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Flashcards in Goldstien Peds Deck (40)
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1

Risk factors for acute hematogenous osteomyelitis (6)

  • Diabetes
  • Chronic renal disease
  • Hemoglobinopathies
  • Rheumatoid arthritis
  • Concurrent varicella infection
  • Immunocompromise

2

Osteomyelitis differential diagnosis (11)

  • Thrombophlebitis
  • Bone infarction
  • Sickle cell crisis
  • Cellulitis
  • Rheumatic fever
  • Septic arthritis
  • Fracture
  • Toxic synovitis
  • Caffey’s disease
  • Gaucher’s disease
  • Malignancy (including leukemia)

 (V.I.T.I.M.N. – vascular, infectious, trauma, inflammatory, metabolic, neoplastic)

3

Indications for surgical treatment of osteomyelitis (3)

  • Aspiration of pus
  • Imaging findings of an abscess or sequestrum
  • Failure of non-surgical management

4

Indications for step-down from parenteral to oral antibiotics in osteomyelitis treatment (5)

  • No fever
  • Normal use of the limb
  • Local inflammation subsided
  • Able to tolerate oral antibiotics
  • Improving serologic markers

5

Complications of pediatric osteomyelitis (9)

  • Meningitis
  • Chronic osteomyelitis
  • Septic arthritis
  • Septicaemia
  • Limb-length discrepancy
  • Angular deformity
  • Pathologic fracture
  • Gait abnormality
  • Venous thromboembolism

6

Factors leading to subacute presentation of osteomyelitis (3)

  • Increased host resistance
  • Less virulent organism
  • Prior antibiotic exposure

7

Classification of subacute osteomyelitis (6)

- IA/B: bony lucency

- II: metaphyseal with cortical bone loss

- III: diaphyseal

- IV: presence of onion skinning

- V: epiphyseal

- VI: spine

8

Classification of cerebral palsy (2)

- Physiologic

o Spastic – increased muscle tone, hyperreflexia (#1)

o Athetoid – slow, writing involuntary movements

o Ataxic – inability to coordinate muscles for voluntary movement

o Mixed- A
-anatomic

 Hemiplegic – unilateral UE/LE

o Diplegic – LE > UE, strabismus, IQ may be normal

o Quadriplegic – all 4 extremities, low IQ

9

Predictors of walking in CP (5)

- Positive

o Sitting by age 2

o Pulling to stand by age 2

- Negative

o Persistence of ≥ 2 primitive reflexes by age 1

o Not sitting by 5 years

o Not walking by 8 years

10

Grading of CP with the Gross Motor Function Classification System (5)

- Level I: walks and runs, does stairs independently

- Level II: walks with no aids, stairs with railing

- Level III: walks with aids as a primary method of travel

- Level IV: stands, uses wheelchair independently                 (manual/motor)

- Level V: wheelchair powered by caregiver

11

Treatment options for cerebral palsy (4)

- Physiotherapy (ROM, stretching, strengthening)

- Tone reduction (medications for spasticity control,     Botox)

- Bracing/orthotics

- Serial casting

- Surgery

12

Surgical options for elbow flexion contracture in CP (3)

- Musculocutaneous neurectomy

- Biceps lengthening

- Brachialis lengthening

- lacertus fibrosis release

- brachioradialis origin release

- pronator teres release

- transfer of the FCU to the ECRB

13

Goals of surgical treatment of GMFCS I-III CP (4)

- Optimize gait efficiency

o Decrease energy expenditure

o Increase physical function

o Increase activity participation

- Improve gait cosmesis

14

14. Requirements for successful ambulation in children with CP (5)

- Stability in stance phase

- Clearance in swing phase

- Preposition of foot at initial contact

- Adequate step length

- Optimal energy consumptions

15

Classification of scoliosis in cerebral palsy (4)

Weinstein classification
Group I - double curves with thoracic and lumbar component and minimal pelvic obliquity


Group II - large lumbar or thoracolumbar curves with marked pelvic obliquity

16

Indications for surgery for scoliosis in CP (3)

- Progressive deformity (> 45-50°)

- Sitting imbalance

- Pelvic obliquity

17

Principles of surgery for scoliosis in CP (4)

- Pre-op nutrition assessment ± g-tube

- Posterior spinal fusion

- Segmental instrumentation

- Include the pelvis (if non-ambulatory)

18

Classification of hip disorders in CP (3)

- Hip at risk – abduction < 45° with partial uncovering

                        reimers index <30

- Hip subluxation - reimers index >30

- Spastic dislocation - RI >100

- windswept

19

Gait problems in CP (3)

- Equinus gait

- Jump gait

- Crouched gait

- Stiff-knee gait

20

Risk factors for myelodysplasia (4)

- Maternal hyperthermia

- Maternal diabetes

- Valproic acid/carbamazepine

- Maternal folate deficiency

21

Classification of myelodysplasia (4)

- Spina bifida occulta

- Meningocele

- Myelomeningocele

- Rachischisis

22

Things to remember about scoliosis in myelodysplasia (6)

- Bracing ineffective

- May need anterior spinal fusion due to deficient posterior elements (pre-op 3D CT)

- Check shunt prior to surgery

- Pre-op MRI to rule out Chiari II malformation/tethered cord

- Latex allergy

- Higher risk of pseudarthrosis/infection

23

Classification of spinal muscular atrophy (3)

- Type I

o Acute Werdnig-Hoffman

o < 6 months

o Death by 2 years

- Type II

o Chronic Werdnig-Hoffman

o 6-24 months

o May live into 40’s

- Type III

o Kugelberg-Welander disease

o 2-10 years

o Best prognosis

24

Classification of osteogenesis imperfecta (Sillence) (4)

- Type I:

o Autosomal dominant

o Blue sclera

o Hearing loss

 A – teeth involved

 B – teeth normal

- Type II:

o Autosomal recessive

o Blue sclera

o Lethal in utero

- Type III:

o Autosomal recessive

o Normal sclera

o # at birth with progressive short stature

- Type IV:

o Autosomal dominant

o Blue sclera

 A – teeth involved

 B – teeth normal

25

Histologic findings of osteogenesis imperfecta (6)

- Increased diameter of haversian canals

- Increased size of osteocyte lacunae

- Increased number of cells

- Replicated cement lines

- Decreased number of trabeculae

- Decreased cortical thickness

26

Outcomes of bisphosphonate treatment of osteogenesis imperfecta (3)

- Increased cortical thickness

- Decreased fracture rates

- Decreased pain

27

Methods of classifying skeletal dysplasias (5)

- Proportionate vs. disproportionate

- By bone segment involved

o Rhizomelic – proximal

o Mesomelic – middle

o Acromelic – distal

- By bone involved

- By causative gene defect

- By presence or absence of spine involvement

28

Disorders of the primary ossification centre (3)

- Cleidocranial dysplasia

- Apert’s syndrome

- Proximal femoral focal deficiency

- (C.A.P.)

29

Disorders of the secondary ossification centre (4)

- Diastrophic dysplasia

- Spondyloepiphyseal dysplasia congenital

- Spondyloepiphyseal dysplasia tarda 

- Multiple epiphyseal dysplasia

- (D.S.M.)

30

Disorders of hypertrophic zone

- psudoachondroplasia

- Mucopolysaccharidoses

o Morquio’s 

o Hurler’s

o Hunter’s

o San Filippo’s

- Enchondroma

- Rickets

- SCFE