peds67

Question 1

management of osteomyelitis

Answer 1

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

Question 2

complications of osteomyelitis

Answer 2

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

Question 3

in-toeing

Answer 3

most is normal and corrects with growth

Question 4

causes of in-toeing

Answer 4

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

Question 5

metatarsus adductus

Answer 5

medial curvature of the mid-foot

Question 6

metatarsus adductus- what age and cause?

Answer 6

kids less than 1; caused by intrauterine constraint

Question 7

clinical features of metatarsus adductus

Answer 7

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

Question 8

management of metatarsus adductus

Answer 8

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

Question 9

talipes equinovarus

Answer 9

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

Question 10

etiology of clubfoot

Answer 10

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

Question 11

treatment of clubfoot

Answer 11

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

Question 12

internal tibial torsion

Answer 12

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

Question 13

most common cause of intoeing in kids less than 2

Answer 13

internal tibial torsion

Question 14

cause of internal tibial torsion

Answer 14

uterine positioning

Question 15

clinical features of internal tibial torsion

Answer 15

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

Question 16

management of internal tibial torsion

Answer 16

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

Question 17

femoral anteversion

Answer 17

inward angulation of the femur

Question 18

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

Answer 18

femoral anteversion

Question 19

clinical features of femoral anteversion

Answer 19

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

Question 20

management of internal tibial torsion

Answer 20

observation only; usually resolves by 8 yo

Question 21

out-toeing major cause

Answer 21

calcaneovalgus foot (flexible foot held in lateral position)

Question 22

out-toeing cause

Answer 22

uterine constraint

Question 23

clnical features of out-toeing

Answer 23

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

Question 24

management of out-toeing

Answer 24

stretching the foot; rarely, casting may be needed

Question 25

bowed legs

Answer 25

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

Question 26

clinical featuers of bowed legs

Answer 26

"cowboy stance"; normal gait;

Question 27

when to order a radiograph for bowlegged

Answer 27

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

Question 28

management of bowing

Answer 28

observation; bracing not necessary; resolved by 2 yo

Question 29

blount's disease

Answer 29

aka tibia vara; progressive angulation a the proximal tibia

Question 30

classic kid for blount's disease

Answer 30

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

Question 31

clinical features of blount's disease

Answer 31

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

Question 32

when should blount's disease be suspected?

Answer 32

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

Question 33

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

Answer 33

Blount's disease

Question 34

management of blount's disease

Answer 34

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

Question 35

prognosis for blount's disease

Answer 35

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

Question 36

knock-knees

Answer 36

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

Question 37

cause of knock-knees

Answer 37

usually overcorrection of normal genu varum

Question 38

clinical features of knock knees

Answer 38

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

Question 39

management of knock knees

Answer 39

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

Question 40

prognosis for knock knes

Answer 40

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

Question 41

osgood-schlatter disease

Answer 41

inflamm or microfracture of tibial tuberosity caused by overuse injury

Question 42

age of onset for osgood-schlatter

Answer 42

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

Question 43

clinical features of osgood shlatter

Answer 43

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

Question 44

management of osgood-shlatter

Answer 44

rest, stretchign of quads and hamstrings, and analgesics

Question 45

patellofemoral syndrome

Answer 45

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

Question 46

clinical features of patellofemoral syndrome

Answer 46

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

Question 47

diagnosis of patellar femoral sydnrom

Answer 47

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

Question 48

management of patellofemoral syndrome

Answer 48

rest, stretching and strengthening of the medial quadriceps

Question 49

growing pains

Answer 49

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

Question 50

growing pains in what age group

Answer 50

very common; occur in 4-12 year olds