Knott - Peds

Question 1

approach to peds ortho

Answer 1

1. age
2. context
3. hx
4. pe
5. imaging → xray, US, CT, MRI
6. referral → ED/ortho

Question 2

what are 3 types of ortho infxns

Answer 2

1. transient (toxic) synovitis
2. septic arthritis
3. osteomyelitis

Question 3

mc location for transient synovitis

Answer 3

hip

Question 4

what do you think when you see a non toxic, post viral infxn pediatric pt w. an antalgic gait and his hip abducted and externally rotated

Answer 4

transient synovitis

Question 5

a pt w. septic arthritis will appear

Answer 5

ill

fever

irritable

Question 6

septic arthritis is almost always caused by

Answer 6

staph

Question 7

osteomyelitis commonly affects the

Answer 7

long (tubular) bones

Question 8

what do you think when you see periosteum elevation of a long bone

Answer 8

osteomyelitis

Question 9

mc place for osteoid osteoma

Answer 9

le → proximal femur

Question 10

benign bone lesions progress

Answer 10

slowly

Question 11

what are the benign bone lesions

Answer 11

1. osteoid osteoma
2. osteoblastoma
3. osteochondroma

Question 12

malignant bone lesions are characterized by

Answer 12

lots of pain → kids waking up screaming at night

Question 13

an osteoma is a

Answer 13

non malignant bone lesion

Question 14

what do you think when you see small radiolucent nidus

< 1 - 1.5 cm

Answer 14

osteoid osteoma

Question 15

what is the mc place for an osteoblastoma

Answer 15

posterior column of the spine

Question 16

what do you think when you see non-malignant bone lesion larger than osteoid osteoma

Answer 16

osteoblastoma

Question 17

what are the 3 mc place for osteochondroma

Answer 17

distal femur

around knee

proximal humerus

Question 18

what do you think when you see a cartilage-capped bony spur on the external surface of a bone

Answer 18

osteochondroma

Question 19

what creates a cauliflower appearance on xray

Answer 19

osteochondroma

Question 20

what are the malignant bone lesions

Answer 20

1. osteosarcoma
2. ewing’s sarcoma

Question 21

what is the mc location for osteosarcomas

Answer 21

femur

Question 22

what is the mc primary malignant bone lesion in kids

Answer 22

osteosarcoma

Question 23

osteosarcoma often occurs

Answer 23

post trauma

Question 24

what do you think when you see a pt w. localized pain for several months that waxes and wanes with normal labs except for elevated alk phos and LDH

Answer 24

osteosarcoma

Question 25

what does this xray make you think - sunburst, codman's triangle

Answer 25

osteosarcoma

Question 26

what is the mc location for ewing's sarcoma

Answer 26

long bones of extremities → 1. **femur** 2. tib/fib 3. humerus

Question 27

what does this xray make you think - moth eaten, permeative appearance; codman's triangle; onion peel; periosteal elevation

Answer 27

ewing's sarcoma

Question 28

what are 6 considerations in evaluation of pediatric fx

Answer 28

1. age 2. MOI 3. anatomic location 4. soft tissue involvement → open vs closed 5. key PE 6. xrays

Question 29

what is the most metabolically active portion of the bone

Answer 29

metaphysis

Question 30

what portion of the bone is the most prone to fx

Answer 30

metaphysis

Question 31

be able to label this pic

Question 32

4 types of peds fx

Answer 32

1. buckle 2. plastic deformation → bowing 3. greenstick 4. physeal

Question 33

what is the mc pediatric fx

Answer 33

buckle

Question 34

buckle fx is caused by what type of injury

Answer 34

FOOSH

Question 35

mc location for buckle fx

Answer 35

ulna/radius

Question 36

what is the mc location for a bowing fx

Answer 36

ulna radius

Question 37

what is this fx called

Answer 37

bowing fx

Question 38

what is this fx

Answer 38

greenstick → bone is bent w. fx line, but fx does not extend completely thru bone

Question 39

salter harris fx's involve the

Answer 39

growth plate → physeal fx

Question 40

salter harris types III-V usually require \_\_ dt risk of \_\_

Answer 40

ortho referral stunted growth

Question 41

what might you be concerned about w. a toddler fx

Answer 41

child abuse

Question 42

what is the mc location for a toddler fx

Answer 42

femur tib/fib

Question 43

what is the mc elbow injury/elbow fx in kids

Answer 43

supracondylar fx

Question 44

supracondylar is a ___ injury

Answer 44

do not miss!

Question 45

what do you think when you see a pt w. elbow pain and guarding and no ROM

Answer 45

supracondylar fx

Question 46

what does the fat pad sign on a peds elbow xray make you think of

Answer 46

supracondylar fx

Question 47

what peds pt population usually has clavicle fx

Answer 47

adolescents athletes

Question 48

where do boxers fx occur

Answer 48

fx of head/neck of 5th metacarpal

Question 49

what is a nat

Answer 49

non accidental trauma

Question 50

what are 6 nat injuries that might make you suspicious for child abuse if the hx is inconsistent w. injury

Answer 50

1. long bone fx in non ambulatory pt 2. rib fx 3. sternum, scapula, spinous process, vertebral body fx 4. multiple fx in various stages of healing 5. digital fx in \< 3 yo 6. complex skull fx in \< 18 months

Question 51

when does the posterior fontanelle close

Answer 51

2 months

Question 52

when does the anterior lateral fontanelle close

Answer 52

3 months

Question 53

when does the posterior lateral fontanelle close

Answer 53

one year

Question 54

when does the anterior fontanelle close

Answer 54

2 years

Question 55

what is the etiology of torticollis

Answer 55

sternocleidomastoid m

Question 56

in what pt population is back pain concerning

Answer 56

young kids

Question 57

what is the mc scoliosis location

Answer 57

thoracic region → r thoracic l lumbar

Question 58

what are 2 values to evaluate scoliosis

Answer 58

cobb angle risser score

Question 59

what does the risser score measure

Answer 59

iliac ossification/skeletal maturity

Question 60

older kids have a lower risk for progression of

Answer 60

scoliosis

Question 61

what pt population do you think of with spondylolysis and spondylolisthesis

Answer 61

gymnasts divers

Question 62

fx of posterior arch in lower lumbar spine and scotty dog sign on xray should make you think of

Answer 62

spondylolysis and spondylisthesis

Question 63

asymmetric thigh folds and a positive barlow and ortolani should make you think of

Answer 63

developmental hip dysplasia

Question 64

what is the imaging choice for hip dysplasia dx in kids 4-6 weeks old

Answer 64

US

Question 65

what is the diagnostic imaging of choice for developmental hip dysplasia f kids are \> 4-6 weeks old

Answer 65

xray

Question 66

what do you think of when you see an overweight AA middle schooler w. pain and no hx of trauma

Answer 66

slipper capital femoral epiphysis

Question 67

what is this xray showing - widened epiphyseal plate, bloomberg's sign, off-centered Klein's sign

Answer 67

slipped capital femoral epiphysis

Question 68

what LE condition might affect a skinny younger kid after trauma or infxn

Answer 68

legg-calve-perthes dz

Question 69

what is legg-calve-perthes dz

Answer 69

osteonecrosis of femoral head

Question 70

babies are born with with leg formation

Answer 70

fenuvarus → bow legged

Question 71

what are indications for referral with genu valgum

Answer 71

1. \>8 cm btw medial malleoli 2. progressive knock-knees after 4-5 yo 3. unilateral or assymetric 4. associated w. short stature 5. hx metabolic dz or joint swelling/infxn

Question 72

what are indications for referral with genu varus

Answer 72

1. \>6 cm btw femoral condyles 2. progressive bowing 3. persistent bowing \>3yo 4. unilateral or asymmetric 5. short stature 6. hx of concern

Question 73

when would you measure thigh-foot angle

Answer 73

tibial torsion

Question 74

what is the mc congenital foot deformity

Answer 74

metatarsus adductus

Question 75

what is the tx for clubfoot (talipes equinovarus)

Answer 75

early serial casting

Question 76

what is the mc reason for bone pain in adolescents

Answer 76

sever's apophysitis → osgood schlatter's of the ankle

Question 77

what is the most common location for osteochondrosis dessicans (OCD) -

Answer 77

complication of osgood schlatter's knee

Question 78

what condition might you see in little leaguers

Answer 78

lateral epicondylitis

Question 79

how many times should you try to reduce a nursemaid's elbow before xraying

Answer 79

2

Question 80

how do you reduce a nursemaid's elbow

Answer 80

supinate and flex