MSK peds Flashcards
(80 cards)
1
Q
questions to ask during hx
A
- age
- pain or weakness (night pain pattern/worsening often seen in neoplasm)
- trauma
2
Q
PE
A
- gait
- inspection/palpation - abdomen, pelvis, back and extremities
- ROM
- neurovascular status - strength, sensation, reflexes
3
Q
normal gait development
A
- walk w/o support by 12-15mos
- coordination with reciprocal arm swing by 2yrs
- req MSK development of lower back, pelvis, and LE
- neurologic growth - coordination/balance (myelinization in cephalocaudal pattern)
- adult gait pattern attained by 8-10yrs
4
Q
normal gait phases
A
- stance - weight-bearing phase; heel strike -> plantar flex -> toe-off
- swing - toe-off -> heel strike; rotation and tilting of pelvis and stability of lumbar spine and abdomen
5
Q
abnormal gait and cause
A
- antalgic
- trendelenburg limp - problem with glut medius of standing leg
- waddling - b/l hip involvement or neurologic disease
- stiff-legged
- toe walking - habitual or due to mm contractures, spasticity, or puncture wound to heal
- steppage - peroneal neuropathies
- stooped - abdominal pathology
- generalized mm weakness - muscular atrophy or metabolic cause
6
Q
developmental hip dysplasia:
age
A
0-4 yrs
7
Q
developmental hip dysplasia:
pathology
A
abnormal formation of hip joint -> femoral head unstable within acetabolum
8
Q
developmental hip dysplasia:
cause
A
unknown
9
Q
developmental hip dysplasia:
risk factors
A
- female
- breech
- FMH
- first born
- oligohydramnios
10
Q
developmental hip dysplasia:
location
A
L hip more common
11
Q
developmental hip dysplasia: assoc with
A
- other ortho problems (torticollis, metatarusadductus, clubfoot)
- connective tissue disorders (Larsen syndrome)
12
Q
developmental hip dysplasia:
PE
A
- Barlow and ortolani
2. Galeazzi sign
13
Q
developmental hip dysplasia:
treatment
A
pavlik harness up to 6 months, surgical consideration after if bracing fails
14
Q
developmental hip dysplasia:
labs and exams
A
ultrasound
15
Q
Toddler’s fracture:
definition
A
spiral fracture of tibia under 5y/o
16
Q
Toddler’s fracture:
cause
A
sudden twisting of tibia
17
Q
toddler’s fracture:
symptoms
A
- pain
- refusal to walk
- minor swelling/warmth over site
- pain with palpation
18
Q
toddler’s fracture:
treatment
A
long-leg cast; heal within 3-4 weeks
19
Q
toddler’s fracture:
labs and exams
A
X-ray but often difficult to visualize
20
Q
physeal fracture:
definition
A
fracture growth plate
21
Q
physeal fracture:
age
A
- girls: 0-16y/o
2. boys: 0-18y/o (more common in boys)
22
Q
physeal fracture:
location
A
weakest area of growing bone
23
Q
physeal fracture:
type of fracture
A
salter-harris I classification
24
Q
stress fracture:
definition
A
small crack in bone, often from overuse and high impact sports
25
stress fracture:
| location
weight bearing bones, often 2nd/3rd metatarsal
26
stress fracture:
| age
10-18y/o
27
stress fracture:
| symptoms
1. pain that increases with weight bearing activities
2. reduced with rest
3. tenderness to touch
28
stress fracture:
| labs and exams
x-ray: callus around fracture
29
stress fracture:
| treatment
1. rest
| 2. possible surgery, depending on site
30
osteomyelitis:
| definition
inflammation of bone marrow and adjacent bone
31
osteomyelitis:
| age
all age
32
osteomyelitis:
| cause
1. children: hematogenous spread by staph aureus
| 2. adult: subacte/chronic forms, secondary to open wounds
33
osteomyelitis:
| location
metaphysis of long bones
34
osteomyelitis:
| symptoms
1. local inflammation and fever
2. irritability
3. lethargy
4. bone tenderness and decrease ROM
5. systemic symptoms
35
osteomyelitis:
| treatment
IV abx (4-6wks)
36
septic arthritis:
| definition
infection with the joint space -> inflammatory response -> intense synovitis
37
septic arthritis:
| age
all age
38
septic arthritis:
| cause
bacterial, viral, fungi or parasite
39
septic arthritis:
| symptoms
1. monoarticular
2. erythema
3. swelling
4. pain
5. decreased ROM
6. inability to bear weight
40
septic arthritis:
| locaiton
knee
41
septic arthritis:
| treatment
IV/PO abx 4-6 wks
42
gonococcal arthritis:
| definition
septic arthritis of the joint caused by gonococcus
43
gonococcal arthritis:
| age
10-18y/o (sexually active)
44
gonococcal arthritis:
| dx/tx
1. dx: aspiration of joint fluid and send fluid for culture and sensitivity
2. tx: IV/PO abx for at least 1wk
45
transient/toxic synovitis:
| symptoms
1. irritable hip/knee syndrome
2. acute hip pain
3. decrease ROM
46
transient/toxic synovitis:
| age
0-10y/o, more often in boys
47
transient/toxic synovitis:
| dx
dx of exclusion
48
transient/toxic synovitis:
| definition
hip in flexion/abduction and external rotation
49
transient/toxic synovitis:
| cuase
unk, maybe due to infection (often seen post URI)
50
transient/toxic synovitis:
| exams and labs
1. WBC normal
| 2. pos effusion
51
transient/toxic synovitis:
| tx
1. self-limited (5-7 days)
| 2. NSAIDS
52
slipped capital femoral epiphysis:
| definition
1. noninflammatory condition
| 2. epiphysis weak -> femoral head displaced from femoral neck
53
slipped capital femoral epiphysis:
| location
initially b/l
| if u/l, high chance of other side slip
54
slipped capital femoral epiphysis:
| age
10-14y/o, more common in overweight boys
55
slipped capital femoral epiphysis:
| association
endocrine disorders - primary hypothyroid, HGH/pituitary deficiency
56
slipped capital femoral epiphysis:
| symptoms
1. insidious or acute
| 2. complaint of pain in hip and limp
57
slipped capital femoral epiphysis:
| dx
x-ray
58
slipped capital femoral epiphysis:
| tx
1. immediate non-wt bearing
2. surgical stabilization
3. px good
59
legg-calve-perthes disease:
| age
4-10y/o, more common in thin, active boys
60
legg-calve-perthes disease:
| cause
1. trauma
2. inflammation
3. coag abn -protein C/S def, Leiden factor V defect
61
legg-calve-perthes disease:
| definition
lack of blood flow to femoral head -> bone necrosis -> bone collapses (flattens)
62
legg-calve-perthes disease:
| symptoms
1. slight limp
2. pain in knee, thigh, or groin
3. limited ROM
4. leg length discrepancy
63
legg-calve-perthes disease:
| dx
MRI > X-ray
64
legg-calve-perthes disease:
| tx
1. meds
2. reduce activity to decrease pain
3. splinting or surgery to keep hip stable (ROM impt)
65
legg-calve-perthes disease:
| px
1. best if
66
juvenile idiopathic arthritis:
| definition
chronic joint pain for min 6wks and
67
juvenile idiopathic arthritis:
| location
mono or polyarticular
68
juvenile idiopathic arthritis:
| symptoms
1. joint effusion
2. pain
3. limited ROM
4. warmth over the joint
5. morning stiff - hip involvement unusual
6. spiking fever
7. macular rash
69
juvenile idiopathic arthritis:
| exams and labs
1. CBC - no WBC spike
2. inflammatory markers - elevated CRP
3. ANA
4. RF
5. X-rays
70
juvenile idiopathic arthritis:
| tx
1. NSAIDS
2. steroids
3. DMARDS
71
lyme arthritis:
| symptoms
1. episodic initially - 2/3 monoarthritis of knee
| 2. occur months or years after infection
72
lyme arthritis:
| age
10-18 y/o
73
lyme arthritis:
| cause
Borrelia burgdorferi transmitted by tick
74
lyme arthritis:
| prevalence
US - NE, MW, S, W costal areas
75
lyme arthritis:
| tx
1. IV rocephin/PO Amox or doxy for 4 wks
| 2. NSAIDS
76
growing pains:
| definition
intermittent nonarticular pains (vague pain) in childhood (
77
growing pains:
| dx
dx of exclusion
78
growing pains:
| symptoms
1. typically pain at night and limited to calf, thigh, or shin
2. pain is short-lived and resolved with heat, massage or mild analgesics
3. pain free during the day
79
growing pains:
| cause
unknown
80
growing pains:
| tx
reassurance to parents and child
