodie’s abscess

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4
Q

age of person with fibrosarcoma

A

30-60 yrs old

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5
Q

mc place for glomus tumor

A

subungual-70% of time
other plcases palm and wrist
4th decade of life F>M

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6
Q

glomus tumor: triad

A

common vascular benign tumor triad:

intermittent pain, tenderness and sensitivity to touch

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7
Q

meconium ileus is assoc w/

A

cystic fibrosis

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8
Q

asymptomatic kid at birth, initially healthy. 2 months in jaundice and acholic stools

A

biliary atresia

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9
Q

Who loves you more than anyone in the entire world? hint: its a bug

A

me :)

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10
Q

Maternal estrogen effects in newborns

A

Breast hypertrophy
swollen labia
physiologic leukorrhea (white vaginal discharge)
uterine withdrawal bleeding

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11
Q

By age 12 months weight should (1) and height should (2)

A
  1. triple

2. increase by 50%

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12
Q

mc Child vaginal foreign body

A

toilet paper

small toys..objects

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13
Q

foreign body in vagina C/f

A

foul-smelling vaginal discharge,
intermittent bleeding or spotting,
occasional urinary complaints

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14
Q

Rx of foreign body in vagina

A

examine and removal

use Calcium alginate swab or irrigation w/ warmed fluids

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15
Q

Erb-Duchenne palsy

A

Shoulder dystocia: “Waiters tip”

injury to c5-c7

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16
Q

C5 innervates

A

deltoid and infraspinatus

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17
Q

C6 innervates

A

biceps

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18
Q

C7 innervates

A

wrist/finger extensors

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19
Q

Septic arthritis in kid, what do you do first?

A

blood and synovial fluid culture PRIOR to administering empiric antibiotics
Must do Arthrocentesis

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20
Q

Septic arthritis organisms and Rx? birth to 3 months

A

Organism: Staphylococcus, GBS, gram neg bacilli
Rx: Antistaphyloccocal (nafcillin or vanco) PLUS gentamicin or cefotaxime

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21
Q

Septic arthritis in kid older than 3 months, organisms and Rx?

A

Organisms: Staphylococcus, GAS, S.pneumoniae
Rx: nafcillin, clindamycin, cefazolin, or Vanco

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22
Q

MC bone tumor in kids and young adults

A

Osteosarcoma

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23
Q

Frequent location of Osteosarcoma

A

metaphyses of long bones:

distal femur, prox tibia, proximal humerus

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24
Q

Characteristic xray findings of osteosarcoma

A 
spiculated "sunburst" pattern
periosteal elevation (codman triangle)
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25
Q

Rx of osteosarcoma

A

Tumor excision

Chemotherapy

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26
Q

Second MC bone malignancy

A

Ewings Sarcoma

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27
Q

Osteoid osteoma

A

sclerotic cortical lesion with central nidus of lucency

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28
Q

Osteoid osteoma C/F and Rx

A

Pain worse at night and not related to activity

Rx: NSAIDs

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29
Q

Classic child with limp. age 4-12

A

Legg-Calve Perthes disease (LCP)

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30
Q

LCP C/F

A

Mild chronic hip/knee pain of insidious onset w/ antalgic gait
idiopathic osteonecrosis of femoral head

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31
Q

If xrays negative. Kid post infection comes in with limp,

Dx?

A

Transient synovitis

MC follow viral infection

32
Q

As LCP disease progresses what can happen to the leg

A

Internal rotation and abduction at the hip joint

proximal thigh atrophy

33
Q

Kid with SS disease had a painful crisis 3 months ago comes in with hip pain, restricted abduction and Internal Rotation of hip; Dx?

A

Avascular necrosis

34
Q

Why kids usually don’t get aseptic necrosis of femoral hip?

A

Have patent blood supply via ascending arteries and foveal artery which lie w/in the ligamentum teres.
Obliterates later in life

35
Q

Dad pulls on daughters hand and now she has pain. She keeps her hand in the extended, pronated position without moving it. Dx?

A

Radial head subluxation

nursemaids elbow

36
Q

How nursemaids elbow happens

A

axial traction on forearm with elbow extended

radial head pulled through annular ligament around it

37
Q

Rx radial head subluxation

A

Hyperpronation of forearm or

Supination of forearm and flexion of elbow

38
Q

chronic inflammatory papulosquamous disease; yellow papules and occasional scaling plaques; mc around eyebrows, nasolabial folds, eyelashes, paranasal skin

A

Seborrheic dermatitis

39
Q

Rx of Seborrheic dermatitis

A 
moisturizers
topical antifungals,
anti-dandruff shampoos
topical steroids
If severe--> underlying ID
40
Q

Red, Sharply demarcated, scaling lesions that may coalesce to form round or oval plaques

A

Psoriasis

onset: 20-50s

41
Q

Infant: Itchy, red, scaly crusted lesions on extensor surfaces, trunk, cheeks and scalp
Child adult: lichenified plaques in flexor creases

A

Atopic dermatitis

Eczema

42
Q

Rx: eczema

A

Topical emollients +/- steroid ointment

43
Q

Complications of atopic dermatitis

A

Eczema herpeticum
Cellulitis/abscess
discomfort interfering w/ daily activities and sleep

44
Q

Foot deformity: aduction of anterior aspect of ft w/ convex lateral border and concave medial border; active mt of ft overcorrects the deformity into abduction; Dx?

A

Metatarsus adductus type 1

45
Q

Type 1 metatarsus adductus

A

ft that overcorrect both passively and actively into abduction

46
Q

Type II metatarsus adductus

A

ft correct to neutral position w/ passive and active mvts

47
Q

Type III metatarsus adductus

A

rigid ft and do not correct

48
Q

Rx of metatarsus adductus

A

Type 1: reassurance
Type 2: orthosis or corrective shoes, sometimes cast
type 3: serial casts

49
Q

obese boy with pain in hip, 10-16 years, altered gait; Dx?

A

Slipped capital femoral epiphysis (SCFE)

50
Q

kids with SCFE hold leg in

A

affected hip in passive external rotation and exhibit decreased internal rotation, abduction and flexion

51
Q

Rx SCFE

A

stat surgical screw fixation to avoid avascular necrosis

52
Q

femoral neck stress Fx c/f

A

runners or athletes in training
hip pain, esp w/ actiity
pain w/ passive ROM esp internal and external rotation

53
Q

Legg Calve Perthes disease

A

AVN of hip common in boys age 5-7

54
Q

Vit D deficiency Labs

A 
Ca: N/Decreased
Phosphorus: N/Decreased
ALP: INCreased
PTH: Increased
25-OH Vit D: Decreased
55
Q

eczema herpeticum is what

A

form of primary HSV infection that is assoc w/ atopic dermatitis

56
Q

eczema herpeticum apperance

A

numerous umbilicated vesicles over the area of healing atopic dermatitis are typical

57
Q

Rx of eczema herpeticum

A

STAT acyclovir

58
Q

osteomyelitis in SS kids, mC organisma

A

Salmonella

S. Aureus

59
Q

Growing pains

A

Occur at night and resolve by morning
Affect LE usually bilateral
Normal PE and activity

60
Q

Rx growing pains

A

Parental education & reassurance

Massage, stretching exercises, heat and analgesics

61
Q

subperiosteal hemorrhage, limited to the surface of one cranial bone

A

Cephalohematoma

spontaneously heal w/in 2 wks to 3 months

62
Q

diffuse, sometimes ecchymotic, swelling of scalp, extends across suture lines

A

caput succedaneum

63
Q

back pain, neuro dysfunction (Urinary incontince, anal sensation), palpable “step off” at L-S area….. Dx?

A

Spondylolisthesis

64
Q

Compartment syndrome C/f

A 
Severe pain (w/ increase meds not helping)
pallor
poiklothermia
paresthesias
late findings: pulselessness/paralysis
65
Q

Single lytic bone lesion on xray, overlying tender swelling and pain; labs show hypercalcemia, dx?

A

Langerhans cell histriocytosis

66
Q

Precocious puberty, cafe au lait spots
multiple bone defects
endorcine disorder: Hyperthyroid, prolactin, GH tumor, adrenal hypercortilism; DX?

A

McCune Albright Syndrome

67
Q

McCune Albright syndrome defect?

A

defect in the G protein cAMP-kinase function: autonomous activity of that tissue

68
Q

3 ps of Mccune albright

A

Precocious puberty
pigmentation: cafe au lait
polyostotic fibrous dysplasia

69
Q

Osteogenesis imperfect inherited defect

A

AD mutation of COL1A1

70
Q

Patient with OI present w/

A 
Osteopenia
blue sclerae
Recurrent Fx, bruising, hypotonia
Hearing loss
Dentigenesis imperfecta
71
Q

Albright hereditary osteodystrophy (AHOD) chemical findings

A

low Ca, High PO4
High PTH
(resistance to PTH)

72
Q

Phenotype of AHOD

A 
Short statue: delayed BA
MR
Increased bone density throughout body (skull)
brachydactyly
Obesity: round face
Short neck
Subscapular cataracts
Cutaneous/subcutaneous/ perivascular calcification of Basal ganglia
73
Q

what can develop with prolonged immobilization, Fx? labs,,,

A

hypercalcemia

hypercalciuria

74
Q

vit d resistant rickets labs

A

low PO4

Normal Ca

75
Q

Common presentation of JRA

A

1-4 y/o blue-eyed, blonde female with arthritis of knee/ankle.

High risk for uveitis

PEDS UWORLD (9 decks)

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