Ortho and Rheumatology Flashcards
(122 cards)
1
Q
Three main causes of toeing IN
A
metatarsus Varus
Tibial Torsion
Femoral anteversion
2
Q
inward deviation of the forefoot due to intrauterine positioning. Most resolve spontaneously. Can usually move the foot back to midline
A
Metatarsus Varus/ adducutus
3
Q
if metatarsus varus/ adductus is rigid what can you do?
A
Use serial casting
4
Q
there is a small percentage of kids with metatarsus varus/ adductus that also have what?
A
Hip dysplasia
5
Q
Rotation of leg between knee and ankle
most common cause of in-toeing <2 years
A
Tibial torsion
6
Q
when will the tibia rotate itself back out by
A
16 months
7
Q
what can exacerbate tibial torsion
A
Sit with feet behind them
8
Q
tx for tibial torsion
A
splints if needed, most get better by age 2
9
Q
what causes toeing in beyond 2-3 years?
A
Femoral Anteversion
10
Q
when is femoral anteversion the worst?
A
4-6 years
more common in girls
11
Q
Tx for femoral anteversion
A
Bicycling and skating/ exercises
stop sitting in “w” position
12
Q
what is there the foot is bent very far towards the shin? (dorsiflexion and eversion)
A
Calcaneovalgus
13
Q
Tx for calcaneovalgus
A
Resolves sponteaneously
14
Q
Complete disruption in the bones, not just positional. Tarsal bones espeically Talus are hypoplastic
A
Talipes equinovarus
Club feet
15
Q
Plantar flexion of foot at the ankle joint (equinus)
Inversion deformity or heel (varus)
Medial deviation of the forefoot (varus
A
talipes equinovarus
16
Q
3 cateogires of talipes equinovarus
A
congenital
teratologic (meningomyelocele or arthrogryposis)
positional
17
Q
Tx for talipes equinovarus
A
Manipulation of foot
stretching, splinting
may need surgical tendon release
best to start early
18
Q
when is bowleg (varum) normal?
A
infancy to 2-3 years
19
Q
what is the term for knock knee’d?
A
valgum
20
Q
when should valgum straighten out?
A
by 8 years old
21
Q
when do you refer for genus varum?
A
bowing of only one leg
worsening bowlegs
22
Q
abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus deformity. unilateral
typically affects overweight AA males
A
Blout’s disease
23
Q
tx for blout’s dz before age 4
A
orthotics
24
Q
tx for blout’s dz after 4 years
A
surgery
25
anterior knee pain that is worse with activity, stairs, and prolonged sitting. more common in female athletes
Patellofemoral pain sydomre (chrondomalacia patella)
26
tx for patellofemoral pain syndrome
RICE
PT eval
complex
27
Found in young athletes, more common males. Age of 11-15 during fast growth and open growth plates. WIll have knee pain during and activity and will limp, stop playing.
Osgood Schlatter Dz
28
What will you see on x-ray with osgood schlatter dz
fragmentation
| microfractures of tibial tuberosity
29
Tx for osgood-schlatter
rest + activity
| NSAIDs, ice, stretching quads and hamstrings
30
how long can symptoms of osgood-schlatter last for?
1-2 years
31
Will there be pain on rest with osgood-schlatter
no pain at rest
32
Abnormal relationship between acetabulum and proximal femur
hip dysplasia
33
first factors for developmental hip dysplasia
first born
female
breech
family hx
34
if an infant has positive hip dysplasia tests on PE when should they get an US?
4-6 weeks
35
when should an infant get an AP pelvis for suspicion of hip dysplasia on PE
>4 months old
36
how may hip dysplasia present in a walking child?
Limb length discrepancy
37
are asymmetric skin fold diagnostic of hip dysplasia
No, need them with a positive barlow or ortalani or pertinent hx.
38
what is the most useful initial evaluation of DDH?
Ultrasound
39
tx of hip dysplasia
Pavlik harness in first 4-6 months in flexion and abduction
40
The most common cause of limping and pain in the hip in children in US.
Acute inflammatory reaction that often follows an URI
generally self limiting
Transient Synovitis of the Hip
41
will transient synovitis have elevated ESR, WBC or temp >38.3 C?
No
42
what age group is transient synovitis common in ? and sex
boys aged 3-8 years old
43
what limitations will a child with transient synovitis of the hip have?
Limitations in internal rotation of hip
| pain in groin/ hip
44
Tx for transient synovitis of teh hip
Rest
anti-inflammatory
traction
slight flexion of the hip
45
what is a possible complication of transient synovitis
avascular necrosis
| F/U with xrays
46
what will labs show with septic arthritis of hip?
elevated ESR, WBC
47
most common organism for septic arthritis of hip
Staph aureus
48
tx for septic arthritis
First 24-72 hours may use ABX alone
| aspirate joint to determine if sx is needed
49
Idiopathic Avascular Necrosis of Proximal Femoral Head
| Highest incidence 4-8 years, boys 4x girls
Legg-Calve-Perthes Dz
50
Symptoms of Legg-Calve-Perthes Dz
pain and limp, no fever
worse w/ activity
decreased internal rotation and abduction
51
Tx for legg-calve-perthes dz
protect joint, not splinting
track through x-rays
eventually bone will regrow
52
what hip problem is a surgical emergency
Slipped Capital Femoral Epiphysis (SCFE)
53
Displacement of proximal femoral epiphysis due to disruption of growth plate
Ice cream off the cone
Head displaced medially and posteriorly
Slipped Capital Femoral Epiphysis
54
who is SCFE common in?
Adolescents ages 10-16 yaers old, obses males
55
Symptoms of SCFE
vague over time
| pain in hip, medial knee, anterior thigh
56
tx for SCFE
immediate non weight bearing
| ortho referral- need sx
57
Lateral curvature of spine, with internal rotation of involved vertebrae. Usually idiopathic.
scoliosis
58
do children get joint infections as much as adults
no
59
who is scoliosis more common in?
Girls
60
if scoliosis is painful what should you look for?
underlying disorder ie tumor
61
Testing for scoliosis
have pt bend forward 90 degrees with hands held in midline.
Asymmetry of scapula, ribs, paravertebral muscles.
62
When do you tx for scoliosis
Over 20 degrees
63
when do you use bracing for scoliosis
20-50 degrees
64
when may someone with scoliosis need spinal sx
>40 degrees
65
Greater than what degree for scoliosis will have poor pulmonary function as adults
>60 degrees
66
Injury to sternocleidomastoid (during delivery)
Head twisted away from affected side
Palpable mass in muscle = fibrous ( not tumor)
Torticollis
67
Tx of torticollis
passive stretching, massage
68
causes of torticollis in older children
muscular spasm
| ENT infections
69
diagnostics to do with troticollis?
xrays to r/o cervical deformity
70
No using arm, held in flexion with hand pronated, tenderness over radial head. may have some swelling.
Nursemaid's elbow
| radial head subluxation
71
tx for radial head subluxation
pressure on radial head
grasp wrist and provide slight traction
suprine wrist while flexing elbow to 90 degrees
72
what should you watch out with radial head subluxation
supracondylar fractures
| compartment syndrome
73
Buckling of cortex
Usually distal ulna or radius
Usually at metaphyseal / diaphyseal junction
Torus fracture (stable)
74
tx for torus fractures
immobilize x 3 weeks
75
Disruption of cortex on one side of bone
| Angulated but not displaced
Greenstick fracture
76
tx for greenstick fracture
external reduction and cast
77
Fracture of the distal tibia without a fibula fracture. Often no significant trauma, and initial radiographs don't always show fracture.
Toddlers fracture
78
transverse fracture through the physis, growth disturbance is unusual
Type I SH
79
most common type of SH fracture
Type II
80
- fracture through a portion of the physis and epiphysis into the joint that may result in complication because of intra-articular component and because of disruption of the growing or hypertrophic zone of the physis
Type III SH
81
fracture through the metaphysis, physis, and epiphysis with a high risk of complication
Type IV SH
82
fracture through a portion of the physis and metaphysis
Type II SH
83
a crush injury to the physis with a poor functional prognosis
Type V SH
84
Benign, pain free bony growth
| most common bone tumor in children
osteochondroma
85
pain in a long bone, pathologic fracture common
| Malignant
osteosarcoma
86
tx for osteosarcoma
surgical excision or amputation (after chemo)
87
Tumor that destroys cortex, pain and tenderness. Will have fever, leukocytosis. inflammatory type presentation
Ewing Sarcoma
88
Tx for ewing sarcoma
chemo
radiation
sx
89
Connective tissue disorder
| can have subluxation of ocular lenses (cataracts, colobomas strabismus)
Marfan syndrome
90
multiple and recurrent fractures
| blue sclera
osteogenesis imperfecta
91
tx for osteogensis imperfecta
bisphosphonates to help w/ pain
92
Upper arms and thighs proportionally shorter than forearms and legs.
Extreme lumbar lordosis
achondroplasia
93
infection in the synovium
synovitis
94
inflammation of the insertion of a ligament
enthesitis
95
labs for rheumatic dz
CBC with diff
ANA
RF
ESR
96
what type of JRA is associated w/ uveitis
pauciarticular
97
to have polyarticular JRA what must you have
5 or more joints involved
98
type of JRA that is in spine and lower extremity
spondyloarthropathy
99
who are at highest risk of uveitis with JRA
young girls, with pauciarticular JRA and a positive antinuclear antibody are at highest
100
most common form, most commonly asymmetric, in kneed, weight bearing joints can occur with uveitis
Pauciarticular
101
symmetric pattern large and small joints. can have nodules, may start to have low grade fevers
polyarticular JA
102
high spike in fevers a couple times a day. salmon-pink macular rash will have arthritis after systemic sx. can be any joint large or small. Will have pleurisy and pain
systemic form JA
103
what does the lupus rash look like?
is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales.
104
What is ANA?
Antinuclear antibody
| test for lupus
105
what sex does lupus affect more?
girls
106
what is the most common presenting symptom of lupus?
joint pain
107
what skin effects does lupus have?
butterfly rash
purpura
alopecia
Raynauds phenomenon
108
What can happen in the pleural lining with lupus?
Pleurisy with effusion
peritonitis
pericarditis
109
What happens to the GI system with lupus?
HSM
lymphadenopathy
acute pancreatitis (uncommon)
110
what is the reading cause of death from lupus?
diffuse proliferative nephritis... nephrosis and uremia
111
what is the treatment for lupus?
steroids
NSAID from pleuritic pain
hydroxycholorquin for skin, arthritis, fatigue
112
what other antibody (besides ANA) is found in lupus
anticardiolipin antibody
| lupus coagulant
113
Rare inflammatory dz of muscles and skin. - face and hands, scaley red plaques on knuckles or extensor surfaces, proximal muscle pain.
Dermatomyositis
114
what sex is affected more by dermatomyositis?
females
115
What muscles does dermatomyositis affect?
pelvic and should girdle muscles
| symmetric
116
what labs will be abnormal with deramtomyositis?
abnormal muscle enzymes (CK, LDH, ALT, AST)
+/- ANA
WBC, ESR and CRP often normal
117
Treatment for dermatomyositis
steroids
| usually induces remission
118
what is the most most common vasculitis in childhood?
henoch schonlein purpura
119
what sex does HSP affect more?
boys
120
what time of year is HSP more common?
winter
121
where is palpable purpura most often found with HSP?
below waist
| knees and ankles most common
122
what labs will be elevated with HSP?
ESR
WBC
CRP
