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Flashcards in peds67 Deck (50):
1

management of osteomyelitis

antibiotics for 6 weeks; when ESR goes down, can start oral abx; surgery to drain abscess if fever and swelling for >48 hours

2

complications of osteomyelitis

spread of infection; chronic osteomyelitis; pathologic fracture; angular deformity or limb length discrepancy

3

in-toeing

most is normal and corrects with growth

4

causes of in-toeing

metatarus adductus (medial curvature of the midfoot); talipes equinovarus (clubfoot); internal tibial torsion; femoral anteversion

5

metatarsus adductus

medial curvature of the mid-foot

6

metatarsus adductus- what age and cause?

kids less than 1; caused by intrauterine constraint

7

clinical features of metatarsus adductus

C-shaped foot that can be straightened by manipulation; ankle can't dorsiflex

8

management of metatarsus adductus

observation, exercises, if foot is stiff and cannot be straightned, refer to ortho for possible cast

9

talipes equinovarus

clubfoot; fixed foot in inversion with no flexibility; bilateral in 50% of cases

10

etiology of clubfoot

fam hx; associated with DDH, myelomeningocele, myotonic dystrophy, and some skeletal dysplasias;

11

treatment of clubfoot

casting within the first week of life; surgical correction may be necessary if does not improve

12

internal tibial torsion

medial rotation of the tibia, causing the foot to point inward

13

most common cause of intoeing in kids less than 2

internal tibial torsion

14

cause of internal tibial torsion

uterine positioning

15

clinical features of internal tibial torsion

foot points medially; bilateral most commonly; present at birth but noticed when kid starts to stand

16

management of internal tibial torsion

observation only; usually improves by 3 yo and resolution by 5 yo

17

femoral anteversion

inward angulation of the femur

18

most common cause of in-toeing in kids over 2 years

femoral anteversion

19

clinical features of femoral anteversion

feet and patella point medially; hips are able to internally rotate more than normal; kid prefers to sit in W position

20

management of internal tibial torsion

observation only; usually resolves by 8 yo

21

out-toeing major cause

calcaneovalgus foot (flexible foot held in lateral position)

22

out-toeing cause

uterine constraint

23

clnical features of out-toeing

flexible foot with toes pointed outward; plantar flexion is restricted and foot is excessively dorsiflexed

24

management of out-toeing

stretching the foot; rarely, casting may be needed

25

bowed legs

aka genu varum; symm bowing of the legs in kids less than 2

26

clinical featuers of bowed legs

"cowboy stance"; normal gait;

27

when to order a radiograph for bowlegged

only if bowing is unilateral, is severe, or perists after 2 years of age to assess for pathologic bowing (rickets, growth plate injury)

28

management of bowing

observation; bracing not necessary; resolved by 2 yo

29

blount's disease

aka tibia vara; progressive angulation a the proximal tibia

30

classic kid for blount's disease

obese african american boys who are early walkers; thought to be result of overload injury to the medial tibial growth plate

31

clinical features of blount's disease

angulation just below the knee; lateral thrust with gait (shifting weight away from midline when walking)

32

when should blount's disease be suspected?

any kid with progressive bowing, unilateral bowing, or persistent bowing after 2 yo; dx with AP radiograph

33

metaphyseal-diaphyseal angle of greater than 11 deg in lower extremity

Blount's disease

34

management of blount's disease

bracing for 1 year; surgical osteotomy of no improvement w bracing

35

prognosis for blount's disease

osteoarthritis common if angulation not corrected; recurrance of angulation common in obese kids or if treatment started after 4 yo

36

knock-knees

aka genu valgum; idiopathic angulation of the knees toward the midline

37

cause of knock-knees

usually overcorrection of normal genu varum

38

clinical features of knock knees

separation of ankles when standing erect; lateral swinging of legs when walking

39

management of knock knees

observation; surgery only if it persists after 10 yo or causes knee pain

40

prognosis for knock knes

spontaneously resolves in majority of patients; osteoarthritis may occur if persists beyond adolescence

41

osgood-schlatter disease

inflamm or microfracture of tibial tuberosity caused by overuse injury

42

age of onset for osgood-schlatter

10-17 yo; happens in kids who play sports like basketball or soccer w repetitive jumping

43

clinical features of osgood shlatter

swelling of tibial tuberosity and knee pain with point tenderness over the tibial tubercle; pain worsens with running/jumping

44

management of osgood-shlatter

rest, stretchign of quads and hamstrings, and analgesics

45

patellofemoral syndrome

slight malalignment of the patella that causes knee pain; common in adolescent girls

46

clinical features of patellofemoral syndrome

knee pain directly under or around the patella; pain worse with activity and relieved w rest; phys exam shows patella in lateral position

47

diagnosis of patellar femoral sydnrom

hx and pe; a "sunrise view" radiograph of the knee may show he patella in a lateral position

48

management of patellofemoral syndrome

rest, stretching and strengthening of the medial quadriceps

49

growing pains

idiopathic bilateral leg pains that occur in the late afternoon or evening but do not interfere w play during the day

50

growing pains in what age group

very common; occur in 4-12 year olds