Peds - Musculoskeletal

Question 1

Inflammation of the tibial tubercle as a result of repetitive stressors in patients with immature skeletal development.

Answer 1

Osgood-Schlatter

Question 2

Peak age of incidence for Osgood-Schlatter

Answer 2

11 - 14 years

Question 3

Osgood-Schlatter -

Treatment (2)

Answer 3

o some limitation of activity to control pain

o knee immobilizers may provide some relief

Question 4

Insidious, unilateral, self-limiting inflammation of the hip, most likely due to viral or immune cause.

Answer 4

Toxic synovitis

Question 5

TOXIC SYNOVITIS - epidemiology
o peak
o age range
o gender

Answer 5

o peak in ages 2 - 6 years
o occurs ages 1 - 15 years
o males > females

Question 6

Toxic synovitis -

signs and symptoms

Answer 6

o painful limp
o internal rotation of hip causes spasm
o no obvious sign of infection

Question 7

Toxic synovitis -

treatment (2)

Answer 7

analgesics

bed rest

Question 8

Toxic synovitis -

red flags

Answer 8

high fever / suspicion of septic arthritis

= hospitalization

Question 9

Toxic synovitis -

diagnostics

Answer 9

Xrays - normal

Joint fluid aspiration - normal (not usually done)

Question 10

Afebrile aseptic or avascular necrosis of the femoral head causing insidious limp with knee pain that radiates UPWARD to the hip.

Answer 10

Legg-Calve-Perthes Disease (LCPD)

Question 11

Legg-Calve-Perthes Disease -

observation vs. aggressive treatment

Answer 11

OBSERVATION if:
o FROM is preserved
o < 6 years old
o < 1/2 of femoral head involved (xray)

AGGRESSIVE if:
o worse than above criteria
o refer to ortho –> eventual hip replacement

Question 12

Spontaneous dislocation of femoral head (capital epiphysis) both downward and backward relative to the femoral neck and secondary to disruption of the epiphyseal plate; pain radiates DOWNWARD from hip to knee

Answer 12

Slipped Capital Femoral Epiphysis (SCFE)

“skiffy”

Question 13

Slipped Capital Femoral Epiphysis (SCFE) -

epidemiology (4)

Answer 13

more common in
MALES

AFRICAN AMERICANS

SEDENTARY

OBESE

Question 14

Scoliosis -

two red flags that lead to referral

Answer 14

REFER for
any PAIN
-or-
>25 degree curvature

Question 15

Painless dislocation of the hip in which the femoral head is partially or completely displaced from the acetabulum.

Answer 15

Developmental dysplasia of the Hip (DDH)

Question 16

Up until what age is each test useful?

• Barlow
• Ortalani
• Galeazzi

Answer 16

Barlow – 6 months
Ortolani – 12 months
Galeazzi – ??

Question 17

Stretching and/or tearing of the ligaments around the ankle.

Answer 17

Ankle sprain

Question 18

Ankle sprain - grade I

• definition
• signs and symptoms (4)

Answer 18

stretching but no tearing of ligaments; no joint instability

o local tenderness
o minimal edema
o ecchymosis insignificant or absent
o able to ambulate

Question 19

Ankle sprain - grade II

• definition
• signs and symptoms (4)

Answer 19

partial tear; some joint instability

o pain immediately upon injury
o local edema and ecchymosis
o limited ROM
o increased pain with weight bearing

Question 20

Ankle sprain - grade III

• definition
• signs and symptoms (5)

Answer 20

complete tear; joint unstable

o  severe pain immediately upon injury
o  significant edema of foot and ankle
o  profound ecchymosis
o  cannot bear weight
o  no ROM

Question 21

When is radiograph indicated for ankle sprain -

Answer 21

According to Ottawa Ankle Rule:

o pain near malleoli -and-
o bone tenderness at posterior edge of distal 6 cm of either maleolus -OR-
o patient is unable to walk 4 steps at injury AND evaluation

Question 22

Ankle sprain management

Answer 22

o R-I-C-E

o NSAIDS

Question 23

Injury often associated with outstretched arm fall.

Answer 23

Elbow fracture

Question 24

Elbow fracture -

x-ray findings

Answer 24

+ fat-pad sign on lateral view suggests occult fracture

Question 25

Elbow fracture -

follow up for + fat pad sign on lateral view

Answer 25

o follow up with oblique view

o refer to ortho

Question 26

Radial head subluxation is otherwise known as:

Answer 26

Nursemaid’s elbow