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General Peds Boards > Sports Med/MSK > Flashcards

Sports Med/MSK Flashcards

1
Q

Mouthgaurd Use

A
  • Use of mouthgaurds during sports decrease risk of all oral/tooth injuries
  • Basketball is one of the highest injury sports
  • Professionally fitted are not better than self fitted
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2
Q

Anterior knee pain in an active teenager with exam of swelling at patellar insertion site on tibia

A

Osgood Schlatter - treat with activity modification and a patellar strap

  • Apophysitis of the tibial tuberosity
  • Common in girls age 10-13 and boys age 12-15
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3
Q

Toddler fracture management

A
  • Oblique fracture of distal tibia with relatively minor trauma
  • Ages 1-5
  • Difficult to see with just AP view CXR right after injury
  • Cast and repeat imaging in 2 weeks (will often see healing fracture)
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4
Q

Idiopathic toe walking is normal until what age

A
  • Age 3 - just reassurance until then, then could consider treatment but most are not effective
  • If unilateral, needs workup right away
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5
Q

Cause of apophyseal avulsion injury

A
  • A strong muscle contraction causes a piece of bone to pull away from the skeleton at the relatively weak apophysis (due to immature pediatric skeleton, common in hips)
  • Common in young athletes when they “hear a pop”
  • Tx: rest, surgery is rarely indicated
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6
Q

Indications for referral to a cardiologist for sports clearance

A
  • Syncope or chest pain with exertion
  • Palpitations at rest or irregular heart rhythm
  • Excessive SOB or fatigue
  • Family history of Marfans, carrdiomyopathy, long QT, or clinically significant arrhythmias
  • Weak or delayed femoral pulses
  • Cardiac exam: fixed split second heart sound, a systolic murmur graded 3/6 or greater, diastolic murmur
  • Turner syndrome patient with chest pain
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7
Q

Contraindications to sports participation

A
  • Pulmonary vascular disease with cyanosis and large R to L shunt
  • Severe PH
  • Severe aortic or mitral valve disease
  • Cardiomyopathies
  • Vascular form of Elhers-Danlos syndrome
  • Coronary anomalies of wrong sinus origin
  • Acute pericarditis or myocarditis
  • Acute phase of Kawasaki (8 weeks)
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8
Q

Things to consider in a type 1 diabetic that is exercising

A
  • Needs increased caloric intake and decreased insulin dose to avoid hypoglycemia
  • Could be a delayed response to exercise hours later resulting in hypoglycemia
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9
Q

Symptoms of heat exhaustion

A

Mild dehydration, temperature less than 104, headache, thirsty, vomiting
Tx: stop exercising and drink fluids

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10
Q

Symptoms of heat stroke

A
  • Temperature > 105
  • Hot, dry skin (not sweaty)
  • CNS depression/altered mental status
  • Severe dehydration
  • Can lead to end organ damage because of the release of endotoxins and cytokines
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11
Q

Treatment of heat stroke

A
  • COOL THEM! (start in the field)
  • Rehydrate with IV fluids
  • Can use vasopressors to maintain BP if needed
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12
Q

Grade 1 sprain

A

Minor stretching of the ligament, minimal discomfort

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13
Q

Grade 2 sprain

A
  • Ligaments are partially torn

- Tenderness, swelling, ecchymosis

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14
Q

Grade 3 sprain

A
  • Ligament is completely torn with significant loss of function
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15
Q

Most common type of ankle injury

A

Anterior talofibular ligament injury (inversion injury)

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16
Q

Symptoms of compartment syndrome

A

5 P’s:

  • Pain
  • Paresthesias
  • Pallor
  • Paralysis
  • Pulselessness
  • -> the last two are late findings so absence of those doesn’t rule out compartment syndrome
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17
Q

“Pop” after a change in direction off a pivoted knee

A

Subluxation of the patella

  • On exam have pain over the lateral aspect of the patella, can have deformity over the medial aspect
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18
Q

Anterior knee pain in adolescents involved in jumping, running, and squatting

A

Patellofemoral syndrome

  • More common in females
  • Tx: knee bracing, patellar taping, and NSAIDs
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19
Q

Anterior knee pain over the patella with visible swelling

A

Prepatellar bursitis

- Tx: NSAIDs

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20
Q

Pain over anatomical snuffbox (dorsum of the hand near the base of the thumb)

A

Scaphoid fracture

  • May not see on xray
  • Concern due to poor neurovascular supply
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21
Q

Distal radial epiphyseal injury

A
  • Pain on wrist that is worsening but has no swelling and normal range of motion
  • Point tenderness on distal radius
  • Treat with rest and splint
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22
Q

Elbow fracture from fall on an outstretched arm with hyperextended elbow

A
  • Supracondylar humeral fracture
  • Commonly can impact the neurovascular components but is frequently a transient deficit (watch for pain on passive extension of the fingers)
  • Posterior far pad sign on lateral elbow xray
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23
Q

Fall on an outstretched arm when elbow is supinated and partially extended

A

Dislocation of the elbow –> can have neurovascular compromise

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24
Q

Elbow lateral condyle fracture

A

Forearm is supinated, neurovascular compromise is very unlikely

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25
Q

Shoulder injury from patient falling back on a posteriorly rotated abducted arm

A

Anterior humeral dislocation

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26
Q

Shoulder injury with pain and prominence over the distal clavicle

A

Acromioclavicular injury

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27
Q

Shoulder injury from direct force to the posterior shoulder and pain over teh sternoclavicular joint

A

Posterior sternoclavicular dislocation

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28
Q

Shoulder injury with shoulder/upper arm pain int he absence of asymmetry

A

Proximal humeral fracture

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29
Q

Shoulder pain with elevating and lowering the arm without any deformity

A

Rotator cuff injury

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30
Q

Association with medial clavicular fracture

A

If anterior or posterior displacement will need an evaluation for possible displacement of the trachea or mediastinal structures

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31
Q

Clavicular fracture vs acromioclavicular separation

A
  • Fracture in younger kids and will have crepitus

- AC separation will been in teenagers and have a palpable step off as well as point tenderness on the joint

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32
Q

Reasons that kids can’t participate in sports

A
  • Fever

- Carditis and acute hepatosplenoemgaly (mono) can’t do contact sports

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33
Q

Indications that kids can’t do contact sports

A
  • Splenomegaly
  • Hepatomeglay
  • One functioning kidney
  • Repeated concussions
34
Q

Sport with leading eye injuries

A

Baseball –> under age 14 should wear a facemask when batting

35
Q

Timing to detecting steroid use

A
  • Oral steroids stay in the urine for days to weeks

- IM steroids stay in the system for 6 months or more

36
Q

Female complications of steroid use

A
  • Hirsutism and low voice

- Early closure of epiphyseal plates

37
Q

Male complications of steroid use

A
  • Severe acne
  • Gynecomastia
  • High pitched voice
  • Hypogonadism
38
Q

Lab findings with steroid use

A
  • Elevated LFTs
  • Lower HDL, increased LDL
  • Oligospermia and azoospermia
39
Q

Symptoms in classic type Ehlers Danlos

A
  • Hyperextensible skin
  • Hyperextensible joints
  • Tissue fragility/easy bruising
  • Unique appearance (nose, clear skin)
  • Can also have delayed wound healing
40
Q

Symptoms in hypermobility type Ehlers Danlos

A
  • Hypermobile joints
  • Dislocations/chronic pain
  • This is the most common type of ED (80% of cases)
41
Q

Symptoms of vascular type Ehlers Danlos

A
  • Acrogeria (old skin)

- Blood vessel ruptures

42
Q

Caffey disease

A

Autosomal dominant - symptoms start prior to 6 months and are usually done by 24-30 months

  • Mandible is involved > 95% of the time
  • Cortical thickening and subperiostal new bone formation
  • Leukocytosis, elevated ESR, increased alkaline phosphatase
43
Q

Bone parts

A
  • Physis: growth plate
  • Metaphysis: end of the long bone
  • Epiphysis: rounded end of a long bone
44
Q

Varus/valgus

A
  • Varus: distal part of the deformity points toward the midline
  • Valgus: distal part of the deformity points away from the midline
45
Q

Reasons why genu varus would be abnormal

A
  • Unilateral
  • Worsens after age 1
  • Does not resolve after age 2 (think about Rickets or Blount’s disease)
46
Q

Blount’s disease

A
  • African Americans
  • In adolescents it is due to being overweight
  • Don’t need any treatment
  • Abnormality with proximal tibial physis and epiphysis
47
Q

Salter harris fractures

A
  • SALTR
  • Type 1: Straight through physis (casting)
  • Type 2: Above physis in metaphysis (closed reduction casting)
  • Type 3: Lower physis through epiphysis (open reduction)
  • Type 4: Through all 3 layers (reduction in OR)
  • Type 5: cRush (risk microvascular compromise with high risk of poor growth)
48
Q

Fall on an outstretched hand with cortical break on one side of the bone and intact periosteum on the opposite side

A

Greenstick fracture

49
Q

Fractures in preschool years, autosomal dominant, blue sclera

A

OI type 1 - most common

  • Often also have hearing loss
  • Normal height, normal lifespan
50
Q

Born with multiple fractures, often stillborn

A

OI type 2 - dominant new mutation or germinal mosaicism

- Usually lethal in first week of lfie

51
Q

Born with fractures and deformities are progressive

A

OI type 3

  • Have blue/gray sclerae that lighten over time
  • SGA with macrocephaly
  • Wormian bones in the skull, codfish vertebrae
  • Short stature, hearing is abnormal, intellect is normal
52
Q

Causes of torticollis

A
  • Muscular (positioning or trauma)
  • Paroxysmal (migraine variant that can last for just a minute at a time)
  • Vertebral anomalies
  • Posterior fossa tumor
53
Q

Symptoms of congenital torticollis

A
  • Head tilted to one side, mass in SCM muscle, facial asymmetria
  • Tx with daily stretching and PT- Can be associated with developmental dysplasia of the hip
54
Q

Fusion of cervical vertebrae (short neck, low occipital hairline)

A

Klippel-Feil syndrome

- Can be associated with scoliosis, spina bifida, renal problems, deafness

55
Q

Mimics torticollis, unilateral shorter/broader neck

A

Sprengel deformity

- Failure of scapula to descend to normal position in fetal development

56
Q

Risk factors for DDH

A
  • Breech
  • Female
  • Family history
  • First born
  • Oligohydraminos
  • Can be associated with torticollis, metatarsus adductus, club foot
57
Q

Exam findings for DDH

A
  • Barlow (putting hip out of place), ortalani (putting it back in) - these are only reliable until 3 months of age
  • After 3 months: limitations in hip abduction is the most common sign, unequal knee high, asymmetric gluteal folds
  • Older child with waddling gait or leg length discrepancy
58
Q

Workup for DDH/treatment

A
  • US until 4 months of age
  • AP and frog leg xray after that
  • Tx is Pavlik hanress in abduction, flexion, and external rotation positioning
59
Q

Symptoms/labs in viral myositis

A
  • Weakness and tenderness, commonly in the calf
  • Elevated CK
  • Recent URI or influenza
60
Q

Most common viruses for toxic synovitis

A
  • Parvovirus B19
  • Influenza
  • Hepatitis B
  • Rubella
  • EBV
61
Q

Symptoms/management of septic arthritis

A
  • MC in kids < 2, won’t walk or won’t move joint, fever, elevated inflammatory markers, joint is red/swollen, won’t let you examine it, increased joint space on xray, often hematogenous spread
  • Need joint aspiration and IV antibiotics - don’t delay treatment for aspiration
62
Q

MC organisms for septic arthritis

A

Staph aureus

  • Neonates: GBS, E coli
  • Infants/children: strep pneumo, GAS, h. flu
  • Gonorrhea in teens

Sickle cell: think Salmonella

63
Q

MC organisms for osteomyelitis

A

Staph aureus

  • Neonates: femur/tibia (hematogenous, often associated with septic joint): GBS, e coli
  • GAS, Kingella, H. flu type b
  • Sickle cell: Salmonella
  • Step on a nail: pseudomonas
64
Q

Treatment for osteomyelitis

A
  • Staph: oxacillin, clindamycin, cephalosporin
  • H. flu: ceftraixone
  • Salmonella: ceftriaxone
65
Q

Hip pain or limp in kids (usually boy) from age 5-7

A

Legg calve perthes

  • Avascular necrosis of the femoral head
  • Xray shows one femoral head being smaller than the other
  • May actually complain of knee pain
  • Need non-weight bearing, splinting, possible surgery
66
Q

Obese teenager with hip or knee pain

A

SCFE

- Immobilization, stabilization with pins

67
Q

Athletic teen with pain just below the patella

A

Osgood schlatter

  • Due to excessive activity
  • Insertion of patellar tendon at anterior tibial tubercle
  • Tx rest and NSAIDs
68
Q

Sever’s syndrome

A
  • Heel pain in young athletes

- Calcaneal apophysitis

69
Q

Toddler’s fracture

A

May not see it on xray, may just have point tenderness on exam

70
Q

Simple bone cyst

A

Commonly found at proximal humerus or femur, not precancerous

71
Q

Aneurysmal bone cyst

A

Common tibia or femur, can be painful, can be associated with underlying bone tumors

72
Q

Symptoms of Ehlers danlos

A
  • Stretchy skin
  • Hypermobile joints
  • Poor wound healing
  • Easy bruising
73
Q

Symptoms/workup with congenital scoliosis

A
  • Malformation of spinal column or ribs

- Screen with renal ultrasound and an echo as well as spinal MRI

74
Q

Scoliosis diagnostic criteria

A
  • Curvature of less than 25 degrees: observation only
  • If more than 2 years of growth still expected tehn do bracing for curvature between 25-40 degrees
  • Surgery for greater than 40 degrees
  • May need further workup if more than 1 degree per month during a growth spurt
75
Q

Normal range for kyphosis

A

20-40 degrees

- PFTs if kyphosis is > 60 degrees

76
Q

Scheuermann disease

A

Kyphosis, bad posture, back pain - present in teenagers, often just need NSAIDs and PT

77
Q

Annular ligament displacement

A

Nursemaid’s elbow

- Pulled by the arm and now not using it

78
Q

Inheritance of polydactyly

A

Autosomal dominant if isolated

- Tx is ligation until it falls off if it is simple postaxial polydactly

79
Q

Treatment of club foot

A

Ortho referral, stretching, casting, possible surgical release later in life

80
Q

Toe walking

A

Normal until after age 2-3

- Tx is foot dorsiflexion exercises

81
Q

3 main causes of in-toeing

A
  • Metatasus adductus in infancy
  • Tibial torsion in toddlerhood
  • Femoral anteversion in early childhood

General Peds Boards (24 decks)

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