Ortho, Rheumatology, Vasculitis Flashcards
(26 cards)
Fever, irritability, lethargy, pain over long bone, swelling, erythema of knee. Radiograph reveals no bony abnormalities. Dx? Test? Rx? Complications?
Osteomyelitis. CBC, ESR, CRP, Blood culture, Bone Scan (will become positive after 3 days), MRI. Admit patient. Infants: Oxacillin and cefotaxime. Children: Vancomycin. Chronic osteomyelitis, fracture, leg length descrepancy.
Pt presents with high fever, pain, joint stiffness, erythema, edema and limp after suffering trauma to knee. Aspiraiton of joint is positive. Dx? Rx?
Septic Athritis. CBC (normal WBC does not rule out infection) ESR, Blood culture. Joint Aspiration diagnostic and therapuetic. Give (Oaxcillin and cefotaxime (if gram neg) - < 3months . Vanco if > 3 months
Most common cause of hip pain in child. Child presents with fever, and refuses to bear weight on leg. Leg is swollen and warm and pt refuses extenion and flexion. Next best step? Rx?
Get synovial fluid analysis. Transient Synovitis is a diagnosis of exclusion. When joint aspirate is negative. Supportive therapy with NSAIDs.
Athletic pt presents with significant tenderness and swelling of the tibial tuberosity. Dx? Test? Rx?
Osgood-Schlatter Disease due to overuse of the knee. Clinical Diagnosis. Rest.
Boy presents with hip and knee pain he has been limping. He is unable to abduct or internally rotate his hip. CXR: shows erosion of the femor. Dx? Rx? Complicaiton?
Legg-Calve Perthes disease (avascular necrosis of the femoral head) Pain can come from hip and radiate to thigh. AP and frog-leg lateral position. Complication: Pain meds, Protect join, abduction orthosese to keep head in acetabulum surgery/ortho consult. Leg length discrepancy.
Most common cause of limping and acute hip pain in children age 3-10 yrs?
Toxic Synovitis.
Obese 14 yo Pt has pain in the left anterior thigh for 2 months. Limited passive flexion and internal rotation of his hip.
Slipped Caital Femoral Epiphysis. (occurs at pubertal growth spurt) AP and Frog-leg lateral views of the pelvis. Pining.
Chronic dz with inflammation of the joints. Diagnosis of exclusion. What is the diagnostic criteria. Name the 3 types. Rx?
Must be < 16 and duration must be > 6 months, many joints affected, exclude everything else. Juvinille Rheumatoid Athritis. Most children test negative for RF. 1. Polyarticular (more the 5 joints big and smal) 2. Pauciarticular (fewer than 5 and mainly large joints) 3. Systemic (rash and fever may be present) Rx: NSAID, physical therapy, Methotrexate.
Cant see cant pee cant climb a tree. Dx?
Reiters Syndrome. Athritis, Conjunctivites, Urethritis caused by salmonella, shigella, camplybactor, Yersisinia
Bulging of the concave cortex of the long bone due to compression. Dx?
Torus Fracture (buckle fracture)
A break in the convex cortex under tension caused by bending of malleable bone.
Greenstick fracture.
Nondispalced spiral fracture of the tibia. Which should be included in the differential diagnosis.
Toddler Fracture. Non accidental Trauma.
2 yo boy keeps his arm in the flexed and pronated position. He refuses to supinate. Mom remembers pulling his arm yesterday. Dx? Rx?
Sublaxation of the radial head. (Nurse Maid elbow) Imaging unecessary. Clinical Diagnosis. Fully supinate arm and arm is slowly moved from full Flexion to extension.
Pt presents with dull, aching pain of the long bone for several months that suddenly become more severe. Dx? Test? Rx?
Osteosarcoma. Xray and CT scan show sun burst pattern. Amputation in severe cases. Radiation and Chemo. 75% survivial in nonmetastatic dz.
Pt presents with leg pain, fever and weight loss. Calcified periosteal elevation (onion skinning) seen on radiographs. Dx? Rx?
Ewing Sarcoma. Radiation and Chemic. Surgical resction if needed.
Pain and point tenderness predominantly found in boys. Benign. Dx? Rx?
Osteoid Osteoma. salicylates (Aspirin) relive pain. Good Prognosis.
Pedunculated or sessile mass in the metaphyseal region of long bones. Dx?
Osteochondroma.
Herniation of the synovium in the knee joint into the popliteal region. Dx?
Baker’s Cyst.
Abnormal growth and development of the hip resulting in an abnormal relationship bewtween the proximal femur and the acetabulum. Dx? Test? Rx?
Developmental Dysplasia of the Hip. Ortoloni, Barlow. Pavlik Harness.
Apparent shortening of the femur on the side of the dislocated hip and is noted by placing both hips 90 degrees of flexion comparing the height of the knees.
Ortoloni Sign
Most common in firstborn. Forefoot adducted from flexible to rigid. . Dx? Rx?
Metatarsus Adductus. Serial plaster cast befoe 8 months of age, orthoses, corrective shoes.
Blue sclerae, hearing loss, easy fractures, easy brusability and opalescent teeth. Dx? Test? Rx?
Oteogenesis Imperfecta. AD mutation in COLA1. Radiographic findings indicate osteopenia. Rx: Bisphosphenates and Surgical correction of long bone deformities.
Athritis, Pupura, Rash, Abdominal pain, scrotal swelling elevated BUN and Cr with blood in urine and NORMAL COAGULATION studies. Dx? What does it deposit? Rx?
Henoch Scheolein Pupura. Deposits IgA in the kidney. Supportive treatment with iv fluids and pain meds (NSAIDs).
Name the diagnosis 1. Fever and back pain? 2. Neurologic dysfunction and back pain? 3. Backpain but no neurologic dysfunction.
- Epidural abscess. 2. Spondylethiesis (forward slippage of the vertebrae a developmental disorder). 3. Ankylosing spondylitis occurs in adolescent males or spondylosis.
