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Peds MSK Flashcards

1
Q

Salter-Harris classification?

A 
S: slipped
A: above
L: lower
T: thru
R: rammed
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2
Q

Salter-Harris type I –> XR appearance?

A
  • soft tissue swelling
  • normal physis
  • asymmetrically widened physis
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3
Q

pediatric elbow –> order of ossification? age ossify?

A

CRITOE:

  • capitellum 1yo
  • radial head 3
  • internal (med) epicondyle 5
  • trochlea 7
  • olecranon 9
  • external (lat) epicondyle 11
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4
Q

distal humerus –> capitellum vs trochlea?

A

articular surface of distal humerus:

  • capitellum –> articulate w radial head
  • trochlea –> olecranon
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5
Q

elbow alignment lines? (2)

A
  • ant humeral line

- radiocapitellar line

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6
Q

abnormal ant humeral line –> suggests what condition?

A

supracondylar fx

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7
Q

abnormal radiocapitellar line –> suggests what condition?

A

elbow dislocation

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8
Q

what is Toddler’s fx?

A

tibial metadiaphysis –> nondisplaced spiral fx

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9
Q

iliac crest apophysis –> muscle?

A

abd muscles

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10
Q

ASIS apophysis –> muscle?

A

sartorius

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11
Q

AIIS apophysis –> muscle?

A

rectus femoris

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12
Q

ischial tuberosity apophysis –> muscle?

A

hamstring

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13
Q

pubic symphysis apophysis –> muscle?

A

hip adductors & gracilis

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14
Q

grter trochanter apophysis –> muscle?

A

gluteus

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15
Q

lesser trochanter apophysis –> muscle?

A

iliopsoas

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16
Q

lesser trochanter fx –> diff bw adolescent vs adult?

A

adolescent: avulsion fx
adult: pathologic fx

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17
Q

nonaccidental trauma –> bone scintigraphy –> pros (1) vs cons (3) ?

A

pro:
- more sensitive for post rib fx

cons:
- higher radiation than XR
- insensitive for skull fx
- can’t eval fx age

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18
Q

fx age –> callus vs no callus?

A

no callus: <2wk

callus: at least 1wk

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19
Q

nonaccidental trauma –> highly specific fx? (5)

A
  • classic metaphyseal lesion
  • post rib
  • scapula
  • sternum
  • spinous process
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20
Q

nonaccidental trauma –> suspicious (but not highly specific) fx? (5)

A
  • > 1 fx
  • fx OOP to hx
  • infant –> digit
  • nonambu –> long bone
  • complex skull
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21
Q

what is bone dysplasia?

A

normal bone growth –> impair –> abnormal skeleton

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22
Q

achondroplasia –> key XR findings? (4)

A
  • narrow interpeduncular distance
  • post scalloping of vertebral bodies
  • “tombstone” iliac wings
  • flat acetabula, short femoral neck
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23
Q

MC lethal skeletal dysplasia

A

thanatophoric dysplasia

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24
Q

thanatophoric dysplasia –> key XR findings? (3)

A
  • H-shape vertebrae
  • narrow interpeduncular distance
  • telephone receiver femurs
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25
prenatal fx --> dx?
osteogenesis imperfecta
26
osteogenesis imperfecta --> XR findings? (4)
- osteopenia - mult fx - bowed long bones - Wormian bones
27
osteogenesis imperfecta --> rib appearance?
accordion ribs
28
what is asphyxiating thoracic dystrophy (Jeune synd)?
AR --> small thorax --> resp distress
29
asphyxiating thoracic dystrophy (Jeune synd) --> bone findings? (4)
- small thorax - short ribs --> ant is bulbous - high "handlebar" clavicle - "trident" acetabulum
30
cleidocranial dysostosis --> XR findings? (4)
- KEY finding: complete/partial absence of clavicles - wormian bones - delayed ossfication of skuls - wide pubic symphysis
31
what conditions can have stippled epiphyses? (4)
- chondrodysplasia punctata - mult epiphyseal dysplasia - hypothyroid - maternal warfarin use
32
enchondromatosis is characterized by what?
asymm --> mult intra-osseous benign cartilaginous tumors
33
conditions w enchondromatosis? (2)
- Ollier dz | - Maffucci synd
34
Ollier dz --> synd?
- enchondromatosis | - no other abnormalities
35
Mafucci synd --> synd?
- enchondromatosis | - venous malformation --> phlebolith
36
what is mult hereditary exostoses (osteochondromatosis)?
AD --> long bone --> metaphysis --> mult benign osteochondromas
37
mult hereditary exostoses (osteochondromatosis) --> complication?
malig transform --> chondrosarcoma
38
what is mult hereditary exostoses (osteochondromatosis) --> symm or asymm?
symm
39
mucopolysaccharidoses --> XR findings? (5)
- ant vertebral body beaking - thick rib - undertubulated bones - Madelung deform - thick calvarium --> J-shape sella
40
mucopolysaccharidoses --> Hurlers vs Morquio --> XR findings?
ant beaking of vertebra body: - Hurlers: inf - Morquio: mid portion of vertebra
41
mucopolysaccharidoses --> Morquio --> other assoc findings? (2)
- spinal stenosis | - atlantoaxial instability
42
septic arthritis --> MC MOA? MC org?
S. aureus --> hematogenous spread --> metaphyseal osteomyelitis --> brk thru periosteum --> infect jt capsule
43
hip effusion --> XR findings? (2)
- displace gluteal/psoas fat plane | - widening of teardrop distance
44
hip effusion --> imaging modality of choice?
US
45
slipped capital femoral epiphysis --> epidemiology?
obese pre-adol (10-16yo)
46
slipped capital femoral epiphysis --> XR findings? (2)
- wide proximal femoral physis | - Klein's line --> not intersect femoral head
47
what is Klein's line?
line --> lat margin of femoral neck --> should intersect femoral head
48
Klein's line --> used on what view?
AP
49
slipped capital femoral epiphysis --> wide proximal femoral physis --> best seen on what view?
frog leg lat
50
what is Legg-Calve-Perthes dz?
avascular necrosis of capital femoral epiphysis ossification ctr
51
Legg-Calve-Perthes dz --> age range?
4-8yo
52
Legg-Calve-Perthes dz --> bilat --> assoc condition? (2)
systemic dz: - sickle cell - steroid
53
Legg-Calve-Perthes dz --> etiology?
unknown
54
early Legg-Calve-Perthes dz --> XR finding?
XR: femoral head --> subtle sclerosis
55
late Legg-Calve-Perthes dz --> XR findings? (2)
- osteonecrosis: femoral head --> flat & distort | - OA
56
early Legg-Calve-Perthes dz --> bone scan finding?
bone scan: decreased uptake
57
late Legg-Calve-Perthes dz --> bone scan finding?
repair attempt --> increased uptake
58
MC primary pediatric bone tumor
osteosarcoma
59
osteosarcoma --> MC subtype?
75% --> conventional (intramedullary)
60
conventional (intramedullary) sarcoma --> MC location?
knee: - distal femur - prox tibia
61
conventional (intramedullary) sarcoma --> XR appearance?
- destructive --> invade cortex | - osteoid matrix
62
2nd MC primary pediatric bone tumor
Ewing sarcoma
63
Ewing sarcoma --> MC location? 2nd MC?
``` #1 --> femoral diaphysis #2 --> pelvis --> flat bone ```
64
Ewing sarcoma --> mets --> MC location?
lung
65
Ewing sarcoma --> XR appearance?
soft tissue mass --> difficult to see on XR
66
what are Langerhans cells?
epidermis & LN --> dendritic cells (histiocytes) --> Ag-presenting cells
67
histiocytes --> microscopic finding?
Birbeck bodies
68
Langerhans cells histiocytosis --> 4 clinical subtypes?
- eosinophiic granuloma (osseous LCH) - Hand-Schuller-Christian (multfocal unisystem) - Letterer-Siew (multifocal multisystem) - pulm LCH
69
pulm Langerhans cells histiocytosis --> epidemiology?
adult smoker
70
eosinophiic granuloma (osseous LCH) --> location?
skeleton only --> mono or poly-ostotic
71
LCH --> subtype --> Hand-Schuller-Christian (multfocal unisystem) --> clinical triad?
- pituitary hypophysitis --> diabetes insipidus - exophthalmos - lytic bone lesions --> skull
72
eosinophiic granuloma (osseous LCH) --> epidemiology?
5-15yo
73
eosinophiic granuloma (osseous LCH) --> clinical presentation?
pain, tender, fever --> mimic osteomyelitis
74
eosinophiic granuloma (osseous LCH) --> skull --> XR appearance?
lytic lesion --> "beveled edge" ("hole within a hole)
75
eosinophiic granuloma (osseous LCH) --> flat bone (ie pelvis) --> XR appearance?
lytic lesion --> "hole within a hole"
76
eosinophiic granuloma (osseous LCH) --> long bone --> XR appearance? can look like what other condition? (2)
permeative destruction --> lytic lesion w faint sclerotic rim --> agg periosteal rxn - lymphoma - Ewing sarcoma
77
eosinophiic granuloma (osseous LCH) --> spine--> XR appearance?
vertebra plana
78
eosinophiic granuloma (osseous LCH) --> maxilla --> XR appearance?
"floating" teeth
79
<30yo --> lytic bone lesion --> ddx? (2)
- infx | - eosinophiic granuloma (osseous LCH)
80
pediatric --> osteomyelitis --> MC location? MC MOA?
hematogenous spread --> metaphyseal marrow
81
pediatric --> osteomyelitis --> metaphysis --> age range when common to have infection spread to epiphysis? why?
infant --> transphyseal vessels older children --> capillaries NOT cross physis --> transphyseal extension uncommon
82
pediatric --> osteomyelitis --> MC org?
S aureus
83
pediatric --> sickle cell --> osteomyelitis --> MC org?
Salmonella
84
osteomyelitis --> when can be visualized by XR?
10-15day
85
osteomyelitis --> initial XR finding?
focal osteopenia (d/t hyperemia)
86
early osteomyelitis --> which imaging modality is more sensitive than XR? (2)
- MRI | - scintigraphy
87
osteomyelitis --> XR appearance?
intramedullary lesion --> lucent --> erode cortex --> periosteal rxn
88
isolated discitis --> occur in children or adult? why?
children only --> presence of blood vessels directly feeding disc --> infection begin in disc adult --> infection can SPREAD to disc --> but not isolated discitis
89
pediatric --> discitis --> classic age & presentation?
- young child (up to 4yo) - preceding URI - back pain or refuse to sit
90
pediatric --> discitis --> MC location?
lumbar
91
discitis --> XR appearance?
- disc space narrow | - endplate irreg
92
discitis --> MRI appearance?
- disc space narrow - BM edema - vertebra --> may enhance
93
what is chronic recurrent multifocal osteomyelitis (CRMO)?
nonpyogenic inflamm disorder --> mimic osteomyelitis
94
chronic recurrent multifocal osteomyelitis (CRMO) --> key imaging finding?
lytic & sclerotic lesions --> migratory --> in time and space
95
chronic recurrent multifocal osteomyelitis (CRMO) --> can be indistinguishable from infectious osteomyelitis --> but CRMO should NOT have these findings? (3)
- soft tissue abscess - bony sequestra - fistula
96
chronic recurrent multifocal osteomyelitis (CRMO) --> assoc synd?
SAPHO synd
97
SAPHO synd --> synd?
- synovitis - acne - pustulosis - hyperostosis - osteitis
98
MC pediatric malig?
leukemia
99
leukemia --> XR findings? (3)
- metaphyseal lucent band - osteopenia - permeative lytic lesions
100
metaphyseal lucent band --> ddx? (4)
- leukemia/lymphoma - severe illness - TORCH infx - scurvy
101
what is rickets?
metabolic bone dz --> inadeq vitD --> zone of provisional calcification --> abnormal calcification --> abnormal physeal dev
102
rickets --> XR findings? (4)
- long bone --> metaphysis --> expand, fray, cupping --> periosteal rxn - leg bowing - osteopenia - fx
103
rickets --> rib finding?
rachitic rosary: ant cupping of ribs --> wide rib epiphyseal cartilage
104
what is oncogenic rickets?
variant of rickets
105
leg bowing --> ddx? (3)
- developmental/congenital - Blount dz - osteogenesis imperfecta
106
metaphysis --> flare --> ddx? (5)
- bone dysplasia - chronic lead poison - anemia - fibrous dysplasia - storage disorder
107
TORCH infx --> syphilis --> what bone dz?
congenital syphilitc osteomyelitis
108
Wimberger sign vs Wimberger ring sign?
Wimberger sign: - TORCH syphilis - prox tibia --> metaphysis --> med aspect --> erosion Wimberger ring sign: - scurvy - ossification ctr --> increase density
109
MC chronic arthopathy of childhood
juvenile idiopathic arthritis (JIA)
110
juvenile idiopathic arthritis (JIA) --> age range by definition?
<16yo
111
juvenile idiopathic arthritis (JIA) --> MC subtype
pauciarticular
112
juvenile idiopathic arthritis (JIA) --> pauciarticular subtype --> epidemiology?
young girls
113
juvenile idiopathic arthritis (JIA) --> MC location?
knee
114
juvenile idiopathic arthritis (JIA) --> early imaging appearance? (3) later changes? (2)
early: - osteopenia - ST swelling - jt eff later: - periosteal rxn - erosion
115
juvenile idiopathic arthritis (JIA) --> eventual endpt of dz?
jt ankylosis
116
juvenile idiopathic arthritis (JIA) --> jt ankylosis --> MC sites? (3)
- wrist - carpometacarpal jt - cervical spine
117
cervical spine --> ankylosis --> ddx? (2) how to differeniate? (1)
- juvenile idiopathic arthritis (JIA): no segmentation anomalies - Klippel-Feil: segmentation anomalies
118
juvenile idiopathic arthritis (JIA) --> jt ankylosis --> MOA?
synovitis --> hyperemia --> accel bone growth & maturation --> abnormal bone growth, premature fusion of physes
119
what is Still dz?
JIA subtype --> acute systemic
120
Still dz --> epidemiology?
<5yo
121
Still dz --> clinical presentation? (5)
- fever - anemia - leukocytosis - hepatosplenomeg - polyarthritis
122
what is dev dysplasia of hip (DDH)?
femoral head - acetabulum relationship --> abn dev
123
breech birth --> screen for DDH --> when?
few (4-6) wks after birth
124
dev dysplasia of hip (DDH) --> screening US --> eval what? (2)
- alpha angle (normal >60) | - acetabular covering (normal 50%)
125
dev dysplasia of hip (DDH) --> when can screen w XR?
after 6mo (when femoral heads ossify)
126
XR --> screen DDH --> Hilgenreiner & Perkins lines --> normal location of femoral heads?
inner low quad
127
what is osteochondrosis?
group of disorders: bone necrosis --> affect the progress of bone growth
128
osteochondrosis --> epidemiology?
children & adol who are still growing
129
osteochondrosis --> what are 3 examples?
- Legg-Calve-Perthes dz - Osgood-Schlatter dz - Sever dz
130
osteochondrosis --> what is Blount dz?
osteochondrosis --> prox tib metaphysis --> tibia bowing (varus) & int rot --> progressive deform --> gait deviation, leg length discrepancy
131
osteochondrosis --> Blount dz --> infantile form --> etiology?
early walking + obesity
132
osteochondrosis --> Blount dz --> differentiate infantile vs adolescent form?
infantile: - infant - bilat adol: - >6yo - unilat
133
what is Madelung deformity?
osteochondrosis --> dysplasia of distal radius --> medial --> physis --> growth disturb --> medial sloping of distal radius
134
what is Panner dz?
osteochondrosis --> capitellum
135
what is little league elbow?
osteochondrosis --> med epicondyle
136
what is Scheuermann kyphosis?
osteochondrosis --> mult thoracic vertebra --> avascular necrosis --> mult compression fx
137
what is Kienbock dz?
osteochondrosis --> lunate
138
what is Osgood-Schlatter dz?
osteochondrosis --> tibial tuberosity
139
what is Freiberg infraction?
osteochondrosis --> 2nd metatarsal head
140
what is Kohler dz?
osteochondrosis --> navicular
141
what is Sever dz?
calcaneal apophysitis
142
what is fibromatosis coli?
idiopathic sternocleidomastoid enlrg --> torticollis
143
fibromatosis coli --> tx?
PT
144
tarsal/carpal coalition --> 3 types of coalition?
- fibrous - cartilaginous - osseous
145
what is tarsal/carpal coalition?
abnormal joining of 2 bones
146
tarsal coalition --> 2 MC subtypes?
- talocalcaneal | - calcaneonavicular
147
carpal coalition --> MC subtype? 2nd MC?
``` #1 lunotriquetral #2 capitohamate ```
148
physiologic periosteal reaction of the newborn --> age? why does it occur?
1-4mo rapid bone growth & loosely adherent periosteum
149
physiologic periosteal reaction of the newborn --> XR appearance?
- long bone --> med or lat aspect (not both) | - smooth, thin
150
infant/child --> periosteal rxn --> etiology? (7)
- physiologic periosteal rxn of newborn - prostaglandin therapy - infx - neoplasm - trauma - metabolic - syndromic
151
what is Caffey dz (infantile cortical hyperostosis)?
inflamm dz --> periostitis --> mandible, scapula, clavicle
152
what is Tillaux fx?
Salter-harris III --> distal tibia
153
MC pediatric idiopathic inflammatory myopathy
dermatomyositis
154
dermatomyositis --> MC location?
proximal thigh musculature (particularly the anterior compartment) and pelvic musculature
155
dermatomyositis --> chronic imaging findings? (2)
- muscle fatty infiltration | - periarticular soft tissue calcifications
156
clubfoot (talipes equinovarus) --> components? (4)
- hindfoot equinus: plantarflex, tibiocalcaneal angle >90 - hindfoot varus: talocalcaneal angle <20 - metatarsus adductus (forefoot varus): talus to first metatarsal angle >15 - talonavicular subluxation
157
MC congenital foot abnormality
metatarsus adductus
158
what is diastatic fx?
fracture of suture
159
diastatic fx --> MC location?
lambdoid suture
160
skull --> depressed fracture --> - "depressed" measurement? - what is compound? - what is penetrating?
- depressed: >skull thickness - compound: + scalp lac - penetrating: + dural tear
161
what is ping pong fx?
type of depressed fx --> greenstick/buckle type
162
differentiate: depressed vs ping pong fx --> clinical outcome?
- depressed: high morbidity | - ping pong: favorable/benign
163
cause? - diastatic fx - depressed fx - ping pong fx
- diastatic: sig blow - depressed: sig blow - ping pong: birth trauma
164
depressed skull fx --> tx: surg --> indications? (5)
- >5mm depression --> assoc w dural tear - epidural bleed - superinfx - cosmetic correction - frontal sinus involved --> prevent mucocele formation
165
what is leptomeningeal cyst?
growing skull fx
166
leptomeningeal cyst --> MOA?
skull fx --> dural tear --> leptomeninges herniate thru --> CSF pulse --> widen fx --> brain herniate thru
167
focal skull defect + assoc vasc malformation --> dx?
sinus pericranii
168
CT --> focal skull defect --> overlying lesion --> suspect vasc malformation --> next step?
US/MRI to demonstrate vasc component
169
sinus pericranii --> what kind of vasc malformation?
low flow vasc malformation --> bw dural venous sinus & extracranial vein
170
retroclival hematoma --> above/below tectorial membrane --> subdural vs epidural?
above tectorial membrane --> subdural | below tectorial membrane --> epidural
171
vertex --> thrombosed cortical V --> dx?
NAT
172
retroclival hematoma --> dx?
NAT
173
cervical soft tissue --> edema --> dx?
NAT
174
benign enlrgmt of subarachnoid space in infancy (BESSI) --> etiology?
immature villa
175
benign enlrgmt of subarachnoid space in infancy (BESSI) --> measuremt?
>5mm
176
differentiate: BESSI vs subdural hygroma (1)
BESSI: positive cortical V sign --> cortical V --> adj to inner table subdural hygroma: neg cortical V sign --> cortical V --> displaced away from inner table & compressed --> not seen
177
enlrg extra-axial spaces --> RF?
premature --> ECMO
178
benign enlrgmt of subarachnoid space in infancy (BESSI) --> potential complication?
subdural bleed
179
differentiate: BESSI-related vs NAT-related subdural hematoma
BESSI: same age blood NAT: diff age blood
180
macrocephaly --> MCC
benign enlrgmt of subarachnoid space in infancy (BESSI)
181
benign enlrgmt of subarachnoid space in infancy (BESSI) --> epidemiology?
2-3mo M
182
periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) --> MOA?
ischemic/hemorrhagic injury --> typically during birth
183
periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) --> RF? (2)
- premature | - low birth weight
184
periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) --> MC complication?
50% --> cerebral palsy
185
periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) --> MC location?
watershed areas --> lateral ventricles --> dorsal & lat white matter
186
periventricular leukomalacia (hypoxic-ischemic encephalopathy of the newborn) --> grade 4 --> subcortical cysts --> epidemiology?
fullterm
187
differentiate: periventricular blush vs periventricular flaring vs periventricular leukomalacia
periventricular blush: periventricular white matter --> physiologic bright --> symm periventricular flaring: periventricular white matter --> bright --> may be PVL --> but go away in 1wk periventricular leukomalacia: periventricular white matter --> bright --> persist >7days
188
R-sided fibromatosis coli: direction of: - head tilt? - look toward?
R-sided fibromatosis coli: - head tilt --> R - look toward --> L
189
neck mass --> outside SCM --> calcifications --> dx?
neuroblastoma

CORE (33 decks)

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