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CUCC > Peds - Bone & Joint Disease > Flashcards

Peds - Bone & Joint Disease Flashcards

1
Q

_____ is characterized by adduction of the forefoot on the hind foot, with the heel in normal position or slightly valgus.

A

metatarsus varus

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2
Q

Metatarsus varus is usually due to _____.
_____% correct by age 3-4 years

A

intrauterine posture
85%

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3
Q

Name the deformities associated with club foot.
Alternate name?

A

Talipes Equinovarus

  1. Equinus or plantar flexion of the foot at the ankle
  2. Varus or inversion deformity of the heel
  3. Forefoot varus
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4
Q

Incidence of club foot?
Hereditary?
Can be associated with anomalies of the _____

A

1 per 1000
Yes
Spine

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5
Q

Club foot

____% eventually require surgery

A

50%

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6
Q

______ is characterized by excessive dorsiflexion at the ankle and eversion of the foot

A

talipes calcaneovalgus

usually due to uterine position

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7
Q

Name the three conditions associated with cavus foot

A
  1. charcot-marie-tooth
  2. poliomyelitis
  3. friedreich’s ataxia
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8
Q

Cavus foot is associated with what contracture?

A

claw toes. - contracture of toe extensors

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9
Q

With regard to genu varum/valgus, a child’s knees typically assume their ultimate configuration by _____ age

A

6-7 yoa

  • start out genu varum. By 12-18 months, the legs have straightened and progressed to mild knock knee (genu valgus)
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10
Q

_____ is due to abnormal function of the medial portion of the proximal growth plate and results in bowing in the proximal tibia.

A

Bounts disease (Tibia Vara)

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11
Q

Bounts disease is most common morphologic cause of bowing in the young child and is found most commonly in _____

A

obese children who walk at 9-10 months

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12
Q

Bounts disease is more common in what ethnicity?
should be suspected in all children with persistent bowing after ____ age

A

AA

2 years old

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13
Q

Treatment of tibia vara?

A

typically osteotomy of proximal tibia

epiphysiodesis also common.

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14
Q

Hip dislocation occurs in _____ births
More common in ____ presentation
Males ____ females

A

1 in 1000
breech
females > males

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15
Q

If a mother has a history of dislocated hip, the risk to the baby is increased to _____ non-breech and ____ breech births

A

1 in 1000 regardless

increased to 1 per 25 in non-breech
1 per 15 in breech

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16
Q

children with _____ or ___ at birth have increased risk of hip dsplasia

A

metatarsus adductus
torticollis

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17
Q

What is the galeazzi (allis) test?

A

Flex hip and knees bilaterally, looking at the level of the knees. positive test shows the level of one knee lower indicating hip dysplasia in the lower leg.

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18
Q

What are the Barlow and Ortolani tests?

A

Barlow test is used to determine if a dislocated hip can be readily dislocated.
- at rest the hip is reduced and abduction is normal
- with the leg in a flexed and adducted position, push the femur posteriorly with the htumb. If hip dislocates posteriorly, test is positive and dislocation is palpable.

Ortolani test verifies dislocation as this test reduces the hip.
- as the hip is gently abducted the long finger over the greater trochanter pushes anteriorly to lift the femoral head over the posterior lip of the acetabulum to reduce the hip.
- a positive test is present when a palpable “clunk” is noted by the examiner as the hip reduces. A high-pitched click at full abduction is not a positive and is probably due to TFL slipping over the greater troch.

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19
Q

If diagnosis of hip instability is made in the first few months of life, closed reduction and use of Pavlik harness or hip spica cast is used
_____ degrees of flexion is maintained
for how long?

A

90-120 degrees to limit hip adduction
for 3-4 months

  • care must be taken to avoid forced hip abduction in the brace or splint as this may cause AVN
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20
Q

The incidence of congenital muscular torticollis is about _____ live births with ____% involving the right side

A

1 per 250
75% on right side

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21
Q

With regard to congenital muscular torticollis, what is the olive sign

A

represents a soft, nontender enlargement of the SCM on physical exam and is seen within the first 6 weeks and subsides within 4-6 months of age

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22
Q

Name the 4 secondary findings associated with congenital muscular torticollis.

A
  1. flattening of the ipsilateral face
  2. contralateral occipital flattening
  3. orbital asymmetry (plagiocephaly)
  4. ipsilateral hip dysplasia
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23
Q

Torticollis can be the physical sign of an underlying problem usually due to _____, ____, or _____ which must be excluded.

A
  1. muscular fibrosis
  2. presence of a cervical hemivertebra
  3. atlantoaxial rotary subluxation
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24
Q

The most common cause of congenital torticollis is _____

A

fibrosis of the SCM - suggested causes include birth trauma and ischemia due to intrauterine position of the head and neck

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25
Q

Mainstay of conservative treatment for congenital muscular torticollis includes (3)

A
  1. stretch the contracted SCM muscle 15–29 times per session, four to six times a day
    - for R torticollis, til the childs head ot the left and rotation to the right.
  2. Position the crib so that the child has to stretch toward the center of the room, and stretch the ipsilateral neck musclesin an effort to encourage gaze toward ipsilateral superior direction.
  3. put a mobile in the crib as follos:
    - for right torticollis, put the mobile to the right of the crib
    - for left torticollis, put the mobile to the left of the crib
26
Q

In congenital torticollis, if failure to regain full cervical ROM by 1 year of age, _____ will result

A

persistent facial asymmetry.

27
Q

In torticollis, surgery is best in kids < ____ age.
In older kids with persistent torticollis, ____ is indicated
_____ is indicated with cervical hemivertebrae

A

12 years old
surgical lengthening of the affected SCM
Surgical fusion is performed ot prevent increased scoliosis

28
Q

In Nursemaids elbow, the radial head and neck are displaced distal to _____

A

annular ligament

29
Q

Reduction of nursemaids elbow is usually achieved by

A

supination and extension of the forearm

30
Q

____ results from repetitive traction stresson teh apophysis of the medial epicondylar ossification center of the humerus

A

medial epicondylar apophysitis (little leaguer’s elbow)

Can be due to repetitive valgus stress on the elbow from activities such as throwing a baseball (especially pitching)

31
Q

Pain in osgood-schlatter’s disease results from:

A

inflammation/repeated microfractures int he spophyseal cartilage between the tibial tubercle and the secondary ossification center fo the tibial tuberosity where the patella tendon attaches. These microfractures occur as the cartilage is less able to resist the stress of repeated knee extensions.

32
Q

_____ is the most common cause of limping and pain in the hip of children

A

transient (toxic) synovitis of the hip

33
Q

_____ is a result of rapid growth in relation to blood supply - the secondary ossification centers in the epiphysis are subject to AVN.

A

Legg-Calve-Perthes disease (AVN of the proximal femur) more common in boys

34
Q

____ is the most common hip disorder of preadolescent and adolescent children. It involves separation of the proximal femoral epiphysis through the growth plate (epiphysiolysis)

A

Slipped capital femoral epiphysis. more common in obese children boys > girls.

35
Q

Incidence of acute transient toxic shynovitis (ATS)

A

2:1000

36
Q

Incidence of Legg-Calve-Perthes disease

A

1:750

37
Q

Incidenceof slipped capital femoral epiphysis (SCFE)

A

10.8:100000

38
Q

Age onset:
Acute transient/toxic synovitis:
Legg calve perthes disease
SCFE

A

ATS: 3-6 yoa Boys>girls
LCP: 4-10 yoa boys > girls
SCFE: 9-15 yoa boys > girls blacks > whites

39
Q

surgical option for legg-calve-perthes disease

A

varus osteotomy

40
Q

good prognosis in children with legg-calve-perthes disease is ___ and ____

A

detected <50% of femoral head involvement.

41
Q

Idiopathic scoliosis accounts for ____% of patients with structural scoliosis.

A

80% - autosomal dominant component with incomplete penetrance.

42
Q

Idiopathic scoliosis is subdivided according to the age of onset with three well defined periods.

A

1 infantile - 0-3 years old
2. juvenile - 4 years old to onset of puberty
3. adolescent puberty to just prior to closure of epiphyseal plates. (most common)

43
Q

Curve pattern for
1. infantile idiopathic scoliosis
2. juvenile idiopathic scoliosis
3. adolescent idiopathic scoliosis

A
  1. left thoracolumbar
  2. right thoracic or double curve
  3. right thoracic 1; right thoracic/left lumbar 2
44
Q

The Cobb Angle is measured with which view of xray

A

PA view of thespine.

45
Q

How do you measure the cobb angle?

A
  • one line is drawn along the superior endplate of the vertebra, tiltedthe most at the top of the curve
  • a second line is drawn along the inferior endplate of the vertebra, tilted the most at the bottom of the curve

A large scoliosis will allow these two lines to intersect, forming the angleIf the curve is not large enough, strike perpendiculars to form a second angle

46
Q

If the thoracic scoliotic curve exceeds _____, abnormalities may appear on PFTs

A

50-60 degrees.

47
Q

During a period of rapid adolescent growth, progressive scoliosis curves increase at a rate of _____

A

1 degree per month.

48
Q

If thoracic curves can be kept less than ______ and lumbar curves kept less than _____ by completion of adolescent growth, the likelihood of the curve increasing during adult life is small

A

<40%

49
Q

If a scoliosis curve is 20-40 degrees, what are the treatments of choice if idiopathic vs neuromuscular?

A

Brace

surgery (sooner if rapidly progressive)

50
Q

____ is demonstrated when > or = 3 consecutive vertebra are wedged > 5 degrees.

A

Scheuermanns disease (juvenile kyphosis)

  • cuase is overall unknown but felt to be resultant of repetitive microtrauma and fatigue failure (osteochondrosis) of the immature thoracic vertebral bodies.
51
Q

Scheuermanns disease occurs in ____% of the population with increased prevalence in males

A

0.5-8%

52
Q

_____ can be seen in scheuermanns disease and are protrusions of disc material into the spongiosumof the vertebral bodies.

A

schmorl’s nodes.

53
Q

_____ is often the presenting symptom of spondylolisthesis

A

difficulty with forward bending.

54
Q

In children with spondylolisthesis, ____ or ____ types are most common and occur most often at what levels?

A

dysplastic
isthmic

occur most commonly at L5/S1 then L4/L5

55
Q

A _____ is the result of vertebral body slippage due to a spondylolysis (fracture of the pars interarticularis)

A

isthmic spondylolisthesis. - most common type.

56
Q

In isthmic spondylolisthesis, pars defect is at ____ in 67% of people, at ____ in 15-30%, and ____ in 2%

A

L5
L4
L3

57
Q

The frequency of pars defects is
_____% in children
_____% in adolescents
_____% in gymnasts

A

4.5%
6%
12%

58
Q

______ involves a congenital malformation of the facet joints at the lumbosacral junction with pars elongation or attenuation.

A

dysplastic (congenital) spondylolisthesis - congenital dysplasia of the sacrum or L5 neural arch. Spondylolysis may occur later as the slip increases.

  • rarer but has more severe neurologic deficits. Most likely to cause compression of the cauda equina as the L5 vertebra moves anteriorly on the sacrum.
59
Q

Most common presenation of congenital scoliosis

A

multiple hemivertebra or unilateral failure of segmentation in which one lateral half of the vertebra fails to form

60
Q

congenital scoliosis is associated with ____ and ____

A

congenital urinary abnormality and spinal cord abnormality

61
Q

Describe VACTERL (or VATER) syndrome

A

Vertebral defects
imperforate Anus
Cardiac defects
TrachEoesophageal fistula
Radial and Renal dysplasia

62
Q

Scoliosis associated with NMD (acquired scoliosis) is uncommon in NMD children who are able to

A

walk

Even in DMD, scoliosis is unusual until child is WC bound

CUCC (26 decks)

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