Paediatrics: normal growth and development

Question 1

Evolution of legs at various ages

Answer 1

Newborn: genu varum
1.5-2 years: straight (feet slightly out)
2 years-3.5: genu valgum
7 years: straightens out

Question 2

endochondral ossification

Answer 2

process in which an initial small hyaline cartilage grows and turns into bone: ossifies. when the growth plate ossifies bone growth ceases.

Question 3

What is at each end of the bone

Answer 3

Epiphysis
epiphyseal growth plate
metaphysis
diaphysis(shaft)

Question 4

where does circumferential growth take place

Answer 4

periosteum ( membrane that covers bone) via appositional growth where the bone thickens

Question 5

Where do the stages on bone growth occur?

Answer 5

Primary: shaft
Secondary: epiphyses
continued growth at epiphyseal growth plate

Question 6

factors affecting the growth phase

Answer 6

Diet
Vitamin D
hormones
Illness/injury

Question 7

When can a baby:

1) sit alone/crawl
2) stand
3) walk
4) jump
5) manage stairs alone

Answer 7

1) 6-9 months
2) 8-12 months
3) 14-17 months
4) 24 months
5) 3 years

Question 8

when can a baby:

1) loss of primitive reflexes
2) control head
3) speak a few words
4) feed self and use spoon
5) stacks 4 blocks and can understand 200 words
6) potty trained

Answer 8

1) 1-6 months
2) 2 months
3) 9-12months
4) 14 months
5) 18 months
6) 3 years

Question 9

Varum vs Valgum

Answer 9

Varum: bow legged
Valgum: knock knees

Question 10

When is Genu varum normal

Answer 10

Under 2

Question 11

What presentation may suggest abnormal genu varum

Answer 11

> 2
unilateral
severe
painful

Question 12

Causes of pathological Genu varum

Answer 12

skeletal dysplasia: generic disorder
Rickets: Vit D deficiency 
tumour: enchondroma 
blounts disease
trauma

Question 13

Blounts disease

Answer 13

Growth arrest of medial tibial physis (growth plate)

Question 14

When is genu valgum normal

Answer 14

3.5 years

Question 15

causes of genu valgum

Answer 15

tumours, rickets, neurofibromatosis, idiopathic

Question 16

when is surgery indicated in genu valgum

Answer 16

If the intermalleolar distance >8cm at age 11

Question 17

What classification of deformity are genu valgum/genu varum

Answer 17

Angular deformity

Question 18

What classification of deformity is intoeing?

Answer 18

rotational deformity

Question 19

what can cause intoeing ?

Answer 19

1) Femoral neck anteversion
2) internal tibial torsion
3) Metatarsus adductusn

Question 20

Normal anteversion of femoral head in comparison to the femoral condyles

Answer 20

at birth: 30-40 degrees

adult: 15 degrees

Question 21

symptoms of femoral neck anteversion

Answer 21

intoeing gait
children sit in W position
awkward running
increased internal rotation of hip and decreased external rotation

Question 22

what is Internal tibial torsion

Answer 22

internal rotation of the tibia

Question 23

when does internal tibial torsion present

Answer 23

1-3 year olds but usually resolves by 6

Question 24

management of internal tibial torsion

Answer 24

most resolve by age 6
bracing and orthotics ineffective
surgery very very rarely for severe severe cases

Question 25

Metatarsus Adductus

Answer 25

common benign

Question 26

flat feet physiology

Answer 26

all born with flat feet but we develop medial arch once walking as the tibialis posterior strengthens

Question 27

how do you asses hypermobility

Answer 27

Beighton score

Question 28

differences types flat feet

Answer 28

Flexible: generalised ligamentous laxity or tightness of gastrocsoleus complex
fixed: may suggest bone fusion, if sore can operate

Question 29

curly toes: age, common toes affected and management

Answer 29

common in toddlers but vast majority resolve by 6, mostly 3rd/4th toes, splinting/taping is ineffective, v rarely if persists can operate

Question 30

anterior knee pain presentation

Answer 30

females>knees
localised patellar tenderness
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