Pediatric MSK Flashcards
(124 cards)
1
Q
Name the histological zone closest to the metaphysis within the growth plate/physis
A
zone of provisional calcification
2
Q
What cells make up the zone of provisional calcification?
A
chondrocytes underrgo apoptosis to make matrix for calcification
3
Q
Describe Salter Harris classification
A
Physeal fractures; SALTR, SMETC I. physis II. physis, metaphysis III: epiphysis, physis IV: metaphysis, epiphysis V: physis crushed
4
Q
Example of type 1 SH injury
A
SCFE, gymnast’ wrist
5
Q
Example of type 2 SH injury
A
nondisplaced fracture of the base of the phalynx
6
Q
Example of type 3 SH injury
A
juvenile tillaux fracture; distal tibial epiphyseal fracture
7
Q
Example of type 4 SH injury
A
triplane fracture
8
Q
Example of type 5 SH injury
A
physis crushed
9
Q
Name ossification centers of elbow and age
A
CRITOE
Capitellum, radial head, internal/medial epicondyle, trochlear, olecranon, external/lateral epidcondyle
10
Q
Pitfall with 3 yr old elbows
A
make sure trochlear and internal/medial epicondyle are not confused for avulsion fracture
11
Q
pediatric elbow effusion – think?
A
pathognomic for fracture; rx xr in 7-14 days
12
Q
Elbow alignment lines and associated abnormality?
A
anterior humeral line (supracondylar fracture); radiocapitellar line (elbow dislocation)
13
Q
most common pediatric fx
A
supracondylar fx, 2nd is lateral condyle fx
14
Q
most common adult fracture
A
radial head
15
Q
what is a toddler’s fx
A
nondisplaced spiral fx through tibial metadiaphysis; rotational; faint sclerotic line
16
Q
radial buckle fx
A
focal cortical irregularity
17
Q
what is an apophysis?
A
growth plate that does not contriute to logitudinal growth
18
Q
name the 5 pelvic apophysis
A
iliac crest ASIS AIIS ischial tuberosity pubic rami
19
Q
name muscular attachments to pelvic apophysis
A
iliac crest: abdominal muscles ASIS: sartorious AIIS: rectus femoris ischial tuberosity: hamstrings pubic ramus: adductors, gracilis
20
Q
when do apophyses fuse?
A
arise in puberty, fuse by 3rd decade
21
Q
what SH injury are apophyseal avulsion injuries?
A
type 1
22
Q
name 2 femoral apophyses
A
greater trochanter, lesser trochanter
23
Q
name muscular attacments to femoral apophyses
A
greater trochanter: gluteus medius/minimus
lesser trochnater: iliopsoas (suspicious for pathologic fx in adult)
24
Q
bone scintigraphy has high sensitivity for what type of fx? low sensitivity for what type of fx?
A
posterior rib, low sensitivity for skull fx
25
specific fx for child abuse
metaphyseal corner fx, posterior rib fx, scapula, sternum fx, spinous process fx
26
suspicious fx for child abuse
polyfracture, fracture out of proportion to history, digital fracture, long bone fx in nonambulatory child, complex skull fx
27
nonspecific fx concerning for child abuse
long one fx in ambulatory child, linear skull fx
28
NM study for child abuse
Tc99 MDP, HMDP, DPD
Several 99mTc-labelled radiopharmaceuticals are available
for bone scintigraphy:
Medronate (methylene diphosphonate, MDP)
Oxidronate (hydroxymethylene diphosphonate, HMDP
or HDP)
Diphosphonopropanedicarboxylic acid (DPD)
29
Define these terms: rhizomelia, mesomelia, acromelia, micromelia, amelia
proximal limb shortening, middle limb shortening, distal limb shortening, entire limb shortening, limb absent
30
most common cause of dwarfism
achondroplasia
31
key XR findings in achondroplasia
frontal bossing of skull, narrowing of interpeduncular distance in the lower spine, posterior scalloping of vertebral bodies, tombstone iliac wings, flat acetabula, short femoral neck
32
Most common lethal skeletal dysplasia
thanotorphoric dysplasia
33
inheritance of thanotorphoric dysplasia
AD
34
Key findings in thanotorphoric dysplasia
platyspondyly, flattening of veretebral bodies (H shaped); curved telephone receiver femurs
35
Cause for osteogenesis imperfecta
abnormal type I collagen
36
Key indings in OI
multiple rib, vertebral body, long bone fx (accordian ribs), ; bowed long bones, osteopenia, wormian bones in skull
37
What is Jeune syndrome
asphyxiating thoracic dystrophy; small thorax causing respiratory distress; AR
38
XR findings of asphyxiating thoracic dystrophy
short ribs (bulbous anteriorly), high riding handlebar clavicle, trident acetabulum
39
What is cleidocranial dysostosis?
abnormalities with clavicles; short or partial absent; also associated with wormian bones
40
Wormian bones associated with?
OI, hypothyroidism, healing rickets, cleidocranial dysostosis, Down syndrome
41
Key XR findings in cleidocranial dysostosis
wormian bones, delayed ossification of skull, widened pubic symphsyis (seen later), clavicular anomalies, supernumary eeth
42
What skeletal dysplasia and metabolic bone disease cause stippling of epiphyses?
chondrodysplasia punctata, multiple epiphyseal dysplasia, hypothyroidism, complications of maternal warfin use
43
What is chondrodysplasia puncata?
rhizomelic, short limbed dwarfism
44
What is multiple epiphyseal dypslasia
Fairbank disease; mildly short limbed AD skeletal dysplasia that manifests in late childhood/adolescense
45
What is enchondromatoses?
syndromes; multiple intra-osseous benign cartilaginous tumors in an asymmetric distribution
46
Types of enchondromatoses
Maffuci ; Ollier
47
Maffuci syndrome
enchondromatosis with venous malformations/hemangioma, lots of phleboliths
48
Ollier syndrome
mostly enchondromatosis with associated limb shortening
49
enchondromatoses can have malignant transformation into?
chondrosarcoma; maffucci > ollier
50
Multiple hereditary exostoses inheritance pattern? distribution?
AD; symmetric, long bone metaphyses
51
Multiple benign osteochondromas syndrome?
MHE, osteochondromatosis; usually long bones metaphyses
52
malignant degeneration of osteochondromas?
chondrosarcoma
53
What are mucoplysaccharidoses?
lysosomal storage disorders -- hurlers, morquio, hunters
54
XR findings of mucopolysaccharidoses
anterior vertebral beaking, thick ribs, undertubulated bones, Madelung deformity of wrists, J shaped sella/thickened calarium, hypoplastic dens
55
Hurlers XR findings
anterior beaking of vertebral bodies, mostly inferiorly
56
Morquio XR findings
anterior beaking of middle potion of vertebral body, spinal stenosis, atlantoaxial instability
57
Ddx for child with a limp
trauma, septic arthritis, fracture, avascular necrosis, lymphoma
58
Ddx for septic arthritis
aseptic toxic synovitis, hemarthrosis in trauma, hemophilia
59
Most common cause of septic arthritis?
S aureus
60
XR findings for hip effusion
displacement of gluteal/psoas fat planes
| widening of teardrop distance
61
What muscles insert on greater trochanter? lesser trochanter?
gluteus medius/minimus; psoas
62
best modality of choice to evaluate for hip effusion?
ultrasound
63
What type of SH is SCFE?
Salter Harris 1
64
What is SCFE?
fracture of the proximal femoral epiphysis in obese preadolescents 10-16yo
65
XR findings of SCFE
asymmetric widening of proximal femoral growth plate, lack of intersection of Klein's line
66
What is the Klein's line?
line along lateral margin of femoral neck
67
Bests view to evaluate physeal widening/displacement for SCFE?
frog leg lateral projection
68
Is SCFE bilateral or asymmetric usually?
asymmetric, but evaluate both sides still
69
Age of presentation for LCP?
4-8yo
70
What is LCP?
avascular necrosis of the capital femoral epiphysis ossification center
71
XR and NM findings of LCP?
XR: subtle sclerosis --> osteonecrosis and distortion of femoral head
NM: Tc99 MDP; decreased uptake and then increased uptake with attempted repair
72
Most common pediatric bone tumor? most common site?
osteosarcoma, most common intramedullary type and mostly by the knee (distal femur/proximal tibia)
73
XR of osteosarcoma
destructive lesion invading cortex; extensive osteoid matrix
74
second most common primary pediatric bone tumor
ewing sarcoma
75
cell type for ewing
aggressive small round blue cell tumor; neuroectodermal differentiation
76
Common locations for Ewing
femoral diaphysis, flat bones of pelvis, tibia, humerus, ribs
77
common met site of Ewing
lung
78
XR appearance of Ewing
permeative lesion within the medullary; wide zone of transition; aggressive lammelated/onion skin or spiculated periosteal reaction ; may also have soft tissue mass component
79
What is langerhans cell histiocytosis?
abnormal proliferation of LCH (dendritic cells/histiocytes) that live in the epidermis/lymph nodes; Birbeck bodies on electron microscopy
80
Presentation for LCH
age 5-15; pain/tenderness/fever; similar to osteomyelitis
81
most common variant of LCH
eosinophilic granuloma
82
XR findings of LCH
```
skull: beveled edge lytic lesion
flat bones: hole in a hole lytic lesion
long bones: diaphysis commonly, permeative destruction with lysis and faint rim of sclerosis
spine: vertebra plana
maxilla: floating tooth
```
83
Ddx for lytic lesions in undre 30 yos
LCH, infection, eosinophilic granuloma
84
Common site for osteomyelitis in bones
metaphysis marrow; transphyseal vessels in infants supply the epiphysis; transphyseal infection in older children rare
85
Common organisms for osteomyelitis
S aureus, Salmonella in sickle cell
86
XR, NM, MR findings of osteomyelitis
XR: irregular lucencies/periosteal reaction
NM: Tc 99m MDP scan with increased uptake on all 3 phases (angio, bone, blood pool phases)
MR: increased T2 weighted sequences, marrow edema
87
Disciitis in kids vs adults
infections begins in disk in kids, spread through disk in adults; blood vessels feed intervertebral discs directly in kids
88
Presentation for disciitis
young child <4 with preceding URI, new onset back pain/refusal to sit
89
Cmmon location for discitis
lumbar spine (young children), thoracic spine (preteen)
90
XR , MR findings of discitis
XR: disc space narrowing and vertebral end plate irregularity
MR: narrowing of disc space, bone marrow edema
91
What is CRMO
chronic recurrent multifocal osteomyelitis; nonpyogenic inflammatory disorder that mimics osteomyelitis
92
Key imaging findings of CRMO
lytic/sclerotic lesions migratory separateed by time and space; no soft tissue abscess, bony sequestra, fistula
93
Associations with CRMO
SAPHO: synovitis, acne, pustulosis, hyperostosis, osteoitis
94
XR finding with luekemia
metaphyseal lucent band; osteopenia, permeative lytic lesions
95
Causes of metaphyseal lucent band
leukemia, severe illness, scurvy, TORCH infections, lymphoma
96
XR rickets findngs
fraying/cupping of metaphyses, rachitic rosary, bowing legs, osteopenia, fractures
97
What is oncogenic rickets
associated with hemangiopericytoma, NOF due to tumor metabolits that derange vitamin D metabolism
98
Organism for sphilis
spirochete Treponema pallidum; can cross placenta
99
What is the Wimberger sign
destructive erosion of medial aspect of proximal tibial metaphysis (different from scurvy Wimberger ring sign)
100
XR findings of syphilis in peds
symmetric periosteal reaction, Wimberger sign
101
Most common arthropathy in kids
JIA: 6+ weeks in pt under 16; RF negative
102
XR findings
early: synotitis like; joint effusion, soft tissue swelling, osteopenia
later: periostitis, erosions
chronic: joint ankylosis (wrist, CMC, cervical sign)
103
XR findings of Klippel Feil syndrome
segmentation anomalies
104
What is still dx
subtype of JIA affecting kids <5yo; fever, anemia, leukocytosis, hepatosplenomegaly, polyarthritis
105
DDH first US performed?
4-6w due to normal neonatal ligamentous laxity after birth (perinatal maternal hormones)
106
How to measure DDH on US
coronal US
| alpha angle: bony ileum/acetabular roof; normal >60 degrees and covers 50% of cartilagenous femoral head
107
DDH XR performed?
6 mo when femoral head ossification centers appear
108
Describe Hilgrenreiner line and Perkins line
Hilgrereiner: horizontal line through triradiate cartilage
| Perkins line: perpendicular through lateral acetabulm perpendicular to Hilgrenreiner line
109
Kids who get DDH
breech births
110
Blount disease XR findings
oxteochondrosis of tibial metaphysis; usually males <6 unilateral
XR: tibia varus/bowing, internal rotation --> limb length discrepancy/gait deviations
111
Madelung deformity
medial sloping of distal radius; dysplasia of medial distal radial diaphysis
112
Panner disease
osteochondrosis of capitellum
113
Little league elbow
osteochondrosis of medial epicondyle
114
Scheurmann kyphosis
AVN of thoracic vertebral bodies; compression fx
115
LCG
osteochondrosis of capital femoral epiphysis
116
Kienbock dx
osteochondrosis of carpal lunate
117
Osgood Sclater
osteochondrosis of tibial tuberosity
118
Freiberg infarction
osteochondrosis of 2nd metatarsal head
119
Kohler dx
self limited osteochondrosis of navicular bone
120
Sever disease
calcaneal apophysitis; heel pain
121
What is torticollis?
fibromatosis coli/idiopathic SCM enlargmenet; can't straighten neck
122
Tarsal coalition
abnormal fusion of tarsus bones -- osseous, cartilaginous, fibrous
Talocalcaneal/calcaneonavicular
123
Carpal coalition
joining of carpal bones; most common lunotriquetral then capitohamate
124
Types of periosteal rx in peds
physiologic periosteal rx in newborn, prostaglandid therapy, infectious, syphilis, neoplastic, trauma, metabolic (rickets/scurvy, hypervit A), syndromic (Caffey disease)
