Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med II - Ortho > Peds > Flashcards

Peds Flashcards

1
Q

Checklist of how to think

A 
Toxins
Tumors
Trauma
Infection
Inflammation / immunologic
Metabolic
Endocrinologic
Hematologic
Vascular
Neurologic
Congenital
Psychologic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Congenital clubfoot

A 
Clinical/pathologic anatomy
Cavus
Adductus
Varus
Equinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Talipes Equinovarus - in general

A

Congential deformity of hindfoot equinus, forefoot adduciton and varus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Talipes Equinovarus - e/e

A 
Unknown
High correlation to genetics & environment
Commonly associated with other defects
- spina bifida
- arthrogryposis
- myelodysplasia
Male x2
50% bilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Talipes Equinovarus - PE

A

R/o hip dysplasia & torticollis

Degree & flexibility of deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Talipes Equinovarus - imaging

A

X-ray

Parallelism between talus & calcaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Talipes Equinovarus

A

Progressive casting
Sx
Bracing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Torticollis - in general

A 
Congenital muscular d/o
Most common
Contracture of SCM
Right side - 75%
Palpable mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Torticollis - imaging

A

X-ray

R/o vertebral anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Torticollis - PE

A

Check hips with exam and US (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Torticollis - tx

A

Therapy 90% effective

Sx if refractive after 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Galeazzi

A

Bend legs at knee and place feet on solid surface

Measure knee heights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Developmental Hip Dysplasia - in general

A 
Continuum of d/o ranging 
Shallowness of acetabulum
Instability / sublux of femoral head
Frank dislocation
May not be present at birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Developmental Hip Dysplasia - Classification

A 
Teratologic
Typical
- Sublxed
- Dislocatable
- Dislocated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Developmental Hip Dysplasia - Hx & PE

A 
Positive FHx
Breech presentation - increase 20%
Girls (4:1)
Left side
Foot & knee deformities
Torticollis
Asymmetry in thigh folds (Ant/post)
ROM - decreased abduction
Galeazzi sign
Ortolani & Barlow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Developmental Hip Dysplasia - dx

A 
US
- Less than 6 months
- Use in high risk or equivocal exam
- Use to follow rx with pavilik bracing
Xray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Developmental Hip Dysplasia - tx

A

REFER
Pavlik bracing
- 90-95% effective
- less than 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pavlik bracing resolution

A

Subluxated hips - 99% resolution

Dislocated hip - 50% resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Developmental Hip Dysplasia - bilateral cases

A

Excessive lordorsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Normal Gait

A 
Stance - 60%
- Heel strike
- Tibial Translation
- Heel rise
Swing (40%)
- Toe off
- Midswing
- Terminal swing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DDX in a toddler (1-3 yo)

A 
Trauma
Transient synovitis
Septic arthritis
Diskitis
Toddler's fx
CP
DDH
Muscular distrophy
Coxa Vara
Pauciarticular JRA
Leukemia
Osteoid osteoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DDx - Child (4-10 yo)

A 
Transient synovitis
Septic Arthritis
Legg-Calve-Perthes dz
Discoid meniscus
Limb length discrpancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DDX - adolescent (11-15yo)

A 
SCFE
Hip dysplasia
Trauma
Overuse syndromes
Osteochondritis dissecans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DDX of the limping child - in general

A

Inflammatory & infectious
Trauma / fx
Anatomic
Neoplasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

DDX of the limping child - inflammatory & infectious

A 
Osteomyelitis
Diskitis
Transient synovities
JRA
Psoas abscess
Pyogenic sacroiliits
Lyme arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DDX of the limping child - anatomic

A 
DDH
Coxa vara
Perthes dz
SCFE
Chondrolysis
OCD
LLD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

DDX of the limping child - Neoplasms

A

Leukemia

Osteoid osteoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Septic hip - Kocher criteria

A

Fever (>38.5°C)
Non-weight-bearing
EST (greater than 40 mm/hr)
WBC count > 12,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Kocher criteria probability of septic hip

A 
0 predictors - 0.2%
1 predictors - 3%
2 predictors - 40%
3 predictors - 93%
4 predictors - 99%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Septic Arthritis - in general

A

Requires urgent management b/c of potential for joint destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Septic Arthritis - s/s

A 
Acute onset of pain, limp/refusal of weight bearing
Hx of mild trauma or concurrent illness
Progresses to febrile systemic illness
Immobile joint
Swelling
Erythema
Tenderness possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Septic Arthritis - labs

A 
Elevated
WBC
CRP
ESR
Blood culture 30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Septic Arthritis - Radiographs

A

Negative at onset of symptoms (soft-tissue swelling)
Changes due to bone infection after 7-10 days
- Protracted, active process
- Erosion and joint narrowing with cartilage destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Septic Arthritis - Bone scan

A

Only necessary if localization not possible

Positive after 24-48h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Septic Arthritis - Aspiration

A 
WBC - 80-200
>75% PMN
Gram stain not sensitive
Cultures
- Staph aureus
- Kingella Kingae
- Less H. flu
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Osteomyelitis - in general

A

Generally secondary to hematogenous spread

S. aureus most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Osteomyelitis - clinical presentation

A 
Local swelling
Pain
Possible pseudoparalysis
Sudden onset of fever
Systemic illness in children
Slower onset in adolscents
38
Q

Osteomyelitis - imaging

A

Bone destruction on radiograph (metaphyseal) late finding (several days)

39
Q

Transient synovitis - in general

A

Most common cause of lower extremity pain

3-8yo

40
Q

Transient synovitis - presentation

A

Rapid onset of hip pain
Limited ROM
Limping or inability to bear weight
Frequent receding viral illness

41
Q

Transient synovitis - ddx

A

Septic arthritis

42
Q

Transient synovitis - labs

A

Normal
CBC
ESR
CRP

43
Q

Transient synovitis - eval

A

US - effusion
Aspiration
- WBC 5-15K
>25% PMN

44
Q

Transient synovitis - tx

A

Goal - expedite spontaneous resolution
Brief bed-rest / NWB - light traction may alleviate pain
NSAIDs
Routine aspiration - no demonstrable therapeutic benefit
Crutches until limp resolves
Average duration of s/s - 10d

45
Q

Muscular Dystrophy - in general

A 
Boys 2-5 yo
Delayed ambulation
Stumbling
Falling
Stair difficulty
Proximal weakness
Gower's sign
Toe walking
Pseudohypertrophy of the calf
Elevated serum creatinine phosphokinase
46
Q

Duchenne

A

Caused by an error in an x-linked recessive gene, meaning it mainly affects boys

47
Q

Trigger thumb - in general

A

Nodular enlargement of flexor tendon that becomes locked at A1 pulley
Presents 4-24m of age
30% bil
Flexed, locked thumb

48
Q

Trigger thumb - tx

A

Less than 1 yo - observation

Sx

49
Q

Brachial Plexus Injury - RF

A 
Shoulder/fetal dystocia
Obesity
Prolonged labor
Breech presentation
Multiparous PG
Traction injury
50
Q

Erb’s Palsy

A 
Most common
C5-C6
Position - Waiter tip
- Shoulder Adducted / IR
- Elbow extended
- Forearm pronated
- Wrist/fingers flexed
51
Q

Klumpke’s Palsy

A

C8-T1
Hand paralysis
Should/elbow maintained

52
Q

Brachial Plexus Injury - tx / recovery

A

Recovery dependent of severity

  • 90% spontaneously resolve in 1 yr
  • Most improvement 1st 3 months
53
Q

Brachial Plexus Injury - Management

A

ROM
Microscopic repair of plexus
Muscle procedures
Rotational humeral osteotomy

54
Q

Nursemaid’s elbow - in general

A

Radial head subluxation under annular ligament

Secondary to forceful traction on arm

55
Q

Nursemaid’s elbow - presentation

A

<4yo
Arm held in pronation with slight flexion
Pain at radial head

56
Q

Nursemaid’s elbow - imaging

A

x-ray

r/o fx

57
Q

Nursemaid’s elbow - tx

A 
Reduction
- posterior pressure on radial head whil flexing &amp; supinating arm or hyperpronation
- immediate click and relief of pain
No immobilization if 1st time
Recurrent may need casting
58
Q

Most common complication caused by tx in ED/UC

A

Pressure sore

59
Q

Pediatric Fx system of naming

A

Salter-Harris

60
Q

Distal Femoral Physeal fx - in general

A

Direct blow mechanism
Salter I or II common
Check NV status
- Less common than with tibial injury

61
Q

Distal Femoral Physeal fx - complications

A 
High rate of premature growth arrest
- rare <2yo
- 80% 2-11yo
- 50% >11yo
Angular deformity
Leg length discrpancy
62
Q

Distal Femoral Physeal fx - f/u

A

6m x-ray of other side

At regular intervals until maturity

63
Q

SCFE

A

Slipped Capital femoral epiphysis

64
Q

SCFE - s/s

A

Referred knee pain

65
Q

SCFE - complications

A

Obligate external rotation
AVN
THR

66
Q

SCFE - tx

A

w/c or crutches until sx

67
Q

Patellar Sleeve fx

A

8-12 yo
Inferior pole sleeve of cartilage may displace
May have small ossified portion
<2mm displaced, intact extensor mechanism - tx non-operatively

68
Q

Patella fx - in general

A

Tension band or screw if large enough
Consider excising small marginal fragments
Good PPX

69
Q

Patella fx - complications

A

Alta
Ext lag
Quad muscle atrophy

70
Q

Proximal tibial physeal fx

A

Usually Salter II fx
Occasionally Salter I or IV
Post displaced epiphysis or metaphysis can cause vascular injury
HYPEREXTENSION
Exploration or arteriography if ischemic or diminished pulse after fx reduction

71
Q

Principles of distal tibial growth

A 
Distal tibia ossific nucleus
- appears: 2-3 yo
- fuses: girls-15; boys-17
Fuses central to medial and then lateral over 18 months
Distal fibula ossific nucleus
- appear: 2 yo
- fused: 20yo
Secondary ossification centers
72
Q

SC joint fx / dislocation

A

SC dislocation posterior can be emergent b/c of trachea
One of the last growth plates to fuse
Most kids fuse w/o tx
May need to be reduced, but pretty stable post-reduction
Sx - Severe shortening; open fx

73
Q

Proximal humerus fx

A

If >2yr of growth left & <10 yo - no sx

If <2yr growth left - may need sx

74
Q

Elbow fx

A

As you grow/age you see growth in a weird pattern - CRITO
Ulna is not linging up with the humerus
Can inject dye before x-ray, but most ERs will say no or MRI

75
Q

Supercondyler humerus fx - in general

A

Extension > Flexion type
Gartland classification
Recall the anterior interosseous N.

76
Q

Supercondyler humerus fx - Gartland classification

A

I - Crack; non-displaced
II - crack and angulated backward
III - Hinge is not intact
IV - can move all around

77
Q

Supercondyler humerus fx - tx

A

I - cast

II & III - fixation with pins

78
Q

Elbow dislocation

A

Usually can be reduced in the ER, but find the medial epicondyle

79
Q

Ossification

A

Capitellum - 6m to 2yr
Medial epicondyle - 5-9yr
Trochlea - 7-13yr
Lateral epicondyle - 8-13yr

80
Q

Septic hip - in general

A

Most common in first decade
Difficult to dx - if in doubt, admit and observe
Serious sequelae

81
Q

Modified Kocher criteria

A 
0 predictors - 17%
1 predictor - 37%
2 predictors - 62%
3 predictors - 83%
4 predictors - 93%
5 predictors - 98%
82
Q

Septic hip - etiology

A

Hematogenous spread
Direct seeding of synovium
Metaphyseal osteomyelitis then enters the joint

83
Q

Septic hip - work-up

A 
X-rays
Blood cultures
CRP
ESR
CBC with differential
US
Aspiration
84
Q

Septic hip - Aspiration

A

Definitive Dx

Cloudy appearance WBC count between 80-200 with >75% polys

85
Q

Septic hip - tx

A

Standard - I&D
- approach depends on preference
IV abx followed by oral abx
Serial CRPs

86
Q

Compartment syndrome - injury

A

Can occur at any site here muscle is contained in a closed fascial space
Common areas are lower leg, forearm, foot, hand, gluteal region & thigh
Develops when pressure in the osteofascial compartment cause ischemia and necrosis
Ischemia can be caused by swelling or constricting dressings
End stage is and ischemic Volkmann’s contracture

87
Q

Compartment syndrome - assessment

A 
High risk
- tibia or forearm fx
Crush injuries
tight dressings or casts
Difficult to assess in the pt with altered mental status
88
Q

Compartment syndrome - s/s

A 
Pain out of proportion to injury
Pain with passive stretching
Paresthesia
Decreased sensation or functional loss
Tense swelling
Weakness or paralysis and loss of pulses are late sign
89
Q

Compartment syndrome - dx

A

Dx is Clinical
Based on hx of injury & PE
Intracompartmental pressures are helpful
Tissue pressures >35-45mmHg or with 30 mmHg of diastolic pressure are suggestive of compartment syndrome

90
Q

Compartment syndrome - tx & management

A

Management - loosening tight dressings, splints & casts

If no improvement, then fasciotomy is requires

91
Q

Compartment syndrome - Three A’s

A

Anxiety
Analgesia
Agitated

Clin Med II - Ortho (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions