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pediatrics > Low Yield > Flashcards

Low Yield Flashcards

1
Q

What fracture pattern in a pediatric patient is pathognomonic for osteopenia imperfecta?

A

Olecranon fracture

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2
Q

Pediatric elbow dislocations are a/w with what condition(s)?

A

1) Pediatric abuse

2) Medial epicondyle fractures

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3
Q

Salter Harris fractures occur at what portion of the physis?

A

Zone of provisional calcification within the hypertrophic zone

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4
Q

What age group is Nursemaid’s elbow most common?

A

2-5yo

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5
Q

How are Nursemaid elbow’s reduced?

A

performed by manually supinating the forearm and flexing the elbow past 90 degrees of flexion; during this maneuver the physician’s thumb applies pressure over the radial head and a palpable click is often heard with reduction of the radial head.
alternative technique includes hyperpronation of the forearm while in the flexed position

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6
Q

What must be examined in a suspected isolated radial head dislocation in pediatric patient?

A

must examine for plastic deformation of the ulna if there is a presumed isolated radial head dislocation

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7
Q

What is indicated in pediatric patients with an unreducible radial head in a Monteggia fracture?

A

Ulnar osteotomy +/- open reduction of radial head

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8
Q

What nerve palsy is common in acute Monteggia fractures?

A

PIN; 10% in acute injuries

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9
Q

What is a common radiographic finding in the sequelae of pediatric hip dislocation?

A

Coxa magna (20%)

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10
Q

Under or overgrowth of the greater trochanter apophysis due to trauma can result in what deformities?

A

Undergrowth- coxa valga

Overgrowth- coxa vara

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11
Q

What is the treatment of pediatric femoral neck fractures?

A

1) Open reduction and capsulotomy within 24hrs
2) CRPP with k-wires for very young pts, cannulated screws for older
3) Stop short of physis in younger pts
4) cross physis if need to for stability, cross physis if >12yo
5) avoid anterolateral quadrant of epiphysis and posterior perforation of femoral neck to prevent injury to vasculature

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12
Q

What is the most common complication of pediatric femoral neck fracture?

A

AVN; almost 100% in Delbet IB (subcapital with dislocaiton of epiphysis); most susceptible age for AVN is 3-8 years
Second most common is coxa vara

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13
Q

Pediatric proximal tibia metaphyseal fractures can develop what late deformity?

A

Valgus; known as a Cozen deformity
Try to prevent with varus mold in cast, most spontaneously resolve in 12-24 months; affected tibia is often longer (average 9mm)

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14
Q

What is the treatment for a patellar sleeve avulsion fracture?

A

Cylinder cast if displaced less than 2cm; ORIF with tension band if >2cm displacment (can also use suture tunnels)

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15
Q

Toddler’s fracture usually affects what area of the tibia as opposed to fractures due to abuse?

A

Toddler’s-distal tibia

Abuse- proximal tibia

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16
Q

What is the treatment of most Toddler’s fracture?

A

Closed reduction and long leg cast if reduction acceptable

50% apposition

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17
Q

What is a congenital condition of a hypoplastic, undescended scapula?

A

Sprengel’s deformity; a/w Klippel-Feil syndrome

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18
Q

What shoulder motion is most limited in Sprengel’s deformity?

A

abduction

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19
Q

What are the associate manefestations of proximal femoral focal deficiencies?

A 
fibular hemimelia (50%) 
ACL deficiency 
coxa vara
knee contractures
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20
Q

Anterolateral bowing of the tibia is a/w what pediatric condition?

A

Congenital pseudoarthrosis, commonly a/w neurofibromatosus; posteromedial is physiologic, anteromedial is a/w fibula hemimelia

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21
Q

What is the treatment for tibial deficiency?

A

1) Complete absence of tibia w/o knee extension- knee disarticulation
2) Proximal tibia present w/ intact knee extension- tib/fib synostosis with Syme amputation

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22
Q

What foot deformity often accompanies posteromedial bowing of the tibia?

A

Calcaneovalgus foot

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23
Q

What is the cause of posteromedial bowing of the tibia?

A

Intrauterine positioning

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24
Q

What is the most common sequelae of posteromedial bowing?

A

Leg length discrepancy of 3-4cm

25
Q

What is the treatment of posteromedial bowing?

A

Observation; most resolve by age 5-7yo; may need growth modulation d/t development of LLD

26
Q

What is the most common cause of in-toeing gait?

A

Internal tibial torsion

27
Q

What are causes of in-toeing?

A

1) Internal tibial torsion (most common)
2) Femoral anteversion
3) Metatarsus adductus

28
Q

At which point is surgery indicated in patients with internal tibial torsion?

A

> than 8yo with thigh-foot angle >15 degrees; perform derotational supramalleolar osteotomy

29
Q

What is the normal femoral anteversion at birth?

A

30-40 deg

30
Q

What physical exam finding is indicative of increased femoral anteversion?

A

Decreased external rotation of the hip

31
Q

What patients with external tibial torsion are candidates for supranalleolar osteotomy?

A

Age >8 and rotation >2 SD above the norm (>40 deg)

32
Q

What is the cause of metatarsus adductus?

A

Packaging disorder

33
Q

Metatarsus adductus is associated with what gait abnormality?

A

in-toeing

34
Q

What is the treatment for metatarsus adductus?

A

Non-operative:
Stretching for flexible deformities, rigid deformities serial casting

Operative:
Lateral column shortening, medial column opening wedge osteotomy

35
Q

Cavovarus foot is described as?

A

Elevated longitudinal arch with fixed plantarflexed forefoot

Tibialis anterior is overpowered by the peroneus longus

36
Q

What muscle imbalance is responsible for cavovarus foot?

A 
Tibialis anterior is overpowered by the peroneus longus
a/w :
Charcot-Marie-Tooth 
Freidreich's ataxia 
Cerebral palsy
Polio
spinal cord lesions
37
Q

Coleman block testing assesses what?

A

Flexible hindfoot in a cavovarus deformity
Placed under the lateral column which removes the contribution of a plantarflexed first ray; if does not correct then is rigid hindfoot

38
Q

What is the treatment for cavovarus foot?

A

Mild and flexible: medial rigid insole with lateral wedge
Flexible: plantar fascia release, post tib transfer, TAL, 1st MT dorsiflexion osteotomy
Rigid: Calcaneal valgus osteotomy
Severe rigid: triple arthrodesis

39
Q

Lack of frataxin gene is characteristic of what disease?

A

Friedreich’s ataxia; due to GAA repeat on Ch 9q13

40
Q

What is the most common cause of death in Friedreich’s ataxia?

A

Cardiopulmonary compromise; usually by age 50.

Wheelchair bound by age 30

41
Q

What is the treatment of Friedreich’s ataxia?

A

Treat associated disorders:
Scoliosis- observe/brace if less than 40deg, PSF if >60deg
Cavovarus foot- transfers and osteotomies, possible triple arthrodesis

42
Q

What is Kohler’s disease?

A

Idiopathic AVN of the navicular;
Ages 4-7yo
80% occur in boys

43
Q

Why is the treatment for Kohler’s disease?

A

NSAIDs and short leg walking cast

44
Q

What is the treatment for accessory navicular?

A

Activity and shoe modification
Casting if refractory
Surgical excision in chronic refractory cases

45
Q

What technical trick helps prevent recurrence in excision of accessory navicular?

A

Recurrence of symptoms MC d/t inadequate bone resection

Respect flush with the medial cuneiform

46
Q

What is the treatment for congenital curly toe?

A

Observation; most go away on their own, taping does not help; surgical release of severe toe or nail deformity in kid >3yo

47
Q

Describe flexible pea plants in pediatric patients?

A

Physiologic variant consisting of a decrease in the medial longitudinal arch and a valgus hindfoot and forefoot abduction with weightbearing;
Corrects with Coleman block testing (tarsal coalition flatfoot does not)

48
Q

What is the treatment of flexible pes planus in children?

A

Observation; arch redevelops by maturity and orthotics don’t change the course of the disease
Surgery (Evans calcaneus osteotomy and TAL or Strayer) is rarely indicated

49
Q

What proteins are a/w Larsen’s syndrome?

A

AD (autosomal dominant) form gene codes for filamin B

AR form is carbohydrate sulfotransferase 3 deficiency

50
Q

What is Larsen’s syndrome?

A

rare genetic disorder with characteristic findings of ligamentous hyperlaxity, abnormal facial features, and multiple joint dislocations
a/w cervical kyphosis that presents with myelopathy (posterior cervical fusion at 18mths of life)

51
Q

What is arthrogryposis?

A

Nonprogressive congenital disorder involving multiple rigid joints (usually symmetric) leading to severe limitation in motion; normal cognition

52
Q

What mutation causes spinal muscular atrophy?

A

Mutation of SMN-I present in all SMA pts; severity determined by number of functional copies of SMN-II; causes progressive loss of alpha-motor neurons in anterior horn of spinal cord

53
Q

What is the mutation involved with Ehlers-Danlos?

A

COL5A1 or COL5A2; gene for type V collagen

important in proper assembly of skin matrix collagen fibrils and basement membrane

54
Q

What is the physical exam scoring system for joint hypermobility?

A

Beighton-Horan scale: (5 or more pts)

1) passive hyperextension of each small finger >90° (1 point each)
2) passive abduction of each thumb to the surface of forearm (1 point each)
3) hyperextension of each knee >10° (1 point each)
4) hyperextension of each elbow >10° (1 point each)
5) forward flexion of trunk with palms on floor and knees fully extended (1 point)

55
Q

Define juvenile idiopathic arthritis?

A

A persistent autoimmune inflammatory arthritis lasting > 6 weeks in a patient younger than 16 years of age; HLA markers DR4 associated with polyarticular
DR8, DR5, DR2.1 associated with pauciarticular
RF- seropositive in

56
Q

What condition a/w juvenile idiopathic arthritis requires outside consultation?

A

Anterior uveitis: consists of iridocyclitis frequently indolent and requires immediate ophthalmologic evaluation for slit lamp examination; indolent and can lead to blindness if overlooked

57
Q

Which type of juvenile idiopathic arthritis has the best prognosis?

A

Pauciarticular; less than 5 joints involved, typically presents with painful limp that improves throughout the day
Pauciarticular>polyarticular>systemic
Polyarticular typically involves hand/wrist
Systemic (Still’s disease) fever, rash, splenomegaly

58
Q

What lysosomal storage disease is common in Ashkenazi Jews?

A

Gaucher’s; leads to accumulation of sphingolipids

59
Q

What is the deficiency in Gaucher’s disease?

A

B-glucocerebrosidase

pediatrics (37 decks)

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