MSK CCP - Pitcher

Question 1

important for history of limping child

Answer 1

age and gait**

Question 2

normal gait

Answer 2

stance phase - weight bearing
-hell strike, plant, toe off

swing phase - toe off to heel strike
-rotation and tilting of pelvis

Question 3

transient/toxic synovitis

Answer 3

in DDx for limping in kid

infection

Question 4

hip dysplasia

Answer 4

age 0-4 years

abnormal formation of hip joint

femoral head that doesn’t fit

more common in females

Question 5

barlow ortolani

Answer 5

physical exam of hip in infants

barlow - push hip down

Question 6

toddlers fracture

Answer 6

spiral fx of tibia under age 5yo

sudden twisting of tibia

pain, won’t walk, pain with palpation

tx - long leg cast, heal 3-4 weeks

Question 7

physeal fracture

Answer 7

of growth plate in kids

boys more common
salter harris classification

Question 8

stress fracture

Answer 8

small crack in bone

from overuse, highimpact

commonly metatarsal 2 or 3

pain with weight bearing activities

tender to touch

tx - rest and possible surgery

Question 9

osteomyelitis

Answer 9

bone infection

infer long bone infection

tx - IV antibiotics

hematogenous spread - sick looking kid

Question 10

septic arthritis

Answer 10

infection in joint space

monoarticular erythema swelling pain decreased ROM

knbee - common

tx - antibiotics

Question 11

irritable hip syndrome

Answer 11

transient/toxic synovitis

post viral**

decreased ROM

diagnosis of exclusion

Question 12

isolate to hip

Answer 12

rotation

internal or external

Question 13

legg calve perthes disease

Answer 13

LCP

aka perthes disease or idiopathic osteonecrosis of femoral head**

blood supply returns after several months

thin active boys

slight limp, knee pain, thigh or groin pain, limited ROM, leg length discrepancy

tx - reduce activity - or surgery with stabilization

Question 14

slipped capital femoral epiphysis

Answer 14

femoral head displaced from femoral neck**

endocrine underlying - hypothyroid and GH deficiency

overweight boys - with shear stress on hip

tx - surgical stabilization

Question 15

JIA

Answer 15

juvenile idiopathic arthritis

chronic joint pain for minimum of 6 weeks and >16yo

joint effusion, pain, limited ROM, warm over joint

Question 16

lyme arthritis

Answer 16

2nd most frequent presenting symptom
-rash is #1

months or years after infection

initially episodic

kids running through woods - borrelia burgdorferi tick

tx - antibiotics and NSAIDs

Question 17

gonoccoccal arthritis

Answer 17

not unless sexually active**

tx - aspiration of joint fluid

Question 18

growing pains

Answer 18

intermittent nonarticular pains

diagnosis of exclusion

pain at night and b/l - limited to calf, thigh, or shin

resolved with heat, massage, mild analgesics

tx - reassurance of parents and child and observation

Question 19

risk for hip dysplasia

Answer 19

breech presentation

Question 20

elevated WBC, low hemoglobin, low platelets

Answer 20

think ALL - acute lymphocytic leukemia

Question 21

stooped

Answer 21

abdominal pathology

Question 22

10-18 year olds

Answer 22

SCFE
gonoccocal arthritis
stress fx

Question 23

4-10 year olds

Answer 23

legg-calve-perthes disease

juvenile idiopathic arthritis

Question 24

common septic arthritis organism

Answer 24

staph aureus

Question 25

acute swelling of knee with fever

Answer 25

septic arthritis

Question 26

definitive diagnosis of septic arthritis

Answer 26

aspiration and culture of synovial fluid

Question 27

SCFE

Answer 27

slipped capital femoral epiphysis