Peds Flashcards
(95 cards)
1
Q
physical fx
A
z of provisional calc in z of hypertrophy
2
Q
physical arrest
A
bar resection if >2cm growth and <50% physeal involvement
3
Q
Block to reduction proximal humerus fracture
A
biceps tendon, deltoid, periosteum
4
Q
Acceptable reduction proximal humerus fx
A
<5 yo: 70° and 100% displacement
5-12yo:Upto40°to70°
>12 yo: 40° and 50% displacement
5
Q
angulation tolerated humeral shaft fx
A
30 degrees
6
Q
SCH fx
N injury for extension
N injury for flexion
A
AIN for extension type
ulnar nerve for flexion type
7
Q
lateral condyle fx xray
A
internal oblique
8
Q
lat condyle complication
A
avn - posterior blood supply
cubitus valgus - ulnar n palsy
9
Q
transphyseal distal hum fx
A
child abuse
10
Q
proximal radius fx
A
reduce if >30-45 degrees
11
Q
forearm fx alignment
A
– Bayonet OK – Younger than 9 • 15° angulation • 45° rotation – Older than 9 • 10° angulation proximal • 15° angulation distal • 30° rotation if distal – Anatomic if approaching skeletal maturity
12
Q
cast index
A
<0.8 thickness over width
13
Q
femur fx
A
• Up to 6 mo: Pavlik • Up to 5 years: – Spica Cast – Up to 2 cm shortening – 0.5 to 2 cm overgrowth >5 years Flexi nails if <11 yo or <45-50 kg, 80% fill or rigid nail
14
Q
tibial tubercle fx
A
type 3 involves the joint
if block to reduction it’s likely meniscus
15
Q
tibial spine fx
A
type 1/2 - non displaced can treat in LLC in extension
Type 3/4 need arthroscopic or ORIF
complication is high rate of stiffness and late instability
16
Q
late deformity for proximal tibia fx
A
valgus deformity 6 months after, usually corrects in 1-2 years
17
Q
tibia fx operative
A
Consider operative
• >5° Posterior
• >5-10° Varus/Valgus
18
Q
risk of growth arrest for distal tibia fx
A
post reduction gap of >3mm
19
Q
tillaux fx
A
aitfl
20
Q
triplane
A
SH2 on lat, SH3 on AP, is a SH4
21
Q
kid halo pins
A
6-8 pins at 2-4 inch pounds
22
Q
what bug needs blood culture medium
A
kingella kingae
23
Q
involucrum
A
new bone formed by active periosteum
24
Q
sequestrum
A
necrotic bone atet is avascular
25
gene for MRSA
PVL gene can cause septic emboli/DVT
26
joints w/intraarticular metaphysis
shoulder, elbow, hip, ankle
27
kosher criteria
```
Kocher Criteria
– NWB
– ESR > 40
– Fever > 38.5
– WBC > 12K
• Kocher JBJS 1999
– 4=99%,3=93%,2=40%,1=3%
• Caird JBJS 1999
– Added CRP >2.0
– 5=98%,4=93%,3=83%
Fever best predictor followed by CRP
```
28
Lyme disease tx
doxy if >8years, amoxicillin if younger
29
MRI for CP kid
periventricular leukomalacia
30
GMFCS
I – Speed, balance, coordination impaired
II – Hold railing, trouble with uneven surface
III – Rolling walker, self propelled wheelchair
IV – Operate powered wheelchair
V – Completely dependent
31
botox mechanism
inhibits presynaptic release of ACH
32
arthrogryposis hip
pavlik doesn't work, needs open reduction, reduce if unilateral
33
spina bifida
maternal serum alpha fetoprotein
34
spina bifida based on lowest motor level so what is needed for community ambulation
L4
35
sacral agenesis associated w/
maternal diabetes
36
muscular dystrophy
duchess XLR, dystrophin protein
Becker less severe
20 degrees of curve is indication for fusion
37
Fascioscapulohumeral MD
can't whistle, AD, scapular winging
38
treatment of CMT pes cavus
Lateral post with depression for 1st ray – PF release and 1st MT Osteotomy
– Post Tib Transfer if hindfoot flexible
– Calc Osteotomy if rigid
• Coleman block test
39
spinal muscle atrophy hip management
treated nonop
40
infantile blounts
often unilateral, obese,
| XRAY metaphyseal peaking, drennen angle >16
41
adolescent blount
often unilateral, widening of prox medial physic
42
asymmetric out toeing
may be a SCFE
43
limb length growth
Amount of growth remaining
– Prox Femur – 3mm/year – Distal Femur – 9 mm/year – Prox Tibia – 6 mm/year
– Distal Tibia – 5mm/year
• Cessation of growth
– 14 years old for females – 16 years old for males
44
LLD TREATMETN
```
Treatment
– <2cm at maturity
• Observation/shoe lift
– 2-5cm
• Epiphysiodesis of long side
• Shortening vs. Lengthening
- > 5cm
- shortening vs. lengthening
```
45
POSTEROMEDIAL BOWING
bowing will resolving, associated with calcaneovalgus foot, will develop LLD of 3-4 cm
46
anterolateral bowing
NF, associated with pseuedarthrosis of tibia
brace to prevent fx
difficult to fix
47
anteromedial bowing
fibular hemimimeila, tarsal coalition, ball/socket ankle joint
48
fibular hemimelia gene
SHH
| Ball and socket ankle
49
club foot
related to PITX1 gene
CAVE
caves, adducts, varus, equines
50
deficient artery in clubfoot
tibialis anterior
51
hindfoot parrallelism
dorsiflexion lateral has talocalcaneal angle of <35
52
congenital vertical talus
navicular doesn't reduce on plantar flexion view, manipulation casting, pinning, tenotomy
53
treatment calcaneovalgus foot
stretching, due to excessive dorsiflexion
54
progression of scoliosis after maturity
thoracic curve >50 degrees
lumbar curve >30 degrees
typically 1-2 degrees per year
55
treatment AIS
<25 obs
<40 obs
25-40 brace
>50 surgery
56
what is early onset scoliosis
<10 years
usually left thoracic
RVAD >20 is high risk for progression
57
treatment of infantile idiopathic
< 25°; RVAD < 20° = observation
25-45°; RVAD > 20° = cast / brace/MRI
> 50° = MRI, +/- surgery
58
worst prognosis for congenital scoliosis
unilateral bar and contralateral hemivertebrae, nearly 100% progression
59
treatment for congenital
MRI preop
Surgery for documented progression of 10 degrees
usually do insitu fusion UNLESS L4 or L5 hemivertebra then you do hemivertebrectomy
if <8 do growing rod type
60
what type of spine deformity has highest risk fro neurologic compromise
congenital kyphosis
61
what is Vertebral scalloping
Enlarged foramina
Pencilling of ribs
Short segmented, sharp curves Kyphoscoliosis
NF with dystrophic type scoliosis needs ASF and PSF with instrumentation
62
test to order when normal X-ray and concern for spondylolysis
SPECT, most sensitive
63
atlantoaxial instability
More than 5mm
Treatment: PSF
Different indications for Down’s
Fusion if symptomatic or ADI > 10mm
64
when does proximal femur ossific nucleus appear
6 months
65
what do anterior/posterior straps do on pavlik harness
anterior - flexion
| posterior - abduction
66
what is superolateral filling defect on DDH arthrogram
inverted limbus
67
when to leave DDH hips dislocated
Bilateral over age 6?? Leave alone
| Unilateral over age 8?? Leave alone
68
hip acetabular angle in a child
>35 treat with abduction brace
69
PAO unique in what way
posterior column remains intact
70
shelf/chiari requires what?
requires metaplasia
71
define congenital coxa vara
decreased neck/shaft angle
| treatment is valgus osteotomy for neck-shaft angle 90 or less
72
when can you use lateral pillar classificatin
end of fragmentation phase
73
what drives prognosis in perthes
poor prognosis if onset 6 years old or later
| and total head involvement
74
outcome of perthes determined by
ROM and spherical head
75
how does neck displace in SCFE
neck displaced anteriorly and externally rotates
76
stable vs unstable scfe
stable you can walk on it. if unstable = AVN, less than 10% AVN risk in stable
77
when pin bilateral scfe
endocrine workup if <10 yo, pin bilateral when endocrine etiology or open tri-radiate cartilage
78
longitudinal femoral deficiency
sonic HH gene, limb bud
79
congenital short femur presentation
bulky thigh, externally rotated femur, coxa vara, often absent ACL, can be lengthened if 30% or less shortening
80
treatment for LLD
shoe lift if 1 inch or less
2.5-4.0 cm epiphysiodesis
4 cm or > lengthening
prosthesis w/or w/o conversion 30% or more shortening
81
amputations
preserve heel pad, prevent overgrowth so do disarticulation if you can
82
when is best time to do lower extremity amputation
when child starts to walk
83
when is best time to do UE amputation
6 months
84
how to treat congenital knee dislocation
frequently associated with ipsilateral dislocated hip
| Treat knee dislocation first if both present, treatment is with casting
85
treatment of osgood schlatters
activity modification
86
how to treat popliteal cyst
observation
87
groove of ranvier
contributes cells to resting zone
88
ring of lacroix
fibrous/support structure
89
rosebud hand
FGFR2
| Aperts syndrome
90
gene involved in MED
COMP
91
hitchhiker thumb
| cauliflower ear
DIASTROphic dysplasia
| failure of DTD gene
92
Trevors disease.dysplasia epiphyseal hemimlica
epiphyseal osteochondroma, often on talus
93
osteochondroma
EXT gene defect, loss of hedgehog regulation
94
filamin b mutatino
Larsen syndrome
accessory calcarea ossification center
multiple joint dislocations
cervical kyphosis
95
Trevors disease
osteochondroma in the epiphysis
AKA dysplasia epiphyseal hemimelica
defect in groove of ranvier
