Paeds

Question 1

Clinical findings of congenital muscular torticollis?

Answer 1

Plagiocephaly
Facial asymmetry
Decreased neck movement

Question 2

Etiology of congenital muscular torticollis?

Answer 2

Birth trauma
Vascular
Compartment syndrome

Question 3

Causes of painful limp?

Answer 3

Infection
Inflammation
Osteochondrosis
Trauma
Tumour

Question 4

Infection in painful limp?

Answer 4

Hip & Knee - Septic arthritis
LL - osteomyelitis

Question 5

Inflammation in painful limp?

Answer 5

Hip = TSH, JRA
Knee, Ankle, Foot = JRA

Question 6

Transient synovitis of hip?

Answer 6

4-8 yo
Hx of URI in past 2 weeks
Looks well
No fever

Question 7

Differentials of TSH?

Answer 7

Inflammatory arthritis
Perthes Disease
Septic arthritis

Question 8

Manifestation of Perthes?

Answer 8

4-10yo, mostly boys
Short for age
Bone age 2-3 years behind chronological age

Question 9

EArly complications of Supracondylar frac?

Answer 9

MN damage [AIN]
Artery [Brachial] - compt syndrome, Volkmann’s
UN damage

Question 10

Late complications of supracondylar frac?

Answer 10

Non-union
Malunion -> CUBITUS VARUS
Stiffness

Question 11

Gartland classification for supracondylar frac?

Answer 11

1 = undisplaced
2 = displaced in 1 plane
3 = Displaced in 2/3 planes
4 = complete periosteal disruption with instability in flexion and extension

Treat with cast for Type 1
CRPP most common for 2/3/4

Question 12

What is Iselin’s disease?

Answer 12

Caused by traction apophysitis of the the peroneus brevis tendon at the tuberosity of the fifth metatarsal in children and presents with lateral foot pain.

Question 13

What is Osgood Schlatter’s disease?

Answer 13

osteochondrosis or traction apophysitis of the tibial tubercle, commonly presenting as anterior knee pain

Just manage with NSAIDs + activity modification

Question 14

How to diagnose Osgood Schlatter’s

Answer 14

Clinical diagnosis with **enlarged tibial tubercle **
XR shows irregularity and fragmentation of the tibial tubercle

Question 15

How to diagnose Iselin’s disease?

Answer 15

Clinical diagnosis with pain over 5th MT base.
XR shows enlarged apophysis with disordered ossification and widened chondro-osseous junction.

Question 16

When to confirm diagnosis of DDH?

Answer 16

With **US in first 4 months, **
Radiographs 4-6 months after femoral head ossification occurs

Question 17

Treatment options for DDH?

Answer 17

Pavlik bracing
Surgical reduction, osteotomy etc.

Question 18

In which hip is DDH more common?

Answer 18

In left hip [60%]. Due to more common intrauterine position being occiput anterior

Bilateral in 20%.

Question 19

DDH is a spectrum that includes ____

5 things

Answer 19

Dysplasia
Subluxation
Dislocation
Teratologic hip
Late (adolescent) dysplasia

Question 20

What conditions is DDH a/w?

Answer 20

Congenital muscular torticollis 20%
Metatarsus adductus 10%
Congenital knee dislocation

Question 21

Classification of DDH?

Answer 21

Subluxable = Barlow-suggestive
Dislocatable = Barlow-positive
Dislocated = Ortolani positive early if reducible

Ortolani-negative late when irreducible dislocation

Question 22

PE confirmation for DDH?

Answer 22

Barlow = dislocates a dislocatable hip by adduction and depression of flexed femur
Ortolani = reduces dislocated hip by elevation + abduction of flexed femur

Barlow = “Click of exit”
Ortolani = “click of entry”

Barlow-Ortolani rarely positive after 3 months

Question 23

What PE to do from 3 months - 1 year for DDH?

Answer 23

Limitations in hip abduction.
Occurs as laxity resolves and stiffness begins to occur.
LLD predominates

Question 24

**Salter-Harris **classification to grade fractures in kids that involve physial plate?

Answer 24

Separated GP
Above GP
Below GP
Through GP
ERasure of GP

GP = Growth plate

Question 25

Common age for Transient Synovitis of Hip?

Answer 25

4-8 years **MUST be differentiated from septic arthritis of hip** | M:F ratio 2:1

Question 26

RF for transient synovitis?

Answer 26

**URTI Hx in last 2 weeks ** Bacterial infection Trauma Allergy

Question 27

What is natural position of hip in Transient Synovitis?

Answer 27

Flexion, abduction, external rotation | Lowest intracapsular pressure

Question 28

Presentation of Transient Synovitis of hip?

Answer 28

**Groin/Hip pain**. **Limp (main)** No fever | MUST be differentiated from septic arthritis

Question 29

Mx for Transient Synovitis of hip?

Answer 29

Just rest. NSAIDs if want meds | If symptoms improve with NSAIDs, then likely TS

Question 30

How to differentiate btw TS and septic arthritis?

Answer 30

CRP<20mg/l in TS. Most impt factor TRO Septic arthritis. Invasive studies of synovial fluid aspiration can also be done

Question 31

What is Perthes disease? | Coxa Plana

Answer 31

Idiopathic AVN of proximal femoral epiphysis in children | Can cause Trendelenberg gait ## Footnote Usually unilateral. If bilateral, think skeletal dysplasia instead

Question 32

Mx of Perthes' Disease?

Answer 32

Observation/symptomatic if <8yo Femoral and/or pelvic osteotomy >8yo | Symptomatic can mean like simply restoring ROM or analgesia

Question 33

What is teratologic dislocation of hip?

Answer 33

Congenital dislocation which is irreducible by gentle manipulation at birth

Question 34

What is Slipped capital femoral epiphysis

Answer 34

Slippage of metaphysis relative to epiphysis. Common in **adolescent obese** males | More common in left hip. But can be bilateral too

Question 35

Mx for Slipped capital femoral epiphysis?

Answer 35

Usu percutaneous pin fixation. Contraleteral pinning for high risk patients.

Question 36

Secondary causes or RFs for SCFE?

Answer 36

**Fat, pubertal boys** Endocrine causes -> hypoT, hypoGonadism etc. They weaken physis + overgrowth ## Footnote Bilateral SCFE points towards endocrine

Question 37

Presentation of SCFE?

Answer 37

**Knee pain** + painful limp + Hip/groin pain Can have referred pain to ant thigh or knee

Question 38

What is Osteochondritis Dissecans

Answer 38

Separation of small osteocartilaginous fragment from femoral condyle articular surface, usu a/w hx of trauma ## Footnote Poorly localized knee pain. Activity related.

Question 39

When does osteochondritis dissecans occur?

Answer 39

10-15 yo when physis still open. Adult form exists too.

Question 40

Physiological evolution of leg alignment?

Answer 40

-18 months = Genu varus (tibial intorsion) 1.5yo - 2 yo = Neutral 2 - 6yo = Genu valgum (Ligamentous laxity) 7 yo = Normal valgus angle (<12˚)

Question 41

What is Chondromalacia Patellae?

Answer 41

Idiopathic articular changes to patella causing anterior knee pain | Mostly adolesents and young adults

Question 42

PE of chondromalacia patellae?

Answer 42

Quadriceps atrophy Patella maltracking Palpable crepitus Pain with patellar compression Limited knee ROM

Question 43

XR findings of Chondromalacia patellae?

Answer 43

May see chondrosis on XR Shallow sulcus, patella alta/baja, lateral patella tilt

Question 44

What is Kohler's disease?

Answer 44

Avascular necrosis of navicular bone. Pain on dorsal and medial surface of foot

Question 45

Postural vs Structural scoliosis?

Answer 45

Secondary tilt to compensate for extra-spinal conditions vs Fixed primary tilt a/w abnormal bone & vertebral rotation

Question 46

Mx of frac or dislocation in kids?

Answer 46

If frac close to growth plate, remodelling potential is great and not much is needed. Child under 10 = remodelling even with 100% displacement Pre-pubertal = Under 20deg angulation is acceptable