Paed - pathology

Question 1

talipes =

Answer 1

foot twisted

Question 2

talipes equinus =

Answer 2

foot twisted in plantar flexion

Question 3

talipes calcaneus =

Answer 3

foot twisted in dorsiflexion

Question 4

foot twisted towards midline =

Answer 4

talipes varus

Question 5

foot twisted away from midline

Answer 5

talipes valgus

Question 6

physiological talipes aka

it is fully __

Answer 6

positional talipes

correctable

Question 7

equinovarus =

Answer 7

clubfoot

Question 8

Rx of equinovarus

Answer 8

ponseti cast (divide Achilles tendon) for 3 months boots and bar > boot at night for yrs

Question 9

calcaneovalgus =

if uncorrectable may be due to

Answer 9

rockerbottom foot

congenital vertical talus

Question 10

irreducible hip at birth is ___ not ___

Answer 10

teratogenic (not DDH)

Question 11

irreducible hip at birth can be due to __/__

Answer 11

arthrogryposis (fixed contractures of joints ass with neuro deficit)
spina bifida

Question 12

meningocele contains

Answer 12

CSF

Question 13

form of spina bifida that is found in 10% of normal pop and of no clinical relevance

Answer 13

occulta

Question 14

myelomeningocele contains

Answer 14

CSF and nerve roots

Question 15

if myelomeningocele in spina bifida is above L1/2 =

Answer 15

in a wheelchair

Question 16

if myelomeningocele in spina bifida is T12 and above =

Answer 16

numb from waist down , no hip movement

Question 17

if myelomeningocele in spina bifida is L1 =

Answer 17

numb below waist and limited hip movement

Question 18

if myelomeningocele in spina bifida is L2-3

Answer 18

numb from lower hip and weak hip muscles

Question 19

if myelomeningocele in spina bifida is L4

Answer 19

numb below knee and weak leg muscles

Question 20

if myelomeningocele in spina bifida is L5-S1

Answer 20

numb in buttock and feet

abnormal feet position

Question 21

if myelomeningocele in spina bifida is S2-4

Answer 21

can walk without aids, need shoe inserts
numb buttocks
skin sensation may be affected

Question 22

painful limb aka

minimise __ phase

Answer 22

antalgic gait

stance

Question 23

lurch to one side to get foot clearance as abductors don’t lift pelvis =

Answer 23

trendelenberg gait

Question 24

causes of trendelenberg gait

Answer 24

weak abductors (polio, muscular dystrophies, Hip Sx, motor neuron)
defective fulcrum (congenital/pathological dislocation of hip)
defective lever (Perthes, coxa vara)

Question 25

assess a tight Achilles with ___ test =

Answer 25

Silverskold test | flex knee and relax gastroc = can get more dorsiflexion in this position

Question 26

neurological gait (spasticity) can be caused by

Answer 26

spina bifida, cerebral palsy, spinal cord/CNS pathology | muscular dystrophy

Question 27

loss of motor development, maintenance of primitive reflexes, selective motor control loss, weakness, balance mechanism injury and abnormal tone are all primary features of ___ may => _+_+_

Answer 27

Cerebral palsy | deformity, contractures and dislocations

Question 28

prenatal causes of Cerebral palsy

Answer 28

prem + low birth wt due to congenital brain malformation | intrauterine infection - TXMS, CMV

Question 29

perinatal causes of cerebra palsy

Answer 29

birth trauma/asphyxia | kernicterus - choreoathetosis

Question 30

postnatal causes of cerebral palsy

Answer 30

meningitis NAI cerebral haemorrhage

Question 31

CP with a flexed knee and upper limb + tip toe walk =

Answer 31

hemiplegia/unilateral

Question 32

CP with predom lower limb, femoral anteversion => intoe. Often hip and knee flexion contracture =

Answer 32

diplegia

Question 33

5 different neurological classes of CP

Answer 33

``` spastic athetoid dystonic rigid mixed ```

Question 34

scale used to assess severity of CP

Answer 34

GMFCS levels 1-5

Question 35

orthopaedic problems seen in non-walking cerebral palsy ptnts

Answer 35

hip dislocation pelvic obliquity spinal deformity perineal hygiene issues

Question 36

if in Thomas test lumbar lordosis is not obliterated =

Answer 36

hip flexion contracture

Question 37

orthopaedic problems seen in CP

Answer 37

``` psoas and adductors (contractures) hamstrings gastrocsoleus hip dislocation pelvic obliquity spinal deformity ```

Question 38

management of CP =

Answer 38

Sx for contractures benzodiazepines and baclofen selective dorsal rhizotomy botox IM

Question 39

Hip problem common in pre/peri walker (0-18m)

Answer 39

Congenital dislocation of the hip

Question 40

hip problem common in 2-5yo

Answer 40

transient synovitis

Question 41

hip problem common in 5-10yo

Answer 41

Perthes

Question 42

hip problem common in 11-15yo

Answer 42

SUFE

Question 43

DDH aka | risks =

Answer 43

developmental dysplasia of the hip breech birth FH more likely in F and 1st born

Question 44

instability tests for DDH = | unreliable after ___ old

Answer 44

Barlow Ortolani Gariatri 6wks

Question 45

instability test for DDH where you can dislocate/sublux the hip by flexion adduction

Answer 45

Barlow

Question 46

instability test for DDH where if you try to relocate dislocated hip by abduction you can feel a clunk at ring finger on the trochanter

Answer 46

Ortolani

Question 47

instability test for DDH where if you lie them on their back with hip 90 degrees flexed there is asymmetry

Answer 47

Gariatri

Question 48

imaging for DDH indication = time to do it =

Answer 48

>3-6m = xray <3m = US - lateral (spoon and teacup) if FH/breech in first4-6wk preferably

Question 49

treatment of DDH diagnosed early

Answer 49

relocate, splint in Pavlik harness (95% success) and monitor acetabular development

Question 50

Rx for DDH >3m >9m >2yo

Answer 50

``` 3 = closed reduction 9 = open reduction 2 = femoral / pelvic osteotomy, preop gallows traction > plaster spica for 3 months - never get a normal hip ```

Question 51

idiopathic AVN of capital epiphysis of femur

Answer 51

Perthes

Question 52

Perthes: age: M:F usually __+__ present with __/__

Answer 52

4-8yo M4:1F - small active limp/pain

Question 53

Rx Perthes :

Answer 53

contain femur in acetabulum | rest brace and Sx to maintain hip abduction

Question 54

``` SUFE aka age M:F black:white 25-60% are ___ 10-15% complain of only ___ ```

Answer 54

``` slipped upper femoral epiphysis 10-16yo M2:1F black 2 : 1 white bilateral knee/distal thigh pain ```

Question 55

Ix for SUFE

Answer 55

xray - AP (trethowans sign - line from femoral neck doesnt go through epiphysis) and lateral (imperative) whole leg sticks out

Question 56

less than __ duration makes SUFE acute (any longer = chronic)

Answer 56

<3months

Question 57

3 characteristics used to classify SUFE

Answer 57

acute/chronic magnitude of slip - mild, mod, severe stability of slip - wt bear w/wo aids?

Question 58

adolescent with hip/groin, thigh or knee pain = __ until disproven = immediate ___

Answer 58

SUFE | xray