Rheum and Sports Flashcards
(17 cards)
5 weeks left hip pain, intermittent fever 38.3
xray of hip showing radiolucent lesion with layered periosteal reaction
biopsy picture shown = sheets of small blue cells
ewing sarcoma!!! -> xray can also show central lytic lesion with motheaten appearance
NOT osteomyelitis as usually involves long bones, no history of trauma or immune deficiency, histopathology would show inflamatory cell invasion
NOT osteosarcoma as typically found in metaphysis of long bones and biopsy would show sheets of pleomorphic cells surrounded by osteoid
SUFE may still be seen in thin tall adolescents during periods of rapid growth!! even though obesity is a risk factor.
learn the imaging!!!
management?
bilateral SUFE may occur -> waddling gait
physis stabilisation with screw fixation
what is a key complication of oligarticular juvenile idiopathic arthritis?
Uveitis!!
eye screenings important
13 yo. mass palpated above knee. x ray shows bony spur. no fevers or weight loss.
essentially xray in keeping with osteochondroma. without intervention, what is the most likely prognosis?
benign growth until physeal closure
bilateral leg pains that occur at night = growing pains -> manage by reassurance and supportive care
what complication is associated with Iga vasculitis/HSP
intussuception!!!
GI bleeding and edema can create lead point
strength training is safe in children
flattening of right occiput + anterior displacement of right ear and forehead. neck mass on right SCM muscle when head turned to right
most likely cause?
postural deformity of the neck!!! = congenital muscular torticollis. limited head motion increases risk of positional plagiocephaly
craniosynostosis (premature closure of cranial sutures) can also cause plagiocephaly but head tilt and neck mass wont be seen
spondylosis fatigue fracture in pars intarcularis -> overuse injury. seen in young athletes
pain with lumbar extension due to stressing of fracture site. pain decreases with lumbar flexion. pain worsens with activity. tenderness at palpation of region.
first step in diagnosis? management?
spine x ray!!
sports cessation for 90 days and support!
traction to arm of child
now arm is held in extended and pronated position (radial head subluxaton/nursemaids elbow - annular ligament injury)
the question already described management = arm was supinated and flexed and patient started using arm again
reassurance and return to normal activities!!!
management = arm supinated and flexed and patient started using arm again
OR management = forearm hyperpronation
16 yo boy right knee swelling.
large effusion but minimal pain. leukocyte count on aspiration 15,000 with negative gram stain and culture
most likely causative organisim?
borrelia burgdoferi infection!!!
lyme arthritis!!! -> late hallmark of lyme disease infection
osteosarcoma is most common bone tumor in children, what does the x ray show?
sunburst pattern!!
lytic bone lesions, body rash, and polyuria (CNS involvement -> CDI, polydipsia, hypernatremia)
diagnosis?
langerhans cell histiocytosis
2 month old girl
leg assymettry shown through Galeazzi test and asymettric skin folds on groin buttock or thigh
barlow and otorlani test negative
next step in management?
USS hips!!!
Xray only used if >4 months old!!
what extra screening is important for patients with DMD?
echocardiography!! and ecg!!
absent dystrophin in cardiac muscle -> dilated cardiomyopathy, arrhythmia
toddler fractures/spiral tibial fractures common in first few years of walking. twisting motion during minor fall, no further workup needed after x ray
However!!! If a 9 month old has a spiral Fracture and mother says he slipped on a wet floor = notification of child protective services!!! 9 month old should be able to walk yet. Similarly to a claim that a 3 week old infant rolled off the bed
Also spiral fractures occur with rotational forces eg TWISTING of limb
Achondroplasia is due to a defect in?
Fibroblast growth factor 3!!!!
