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Basic Science > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Brachial plexus palsy typically manifests as what?

A

Internal shoulder rotation (results in glenoid hypoplasia), flexion of elbow and wrist

90% of cases will resolve without intervention

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2
Q

What carries a poor prognosis in brachial plexus injury?

A

No biceps function at 6 months

Horner syndrome

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3
Q

What innervates the teres major?

A

Lower scapular nerve (C5-C7)

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4
Q

What innervates the latissimus muscle?

A

Thoracodorsal nerve (C6-C8)

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5
Q

What is the name for undescended scapula?

A

Sprengel deformity

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6
Q

What is the name for unilateral chest wall hypoplasia?

A

Poland syndrome (Can have hypoplasia of the hand and forearm, hand deformities)

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7
Q

What are the three possible causes of pediatric in-toeing?

A
  1. Metatarsus adductus
  2. Internal tibial torsion
  3. Femoral anteversion
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8
Q

What exam finding favors tibial torsion?

A

Thigh foot angle <-10 degrees (normal is 0-20)

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9
Q

How much does each area contribute to growth per year?

A

Distal femur 9 mm
Proximal tibia 6 mm
Proximal femur 3 mm

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10
Q

How do I treat a LLD of 2 cm?

A

Shoe lifts if at maturity

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11
Q

What are the risk factors for DDH?

A

Breech, positive family history, female, firstborn

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12
Q

When can I use ultrasound for DDH?

A

Up until 4-6 months

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13
Q

What is the normal alpha angle on hip ultrasound for infants?

A

60 degrees

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14
Q

What is the normal acetabular index on xrays?

A

Less than 25 degrees

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15
Q

AIN innervates what three muscles?

A

FPL
PQ
Radial half of the FDP

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16
Q

What nerve is commonly injured with flexion type SCH?

A

Ulnar nerve

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17
Q

How old should I consider an open reduction for dislocated hips?

A

18 months to 3 years

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18
Q

How old shoulder I consider an osteotomy for dislocated hips?

A

3 to 8 years

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19
Q

For dislocated hips, what osteotomy is available for growth plates are closed?

A

Ganz and Chiari procedures

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20
Q

Excessive flexion in a pavlik harness can cause what palsy?

A

Femoral nerve palsy

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21
Q

How long should I give a pavlik harness to reduce a hip?

A

3 weeks tops

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22
Q

What are the treatments for the following Coxa Vara:
1. Hilgenreiner epiphseal angle <45 deg
2. HE 45-60 deg
3. HE>60

A
  1. Will resolve
  2. close observation
  3. Surgery (subtroch valgus osteotomy)
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23
Q

When do I consider surgery for Perthes disease?

A

Skeletal maturity (over the age of 8) with lateral pillar groups (B or B/C)

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24
Q

When should I consider an endocrine work up for SCFE?

A

Patient less than 10 years old

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25
Q

Whats included in Kochers criteria?

A

T>101.3
Elevated ESR
Refusal to bear weight
WBC > 12

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26
Q

What joints do not have intraarticular metaphysis?

A

Hip, Knee, Ankle, Elbow

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27
Q

When can I treat osteomyelitis with only atbx?

A

If there is no subperiosteal abscess or abscess within the bone

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28
Q

genu varum in children turns into genu valgum by what age?

A

2.5 years

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29
Q

When is surgery indicated for infantile blounts disease? (0-4 years)

A

Patient over 3 years at stage II or stage III (Langenshlold classification)

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30
Q

Up to what degree of valgum is common in children 2-6 years of age?

A

15 degrees (maxium valgus is at 3-4 years)

31
Q

What is the most common cause of bilateral genu valgum thats pathologic?

A

Renal osteodystrophy

32
Q

What type of tibia bowing is likely phsiologic?

A

Posteromedial tibial bowing

33
Q

What is the most common type of long bone deficency?

A

Fibular hemimelia
(linked to SHH)

34
Q

Neurofibromatosis causes what type of tibial bowing?

A

Anterolateral

35
Q

Kingaella septic arthritis often has negative cultures, what test can be helpful in its diagnosis?

A

PCR

36
Q

Where is OCD most commonly found?

A

Posterolateral portion of the medial femoral condyle

37
Q

Congenital dislocation of the knee is associated with what other conditions?

A

DDH
Clubfoot
Metatarsus adductus

38
Q

When should I operate for congenital dislocation of the knee?

A

If there is less than 30 degrees of knee flexion after 3 months of casting

39
Q

What makes up clubfoot?

A

CAVE
Cavus
Adduction of forefoot
Varus of hindfoot
Equinus

40
Q

Clubfoot is associated with what vascular anomly?

A

Diminished or absent anterior tibial artery

41
Q

PITX1-TBX4 is associated with what condition?

A

Club foot

42
Q

What is the first casting method for clubfoot?

A

Go after the Cavus
Supinate forefoot and dorsiflex the first ray

No impairment in athletic ability after treatment

43
Q

What is a common deformity after clubfoot treatment?

A

Dynamic supination (15-20%)

44
Q

The heel bisector shoulder be between what toes?

A

2nd and 3rd (useful to evaluate for metatarsus adductus)

45
Q

What protein is affected in Charcot-Marie-Tooth?

A

PMP-22 (helps with myelination)

-Think cavus feet

46
Q

What muscles overpower what muscles in CMT?

A

Peroneus longus and the posterior tibialis overpower the peroneus brevis and tibialis anterior

47
Q

How is the forefoot in vertical talus?

A

Abducted and dorsiflexed

48
Q

When should I perform a subtalar arthrodesis for talocalcaneal coalition?

A

If more than 50% of the facet is involved

49
Q

calcaneovalgus foot is associated with what tibia abnormality?

A

Posteromedial bowing of the tibia

50
Q

If you see bilateral perthes, what must you do first?

A

Rule out MED, bone survey to examine other physes

51
Q

On Adams forward bending test, what degrees is associated with a 20 degree coronal curve?

A

7 degrees

52
Q

When to get MRI for scoliosis?

A

Left sided curve
Rapidly progressing
Apical kyphosis
Onset before 10
Neurologic signs or symptoms
Congenital abnormalities (e.g. cavus feet)

53
Q

What determines rate of progression in infantile idiopathic scoliosis?

A

Medial rib relative to the apical vertebra (RVAD), more than 20 degrees high risk for progression (80%)

Rib overlap is also a high risk for progression

54
Q

When is surgery for scoliosis indicated for ducheene muscular dystrophy?q

A

Curve more than 25-30 degrees or progressive with FVC >40%

55
Q

What is the chromosome in NF-1?

A

17
Autosomal dominant
(Protein is a tumor suppressor that inhibits ras activity via stimulating GTPase)

56
Q

What else is seen with Klippel Fiel syndrome?

A

Sprengel deformity
Auditory issues
Heart issues
Renal disease

57
Q

When should I do a fusion in a patient with atlantoaxial instability?

A

Neurologic symptoms or ADI>10 mm

58
Q

When does halo, reduction come into play for atlantoaxial rotatory displacement?

A

Greater than 1 month of symptoms

59
Q

What is the most important determinant for nonunion and pain in spondylolisthesis?

A

Slip angle

60
Q

For CP patients, the ability to do what independently is highly prognostic of ability of walk?

A

Sit independently

61
Q

Syndrome with multiple joint dislocations?

A

Larsen syndrome

Dominant form - filamin B

Recessive form - carbodhydrate slfotransferase 3 deficency

Watch out for cervical kyphosis

62
Q

What is increased in utero in myelodysplasia?

A

Alpha fetoprotein

Commonly associated with Type II Arnold Chiari Malformation

63
Q

What is the first muscle group typically affected in Duchennes?

A

Hip extensors

DMD associated with low IQ, megacolon, volvulus, and malabsorption

64
Q

What disease is due to a GAA repeat?

A

Friedreich ataxia (recessive)

Wide base gait, nystagmus, cardiomyopathy, cavus foot, scoliosis

65
Q

What is the most common cause of pes cavus?

A

CMT

Plantar flexion of the first ray is the first foot deformity because TA is weak

66
Q

What causes destruction of the anterior horn cells in the spinal cord?

A

Polio

muscle weakness WITHOUT sensory deficity

67
Q

What gene with achondorplasia?

A

FGFR3 gain of function

67
Q

What disease has a genetic defect with cAMP?

A

McCune Albright

67
Q

What differentiates spondyloepiphyseal dysplasia (type II collagen defect) from MED?

A

Involved of the spine: scoliosis with sharp curve over small number of vertebra

Also common are retinal detachment and respiratory problems

68
Q

Morquio syndrome (AR) may have dwarfism, cloudy corneas, but what orthopedic issue am I worried about?

A

C1-C2 instability due to odontoid hypoplasia

Urinary excretion of keratan sulfate

69
Q

What is the inheritance for Hunter syndrome?

A

X linked

No cloudy corneas

70
Q

What is the protein involved for cleidocranial dysplasia?

A

CBFA-1 (osteocalcin)

Delayed closure of the skull sutures and frontal bossing

71
Q

Describe bone healing in osteopetrosis?

A

Healing is normal but may be prolonged

72
Q
A

Basic Science (10 decks)

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